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WEEK 7 ABX Flashcards

1
Q

There is a risk for __ when taking birth control pills.

A

clots

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2
Q

Viagra causes __ and __.

A

hypotension; headaches

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3
Q

What is the first step for calculating the hourly flow rate of an IV medication order?

A
  1. Calculate the dosage flow rate

Dosage on hand/Amount of solution on hand desired per min

=

Dosage desired per min/ X amount

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4
Q

What is the second step for calculating the hourly flow rate of an IV medication order?

A
  1. Take the dosage flow rate and multiply it by 60 minutes per hour to get the hourly flow rate

ml/min X 60 min/hr = ml/hr

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5
Q

Calculate the hourly flow rate:

ORDER: Lidocaine 2 GM IV in 500 ML D5W at 2 MG/MIN via infusion pump

A

dosage flow rate = 0.5 ml/min

hourly flow rate = 30 ml/ hour

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6
Q

Calculate the hourly for an IV med ordered per kg per minute:

ORDER: 250 mL of IV solution with 225 mg of a medication to infuse at 3 mcg/kg/min via infusion pump for a person who weighs 110 lb

A
  1. Dosage Flow Rate = 0.17 ml/ min
  2. Hourly Flow Rate =
  3. 2 ml/ hour
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7
Q

TITRATING IV DRUGS

Order: To induce labor: LR 1000 ml IV with Pitocin 20 units. Begin a continuous infusion IV at 1 milliunit/min, increase by 1 milliunit/min q 15 min to a max of 20 milliunits/min

What is Step 1?

A

Step 1: Calculate milliunits/ml

Answer: 1 milliunit Pitocin = 0.05 ml

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8
Q

TITRATING IV DRUGS

Order: To induce labor: LR 1000 ml IV with Pitocin 20 units. Begin a continuous infusion IV at 1 milliunit/min, increase by 1 milliunit/min q 15 min to a max of 20 milliunits/min

What is Step 2?

A

Find flow rate in ml/hr to infuse 0.05 ml/min

(1 milliunit pitocin/ min)

Answer: set infusion pump at 3 ml/hour to infuse piton 1 milliunit/min as ordered

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9
Q

TITRATING IV DRUGS

Order: To induce labor: LR 1000 ml IV with Pitocin 20 units. Begin a continuous infusion IV at 1 milliunit/min, increase by 1 milliunit/min q 15 min to a max of 20 milliunits/min

What is the Maximum flow rate in ml/hour that piton infusion can be set for the titration as ordered?

A

Answer: Rate of 60 ml/hour will deliver 20 milliunits/min

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10
Q

Infection Pathophysiology

What kind of disease-producing organism is this?

  1. Gram +, Gram -
  2. Cell wall differs in structure -> there are bacilli and cocci shaped structures
  3. can be aerobic or anaerobic
A

Bacteria

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11
Q

Infection Pathophysiology

What kind of disease-producing organism is this?

Smallest pathogen, toughest

A

Viruses

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12
Q

Infection Pathophysiology

What kind of disease-producing organism is this?

Yeasts or mold, infect skin or subcutaneous tissue

A

Fungi

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13
Q

Infection Pathophysiology

What kind of disease-producing organism is this?

Amoeba, Plasmodium

A

Protozoa

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14
Q

Infection Pathophysiology

What kind of disease-producing organism is this?

Ascaris Lumbricoidies

A

Parasite

  • this is a round worm, typically seen in developing countries
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15
Q

In bacteria, what does bacilli mean?

A

elongated, or rod-shaped cell wall structure

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16
Q

In bacteria, what does cocci?

A

spherical cell wall structure

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17
Q

People who take antibiotics since they are young have an increased risk for __

A

obesity

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18
Q

Increased use of antibiotics increases the risk of __ __

A

breast cancer

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19
Q

What does Plasmodium cause?

A

malaria

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20
Q

Which groups are at increased risk of getting roundworms?

A
  1. Foreign born children
  2. Vegans
  3. Homeless
  4. People who travel often
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21
Q

Bacteria are __-__ organisms who lack a true __ and __ __

A

single-celled

nucleus; nuclear membrane

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22
Q

Bacteria: Cocci

What does staphylococci mean?

A

clusters

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23
Q

Bacteria: Cocci

What does streptococci mean?

A

chains

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24
Q

Gram Positive: does it retain stain?

What are examples of gram positive bacteria? ( 4)

A

Yes it retains stain

Ex:

  1. Staphylococcus aureus
  2. Streptococcus pneumoniae
  3. Group B streptococcus
  4. Clostridium perfringens
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25
Q

Gram Negative: does it retain stain?

What are examples of gram negative bacteria (3)

A

No it does not retain stain

Ex:

  1. Neisseria meningitides
  2. Escherichia coli
  3. Haemophilus Influenzae
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26
Q

Which bacteria resides in our skin, hair, and nails?

A

staphylococcus aureus

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27
Q

Which bacteria lives in the gut?

A

e. coli

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28
Q

Is this a gram positive or gram negative bacteria?

N. Gonorrhoeae

A

gram negative

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29
Q

Is this a gram positive or gram negative bacteria?

E.Coli
Klebsiella SP
E.Coli/Kleb SP ESBL+
E.Coli/Klebs SP KPC+

A

gram negative

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30
Q

Is this a gram positive or gram negative bacteria?

Strep pneumoniae

A

gram positive

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31
Q

Is this a gram positive or gram negative bacteria?

Shigella SP.

A

gram negative

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32
Q

Is this a gram positive or gram negative bacteria?

Staph aureus (Methicillin Sensitive)
Staph aureus (Methicillin Resistant)
Staph aureus (Community Acquired-Methicillin Resistant)
A

gram positive

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33
Q

Is this a gram positive or gram negative bacteria?

N. Meningitidis

A

gram negative

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34
Q

Is this a gram positive or gram negative bacteria?

Salmonella SP

A

gram negative

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35
Q

Is this a gram positive or gram negative bacteria?

Proteus Vulgaris

A

gram negative

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36
Q

Is this a gram positive or gram negative bacteria?

Brucella SP.

A

gram negative

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37
Q

Is this a gram positive or gram negative bacteria?

