WEEK 7 ABX Flashcards
1
Q
There is a risk for __ when taking birth control pills.
A
clots
2
Q
Viagra causes __ and __.
A
hypotension; headaches
3
Q
What is the first step for calculating the hourly flow rate of an IV medication order?
A
- Calculate the dosage flow rate
Dosage on hand/Amount of solution on hand desired per min
=
Dosage desired per min/ X amount
4
Q
What is the second step for calculating the hourly flow rate of an IV medication order?
A
- 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
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
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
- Dosage Flow Rate = 0.17 ml/ min
- Hourly Flow Rate =
- 2 ml/ hour
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
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
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
10
Q
Infection Pathophysiology
What kind of disease-producing organism is this?
- Gram +, Gram -
- Cell wall differs in structure -> there are bacilli and cocci shaped structures
- can be aerobic or anaerobic
A
Bacteria
11
Q
Infection Pathophysiology
What kind of disease-producing organism is this?
Smallest pathogen, toughest
A
Viruses
12
Q
Infection Pathophysiology
What kind of disease-producing organism is this?
Yeasts or mold, infect skin or subcutaneous tissue
A
Fungi
13
Q
Infection Pathophysiology
What kind of disease-producing organism is this?
Amoeba, Plasmodium
A
Protozoa
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
15
Q
In bacteria, what does bacilli mean?
A
elongated, or rod-shaped cell wall structure
16
Q
In bacteria, what does cocci?
A
spherical cell wall structure
17
Q
People who take antibiotics since they are young have an increased risk for __
A
obesity
18
Q
Increased use of antibiotics increases the risk of __ __
A
breast cancer
19
Q
What does Plasmodium cause?
A
malaria
20
Q
Which groups are at increased risk of getting roundworms?
A
- Foreign born children
- Vegans
- Homeless
- People who travel often
21
Q
Bacteria are __-__ organisms who lack a true __ and __ __
A
single-celled
nucleus; nuclear membrane
22
Q
Bacteria: Cocci
What does staphylococci mean?
A
clusters
23
Q
Bacteria: Cocci
What does streptococci mean?
A
chains
24
Q
Gram Positive: does it retain stain?
What are examples of gram positive bacteria? ( 4)
A
Yes it retains stain
Ex:
- Staphylococcus aureus
- Streptococcus pneumoniae
- Group B streptococcus
- Clostridium perfringens
25
Gram Negative: does it retain stain?
| What are examples of gram negative bacteria (3)
No it does not retain stain
Ex:
1. Neisseria meningitides
2. Escherichia coli
3. Haemophilus Influenzae
26
Which bacteria resides in our skin, hair, and nails?
staphylococcus aureus
27
Which bacteria lives in the gut?
e. coli
28
Is this a gram positive or gram negative bacteria?
N. Gonorrhoeae
gram negative
29
Is this a gram positive or gram negative bacteria?
E.Coli
Klebsiella SP
E.Coli/Kleb SP ESBL+
E.Coli/Klebs SP KPC+
gram negative
30
Is this a gram positive or gram negative bacteria?
Strep pneumoniae
gram positive
31
Is this a gram positive or gram negative bacteria?
Shigella SP.
gram negative
32
Is this a gram positive or gram negative bacteria?
```
Staph aureus (Methicillin Sensitive)
Staph aureus (Methicillin Resistant)
Staph aureus (Community Acquired-Methicillin Resistant)
```
gram positive
33
Is this a gram positive or gram negative bacteria?
N. Meningitidis
gram negative
34
Is this a gram positive or gram negative bacteria?
Salmonella SP
gram negative
35
Is this a gram positive or gram negative bacteria?
Proteus Vulgaris
gram negative
36
Is this a gram positive or gram negative bacteria?
Brucella SP.
gram negative
37
Is this a gram positive or gram negative bacteria?
PS Aeruginosa
gram negative
38
Is this a gram positive or gram negative bacteria?
Enterococcus Faecalis
Enterococcus Faecium
gram positive
39
Is this a gram positive or gram negative bacteria?
Staph Epidermidis
gram positive
40
Is this a gram positive or gram negative bacteria?
Enterobacter SP.
gram negative
41
Is this a gram positive or gram negative bacteria?
Bacillus Anthracis
gram positive
42
Is this a gram positive or gram negative bacteria?
M. Catarrhalis
gram negative
43
Is this a gram positive or gram negative bacteria?
H. Influenzae
gram negative
44
Is this a gram positive or gram negative bacteria?
Acinetobacter SP.
gram negative
45
Is this a gram positive or gram negative bacteria?
Legionella SP.
gram negative
46
Is this a gram positive or gram negative bacteria?
Serratia Marcescens
gram negative
47
Is this a gram positive or gram negative bacteria?
