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2012-05-29 18:12:31
Antimicrobials Test2

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  1. What is the action of ampicillin?
    • Binds to bacterial cell wall resulting in cell death
    • Bactericidal
    • Spectrum is broader than penicillin
  2. What are some adverse reactions to Ampicillin?
    • Diarrhea (because it kills of native flora)
    • Rash: Nonallergic (response to Rx itself), dull red, macular or maculopapular, mildly pruritic. Always ask what the allergic reaction is because it may not actually be a histamine reaction and simply the normal response to the drug.
    • Decreased effectiveness of BC (birth control) pills; one of the WORST offenders.
    • Contraindications:
    • History of Penicillin sensitivity. Ampicillin is a Penicillin derivative, so pt will likely be sensitive to both and all related anibiotics. If pt has never been subjected to antibiotic treatments, stay in the room with the pt to monitor possible rxn.
  3. What do you need to tell your pt about Ampicillins?
    • Take all medication on schedule
    • Monitor for superinfections
    • Notify health care provider if symptoms do not improve. Should see improvement 24-48 hrs.
    • Those on BC Pills should use additional birth control measures
    • Best absorbed if taken on an empty stomach, so take 1hr before or 2hrs after eating. However, may cause upset stomach so may have to administer with food.
  4. What is Probenecid?
    Medication used in conjunction with Penicillin and other related antibiotics to prolong and increase serum levels because it delays renal excretion. Keeps Ampicillin active even though it binds to the molecule.

