NRS 112 Antimicrobials
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- Kills organisms
- Used only on non living objects.
Inhibits growth of microorganisms but does not neccessarily kill them.
Applied exclusively to living tissue.
Kills or destroys microorganisms
Retards growth of microorganisms
used by bacteria to destroy PCN
breaks down structure of the ABX and inactivates the drug
Severe hypersensitivity reaction
Inflammation of skin and mucous membranes progressing to necrosis. Can progress to lining of organs.
Secondary infections during ABX tx.
Located in groin, axilla, mouth, unber breast tissue, ANY WARM MOIST AREA.
Caused by yeast/bacteria.
Broad spectrum ABX
Effective against Gram neg and Gram pos.
Includes carbapenems, extended spectrum cephalosporins, beta-lactam/beta-lactamase inhibitors, fluoroquinolones.
Narrow spectrum ABX
Effective against limited number of microorganisms.
PCN G, Macrolides, Nitrofurantoin, Metronidazole, Aztreonam, Nalidixic Acid.
Sulfadiazine, Sulfamethoxazole, Sulfisolxazole
Often combined w/ other ABX - combined with trimethoprim = Bactrim or Septra
- Effective against Gram pos and neg
- Used to tx UTI's and URI's.
Sulfonamides: Mechanisms of Action
Prevents synthesis of Folic Acid
Does not effect human cells or certain bacteria, only organisms that synthesize their own folic acid
Sulfonamides: Adverse effects
Hemolytic or aplastic anemia, thrombocytopenia, agranulocytosis, photosensitivity, exfoliative SJS, epidermal necrosis, n/v/d, pancreatitis, convulsions, crystalluria, toxic neprhosis, h/a, peripheral neuritis, urticaria.
- Bacteriocidal: inhibit cell wall synthesis
- Effective against wide variety of bacteria.
PCN G, PCN V K+.
Penicillinase resistant drugs
Cloxacillin, dicloxacillin, nafcillin, oxacillin.
Extended spectrum drugs
Piperacillin, ticarcillin, barbenicillin
Usually used with other drugs, rarely used alone.
Penicillin lactamase inhibitor combinations
Unasyn - Ampicillin + sulbactam
Augmentin - Amoxicillin + clavulanic acid
Timentin - Ticarcillin + clavulanic acid
Zosyn - Piperacillin + tazobactam
Enter via cell wall, disrupt normal bacterial cell synthesis.
Does not kill other cells in body
Prevention and tx of Gram pos, streptococcus, Enterococcus, Staphylococcus bacteria.
PCN adverse effects
Allergic reactions in .7 - 4% of cases.
Allergic to PCN = four to sixfold higher risk of allergy to other beta-lactam ABX
NSAIDs, oral contraceptives, Warfarin (enhances anticoagulant effect r/t decrease in intestinal flora)
Producing vitamin K
Nursing considerations for PCN
Take with full glass of water
Don't skp doese
Take all as prescribed
Notify MD of adverse reactions
Structurally/pharmacologically r/t PCN
First Generation Cephalosporins
Good gram pos coverage/poor gram neg coverage.
Cefadroxil, cephradien, cefazolin, cephalexin (Keflex)
Surgical prophylaxis and for susceptible staph infections.
Second generation Cephalosporins.
Good gram pos/better gram neg than 1st gen.
Cefaclor, cefprozil, cefoxitin, cefuroxime, loracarbef, cefotetan.
Cefoxitin IV and IM used prophylactically for ABD or colorectal surgeries. Kills anaerobes.
Cefuroxime - Zinacef parenteral, Ceftin PO- surgical prophylaxis, does not kill anaerobes
Third gen Cephalosporins
Most potent agains gram neg/less active agains gram pos.
Ceftibuten, cefotaxime, ceftazidime, cefdinir, ceftizoxime, ceftriaxone, ceftazidime
IV and IM, long half life, QD dosing
Tx CSF and CNS infections
- IV and IM
- Excellent gram neg coverage
- Used for difficult to tx organisms such as pseudomonas
- Renal eliminations
Fourth gen Cephalosporins
Broader spectrum, especially against gram pos.
Used for UTI's- cefepime (Maxipime)
Fifth gen Cephalosporins
Ceftobipriole (not available)
Broader spectrum- effective against MRSA, pseudomonas.
Cepholosporins Adverse Effects
Similar to PCN
Potential cross sensitivity with PCNs
Used for complicated body cavity and CT infections.