Clostridium (difficile, perfringens, tetani)
gram positive
48
Name 5 Anaerobic Bacteria:
1. Actinomyces
2. Bacteroides fragilis
3. Clostridium difficile
4. Clostridium (others)
5. Peptostreptococcus sp
49
Name 4 Miscellaneous Bacteria
Chlamydophila sp.
M. Pneumoniae
Rickettsia sp.
Mycobacterium Avium
50
Antibiotics are chemicals produced by one of microorganism that...
inhibit the growth of or kill another
51
Antibiotics are used to treat ___
infections
52
Antibacterial and antimicrobial agents inhibit __ __ or __ bacteria and other microorganisms
bacterial growth; kill
53
Define Bactericidal.
kill microorganisms
54
Define Bacteriostatic
inhibits growth of microorganisms
55
What are the actions of Antibacterial Drugs? (5)
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
56
What are factors that influence the body's defense? (7)
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
57
Do very young and older people have dirtier hands? And why?
Older people's hands have more bacteria because they have wrinkles which increases the crevices for bacteria to stay and grow
58
SAR and H1N1 mostly affected which group of people?
middle age people
59
Name the type of resistance to antibacterials.
Can occur between antibacterial drugs that have similar actions
Cross-resistance
60
Infection acquired while client is hospitalized. Many are due to drug-resistant bacteria. What is this type of infection?
Nosocomial infections
61
Name the type of resistance to antibacterials.
caused by prior exposure to antibacterial
acquired resistance
62
Name the type of resistance to antibacterials.
occurs without previous exposure to antibacterial drug
natural resistance
63
Acquired resistance causes many __ __ such as __, __, and __.
nosocomial infections
MRSA, VREF, VRSA
64
What are 4 ways bacteria resist antibiotics?
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
65
Before administering an antibiotic what should you check for?
estimate the glomerular filtration rate (GFR)
66
What does the GFR tell you?
the amount of blood filtered by each glomerulus per minute
67
What is the normal range for GFR?
85-135 ml/min (average 125)
68
What is the Cockcroft and Gault formula for estimating GFR in males?
(140-AGE) x Weight in Kg / 72 x Serum Creatinine
69
What is the Cockcroft and Gault formula for estimating GFR in females?
((140-AGE) x Weight in Kg / 72 x Serum Creatinine) x 0.85 (because of decreased muscle mass)
70
__ patients may require adjustments for estimating GFR
obese
71
What is antibiotic stewardship?
when a hospital institution stops using a certain antibiotic for a period of time
72
Each kidney has ~__ ___ glomeruli
1 million
73
What is GFR also known as?
Creatinine Clearance
74
What is the significance of measuring creatinine clearance or GFR?
Exchange information with health care team to determine need to adjust medication dose
75
What are the 3 major adverse reaction categories for antibacterials?
1. allergic or hypersensitivity
2. superinfection
3. organ toxicity
76
What are mild symptoms of an allergic reaction/hypersensitivity to antibacterials?
rash
pruritus
hives
77
What is a severe allergic reaction/hypersensitivity to antibacterials called?
anaphylactic shock
78
What are the treatments for allergic reactions/hypersensitivity to antibacterials?
1. Antihistamines
2. Epinephrine
3. Bronchodilator
79
What is a superinfection?
secondary infection
80
What type of superinfections (major adverse reaction) can we see when using antibacterials?
```
mouth
respiratory tract
intestine
GU tract
skin
```
81
What organs are typically damaged in organ toxicity? (major adverse reaction of antibacterials)
damage to liver
| damage to kidneys
82
White patches in the mouth and oral mucosa is known as
Leukoplakia
83
Leukoplakia is a type of ___
superinfection
84
Superinfections are all __ related
fungal
85
What is a narrow-spectrum antibiotic?
primarily effective against one type of organism
86
What can broad-spectrum antibiotics affect?
They can be effective against gram + and gram - organisms
87
Broad-spectrum antibiotics are frequently used when microorganisms can not be __ by __ & __
identified
culture & sensitivity (C&S)
88
Name 4 types of broad-spectrum antibiotics
tetracycline
cephalosporins
gentamycin
vancomycin
89
What should you do FIRST when a patient comes in with a possible infection?
COLLECT:
blood cultures
urine cultures
sputum (if applicable)
90
What is the structure of penicillins?
beta-lactam rings
91
Basic penicillins were introduced to kill
staphylococcus
92
Basic penicillins interfere with __ __ __ leading to __ __ and __ __
cell wall synthesis
cell lysis
cell death
93
Basic penicillins are considered broad spectrum or narrow spectrum?
narrow spectrum
94
What are two examples of basic penicillins?
