NURS 340: module 2-antibiotics

refer to module 2 lecture

What are bacteria?

Single-cell organisms with different shapes and cell walls

Why must antibiotics match the organism?

They target specific characteristics of the bacteria

What are cocci?

Round-shaped bacteria

What are bacilli?

Rod-shaped bacteria

Gram-positive bacteria cell wall structure?

Two layers; easy to penetrate

Gram-negative bacteria cell wall structure?

Three layers; difficult to penetrate

What makes mycobacterium difficult to kill?

Waxy cell wall

Common mycobacterium species?

Mycobacterium tuberculosis

What are viruses?

Intracellular parasites that reproduce inside cells

What are fungi?

Plant-like organisms that do not need light

What are parasites?

Live in host blood, organs, or structures

ex: malaria

Aerobic organisms require what?

Oxygen

Anaerobic organisms require what?

No oxygen

What does sensitivity mean?

Antibiotic kills the bacteria

What does resistance mean?

Antibiotic does NOT kill the bacteria

When are sensitivity reports available?

24-hour and 48-hour reports

What is the functions of beta-lactams?

Attack the cell wall

What infections do penicillins (PCN) treat?

treat broad-spectrum infections: ear, throat, urinary, sexually transmitted infections

Penicillins are effective against which bacteria?

MOST Gram-positive cocci and bacilli (some gram-negative)

Why is clavulanic acid added to penicillin?

Prevents bacterial deactivation of beta-lactam antibiotics

Prototype penicillin drug?

Amoxicillin (or Amoxil) + clavulanic acid = Augmentin

What type of drug is penicillin?

antibacterials

How do you prevent the deactivation of beta-lactam due to bacteria?

Adding clavulanic acid (amoxicillin-clavulanic acid [Augmentin])

AKA: act as a body guards

Penicillin mechanism of action?

Destroys bacterial cell wall

GI adverse effects of penicillin?

Diarrhea, nausea, vomiting

Superinfections associated with penicillin?

Candidiasis and C. difficile

Allergic reactions to penicillin?

Rash, hives, anaphylaxis

How are cephalosporins related to penicillins?

Similar uses and adverse effects

Prototype cephalosporin?

Cephalexin (Keflex)

GI adverse effects of cephalosporins?

Diarrhea, nausea, vomiting, rarely C. diff

Serious allergic reaction risk with cephalosporins?

Anaphylaxis

What type of spectrum antibiotics is cephalosporins?

Beta-lactam broad spectrum

Spectrum of monobactams?

Narrow spectrum

What type of antibiotic is monobactams?

beta-lactam antibiotic

What infections do monobactams treat?

Lower respiratory, urinary, abdominal, and gynecologic

Prototype monobactam?

Aztreonam (Azactam)

Route of administration for aztreonam?

IM or IV only

Adverse effects of monobactams?

Pain, thrombophlebitis

superinfection (C. diff)

seizures

anaphylaxis

Vancomycin treats which bacteria?

Gram-positive infections

Is Vancomycin a beta lactam?

No

What resistant organisms does vancomycin treat?

MRSA and C. difficile

Important dosing consideration for vancomycin?

Weight-based and renal dosing (can be nephrotoxic)

What is the prototype for vancomycin?

Vancomycin itself!!!

Renal adverse effects of vancomycin?

Nephrotoxicity: monitor peak & trough; CREAT, BUN, GFR

Ototoxicity (rare): damage to inner ear

Tachycardia, hypotension, rash, pruritus, urticaria, Red Man syndrome

Red Man Syndrome symptoms?

Flushing, rash, hypotension, pruritus

How should vancomycin be administered IV?

Diluted and infused slowly

How is vancomycin given for C. diff?

Orally (add flavor)

What infections do tetracyclines treat?

Chlamydia

Mycoplasma

RMSF (Rocky Mountain spotted fever)

syphilis (if allergic to PCN)

acne treatment

What is one concern when overusing tetracycline?

Can lead to resistance

Prototype of tetracycline?

Tetracycline itself!!!

Effect of tetracyclines on bones & teeth?

Suppresses bone growth; stains teeth

Unique adverse effect of tetracyclines?

Photosensitivity

Important drug interactions with tetracyclines?

Calcium foods; ↓ oral contraceptive effectiveness

Adverse effect of tetracyclines on GI?

nausea, vomiting, diarrhea, abdominal pain

Prototype macrolide?

