Antibiotics

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latarsha
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11962
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Antibiotics
Updated:
2010-03-28 21:07:04
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medicine antibiotics
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Exam 4
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  1. What are the actions of antibiotics (2)
    • 1. Bactericidal: Kill Bacteria
    • 2. Baceriostatic: Inhibits growth of susceptible bacteria, rather than killing them immediately; will eventually lead to bacterial death.
  2. What was one of the first groups of Antibiotics
    sulfonamides
  3. What is a clue of recognizing Sulfonamides
    • Sulfonamides begins with sulf
    • 1 sulfadiazine
    • 2 sulfamethoxazole
    • 3 sulfisoxazole
  4. What antibiotic is usually combined with sulfonamides
    Trimethoprim
  5. what are some mechanisms of actions of sulfonamides
    • 1. bacteriostatic action
    • 2. prevent synthesis of folic acid required for synthesis of purines and nucleic acid
    • 3. do not affect human cells or certain bacteria (they can use performed folic acid)
    • 4. only affect organisms that synthesize their own folic acid
  6. what are some indications of sufonimides
    • Treatment of UTI's caused by susceptible strains of:
    • Enterobacter spp, Escherichia coli (from bile or stool), Klebsiella spp, proteus mirabillis, proteus vulgaris, staphylococcus areus
  7. what are some more indications of sulfonimides
    • 1. pnemocystis jiroveci pneumonia (pjp) pneumonia (complication HIV pt.'s get)
    • 2. upper respiratory tract infections
    • 3. other uses also
  8. what are some different combinations of sulfonamides (2 types)
    single and combination drugs
  9. what are some adverse effects of sulfonamides
    1 anemia 2 photosensitivity (tell pt. to stay out of sun 3 steven johnson (immune problems)
  10. B-Lactam Antibiotics what are the 4 kinds
    • 1. Penicillins
    • 2. Cephalosporins
    • 3. Carbapenems
    • 4. Monobactams
  11. what is a clue to know the antibiotic is a penicillin
    they end in cillins ex: Aminopenicillins
  12. what antibiotic are also called B-lactams
    Penicillins
  13. What should be known about Penicillins
    • 1 Bactericidal
    • 2 Kill a wide variety of bacteria
  14. what produce enzymes capable of destroying penicillins
    bacteria
  15. what are the enzymes produced that are capable of destroying penicillins
    B-lactamases (as a resul this medicine is not effective)
  16. Chemicals have been developed to inhibit the enzymes that destroy penicillins, what do these chemicals do
    bind with B-lactamase and prevent the enzyme from breaking down the penicillin, thus makin the drug more effective.
  17. penicillin is also a combination drug combined with what
    B-lactamase inhibitor ex: piperacillin+tazobactam =zosyn
  18. What are some indications of penicillins
    • prevention and treatment of infections caused by susceptible bacteria, such as
    • 1 Gram-positive bacteria
    • 2 Streptococcus spp. Enterococcus spp, Staphylcoccus spp
  19. How does penicillin enter the bacteria
    via the cell wall
  20. what are some adverse effects of penicillin
    Allergic reactions occur in 0.7% to 4% of cases (Urticaria, pruritus, angioedema)
  21. cross reactivity between penicillins and cephalosprins is what
    between 1% and 18%
  22. can penicillin cause anaphylaxis
    yes
  23. what are some interactions of penicillin with other drugs
    • There are many interactions
    • 1. NSAIDS
    • 2. Oral contraceptives (can get pregnant if on these and penicillin. contraceptives are not effective)
    • 3. Warfarin (do not give with penicillin)
    • 4. others
  24. what is the 2nd most common antibiotic
    cephalosporins
  25. cephalosporins has what kind of action
    bactericidal action (kills bacteria)
  26. How are cephalosporins divided
    divided into groups according to their antimicrobial activity (Lots of groups)
  27. How many generations do cephalosporins have
    4
  28. 1st generation of cephalosporins are used for what
    used for surgical prophylaxis, URIs, otitis media
  29. 2nd generation of cephalosporins are used for what
    used prophylactically for abdominal or colorectal surgeries
  30. 3rd generation cephalosporins
    most potent group against gram-negative less active against gram positive
  31. 3rd generation cephalosporins ceftriaxone (Rocephin) is used for what
    • 1. IV and IM, long half-life, once a day dosing
    • 2. elimination is primarily hapatic
    • 3. easily passes meninges and diffused into csf to treat cns infections
  32. what is the newest cephalosporin drug
    4th generation cephalosporins
  33. which cephalosporin has a broader spectrum of antibacterial activity than third generation, especially against gram-positve bacteria
    4th generations cephalosporins. (we may see and order for C and S prior to administering this drug)
  34. what are some adverse effects of cephalosporins
    • similar to penicillins
    • mild diarrhea, abdominal cramps, rash, pruritis (itching), redness, edema
    • potential cross sensitivity with penicillins if allergies exist
  35. what are the implications of Carbapenems
    • 1. very broad-spectrum antibacterial action
    • 2. reserved for complicated body cavity and connective tissue infections
    • 3. may cause drug-induced seizure activity
    • 4. all given parenterally
  36. carbapenems are used for what
    used for treatment of bone, joint, skin, and soft tissue infections (cellulitis) (many other uses)
  37. Monobactams are used for what
    • 1. bactericidal
    • 2. used for moderately severe systemic infections and UTIs
  38. macrolides what are the mechanisms of action
    • 1. prevent protein synthesis within bacterial cells
    • 2. considered bacteriostatic
    • 3. bacteria will eventually die
    • 4. in high enough concentrations, may also be bactericidal
  39. what are some diseases macrolides are used for
    • 1. strept infections
    • 2. mild to moderate URI and LRI
    • 3. syphilis and lyme disease
