PHARM [exam 1] chapt 38,39, 40, 42, 48 - antibiotics & immunosuppressants

a. what kind of microorganisms do antibacterials (antibiotics) treat?

b. what kind of microorganisms do antivirals treat?

c: what kind of microorganisms do antifungals treat?

bacteria, viruses, fungi

the signs listed are signs of what kind of reaction? (2 in alphabetical order.)

1. skin reactions (rash, urticaria, pruritus, swelling) and anaphylactic reactions (tightness in throat, chest, wheezing, dyspnea)

anaphylactic, hypersensitivity

a: _____: a new infection that occurs because of antibiotics (destruction of normal flora)

• examples:

  • ___: a creamy white lesion and sore mouth

  • ___: perineal itching, thick, white vaginal discharge

  • ___: persistent or bloody diarrhea, fever, abdominal pain

  • ___: if it occurs, stop meds. may be fatal. it will require further evaluation +collect stool specimens (say shortened name)

superinfections, thrush, vaginal yeast infections, pseudomembranous colitis, c. diff

a. why obtain a culture before the first dose of antibiotic is given? in order to .. ___ the causative organism

b: ___ therapy: treat a likely cause of an infection before the specific bacteria is known

c: ___ therapy: administration of antibiotics based on known results of culture and testing

d: ___ therapy: antibiotics taken before anticipated exposure to infectious organism to prevent an infection

identify, empiric, definitive, prophylactic

a: _______: index where there is a low difference between effective + toxic dose, so measure blood levels closely + small increases of drug levels can lead to toxicity + small decreases of drug levels can lead to therapeutic failure

narrow therapeutic index

*antibiotics

a: ___: used for serious infections caused by gram-positive bacteria or prophylaxis of infection

b: examples of infections discussed in class (alphabetical order)

c: obtaining peak/trough blood levels for vancomycin:

• _____: measured after completion of infusion (not recommended) - highest concentration of drug in blood

• _____: measured within 30 min before the next scheduled dose (lowest concentration of the drug

vancomycin, C. diff, MRSA, peak, trough

a: what are the adverse effects and toxicities associated with vancomycin? identify them below

• ____: tinnitus (ringing in the ears), hearing loss. perform a whisper test

• ____: increased BUN and creatinine, decreased urine output, hematuria, edema. monitor drug blood levels, trough levels, and ensure adequate hydration. If creatinine is >1.2, withhold the drug + contact provider

b: trough level therapeutic range: _____mcg/mL

c: what do nurses have to assess before infusing vancomycin? read only

• check the trough level to see if kidneys are clearing meds

• assess hearing, assess renal function (creatinine & blood urea nitrogen levels) + intravenous site for phlebitis

d: read only: drugs to avoid: ototoxic meds (ahminoglycosides, furosemide) + avoid nephrotoxic meds (ahminoglycosides, NSAIDS, cyclosporine

e: how long to infuse vancomycin? infuse _____ over _ hour

f: based on the described symptoms, what adverse effect is this describing: flushing, erythema, pruritus, hypotension, dyspnea, tachycardia, chest pain, myalgia

• what causes it? ____ infusion rate of vancomycin, so histamine is released

• to manage it, hold infusion and restart at a slower rate once symptoms resolve, monitor vital signs, and lung sounds

• may order antihistamines (diphenhydramine + steroids may be ordered

irreversible ototoxicity, nephrotoxicity, 10-20, slowly, 1, red man syndrome, fast

*metronidazole: - metro no alcohol

a: what should be avoided before and during metronidazole therapy? no .. ____

b: if ^ is taken, a disulfiram-like reaction will occur tachycardia, hypotension

c: until treatment is completed, they should avoid _____ _____, otherwise they can infect each other

d: MOA: disrupts bacterial DNA synthesis > causes cell death

alcohol, sexual intercourse

a: what is the mechanism of action (MOA) of macrolides? Macaroni lights

• prevent ____ ___ within bacterial cells ; bacteriostatic

b: macrolides bind to the ___S ribosomal subunit

c: macrolides are commonly used to treat _____ ____ infections, ___, and _____

d: macrolides are a common alternative for patients with a ____ allergy

e: read only: common side effects of macrolides include: nausea, anorexia, and mild diarrhea, GI distress

f: macrolides cause ____ toxicity, indicated by ____ urine, ____ stools, _____, abdominal pain, fatigue, and elevated liver function tests

g: macrolides may prolong the _____ interval, increasing the risk for _____ _____

protein synthesis, 50S, respiratory tract, chlamydia, gonorrhea, penicillin, hepatotoxicity, dark, pale, jaundice, QT, cardiac arrhythmias

a: what antibiotics are these describing? : erythromycin, azithromycin, (zithromax), clarithromycin (niacin)

macrolides

*tetracyclines:

a: tetracycline antibiotics end in the suffix: _______

b: examples: tetracycline (sumycin), doxycycline (vibramycin), minocycline (minocin), demeclocyline (declomycin), tigecycline (tygacil)

c: tetracyclines are used to treat ____ ____ spotted fever, ____ disease, ____> _____ (STI), _____ pylori, and _____ infections.