Penicillin G
| Penicillin V
95
What kind of drugs decrease excretion of penicillins?
uricosuric drugs (probenecid)
96
Uricosuric drugs increase __ __ __ thus increasing the __
serum penicillin levels
effectiveness
97
The first OFFICIAL antibiotic is
penicillin
98
The first TRUE antibiotic is
Sulfa
99
PCN was first used to treat
wound infections and STDs
100
Where is the majority of abx produced worldwide used in?
in agriculture -> livestock
70% are used in cows, chickens, fish
oranges are sprayed with streptomycin
101
Broad-spectrum penicillins may be used to treat both __-__ and __-__ bacteria
gram + and gram -
102
What are 3 examples of bacteria that broad-spectrum penicillins can treat?
1. escherichia coli
2. salmonella spp.
3. haemophilus influenzae
103
Are broad-spectrum penicillins bacteriostatic or bactericidal
bactericidal
104
Broad-spectrum penicillins are also known as
aminopenicllins
105
Examples of aminopenicillins:
1. Ampicillin (Omnipen)
2. Amoxicillin (Amoxil)
3. Augmentin (Clavulanate)
106
Broad-spectrum penicillins are excreted by the
kidneys
107
Penicillianse-resistant penicillins are used to treat
penicillinase-produceing S. Aureus
108
What are the names of the two ORAL penicillinase-resistant penicillins?
1. Cloxacillin (Cloxapen)
| 2. Dicloxacillin (Dynapen)
109
What are the names of the two IM & IV penicillinase-resistant penicillins?
1. Nafcillin (Unipen)
| 2. Oxacillin (Prostaphin)
110
Extended-spectrum penicillins are used against which type of organisms?
gram negative organisms
111
What are 3 examples of gram negative organisms that extended-spectrum penicillins work against?
1. pseudomonas aeruginosa
2. proteus spp
3. klebsiella pneumoniae
112
Extended-spectrum penicillins treat which type of infections (6)
1. bone
2. joint
3. skin
4. soft tissue
5. respiratory tract
6. urinary tract
113
Extended-spectrum penicillins are also called
Anti-pseudomonal penicillins
114
What are the names of 3 extended-spectrum penicillins?
1. piperacillin (pipracil)
2. ticarcillin (ticar)
3. carbenicillin (geopen)
115
Beta-lactamase inhibitors are NOT:
given alone
116
Beta-lactamase inhibitors are combined with:
penicillinase-sensitive penicillin
117
Name 4 beta-lactamase inhibitors:
1. Clavulanic acid
2. Sulbactam
3. Tazobactam
4. Ticarcillin
118
What do beta-lactamase inhibitors do?
they inhibit bacterial beta-lactamase enzyme
119
What is the combo (penicillinase-sensitive penicillin + beta-lactamase inhibitor)
for Augmentin?
Amoxicillin - Clavulanate
120
Augmentin (Amoxicillin - Clavulanate) is given __ and this combination intensified the effect of __.
orally
amoxicillin
121
What is the combo (penicillinase-sensitive penicillin + beta-lactamase inhibitor) for Zosyvn?
Piperacillin + Tazobactam
122
What is the combo (penicillinase-sensitive penicillin + beta-lactamase inhibitor) for Timentin?
Ticarcillin - Clavulanate
123
What is the combo (penicillinase-sensitive penicillin + beta-lactamase inhibitor) for Unasyn?
Ampicillin - Sulbactam
124
Ampicillin - Sulbactam (Unasyn) is given __. This combination extends the __.
parenterally
spectrum
125
Beta-lactamase is the enzyme produced by the bacteria to.....
This is a step up to kill off the __ __
resist the antibiotic
resistant organism
126
-BACTAM =
beta-lactamase inhibitors
127
What are the side effects of penicillins?
1. allergic reactions, hypersensitivity
| 2. GI: n/v/d
128
How many percent of persons receiving penicillins have an allergic reaction?
5 - 10%
129
If a person is hypersensitive to penicillins, what could occur? (2)
1. rash
| 2. allergic reaction leading to anaphylaxis
130
What do you use to treat for a mild allergic reaction to PCN?
Diphenhydramine (Benadryl)
131
How should you treat a person who develops anaphylaxis when taking PCN?
1. manage airway
2. epinephrine, corticosteroids
3. saline or plasma expanders
132
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 __ __.
1. hypersensitivity
2. cephalosporin
3. cephalosporins ; cross sensitivity
4. renal insufficiency
133
Food-Drug interactions: Food may __ absorption of many oral penicillins
decrease
134
Take penicillins with __ __ of __ __ hour before OR __ hours after a meal
full glass; water ; One
Two
135
You should take an antibiotic on an __ __ because there is greater ___ without food; However you can experience __, __, __
empty stomach
effectiveness
nausea, vomiting, diarrhea
136
What is the structure of cephalosporins?
beta-lactam structure
137
What is the mechanism of action for cephalosporins?
inhibits bacterial cell-wall synthesis
138
Are cephalosporins bactericidal or bacteriostatic?
bactericidal
139
What infections do cephalosporins treat?
