Wk 2 Anti-infective Meds Flashcards
Key Terms Pathogen Antimicrobials/Antimicrobial drug Antibiotic Bactericidal Bacteriostatic spectrum Generation
Pathogen Antimicrobials/Antimicrobial drug Antibiotic Bactericidal Bacteriostatic spectrum Generation
Key Terms Broad spectrum Narrow spectrum Superinfections Cross-Sensitivity Secondary Infection Opportunistic Infection
Broad spectrum Narrow spectrum Superinfections Cross-Sensitivity Secondary Infection Opportunistic Infection
General Nursing Implications for Antimicrobial Drug Therapy Box 5.1- p. 67 Assessment Planning & Intervention Evaluation
Assessment- History Obtain Specimens-C&S Focused Assessment Check Allergies Female & Oral Contraceptive Use
Planning & Intervention-
Monitor for Side Effects-Diarrhea
Monitor for Adverse Reactions
Take as prescribed
Evaluation-
Is med effective?
Follow-up Labs?
General Teaching Points for Patients & Families during antimicrobial Drug Therapy
Box 5.2- p. 68
- Diarrhea
- Take as prescribed-around the clock-even doses
- Report difficulty breathing/swelling lips STAT
- Rash/Hives-Stop taking-Call Doc
- Take until gone/as prescribed-don’t save for later
Penicillins (PCN) Action Uses Expected Side Effects Adverse Reactions Drug Interactions Examples of Common Penicillin Drugs
Action Uses Expected Side Effects Adverse Reactions Drug Interactions Examples of Common Penicillin Drugs
- Antacids may decrease absorption of penicillin.
- Laboratory results may change when penicillin is used.
- Ampicillin use may decrease the effectiveness of oral contraceptives, making the woman at increased risk for pregnancy.
Penicillins (2 of the 5 Generations)
Natural Penicillins - -penicillin V (pen-Vee K) Aminopenicillins - -amoxicillin (Amoxil) -ampicillin sodium and sulbactam sodium (Unasyn)
Penicillins
Nursing Implications
Nursing Implications
- Dosage depends on type and severity of infection
- Penicillin interferes with the accuracy of many lab tests
- Avoid giving ineffective doses since this may lead to the development of resistant strains
- Use with caution in patients with multiple allergies (cross-sensitivity occurs with many categories of antibiotics)
Penicillins
Why do organisms become resistant to antibiotics?
Before administering IM penicillin injections, the nurse should obtain the patient’s blood pressure and pulse. Following administration, the patient should be advised to wait 30 minutes before leaving the clinic. Why?
What signs and symptoms would the patient experiencing an allergic reaction to penicillin exhibit?
?
Penicillins
Patient Teaching
Patient Teaching
Take all meds as prescribed
Watch for s/s of superinfection (overgrowth of other organisms)
Notify Dr. if rash, hives, decreased urination, diarrhea, or other unusual symptoms occur (allergic reaction)
Go to ER right away if become SOB after taking med (anaphylaxis is the most serious adverse reaction)
Examples of Common Penicillin’s & Cephalosporin’s Table 5.1, p. 70-71
Penicillin's Cephalosporin's -1st generation cephalexin (Keflex) -2nd generation cefaclor (Ceclor) cefoxitin (Mefoxin) -3rd generation ceftriaxone (Rocephin) Vancomycin Carbapenems
Broad Spectrum Antibiotics
Action
Uses
Action
Attack a bacterium’s internal cell processes
May destroy the external cell wall
Therefore can be either bactericidal or bacteriostatic
Uses
Used to treat infections caused by certain susceptible organisms
These organisms must be identified by a culture and sensitivity test
To prevent/treat a secondary bacterial infection following a viral infection
Broad Spectrum Antibiotics
Adverse Reactions
Adverse Reactions
Superinfection
–May show up in the oral (thrush) , vaginal (yeast), or rectal (diarrhea) areas
–Treat with antifungals
–Mild to life threatening effects
Organ Damage
–Ototoxicity, nephrotoxicity, hepatotoxicity
Hypersensitivity (allergy)
–May develop within minutes of taking the drug or appear days after stopping the medication
–Anaphylaxis
–Cross sensitivity
Broad Spectrum Antibiotics
Ex. Serious Adverse Reactions
Ex. Serious Adverse Reactions
erythromycin (EES)
–Ototoxicity, hepatotoxicity
clindamycin (Cleocin)
–Severe and fatal colitis (may not occur until after tx is completed)
vancomycin (Vancocin)
–Nephrotoxicity, ototoxicity
Broad Spectrum Antibiotics
Categories:
(generations)
Categories: cephalosporins -1st generation cephalexin (Keflex) -2nd generation cefaclor (Ceclor) cefoxitin (Mefoxin) -3rd generation ceftriaxone
Cephalosporin’s
Action
Action
Cephalosporin’s
Uses
Uses
Cephalosporin’s
Expected Side Effects
Expected Side Effects
Cephalosporin’s
Adverse Reactions
Adverse Reactions
Cephalosporin’s
Drug Interactions
Drug Interactions
Severe disulfiram reaction resulting in severe flushing, vomiting, and collapse.