d: what is the mechanism-related property of tetracyclines: ____

e: FOOD products to never take w/ tetracyclines: dairy, antacids, iron, sucralfate

f: taking tetracyclines with these products can reduce absorption by _____%

g: tetracyclines should be taken with ___-__ oz of water

h: what populations should not receive tetracyclines? ____ women, lactating women, and children under age ___

i: why are tetracyclines contraindicated in children under 8 years old?

• drug binds to ______ in teeth, which causes ____ ____

j: why are tetracyclines contraindicated in pregnancy or lactation?

• causes _____ discoloration in fetuses /infants and may suppress growth in

k: a common side effect of tetracyclines is _____< so patients should avoid _____ and ______ beds

L: sunscreen should be applied ____ minutes before sun exposure

m: tetracyclines may reduce the effectiveness of _____ ____

n: alteration of normal flora may lead to ____ ____ or _____ infections

-cycline, Rocky Mountain, Lyme, acne, chlamydoa, H., skin calcium, 50-90, 6-8. pregnant, 8, calcium, tooth discoloration, tooth enamel, long bones, photosensitivity, sunlight, tanning, 30, oral contraceptives, clostridium difficile, yeast,

*aminoglycosides - -micin/-mycin GRAM NEGATIVE / GNATS

a: examples of aminoglycosides: amikacin, gentamicin, tobramycin, neomycin, streptomycin

b: aminoglycosides are used to treat serious _____-negative bacterial infections, including _____ infections

c: why do we monitor drug blood levels? to prevent _____ by monitoring _____ and _____ levels

d: when is the peak level checked? measured _____ competition of infusion and represents the ____ concentration of the drug in the blood

e: when is the trough level checked? measured within ____ minutes _____ the next scheduled dose and represents the ____ concentration of the drug

f: symptoms of ototoxicity: _____, _____ issues, tinnitus, _____ loss

• nurses assess for ototoixicty by checking trough levels and perform baseline hearing and vestibular function tests

g: what are symptoms of nephrotoxicity? proteinuria, BUN, creatinine

h: how does the nurse assess for nephrototixicty? monitor renal function + urine output + encourage patient to drink plenty of ____, use caution if receiving IV contrast!

i: what lab value is concerning and requires holding the drug? if the creatinine is greater than ____

J: red flag patient complaint while taking aminoglycosides?? _____ in the ears. this means they got an adverse effect of _____

gram, Pseudomonas, toxicities, peak, trough, after, highest, dizziness, balance, hearing, fluids, 1.2, ringing, tinnitus

*fluoroquinolones -

a: names of these drugs: ciprofloxacin, levofloxacin, moxifloxacin, gemifloaxcin, delafloxacin

b: what do fluoroquinolones end in?

c: what is the mechanism of action of fluoroquinolones?

• they alter bacterial _____, causing ____ of the bacteria

d: how would you describe fluoroquinolones? they are potent, bactericidal, and _____-spectrum antibiotics

e: infections typically treated: respiratory, skin, urinary tract. STDS. GI, bone, joint infections. pseudomonas

f: what is the FDA black box warning associated with fluoroquinolones? _____ and ____ ____

g: what symptoms may indicate tendon rupture? ____ pain, _____, or ____

h: what are CNS adverse effects of fluoroquinolones? confusion, neuropathy, depression

i: what are GI adverse effects of fluoroquinolones? ______ colitis, C. diff diarrhea, ____

j: what CV adverse effect is associated with fluoroquinolones? prolonged _____ ____

k: which medications should be avoided due to QT prolongation? _____ and ____ ____

L: what are the skin-related adverse effects of fluoroquinolones? rash, pruritus, urticaria, photosensitivty

m: what food products should be avoided while taking fluoroquinolones? antacids, dairy, milk

n: which minerals reduce fluoroquinolone absorption, calcium, magnesium, aluminum, iron, zinc, sucralfate

o: when should interacting medications/products be taken? at least _ hours ____ and hours ___ the fluoroquinolone dose

p: how much fluid should be consumed daily while taking fluoroquinolones? at least ___ mL per day to prevent ____ and avoid ____ problems

q: what patient teaching should be given regarding sunlight? avoid exposure to ___,

r: monitor ____ and ____ functions (alphabetical)