PS Aeruginosa

A

gram negative

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38
Q

Is this a gram positive or gram negative bacteria?

Enterococcus Faecalis
Enterococcus Faecium

A

gram positive

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39
Q

Is this a gram positive or gram negative bacteria?

Staph Epidermidis

A

gram positive

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40
Q

Is this a gram positive or gram negative bacteria?

Enterobacter SP.

A

gram negative

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41
Q

Is this a gram positive or gram negative bacteria?

Bacillus Anthracis

A

gram positive

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42
Q

Is this a gram positive or gram negative bacteria?

M. Catarrhalis

A

gram negative

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43
Q

Is this a gram positive or gram negative bacteria?

H. Influenzae

A

gram negative

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44
Q

Is this a gram positive or gram negative bacteria?

Acinetobacter SP.

A

gram negative

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45
Q

Is this a gram positive or gram negative bacteria?

Legionella SP.

A

gram negative

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46
Q

Is this a gram positive or gram negative bacteria?

Serratia Marcescens

A

gram negative

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47
Q

Is this a gram positive or gram negative bacteria?

Clostridium (difficile, perfringens, tetani)

A

gram positive

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48
Q

Name 5 Anaerobic Bacteria:

A
  1. Actinomyces
  2. Bacteroides fragilis
  3. Clostridium difficile
  4. Clostridium (others)
  5. Peptostreptococcus sp
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49
Q

Name 4 Miscellaneous Bacteria

A

Chlamydophila sp.
M. Pneumoniae
Rickettsia sp.
Mycobacterium Avium

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50
Q

Antibiotics are chemicals produced by one of microorganism that…

A

inhibit the growth of or kill another

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51
Q

Antibiotics are used to treat ___

A

infections

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52
Q

Antibacterial and antimicrobial agents inhibit __ __ or __ bacteria and other microorganisms

A

bacterial growth; kill

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53
Q

Define Bactericidal.

A

kill microorganisms

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54
Q

Define Bacteriostatic

A

inhibits growth of microorganisms

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55
Q

What are the actions of Antibacterial Drugs? (5)

A
  1. Inhibition of cell wall synthesis
  2. Alteration in membrane permeability
  3. Inhibition of protein synthesis
  4. Inhibition of RNA & DNA synthesis
  5. Interference with cellular metabolism
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56
Q

What are factors that influence the body’s defense? (7)

A

1.Age (very young, very old, premature increased risk for infection)
2.Nutrition
Immunoglobulins (lack of protein)
3.Circulation, WBCs (diabetics have harder time getting infection b/c of decreased circulation)
4.Organ function
5.Skin integrity – skin breakdown
6.Medications

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57
Q

Do very young and older people have dirtier hands? And why?

A

Older people’s hands have more bacteria because they have wrinkles which increases the crevices for bacteria to stay and grow

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58
Q

SAR and H1N1 mostly affected which group of people?

A

middle age people

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59
Q

Name the type of resistance to antibacterials.

Can occur between antibacterial drugs that have similar actions

A

Cross-resistance

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60
Q

Infection acquired while client is hospitalized. Many are due to drug-resistant bacteria. What is this type of infection?

A

Nosocomial infections

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61
Q

Name the type of resistance to antibacterials.

caused by prior exposure to antibacterial

A

acquired resistance

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62
Q

Name the type of resistance to antibacterials.

occurs without previous exposure to antibacterial drug

A

natural resistance

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63
Q

Acquired resistance causes many __ __ such as __, __, and __.

A

nosocomial infections

MRSA, VREF, VRSA

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64
Q

What are 4 ways bacteria resist antibiotics?

A
  1. having thicker cell walls
  2. creating enzymes
  3. flushing out antibiotic (bacterial pushes antibiotic out of cell when the antibiotic goes inside the cell)
  4. having communication techniques with other bacteria
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65
Q

Before administering an antibiotic what should you check for?

A

estimate the glomerular filtration rate (GFR)

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66
Q

What does the GFR tell you?

A

the amount of blood filtered by each glomerulus per minute

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67
Q

What is the normal range for GFR?

A

85-135 ml/min (average 125)

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68
Q

What is the Cockcroft and Gault formula for estimating GFR in males?

A

(140-AGE) x Weight in Kg / 72 x Serum Creatinine

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69
Q

What is the Cockcroft and Gault formula for estimating GFR in females?

A

((140-AGE) x Weight in Kg / 72 x Serum Creatinine) x 0.85 (because of decreased muscle mass)

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70
Q

__ patients may require adjustments for estimating GFR

A

obese

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71
Q

What is antibiotic stewardship?

A

when a hospital institution stops using a certain antibiotic for a period of time

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72
Q

Each kidney has ~__ ___ glomeruli

A

1 million

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73
Q

What is GFR also known as?

A

Creatinine Clearance

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74
Q

What is the significance of measuring creatinine clearance or GFR?

A

Exchange information with health care team to determine need to adjust medication dose

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75
Q

What are the 3 major adverse reaction categories for antibacterials?

A
  1. allergic or hypersensitivity
  2. superinfection
  3. organ toxicity
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76
Q

What are mild symptoms of an allergic reaction/hypersensitivity to antibacterials?

A

rash
pruritus
hives

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77
Q

What is a severe allergic reaction/hypersensitivity to antibacterials called?

A

anaphylactic shock

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78
Q

What are the treatments for allergic reactions/hypersensitivity to antibacterials?

A
  1. Antihistamines
  2. Epinephrine
  3. Bronchodilator
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79
Q

What is a superinfection?

A

secondary infection

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80
Q

What type of superinfections (major adverse reaction) can we see when using antibacterials?

A 
mouth 
respiratory tract 
intestine
GU tract 
skin
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81
Q

What organs are typically damaged in organ toxicity? (major adverse reaction of antibacterials)

A

damage to liver

damage to kidneys

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82
Q

White patches in the mouth and oral mucosa is known as

A

Leukoplakia

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83
Q

Leukoplakia is a type of ___

A

superinfection

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84
Q

Superinfections are all __ related

A

fungal

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85
Q

What is a narrow-spectrum antibiotic?