Cephalosporin’s
Nursing Implications and Patient Teaching
Nursing Implications and Patient Teaching
Must be given IV or IM
Patients with a severe reaction to penicillin should not take these products.
Broad Spectrum Antibiotics
Generations: meds that are developed from other meds
Generations: meds that are developed from other meds
- 2nd and 3rd generation meds are more effective against a broad group of gram – organisms, however they are less effective against gram +.
- 3rd generation meds are more effective against resistant organisms and have increased resistance to inactivation by beta-lactamase
- 3rd generation meds are newer, cost more, and have more side effects
- 1st generation meds are more effective against gram + organisms
Broad Spectrum Antibiotics
Categories (cont…)
Categories (cont…) -Aminoglycoside gentamicin (Garamycin) -Fluoroquinolones ciprofloxacin (Cipro) -Macrolides erythromycin (EES) -Miscellaneous vancomycin (Vancocin)
Broad Spectrum Antibiotics
Other Cell Wall Synthesis Inhibitors
Other Cell Wall Synthesis Inhibitors
Vancomycin & carbapenems
-used for infections caused by multidrug-resistant (MDR) bacteria
-given intravenously by IV push or by infusion over an hour or more in an acute care setting
-Nausea, vomiting, diarrhea, headache, rash, fever, and chills can occur
Broad Spectrum Antibiotics
Nursing Responsibilities
Nursing Responsibilities Assess for allergies Administer per orders and policy Assess for therapeutic effects Monitor for adverse effects Monitor for common drug interactions that: Decrease effectiveness of antibiotic Alter effect of other med
Broad Spectrum Antibiotics
Patient Teaching
Patient Teaching
Take at proper time; full course of therapy
Take with or without food as order (tetracyline and lincomycin are better absorbed on an empty stomach)
Increase fluid intake (minimum of 1500c per day) to decrease renal toxicity
Tetracyclines Table 5.2, p. 73-75 Action Uses Expected side effects Adverse effects Drug interactions
Action- Protein synthesis inhibitors
Uses- Broad Spectrum Drugs
Expected side effects- N//V/D, yeast infection, skin sensitivity/sunburn
Adverse effects- Liver toxicity, decreased renal/kidney function
Drug interactions- Milk, dairy, and calcium
Macrolides p. 74 Actions Uses Expected Side Effects Adverse Effects Drug Interactions Nursing Implications Patient Teaching
Actions Uses Expected Side Effects Adverse Effects Drug Interactions Nursing Implications Patient Teaching
Sulfonamides p. 76-77
Action
Uses
Bactrim or Septra (sulfamethoxazole & trimethoprim) Action Bacteriostatic effect against a wide range of gram + & gram - micro-organisms by inhibiting folic acid synthesis Uses Acute and chronic UTIs Ulcerative colitis Pre- and post-op bowel surgery Otitis media
Sulfonamides
Adverse Reactions
Adverse Reactions Headache Drowsiness Fatigue Dizziness Vertigo Tinnitus Anaphylactic shock
Sulfonamides
Drug Interactions
Drug Interactions
Potentiate the effects of anticoagulants, methotrexate, sulfonylureas, thiazides, phenytoin
Decrease the effect of penicillin
Antacids decrease absorption of sulfonamides
Sulfonamides
What is the rationale for encouraging fluid intake for those patients prescribed sulfonamides?
If the patient develops toxemia while taking sulfonamides, what is the cause?
A patient complaining of tinnitus reports what type of symptoms?
What is the rationale for encouraging fluid intake for those patients prescribed sulfonamides?