-floxacin, DNA, death, broad, tendinitis, tendon rupture, tendon, inflammation, swelling, pseudomembranous, hepatotoxicity, QT interval, macrolides, beta blockers, 2, before, 2 after, 2000, crystalluria, kidney, sunlight, liver, renal

*sulfonamides:

a: names of sulfonamide antibiotics include: ____ and _____ (SMX-TMP)

b: why is SMX-tmp considered a synergistic antibiotic? they work together for ____ ____

b: sulfonamides are primarily used to treat: _______ tract infections, and _____ infections

c: mechanism of action: sulfonamides prevent bacterial synthesis of ____ ___

d: sulfonamides are considered _____ (bactericidal or bacteriostatic?_

e: sulfonamides are ____ spectrum and effective against gram-_____ and gram-____ bacteria

f: collect a ____ specimen _____ starting therapy

g: the symptoms of this description is describing what rare + life-threatening adverse effect? flu, fever, malaise, aches. rash, blisters, widespread peeling of skin, and mucous membranes

h: blood -related adverse effects with prolonged use include: agranulocytosis, hemolytic anemia, thrombocytopenia

i: what labs should be monitored w/ long-term sulfonamide therapy?

j: patients should report symptoms of sore throat, fever, infection

k: allergic reaction symptoms: delayed reaction and rash

L: what medication contains a sulfonamide and may cause cross-sensitivity: _____

m: what skin reaction can occur due to sun exposure?

n: sulfonamides may increase the risk of hypoglycemia when taken with _____

o: sulfonamides may increase bleeding risk when taken with ______

p: sulfonamides may potentiate toxic effects of which anti seizure drug?

q: sulfonamides may reduce the effectiveness of ____ ____

L: how much fluid intake is recommended daily? ___ mL

sulfisoxazole, sulfamethoxazole-trimethoprim, increased effect, urinary, Staphylococcus, folic acid. bacteriostatic, positive, negative, urine, before, stevens-johnson syndrome, CBC, celecoxib, photosensitivity, sulfonylureas, warfarin, phenytoin, oral contraceptives, 2000

*penicillin

a: drug classes: the beta-lactam family includes which 3 drug classes:

____, ____, ____ (alphabetical order)

b: ampicillin combined with sulbactam is called _____

c: amoxicillin combined w/ clavulanate is called _____

d: ticarcillin combined w/ clavulanate is called ____

e: piperacillin combined w/ tazobactam is called: ____

f: why are clavulanate, sulbactam, or tazobactam combined w/ penicillin? they block

• they bind with ____ and protect it from ____

• this makes penicillin effective against bacteria that produce ____

g: what is the major adverse effects of penicillin? ____ reactions

h: what are signs of an allergic reaction to penicillin? ____- (rash/hives/fever) and _____ (itching)

i: what should the nurse do if an allergic reaction occurs? _____ the medication and ____ it immediately

j: the symptoms listed describe what reaction? “tightness in throat, wheezing, breathing”

L: anaphylaxis is treated by administering _____ injection into the middle of the ____ thigh, can be given through clothing, hold pen in place for ____ seconds, seek immediate medical care after

m: can an epipen be reused/refilled (yes/no)

n: an extra epipen should be available bc medication can ___ ___

o: patients allergic to penicillin may also have cross sensitivity to which drug class?

p: products to be avoided whilst taking penicillin: caffeine beverages, citrus, fruit, tomato

q: nurses should assess for history of ___ ___ prior to administering penicillin

r: penicillin may reduce effective of ___ ___

carbapenems, cephalosporins, penicillins, unsays, augmentin, timentin, zosyn, beta-lactamase, penicillin, destruction, beta-lactamase, allergic, urticaria, pruritus, stop, report, anaphylactic reaction, epinephrine, outer, 3, no, wear off, cephalosporins, penicillin allergy, oral contraceptives

*cephalosporins

a: cephalosporins are chemically very similar to which antibiotics?

b: cephalosporin drug names usually begin w/ cef-, ceph-

c: MOA: cephalosporins affect the ____ ___ , making it defective and unstable

d: are cephalosporins bactericidal or bacteriostatic?

e: cephalosporins are used to treat infections such as otitis media, pharyngitis, tonsillitis, respiratory, urinary infections

f: cephalosporins are divided into how many generations:

g: as cephalosporin generation increases, gram-____ coverage ____

penicillins, cell wall, bactericidal, 5, negative, increases

*1st gen - cephalosporins

a: generally stronger against gram-___ bacteria

b: destroyed by ___-____

c: common uses: surgical prophylaxis & otitis media

d: examples: cephalexin (reflex) & cefazolin (ancef)

positive, beta-lactamases

*2nd gen cephalosporins

a: 2nd gen have better gram-_____ coverage than 1st gen

b: they are less sensitive to destruction by ____

c: cefoxitin is which gen of cephalosporin?