A

primarily effective against one type of organism

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86
Q

What can broad-spectrum antibiotics affect?

A

They can be effective against gram + and gram - organisms

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87
Q

Broad-spectrum antibiotics are frequently used when microorganisms can not be __ by __ & __

A

identified

culture & sensitivity (C&S)

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88
Q

Name 4 types of broad-spectrum antibiotics

A

tetracycline
cephalosporins
gentamycin
vancomycin

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89
Q

What should you do FIRST when a patient comes in with a possible infection?

A

COLLECT:
blood cultures
urine cultures
sputum (if applicable)

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90
Q

What is the structure of penicillins?

A

beta-lactam rings

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91
Q

Basic penicillins were introduced to kill

A

staphylococcus

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92
Q

Basic penicillins interfere with __ __ __ leading to __ __ and __ __

A

cell wall synthesis

cell lysis

cell death

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93
Q

Basic penicillins are considered broad spectrum or narrow spectrum?

A

narrow spectrum

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94
Q

What are two examples of basic penicillins?

A

Penicillin G

Penicillin V

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95
Q

What kind of drugs decrease excretion of penicillins?

A

uricosuric drugs (probenecid)

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96
Q

Uricosuric drugs increase __ __ __ thus increasing the __

A

serum penicillin levels

effectiveness

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97
Q

The first OFFICIAL antibiotic is

A

penicillin

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98
Q

The first TRUE antibiotic is

A

Sulfa

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99
Q

PCN was first used to treat

A

wound infections and STDs

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100
Q

Where is the majority of abx produced worldwide used in?

A

in agriculture -> livestock

70% are used in cows, chickens, fish

oranges are sprayed with streptomycin

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101
Q

Broad-spectrum penicillins may be used to treat both __-__ and __-__ bacteria

A

gram + and gram -

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102
Q

What are 3 examples of bacteria that broad-spectrum penicillins can treat?

A
  1. escherichia coli
  2. salmonella spp.
  3. haemophilus influenzae
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103
Q

Are broad-spectrum penicillins bacteriostatic or bactericidal

A

bactericidal

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104
Q

Broad-spectrum penicillins are also known as

A

aminopenicllins

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105
Q

Examples of aminopenicillins:

A
  1. Ampicillin (Omnipen)
  2. Amoxicillin (Amoxil)
  3. Augmentin (Clavulanate)
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106
Q

Broad-spectrum penicillins are excreted by the

A

kidneys

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107
Q

Penicillianse-resistant penicillins are used to treat

A

penicillinase-produceing S. Aureus

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108
Q

What are the names of the two ORAL penicillinase-resistant penicillins?

A
  1. Cloxacillin (Cloxapen)

2. Dicloxacillin (Dynapen)

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109
Q

What are the names of the two IM & IV penicillinase-resistant penicillins?

A
  1. Nafcillin (Unipen)

2. Oxacillin (Prostaphin)

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110
Q

Extended-spectrum penicillins are used against which type of organisms?

A

gram negative organisms

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111
Q

What are 3 examples of gram negative organisms that extended-spectrum penicillins work against?

A
  1. pseudomonas aeruginosa
  2. proteus spp
  3. klebsiella pneumoniae
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112
Q

Extended-spectrum penicillins treat which type of infections (6)

A
  1. bone
  2. joint
  3. skin
  4. soft tissue
  5. respiratory tract
  6. urinary tract
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113
Q

Extended-spectrum penicillins are also called

A

Anti-pseudomonal penicillins

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114
Q

What are the names of 3 extended-spectrum penicillins?

A
  1. piperacillin (pipracil)
  2. ticarcillin (ticar)
  3. carbenicillin (geopen)
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115
Q

Beta-lactamase inhibitors are NOT:

A

given alone

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116
Q

Beta-lactamase inhibitors are combined with:

A

penicillinase-sensitive penicillin

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117
Q

Name 4 beta-lactamase inhibitors:

A
  1. Clavulanic acid
  2. Sulbactam
  3. Tazobactam
  4. Ticarcillin
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118
Q

What do beta-lactamase inhibitors do?

A

they inhibit bacterial beta-lactamase enzyme

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119
Q

What is the combo (penicillinase-sensitive penicillin + beta-lactamase inhibitor)
for Augmentin?

A

Amoxicillin - Clavulanate

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120
Q

Augmentin (Amoxicillin - Clavulanate) is given __ and this combination intensified the effect of __.

A

orally

amoxicillin

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121
Q

What is the combo (penicillinase-sensitive penicillin + beta-lactamase inhibitor) for Zosyvn?

A

Piperacillin + Tazobactam

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122
Q

What is the combo (penicillinase-sensitive penicillin + beta-lactamase inhibitor) for Timentin?

A

Ticarcillin - Clavulanate

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123
Q

What is the combo (penicillinase-sensitive penicillin + beta-lactamase inhibitor) for Unasyn?

A

Ampicillin - Sulbactam

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124
Q

Ampicillin - Sulbactam (Unasyn) is given __. This combination extends the __.

A

parenterally

spectrum

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125
Q

Beta-lactamase is the enzyme produced by the bacteria to…..

This is a step up to kill off the __ __

A

resist the antibiotic

resistant organism

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126
Q

-BACTAM =

A

beta-lactamase inhibitors

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127
Q

What are the side effects of penicillins?

A
  1. allergic reactions, hypersensitivity

2. GI: n/v/d

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128
Q

How many percent of persons receiving penicillins have an allergic reaction?

A

5 - 10%

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129
Q

If a person is hypersensitive to penicillins, what could occur? (2)

A
  1. rash

2. allergic reaction leading to anaphylaxis

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130
Q

What do you use to treat for a mild allergic reaction to PCN?

A

Diphenhydramine (Benadryl)

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131
Q

How should you treat a person who develops anaphylaxis when taking PCN?

