Topic 10: Antibacterials

cultures

this must be drawn/taken prior to starting antibiotics to determine the sensitivity to specific antibiotic drugs

bactericidal

killing fast; antibiotics will function to destroy or kill bacteria

bateriostatic

killing slowly; antibiotics will function to stop or slow the growth of bacteria

1. age

2. nutrition

3. immunoglobulins

4. circulation

5. WBCs

6. organ function

what are the natural body defenses to fight off bacteria that causes illness

inherent resistance

resistance to antibacterials; resistance you are born with

acquired resistance

resistance to antibacterials; what you get from mom and from exposure

MRSA, VREF, VRSA

healthcare-acquired infections that are resistant to antibacterials

antibiotic misuse

occurs when antibiotics are taken unnecessarily for viral infections, when no bacterial infection is present, and if taking antibiotics incorrectly (skipping doses) that increases antibiotic resistance

cross resistance

antibiotic resistance that occurs between antibacterial drugs with similar actions

allergic reaction, superinfection, organ toxicity

what are the 3 general adverse reactions of antibacterials

allergic reaction

general adverse reaction that includes hypersensitivity, rash, pruritus, hives, anaphylactic shock

superinfection

general adverse reaction that occurs when normal flora is killed; commonly occurs at the mouth (stomatitis), skin (Stevens-Johnson), respiratory tract (phenomena, sepsis), GU tract (UTI), and intestines (C-diff)

organ toxicity

general adverse reactions that includes ear toxicity (ototoxicity), liver toxicity (hepatotoxicity), and kidney toxicity (nephrotoxicity)

narrow spectrum

antibacterial spectrum that primarily effects one bacteria type; ex) penicillin, erythromycin

broad spectrum

antibacterial spectrum that is primarily effective against gram-positive and gram-negative bacteria; frequently used to treat infections when the offending microorganism has not been identified by testing; ex) tetracycline, cephalosporins, amoxicillin

1. basic

2. broad spectrum

3. penicillinase-resistant

4. extended-spectrum

what are the 4 types of penicillin

assessment of renal function

with penicillin, what is the most important nursing consideration when giving to an older adult

amoxicillin

uses include:

• OM

• tonsillitis

• sinusitis

• gastric/duodenal ulcers

• skin, respiratory, and urinary tract infections

• septicemia

• meningitis

• peritonitis

• gonorrhea

amoxicillin

side effects include:

• diarrhea, N/V

• ototoxicity

• neuropathy

• tongue and tooth discoloration

• edema

• insomnia

• superinfection of stomatitis and vaginitis

• hepatotoxicity, nephrotoxicity, anaphylaxis

stomatitis

sores of the mouth

Rocephin

what is the brand/trade name for ceftriaxone

third-generation cephalosporin

what is ceftriaxone (Rocephin) classified as

ceftriaxone (Rocephin)

uses:

• OM

• meningitis

• appendicitis

• gonorrhea

• septicemia

• surgical infection prophylaxis

• skin, respiratory, bone/joint, gynecologic, and urinary tract infections

ceftriaxone (Rocephin)

side effects include:

• diarrhea

• flushing, diaphoresis, fever

• edema

• elevated hepatic enzyme levels

• jaundice

• hematuria

• Stevens-Johnson syndrome

cholelithiasis

gallstones

Stevens-Johnson syndrome

severe skin reaction that causes painful blisters and peeling of the mucous membranes

epistaxis

nose bleed

disulfiram-like reaction of flushing, dizziness, HA, N/V, and muscular cramps

what occurs when alcohol is combined with ceftriaxone (Rocephin)

decreased cephalosporin excretion

what occurs when ceftriaxone (Rocephin) is combined with uricosurics (treatment for gout)

Zithromax (Zmax)

what is the brand/trade name for azithromycin

does not treat UTIs

what is unique about what azithromycin (Zithromax) can and cannot treat

azithromycin (Zithromax)

uses:

• bacterial conjunctivitis

• OM

• tonsillitis

• sinusitis

• STIs, skin and respiratory infections

azithromycin (Zithromax)

side effects include:

• blurred vision

• tongue discoloration

• conjunctivitis/ocular irritation

• photosensitivity

• superinfection (c. diff)

• hepatotoxicity

• ototoxicity (tinnitus)

• sudden cardiac death with erythromycin (prolongs QT interval if taken for too long or due to severe reaction)

• elevated hepatic enzymes

• Stevens-Johnson syndrome

azithromycin (Zithromax)

needs to be taken one hour before or after meals and will a full glass of water

warfarin, theophylline, carbamazepine

azithromycin (Zithromax) causes levels of these drugs to increase when taken together

erythromycin levels increase

what occurs when azithromycin (Zithromax) is combined with fluconazole, ketoconazole, itraconazole, verapamil, diltiazem, or clarithromycin that risks sudden cardiac death

azithromycin (Zithromax)

nursing considerations include:

