Week 3 (12 questions) Flashcards
Four adverse effects of ALL antibiotics
1) ALLERGIC REACTIONS
2) SUPER/SUPRA INFECTION (interchangeable terms)
3) ALWAYS FINISH THE ENTIRE THERAPY
4) ANTIBIOTICS CAN INTERACT WITH LOTS OF DRUGS
An adverse effects of all antibiotics
Diarrhea
Allergic reactions
Assess
Evaluate
How long to observe patient if they have allergy?
ASSESS- allergies of your patients
If they list an allergy, investigate! What happened?
Type I or Type 4?
EVALUATE- after giving an antibiotic, observe your patient for a reaction (~30 minutes after end of infusion)
◦Manage reaction!
SUPER/SUPRA INFECTION (interchangeable terms)
CDIFF
CANDIDA ALBICANS
Antibiotics kill bad bacteria + protective bacteria
◦RISK 1: Clostridium difficile infection (Pseudomembranous Colitis)
◦Preventative- probiotics
◦Treatment: antibiotics
◦RISK 2: Candida albicans infection
◦Oral/vaginal- treat with antifungals
ALWAYS FINISH THE ENTIRE THERAPY
◦Never stop early (even if feeling better )
◦Premature stoppage can cause resistant bacteria
ANTIBIOTICS CAN INTERACT WITH LOTS OF DRUGS
warfarin?
ORAL CONTRACEPTIVES
Oral contraceptives require healthy gut flora for proper absorption
antibiotics may kill gut flora that helps absorb oral contraceptives (unintended pregnancy risk!)
warfarin blocks vit. K + antibiotics reduce vit. K = increased bleeding risk
blood thinning 2X with decreased vit k and warfarin in system
ALLERGIC/HYPERSENSITIVITY REACTIONS
Type 1
*Anaphylaxis (B-Cell Mediated)
*PENICILLIN
*LIFE THREATENING
*IgE mediated
*Histamine gets released- causes capillary leakage (swelling of airways-difficulty breathing), causes itching and more dangerously a drop in blood pressure
How do I remember Anaphylaxis? UH-OH Angie!
Urticaria (HIVES)
Hives
Oxygen is gone (angioedema= narrowing of air ways)
Hypotension
(blood pressure is dropping)
Angie- Angioedema
Type 1 ANAPHYLAXIS TREATMENT
nursing actions
◦1) Stop medication immediately (turn off the IV!) and notify Rapid Response Team
◦2) Establish Airway to maintain ventilation (bronchodilators if needed)
◦3) Administer Oxygen
◦4) Treat with Epinephrine (IM or IV) every 5 to 10 minutes if needed
◦WHY?
◦5) Administer diphenhydramine (decrease angioedema and urticaria)
Epi-Pen® - Epinephrine (how to use)?
*Do not place hands over any ends of the pen (risk for accidental poke)
*“Blue to the Sky, Orange to the Thigh”
*Remove the safety cap
*Okay to inject through clothes!
*“Hold for 3-10 seconds”
*Can massage site afterwards (10 seconds) Generally, the only time you massage
*You can use another dose 5-15 minutes after (max is 2 doses)
SEEK MEDICAL HELP
ALLERGIC/HYPERSENSITIVITY REACTIONS
Type 4
SCAR?
SJS?
TEN?
#1 CULPRIT?
Delayed Hypersensitivity (T-Cell Mediated)
SCAR- Severe Cutaneous Adverse Reactions (skin melts off)
◦Steven Johnson Syndrome (SJS)
◦Toxic Epidermal Necrolysis (TEN)
***#1 Culprit? Drugs
Type 4 Early warning signs:
ONSET?
FEVER + Flu-like symptoms
RASH -> Blistering
Lip peeling, mouth sores
onset (type 4)
Not instant, can take days, maybe even weeks
Broad spectrum
Targeting a type of infection
(don’t know what it is, give antibiotics that kills a lot of stuff)
◦Example: Patient presents with Sepsis
◦Piperacillin-Tazobactam (Zosyn®) + Vancomycin
Narrow spectrum
Targeting a specific bacteria
*Example: Hospital Acquired Pneumonia caused by Pseudomonas aeruginosa
*Aztreonam (Azactam®)
bactericidal?
bacteriostatic?
kills bacteria
Inhibits bacterial growth
What do you do if a patient comes to the clinic with sepsis?