    Rarely seen with Penicillin … but might see with more expensive newer meds.
  5. What are some Nursing Implications for administering Ampicillin and related drugs?
    • Monitor for signs of hypersensitivity, ie hives, rash, wheezing, etc.
    • D/C therapy at first sign of hypersensitivity
    • Monitor clients for 30 minutes after receiving PCN (Penicillin) in ER or MD’s office
    • Some forms may cause bleeding abnormalities
    • High IV doses of NA or K salts of PCN my produce E+lyte imbalance
    • Oral on empty stomach
  6. Drugs that weaken the bacterial cell wall
    • Cephalosporins
    • Beta-lactam antibiotics, very close realtives to PCNs, which means PCN sensitive pts may or may not be sensitive to Cephalosporins.
    • Similar to penicillin structure
    • Bactericidal
    • Usually given parenterally, a few can be given orally.
  7. What are the actions of Cephalosporins?
    • Binds to bacterial cell wall, causing cell death
    • Bactericidal
  8. How are antibiotics used profilactically?
    • One dose given immediately before surgery, another immediately afterward.
    • Can drammatically reduce postop nfxn.
  9. What are some adverse reactions to Cephalosporins?
    • Nausea
    • Vomiting
    • Diarrhea
    • Pain at injection site
    • Phlebitis: Results in inflamed vein, burning, almost immobile. Remove IV and restart infusing at different site. Continued infusion will resutl in scarring and prevent subsequent IV infusion at that site.
    • Alcohol intolerance
    • Interference with VitK metabolism-->Global bleeding/bruising.
    • Pseudomembraneous Colitis: Overgrowth with Clostridium Difficile-->Amazing diarrhea (green, mucous, continuous, heroically unforgettable stench. If smelled, treat immediately. Treated with donar feces containing normal flora. Wash hands with soap and water after treating pt with C. diff.
    • Use caution in those with PCN allergies; 5-16% will have cross sensitivity
  10. Glycopeptides
    • Vancomycin (not to be confused with Cephalosporines)
    • Used only for serious infections where other antibiotics are not effective
    • Pseudomembraneous colitis (C. Difficile)
    • MRSA
    • Those with allergies to PCN
  11. What are the actions of Vancomycin?
    • Binds to precursors for cell wall biosynthesis, thereby promoting cell lysis and death. Binds to precursors to ALL rapidly dividing cell wall, ie wbc, mucous membranes, hair, skin, etc.
    • Only effective against Gram+ organisms (narrow spectrum)
    • Use should be reserved for the most severe infections
  12. What are some adverse effects to Vancomycin?
    • Nephrotoxicity
    • Monitor I and O (Intake should = output) If I>O then indicative of nephrotoxicity.
    • Pink or cloudy urine, need to be able to monitor urine.
    • Creatinine clearance. Need test 1/day.
    • Ototoxicity:
    • Monitor 8th cranial nerve function by...
    • Hearing loss
    • Tinnitus
    • Vertigo
    • Hypotension; Administer SLOWLY over 60 minutes
    • Monitor BP
    • Safety measures; ie call bell, bed rails, etc.
    • Phlebitis; should always be admin'd with pick or central line.
    • Red Man Syndrome: Related to rapid infusion.
    • Sudden, severe hypotension
    • Flushing and/or maculopapular rash of face, neck, chest and upper extremities
  13. What are some nursing implication for administering Vancomycin?
    • Monitor lab values
    • Peak and trough; Peak 25 mcg/ml, Trough 5-10 mcg/ml
    • Monitor 8th cranial nerve function for ototoxicity.
    • Assess for superinfections; candida, c. diff. (nausea, vomitting)
    • Monitor IV insertion site closely; everytime you hang meds before you start Rx.
    • Monitor BP closely
    • Assess bowel status/sounds, frequency and character of stools, presence of blood in stool. Must be able to tell if normal diarrhea (from death of normal flora) or c. diff. diarrhea.
  14. Carbapenems Imipenem
    General Info
    • Beta lactam antibiotics (again, similar to PCNs)
    • Broad spectrum
    • Bind to bacteria cell wall
    • Parenteral dosing required, no oral administrations.
    • Effective against both gram + and gram –
    • Effective against anaerobic organisms. Getting an effective therapeutic dose to site of nfxn is difficult.
    • Crosses blood-brain barrier and placental barrier.
    • May be given with cilastatin which prevents inactivation in the renal system
  15. What are some adverse effects of Imipenem?
    • GI
    • Hypersensitivity reactions
    • Suprainfections; candida in vaginal canal, tongue, mouth, throat, warm moist mucous membranes.
  16. Monobactums
    Aztreonam (Azactam)
    • Beta lactam antibiotics
    • Inhibits bacteria cell wall synthesis
    • Narrow spectrum
    • Gram-
    • Must be administered parenterally
    • Crosses blood brain barrier
    • Adverse effects similar to other antibiotics
  17. What are Nursing Implications for administration of Monobatums (Aztreonam)
    • Monitor for signs of hypersensitivity
    • Use with caution in those with renal impairment
    • IM injection—deep IM; at least 1.5" needle into thigh.
    • Increased risk for thrombophlebitis (phlebitis-->thrombus).
    • Monitor for GI disturbance, renal impairment, hematological changes (wbc, rbc, platelets)
  18. Bacteriostatic Inhibitors of Protein Synthesis
    General Info
    • Tetracyclines, Macrolides, Clinidamycin, and Chloramphenicol
    • Drugs inhibit protein synthesis
    • Are Bacteriostatic
    • Generally are second-line drugs
  19. What are the actions of Tetracyclines?
    • Inhibit the binding of transfer RNA
    • Bacteriostatic
    • Considered a broad-spectrum antibiotic
    • Tetracycline
    • Doxycycline
    • Minocycline
  20. Indications for Tetracyclines?
    • Treatment of rickettsial diseases, Lyme Disease, Rocky Mountain Spotted Fever
    • Gastric infection (PUD)with H. Pylori (in combination with PPIs)
    • Acne
    • Rheumatoid Arthritis; action against RA is unknown.
    • Periodontal Disease (given profilactically).
  21. What are adverse effects of Tetracyclines?
    • GI irritation
    • Effects on bone and teeth: Should not be given prepuberty.
    • Teeth discoloration
