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Penicillin G Potassium thereapeutic uses
Endocarditis
Diphtheria
Neurosyphilis
Tetanus
Penicillin G Potassium complications
Hypersensitivity reaction
Renal impairment
Hyperkalemia
Dysrhythmia
Penicillin G Potassium contraindications/precautions
Precautions: allergy, renal impairments
Contraindications: anaphylaxis
Penicillin G Potassium interactions
Probenecid
Delays excretion of PCN
Penicillin G Potassium MOA
destroy bacteria by weakening the bacterial cell wall
Penicillin G Potassium broad or narrow spectrum?
Narrow-spectrum for IM/IV use
Amoxicillin therepeutic uses
Chlamydia (pregnancy)
Endocarditis (prophylaxis before dental procedures)
Acute otitis media
CAP
Rhinosinusitis
Skin/soft tissue infection (SSTI)
Streptococcal pharyngitis
UTI
Amoxicillin complications
Hypersensitivity reactions
Renal impairment
Amoxicillin contraindications/precautions
Precautions: allergy, renal impairments
Contraindications: anaphylaxis
Amoxicillin interactions
Probenecid
Delays excretion of PCN
Amoxicillin MOA
destroy bacteria by weakening the bacterial cell wall
Amoxicillin broad or narrow spectrum
Broad-spectrum (PO)
Cephalexin (1st generation) drug class
Cephalosporins
Cephalexin (1st generation) therepetuc uses
Endocarditis (prophylaxis)
Prosthetic joint infection
SSTI
Strep. pharyngitis (group A)
UTI
Cephalexin (1st generation) complications
Hypersensitivity reactions
Hemolytic anemia
C. difficile diarrhea
Renal impairments
Cephalexin (1st generation) contrindications/precautions
Precautions: renal impairments
Contraindications: anaphylaxis
Cephalexin (1st generation) interactions
Probenecid
Delays renal excretion
Cephalexin (1st generation) MOA
destroy bacterial cell walls causing destruction of microorganisms
Vancomycin drug class
Glycopeptide
Vancomycin therapeutic uses
MRSA coverage
Bloodstream infection
C. difficile (PO)
Endocarditis
Bacterial meningitis
Pneumonia
SSTI
Vancomycin complications
Ototoxicity
Rare and reversible
sign of Renal injury
Infusion reactions
Red man syndrome
Rapid infusion
Rash, itching, flushing, tachycardia, hypotension
Thrombophlebitis
Vancomycin contraindications/precautions
Precautions: renal impairments
Contraindications: allergy
Vancomycin interactions
Renally-toxic agents
Loop diuretics
Aminoglycosides
Vancomycin important things to note
have to give PO to treat c.diff. only give PO for c.diff
ototoxic is toxic to ears. stop if tinnitus occurs
stop infusion if red man syndrome. give supportive care and benadryl
Tetracycline therepeutic uses
Acne vulgaris
Chlamydia trachomatis
Pneumonia (Mycoplasma)
Lyme disease
H. pylori (PUD)
UTI
Tetracycline complications
GI discomfort
Cramping, NVD
Tooth discoloration
Cant give to children bc teeth color is permanent
Hepatotoxicity
Photosensitivity
Wear protective clothing and ≥ SPF 30 while outdoors
Tetracycline contraindications/precautions
Precautions: renal/hepatic impairments, children < 8 years
Tetracycline interactions
Milk products, calcium, iron, antacids
Reduce absorption of tetracyclines
Digoxin
Increased risk of digoxin toxicity
Tetracycline MOA
b-s that inhibit microorganisms by preventing protein synthesis
Erythromycin drug class
Macrolides
Erythromycin thereputic uses
Endocarditis (prophylaxis)
Bordetella pertussis
Chlamydia
Mycoplasma pneumonia
Streptococcal infections
Erythromycin complications
GI discomfort
Pain, NV
Prolonged QT interval
Ototoxicity
High dose therapy
Erythromycin contraindications/precautions
Contraindications: liver disease, prolonged QT
Erythromycin interactions
Antihistamines, theophylline, carbamazepine, warfarin, digoxin
Inhibits metabolism of these agents leading to toxicity
Verapamil, diltiazem, HIV protease inhibitors, antifungal agents
Inhibit the metabolism of erythromycin leading to toxicity
Erythromycin MOA
slows the growth of microorganisms by inhibiting protein synthesis (bacteriostatic)… is bactericidal at high doses
antimicrobials rule of thumb
all antimicrobials basically cause GI distress. give with small snack