Draw STAT blood cultures
Give Broad Spectrum Antibiotics or multiple antibiotics
Review Culture Results (Sensitivity)
Give Narrow Spectrum Antibiotics or targeted antibiotics
Name 4 BETA-LACTAMS
PCCM
Penicillins- “Cillin”
Cephalosporins- “Cef”, “Ceph”
Carbapenems- “penem”
Monobactams- Aztreonam
Almost all beta lactams are eliminated how?
Renally
Do not give penicillin if?
History of a BETA-LACTAM allergy (cross-reactivity)
-This means penicillins, cephalosporins, carbapenems, monobactams
Current infection with EBV (Mononucleosis)
-Common to see rash if patient has Mono (EBV)
-Specifically seen with amino-penicillins (like amoxicillin)
PENICILLIN G/V POTASSIUM
what does potassium mean in the name?
G is IV, V is Oral
See potassium in the name? This can cause hyperkalemia
Risk for hyperkalemia (can lead to dysrhythmia)
Penicillin administration
Education?
Which penicillins are IM?
Educate patients to ALWAYS finish the entire course of therapy- never stop antibiotics prematurely (even if symptoms resolve!)
Penicillin G Benzathine and Penicillin G Procaine are IM only!
Tazobactam + Clavulanic Acid
Beta-lactamase Inhibitors: enzymes that break down beta lactam
NOT AN ANTIBIOTIC!
Adds coverage to other antibiotics
This is NEVER given by itself
ALWAYS combined with an antibiotic
Cephalosporins:
Cef, Ceph
gram what?
better resistance to what?
Gram + bacteria
Better CSF penetration (ceftriaxone great for meningitis)
Better resistance to penicillinase
cephalosporin adverse effects
NO ALCOHOL
four
ALLERGIC REACTION
DIARRHEA
Supra-infection
PHLEBITIS with IV Infusion
cephalosporin allergic reaction
◦Very similar to penicillin’s
◦Cross Sensitivity- Beta lactams!
concern is C.diff- notify provider
pseudomembranous colitis, candida albicans)
cephalosporin PHLEBITIS with IV Infusion
Observe injection site for findings of phlebitis
Rotate injection sites.
Administer as a dilute intermittent infusion or slowly over 3 to 5 min and in a dilute solution for bolus dosing.
Side effects?
UNIQUE TO “Cefs”
Disulfiram like reaction with alcohol
(throw up) and bleeding risk
Cephalosporins: “Cef”, “Ceph” drug interactions
IV CALCIUM+ IV CEFTRIAXONE= NO!
Can form precipitant
Cephalosporins: “Cef”, “Ceph” administration
IM or ORAL
cephalosporins
IM route
How to give?
What is mixed with it to reduce pain?
Administer IM injections deep into a large muscle mass (into the ventrogluteal site). Educate client about the possibility of pain at the injection site prior to administration.
Often lidocaine mixed with ceftriaxone to reduce pain of IM injections
oral route cephalosporins
Refrigerate Oral Suspensions (shake well!)
TAKE these with FOOD!
Carbapenems
How many used?
All are what route?
Currently only FOUR used-
All are parenteral
Broadest coverage of all antibiotics
◦Gram +/- and anaerobes (except MRSA)
Try to reserve these to avoid resistance
Carbapenems are used to treat?
SEVERE INFECTIONS, Pseudomonas aeruginosa
Adverse effects of carbapenems
Same as PCNs, Cephalosporins
-ALLERGIC REACTION!
-Cross sensitivity to beta lactams
-SEIZURE RISK! Big Carbapenem Class effect
-CNS - confusion, hallucinations
drug to drug interaction Carbapenems
Carbapenems lower levels of Divalproex/Valproate/Valproic Acid (seizure med)
Makes Valproate less effective. IRONIC?
Monobactams (beta-lactam)
AZTREONAM
Aztreonam is the only one currently
Only covers aerobic gram-negative bacteria
nursing process for antibiotics
assess- allegies, renal function
diagnosis- Infection?
planning- duration of antibiotics, adverse effects
implementation
-IV/IM
-special oral
evaluation-
intended outcome
uninitended outcome