A
  1. manage airway
  2. epinephrine, corticosteroids
  3. saline or plasma expanders
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132
Q

Penicillin Contraindications:

  1. History of __ to penicillins
  2. If history of mild allergy, give __ instead
  3. If history of SEVERE reaction, avoid __ because there is a 5-10% __ __.
  4. Avoid with SEVERE __ __.
A
  1. hypersensitivity
  2. cephalosporin
  3. cephalosporins ; cross sensitivity
  4. renal insufficiency
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133
Q

Food-Drug interactions: Food may __ absorption of many oral penicillins

A

decrease

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134
Q

Take penicillins with __ __ of __ __ hour before OR __ hours after a meal

A

full glass; water ; One

Two

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135
Q

You should take an antibiotic on an __ __ because there is greater ___ without food; However you can experience __, __, __

A

empty stomach
effectiveness

nausea, vomiting, diarrhea

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136
Q

What is the structure of cephalosporins?

A

beta-lactam structure

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137
Q

What is the mechanism of action for cephalosporins?

A

inhibits bacterial cell-wall synthesis

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138
Q

Are cephalosporins bactericidal or bacteriostatic?

A

bactericidal

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139
Q

What infections do cephalosporins treat?

A
  1. respiratory
  2. urinary tract
  3. skin
  4. bone
  5. joint
  6. genital
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140
Q

Cephalosporins: has a total of __ generations

A

4

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141
Q

1st generation cephalosporins are effective against:

A

gram + bacteria

142
Q

Name two 1st generation cephalosporins:

A
  1. Cefazolin (Ancef, Kefzol)

2. Cephalexin (Keflex)

143
Q

The 2nd generation cephalosporins have greater, same, or less effectiveness as the 1st generation cephalosporins?

144
Q

2nd generation cephalosporins have a broader spectrum against other __ __ bacteria but not __.

A

gram negative

pseudomonas

145
Q

What are 2 examples of 2nd generation cephalosporins?

A
  1. Cefaclor (Ceclor)

2. Cefoxitin Sodium (Mefoxin)

146
Q

Pseudomonas is found where in the body?

A

primarily in lungs, nose (respiratory tract)

in GI tract

147
Q

The 3rd generation cephalosporins have greater, same, or less effectiveness as the 1st and 2nd generation cephalosporins?

148
Q

3rd generation cephalosporins are also effective against other __ __ bacteria

A

gram negative

149
Q

__ and __ (3rd generation cephalosporins) are active against PSEUDOMONAS aeruoginosa

A

Ceftazidime

Cefoperazone

150
Q

3rd generation cephalosporins may be effective against some…

A

beta-lactamse- producing strains

151
Q

3rd generation cephalosporins are excreted by __ or __ __

A

kidney

biliary tract

152
Q

4th generation cephalosporins are similar to __ generation

153
Q

4th generation cephalosporins have a more extended gram negative activity including __

A

pseudomonas

154
Q

4th generation cephalosporins also have a broader __ __ activity

A

gram positive

155
Q

4th generation cephalosporins may cross

A

blood brain barrier

156
Q

4th generation cephalosporins are excreted by

157
Q

Give an example of a 4th generation cephalosporin:

A

Cefepime (Maxipime)

158
Q

Hypersensitivity of cephalosporins are similar to __

A

penicillin

159
Q

__% to __% __ allergenicity between cephalosporins and penicillin

A

5%; 10% CROSS

160
Q

What are GI side effects of cephalosporins?

A

Nausea
Vomiting
Diarrhea

161
Q

What are Hematologic side effects of cephalosporins?

A
  1. Alterations in blood clotting with large doses
  2. Neutropenia
  3. Hemolytic anemia

more prone to infection

162
Q

What are Renal side effects of cephalosporins?

A

Nephrotoxicity in those excreted by kidney

adjust dose if renal impairment

163
Q

What are drug interactions between some cephalosporins and alcohol?

A

flushing
dizziness
headache
n/v

164
Q

What should you include in your ASSESSMENT before giving penicillins and cephalosporins?

A
  1. history of allergy or hypersensitivity
  2. check lab results for liver and renal function
  3. assess v/s and urine output
165
Q

What are possible NURSING DIAGNOSES for someone on penicillins and cephalosporins?

A
  1. Risk for infection
  2. Risk for impaired tissue integrity
  3. Noncompliance with drug regimen
166
Q

What is the PLAN (goal) for patient on penicillins and cephalosporins?

A
  1. Patient’s infection will be controlled and eliminated

2. Patient will be instructed on how to take meds post discharge

167
Q

What are the INTERVENTIONS for a patient who needs penicillins and cephalosporins?

A
  1. Culture infected area before antibiotic tx

2. monitor signs and symptoms of superinfection and allergy - treat PRN

168
Q

What patient EDUCATION is key for patient taking penicillins and cephalosporins?

A
  1. Take drug around the clock & finish as ordered; don’t skip or double doses
  2. Chew or crush chewable tabs before swallowing
  3. Do not share drugs with others
  4. Report symptomatic allergic reaction, side effects, superinfection
  5. Wear or carry ID if drug or food allergies
169
Q

Which 3 antibacterials have spectrums of similar effectiveness to penicillin but differ in structure?

A
  1. Macrolides
  2. Lincosamides
  3. Glycopeptides
170
Q

If pt is allergic to PCN , give erythromycin which is a

171
Q

Name 3 macrolides

A
  1. Azithromycin (Zithromax)
  2. Clarithromycin (Biaxin)
  3. Erythromycin (E-Mycin)
172
Q

Name 1 Lincosamides

A

Clindamycin

173
Q

Name 1 Glycopeptide

A

Vancomycin

174
Q

Are macrolides bactericidal or bacteriostatic?

A

bacteriostatic

bactericidal in large doses

175
Q

What is the mechanism of action for macrolides?

A

inhibit protein synthesis : bacteria need protein to live

176
Q

Macrolides can be given __ or __

177
Q

Macrolides are active against MOST __-__ bacteria

A

gram-positive

178
Q

Macrolides are active against some __-__ bacteria

A

gram-negative

179
Q

What are the uses for macrolides?

A

For the moderate to severe infections of the:

  1. respiratory
  2. GI
  3. Skin
  4. Soft tissue
  5. Mycoplamsa pneumoniae
  6. Legionnaires’ disease
180
Q

What is the prototype of macrolides?