Gentamicin drug class
Aminoglycosides
Gentamicin therepeutic uses
E. coli
CNS infections
STI
UTI
Gentamicin complications
Ototoxicity
Nephrotoxicity
Neuromuscular blockade
Respiratory depression, muscle weakness
Hypersensitivity
Gentamicin contraindications/precautions
Precautions: renal/hepatic impairments, MG
Gentamicin interactions
PCN
Do not administer in the same solution
Ototoxic agents
Loop diuretics
Skeletal muscle relaxants
Gentamicin MOA
bactericidal agents that destroy microorganisms by disrupting protein synthesis
Gentamicin things to note
used for bad, life threatening infections
used to treat the damn plauge
will probably give you renal damage
Trimethoprim-Sulfamethoxazole drug class
Sulfonamides and Trimethoprim
Trimethoprim-Sulfamethoxazole complications
Hypersensitivity
Stevens-Johnson syndrome (SJS)
Blood dyscrasias
Crystalluria
AKI
Hyperkalemia
Trimethoprim-Sulfamethoxazole contraindications/precautions
Precautions: renal impairments
Contraindications
Allergies: sulfa, thiazide diuretics, sulfonylurea-type oral hypoglycemics, loop diuretics
Trimethoprim-Sulfamethoxazole therepeutic uses
UTI
E. coli
Otitis media
Trimethoprim-Sulfamethoxazole interactions
Warfarin, phenytoin, sulfonylurea oral hypoglycemics
Increased effects of these agents
Trimethoprim-Sulfamethoxazole MOA
inhibit bacterial growth by preventing the synthesis of a folic acid derivative
Folic acid is essential for the production of DNA, RNA, and proteins
Trimethoprim-Sulfamethoxazole important thing to note
SJS life threatening anaphylaxis starts in mucous membrane. check gums.
Nitrofurantoin drug class
Urinary Tract Antiseptics
Nitrofurantoin thereputic uses
UTI
Prophylaxis for recurrent lower UTI
Nitrofurantoin complications
GI discomfort
Anorexia, NVD
Hypersensitivity
Blood dyscrasias
Peripheral neuropathy
Headache, dizziness
Nitrofurantoin contraindications/precautions
Precautions: renal impairments
Contraindications: older adults with renal impairments
Nitrofurantoin interactions
No significant interactions
Nitrofurantoin MOA
bacteriostatic and bactericidal properties… destroys bacteria by damaging DNA
Ciprofloxacin drug class
Fluoroquinolones
Ciprofloxacin therepeutic uses
UTI
Respiratory infections
GI tract infections
Osteomyelitis
SSTI
Animal bites
STI
Ciprofloxacin complications
GI discomfort
NVD
Achilles tendon rupture
Photosensitivity
Ciprofloxacin contraindications/precautions
Precautions: older adults
Contraindications: age < 18 years
Ciprofloxacin interactions
Antacids, iron salts, sucralfate, dairy products
Decrease absorption of ciprofloxacin
Theophylline
Theophylline toxicity
Warfarin
Warfarin toxicity
Ciprofloxacin MOA
bactericidal due to inhibition of an enzyme necessary for DNA replication
Acyclovir drug class
Antivirals
Acyclovir thereputic uses
Herpes simplex virus (HSV)
Varicella-zoster viruses (VZV)
Acyclovir complications
Phlebitis and inflammation (IV)
Nephrotoxicity (IV)
GI discomfort (PO)
NVD
Acyclovir contraindications/precautions
Precautions: renal impairments
Acyclovir interactions
Probenecid
Decrease elimination of acyclovir
Zidovudine
Drowsiness
Acyclovir client education
Avoid sexual contact if lesions are present
Use barrier contraceptive
Acyclovir MOA
prevent the reproduction of viral DNA … interrupt cell replication
when should you obtain a culture
before initiating antimicrobials (with the exception of life threatening infections like bacterial meningitis)
whats the best way to handle invasive cultures and prevent them from getting lost (ex CSF fluid obstained from invasive spinal tap procedure)
walk down to lab yourself to ensure it doesnt get lost
(because you wouldn’t want to make a client get a spinal tap twice if the culture was lost due to hospital error)
client education when taking antimicrobials for STI treatment
Abstain from intercourse until course of treatment is complete
general client teachings with antimicrobials
Complete the full course of treatment
Several agents interact with oral contraceptives
Use additional methods
GI discomfort?