If the patient develops toxemia while taking sulfonamides, what is the cause?
A patient complaining of tinnitus reports what type of symptoms?
Sulfonamides
Patient Teaching
Patient Teaching
Take on an empty stomach
Take with lots of water (better absorption)
Stay out of sun (photosensitivity)
Take all medications
Notify Dr. if no improvement
Notify Dr. if skin rash, blood in urine, bruises, nausea, or other adverse effects develop
Tuberculosis p. 78-83
Caused by?
Where?
Increasing in US why?
Disease cause by Mycobacterium tuberculosis
Most often seen in underdeveloped nations where conditions are crowded and unsanitary
Increasing in US especially in persons with AIDS, lowered immunity, & alcoholics
Tuberculosis p. 78-83
What does the term multiple-drug-resistant (MDR) refer to?
What role do the Centers for Disease Control and Prevention (CDC) have in relationship to tuberculosis treatment?
Why have states enacted laws related to the treatment of tuberculosis?
What does the term multiple-drug-resistant (MDR) refer to?
What role do the Centers for Disease Control and Prevention (CDC) have in relationship to tuberculosis treatment?
Why have states enacted laws related to the treatment of tuberculosis?
TuberculosisTreatment: (Multiple meds/long-term)
Isoniazid- Bactericidal drug
Rifampin- Prevents reproduction of TB organism both in infected tissue and in macrophages & TB granulomas. Bactericidal if high concentration
Pyrazinamide- Alters pH of infected cells
Ethambutol - Bacteriostatic and always used in combination with other drugs
Tuberculosis
Meds: Adverse Effects:
Meds: Adverse Effects:
- Most have only mild side effects
- Some are toxic to ears, kidney, & liver (also report jaundice, visual changes, bruising, bleeding, tremors, skin rashes)
- Interact with multiple other meds
- Drug toxicity - due to prolonged treatment
- Drug resistance - if only 1 med given at a time (most are bacteriostatic)
Tuberculosis
Patient Teaching
Patient Teaching
- Importance of taking the meds as directed
- This is a Long Term course of medication
- Need to follow up with lab/x-ray exams to assess progress
- Report any close contacts to the health dept.
- The patient is contagious initially – Need to take special precautions
- Importance of adequate rest and diet
Antifungals
Uses
Uses
Treat mycotic infections
Fungal-specific medications
Systemic medications
Antifungals
Common medications
-Ketoconazole (Nizoral)
Broad-spectrum fungistatic and fungicidal action
Used to treat oral thrush, candidiasis, histoplasmosis
-Nystatin
Antibiotic with fungistatic and fungicidal action
Used to treat intestinal, vaginal, and oral fungal infections caused by Candida strains
Antifungals
Adverse Reactions
Drug Interactions
Adverse Reactions -Nausea, vomiting, diarrhea -Similar to symptoms of fungal infection so it is difficult to decide if patient needs more or less of a med Drug Interactions -Corticosteroid s May cause sever superinfections -Alcohol Potentiates effect of alcohol-can have severe cardiac problems
Antifungals
Nursing Implications and Patient Teaching
Nursing Implications and Patient Teaching
- Take all the medication as ordered; do not stop when symptoms disappear
- Avoid alcohol
- Report nausea, vomiting, and diarrhea; watch for easy bruising, sore throat, rash, or fever
- Nystatin must be shaken thoroughly before use
- Intolerance to the sun (photosensitivity) can occur with griseofulvin therapy
- Cleanliness of hair, skin, and nails will limit spread
Antiparasitics
Classifications (3)
Classifications Amebicides --Flagyl (metronidazole) Also used if mixed fungal & bacterial, protozoan, or anaerobic bacterial infection Anthelmintic --Pin-X (pyrantel) – for roundworms and pinworms --Albenza (albendazole) – for tapeworms Antimalarial --Plaquenil (hydroxychloroquine) Also used to treat rheumatoid arthritis
Amebicides Amebiasis Caused by Action Use
Amebiasis
-Caused by a parasite.
-In the US or Canada seen primarily in people who have traveled abroad.
-Also for those who have eaten unwashed fruits and veggies that were imported
Action
-Destroy invading amoeba
Use
-Treatment of intestinal and extraintestinal amebiasis
Amebicides
Adverse Reactions
Adverse Reactions
Nausea, vomiting, headache, anorexia, diarrhea, or GI distress
Flagyl (metrondiazole)
Combining this with alcohol can produce severe headache, flushing, cramps, nausea, and vomiting.
