Aminoglycosides,Quinolines, Sulfonamides

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jean
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Aminoglycosides,Quinolines, Sulfonamides
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2010-05-03 10:46:47
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Aminoglycosides Quinolines Sulfonamides
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Aminoglycosides, Quinolines, Sulfonamides
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  1. Antibiotics: Aminoglycosides
    • gentamicin (Garamycin)
    • Tobramycin
    • HINT HINT!! They usually end in mycin
  2. Aminoglycosides are …..
    • Natural and semi-synthetic
    • Poor oral absorption; no PO forms
    • Very potent antibiotics with serious toxicities
    • Bactericidal
    • Kill mostly gram-negative; some
    • gram-positive also
  3. Aminoglycosides effect electrolytes ….
    • Lowers K+ (cardiac function)
    • Mg+ (nerve function)
  4. Aminoglycosides used to kill….
    • Pseudomonas spp., E. coli, Proteus spp., Klebsiella spp., Serratia spp.
    • Often used in combination with other antibiotics for synergistic effect.
    • BIG GUN!!!!
  5. Adverse Effects Aminoglycosides
    • Nephrotoxicity
    • Ototoxicity
    • Neurotoxicity
    • thrombocytopenia
  6. Aminoglycosides: Side Effects
    Ototoxicity and nephrotoxicity are the most significant
  7. Aminoglycosides require Therapeutic Drug Monitoring
    • Peak= 30-60 min after infused
    • Trough= immediately before administration of next dose
  8. Must do what when giving Aminoglycosides?
    • Flush between administration of other antibiotics
    • Space of 2 hours between antibiotics
    • 2000 to 3000 cc fluid each day
    • Monitor Liver enzymes
    • Monitor BUN and Creatinine
    • Monitor K+ and Mg+
  9. Antibiotics: Quinolones
    • Ciprofloxacin (Cipro) –anthrax, pneumonia, UTI, skin & joint infection
    • Norfloxacin ( Noroxin)- not used as much
    • Levofloxacin (Levaquin) – community pneumonia, resp.
  10. Drug Interactions of Aminoglycosides
    PCN & aminoglycoside = inactivates the aminogylcosides
  11. Quinolones
    • Excellent oral absorption
    • Absorption reduced by antacids
    • First oral antibiotics effective against gram-negative bacteria
  12. Quinolones: Mechanism of Action
    • Bactericidal
    • Effective against gram-negative organisms and some gram-positive organisms
    • Alter DNA of bacteria, causing death
    • Do not affect human DNA
  13. Quinolones: Therapeutic Uses
    • Lower respiratory tract infections
    • Bone and joint infections
    • Infectious diarrhea
    • Urinary tract infections
    • Skin infections
    • Sexually transmitted diseases
  14. Quinolones: Side Effects
    • Dizziness, HA, tinnitus
    • Photosensitivity
    • Nausea and vomiting, diarrhea
    • superinfections
    • Flushing, rash
    • Restlessness, fatigue, insomnia
    • Tremors
    • Ringing in ears (Levoquin)
  15. Drug Interactions
    • Antacids
    • Iron
    • Theophylline
    • Oral hypoglycemics
    • caffine (cipro –don’t drink coffee)
    • take on empty stomach
  16. Sulfonamides: Mechanism of Action
    • Bacteriostatic action
    • Prevent synthesis of folic acid
    • Does not affect human cells growth
  17. Sulfonamides: Therapeutic Uses
    • Conjunctivitis
    • Corneal ulcers
    • Following eye injury
    • UTI
    • Burns( Silvadene cream) – alters electrolytes
    • Otitis media
    • Lower respiratory tract infections
  18. Sulfonamides: Bactrim combined with trimethoprim therapeutic Uses
    • Used to treat UTIs
    • otitis media
    • eye infections
    • lower respiratory tract infections
    • Prostatitis
    • Gonorrhea
    • pneumonia in AIDs patients
  19. Sulfonamides: Side Effects
    • Photosensitivity
    • Crystalluria
    • Delayed skin reactions
    • Stomatitis
    • Peripheral neuropathy
  20. Sulfonamides: Adverse Effects
    • Thrombocytopenia
    • Hemolytic anemia
    • Aplastic anemia
    • Renal failure
    • RARE
  21. Monitor what lab tests for renal function?
    • BUN and Creatinine levels
    • And Monitor UOP
  22. Monitor CBC
    for potential blood dyscrasias ( < WBC, < platelets, sore throat)
  23. Sulfonamides can increase effects of what other drugs?
    Coumadin and oral antihypoglycemics
  24. Very important to take in __________ mL of fluids while on sulfonamides
    2000 ml/day
  25. Before beginning therapy
    • assess drug allergies
    • other labs
    • Be sure to obtain thorough patient health history
    • Assess for conditions that may be contraindications to antibiotic use
    • Assess for potential drug interactions.
  26. Antibiotics: Nursing Implications
    It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy.
  27. Assess for signs and symptoms of superinfection:
    • Fever
    • Cough
    • Perineal itching
    • Sore throat
  28. .
    • The most common side effects of antibiotics are
    • nausea, vomiting, and diarrhea.
  29. All oral antibiotics are absorbed better if taken with
    at least 6 to 8 ounces of water.
  30. Nursing Implications – Sulfonamides
    • Should be taken with 2000 mL fluid/day
    • Due to photosensitivity, avoid sunlight and tanning beds.
    • These agents reduce the effectiveness of oral contraceptives.
  31. How long should a pt be monitored when given PCN?
    Monitor for 30 minutes.
  32. The effectiveness of oral penicillins is decreased when taken
    with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice.
  33. Antibiotics: Nursing Implications Cephalosporins
    • Orally administered forms should be given with food to decrease GI upset
    • -- even though this will delay absorption.
    • Some of these agents may cause an Antabuse-like reaction when taken with alcohol.
  34. Antibiotics: Nursing Implications - Tetracyclines
    • Avoid
    • Milk
    • Iron
    • antacids
    • 6 to 8 ounces of fluid, preferably water.
    • Due to photosensitivity, avoid sunlight and tanning beds
  35. Antibiotics: Nursing Implications - Aminoglycosides
    • Monitor peak and trough blood levels
    • Symptoms of ototoxicity
    • --dizziness, tinnitus, and hearing loss.
    • Symptoms of nephrotoxicity
    • --urinary casts, proteinuria, and increased BUN and serum creatinine levels.
  36. Antibiotics: Nursing Implications - Macrolides
    these agents are highly protein-bound and will cause severe interactions with other protein-bound drugs.
  37. Antibiotics: Nursing Implications-Monitor for therapeutic effects:
    • Disappearance of
    • Fever
    • Lethargy
    • Drainage
    • Redness

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