A

Azithromycin (Zithromax, Azasite)

181
Q

The mortality rate of Legionnaires’ disease:

182
Q

Legionnaires’ has an association with __; there was a firs outbreak in __. Legionnaire bacteria lives in the __; are __ in the water tanks or in AC and are spread these ways

A

veterans
Philly

water; aerosolized

183
Q

side effects of Macrolides

A
  1. GI distress
  2. tinnitus, ototoxicity
  3. superinfection
  4. hepatotoxicity
184
Q

Macrolides increase serum levels of: (3) drugs

A
  1. Carbamazepine (Tegretol)
  2. Theophylline
  3. Warfarin (Coumadin)
185
Q

Erythromycin levels increase with (2) drugs

A
  1. Fluconazole (Diflucan)

2. Ketoconazole (Nizoral)

186
Q

Increased erythromycin levels from Fluconazole and Ketoconazole increases the risk of __ __ __

A

sudden cardiac death

187
Q

Azithromycin levels may be reduced by __

188
Q

Hearing loss as a side effect of taking antibiotics is reversible OR irreversible?

A

reversible!

189
Q

Antibiotics affect people __. Young children who use antibiotics don’t __ as much. May have to do with __ __.

A

genetically

grow

protein synthesis

190
Q

What is the mechanism of action of lincosamides?

A

inhibit bacterial protein synthesis

191
Q

Lincosamide fight __-__ __ __

A

gram-positive S. Aureus

192
Q

Are lincosamides bacteriostatic, bactericidal, or both?

A

BOTH

depends on dosage

193
Q

Two examples of Lincosamides:

A
  1. Clindamycin (Cleocin)

2. Lincomycin (Lincocin)

194
Q

What are side effects/adverse reactions of Lincosamides? (3)

A
  1. Rash
  2. GI distress, Colitis
  3. Anaphylactic Shock
195
Q

Drug interactions of Lincosamides:

__ and __ decrease Lincomycin Absorption

A

Kaolin and Pectin

196
Q

Drug interactions of Lincosamides:

__ and __ may enhance neuromuscular blockade

A

Tubocurarine ; Pancuronium

197
Q

Clindamycin and Lincomycin are incompatible with: (4)

A
  1. Aminophylline
  2. Phenytoin (Dilantin)
  3. Barbituates
  4. Ampicillin
198
Q

Lincosamides especially clindamycin is the main culprit for __ __ because it kills off gut flora.

199
Q

What is the mechanism of action for glycopeptides?

A

inhibits bacterial cell wall synthesis

200
Q

Glycopeptides primarily act against __ __ bacteria

A

gram positive

201
Q

Glycopeptides given IV are used to treat __ _ __ infections

A

resistant staph infections

202
Q

Glycopeptides given IV are excreted by __

203
Q

Glycopeptides given orally are used to treat: (3)

A
  1. Staph
  2. Enterocolitis
  3. Antibiotic-Associated Pseudomembranous Colitis due to C. diff
204
Q

Glycopeptides given orally are not absorbed so they are excreted in __

205
Q

Examples of glycopeptides (2)

A
  1. Vancomycin (Vancocin)

2. Telavancin (Vibativ)

206
Q

Which two glycopeptides are used to treat vancomycin-resistant enterococci (VRE)

A
  1. Quinupristin/Dalfopristin (Synercid)

2. Linezolid (Zyvox)

207
Q

Are Synercid and Zyvox broad or narrow spectrum?

A

broad spectrum

208
Q

Glycopeptides are wrapped in foil: light sensitivity to __ light, not __ light

A

natural

fluorescent

209
Q

What are 5 adverse reactions for IV Vancomycin?

A
  1. Red Neck or Red Man Syndrome
  2. Nephrotoxicity
  3. Ototoxicity
  4. Blood Dyscrasias
  5. Stevens-Johnson Syndrome
210
Q

Vanco has a pH close to that of __ because it contains __ __

A

vinegar; hydochorlic acid

211
Q

Red Neck or Red Man Syndrome due to __ IV infusion of Vanco. This is a __ reaction and not an __ reaction!

A

RAPID

toxic; allergic

212
Q

What are the symptoms of red neck or red man syndrome due to vanco? (9)

A
  1. vascular dilatation
  2. skin flushing and rash in the head, neck, upper body
  3. pruritus
  4. less frequently hypotension and angioedema
  5. diffuse burning
  6. rapidly become dizzy, agitated
  7. develop headache, chills, fever
  8. paresthesia around the mouth
  9. chest pain, dyspnea in severe cases
213
Q

How to prevent red neck or red man syndrome due to vanco?

A

Dilute:

  1. 500 mg Vanco in 100 ml OR
  2. 1000 mg in 250 ml

AND infuse over 60 - 120 minutes

214
Q

What are 6 interventions for someone getting vanco?

A
  1. Assess for superinfection during therapy
  2. Draw culture and sensitivity before therapy
  3. Check BP during IV & assess S/S of Red Man Syndrome
  4. Rotate IV site & assess for infiltration
  5. Check I&O, daily weight, BUN, creatinine
  6. Monitor for diarrhea
215
Q

Signs of red man syndrome would appear ~ __-__ min after an infusion is started or may begin soon after its __.

A

4-10

completion

216
Q

Red man syndrome is associated with rapid (

217
Q

Delayed reactions of red man syndrome at or near the end of a 90 or 120 min infusion have been seen patients who had been on vanco therapy for longer than…

A

7 days without prior incidence

218
Q

Red man syndrome has also been linked to __ and __ administration of vancomycin

A

intraperitoneal

oral

219
Q

What are the 1st broad-spectrum antibiotics effective against gram (+) & (-) bacteria & many other organisms?

A

Tetracyclines

220
Q

Continuous use of Tetracyclines have resulted in __ __

A

bacterial resistance

221
Q

What is the mechanism of action for Tetracycline?

A

inhibits bacterial protein synthesis

222
Q

Are tetracyclines bactericidal or bacteriostatic?

A

bacteriostatic

223
Q

Tetracyclines are used against __ __

A

mycoplasma pneumoniae

224
Q

Tetracycline in combination with __ and __ __ are used to treat __ __

A

metronidazole
bismuth subsalicyclate

H. pylori

225
Q

Tetracyclines are given __ and __ for severe __ __

A

orally; topically

acne vulgaris

226
Q

What are the side effects of tetracyclines?

