Unit 6 pt 1- Antibiotics & Antivirals Flashcards
Nursing interventions for every abx:
- Monitor baseline vital signs and white blood cells. Looking for a decrease in WBCs with treatment.
- Monitor for s/s of improvement in condition - conversely, monitor for sepsis.
- Monitor for allergic reactions.
- Increase their fluid intake.
Patient teaching for every abx:
- Finish the entire course of the medication. Don’t stop taking it prematurely, even if you feel better.
- Increase fluid intake.
- Monitor for signs and symptoms of a “superinfection” (when the bad bacteria wipes out your good bacteria) - diarrhea, yeast/thrush. Consider taking a probiotic while on it.
- Monitor for allergic reactions
- Notify the provider if signs and symptoms of original infection don’t improve.
- Use an additional method of birth control while on it because abx renders birth control useless.
- Avoid alcohol. Disulfa reactions
Broad vs Narrow-spectrum abx
Broad-spectrum covers gram + and - ; Narrow-spectrum is specific to the bacteria.
Direct observation therapy
Long-term med compliance. Can include observing a patient swallow every dose of their medication to ensure compliance and monitor treatment response (specifically in TB)
T/F: Drugs with a shorter half life are more likely to have side effects
False. Drugs with a longer half life are more likely to have side effects (they stay in the system longer)
Beta-lactam abx include:
Penicillins (any -cillin ending like amoxicillin), cephalosporins (Cefa- prefix like cefalexin), and carbapenems (-enems ending like doripenem or ertapenem).
Pt. teaching and considerations for beta-lactam abx:
General abx teaching + Monitoring renal and hepatic function, coagulation labs (because it can cause anemia and other blood marrow issues), skin issues, GI distress, and special dosing for geriatric & pediatric patients.
RHCSGD - Rabbits (renal) Hop (hepatic) Constantly (coagulation), Seeking (skin) Green (GI distress) Daisies (dosing).
Cillins (penicillin, amoxicillin)
MOA: broad spectrum bactericidal - destroys cell wall.
Considerations:
1. cross-reactivity to cephalosporins (and other beta-lactam abx) so note that
2. this medication contains potassium so watch for hyperkalemia if they take other potassium containing supplements or drugs
3. No citrus based products (orange juice included) with this
Side effects: GI upset.
Adverse effects: Decreased bone marrow, seizures, confusion, hallucinations.
Cephalosporins (Cefalexin, Cefazolin, etc)
MOA: broad spectrum bactericidal - destroys cell wall.
Considerations:
1. take a penicillin allergy into consideration;
2. Not to be given in pregnancy or breast-feeding
Side effects: GI upset, rash, anemia, renal impairment.
Special teaching: Maintain good oral hygiene when on it.
Memory hint: Cefalexin is not for pregnant flexin’; good oral hygiene goes with breast-feeding highly; don’t get anemic or your kidney’s won’t believe it
Carbapenems (Doripenem, ertapenem, meropenem, etc)
MOA: Broadest spectrum of bactericidal abx we have. These ones INHIBIT cell wall synthesis however rather than lysing the cell wall.
Considerations:
1. Take into account allergies to penicillin or cephalosporins
2. risk of seizures on this medication with patients who are epileptic
3. slow IV administration;
Side effects: GI upset, headache, seizure, renal impairment.
Special teaching: side effects may come weeks after discontinuation.
Memory hint: Cefalexin not for prengant flexin; Penicillin is CNS killin’, carpanemes are not epileptics best friends
Imipenem/Cilastatin
used for life-threatening infections like endocarditis. Administered via IV and has drug interactions with other abx so be careful with that.
Monobactams (Aztreonam)
MOA: narrow-spectrum (gram -) bactericidal - inhibit cell wall synthesis like the carbapenems.
No special considerations or teaching besides the general beta-lactams, however, the routes include injection, IV, or inhalation via nebulizer - NOT by mouth.
Side effects: GI upset; for the inhalation drug route: bronchospasm, cough, wheezing, nasal congestion, fever.
