Nursing Pathopharmacology Exam 3

Do viruses have organelles?

No; they use host cell organelles to infiltrate them.

What is a pathogen?

A microorganism that invades the body and enters tissue.

What are the 2 types of pathogens?

Bacteria and viruses.

What happens during non-specific (innate immunity)?

• Inflammation causes the release of prostaglandins, which causes a vascular response.

• An example is when bacteria invade through a cut or when you breathe in viral particles.

What happens during specific (adaptive) immunity?

• Lymphocytes recognize a pathogen and develop antibodies to fight it off.

• Granulocytes and neutrophils notice and send out signals to trigger inflammation and to recruit other immune cells.

What happens during possible sepsis (septicemia)?

Chemicals are released into the bloodstream to fight infection and this triggers systemic inflammation which can cause organ failure.

How do you treat septicemia?

Water, IV fluids.

Signs of septicemia

Fever, tachycardia, tachypnea, hypotension.

Narrow spectrum vs. Broad spectrum antibiotics

Narrow spectrum is for one specific bacteria, broad spectrum work on gram negative and gram positive bacteria.

What do bacteriostatic antibiotics do?

Inhibit bacterial growth or replication.

What do bactericidal antibiotics do?

Kill bacteria.

What is needed for antibiotics to work in the best possible capacity?

An intact immune system.

What is the most common intramuscular antibiotic?

Penicillin.

How are MRSA antibiotics usually administered?

Topically.

When is the peak of an antibiotic?

An hour and a half after the dose.

When is the trough of an antibiotic?

Right before administration.

Are penicillin’s bacteriostatic or bactericidal or both?

Both.

What type of bacteria are most penicillin’s used for?

Gram positive bacteria.

What are penicillin’s used to treat?

Syphilis, gonorrhea, strept, staph.

What pregnancy category are penicillin’s?

B

What should you test before administering penicillin’s?

BUN, creatinine, ALT, AST.

Can you take penicillin’s with food?

Yes.

What should not be given within one hour of penicillin’s?

Aminoglycosides.

Penicillin examples

penicillin G, penicillin V potassium, amoxicillin, ampicillin, nafcillin

Are macrolides bacteriostatic, bactericidal, or both?

Both.

How do macrolides work?

They bind to a subunit of the ribosome within the cell wall.

What pregnancy category are macrolides?

B

What are macrolides used to treat?

Strep, gonorrhea, C-diff (not as effective)

What type of bacteria do macrolides treat?

Gram positive and gram negative but better with gram positive.

How are macrolides used in dentistry?

Are given to patients with preexisting cardiac conditions to prevent infection in case they are allergic to penicillin.

What should the patient avoid before having macrolides administered?

Dairy and grape juice because they decrease effectiveness.

Macrolides side effects

GI, liver issues, confusion, allergy, superinfection

Macrolide examples

Erythromycin, Azithromycin

Are lincosamides safer than macrolides or more dangerous?

More dangerous.

What are lincosamides used for?

Septicemia, chronic bone/joint infections.

Lincosamides pregnancy category

B

Lincosamide side effects

GI, N/V, low blood counts.

Lincosamide example

Clindamycin

Aminoglycosides treat what type of bacteria?

Gram negative.

Are aminoglycosides bactericidal or bacteriostatic?

Bactericidal.

Aminoglycosides pregnancy category

D

Aminoglycoside side effects

GI, N/V, ototoxicity, nephrotoxicity, cramps, tremors, photosensitivity, liver issues, dizziness, vertigo, tinnitus

Aminoglycoside interactions

Interact with diuretics and increase ototoxicity due to increased fluid in the inner ear.

Aminoglycoside examples

tobramycin sulfate, neomycin, gentamicin sulfate

Gentamicin trough level

0.5 - 2 mcg/mL

Gentamicin peak level

5-10 mcg/mL

Are cephalosporins bacteriostatic, bactericidal, or both?

Both.

Cephalosporins have a cross-allergy and are similar to what other antibiotic class?

Penicillin’s

What pregnancy category are cephalosporins?