A
  1. very irritating to gastric mucosa
  2. rash, pruritus
  3. photosensitivity
  4. headache
  5. teratogenic
227
Q

What are the GI side effects of tetracycline?

A
  1. n/v/d
  2. flatulence
  3. epigastric distress
  4. abdominal discomfort
  5. heartburn
228
Q

Because tetracyclines are teratogenic, children under __ years old should not take this

229
Q

If a child under 8 takes tetracyclines, their teeth will turn __

230
Q

What are nursing interventions for someone on tetracyclines?

A
  1. encourage to avoid sun exposure and use sunblock
  2. do not give with dairy products or antacids
  3. newer preparations (e.g. doxycycline) has better absorption
231
Q

What is the synthetic analogue of tetracyclines called?

A

Glycylcyclines

232
Q

What is the mechanism of action for glycylcyclines?

A

blocks protein synthesis

233
Q

Are glycylcyclines bactericidal or bacteriostatic?

A

bacteriostatic

234
Q

What are the indications for glycylcyclines?

A

1 complicated skin infections

2. intra-abdominal infections

235
Q

How are glycylcyclines administered?

236
Q

What are the side effects of glycylcyclines?

A

similar to tetracycline

237
Q

Glycylcyclines may interfere with __ __ and __

A

oral contraceptives

warfarin

238
Q

What is an example of glycylcycline?

A

Tigecycline (Tygacil)

239
Q

Aminoglycosides are __ spectrum

240
Q

Are aminoglycosides bactericidal or bacteriostatic?

A

bactericidal

241
Q

Aminoglycosides do not cross __ __ __ in adults

A

blood brain barrier

242
Q

What is the mechanism of action for ahminoglycosides?

A

inhibits bacterial protein synthesis essential for bacterial growth

243
Q

Aminoglycosides are for “__” infections and are primarily administered by _ and __. Need to obtain a __ and __ level

A

serious

IM ; IV

peak; trough

244
Q

What is an examples of an aminoglycoside?

A

Gentamicin

245
Q

When considering __, use gentamicin

246
Q

What are side effects of Gentamicin?

A
  1. Rash
  2. Numbness
  3. Tremors
  4. Muscle cramps or weakness
  5. Visual disturbances
  6. Photosensitivity
  7. Tinnitus
247
Q

What are adverse reactions of Gentamicin?

A
  1. Oliguria
  2. Uritcaria
  3. Palpitations
  4. Superinfection - Ototoxicity (8th cranial nerve)
    Life-threatening:
  5. Nephrotoxicity
  6. Thrombocytopenia
  7. Agranulocytosis (WBC count decreases)
  8. Neuromuscular Blockade
  9. Liver Damage
248
Q

There is an increased risk for OTOTOXICITY with Gentamicin and __ __ (e.g., __)

A

loop diuretics

Lasix

249
Q

There is an increased risk of NEPHROTOXICITY with Gentamicin and: (5)

A
  1. Amphotericin B
  2. Polymyxin
  3. Cisplatin
  4. Furosemide
  5. Vancomycin
250
Q

Nursing interventions for patient on Gentamicin: (2)

A
  1. check urine output

2. check creatinine clearance

251
Q

Fluoroquinolones are __ spectrum

252
Q

Fluoroquinolones act on which bacteria?

A

gram + and gram - bacteria

253
Q

Fluoroquinolones is bactericidal or bacteriostatic?

A

bactericidal

254
Q

Fluoroquinolones are readily absorbed by __ __

255
Q

Fluoroquinolones mechanism of action

A

interrupts DNA synthesis

256
Q

Uses for Fluoroquinolones:

A
  1. UTI
  2. Bone and Joint infections
  3. Bronchitis
  4. PNA
  5. Gonorrhea
257
Q

What is an example/prototype of a Fluoroquinolone?

A

Levofloxacin (Levaquin)

258
Q

What are the side effects of Levofloxacin?

A
  1. n/v/d
  2. abdominal pain and cramps
  3. flatulence
  4. headache, dizzines
  5. fatigue
  6. restlessness, insomnia
  7. rash, flushing
  8. photosensitivity
  9. tinnitus
259
Q

Levofloxacin has an increased effect with:
1)
2)

A
  1. oral hypoglycemics

2 theophylline

260
Q

Levofloxacin has a decreased absorption with:

A
  1. antacids

2. iron

261
Q

Levofloxacin adverse reactions:

A
  1. Stevens-Johnson Syndrome
  2. Encephalopathy
  3. Seizures
  4. Pseudomembranous Colitis (think C. diff)
262
Q

Levofloxacin has an increased risk of dysrhythmias because of risk of __ __

A

prolonged QT

263
Q

Lipopeptides are __

A

bactericidal

264
Q

What is the mechanism of action for lipopeptides?

A

inhibits protein, DNA, and RNA synthesis

265
Q

What are the uses for lipopeptides?

A
  1. complicated skin infections
  2. septicemia due to staphylococcus aureus infections
  3. infective endocarditis due to MRSA
266
Q

What is an example/prototype of Lipopeptides:

A

Daptomycin (Cubicin)

267
Q

Lipopeptides are used if __ is not working because bacteria is resistant

A

vancomycin

268
Q

What are the side effects of Daptomycin (Cubicin)

A
  1. hypo/hypertension
  2. anemia
  3. numbness
  4. tingling
  5. dizziness
  6. insomnia
  7. pain/burning in urination
  8. n/v
269
Q

What are adverse effects of Daptomycin (Cubicin)?

A
  1. elevated creatinine kinase (rhabdomyolysis) especially when given with Statins
  2. unexplained myopathy, neuropathy
  3. hypo/hyperkalemia, hyperglycemia
  4. pleural effusion
270
Q

Daptomycin (Cubicin) - has toxicity with __

A

tobramycin

271
Q

Daptomycin (Cubicin) - increases bleeding with __

272
Q

Daptomycin (Cubicin) can cause __ type of PNA

A

eosinophilia

273
Q

Sulfonamides are bacteriostatic or bactericidal?