**Mono-bactams cause bronchospactsams (when inhaled)
Sulfamides (-Sulfa prefixes like Sulfamethoxazole and Sulfanilamide)
MOA: Broad-spectrum bacteriostatic - Alters folic acid production and metabolic enzymes in the bacteria to stop bacterial growth.
Considerations:
1. Pt’s who are diabetic are at risk for hypoglycemia
Side effects: HA, anemia/increased risk of bleeding, photosensitivity.
Adverse effect: Crystalluria (uric acid kidney stones), Steven-Johnson syndrome, toxic epidermal necrolysis.
Special teaching: Monitor blood sugar and signs of bleeding. Report symptoms of kidney stones. Wear sunblock or protective clothing. Stop for any type of rash.
**sulfa like the sulfa sun oral antidiabetics! The sun can also burn and cause kidney stones.
Fluoroquinolones (Levofloxacin - CIPROfloxacin)
MOA: broad spectrum bactericidal - inhibits DNA synthesis in the cell wall like the beta-lactams.
Considerations:
1. Maybe not for cardiac issues, MG (myasthenia gravis), renal and hepatic impairment, or anyone on Warfarin due to increased bleeding risk. RHMCW
2. slow IV push.
Side effects: GI upset, CNS impairment (dizziness, drowsiness), photosensitivity.
Adverse reactions (Black Box Warning): tendinitis/rupture of tendons!!, peripheral neuropathy, hallucinations, muscle weakness.
Special teaching: Report signs and symptoms of jaundice and the tendinitis rupture. Don’t drive due to CNS effects. Wear sunscreen due to photosensitivity.
**Cipro causes Black Box tendons & hallucinations and makes you feel weak
Macrolides (azithromycin and erythromycin)
MOA: broad-spectrum bacterioSTATIC - interferes with protein formation to inhibit cell growth and reproduction.
Considerations:
1. This is the STD antibiotic. Their partners need to be treated too!
2. Liver function test prior to administration because it can really interfere with hepatic function.
3. It can also cause arrhythmias so look at previous cardiac conditions, like with fluro’s; and maybe not for people with MG.
4. Cannot be given IM.
Side effects: GI upset, photosensitivity, hypersensitivity (rash, allergic reaction), drowsiness/fatigue/headache.
Adverse effects: Prolong QT (arrhythmias, palpitations, fluttering), hepatotoxicity
Special teaching: Can take with food. Protective clothing or sunblock. Watch for signs of jaundice. Don’t drive when drowsy.
Aminoglycosides (-cin ending like Gentamicin and Streptomycin)
MOA: Very potent broad spectrum bactericidal to inhibit protein synthesis in cell walls of bacteria.
Considerations: 1. Usually given IM or IV because of poor GI absorption.
2. Can be given with beta lactam meds. synergistic effect
3. Nephrotoxic (kidney function), neurotoxic (CNS symptoms), ototoxic (tinnitus, vertigo), and not okay for pregnancy/breastfeeding.
4. DO NOT GIVE WITH ANESTHESIA, LOOP DIURETICS, or MUSCLE RELAXANT - increased CNS toxicity.
Side effects: GI upset, paresthesia, hypotension, dehydration, rash.
Adverse effects: Nephrotoxicity, neurotoxicity (hallucinaton, behavior changes, drowsiness, confusion), ototoxicity (ringing in the ears)
Special teaching: Report skin rash or changes. Slow position changes. Monitor for s/s dehydration like low urine output (monitor kidneys). Report changes in hearing or ringing in ears, as well as numbness/tingling in any extremities (toxicity).
Memory hint: Nephro-neuro-oto, pregnant on gentamicin - oh no! - also can cause hypo (hypotension!)
Tetracyclines (-cycline endings like Doxycycline, minocycline)
MOA: broad-spectrum bacterioSTATIC, binds to bacterial ribosomes to inhibit protein synthesis.
Considerations:
1. Never given to anyone under age 8.
2. Never given in pregnancy or breastfeeding because of oral damage.
3. Known to cause fanconi syndrome (especially nephrotoxic and hepatic toxic).
Side effects: GI upset, enamel hypoplasia, intracranial hypertension (HA, blurred vision), photosensitivity.
