NUR140 - Antibiotics (chapter 9, exam 4)

aerobic

bacteria that depend on oxygen for survival

anaerobic

bacteria that survive without oxygen, which are often found in chronic infections and in the GI tract

gram-negative

bacteria that have only a thin layer of peptidoglycan, making them less likely to absorb stain or become decolorized by alcohol; these bacteria are frequently associated with infections of the genitourinary or gastrointestinal (GI) tract

gram-positive

bacteria that have cell walls with more peptidoglycan layers, which absorb more stain or resist decolorization with alcohol during preliminary identification; these bacteria are frequently associated with infections of the respiratory tract and soft tissues

gram staining

a process used to identify between types of bacteria based on differences of components in their cell walls

synergistic

drugs that work together to increase drug effectiveness

classic signs of an infection

FEVER, lethargy, elevated WBC count, and classic signs of inflammation (redness, swelling, pain, heat)

What should be done before treating a patient with an antibiotic?

culture and sensitivity testingto identify the specific bacteria and its antibiotic susceptibility.

What can cause antibiotic resistance?

Overuse and misuse of antibiotics (such as for viral infections instead of bacterial), incomplete courses of treatment, and lack of infection control.

What can antibiotic use result in the development of?

superinfections, such as the growth of fungi or yeastin the body due to disruption of normal flora.

What is the goal of antibiotic therapy?

reduce the population of invading bacteria to a size that the human immune response can deal with.

Aminoglycosides - drug to know

• gentamicin sulfate (Garamycin)

aminoglycosides - actions and indications

actions: inhibit protein synthesis (bacteriocidal)in susceptible strains of aerobic gram-negative bacteria

indications: E. coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa

synergistic

aminoglycosides - contraindications and cautions

nephrotoxicity and ototoxicity

nursing considerations - aminoglycosides

Monitor renal function, and ensure adequate hydration to reduce toxicity.

Assess for hearing and balance issues due to the risk of ototoxicity.

Very toxic in combination with vancomycin

Carbapenems - drugs to know **not on med list

• Ertapenem (Invanz)*

• Meropenem (Merrem IV)*

carbapenems - actions and indications

inhibits cell wall synthesis; bactericidal

Treatment of serious intra-abdominal, urinary tract, skin and skin structure, bone and joint, and gynecological infections

antibacterial- cephalosporins - drugs to know

• cefazolin (Ancef)

• cefaclor (Kefzol)

• cefdinir (Omnicef)

• cefotaxime (Claforan)

• ceftazidime (Fortaz)

• cefepime (Maxipime)

• cetriafiaxon (Rocephin) UTI

**cef or ceph

cephalosporins - actions and indications

actions: bactericidal and bacteriostatic; inhibit cell wall synthesis

indications: Treatment of respiratory, dermatological, urinary tract, and middle ear infections caused by susceptible strains of bacteria.

similar to penicillins

cephalosporins adverse effects

Nausea, vomiting, diarrhea, rash, superinfection, bone marrow depression, risk for pseudomembranous colitis, risk for bleeding with warfarin, nephrotoxicity risk when used with aminoglycosides

Can CAUSE Cdiff

nursing considerations and patient education: cephalosporins

monitor renal function (BUN and creatinine) and monitor for superinfection

limit fluid intake and maintain nutrition; monitor Is & Os

avoid operating heavy machinery

monitor for allergic reaction

bedside commode or pyridine use does not prevent crystalluria

Flouroquinolones - drugs to know

• ciprofloxin HCL (cipro)

• levofloxin (Levaquin

flouroquinolones - actions and indications

actions: enters the cell and inhibits bacterial DNA synthesis; bacteriocidal

indications: urinary tract infections, respiratory infections, and skin infections.

flouroquinolones adverse effects

The most serious adverse effects of these drugs are tendinitis, tendon rupture, peripheral neuropathy, CNS effects, prolonged QT interval, C. difficile diarrhea, and liver toxicity

photosensitivity

what was the first antibiotic introduced for clinical use?

penicillin

penicillins - drugs to know

• amoxicillin (Amoxil)

• amoxicillin / Clavulanic acid(Augmentin)

• ampicillin-sulbactam (Unasyn)

• piperacillian-tazobactam (Zoysyn)

take on empty stomach

penicillins - actions and indications

action: inhibits synthesis of the cell wall in susceptible bacteria

indications: bacterial infections, including pneumonia, strep throat, ear infections, and syphilis; STIs

penicillins adverse effects

allergic reactions, gastrointestinal disturbances, nephrotoxicity, and superinfections

interferes with oral contraceptives

penicillins drug-drug interactions

aminoglycosides - can enhance nephrotoxicity.

can decrease the effectiveness of oral contraceptives

cephalosporins, carbapenems

sulfonamides - not on med list** - drugs

sulfadiazine (generic) and cotrimoxazole or trimethoprim–sulfamethoxazole (Septra, Bactrim)

sulfonamides - actions and indications

UTIs, otitis media, traveler’s diarrhea, pneumonia

They inhibit bacterial synthesis of folic acid.

bacteriostatic

sulfonamides - adverse effects

Common adverse effects include skin rash, nausea, vomiting, and potential for hypersensitivity reactions to sulfa.