A

bacteriostatic

274
Q

Sulfonamides were first isolated from coal tar in 1900s and produced in 1935 to treat __

275
Q

Usefulness decreased due to __ __, discovery of __ , used in patients allergic to __

A

drug resistance
PCN
PCN

276
Q

What is the mechanism of action for sulfonamides?

A

inhibits formation of folic acid in bacterial cells which is essential for bacterial growth

277
Q

What are the uses for sulfonamides?

A
  1. gram negative infections
  2. UTI
  3. Prostatitis
  4. Respiratory infections
  5. Burn wounds (topical)
  6. Meningococcal meningitis
  7. Newborn eye prophylaxis
  8. chlamydia
  9. toxoplasmosis
278
Q

Examples of sulfonamides:

A
  1. Trimethoprim

2. Sulfamethoxazole (TMP-SMZ, Bactrim, Septra)

279
Q

What is Trimethoprim used for?

A

urinary tract anti-infective

280
Q

Trimethoprim- ___ has a synergistic effect. Both drugs together in one compound cause __ __ to develop much more __.

A

Sulfamethoxazole

bacterial resistance
slowly

281
Q

What are the uses for trimethoprim- sulfamethoxazole?

A
  1. urinary
  2. intestinal
  3. lower respiratory tract infections
  4. otitis media
  5. prostatitis
  6. gonorrhea
  7. used to prevent Pneumocystis Carinii in patients with AIDS and Bone Marrow Disease
282
Q

What are the side effects and adverse reactions for trimethoprim-sulfamethoxazole?

A
  1. moderate rashes
  2. Anorexia
  3. n/v/d
  4. stomatitis
  5. crystalluria
  6. photosensitivity
  7. agranulocytosis, aplastic anemia
  8. hypoglycemia
  9. severe skin reaction - steven johnson’s syndrome
  10. C. diff
  11. Allergic myocarditis
283
Q

Bactrim should be used cautiously in patients with __ __ because it is associated with agranulocytosis.

284
Q

For initial and chronic UTIs, drug action occurs in __ __ and __. This is effective in decreasing ___ __.

A

renal tubule; bladder

bacterial growth

285
Q

What is the prototype for UTI drugs?

A

Nitrofurantoin (Furalan, Furadantin, Macrodantin)

286
Q

Nitrofurantoin (Macrodantin) is a __ or __ depending on the drug dosage

A

bacteriostatic ; bactericidal

287
Q

Nitrofurantoin (Macrodantin) is effective against many __-__ and __-__ organisms especially __ ____

A

gram-positive
gram-negative
E. coli

288
Q

What are the side effects of Nitrofurantoin (Macrodantin) ?

A
  1. rash
  2. pruritus
  3. dizziness
  4. headache
  5. rust/ brown urine (expected)
289
Q

Bacteria __ __ with the use of Nitrofurantoin (Macrodantin)

A

commits suicide

290
Q

What is the prototype for a urinary analgesic?

A

Phenazopyridince HCl (Pyridium)

291
Q

Phenazopyridince HCl (Pyridium) is an __ __, is available about __ years

A

azo dye

40

292
Q

What is the mechanism of action for Phenazopyridince HCl (Pyridium) ?

A

unknown - relieves urinary burning and pain

293
Q

What are the side effects for Phenazopyridince HCl (Pyridium)?

A
  1. GI upset, hemolytic anemia
  2. nephrotoxicity
  3. hepatotoxicity
  4. urine becomes reddish-orange (harmless)
294
Q

Phenazopyridince HCl (Pyridium) is used as an __ for the first __ days of UTI to numb the pain while the __ is taking effect

A

anesthetic
3
antibiotic

295
Q

Mechanism of action for urinary antispasmodics

A

Have direct action on smooth muscles in urinary tract to relieve spasms caused by infection or injury

296
Q

What 3 other types of drugs have the same effect as antispasmodics?

A
  1. Antimuscarinics
  2. Parasympatholytcs
  3. Anticholinergics
297
Q

When should you caution the use of urinary antispasmodics/antimuscarinics?

A

if pt has:

  1. urinary or GI obstruction
  2. glaucoma
298
Q

Name 4 examples of antispasmodics

A
  1. Ditropan
  2. Detrol
  3. Bella Donna
  4. Opium Suppositories
299
Q

What are side effects of Urinary Antispasmodics/

Antimuscarinics?

A
  1. Dry mouth
  2. increased HR
  3. Dizziness
  4. Intestinal Distenion
  5. Constipation
300
Q

Patient education about Urinary Antispasmodics/

Antimuscarinics

A

tell patient to report the following to HCP:

  1. urinary retention
  2. severe dizziness
  3. blurred vision
  4. palpitations
  5. confusion
301
Q

Mycobacterium tuberculosis is an __-__ __

A

acid-fast bacillus

302
Q

How is tb transmitted?

A

person to person via DROPLETS through coughing and sneezing

303
Q

Which clients are at risk for tb?

A
  1. alcohol, addicted, debilitated

2. immunocompromised

304
Q

What are symptoms of tb?

A
  1. cough
  2. sputum
  3. fever
  4. night sweats
  5. weight loss
  6. GI distress
305
Q

Prophpylaxis for TB is recommended for __ -__ months for those who:

A

6-12

  1. are in close contact with TB pt
  2. HIV positive with positive TB test
  3. converted from negative to positive TB test
  4. contraindicated in liver disease
306
Q

Single-drug therapy for anti tubercular drugs are __

A

ineffective

307
Q

Multi drug therapy decreases __ __ to drug and __ __ is decreased

A

bacterial resistance

treatment duration

308
Q

First-line anti tubercular drugs:

A
  1. Isoniazid (INH)
  2. rifampin
  3. ethambutol
  4. streptomycin
309
Q

First-line anti tubercular drugs are more effective than __ __ and are __ toxic

A

second-line

less

310
Q

Second-line anti tubercular drugs .

Are they more or less effective than first-line drugs?

Are they more less toxic than first line drugs?

