NRSG 220 Week 1: Antibiotics for bacterial infection

vancomycin mechanism of action

- bacteriocidal

- inhibits cell wall synthesis

vancomycin primary use

- reserved for severe pr gram positive infections

- MRSA, c. diff

ADR of vancomycin

ototoxicity, nephrotoxicity, red man syndrome, confusion/hallucinations, anaphylaxis

ways to prevent AROs

- use single, specific abx

- teach pt to take full course of abx

- do not save/share

- do not tx viral infections

- do not overprescribe

- C&S prior tp tx is preferred

what is methylicillin-resistant staphylococcus aureus (MRSA) resistant to

fluoroquinolones, macrolides, tetracyclines, ahminoglycosides

how do superinfections start

- abx destroy sensitive bacteria

- only insensitive (mutated) bacteria remain

- host flora killed

- mutate bacteria are free from competition and thrive

- patient develops infection to resistant bacteria that be be transmitted to others

s/s superinfections

diarrhea, bladder pain, painful urination, abnormal vaginal discharge, red rashes with satellite lesions

role of nurse in sulfonamide treatment

- assess for anemia/hematological disorder

- assess renal function - increased risk of crystalluria (increase fluids)

- ensure if on OCP pt uses alternative BC

sulfonamide prototype drug

trimethoprim/sulfamethoxazole (tmp/smz)

trimethoprim/sulfamethoxazole mechanism of action

kill bacteria by inhibiting metabolism folic acid

trimethoprim/sulfamethoxazole primary use

broad spectrum for UTIs, pneumocystitis, pneumonia and bronchitis

trimethoprim/sulfamethoxazole ADRs

skin rash, n/v, agranulocytosis, thrombocytopenia, photosensitivity

What is a consequence of widespread use of sulfonamides?

Increased resistance

What is a common use of sulfonamides in combination therapy?

To treat UTIs

What anti-inflammatory properties do sulfonamides have?

Used to treat rheumatoid arthritis (RA) and ulcerative colitis

Why should sulfonamides be avoided during pregnancy?

They are teratogenic and can cause birth defects

What does a reaction to sulfonamide antibiotics indicate?

Possible allergy to other sulfonamides, such as DM meds, NSAIDs, diuretics, and IBD meds

What should be considered when administering sulfonamide antibiotics to patients with allergies?

Caution with the first dose due to potential sensitivity

fluoroquinolones cautions

- norofloxacin may cause photophobia

- may effect tendons

- monitor for dysrhythmias

- enter into breast milk

How much does the effectiveness of fluoroquinolones decrease if taken with multivitamins or minerals?

90%

What is the equivalence of IV and oral administration for fluoroquinolones?

IV = PO, easy to transition to home

Why should fluoroquinolones be avoided in children and athletes?

Risk of tendon rupture

What serious gastrointestinal condition can fluoroquinolones cause?

C. diff infection

What cardiac risk is associated with fluoroquinolones?

QT prolongation and arrhythmias

aminoglycoside characteristics

- more toxic than most abx

- potential to cause serious ADRs

- last name similar to macrolides

amino glycoside serious ADR

ototoxicity, nephrotoxicity, neuromuscular blockage

What should a nurse monitor when administering erythromycin?

Watch liver function.

What can occur due to multiple drug interactions with macrolides?

Macrolides can affect CYP enzymes.

What should a nurse monitor for in patients with heart disease taking macrolides?

Monitor for exacerbations.

What side effect can macrolides cause in patients?

A metallic taste in the mouth.

What effect do tetracyclines have on oral contraceptive pills (OCP)?

They decrease the effectiveness of OCP.

What is a potential risk when taking tetracyclines with oral contraceptive pills?

Increased risk of vaginal yeast infection.

What conditions require close monitoring with tetracycline therapy

kindly and liver impairment

When should tetracyclines be taken for increased absorption?

On an empty stomach.

What should tetracyclines not be taken with?

Milk, iron supplements, magnesium-containing laxatives, or antacids.

What should nurses watch for when a patient is on tetracyclines?

Supra infections and photosensitivity

What should nurses assess for in patients taking cephalosporins?

History of bleeding disorders, renal and hepatic function (especially in elderly)

why is assessment of bleeding disorder important for cephalosporin therapy

They decrease prothrombin levels

What should nurses monitor for in children taking cephalosporins?

Diarrhea

What should patients avoid while taking cephalosporins?

Alcohol

What reaction can occur if alcohol is consumed with cephalosporins?

Disulfiram-like reaction

What should nurses assess regarding a patient's previous reactions?

Assess previous reactions to penicillins.

What should nurses avoid if a patient has a history of penicillin allergy?

Avoid cephalosporins.

What electrolyte imbalances should nurses watch for in patients on penicillin?

Watch for hyperkalemia and hypernatremia.

In which patients is the risk of hyperkalemia and hypernatremia increased?

Increased risk with diabetes mellitus or if the patient is on dialysis.

What should nurses monitor in relation to cardiac status when administering penicillin?

Monitor cardiac status for ECG changes.

abx classes

Sulfonamides

Penicillins

Cephalosporins

Macrolides

Fluoroquinolones

Aminoglycosides

Tetracyclines

miscellaneous

considerations for all abx

- teach pt to finish all abx

- dp not share

- keep away from kids

- decreased effectiveness of OCP

- teach when o take with food/when to avoid

- wear medical alert bracelet if allergic

- inform as to SE

- take probiotics

- inform about s/s of allergic reaction

- n/v/d

- watch skin, ears, kidneys and drink lots of water

What is the primary goal of antibiotics?

To eliminate pathogens

How do antibiotics affect bacteria?

They affect bacterial structure, metabolism, or life cycle

In what situation can antibiotics be used as prophylaxis?

For people with suppressed or compromised immune systems

What are the two classifications of antibiotics based on their action?

Bacteriostatic or bactericidal

tetracyclines end in

-cycline

penicillins end in

-cillin

Cephalosporins start with

cef-, ceph-

Fluoroquinolones end in

-floxacin

Sulfonamides end in

- azole or - azine

Aminoglycosides end in

-mycin, -micin (same as macrolides)

macrolides end with

-mycin (same as aminoglycosides)

example of aminoglycosides

gentamicin, tobramycin

examples of macrolides

Erythromycin, azithromycin, clarithromycin

carbapenems end in

-penem