B.

Cephalosporin side effects

Dizziness, superinfection.

Can cephalosporins be taken with food?

Yes.

What should you monitor for in cephalosporins?

Bleeding if they also take anticoagulants.

Cephalosprin examples

cephalexin, cefzolin sodium, cefaclor, cefdinir, cefdepime

How do fluoroquinoles work?

Stop synthesis of bacterial DNA.

What are cephalosporins used to treat?

E.coli, Proteus Mirabilis

What are fluoroquinolones used to treat?

Pneumonia, UTI, anthrax

What should you not take with fluoroquinolones?

Antacids, dairy, or iron.Wha

What pregnancy class are Fluoroquinoles?

C

Fluoroquinolones side effects

GI, n/v, peripheral neuropathy, tendonitis and rupture (especially to those over 60), cartilage damage in children.

If fluoroquinolones are taken with NSAIDs, what can happen?

CNS stimulation.

If fluoroquinolones are taken with amiodarone, what can happen?

QT interval will be delayed.

Fluoroquinolones examples

ciprofloxacin, levofloxacin, moxifloxacin

Are tetracyclines bacteriostatic, bactericidal, or both?

Bacteriostatic.

What should you consider with tetracyclines and children?

Don’t give to children under 8 because it can cause teeth issues.

What should tetracyclines not be taken with?

Dairy, Antacids

Tetracycline side effects?

GI, n/v, headache, photosensitivity.

If someone is taking tetracycline, what should you educate the patient to do?

Wear sunscreen!

Tetracycline can lead to toxicity of what other drug?

Digoxin.

What are tetracyclines used for?

Rocky Mountain Spotted Fever (Lyme’s Disease), STDs/STIs, acne

Tetracycline examples

Tetracycline, doxycycline hyclate, tigecycline.

How do sulfonamides work?

Stop bacteria from creating folic acid.

Are sulfonamides bacteriostatic, bactericidal, or both?

Bacteriostatic

What should you not take with sulfonamides?

Antacids.

What are sulfonamides used to treat?

UTIs, pneumonia, ear infections, prophylaxis AIDS patients.

Sulfonamides pregnancy class

D (in third trimester)

What should you educate the patient to do if taking sulfonamides?

Increase fluid intake.

What should you check for before giving sulfonamides?

LFTs, RFTs, CBC.

Sulfonamide side effects

Decreased blood count, GI, N/V, photosensitivity, urine crystals.

What can sulfonamides do to blood sugar?

Lower it in diabetic patients.

Sulfonamide examples

sulfadiazine, trimethoprim-sulfamethoxazole

What is metronidazole used for?

Protozoa, prophylaxis for surgery, H. pylori, IBS, Giardiasis, Trichomonas

Metronidazole is used for what type of bacteria?

Gram (-)

What should you educate the patient on who takes metronidazole?

Avoid alcohol use.

Metronidazole side effects

GI, dark urine, dizziness, headache, dry mouth, metallic taste, seizures.

What pregnancy category is metronidazole?

D.

Are carbepenems bacteriostatic, bactericidal, or both?

Bactericidal.

What are carbapenems used to treat?

Strep, staph, proteus mirabilis.

Carbapenem side effects

N/V, seizures, headache, dizziness, altered mental status.

What are carbapenems contraindicated in?

Seizures, meningitis, advanced kidney disease.

Carbapenems example

Metropenem.

Glycopeptide example

Vancomycin

What are glycopeptides used to treat?

MRSA, osteomyelitis

Do glycopeptides work on gram (-), gram (+), or both?

Gram (+)

What should a nurse do before administering glycopeptides?

Check BUN, creatinine, give slowly via an IV.

Glycopeptide side effects

Ototoxicity, nephrotoxicity, red man syndrome.

How is c-diff treated?

Oral vancomycin

What is the trough level of vancomycin?

5-15 mcg/dL

What is the peak level of vancomycin?

20-40 mcg/mL

What are the normal AST lab values?

7-55 units/L

What are normal AST levels?

8-48 units/L