A
  1. Capreomycin 2.cycloserine
  2. ethionamide 4.kanamycin
  3. amikacin
  4. ciprofoxacin
  5. pyrazinamide (can be sometimes seen as 1st line drug)

less effective
more toxic

311
Q

Anti tubercular drug treatment regimen is divided into __ phases

312
Q

phase 1 of Anti tubercular drug treatment regimen:

A

Duration: 2 months

313
Q

phase 2 of Anti tubercular drug treatment regimen

A

Duration: 4-7 months

314
Q

Isoniazid (INH) is an ___ drug

A

antitubercular

315
Q

How can Isoniazid (INH) be given?

316
Q

What is the mechanism of action for Isoniazid?

A

inhibits bacterial cell wall synthesis

317
Q

What are the side effects/adverse reactions for Isoniazid?

A
  1. GI distress 2.constipation
  2. Blurred vision 4.photosensitivity
  3. Tinnitus
  4. dizziness
  5. Peripheral neuropathy
  6. Psychotic behavior 9.seizures
  7. Blood dyscrasias
  8. hepatotoxicity
318
Q

What drugs increase the effect of Isoniazid (INH)?

A
  1. alcohol
  2. rifampin
  3. cycloserine
  4. phenytoin
319
Q

Isoniazid (INH) decreases __ effect when concurrent

320
Q

__ decrease the absorption of Isoniazid (INH)

321
Q

Alcohol and Isoniazid (INH) increases the risk of

A

neuropathy and hepatotoxicity

322
Q

What should you teach a pt taking isoniazid (INH) ?

A
  1. Take INH 1 hour before meals or 2 hours after meals
  2. Must follow complete regimen
  3. Collect sputum specimen in early morning
  4. Take pyridoxine (vitamin B6) to prevent peripheral neuropathy
  5. Check liver enzymes, CBC
  6. Need frequent eye examinations
  7. Report numbness, tingling, burning
  8. Teach sun precautions, avoid antacids
323
Q

What should you monitor for Streptomycin (anti tubercular drug) ?

A

monitor ototoxicity

monitor renal function

324
Q

What should you monitor for Rifampin (anti tubercular drug) ?

A

warn client that body fluids may be red-orange

325
Q

What should you monitor for Ethambutol (anti tubercular drug) ?

A

Take single daily dose to avoid visual disturbances

326
Q

Viruses are more __ to eradicate than bacteria

327
Q

Viruses enter __ cells and use __ and __ to generate more viruses

A

healthy

DNA and RNA

328
Q

What is the mechanism of action for antiviral drugs?

A

Antiviral drugs interfere with viral nucleic acid synthesis in cell

329
Q

Uses for antiviral drugs:

A
  1. Herpes simplex virus
  2. Influenza
  3. Viral hepatitis
  4. CMV
330
Q

What is the prototype for antiviral drugs?

A

Acyclovir sodium (Zovirax)

331
Q

What are the side effects for Acyclovir sodium (Zovirax)?

A
  1. N/V, diarrhea
  2. Headache, lethargy, tremors
  3. Rash, pruritus
  4. ↑ bleeding time
  5. Phlebitis at IV site
332
Q

What are contraindications for Acyclovir sodium (Zovirax)?

A
  1. Hypersensitivity

2. Caution with severe renal or hepatic disease

333
Q

What are adverse reactions for Acyclovir sodium (Zovirax)?

A
  1. Uritcaria
  2. Anemia

Life threatening:

  1. Nephrotoxicity (large doses)
  2. Bone marrow depression
  3. Thrombocytopenia, leukopenia, granulocytopenia
  4. acute renal failure
334
Q

Antifungals treat mild __ fungal infections such as on the __, __ __

A

superficial

skin, mucous membranes

335
Q

Antifungals are used for __ __ such as __ __ and __

A

systemic infections

severe lungs, CNS

336
Q

What are the 4 anti fungal drug groups?

A
  1. Polyenes
  2. Azoles
  3. Antiprotozoals
  4. Echinocandins
337
Q

Name an example of Polyenes

A

Amphotericin B, Nystatin

338
Q

Name two examples of Azoles

A
  1. Fluconazole (Diflucan), 2. miconazole (Monistat) – topically or IV
339
Q

Name an example of Antiprozoals

A

Atovaquone (Mepron)

340
Q

Name an example of Echinocandins

A

Caspofungin (Cancidas)
– treat Candida, Aspergillosis
route: IV
– if can’t tolerate any of the other drugs

341
Q

amphotericin B, which is a __, treats severe __ __

A

polyene

fungal infections

342
Q

What is the mechanism of action for polyenes?

A

Binds to fungal cell membranes, causing leakage of cellular contents. Fungistatic or fungicidal

343
Q

What is the newer formulation of amphotericin B? does it have fewer or more side effects?

A

Liposomal amphotericin B

FEWER

344
Q

What is the route of Amphotericin B?

A

IV over 2-6 hours

345
Q

What are the side effects/adverse reactions for amphotericin B?

A

Flushing, fever, chills, dyspnea, hypo/hypertension, tachycardia
High doses: nephrotoxicity, electrolyte imbalances, ototoxicity

346
Q

What are nursing interventions for Amphotericin B?

A

Give IV slowly
Monitor vital signs every 30 minutes
Prevent febrile reactions, anaphylaxis
Antipyretics, antihistamines, corticosteroids
Increase fluids
Monitor urine output, weight
Monitor electrolytes, renal and liver function

347
Q

What is the mechanism of action for azoles?

A

Inhibits cytochrome P450 in fungal cells, interfering with the formation of ergosterol – increasing cell permeability

348
Q

What are the uses for azoles?

A

Candidiasis, cryptococcocal meningitis, histoplasmosis

349
Q

What is the route of azoles?

A

oral
IV
vaginal
topical

350
Q

What is the mechanism of action for Metronidazole (Flagyl)?

A

Interferes with DNA function of bacteria

351
Q

What are the side effects of Metronidazole (Flagyl)?

A

Dizziness, headache, confusion, depression, irritability, weakness, insomnia

352
Q

What should you education the patient who is taking Metronidazole (Flagyl)?

A

Avoid alcohol

Disulfram-type reaction: facial flushing, sweating, severe headache, slurred speech

Dark urine or reddish brown (High doses)

Avoid during first trimester pregnancy

PHARM (3 decks)

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