If combined with disulfiram acute psychosis may result
Amebicides
Teaching
Teaching
-Take as prescribed without skipping or doubling dose
-Do not stop taking med without consulting Dr.
-Take with or after meals to decrease stomach upset
-Report all new side effects
-Prevent spread by
–Always washing food carefully before eating
–Wash hands before eating or preparing food
–Wash hands after going to the bathroom
Stool exams need to be done periodically
Malaria
Caused by
Transmitted by
Symptoms
Infectious febrile disease caused by 4 species of the protozoan plasmodium
Transmitted by the bites of infected mosquitoes
Symptoms: periodic attacks of chills, fever, and diaphoresis
AntimalarialsPlaquenil (hydroxychloroquine)
Action
Action
Interfere with life cycle of plasmodium by reducing the ability of DNA to replicate thereby decreasing protein synthesis
AntimalarialsPlaquenil (hydroxychloroquine)
Uses
Uses
Treat acute malaria-
Loading dose of med followed by ½ dose for next 2 days
Suppress malaria-
Take meds 2 wks before, during, & 8 wks after travel into malarial area
One dose per week
Antimalarial
Adverse Effects
Adverse Effects
- Irreversible retinal damage after high doses or prolonged therapy (esp. in children)
- Cardiotoxicity
- Blood dyscrasias (DC drug) (Freq blood tests)
- Neuro and visual changes
- May develop toxicity when given with other meds
Antimalarials
Teaching
Teaching
- Take all of med
- Notify Dr. if ringing in ears, hearing difficulty or visual disturbances
- Take with food to decrease GI upset
- Malaria may reoccur - see Dr. immediately
- Quinine products may cause the skin to appear somewhat yellow
Antihelmintic
Infestation by
Cause
Diagnosis
Vermox (mebendazole)
Helminthiasis
Infestation by worms through contaminated food, unwashed hands, or the skin
Cause
Pinworms, roundworms, hookworms, tapeworms, or whipworms
Diagnosis
Eggs or the parasite in the stool of the infected individual
Helminthiasis: infestation by worms
Common infestations:
Pinworms Roundworms Hookworms Tapeworms Whipworms How is the diagnosis made?
Antihelmintic
Action
Uses
Action
- Paralyzes muscles of parasite
- Causes parasite to detach from intestinal wall
- Interferes with parasite’s metabolic pathways
- Blocks glucose uptake-Vermox (mebendazole)
Uses
- Destroy the worm
- Vermox (mebendazole)
- –To treat pinworms, roundworms, hookworms, & whipworms
Antihelmintic
Adverse reactions
Adverse reactions
Depends on med
–SE increases with higher doses & length of treatment
–Neurotoxic-do not use too often
–HA, weakness, n/v anorexia, abd pain, arthralgia, malaise, skin rash
Antihelmintic
Drug Interactions
Drug Interactions
Antagonsitic if more than 1 are given at a time
Interfere with a # of meds (heparin)
Interfere with a variety of lab tests
Antihelmintic
Nursing Implications
Nursing Implications
May need anti-inflammatory med to treat itching
May cause relapse in pt with malaria if antimalarial agent isn’t given first
May need FE supplement (hookworm causes anemia)
Usually only need 1 treatment but may need a second if all worm aren’t destroyed (need to be rechecked)
Antihelmintic
How can the patient prevent transmission to others in the home?
The patient receiving drug therapy to treat hookworms may require what type of supplement?
What are some foods that are high in iron?
How can the patient prevent transmission to others in the home?
The patient receiving drug therapy to treat hookworms may require what type of supplement?
What are some foods that are high in iron?
Antihelmintic
Teaching
Teaching
All family members may need to be treated for pinworms
Worms passed in stool are still alive and capable of infecting others
Wash toilet seat daily with soap & water
Boil sheets & underwear twice in hot water and disinfectant
Meticulous hand washing when handling food
Wash fruits & veggies; cook all food thoroughly
Wear shoes outside
Key Terms Key Terms, p. 93-Chapter 6
AIDS antiretroviral HIV Opportunistic infection retrovirus virus antiviral
AIDS antiretroviral HIV Opportunistic infection retrovirus virus antiviral
Antivirals
Action and Uses
Action and Uses
Decrease symptoms of viral infection
Stop the virus from growing, but cannot kill it.
