Drug Therapy for the Treatment of Infection Pt. 1

infection

occurs when microorganisms invade host, attach to host cell receptors and multiply, and stimulate the body’s immune response

bacteria, viruses, fungi, parasites

what cause infection? (4)

fever, chills, sweats, diffuse myalgia, tachycardia, fatigue, malaise, lethargy, tachypnea, altered mental status, hypotension (septic shock)

what are some systemic s/sx of infection? (11)

diffuse myalgia

muscle aches and pains

pain, erythema, edema, heat, exudate

what are local s/sx of infection? (5)

WBC, cultures, lactate

what are 3 labs we look at for infections?

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

what are host factors that increase risk of infection? (9)

streptococcus pneumoniae

common cause of pneumonia

UTI

e coli can commonly cause what?

staph aureus

this bacteria is commonly found in skin infections and open wounds

1. obtain detailed exposure history (travel, work, etc)

2. determine the site of infection

3. define the host characteristics (child, adult, chronic illness, etc)

4. establish a microbial diagnosis (cultures)

steps to forming an accurate diagnosis (4 bullets)

bactericidal

causes death and disruption of the bacterial cell

bacteriostatic

inhibits bacterial replication - inhibit protein synthesis

infection control practices (ex. hand hygiene), diet (healthy, low sugar), take all prescribed doses, discard all discontinued drugs, what side effects to expect, report allergic reactions

what are basic patient education for all antibiotics? (6)

kidney damage, neurotoxicity (ototoxicity, complete neuromuscular blockage/seizures), hypersensitivity reactions, GI toxicity, superinfections

what are the most common adverse reactions to anti-infective therapy? (5)

A.

The nurse is preparing to administer an anti-infective agent to the patient. The nurse knows treatment is effective when which of the following occurs?

A. improvement in symptoms
B. fever increased from 37.5 C to 38.2 C
C. urine output 120 ml in 8 hours
D. pt. complains of abdominal pain and constant diarrhea

24-36 hours

we want to see improvement in symptoms ______ after the antibiotic is started

aminoglycosides

antibiotics that inhibits protein synthesis of many gram - bacteria; very potent

aminoglycosides

this antibiotic is used for serious infections: sepsis, respiratory/UTI, and intra-abdominal

True

True or False: aminoglycosides are often used in combination therapy

aminoglycosides

this antibiotic has a very narrow therapeutic index

gentamicin, neomycin, amikacin, tobramycin, streptomycin

what are the 5 main aminoglycosides (only need bold for test)?

GNATS

acronym to remember the aminocglycosides

nephrotoxicity & ototoxicity (BBW), CNS effects (peripheral neropathy), renal effects, GI effects, cardiac effects (edema)

what are the adverse effects of aminoglycosides? (5)

decreased urine output and increased BUN/creatinine

what are things to watch for to indicate nephrotoxicity?

renal/hepatic dysfunction, pre-existing hearing loss, active infection w/herpes, myasthenia gravis/parkinson’s, pregnancy

what are contraindications/use with caution for aminoglycosides (5)

if given with penicillin, do not mix medications or IV tubing and give penicillin 1 hours before or after the aminoglycoside (the penicillin deactivates the amino at peak); urinalysis/BUN/Cr, appropropriately timed peak & trough concentrations; infection s/sx, hearing test

what are nursing implications for aminoglycosides? (5)

beta-lactam antibacterial agents

a widely prescribed group of antibiotics that destroy the cell wall of bacteria

beta-lactamase inhibitor

beta-lactam antibacterials are often given with this to help fight against resistant bugs

Bactrim

this is a combination of trimethoprim and sulfamethoxazole (a beta-lactam and beta-lactamase inhibitor)

Augmentin

this is a combination of amoxicillin and clavulanate (a beta-lactam and beta-lactamase inhibitor)

carbapenems, cephalosporins, monobactams, penicillin

what are the 4 subclasses of beta-lactam antibacterials?

penem

carbapenems end in…

meropenem, ertapenem, imipenem

what are 3 examples of carbapenems (beta lactam subclass)

carbapenems

this is a beta-lactam subclass that is broad spectrum and best used in infections with bacteria that are resistant to other drugs

IV & IM

carbapenems are given… (2) (pharmacokinetics)