Special teaching: Can’t be taken with any dairy, but take with a full glass of water. Inspect mouth regularly. Report any serious side effects of the nephrotoxicity.
Memory hint: Don’t give in pregnancy or children cause it’s TERATOGENIC - tetracycline - get it. It’s not actually, but it causes those teeth problems. Or, kids under 8 shouldn’t be cycline/cycling!
Glycopeptides - Vancomycin (the big kaboom of abx)
MOA: narrow-spectrum abx that inhibits cell wall synthesis.
Uses: MRSA and Cdiff. The big hard infections.
Considerations: 1. Very slow IV infusion. Monitor IV site for severe reaction (burning!).
2. Nephro and ototoxic but NOT neurotoxic (**vanco is gentler than Gento, but it still is harsh on nephro-oto)
3. Discontinue if there’s a rash (Redman) and then restart infusion at a slower rate in 15 mins - if they’re on Vanco, they need it. Discontinue permanently if there’s anaphylaxis though.
4. Draw a peak (1 hr after dose) and trough lab (1 hr before next dose) for this = narrow therapeutic level.
Side effects: GI upset.
Adverse effects: Red man syndrome (big histamine release), nephrotoxicity, ototoxicoty, anaphylaxis, thrombocytopenia and other blood cell issues.
Special teaching: Teach to report ringing in ears or hearing changes. Patient also has to monitor I’s & O’s for kidney function. Teach about Redman syndrome.
Patient teaching for every antiviral:
- Follow medication schedules because dosing intervals can be weird, even if it means getting up in the middle of the night to take a dose.
- Rest if fatigued.
- Monitor I’s and O’s to ensure no impact on the kidney (nephrotoxicity) - don’t give or give cautiously in renal impairment
Acyclovir (antiherpes)
MOA: inhibits replication of DNA in the virus.
Uses: Treats Herpes 1 & 2, EBV, Shingles, and chickenpox.
Considerations: Can be given oral, IV, or topical, but it’s a Slow IV infusion. Never give it via injection. Monitor renals just like every antiviral.
Side effects: GI upset, headaches, tremors, renal impairment.
Tamiflu (Oseltamivir)
MOA: Prevents release of the virus from the human cell.
Uses: Flu.
Considerations:
1. Can only be given within 48 hours of first signs and symptoms - not effective after.
2. Can cause cardiac arrhythmias so teach patient s/s of that.
3. Don’t give or give cautiously in cardiac or respiratory issues, pregnancy/breast-feeding, or recent flu vaccination.
Side effects: GI upset, skin reactions (stop if present), renal impairment
Antiretrovirals (Lamivudine-Zidovudine)
MOA: Inhibits DNA/viral replication and decrease viral load.
Uses: HIV.
Considerations: Monitor liver along with the kidney for this one. Teach patient s/s of anemia and pancreatitis.
Side effects: Renal impairment, hepatomegaly, anemia, pancreatitis. (RAHP)
Memory hint: antiretrovirals don’t like to rahp
Antihepatitis (Adefovir)
MOA: Inhibits translation of viral mRNA into viral proteins (decreasing overall viral replication and load)
Uses: Hepatitis.
Considerations: DOT. Also test for HIV because herpes and HIV go along together a lot of the times.
Side effects: Renal impairment, lactic acidosis (s/s muscle and joint pain), hepatomegaly.
Special teaching: Teach pt s/s of lactic acidosis and emphasize long-term compliance
Memory hint: Hepatitis means liver inflammation -> hepatits drug can cause lactic acidosis (liver inflammation) and renal problems and hepatomegaly
Antifungals
MOA: Bind to ergosterol in cell membranes to lyse the fungus cells.
Uses: Opportunistic infections (like thrush) because funguses don’t usually cause infection.
Considerations: Monitor liver function because these can be hepatotoxic.
Special teaching: Watch for skin changes to see if it’s getting better.