Erythromycin

What kind of spectrum is macrolide?

broad

Cardiac adverse effect of macrolides?

Ventricular dysrhythmias: need to be on heart monitor

Adverse effect of macrolides on GI?

nausea, vomiting, diarrhea, abdominal pain

Adverse effect of tetracyclines on hearing?

Ototoxicity, vertigo, tinnitus: ringing in ears, decrease hearing

What type of infection are macrolides?

Superinfections

CYP3A4 effect on erythromycin (of macrolides)?

Decreased metabolism → increased drug/food/medication interaction levels

What happens when grapefruit juice is consume alongside erythromycin (of macrolides)

Grapefruit juice will win → medication toxicity

Spectrum of aminoglycosides?

Narrow spectrum

Prototype aminoglycoside?

Gentamicin

Adverse effect of aminoglycoside regarding Ototoxicity symptoms?

Tinnitus, vertigo, ataxia, vertigo

Adverse effect of aminoglycoside regarding Nephrotoxicity signs?

↑ BUN/Creatinine, proteinuria, dilute urine

polyuria, dilute urine, and protein in urine

When are peak and trough levels drawn after IV/IM for aminoglycosides?

Peak: 30 min after dose; Trough: 1 hr before next dose

What are the renal panel in this class?

BUN: Blood Urea Nitrogen

CREAT: creatine

GFR: Glomerular Filtration Rate

UA: Urinalysis

Prototype fluoroquinolone?

Ciprofloxacin (Cipro)

Serious musculoskeletal adverse effect?

Achilles tendon rupture

CNS risks of fluoroquinolones?

Confusion in older adults (DK if from UTI or drug)

dizziness & headache

Important nursing instruction with fluoroquinolones?

Timing of administering & skin consideration → many drug interactions → take with fluids

What is the range of infection for fluoroquinolones?

Wide range of infection: severe UTIs, anthrax

GI risks of fluoroquinolones?

nausea, vomitting, abdominal pain, diarrhea

Skin risks of fluoroquinolones?

photosensitivity → wear sunscreen

Extra adverse effects of fluoroquinolones?

seizures, increased ICP (intracranial pressure), suicidal, hepatotoxicity, anaphylaxis, C diff diarrhea

What infections are sulfonamides used to treat?

UTI, Pneumocystis pneumonia, Shigella enteritis, acute & chronic bronchitis, acute otitis media in children

What is the prototype sulfonamide drug?

Trimethoprim

What common combination sulfonamide drugs are used?

Bactrim and Septra

What are the generic components of Bactrim/Septra?

Sulfamethoxazole and trimethoprim

Common GI adverse effects of sulfonamides?

Nausea and vomiting

Life-threatening skin reaction associated with sulfonamides?

Stevens–Johnson syndrome: treats in burn unit

Serious hematologic adverse effects of sulfonamides?

Agranulocytosis, aplastic anemia, thrombocytopenia

What type of infections may develop with sulfonamide use?

Superinfections

How do sulfonamides cause renal damage?

Crystal formation in the urinary tract

What serious neonatal complication is associated with sulfonamides?

Kernicterus (bilirubin deposits in the brain): need to know mental status

Why should hydration be encouraged with sulfonamides?

To prevent crystal formation and renal damage

Which population should avoid sulfonamides due to kernicterus risk?

Newborns and infants

What is the spectrum of urinary tract antiseptics?

Broad spectrum

How do urinary tract antiseptics work?

Interfere with bacterial RNA and DNA

What is the prototype urinary tract antiseptic?

Nitrofurantoin

What are the brand names for nitrofurantoin?

Macrodantin, Macrobid

Common GI adverse effects of nitrofurantoin?

Nausea, vomiting, diarrhea

Serious hypersensitivity reaction associated with nitrofurantoin?

Pulmonary reaction

Symptoms of nitrofurantoin-induced pulmonary toxicity?

Dyspnea, chest pain, chills, cough

Long-term pulmonary complication of nitrofurantoin?

Permanent lung damage (fibrosis): know if patients have lunch problems

Neurologic adverse effect of nitrofurantoin in patients with renal impairment?

Permanent peripheral neuropathy: high-risk diabetes patients → can lose extremities

Symptoms of peripheral neuropathy?

Weakness, numbness, tingling

Hematologic adverse effects of nitrofurantoin?

Red, white, and platelet blood cell deficiencies

Harmless side effect of nitrofurantoin?

Brown urine