    • 4. gonorrhea, chlamydia mycoplasma
  40. what is a clue for macrolides
    the drug is usually followed by the word mycin EX: azithromycin and clarithromycin
  41. macrolides are antibiotics used in what type of patients
    infections associated with HIV/AIDS
  42. what are some adverse effects of macrolides
    • 1. GI effects, primarily with erythromycin
    • 2.nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia
  43. with the newer drugs (macrolides) azithromycin and clairthromycin what should be known about the adverse effects
    fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration
  44. Ketolide is used for what
    • S. pneumoniae (mrsa)
    • active against selected gram-negative bacteria
  45. Ketolide is indicated for what
    indicated for community acquired pneumonia, acute bacterial sinusitis, bacterial exacerbations of chronic bronchitis
  46. what are some adverse effects of Ketolides
    headache, dizziness, GI discomfort, altered potassium levels, prolonged QT intervals
  47. what are some contraindications of ketolides
    cardiac disease (with prolonged QT) or bradycardia
  48. Tetracyclines what is a clue
    it ends in cline
  49. what does tetracycline binds to
    Ca, Mg, Aluminum to form insoluble complexes
  50. what does tetracyclines do
    bacteriostatic (inhibits bacterial growth)
  51. what is important to know about tetracyclines
    • 1.dairy products, antacids and iron salts reduce oral absorption of tetracyclines
    • 2. should not be used in children under age 8 or in pregnant/lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth
  52. what are some indications of tetracyclines
    • gram negative and gram positive organisms
    • pleural and pericardial effusions
  53. what are some adverse effects of tetracyclines
    • 1. strong affinity to calcium
    • 2. dicoloration of permanent teeth and tooth (enamel in fetuses and children, or nursing infants if taken by the mother)
    • 3. may retard fetal skeletal development if taken during pregnancy
  54. adverse effects of tetracyclines, if the intestinal flora is altered what may happen
    • 1. Superinfection (overgrowth of nonsusceptible organisms such as candida)
    • 2.diarrhea
    • 3. pseudomembranous colitis
    • 4. cause C-Diff (big thing)
  55. what are some more adverse effects of tetracyclines we may see
    • 1. vaginal candidiasis
    • 2. gastric upset
    • 3. enterocolitis
    • 4. maculopapular rash
    • 5. other effects
  56. b4 beginning antibiotice therapy what should be assessed
    • assess drug allergies, renal, liver and cardiac functiion and other lab studies
    • assess for conditions that may be contraindicated to anitbiotic use or that may indicate cautious use
    • assess for potential drug interactions
    • (Nurses should always do this)
  57. what are some signs and symptoms that should be assessed when giving antibiotic therapy
    assess for signs and symptoms of superinfection: fever, perineal itching, cough lethargy, or any unusual discharge
  58. what are the most common adverse effects of antibiotics
    nausea, vomiting and diarrhea
  59. all oral antibiotics are absorbed better how
    If taken with at least 6 to 8 ounces of water
  60. Sulfonamides especially should be taken how
    • should be taken with at least 2000 ml of fluid per day, unless contraindicated
    • oral forms should be taken with food or milk to reduce GI upset
  61. How should penicillin be taken
    • taken with water no juice
    • the effectiveness of oral penicillins is decreased when taken with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice; administer with at least 6 ounces of water
  62. any patient taking penicillin should be monitored for what
    carefully monitored for an allergic reaction for at least 30 minutes after its administration
  63. how should cephalosporins be taken
    orally administered forms should be given with food to decrease GI upset, even though this will delay absorption
  64. some cephalosporins may cause what when taken with alcohol
    disulfiram (Antabuse)
  65. Which antibiotic is highly protein bound and will cause severe interactions with other protein bound drugs
    macrolides
  66. (Macrolides) what should we know about how this is absorbed
    the absorbsion of erythromycin is enhanced when taken on an empy stomach but because of the high incidence of GI upset, many drugs are taken after a meal or snack
  67. what should we know about taking tetracyclines
    milk products, iron preparations, antacids and other dairy products should be avoided because of the chelation and drug bindin that occurs
  68. how should tetracyclines be taken
    all meds should be taken with 6 to 8 ounces of fluid, preferably water
  69. what should are patients know about taken tetracyclines and tanning
    due to photosensitivity avoid sunlight and tanning beds
  70. when giving antibiotic therapy what should nurses monitor for
    • monitor for therapeutic effects
    • improvement of signs and symptoms of infection
    • return to normal vital signs
    • negative culture and sensitivity test
    • disapperance of fever, lethargy, drainage, and redness
    • monitor for adverse reactions
  71. Vancomycin is used for what
    treatment of choice for MRSA
  72. What does Vancomycin do
    • Natural, bactericidal antibiotic
    • destroys cell wall
    • treatment of choice for MRSA and other gram positive infections
  73. How should Vancomycin be given
    give over 60 minutes (slow)
  74. what should be monitored when giving Vancomycin
    monitor blood levels to ensure therapeutic levels and prevent toxi
  75. Vancomycin may cause what adverse effects
    ototoxicity and nephrotoxicity
  76. How is vancomycin administered
    IV over 60 minutes
  77. what syndrome might vancomycin cause
    • redman syndrome may occur (flushing/ itching of head, face, neck, upper trunk)
    • Antihistamines may be ordered to reduce these effects
  78. to prevent nephrotoxicity when giving vancomycin what should be done
    ensure adequate hydration (2 L fluids/24 hours) If not contraindicated to prevent nephrotoxicity

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