1. respiratory
2. urinary tract
3. skin
4. bone
5. joint
6. genital
140
Cephalosporins: has a total of __ generations
4
141
1st generation cephalosporins are effective against:
gram + bacteria
142
Name two 1st generation cephalosporins:
1. Cefazolin (Ancef, Kefzol)
| 2. Cephalexin (Keflex)
143
The 2nd generation cephalosporins have greater, same, or less effectiveness as the 1st generation cephalosporins?
SAME
144
2nd generation cephalosporins have a broader spectrum against other __ __ bacteria but not __.
gram negative
pseudomonas
145
What are 2 examples of 2nd generation cephalosporins?
1. Cefaclor (Ceclor)
| 2. Cefoxitin Sodium (Mefoxin)
146
Pseudomonas is found where in the body?
primarily in lungs, nose (respiratory tract)
in GI tract
147
The 3rd generation cephalosporins have greater, same, or less effectiveness as the 1st and 2nd generation cephalosporins?
SAME
148
3rd generation cephalosporins are also effective against other __ __ bacteria
gram negative
149
__ and __ (3rd generation cephalosporins) are active against PSEUDOMONAS aeruoginosa
Ceftazidime
Cefoperazone
150
3rd generation cephalosporins may be effective against some...
beta-lactamse- producing strains
151
3rd generation cephalosporins are excreted by __ or __ __
kidney
| biliary tract
152
4th generation cephalosporins are similar to __ generation
3rd
153
4th generation cephalosporins have a more extended gram negative activity including __
pseudomonas
154
4th generation cephalosporins also have a broader __ __ activity
gram positive
155
4th generation cephalosporins may cross
blood brain barrier
156
4th generation cephalosporins are excreted by
kidney
157
Give an example of a 4th generation cephalosporin:
Cefepime (Maxipime)
158
Hypersensitivity of cephalosporins are similar to __
penicillin
159
__% to __% __ allergenicity between cephalosporins and penicillin
5%; 10% CROSS
160
What are GI side effects of cephalosporins?
Nausea
Vomiting
Diarrhea
161
What are Hematologic side effects of cephalosporins?
1. Alterations in blood clotting with large doses
2. Neutropenia
3. Hemolytic anemia
more prone to infection
162
What are Renal side effects of cephalosporins?
Nephrotoxicity in those excreted by kidney
| adjust dose if renal impairment
163
What are drug interactions between some cephalosporins and alcohol?
flushing
dizziness
headache
n/v
164
What should you include in your ASSESSMENT before giving penicillins and cephalosporins?
1. history of allergy or hypersensitivity
2. check lab results for liver and renal function
3. assess v/s and urine output
165
What are possible NURSING DIAGNOSES for someone on penicillins and cephalosporins?
1. Risk for infection
2. Risk for impaired tissue integrity
3. Noncompliance with drug regimen
166
What is the PLAN (goal) for patient on penicillins and cephalosporins?
1. Patient's infection will be controlled and eliminated
| 2. Patient will be instructed on how to take meds post discharge
167
What are the INTERVENTIONS for a patient who needs penicillins and cephalosporins?
1. Culture infected area before antibiotic tx
| 2. monitor signs and symptoms of superinfection and allergy - treat PRN
168
What patient EDUCATION is key for patient taking penicillins and cephalosporins?
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
Which 3 antibacterials have spectrums of similar effectiveness to penicillin but differ in structure?
1. Macrolides
2. Lincosamides
3. Glycopeptides
170
If pt is allergic to PCN , give erythromycin which is a
macrolide
171
Name 3 macrolides
1. Azithromycin (Zithromax)
2. Clarithromycin (Biaxin)
3. Erythromycin (E-Mycin)
172
Name 1 Lincosamides
Clindamycin
173
Name 1 Glycopeptide
Vancomycin
174
Are macrolides bactericidal or bacteriostatic?
bacteriostatic
bactericidal in large doses
175
What is the mechanism of action for macrolides?
inhibit protein synthesis : bacteria need protein to live
176
Macrolides can be given __ or __
IV; oral
177
Macrolides are active against MOST __-__ bacteria
gram-positive
178
Macrolides are active against some __-__ bacteria
gram-negative
179
What are the uses for macrolides?
For the moderate to severe infections of the:
1. respiratory
2. GI
3. Skin
4. Soft tissue
5. Mycoplamsa pneumoniae
6. Legionnaires' disease
180
What is the prototype of macrolides?