Administer with food/drink
what is HIV
Retrovirus that selectively attacks the CD4+ T lymphocytes responsible for organizing immune response to infection
causes infected people to be more susceptible
seroconversion
The point at which the blood tests positive for HIV antibodies
1-3 months after exposure; can take up to 6 months
best way to diagnose HIV
gold standard is to get ELIZA and then confirm with western blot
Enfuvirtide drug class
Antiretrovirals – Fusion/Entry Inhibitors:
Enfuvirtide therepeutic uses
HIV
Unresponsive to other antiretrovirals
Enfuvirtide complications
Injection site reaction
Rotate sites
Bacterial pneumonia
Fever, chills, rash, hypotension
Enfuvirtide contraindications/precautions
Contraindications: hypersensitivity, breastfeeding
Enfuvirtide interactions
No significant interactions
Enfuvirtide things to note
use for those unresponsive to other therapies. not first line.
Enfuvirtide MOA
decreases and limits the spread of HIV by blocking HIV from attaching to and entering CD4 cells
Raltegravir drug class
Antiretrovirals – Integrase Inhibitors
Raltegravir therepeutic uses
HIV
Combination therapy
Raltegravir complications
Headache
Insomnia
Skin rash
SJS****
Liver injury
Renal failure
Suicidal ideation
Raltegravir contraindications/precautions
Precautions: age < 16 years, older adults, liver disease
Raltegravir interactions
Rifampin, ritonavir
Decreased levels of raltegravir
Raltegravir MOA
interferes with enzyme integrase to prevent HIV replication within the cell
Acquired Immunodeficiency Virus (AIDS) signs and symptoms
Profound immunosuppression with
Opportunistic infections
Malignancies
Wasting (bad weight and muscle loss)
CNS degeneration
HIV risk factors
HIV
Those born in countries with high incidence of TB
Residents of high-risk congregate settings
Correctional facilities
Drug treatment facilities
Homeless shelters
primary TB
Previously unexposed and unsensitized people
Latent infection
Limited spread of the disease within the body
Do not have active disease and cannot spread it to others
May progress to active disease
Fever, weight loss, fatigue, night sweats
primary progressive TB
Reinfection from inhaled droplet nuclei or reactivation of previously healed primary lesion
Immunosuppressed
Pleural effusions and empyema
Low-grade fever, fatigue, weight loss, night sweats
Dry cough that becomes productive
Dyspnea
Isoniazid drug class
Antimycobacterial (Selective Antituberculosis)
Isoniazid therepeutic uses
Latent TB
Daily x 9 months
Active TB
RIPE x 1-2 years
Isoniazid complications
Peripheral neuropathy
Administer Vit. B6 daily
Hepatotoxicity
Isoniazid contraindications/precautions
Precautions: older adults, DM, alcohol use disorder
Contraindications: liver disease
Isoniazid interactions
Phenytoin
INH inhibits phenytoin metabolism leading to toxicity
Tyramine foods, alcohol, rifampin, and pyrazinamide
Increases risk for hepatotoxicity
Isoniazid MOA
Highly specific for mycobacteria… inhibits growth of mycobacteria by preventing synthesis of mycolic acid in the chest wall
tyramine rich foods examples
charcocchie board, wine, cheese,
avocado, bananan