• take 2 antacids 2 hours before or after dose

tetracyclines (doxycycline)

uses:

• acne

• anthrax

• plague

• gingivitis

• STIs

• rickettsia

• cholera

• respiratory, urinary, and skin infections

tetracyclines (doxycycline)

side effects include:

• glossitis, dry mouth

• tooth/nail discoloration

• vision changes

• photosensitivity

• superinfections (stomatitis, anal/genital discharge)

• HTN

• Stevens-Johnson syndrome

milk products, antacids, oral contraceptives, penicillins, aminoglycosides

what are the drug-food interaction of tetracyclines (doxycycline)

tetracyclines (doxycycline)

patient education for this drug includes

• females who are pregnant or contemplating pregnancy that it can cause discoloration of fetus’ teeth

• makes oral contraceptives are ineffective

• do not give to kids younger than 8

• do not take with milk products/antacids

doxycycline

what is the brand/trade name of tetracycline

aminoglycosides

what is gentamicin sulfate classified as

tetracyclines

what is doxycycline classified as

gentamicin sulfate

uses:

• serious respiratory, skin, urinary, bone/joint, intraabdominal infections

• plague

• bacteremia

• septicemia

• endocarditis

• meningitis

• hepatic encephalopathy

neomycin

aminoglycoside that is frequently used as a pre-op bowel antiseptic

gentamicin sulfate

serum drug levels are frequently drawn; peak is 30 min-1 hr after admin and trough is drawn just before next does is admin

gentamicin sulfate

Side effects include:

• skin/ocular irritation

• alopecia

• depression

• peripheral neuropathy

• visual disturbances

• laryngeal edema

• hypokalemia, hypomagnesemia, hyponatremia

• increase ICP

increased risk of ototoxcitiy

what occurs if gentamicin sulfate is taken with loop diuretics

increased risk of nephrotoxicity

what occurs if gentamicin sulfate is taken with NSAIDs, cephalosporins, vancomycin, loop diuretics

decrease serum potassium and magnesium

how can gentamicin sulfate impact labs

gentamicin sulfate

what drug is it especially important to maintain therapeutic drug levels by checking peak and trough drug levels

avoid alcoholic drinks; no mouthwash, aftershave, deodorant, or bath splashes with alcohol contents

for drugs with disulfiram-like reactions, avoiding alcohol includes what products

• ask HCP if they can be treated without antibiotics

• take antibiotics as prescribed

• never skip doses and complete all of the antibiotics even if they feel better

• never take someone else’s antibiotics

what should a nurse educate their clients to avoid antibiotic resistance

Levaquin

what is the brand/trade name for levofloxacin

fluorquinolones

what is levofloxacin (Levaquin) classified as

levofloxacin (Levaquin)

uses:

• anthrax

• plague

• skin, soft tissue, bone/joint, gynecologic, intraabdominal, urinary, and respiratory tract infection

levofloxacin (Levaquin)

side effects include:

• retinal or tendon detachment

• depression

• nightmares, insomnia

• tremor

• photosensitivity

• tinnitus

• superinfection (stomatitis, furry black tongue, vaginitis, anal/genital itching)

• palpitations

• edema

• hypotension, dysrhythmias

• peripheral neuropathy

• hypo/hyperglycemia

• Stevens-Johnson syndrome

• increased ICP

• suicidal ideation

levofloxacin (Levaquin)

nursing interventions include

• do not take with antacids

• can increase effects of oral hypoglycemics

• NSAIDs can cause seizures

• increase fluids to 2 L/day

• causes decreased K, Mg, Na

sulfonamide

what is trimethoprim-sulfamethoxazole (TMP-SMZ) classified as

trimethoprim-sulfamethoxazole (TMP-SMZ)

uses:

• OM

• meningitis

• respiratory and urinary tract infections

• MRSA

trimethoprim-sulfamethoxazole (TMP-SMZ)

giving both drugs together in one compound form causes bacterial resistance to develop much more slowly than if only one of the drugs were to be used alone

trimethoprim-sulfamethoxazole (TMP-SMZ)

side effects include:

• vertigo

• superinfection (stomatitis, furry black tongue, vaginitis, anal itching)

• depression

• insomnia

• arthralgia

• myocarditis

• hyperkalemia, hyponatremia, hypoglycemia

• Stevens-Johnson syndrome

trimethoprim-sulfamethoxazole (TMP-SMZ)

nursing considerations include:

• CBC

• monitor electrolytes for hyperkalemia, hyponatremia, hypoglycemia

• give with a full glass of water

• do not take with antacids

• increase fluid intake to 1200 mL/day

• monitor BS