Azithromycin (Zithromax, Azasite)
181
The mortality rate of Legionnaires' disease:
~20%
182
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
veterans
Philly
water; aerosolized
183
side effects of Macrolides
1. GI distress
2. tinnitus, ototoxicity
3. superinfection
4. hepatotoxicity
184
Macrolides increase serum levels of: (3) drugs
1. Carbamazepine (Tegretol)
2. Theophylline
3. Warfarin (Coumadin)
185
Erythromycin levels increase with (2) drugs
1. Fluconazole (Diflucan)
| 2. Ketoconazole (Nizoral)
186
Increased erythromycin levels from Fluconazole and Ketoconazole increases the risk of __ __ __
sudden cardiac death
187
Azithromycin levels may be reduced by __
antacids
188
Hearing loss as a side effect of taking antibiotics is reversible OR irreversible?
reversible!
189
Antibiotics affect people __. Young children who use antibiotics don't __ as much. May have to do with __ __.
genetically
grow
protein synthesis
190
What is the mechanism of action of lincosamides?
inhibit bacterial protein synthesis
191
Lincosamide fight __-__ __ __
gram-positive S. Aureus
192
Are lincosamides bacteriostatic, bactericidal, or both?
BOTH
| depends on dosage
193
Two examples of Lincosamides:
1. Clindamycin (Cleocin)
| 2. Lincomycin (Lincocin)
194
What are side effects/adverse reactions of Lincosamides? (3)
1. Rash
2. GI distress, Colitis
3. Anaphylactic Shock
195
Drug interactions of Lincosamides:
| __ and __ decrease Lincomycin Absorption
Kaolin and Pectin
196
Drug interactions of Lincosamides:
| __ and __ may enhance neuromuscular blockade
Tubocurarine ; Pancuronium
197
Clindamycin and Lincomycin are incompatible with: (4)
1. Aminophylline
2. Phenytoin (Dilantin)
3. Barbituates
4. Ampicillin
198
Lincosamides especially clindamycin is the main culprit for __ __ because it kills off gut flora.
C. diff
199
What is the mechanism of action for glycopeptides?
inhibits bacterial cell wall synthesis
200
Glycopeptides primarily act against __ __ bacteria
gram positive
201
Glycopeptides given IV are used to treat __ _ __ infections
resistant staph infections
202
Glycopeptides given IV are excreted by __
kidneys
203
Glycopeptides given orally are used to treat: (3)
1. Staph
2. Enterocolitis
3. Antibiotic-Associated Pseudomembranous Colitis due to C. diff
204
Glycopeptides given orally are not absorbed so they are excreted in __
feces
205
Examples of glycopeptides (2)
1. Vancomycin (Vancocin)
| 2. Telavancin (Vibativ)
206
Which two glycopeptides are used to treat vancomycin-resistant enterococci (VRE)
1. Quinupristin/Dalfopristin (Synercid)
| 2. Linezolid (Zyvox)
207
Are Synercid and Zyvox broad or narrow spectrum?
broad spectrum
208
Glycopeptides are wrapped in foil: light sensitivity to __ light, not __ light
natural
fluorescent
209
What are 5 adverse reactions for IV Vancomycin?
1. Red Neck or Red Man Syndrome
2. Nephrotoxicity
3. Ototoxicity
4. Blood Dyscrasias
5. Stevens-Johnson Syndrome
210
Vanco has a pH close to that of __ because it contains __ __
vinegar; hydochorlic acid
211
Red Neck or Red Man Syndrome due to __ IV infusion of Vanco. This is a __ reaction and not an __ reaction!
RAPID
toxic; allergic
212
What are the symptoms of red neck or red man syndrome due to vanco? (9)
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
How to prevent red neck or red man syndrome due to vanco?
Dilute:
1. 500 mg Vanco in 100 ml OR
2. 1000 mg in 250 ml
AND infuse over 60 - 120 minutes
214
What are 6 interventions for someone getting vanco?
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
Signs of red man syndrome would appear ~ __-__ min after an infusion is started or may begin soon after its __.
4-10
completion
216
Red man syndrome is associated with rapid (
217
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...
7 days without prior incidence
218
Red man syndrome has also been linked to __ and __ administration of vancomycin
intraperitoneal
oral
219
What are the 1st broad-spectrum antibiotics effective against gram (+) & (-) bacteria & many other organisms?
Tetracyclines
220
Continuous use of Tetracyclines have resulted in __ __
bacterial resistance
221
What is the mechanism of action for Tetracycline?
inhibits bacterial protein synthesis
222
Are tetracyclines bactericidal or bacteriostatic?
bacteriostatic
223
Tetracyclines are used against __ __
mycoplasma pneumoniae
224
Tetracycline in combination with __ and __ __ are used to treat __ __
metronidazole
bismuth subsalicyclate
H. pylori
225
Tetracyclines are given __ and __ for severe __ __
orally; topically
| acne vulgaris
226
What are the side effects of tetracyclines?
