Week 2 Flashcards
antibiotics
Why do we use antiinfectives?
to target foreign organisms that invaded and infected a human host
What is the role of antiinfectives?
- reduce pathogen population
T or F anti-infectives lack total selective toxicity
True,
- they attack both target organisms and healthy human cells
Cause cell death
Bactericidal
Prevent organism from reproducing
bacteriostatic
The nurse is describing to a client how the client’s newly-prescribed anti-infective medication produces a therapeutic effect. What explanation should the nurse provide the client?
A. Anti-infectives mobilize the client’s own immune system against a microorganism.
B. Anti-infectives increase resilience of human body cells.
C. The goal of treatment is to identify drugs that are selectively toxic to human cells.
D. Many anti-infectives interfere with normal functioning of the target organism.
D!
interferes with normal functioning of the target organism
Broad spectrum of activity
useful in treating a wide variety of infections
narrow spectrum of activity
effective against only a few microorganisms with a very specific metabolic pathway or enzyme
- used with culture/ sensitivity testing
Different roles antiinfective play
- treatment of bacteria
- prophylaxis treatment
Adverse reactions of antiinfectives
- hypersensitivity/ allergy
- CNS effects
- Kidney damage
- GI toxicity
- Superinfections
A client experiencing a urinary tract infection has been prescribed a medication that is a combination of sulfamethoxazole and trimethoprim. What is themostlikely rationale for the use of a combination antibiotic?
A. The drugs’ combined effect exceeds the sum of their individual effects.
B. It is not possible to culture the microorganisms most likely responsible for the infection.
C. One of the antibiotics exists solely to facilitate absorption of the other.
D. One antibiotic is narrow-spectrum and one is broad-spectrum.
A: synergistic; together more powerful
Which client is receiving prophylactic anti-infectives?
A. A client with metastatic lung cancer who will soon begin chemotherapy
B. A client with human immunodeficiency syndrome who begins antiretroviral therapy
C. A client who is prescribed a 3-day course of antibiotics prior to dental surgery
D. A client who has been admitted for the treatment of an infected surgical incision
C. Prior= prophylactic
Otoxicicity
hearing loss, common adverse effect of antibiotics
Nursing considerations for CNS adverse effects?
- nuero assessment
- know pts baseline
- minimize fall risks
- monitor neurologic status
The nurse is caring for a client who is receiving IV gentamicin and who reports difficulty hearing this morning. What should the nurse do?
A. Hold the dose and notify the provider immediately.
B. Make a referral for auditory testing.
C. Administer the dose and report this information to the oncoming nurse.
D. Administer the dose and document the finding in the client’s health record
A. Let dr know ASAP!
T or F kidney damage/ failure can occur from taking antibiotics
TRUE
- direct toxic effect on cells in the kidney
- can cause renal dysfunction
Nursing considerations for kidney dysfunction
- know baseline renal function
- monitor labs; BUN and Cr
- monitor urine output
- stay well hydrated
T or F GI toxicity is very common with many antiinfectives
T!
- kill both good and bad cells
- some are toxic to liver
- opportunistic infections can occur
Nursing considerations for GI toxicity
- anticipate n/v
- monitor stool output
- watch for dehydration
- watch liver labs
Destruction of normal flora allows opportunistic pathogens to take over and invade tissues
superinfections
- c. diff
- yeast infections(thrush/vaginal)
T or F early exposure to antiinfective can lead to early sensitivity
True it can!
T or F older adults can have varied s/s of infections
True they can!
A microorganisms ability to adapt over time to an antiinfective drug and produce cells that are no longer affected by particular drug
resistance
Innate resistance
natural resistance
- not all drugs work on all organisms
Acquired resistance
- occurs from over-exposure
- produce enzyme that deactivates drug
How to prevent resistance
- limit use
- use the right prescription, dose and length
- make sure its the right route
- make sure right drug for right culture sample
- avoid using the newest, strongest antibiotics
The home care nurse is taking care of a client on IV vancomycin for cellulitis of the left calf. The client’s lack of response to treatment suggests possible resistance. What process may have caused this phenomenon?
A. Microorganisms may have altered the blood supply to the infected region.
B. Microorganisms may have stopped healthy somatic cells from reproducing.
C. Microorganisms may have produced a chemical that is an antagonist to the drug.
D. Microorganisms may have changed their cell membrane to mimic that of the drug.
C!
The nurse is providing health education to a client with an infection who lives in the community. What characteristic of the client’s anti-infective regimen willbestprevent the development of resistant strains of microbes?