May cause seizures
Primaxin, Meropenem (Merrem), Ertapenem (Invanz), Doripenem (Doribax)
Carbapenems - Imipenem (Primaxin)
Used for tx of bone, joint, skin and soft-tissue infections.
Inhibits enzyme that breaks down imipenem (Primaxin)
Erythromycin, azithromycin (zythromax), clarithromycin (biaxin), dirithromycin
Preven protein synthesis in bacteria
Bacteriostatic but in high concentrations bacteriocidal
Macrolides - Indications
Mild to moderate URI and LRI
Spitochetal infection -syphillis and Lyme disease
Gonorrhea, Chlamydia, Mycoplasma
Azitrhomycin and clarithromycin
approved for mycobaterium avium intracellular complex infection
Clarithromycin used with omeprazole for ulcers assoc with H pylori
Macrolides - adverse effects
GI effects primarily with erythromycin
n/v/d, hepatotoxicity, flatulenc, jaundice, anorexia
Azithromycin and clirithromycin - fewer side effects, better efficacy, longer duration
Demeclocycline (Declomycin), Oxytetracylcin, tetracyline, doxycicline (doryix, vibramycin), minocycline, tigecycline (tygacil)
Natural and semisynthetic
Obtained from strep cx
Bacteriostatic, stop many essential functions of bacteria
Broad spectrum- gram neg and pos, protozoa, mycoplasma, rickettsia, chlamydia, syphilis, Lyme disease, acne.
Used for SIADH by inhibiting ADH
Tetracyclines - contraindications/warnings
Dairy, antacids and iron salts redude oral absorption
Don't use in children under 8 or in pregnant/lactating women due to teeth discoloration
Tetracylcines - adverse effects
Teeth discoloration, retardation of fetal growth
Alteration in intestinal flora - may result in superinfection, diarrhea, pseudomembranous colitis
Vaginal candidiasis, gastris upset, maculopapular rash
Temporary or permanent hearing loss, balance problems
- Reduced renal function
- Rising serum Cretinine
Monitor levels every 5-7 days
Monitor creatinine every 3 days
Gentamicin, neomycin, tobramyicn, amikacin, kanamycin, streptomycin
Natural and semisynthetic, from streptomyces, poor oral absorption, very potent, bacteriocidal, mostly gram neg
Aminoglycosides - indications
gram neg - pseudomonas, E coli, Proetus, Klebsiella, Serratia
Often used with other ABS for synergistic effects
Used for resistant gram pos infections
Only aminoglycoside given orally, used to decontaminate GI tract before surgery, also used as enema.
Aminoglycosides - adverse effects
Nephro and oto-toxicity ( most significant)
h/a, paresthesia, fever, superinfetions, vertigo, skin rash, dizziness
Ciproflaxin, norfloxacin, levofloxacin, moxifloxacin
Excellent oral absorptoin
Absorptoin reduced by antacids
Gram neg and some gram pos
Bacteriocidal, alters DNA of bacteria, does not affect human DNA
Quinolones - indications
- Gram neg - pseudomonas
- Respiratory infections
- Bone and joint infections
- GI infections
- Skin infections
Quinolones- adverse effects
h/a, dizziness, fatigue, depression, restlessness, insomnia, n/v/d, constipation, thrush, increased liver functions studies, prolonged QT interval, rash, pruritus, urticaria, flushing, photsensitivity, fever, chills, blurred vision, tinnitus.
BLACK BOX WARNING: INCREASED RISK OF TENDONITIS AND TENDON RUPTURE
Chornic bone infections, GU infections, intra abdominal infections.
May cause pseudomembranous coliits
- New class: oxazolidinones
- Tx vancomycin resistant enterococcus faecium (VREF, VRE), hospital acquired infections, MRSA
May cause HYPOtension, serotoniin syndrome if taken with SSRI's and reactions if taken with tyramine containing foods.
Anaerobic organisms, intra abdominal and gynecologic infections, protozoal infections.
Several drug interactions
- use carefully if renal function impaired
- Concentrates in urine
- May cause fatal hepatotoxicity
- Tolerated well if pt is hydrated
Quinupristin and dalfopristin (Synercid)
- Used for bacteremia and infections caused by VRE and skin infections
- May cause arthralgias, myalgias
New class: lipopeptide
Tx complicated skin and soft tissue infections
- Tx of choice for MRSA and gram pos
- Monitor blood for therapuetic levels
- INFUSED OVER 60 MINUTES-rapid infusion may cause hypotension
- Red man syndrome may occur
- Ensure adquate hydration
Nursing implications - ABX
- Allergies, hepatic, renal and cardiac function.