1. very irritating to gastric mucosa
2. rash, pruritus
3. photosensitivity
4. headache
5. teratogenic
227
What are the GI side effects of tetracycline?
1. n/v/d
2. flatulence
3. epigastric distress
4. abdominal discomfort
5. heartburn
228
Because tetracyclines are teratogenic, children under __ years old should not take this
8
229
If a child under 8 takes tetracyclines, their teeth will turn __
black
230
What are nursing interventions for someone on tetracyclines?
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
What is the synthetic analogue of tetracyclines called?
Glycylcyclines
232
What is the mechanism of action for glycylcyclines?
blocks protein synthesis
233
Are glycylcyclines bactericidal or bacteriostatic?
bacteriostatic
234
What are the indications for glycylcyclines?
1 complicated skin infections
| 2. intra-abdominal infections
235
How are glycylcyclines administered?
IV
236
What are the side effects of glycylcyclines?
similar to tetracycline
237
Glycylcyclines may interfere with __ __ and __
oral contraceptives
| warfarin
238
What is an example of glycylcycline?
Tigecycline (Tygacil)
239
Aminoglycosides are __ spectrum
narrow
240
Are aminoglycosides bactericidal or bacteriostatic?
bactericidal
241
Aminoglycosides do not cross __ __ __ in adults
blood brain barrier
242
What is the mechanism of action for ahminoglycosides?
inhibits bacterial protein synthesis essential for bacterial growth
243
Aminoglycosides are for "__" infections and are primarily administered by _ and __. Need to obtain a __ and __ level
serious
IM ; IV
peak; trough
244
What is an examples of an aminoglycoside?
Gentamicin
245
When considering __, use gentamicin
sepsis
246
What are side effects of Gentamicin?
1. Rash
2. Numbness
3. Tremors
4. Muscle cramps or weakness
5. Visual disturbances
6. Photosensitivity
7. Tinnitus
247
What are adverse reactions of Gentamicin?
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
There is an increased risk for OTOTOXICITY with Gentamicin and __ __ (e.g., __)
loop diuretics
Lasix
249
There is an increased risk of NEPHROTOXICITY with Gentamicin and: (5)
1. Amphotericin B
2. Polymyxin
3. Cisplatin
4. Furosemide
5. Vancomycin
250
Nursing interventions for patient on Gentamicin: (2)
1. check urine output
| 2. check creatinine clearance
251
Fluoroquinolones are __ spectrum
broad
252
Fluoroquinolones act on which bacteria?
gram + and gram - bacteria
253
Fluoroquinolones is bactericidal or bacteriostatic?
bactericidal
254
Fluoroquinolones are readily absorbed by __ __
GI Tract
255
Fluoroquinolones mechanism of action
interrupts DNA synthesis
256
Uses for Fluoroquinolones:
1. UTI
2. Bone and Joint infections
3. Bronchitis
4. PNA
5. Gonorrhea
257
What is an example/prototype of a Fluoroquinolone?
Levofloxacin (Levaquin)
258
What are the side effects of Levofloxacin?
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
Levofloxacin has an increased effect with:
1)
2)
1. oral hypoglycemics
| 2 theophylline
260
Levofloxacin has a decreased absorption with:
1. antacids
| 2. iron
261
Levofloxacin adverse reactions:
1. Stevens-Johnson Syndrome
2. Encephalopathy
3. Seizures
4. Pseudomembranous Colitis (think C. diff)
262
Levofloxacin has an increased risk of dysrhythmias because of risk of __ __
prolonged QT
263
Lipopeptides are __
bactericidal
264
What is the mechanism of action for lipopeptides?
inhibits protein, DNA, and RNA synthesis
265
What are the uses for lipopeptides?
1. complicated skin infections
2. septicemia due to staphylococcus aureus infections
3. infective endocarditis due to MRSA
266
What is an example/prototype of Lipopeptides:
Daptomycin (Cubicin)
267
Lipopeptides are used if __ is not working because bacteria is resistant
vancomycin
268
What are the side effects of Daptomycin (Cubicin)
1. hypo/hypertension
2. anemia
3. numbness
4. tingling
5. dizziness
6. insomnia
7. pain/burning in urination
8. n/v
269
What are adverse effects of Daptomycin (Cubicin)?
1. elevated creatinine kinase (rhabdomyolysis) especially when given with Statins
2. unexplained myopathy, neuropathy
3. hypo/hyperkalemia, hyperglycemia
4. pleural effusion
270
Daptomycin (Cubicin) - has toxicity with __
tobramycin
271
Daptomycin (Cubicin) - increases bleeding with __
coumadin
272
Daptomycin (Cubicin) can cause __ type of PNA
eosinophilia
273
Sulfonamides are bacteriostatic or bactericidal?
bacteriostatic
274
Sulfonamides were first isolated from coal tar in 1900s and produced in 1935 to treat __
PNA
275
Usefulness decreased due to __ __, discovery of __ , used in patients allergic to __
drug resistance
PCN
PCN
276
What is the mechanism of action for sulfonamides?
inhibits formation of folic acid in bacterial cells which is essential for bacterial growth
277
What are the uses for sulfonamides?