Most common antiviral drugs may be classed as either antiherpes, antiinfluenza, or neuraminidase inhibitors.
Antivirals
Adverse Reactions
Adverse Reactions
Many of these antiviral drugs are given topically and may have few recognized side or adverse effects.
Some of the drugs are quite new, and information about adverse effects is still being collected
Antivirals
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Viral infections are not suppressed by antibiotics. Studies of viruses such as HIV, herpes, and cytomegalovirus have led to the development of a variety of antiviral drugs.
All these medications are associated with risk, and the benefit-to-risk ratio must be evaluated before their use.
These medications interact with many different products, including some not typically involved in drug reactions.
Anti-Viral Medications
Action and Use
Zovirax (acyclovir)
Symmetrel (amantadine HCL)
Action
Decrease symptoms of viral infections
Do NOT cure infection
Use
To treat opportunistic infections in immunocompromised patients
To treat herpes zoster, herpes simplex, genital herpes, varicella, influenza A
To treat cytomegalovirus (CMV) retinitis
herpes simplex types (2)
herpes simplex virus type 1 (HSV-1)
Responsible for cold sores
herpes simplex virus type 2 (HSV-2)
responsible for genital herpes infections and lesions
Anti-Viral Medications
Adverse Reactions
Some of the drugs are quite new and information about adverse effects is still being collected
Adverse Reactions
All are associated with risk
Most are toxic to liver and/or kidneys
Many cause blood dyscrasias and peripheral neuropathies
Anti-Viral Medications
Drug Interactions
Drug Interactions
Many drug interactions often with products not usually involved in reactions
Anti-Viral Medications
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Review the Nursing Process as it applies to patients receiving antiviral medications.
Patient teaching is always an essential component of any medication regimen.
Patients and significant family members must be taught not only the action and uses of specific medication but also how to store and administer the product.
Why is bottled water recommended for immunocompromised patients? (Because they are at greater risk for further infections. Using bottled water, if it is available, avoids potential pathogens in untreated or poorly treated water supplies.)
Antiviral Drugs for Influenza
Action and use
Actions
prevent the virus from opening the outer coat
Uses
prevent an infection in a patient who has been exposed to the virus or to reduce the symptoms of an existing influenza infection
Antiviral Drugs for Cytomegalovirus (CMV) and Respiratory Syncytial Virus (RSV)
Actions and Uses
Actions and Uses
inhibit the viral enzyme need to make more DNA for viral reproduction
Drugs are used on a short-term basis to reduce infection symptoms
Antiviral Drugs for Hepatitis B and Hepatitis C
Three classes?
drugs used to treat HBV fall into three classes
1 nucleoside reverse transcriptase inhibitors (NRTIs)
2 DNA polymerase inhibitors
3 interferon
Retroviruses
Viruses that contain RNA rather than DNA as their genetic material
The retrovirus, HIV (human immunodeficiency virus), causes AIDS
AIDS, (acquired immunodeficiency syndrome), has a mortality rate as high as 98% within the first 5 years
Anti-Retroviral Medications
Types
Types
Reverse Transcriptase inhibitors
-Prevent new viruses from being produced
zidovudine
Protease Inhibitors
-Causes non-infectious virions to be produced instead of infectious virions
Anti-Retrovirals
Action
Uses
Action
Stop the production of new retroviruses by interfering with he ability of the retrovirus to replicate
Use
Slow the process of AIDS infection and preserve immunity
Prevent HIV seroconversion in infants born to HIV infected mothers and in health care workers and who have been exposed to HIV
Antiretroviral
Adverse Rx
Adverse Rx (often cause severe toxicities)
Pancreatitis, peripheral neuropathy, and myopathies
Less severe reactions such as mouth ulcers, rash, headaches, diarrhea, and nausea
Antiretroviral
Drug Interactions
Drug Interactions
Shouldn’t be given with any other meds since it inhibits an enzyme system in the liver involved in the metabolism of meds
Antiretroviral
Teaching
Teaching
Compliance is essential
Taking < prescribed may result in resistant strain of HIV
Check with Dr. before taking any other meds
DC immediately if s/s of pancreatitis
–Peripheral neuropathy
Usually reversible if med stopped immediately
Warn all HIV positive women of risk of HIV transmission through breast milk