GI effects (diarrhea → pseudomembranous ulcerative colitis), CNS effects (seizures), renal effects, superinfections

what are some adverse effects of carbapenems? (4)

kidney dysfunction, inflammatory bowel disease, no IM in severe shock or AV block d/t lidocaine, known carbapenem/penicillin/cephalosporin allergies

what are contra/use with caution for carbapenems? (4)

cross sensitivity

allergy to another drug class with similar chemical structure

monitor EKG, give IM with lidocaine, seizure precautions (padding, suction)

what are nursing notes for carbapenems? (3)

cephalosporins

this drug subclass comes in generations

cefazolin, cephalexin, cefuroxime, ceftriaxone, cefepime, ceftaroline

what are 6 exampels of cephalosporins?

cephalosporins

this subclass us broad spectrum to treat many infections and most often used prophylactically for pre and post op

PO, IV, IM

what are the pharmacokinetics for cephalosporins?

GI effects, renal effects (give lower dose), bleeding risk, superinfections

what are the adverse effects of cephalosporins? (4)

known cephalosporin/penicillin/carbapenem allergies, renal dysfunction (adjust dose)

contraindications/use with caution for cephalosporins (2)

monitor CBC (Hgb/Hct) and monitor patients on anticoagulants

nursing notes for cephalosporins (2)

cephalosporins

this subclass depletes the gut flora of vitamin K which helps with clots

aztreonam

this is the only monobactam

IV, IM, inhalation

pharmacokinetics for aztreonam (monobactam)

aztreonam

this medication is used for gram negative bacteria and cystic fibrosis inhalation

bronchodilator first, wait 30 min, mucolytic second, wait 30 minutes, aztreonam

steps to taking aztreonam

rash (not allergy), GI effects (pharyngeal pain), localized thrombophlebitis (hard on veins when IV)

adverse reactions for aztreonam (3)

no cross allergy with other beta lactams!

nursing notes for aztreonam (1)

penicillin, amoxicillin, ampicillin, piperacillin (with tazobactam)

what are 4 examples of penicillins?

piperacillin with tazobactam (Piptaz or Zocin)

this pencillin is very common for sepsis and is often combined with a beta-lactamase inhibitor

penicillins

this subclass is the most commonly prescribed antibiotic and is a broad spectrum

IV, IM, PO

pharmacokinetics for penicillins

penicillins

this antibiotic has the highest rate of hypersensitivity

hypersensitivity, GI effects, renal effects (interstitial nephritis) with high doses, CNS effects (confusion, lethargy), BBW (penicillin G can cause cardiac arrest when given accidentally)

adverse effects of penicillins (5)

allergies to pencillins/cephalosporins/carbapenems, renal dysfunction (adjust dosing)

contraindications or use with caution for penicillins (2)

if given with aminoglycosides, do not mix medication or IV tubing and give pencillin 1 hour before or after the aminoglycoside

nursing note for penicillins (1)

ciprofloxacin and levofloxacin

what are two examples of fluoroquinolones?

fluoroquinolones

this antibiotic is used sparingly because it is very potent and has a lot of resistant bugs; it treats complicated UTIs, systemic infections, and chronic bacterial infections; has serious adverse effects

PO or IV

pharmacokinetics for fluoriquinolones

tendonitis/tendon rupture (BBW), CNS effects (muscle weakness), GI/Enddocrine effects (hyper/hypoglycemia in diabetics), skin effects (severe photosensitivity), cardiac effects (QT prolongation); risk of complications higher if over 60 with comorbidities

adverse effects for fluoroquinolones (5)

renal dysfunction, myasthenia gravis, not for patients <18, QT prolonging medications

contraindications/use with caution for fluoroquinolones (4)

educate sunscreen/long sleeves, monitor EKG/QT, monitor blood glucose

nursing notes for fluoroquinolones

B.

The patient is receiving Ciprofloxacin. The nurse is most concerned if the patient complains of which of the following symptoms?

A. diarrhea and mild abdominal pain
B. achilles tendon pain and redness
C. Blood glucose of 140 mg/dL
D. Urine output 500 ml in 8 hours

C.

The patient is receiving Gentamicin. The nurse is most concerned with which of the following complaints?

A. N/V
B. numbness and tingling in extremities
C. tinnitus and difficulty hearing
D. Temperature of 36 C