- s/sx of superinfections, fever, itching, cough, lethargy or unusual discharge.
Nursing implications - aminoglycocides
Monitor peak and trough blood levels
Monitor for therapuetic and adverse effects
S/sx of ototoxicity
dizziness, tinniuts, hearing loss
urinary casts, proteinuria, increased BUN and creatinine
Opportunistic infections- Protozoal
Toxoplasmosis of the brain
Opportunistic infections - Fungal
Candidiasis of the lungs, esophagus and trachea
Opportunistic infections- Viral
CMV disease, HSV infections
Opportunisitc Infections- bacterial
Various mycobacterial infecitons
Nursing implications- Antiretrovirals
Instruce pt to wear gloves when aplying ointment to affected areas
Treat all forms of myobacterium
Common Mycobacterium infection sites
- Lung - primary
- Aerobic bacillus
- Passed from infected humans, cows, birds
First line Antitubercular drugs
- Pyrazinamide (PZA)
Second line Antitubercular drugs
- Para-aminosalicylic acid (PAS)
Antitubercular drugs MOA
Protein wall synthesis inhibitiors-streptomycin, kanamycin, capreomycin, rifampin, rifabutin
Cell wall synthesis inhibitors-cycloserine, ethionamide, INH
- Drug of choice for TB
- Metabolized in liver -watch for slow acetylators
- Contraindicated with liver disease
INH advers effects
- Peripheral neuropathy
Ethambutol adverse effects
- Retrobulbar neuritis
Rifampin- adverse effects
- discoloration of urine, stools and body fluids
- interferes with oral b/c
Nursing implications- Antituberculars
- perform liver function studies on pt rx'd INH and rifampin
- -especially older/high alcohol use pt's
- -Therapy may last up to 2 years
- -Pt's are contagious during initial phase of illness
- -do not consume alcohol while taking ATB's
- -take meds one hour before or two hours after meals
- -Pyridoxine may be used to combat neurologic effects
Antituberculars - adverse effects
fatigue, n/v, numbness and tingling of extremities, fever, loss of appetite, depression, jaundice
Nursing implications - ATB's
- negative airflow room
- micron filter masks
Systemic and topical fungal infections
Amphotericin B is druge of choice
Drug choice depens on type and location of infection
Amphotericin B - adverse effects
- Main concern is renal toxicity and neurotoxicity - seizures and paresthesias
- nausea, gi upset
- renal toxicity
- tingling and numbness in hands and feet
- Lowered K+ and Mg levels
Nursing implications - amphotericin B
Antipyretic and corticosteriods may be given to reduce effects of infusion reaction
use IV infusion pumps and most distal veins possible
Patient scheduled for colorectal surgery, does not have sepsis, WBC count is normal, pt is afebrile and in good health. There is an order to administer an antibiotic before surgery. Why?
To provide prophylactic therapy.
Teenage pt taking tetracycline for acne.What is most important information to give pt when educating her about the drug?
Pt should use sunscreen or avoid exposure to sunlight because tetracycline may cause photosensitivity.
Newly admitted pt reports PCN allergy and provider has ordered a second-generation cephalosporin. Which nursing action is appropriate?
Call prescriber to clarify the order because of the pt's allergy.
During pt education regarding an oral macrolide such as erythromycin, the nurse should include which information?
The pt may take the drug with a small snack to reduce GI irritation.
A woman has been taking an antibiotic for a UTI and calls her NP to c/o of severe vaginal itching and thick whitish vaginal discharge. The NP suspects that...
A superinfection has developed
The nurse is reviewing orders for the use of an antiseptic. Which statement best describe the use of antiseptics?
- Antiseptics are appropriate for use on living tissue
- The pt's allergies should be assessed before using the antiseptic
- Antiseptics are used to inhibit the growth of microorganisms
While assessing a woman who is receiving an antibiotic for community acquired pneumonia,the nurse notes that the pt has thick, white vagina discharge. Pt is also c/o perineal itching. The nurse suspects the pt has.....
Pt has been admitted for tx of an infected leg ulcer and will be started on intravenous linezolid. The nurse is reviewing the list of the pt's current medcitions. Which type of medication would be of most concern if taken with linezold?
When administering vancomycin, the nurse knows that which of the following is the most important thing to assess before giving a dose?