    • Bone growth suppression
    • Suprainfection
    • Hepatotoxicity. Must check liver enzymes
    • Renal toxicity
    • Photosensitivity (will burn easily in sunlight, 15-20 min)
    • Vestibular toxicity. (Inner ear). Look for vertigo, tinnitus.
  22. Drug/Food interactions for Tetracycline?
    • Forms insoluable chelates (bound complex, inactivated) with some minerals, esp calcium and iron.
    • Give medication 2 hours before or after food.
    • Binds to:
    • Calcium supplements
    • Milk
    • Iron Supplements
    • Magnesium containing laxatives
    • Most antacids
    • ...and anything with calcium, iron, or magnesium.
  23. Nursing Implications for Tetracyclines?
    • Avoid use in children under 8
    • Clients should avoid unprotected exposure to direct sunlight or UV light
    • IV therapy in excess of 2 g/day may produce hepatotoxicity (ALT/AST, BUN)
    • Should not be used during pregnancy or if trying to get pregnant or may get pregant. Best if on BC, but BC will be less effective, so use another form of BC with the pill.
    • Monitor for suprainfection esp. of GI tract and/or vagina
    • Avoid use with Ca supplements, antacids, iron, or dairy products
  24. Macrolides
    General Info
    • Inhibit bacterial protein synthesis
    • Bacteriostatic except at high concentrations…must maintain above MIC (Minimal Inhibitory Concentration)
    • Called MACROlides because they are big molecules
    • Macrolides, Streptogramins, Lincosamides and Cholramphenicol have antagonistic actions and should not be given together
  25. What are the actions of Macrolides
    • Binds to ribosomal unit and block addition of new amino acids
    • Usually bacteriostatic
    • Maybe bacteriocidal in high doses
    • Absorbed in intestine
    • Usually enteric coated
    • Sustained release
    • Indications:
    • Legionella pneumophilia
    • Bordetella pertussis
    • Corynebacterium Diphtheriae
    • Otitis media
  26. What are some adverse effects of Erythromycin?
    • Nausea
    • Vomiting
    • Ototoxicity
    • Phelbitis (IV administration)
    • Suprainfections
  27. What are Nursing Implications for administering Erythromycin?
    • Do not crush enteric or sustained release capsules ** There are chewable forms available
    • Identify if can be given with food; always check to see if Rx’d one can be given with food.
    • Assess liver and kidney function
    • Assess for S&S of suprainfection
  28. Macrolides
    • Inhibit bacterial protein synthesis
    • Bacteriostatic except at high concentrations…must maintain above MIC
    • Called MACROlides because they are big molecules
    • Macrolides, Streptogramins, Lincosamides and Cholramphenicol have antagonistic actions and should not be given together
  29. Lincosamides
    • Limited use ~ anaerobic infections
    • Bacteriostatic
    • Can promote severe antibiotic associated pseudomembraneous colitis (look for copious amounts of diarrhea. Can also allow for C. diff once normal flora is eliminated.
  30. Chloramphenicol
    Structurally related to lincosamides, but different action.
    In its own class.
    • Broad spectrum reserved for serious infections that do not respond to other antibiotics
    • Potential for fatal aplastic (without cell structure) anemia and reversible bone marrow depression
    • Monitor serum levels closely due to very narrow therapeutic levels.
    • Complete blood counts should be done at least QOD (every other day)
    • Pt will become pale, O2 sats decline, pourous bleeding, etc.
  31. Oxazolidinones
    • New class of antibiotic, less exposure so some of the resistent bacteria.
    • Bacteriostatic inhibitor of protein synthesis
    • No other antibiotic works in this way-decreased incidence of cross resistance
    • Effective against Multi-drug resistant Gram+ Pathogens, ie VRE MRSA
    • Can cause myelosuppression
  32. What is Myelosuppression
    • "Myelo" referse to function of bone marrow
    • Anemia: Decreased RBC (dyspnea)
    • Leukopenia: Decreased WBC (nfxn, erythema, fever... must establish a baseline to know what is fever)
    • Thrombocytopenia: Decreased Platelets (bruising, orific bleeding)
    • Pancytopenia: Decrease in ALL blood cells (all of the above)
  33. Streptogramins
    • Synergistic combination of two drugs (Wouldn't normally see them used individually)
    • Dalfopristin (70%) and Quinupristin (30%)
    • Each is bacteriostatic by self but in combination is bactericidal
    • Similar efficacy to Vancomycin, might be used in leui of
  34. Streptogramins Side Effects
    • Hepatoxicity
    • Liver function
    • BUN
    • Bilirubin
    • Infusion site reactions… thrombophlebitis (redness and clotting along vein. Should have pck or central line)
    • Inhibition of other drugs metabolized by Cytochrome P450
    • Arthralgia (joint pain) and myalgia (muscle pain)
  35. Mupirocin (aminoglycocides)
    • Action: Inhibits bacterial protein synthesis
    • Nursing Implications:
    • Nurses tend to colonate MRSA in nares. Apply 1/2 of each single use tube in each nostril. After application-close and release nostril several times.
    • Use 2 x daily for 5 days
    • C&S of nares after treatment
    • Would be used in conjunction with systemic antibiotic.
  36. Bacteriocydal inhibitors of protein synthesis
    • Narrow spectrum antibiotic
    • Aerobic Gram neg Bacilli (ie, anthrax, menengitis, encephilitis,) can also be anaerobic
    • Disrupts protein synthesis
    • Serious Nephrotoxicty and Ototoxicity
    • Not absorbed from GI tract: Given orally for local effect only, ie colon surgery because it will wipe out all flora in digestive track to prevent bacteria from spilling into abdomen. Typically given parenterally.
    • Maintain Appropriate Serum Drug Levels –Concentration Dependent Killing
  37. Examples of Aminoglycocides
    • All end in suffix "cin."
    • Gentamycin
    • Tobramycin
    • Amikacin
    • Neomycin
    • Kanamycin
    • Streptomycin
  38. Nursing Implications of Administering Aminoglycocides
    • Ototoxy. Evaluate 8th cranial nerve function by audiometry:
    • Tinnitus
    • Vertigo
    • Ataxia
    • Subjective hearing loss