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
Examples of sulfonamides:
1. Trimethoprim
| 2. Sulfamethoxazole (TMP-SMZ, Bactrim, Septra)
279
What is Trimethoprim used for?
urinary tract anti-infective
280
Trimethoprim- ___ has a synergistic effect. Both drugs together in one compound cause __ __ to develop much more __.
Sulfamethoxazole
bacterial resistance
slowly
281
What are the uses for trimethoprim- sulfamethoxazole?
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
What are the side effects and adverse reactions for trimethoprim-sulfamethoxazole?
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
Bactrim should be used cautiously in patients with __ __ because it is associated with agranulocytosis.
low WBC
284
For initial and chronic UTIs, drug action occurs in __ __ and __. This is effective in decreasing ___ __.
renal tubule; bladder
bacterial growth
285
What is the prototype for UTI drugs?
Nitrofurantoin (Furalan, Furadantin, Macrodantin)
286
Nitrofurantoin (Macrodantin) is a __ or __ depending on the drug dosage
bacteriostatic ; bactericidal
287
Nitrofurantoin (Macrodantin) is effective against many __-__ and __-__ organisms especially __ ____
gram-positive
gram-negative
E. coli
288
What are the side effects of Nitrofurantoin (Macrodantin) ?
1. rash
2. pruritus
3. dizziness
4. headache
5. rust/ brown urine (expected)
289
Bacteria __ __ with the use of Nitrofurantoin (Macrodantin)
commits suicide
290
What is the prototype for a urinary analgesic?
Phenazopyridince HCl (Pyridium)
291
Phenazopyridince HCl (Pyridium) is an __ __, is available about __ years
azo dye
40
292
What is the mechanism of action for Phenazopyridince HCl (Pyridium) ?
unknown - relieves urinary burning and pain
293
What are the side effects for Phenazopyridince HCl (Pyridium)?
1. GI upset, hemolytic anemia
2. nephrotoxicity
3. hepatotoxicity
4. urine becomes reddish-orange (harmless)
294
Phenazopyridince HCl (Pyridium) is used as an __ for the first __ days of UTI to numb the pain while the __ is taking effect
anesthetic
3
antibiotic
295
Mechanism of action for urinary antispasmodics
Have direct action on smooth muscles in urinary tract to relieve spasms caused by infection or injury
296
What 3 other types of drugs have the same effect as antispasmodics?
1. Antimuscarinics
2. Parasympatholytcs
3. Anticholinergics
297
When should you caution the use of urinary antispasmodics/antimuscarinics?
if pt has:
1. urinary or GI obstruction
2. glaucoma
298
Name 4 examples of antispasmodics
1. Ditropan
2. Detrol
3. Bella Donna
4. Opium Suppositories
299
What are side effects of Urinary Antispasmodics/
| Antimuscarinics?
1. Dry mouth
2. increased HR
3. Dizziness
4. Intestinal Distenion
5. Constipation
300
Patient education about Urinary Antispasmodics/
| Antimuscarinics
tell patient to report the following to HCP:
1. urinary retention
2. severe dizziness
3. blurred vision
4. palpitations
5. confusion
301
Mycobacterium tuberculosis is an __-__ __
acid-fast bacillus
302
How is tb transmitted?
person to person via DROPLETS through coughing and sneezing
303
Which clients are at risk for tb?
1. alcohol, addicted, debilitated
| 2. immunocompromised
304
What are symptoms of tb?
1. cough
2. sputum
3. fever
4. night sweats
5. weight loss
6. GI distress
305
Prophpylaxis for TB is recommended for __ -__ months for those who:
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
Single-drug therapy for anti tubercular drugs are __
ineffective
307
Multi drug therapy decreases __ __ to drug and __ __ is decreased
bacterial resistance
treatment duration
308
First-line anti tubercular drugs:
1. Isoniazid (INH)
2. rifampin
3. ethambutol
4. streptomycin
309
First-line anti tubercular drugs are more effective than __ __ and are __ toxic
second-line
less
310
Second-line anti tubercular drugs .
Are they more or less effective than first-line drugs?
Are they more less toxic than first line drugs?
1. Capreomycin 2.cycloserine
3. ethionamide 4.kanamycin
5. amikacin
6. ciprofoxacin
7. pyrazinamide (can be sometimes seen as 1st line drug)
less effective
more toxic
311
Anti tubercular drug treatment regimen is divided into __ phases
2
312
phase 1 of Anti tubercular drug treatment regimen:
Duration: 2 months
313
phase 2 of Anti tubercular drug treatment regimen
Duration: 4-7 months
314
Isoniazid (INH) is an ___ drug
antitubercular
315
How can Isoniazid (INH) be given?
oral, IM
316
What is the mechanism of action for Isoniazid?
inhibits bacterial cell wall synthesis
317
What are the side effects/adverse reactions for Isoniazid?