A. Proactively addressing the possibility of adverse effects
B. Performing culture and sensitivity testing after the completion of treatment
C. Ensuring that the duration of drug use is appropriate
D. Maximizing the frequency of drug ingestion
C!
A nurse is teaching a group of nursing students about actions that have the potential to prevent antibiotic resistance. What teaching point should the nurse include?
A. Antibiotics should be taken promptly to treat colds and other viral infections before the invading organism has a chance to multiply.
B. Antibiotic dosage should be reduced and used for shorter periods of time to reduce unnecessary exposure to the drug.
C. Standing prescriptions for antibiotics should be available to clients so they can be filled as soon as clients suspect they have an infection.
D. It is very important to take the full course of an antibiotic as prescribed and not save remaining drugs for future infections.
D. help prevent!
Nurses responsibility when it comes to antiinfectives
- engage in discussion/ questioning attitude about starting antibiotics
- ensure cultures are collected before starting antibiotics
- proper sample collection> aspectic technique
- improving evaluation of allergies
- education to pts
T or F viral infections are treated with antibiotics
FALSE!
antibiotics do NOT help with viral infections
What fruit may help with UTI’s
cranberries
T or F pre/probiotics have been shown to reduce the incidence of antibiotic-induced diarrhea and superinfections
TRUE
Gram pos infections
- respiratory and soft tissue
Gram neg infections
- GI/ GU infections
Choosing the right antibiotic includes what groups
- gram pos
- gram neg
- aerobic
- anaerobic
- bacteria shape
Aminoglycoside class prototype med
Gentamicin
cephalosporin class prototype med
cefaclor
Carbapenem class prototype med
ertapenem
Fluoroquinolones class prototype med
Ciprofloxacin
Penicillin class prototype med
Amoxicillin
Sulfonamides class prototype med
Cotrimoxazole
What antibiotic is very strong and saved for very sick pts?
Aminoglycosides (gentamicin)
Therapeutic action of Aminoglycosides
- bactericidial
- covers gram neg aerobic bacili
- reserved to treat serious infections due to potentially serious adverse effects
Pharmacokinetics of Aminoglycosides
- poorly absorbed in GI
- IM, IV route
- crosses placenta and breast milk
- metabolized in liver, excreted unchanged in the urine
Adverse Effects of Aminoglycosides
- ototoxicity
- renal(nephro) toxicity
- hypersensitivity
Contradictions of Aminoglycosides
- allergy to drug
- renal or hepatic disease
- preexisting hearing loss
- parkinson’s or myasthenia
- lactating/ pregnant
Drug- drug ineteractions of Aminoglycosides
- synergistic w/ penicillin or cephalosporin
- avoid combining w/ diuretics
- anesthetics can increase neuromuscular blockade and or paralysis
nursing consideration of Aminoglycosides
- evaluation of infection
- monitor hearing changes
- provides adequate fluids
- check kidney function and labs
- I and O
Therapeutic Action for Carbapenem
- broad spectrum
- gram pos and neg
- bactericidal
Indications for Carbapenem
- Treats community-acquired pneumonia, complicated GU, intra-abdominal, skin and acute pelvic infections
Pharmaco-kinetics of Carbapenem
- rapidly absorbed via IM, peak end of IV
- unknown whether it crosses placenta/ breast milk
- excrete unchanged in urine
Adverse Reactions of Carbapenem
- Gi: n/v, c. diff, pseudomembranous colitis
- CNS: seizures w/ other meds
Contraindications of Carbapenem
- allergy to the drug
- seizure disorders
- meningitis
- lactating/ pregnant
Drug-drug interactions of Carbapenem
Valproic acid; may decrease drug level and increase seizure risk
Ganciclovir; may cause seizures
Nursing Considerations of Carbapenem
- GI assess; monitor pt for p. colitis, severe diarrhea, superinfection
-CNS assess; monitor for seizures and safety - assess renal function
- hydration
Therapeutic Action of Cephalosporins
- similar to penicillin
- gram pos and neg
- bacteriostatic and bactericidal
Indications of Cephalosporins
- careful choice due to increasing number of cephlosporin-resistant bacteria
- resp, derm, urinary tract, and middle ear infection
Pharmaco-kinetics of Cephalosporins
- some best absorbed in GI, others IM nad IV
