Chapter 15 (Part 1) Drugs Affecting Inflammation and Infection

What is an infection?

When a microorganism invades a host, attaches to host cell receptors, and multiplies in sufficient numbers to cause injury.

What happens after the body recognizes an infection?

An immune response occurs to fight the infection.

What types of microorganisms can cause infection?

Bacteria, viruses, fungi, and parasites. (BUGS)

What does the professor mean by "bugs"?

Microorganisms that can cause infection.

What are systemic signs and symptoms of infection?

Fever, chills, sweats, diffuse myalgia, tachycardia, fatigue, malaise, lethargy, tachypnea, altered mental status, and hypotension.

What does hypotension during a severe infection indicate?

Septic shock.

What are local signs and symptoms of infection?

Pain, erythema or discoloration, edema, heat, and exudate.

What can happen to WBCs during an infection?

WBCs may be increased or very low.

What host factors increase the risk of infection?

Impaired skin integrity, impaired blood supply, neutropenia, malnutrition, poor hygiene, suppression of normal bacterial flora, immune system suppression, diabetes mellitus, and advanced age.

Why does neutropenia increase infection risk?

The patient has low white blood cells, reducing the body's defense against infection.

Do we treat viruses with antibiotics?

No. We don't treat viruses with antibiotics.

What is the correct order regarding cultures and antibiotics?

Get cultures first, then start antibiotics.

Why must cultures be obtained before antibiotics?

Antibiotics can affect the culture and produce false results.

What are the steps toward an accurate diagnosis of infection?

Obtain a detailed exposure history, determine the site of infection, define host characteristics, and establish a microbial diagnosis.

What does bactericidal mean?

Causes death and disruption of the bacterial cell.

What does bacteriostatic mean?

Inhibits bacterial replication/protein synthesis.

If symptoms do not improve after starting an antibiotic, what is a concern?

Antibiotic resistance.

Are aminoglycosides often used alone or in combination therapy?

Often in combination therapy.

What does a narrow therapeutic index mean for aminoglycosides?

The drug can become toxic easily.

What mnemonic did the professor give for aminoglycosides?

"a-MEAN-oglycosides."

What are examples of aminoglycosides?

Gentamicin

What is the BLACK BOX WARNING for aminoglycosides?

Nephrotoxicity and ototoxicity.

What CNS effect can aminoglycosides cause?

Peripheral neuropathy, causing numbness and tingling.

What cardiac effect can aminoglycosides cause?

Edema.

What conditions require caution with aminoglycosides?

Renal/hepatic dysfunction, pre-existing hearing loss, active herpes infection, myasthenia gravis/parkinsonism, and pregnancy.

If aminoglycosides are given with penicillin, can they be mixed together?

No.

How should penicillin and an aminoglycoside be timed?

Give penicillin 1 hour before or after the aminoglycoside.

What should be monitored with aminoglycosides?

Urinalysis, BUN/Cr, appropriately timed peak and trough concentrations, infection signs/symptoms, and hearing.

What are beta-lactams often combined with?

A beta-lactamase inhibitor.

What are the subclasses of beta-lactams?

Carbapenems, cephalosporins, monobactams, and penicillins.

What are examples of carbapenems?

Meropenem

What serious GI condition are carbapenems associated with?

Pseudomembranous ulcerative colitis.

What CNS adverse effect can carbapenems cause?

Seizures.

What renal adverse effect can carbapenems cause?

Kidney damage.

What superinfection is associated with carbapenems?

C. diff.

What are examples of cephalosporins?

Cefazolin, cephalexin, cefuroxime, ceftriaxone, cefepime, and ceftaroline.

What important adverse effect is associated with cephalosporins?

Bleeding risk—think coagulation.

What superinfection is associated with cephalosporins?

C. diff.

What should be monitored in patients receiving cephalosporins?

CBC, including hemoglobin and hematocrit.

Which patients need special monitoring with cephalosporins?

Patients taking anticoagulants.--> blood thinners

What is unique about aztreonam?

It is the only monobactam.

What is the inhalation order for aztreonam in cystic fibrosis patients?

Bronchodilator → wait 30 minutes → mucolytic → wait 30 minutes → aztreonam.

Does aztreonam have cross-allergy with other beta-lactams?

No. It is the only beta-lactam that does not have that cross-sensitivity concern.

What are examples of penicillins?

Penicillin, amoxicillin, ampicillin, and piperacillin with tazobactam.

What is a major adverse effect of penicillins?

Hypersensitivity.

What renal effect can high-dose penicillin cause?

Interstitial nephritis.

What CNS effects can penicillins cause?

Confusion and lethargy.

What can Penicillin G cause according to the lecture's black box warning?

Cardiac arrest.

If penicillin is given with an aminoglycoside, what should the nurse do?

Do not mix the medications; give penicillin 1 hour before or after the aminoglycoside.

What are examples of fluoroquinolones?

Ciprofloxacin and levofloxacin.

What is the BLACK BOX WARNING for fluoroquinolones?

Tendonitis and tendon rupture.

What CNS effect can fluoroquinolones cause?

Muscle weakness.

What glucose effects can fluoroquinolones cause in diabetic patients?

Hyperglycemia or hypoglycemia.

What skin effect can fluoroquinolones cause?

Severe photosensitivity.

What cardiac effect can fluoroquinolones cause?

QT prolongation.

Who should not receive fluoroquinolones

Patients under 18 years old.

What nursing education is important for fluoroquinolones?

Sunscreen and long sleeves.

What should the nurse monitor with fluoroquinolones?

EKG/QT and blood glucose