    • Renal Function
    • Monitor I&O and Daily weights
    • Monitor drug serum levels
    • Monitor Kidney function
    • Creatinine clearance

    Monitor for suprainfections

    • (Unique to aminoglycocides) May cause a decrease in Serum:
    • Calcium
    • Magnesium (useful in conjunction with calcium, also vasodialator)
    • Potassium (heart function/contractions)
    • Sodium (maintains fluids)
  39. Sulfonamides and Trimethoprim
    • Broad spectrum Antimicrobials via making environment less hospitable for microbes.
    • Disrupt the synthesis of tetrahydrofolic acid. Required by all proteins to synthesis DNA, RNA and other proteins.
    • Primary use is UTI’s
  40. Adverse Effects of Sulfonamides
    • Hypersensitivity reactions (Rashes)
    • Stephens Johnson Syndrome
    • Blood dyscrasias (abnormalities) (Hemolytic anemia, RBC lysis)
    • Kernicterus (Jaundice and itching in skin)~ Increased levels of Bilirubin because of liver dysfunction
    • Crystalluria ~ Increase fluid intake to 8-10 glass water; alkalinilize urine. Sulfur binds to urea--> crystalize.
  41. Nursing Implications of Administering Sulfonamides
    • Administer drugs on an empty stomach
    • Monitor for hypersensitivity reactions
    • Maintain adequate fluid status
    • Monitor for hematologic changes
    • Protect from direct sunlight or UV light
  42. Miscellaneous Antibacterial Drugs: Fluoroquinolones and Metronidazole
    • Fluoroquinolones (very popular) Ciprofloxacin (Cipro):
    • Narrow spectrum antibiotic***
    • Both gram+ and- No Aneaerobes (that's why narrow spectrum)
    • Inhibits bacterial DNA gyrase
    • Uses: multi-system infections
    • MIC increased in the presence of magnesium and in
    • acid environments (pH<6) so don't take magnesium orally. Will lead to higher risk of toxicity.

    • Adverse effects
    • Gastrointestinal
    • Headache (severe, throbbing)
  43. Fluoroquinolones
    Drug and Food interactions

    Absorption reduced by

    Take before meals, 1 hr before or 2 hrs after.

    • Do not take with other medications.
    • Aluminum antacids
    • Magnesium antacids
    • Iron salt
    • Zinc salts
    • Sucralfate
    • Milk and dairy products
  44. Nursing Implications when administering Fluoroquinolones
    • Last resort drug
    • Determine prior use and therapeutic response
    • Note color and nature of sputum (for respiritory issues)
    • Teach appropriate hygiene to ensure safety of others
    • Stress the importance of completing the course of treatment

    • Psuedomembranous colitis
    • Drink plenty of water – crystaluria
    • Use sunscreen
    • Black Box Warning
    • Tendonitis and tendon rupture possible
  45. Metronidazole

    • Uses
    • Protozoal infections (Giardiasis)
    • Infections caused by anaerobes only

    Helicobacter pylori

    • Adverse effects
    • Neurotoxicity (seizures)
    • GI pain, anorexia, nausea
    • Suprainfections
    • Monitor I&O esp with IV **Hi Na content, watch fluid levels.
  46. Drug Therapy of Urinary Tract Infections
    Complicated or uncomplicated

    • Upper
    • Acute pyelonephritis
    • Acute bacterial prostatitis

    • Lower
    • Acute cystitis
    • Acute urethral syndrome
  47. TB nfxn facts
    • IN US # 1 CAUSE OF DEATH IN 1900
    • HAS BEEN INCREASING DUE TO: +Immigrants,HIV Infection
  48. Mantoux Test
    • Has your body developed antibodies to TB baccilus?
    • PPD=Purified Protein Derivative.
    • Done twice because sometimes it takes several days before antibodies stick to foreign bodies.
    • Looking for erythema and induration (raised)
    • Should not bleed (gone too deep). Protein will bind to blood and not create the reaction.
    • BCG=Vaccine given in Europe, but if administered will test positive on PPD test.
  49. Positive test cut point.
    • > or = 5 mm of INDURATION (measuring induration, not erythema.) and/or any/all of the below:
    • ABNORMAL CXR (chest xray)
  50. Positive test for general population
    > OR = 15 mm INDURATION

  51. What is a TB nfxn?
    • + TB SKIN TEST
    • PREVENTIVE TX - ISONIAZID (INH), or cocktail of 2-3 Rx.
  52. What constitutes a TB disease?
    • + TB SKIN TEST
    • PERSON IS SICK : cough, fever, night sweats, weight loss, abnormal CXR