• other examples: cefaclor, cefprozil, cefoxitin, cefuroxime, cefotetan

negative, beta-lactamases, second

*3rd gen cephalosporins

a: third-gun cephalosporins are considered ___ -spectrum

b: which 3rd gen cephalosporin can reach cerebrospinal fluid to treat meningitis?

c: ex of cephalosporins: ceftriaxone, cefotaxime, cefdinir, cefixime, ceftazidime

broad, ceftriaxone

*4th gen cephalosporins

a: 4th gen cephalosporins are effective against BOTH gram-___ and gram ____ bacteria (alpha order)

b: they are useful against ______ and often used for m___

ex: cefepime

negative, positive, pseudomonas, meningitis

*5th gen cephalosporins

a: which cephalosporin is effective against MRSA?

ceftaroline

a: cephalosporins should not be given to patients w/ a history of ____ reactions to _____

b:: signs of allergic reaction to cephalosporins include:

• ______ (rash/hives) and ______ (itching)

c: cefazlin and cefotetan should NOT be taken with what beverage?

d: mixing alcohol with these drugs may cause a _____-like reaction

• symptoms of this reaction: stomach cramps, headache, vomiting, diaphoresis, hypotension, tachycardia

e: antacids and _____ decrease the effectiveness of cephalosporins

f: cephalosporins may reduce the effectiveness of ____ ____

severe, penicillin, urticaria, pruritus, alcohol, disulfiram, iron, oral contraceptives

*Misc antibiotics:- *Clindamycin

a: what is the serious risk associated w/ clindamycin? ____ ____

b: pseudomembranous colitis is caused by overgrowth of _ ____

c: what symptom must be reported immediately while taking clindamycin? persistent ____

d: clindamycin’s mechanism of action is inhibition of bacterial _____

e: clindamycin is primarily (bacteriostatic/bactericidal) - stops growth (hint)

f: at high doses, clindamycin may become (bacteriostatic/bactericidal)

g: clindamycin belongs to the ____ class

h: clindamycin is used to treat chronic ___ infections

pseudomembranous colitis, C. diff, diarrhea, protein synthesis, bacteriostatic, bactericidal, lincosamides, bone

*Misc Antibiotics - Nitrofurantoin:

a: what is nitrofurantoin often used for?

b: adverse effects: Gi distress (take with food), may cause harmless dark yellow or brown color urine + pulmonary toxicity (cough, chest pain, dyspnea)

• liver toxicity: (increased/decreased) liver (ALT/AST) tests, hepatitis, jaundice

c: patient teaching: What to teach regarding how to take the medication and the effect on urine?  

• Increase fluid intake upon taking nitrofurantoin

• May cause harmless dark yellow or brown color urine

UTIs, increased

• Misc antibiotics: Phenazopyridine:

a: what is phenazopyridine (Pyridium) used for? relief of pain for _____

b: what does phenazopyridine do to urine color? turns urine red and ___

c: what are the teaching points? take ____ meals to reduce GI upset + headaches may occur

bladder, orange, after

*misc antibiotics: linezolid

a: when is linezolid used? to treat multi-drug resistance gram-_____ bacteria (example: vancomycin)

b: what foods to avoid while on linezolid? _____ containing foods (cheese, wine, soy sauce, smoked cured meats/fish)

c: what can happen if they eat pepperoni and cheese? may cause ____ reactions

positive, tyramine, hypertension

a: cyclosporines are classified as an _____ drug. (hint: suppresses immunity)

b: cyclosporines mechanism of action is inhibition of __-___ activity.

c: cyclosporine is used to prevent _____ transplant rejection

d: cyclosporine is also used to treat certain _____ conditions

e: a major adverse effect of cyclosporine is _____ toxicity

• also increased risk of infections, risk of malignancies, tremors

f: cyclosporine increases the risk of _____

g: long-term use of cyclosporine increases the risk of _____

h: a common neurologic adverse effect of cyclosporine is ____

i: cyclosporine is often given concurrently with a _____

j: patients taking cyclosporine should avoid _____ juice

k: what is the potential effect of St. johns wort? for example..

• does it lower or raise cyclosporine levels?

• this is bad bc it risks organ transplant rejection

L: what are some nephrotoxic drugs? : cyclosporine, aminoglycosides, amphrotericin B, NSAIDS

immunosuppressant, t cell, organ, autoimmune, nephro- , infections, malignancies, tremors, glucocorticoid, grapefruit, lower