During therapy with an intravenous aminoglycoside, the pt calls the nurse and says, " I'm hearing some odd sounds, like ringing, in my ears." Which is the best action of the nurse at this time?
Stop the infusion immediately and notify the prescriber
When giving intravenous quinalones the nurse needs to keep in mind that these drugs may have serious interactins with which drugs?
The nurse is adminstering an IV aminoglycoside to apt who has had GI surgery. Which nursing measures are appropriate?
- Monitor serum creatinine levels
- Instruct the pt to report dizziness or a feeling of fullness in the ears.
The nurse is teaching a pt who is starting antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see?
Reddish brown urine
During antitbuercular therapy with INH the pt received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this secone medication?
The helps to preven neurologic side effects
When the nurse is counseling a woman who is beginning antitubercular therapy with rifampin, which staetement by the nurse is most important regarding potential drug interactions?
If you are taking bc pills, you will need to switch to another form of bc.
When counselingt a pt who has been newly diagnosed with TB the nusre should make sure that the pt realizes that he or she is contagious....
during the initial period of the illness and its diagnosis
While monitoring a pt, the nurse knows that a therapeutic response to antitubercular drugs woud be....
There is a decrease in sx, along with improved CXR and sputum cx results.
The nurse is monitoring for liver toxicity in a pt who has been receiving long-term INH therapy. Manifestations of liver toxicity include.....
- Darkened urine
The nurse is assessing a pt who is about to receive antifungal drug therapy. Which problem would be of most concern?
While monitoring a pt who is receiving IV amphotericin B, the nurse expects to see which adverse effects?
Fever and chills
When administering antifungal drug therapy, the urse knows that a problem that contributes to many of the drug interactions with antifungals is....
cytochrome P-450 enzyme system
During an infrusion of ampphotericin B the nurse knows that which adminstartion techniqaue may be used to minimize infusion-related adverse effects?
Infusing the medication over a longer period of time
When the nurse is teaching a pt who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct?
Dissolve the lozenge slowly and completely in your mouth
When monitoring a pt who is receiving caspofungin, the nurse should look for which serious adverse effects?
- Blood dyscrasias
The nurse is reviewing the medication history of a pt who is taking hydroxychloroquine. However, the pt's chart does not reveal a history of malaria or travel out of the country. the pt is most likely taking this medcation for......
Which teaching point would be appropriate to include when the nurse is informing pt's about the adverse effects of antimalarials?
These medications may cause anorexia and ABD distress
When teaching a pt about the potential drug interactions with antiprotozoal drugs, the nurse should include information about.....
Before adminstering antiprotozoal drugs, the nurse should review which baseline assessment?
The nurse know that anitmalarial drugs are used to treat pts with infections caused by which protozoans?
When giving metronidazole, the nurse implements appropriate adminstration technicques, including
- Giveing oral forms with food
- Infusing IV doses over 30 to 60 minutes
- Obtaining ordered specimens before starting the medication
PCN interacts with what drugs?
Oral contraceptives, NSAIDs, warfarin
Tetracyclines should be taken with
8 oz of water
Drug of choice for MRSA
What effects of vancomycin should be reported immediately?
- Ringing in ears
- Hearing loss
- Fullness in ears
Colistin infusion should be stopped if these effects are noticed.
Numbness, Vertigo, Dizziness
What lab test should be done prior to and monitored during INH therapy?
Liver enzyme levels
Single cell fungi that reproduce by budding
One of the major groups of antifungal drugs; includes amphotericin B and nystatin.
A very large, diverse group of eukaryotic, thallus-forming microorganisms that requires an external carbon source.
One of the major groups of antifungal drugs, includes ketoconazole and miconazole.
A term for yeast infection of the mouth
One of the older antifungal drugs that acts by preventing susceptible fungi from reproducing.
The oldens antifungal drug
An antifungal drug commonly used to treat candidal diaper rash
An infection casued by fungi
Multicullular fungi characterized by long branching filaments called hyphae which entwine to form a mycelium.
What affects are watched for with Amphotericin B?
Malaise, fever, chills
Before beginning antiprotozoal therapy the nurse should check for which contraindications?
Underlying renal, cardiac, thyroid or liver disease and pregnancy.
Mintezol can cause which adverse affect?
Urine with an asparagus-like odor
Which drug is used mainly for the management of Pneumocystis jirovecii pneumonia?
Pentamidine or Atovaquone
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