1. GI distress 2.constipation
3. Blurred vision 4.photosensitivity
5. Tinnitus
6. dizziness
7. Peripheral neuropathy
8. Psychotic behavior 9.seizures
10. Blood dyscrasias
11. hepatotoxicity
318
What drugs increase the effect of Isoniazid (INH)?
1. alcohol
2. rifampin
3. cycloserine
4. phenytoin
319
Isoniazid (INH) decreases __ effect when concurrent
phenytoin
320
__ decrease the absorption of Isoniazid (INH)
antacids
321
Alcohol and Isoniazid (INH) increases the risk of
neuropathy and hepatotoxicity
322
What should you teach a pt taking isoniazid (INH) ?
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
What should you monitor for Streptomycin (anti tubercular drug) ?
monitor ototoxicity
| monitor renal function
324
What should you monitor for Rifampin (anti tubercular drug) ?
warn client that body fluids may be red-orange
325
What should you monitor for Ethambutol (anti tubercular drug) ?
Take single daily dose to avoid visual disturbances
326
Viruses are more __ to eradicate than bacteria
difficult
327
Viruses enter __ cells and use __ and __ to generate more viruses
healthy
| DNA and RNA
328
What is the mechanism of action for antiviral drugs?
Antiviral drugs interfere with viral nucleic acid synthesis in cell
329
Uses for antiviral drugs:
1. Herpes simplex virus
2. Influenza
3. Viral hepatitis
4. CMV
330
What is the prototype for antiviral drugs?
Acyclovir sodium (Zovirax)
331
What are the side effects for Acyclovir sodium (Zovirax)?
1. N/V, diarrhea
2. Headache, lethargy, tremors
3. Rash, pruritus
4. ↑ bleeding time
5. Phlebitis at IV site
332
What are contraindications for Acyclovir sodium (Zovirax)?
1. Hypersensitivity
| 2. Caution with severe renal or hepatic disease
333
What are adverse reactions for Acyclovir sodium (Zovirax)?
1. Uritcaria
2. Anemia
Life threatening:
1. Nephrotoxicity (large doses)
2. Bone marrow depression
3. Thrombocytopenia, leukopenia, granulocytopenia
4. acute renal failure
334
Antifungals treat mild __ fungal infections such as on the __, __ __
superficial
skin, mucous membranes
335
Antifungals are used for __ __ such as __ __ and __
systemic infections
severe lungs, CNS
336
What are the 4 anti fungal drug groups?
1. Polyenes
2. Azoles
3. Antiprotozoals
4. Echinocandins
337
Name an example of Polyenes
Amphotericin B, Nystatin
338
Name two examples of Azoles
1. Fluconazole (Diflucan), 2. miconazole (Monistat) – topically or IV
339
Name an example of Antiprozoals
Atovaquone (Mepron)
340
Name an example of Echinocandins
Caspofungin (Cancidas)
-- treat Candida, Aspergillosis
route: IV
– if can’t tolerate any of the other drugs
341
amphotericin B, which is a __, treats severe __ __
polyene
fungal infections
342
What is the mechanism of action for polyenes?
Binds to fungal cell membranes, causing leakage of cellular contents. Fungistatic or fungicidal
343
What is the newer formulation of amphotericin B? does it have fewer or more side effects?
Liposomal amphotericin B
FEWER
344
What is the route of Amphotericin B?
IV over 2-6 hours
345
What are the side effects/adverse reactions for amphotericin B?
Flushing, fever, chills, dyspnea, hypo/hypertension, tachycardia
High doses: nephrotoxicity, electrolyte imbalances, ototoxicity
346
What are nursing interventions for Amphotericin B?
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
What is the mechanism of action for azoles?
Inhibits cytochrome P450 in fungal cells, interfering with the formation of ergosterol – increasing cell permeability
348
What are the uses for azoles?
Candidiasis, cryptococcocal meningitis, histoplasmosis
349
What is the route of azoles?
oral
IV
vaginal
topical
350
What is the mechanism of action for Metronidazole (Flagyl)?
Interferes with DNA function of bacteria
351
What are the side effects of Metronidazole (Flagyl)?
Dizziness, headache, confusion, depression, irritability, weakness, insomnia
352
What should you education the patient who is taking Metronidazole (Flagyl)?
Avoid alcohol
Disulfram-type reaction: facial flushing, sweating, severe headache, slurred speech
Dark urine or reddish brown (High doses)
Avoid during first trimester pregnancy