- crosses placenta/ breast milk
- primary metabolism in liver and excreted in the urine
Adverse reactions of Cephalosporins
GI: n/v, c. diff. p. colitis
- phlebitis w/ IV
- local abscess with IM injection
Contraindications of Cephalosporins
- Allergy to penicillins> cross sensitivity
Drug- drug interactions of Cephalosporins
- renal txicity w/ aminoglycosides
- oral anticoags may increase bleeding
- avoid alcohol up to 72hr after last dose
Nursing Considerations of Cephalosporins
- avoid alcohol up to 72hr after last dose
- GI: assess, monitor for p. colitits, severe diarrhea, superinfection
- IV and IM site for phlebitis or abscess
Therapeutic Action of Fluoroquinolone
- broad spectrum coverage of gram neg bacteria
- bactericidal and bacteriostatic
indications of Fluoroquinolones
- resp infections, derm, urinary infections, ear, eye, bone and joint infections
- anthrax, typhoid fever and plague
Pharmaco-kinetic of Fluoroquinolone
- injectable, oral, and topical forms
- widely dispersed in the body
- cross placenta/ breast milk
- metabolised in liver and excreted in urine and feces
Adverse reactions of Fluoroquinolone
Black box warning> tendinitis, tendon rupture, peripheral neuropathy and exacerbation
- cardiac: prolonged QT wave
- photosensitivity; avoid sun and UV light
- GI: c. diff, liver tox
Contraindications of Fluoroquinolone
- allergy to drug
- myasthenia gravis pts
- pregnant/ lactating
- use caution for pts under 18
Drug- drug interactions of Fluoroquinolone
- taking with iron salts, sucralfate, minerals, and antacids decrease effect
- avoid other meds that prolong QT waves
- corticosteroids increase tendon rupture risk
- combination w/ NSAIDS can increase CNS stimulation
Nursing consideration of Fluoroquinolone
- assess pt for tendon pain
- monitor for GI and renal issues
- cardiac: establish baseline EKG and avoid prolonging QT meds
- avoid UV light
- report s/s of adverse effects
Therapeutic action for Penicillin
- first and evolving med
- interfere w/ bacterial cell wall building, burst from osmotic pressure
- broad spectrum
Indications for Penicillin
- broad spectrum of infections; streptococcal, pneumo, and mengi
Pharmaco-kinetics of Penicillin
- rapidly absorbed in the GI tract> oral route
- sensitive to GI acid; take on an empty stomach
- limit use during pregnancy/ breast feeding
- excreted in urine
Adverse effects of Penicillins
GI: mouth- colon reactions
- superinfections; yeast
- hypersensitivity; rash- anaphylaxis
Contraindications of Penicillin
- allergy to penicillin or cephalosporins> cross sensitity
- use caution in pregnancy/ breast feeding
- may cause diarrhea in infants who breastfeed off of mom taking drug
Drug- Drug interaction of Penicillin
- decreased effectiveness when taken w/ tetracyclines
- inactivates aminoglycosides if taken parentally
Nursing Considerations of Penicillin
- GI assess; mouth- colon
- superinfection assess; yeast
- take med on empty stomach
- monitor for allergic reactions and hypersensitivity
Therapeutic Action of Sulfonamides
- bacteriostatic; prevents synthesis of folic acid in susceptible bacteria needed for growth
- covers gram pos and gram neg
Indications of Sulfonamides
- resistant bacteria strains> not used as much anymore
- UTI nad trachoma( infection in eye)
Pharmaco-kinetics of Sulfonamides
- Absorbs in GI tract
- crosses placenta/ breast milk
- metabolizes in liver excreted in kidney
Adverse reactions of Sulfonamides
GI: n/v, diarrhea
Renal: nephrotic syndrome or toxic nephrosis
CNS: vertigo, ataxia, convulsions, depression
Derm: photosensitivity, Steven Johnson syndrome
Contraindications to Sulfonamides
- allergy to sulfonamide, sulfonylureas, or thiazole diuretics
- teratogenic: causes birth defects
- Lactation> causes kernicterus, diarrhea, and rash in child
- use caution in elderly
drug-drug interaction of Sulfonamides
- antidiabetics> hypoglycemia
- cyclosporine> nephrotoxicity risk increases
Nursing Considerations of Sulfonamides
- GI assess: take on an empty stomach, offer small frequent meals
- CNS: obtain baseline
- Renal: monitor renal function, urinalysis, and labs
- drink adequate fluids
- derm: examine skin for rashes
- photosensitivity and steven johnsons syndrome
- DO NOT USE during pregnancy