Crystalluria(kidney stones)-give fluids, proteinuria, hematuria

Serious adverse effects may include agranulocytosis and Stevens-Johnson syndrome.

Photosensitivity

sulfonamides drug-drug interactions

oral diabetics - risk of hypoglycemia

cyclosporine

increases warfarin effects

sulfonamides - nursing considerations

• assess for allergy to sulfa

• teach pt to apply sunlight and wear protective clothing

• encourage increased fluid intake

• monitor renal function and hydration status; educate on potential drug interactions and side effects.

Tetracycline - drug to know

• tetracycline (Sumycin)

Tetracycline - actions and indications

inhibits protein synthesis in bacteria, preventing cell replication; bacteriostatic

Indications: Treatment of various infections caused by susceptible strains of bacteria; acne; when penicillin is contraindicated for eradication of susceptible organisms.

tetracycline adverse effects

may include gastrointestinal disturbances, photosensitivity, and tooth discoloration.

nursing considerations - tetracyclines

Monitor for signs of superinfection, assess for allergies, and advise avoiding sun exposure. frequent mouth care

sun block, take med on empty stomach, encourage fluid intake

calcium, dairy products, iron supplements, magnesium, and antacid salts should be avoided

What is the leading cause of death by infectious disease?

myobacterium tuberculosis

what are the two common infections caused by myobacteria?

Mycobacterium tuberculosis and Mycobacterium leprae

antimycobacterials— not on med list**

• First-line drugs for treating tuberculosis

  • Isoniazid (generic), rifampin (Rifadin), pyrazinamide (generic), ethambutol (Myambutol), rifabutin (Mycobutin), rifapentine (Priftin)

• Leprostatic drug

  • Dapsone (generic)

  • thalidomide

lincosamides - drugs to know

clindamycin (Cleocin)***

lincosamides - actions and indications

used to treat lung abscess, blood infections, skin/soft tissue infections, GI, respiratory infections, Pelvic inflammatory disease, acne/rosacea, penetrating wound in your abdomen like a knife or bullet.

lipoglycopeptides - drugs to know

 vancomycin ***(Vancocin, Firvanq)

lipoglycopeptides - actions and indications

treating deep-seeded and severe infections, such as bloodstream infections, bone and joint infections, and infective endocarditis.

vancomycin adverse effects

can include nephrotoxicity(Cr over 1.3, BUN over 20), ototoxicity(vertigo and tinnitus), and infusion-related reactions like flushing (red man syndrome) or phlebitis

vancomycin nursing considerations

should include monitoring renal function, ensuring adequate hydration, assessing IV site for possible infusion reactions

infuse slowly

monitor BP

anaphylaxis (hives, wheezing, angioedema)

macrolides - drugs to know

• azithromycin (Zithromax)

macrolides - actions and indications

may be bactericidal at high doses or bacteriostatic, exert their effect by binding to the ribosomes within the cell and changing protein synthesis

to treat respiratory infections, skin infections, and certain sexually transmitted infections.

macrolides adverse effects

include gastrointestinal upset, rash, and potential liver injury.

• Oxazolidinones - drugs - not on med list

• tedizolid (Sivextro), linezolid (Zyvox)

oxazolidinones - actions and indications

used to treat infections caused by Gram-positive bacteria, including multi-drug resistant strains. They work by inhibiting protein synthesis.

monobactam antibiotic - drug - not on med list

aztreonam (Azactam)

monobactam antibiotic indications

 used to treat serious infections caused by susceptible Gram-negative bacteria, including urinary tract infections, lower respiratory tract infections, septicemia, and skin infections.They are also used in patients with allergies to penicillin.

Daptomycin

antibiotic used to treat complicated skin and skin structure infections by susceptible Gram-positive bacteria and bacteremia due to Staphylococcus aureus

Tigecycline

antibiotic that fights bacteria in the body. Tygacil is used to treat many different bacterial infections of the skin or the digestive system, as well as pneumonia. Tygacil should be used only for infections that cannot be treated with other medicines.

streptogramins

effective in the treatment of vancomycin-resistant Staphylococcus aureus (VRSA) and vancomycin-resistant Enterococcus (VRE)

Rifaxamin

can treat traveler's diarrhea and irritable bowel syndrome with diarrhea. It can also help prevent recurrence of certain liver problems