Pharm 4 antibacterials

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Pharm 4 antibacterials
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2013-06-26 00:00:16
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pharmacology antibacterials nursing
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pharm 4 antibacterials - Moore
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  1. How do we choose what drug to use for what microbe?
    C&S
  2. How do we choose which drug to use?
    consider selective toxicity & classification of the drug
  3. How is penicillin aqueous admin?
    IV
  4. Selective toxicity?
    drugs kill microbe without harming host cells
  5. 3 ways antimicrobials are classified?
    • 1. susceptible organism
    • 2. mechanism of action
    • 3. bactericidal or bacteriostatic
  6. When will anaphylaxis usually occur?
    w/in first 30 minutes of admin
  7. Bactericidal or bacteriostatic?
    bactericidal - kills microbe

    • bacteriostatic - inhibit growth
    • depends on body's defense mechanism more than bactericidal
  8. 6 factors to consider when choosing the correct drug?
    • 1. pathogen causing infection
    • 2. drug susceptibility
    • 3. broad or narrow spectrum
    • 4. time takes drug to fight pathogen
    • 5. infection site
    • 6. pt health/assessment
  9. Empiric therapy?

    Important consideration?
    give broad spectrum ABX until C&S is done then give correct ABX

    must draw culture sample before giving ABX or ABX will mess up the samples
  10. Why is it important to choose a drug with the narrowest possible spectrum?
    • 1. limits potential for AE like superinfection
    • 2. more specific
  11. What may be used instead of broad spectrum ABX that is more specific?
    combination therapy
  12. Why may a broad spectrum ABX cause a superinfection?
    more likely to kill normal flora
  13. Superinfection?

    Suprainfection?
    superinfection- infection that occurs during Tx of primary infection

    suprainfection- secondary infection usually caused by an oppurtunistic infection
  14. 2 things that may occur with ABX TX?

    Why?
    ABX can kill normal flora & may cause:

    • 1. superinfection with secondary microbe
    • 2. resistant microbe
  15. 2 lab test that help with drug selection?
    • 1. gram staining
    • 2. C&S
  16. What 2 things are determined with gram staining?
    • 1. gram + or -
    • 2. aerobic or anaerobic
  17. What type of microbes does penicillin work best against?
    gram +
  18. What type of ABX is antibiotic resistance most likely to occur with?
    broad spectrum ABX
  19. 4 reasons resistance may occur?
    • 1. microbe produces drug inactivating enzymes
    • 2. improper drug conc., dose strength, or length b/t doses
    • 3. not taking all the drug
    • 4. prophylactic use of ABX
  20. What ABX is used a lot for procedures/
    ancef
  21. 4 important ABX-resistant microbes?
    • 1. MRSA - methicillin-resistant staphylococcus aureus
    • 2. MDR - TB - multiple drug resistant mycobacterium tuberculosis
    • 3. Penicillin-resistant streptococcus pneumoniae
    • 4. VRE - vancomycin resistant enterococcus
  22. If pt starts to feel bad after admin of ABX what should be done?
    do assessment and be sure it is not allergic response
  23. Where does VRE usually occur?
    in the urine
  24. Why does resistance often occur in mycobacterium tuberculosis?
    Treated with multiple drugs & long-term
  25. Teaching for missed ABX dose?
    take ASAP but never double up
  26. Pt teaching for ABX?
    • 1. how long it takes ABX to work
    • 2. keep away from CH
    • 3. S/S of AE and allergic reaction
    • 4. women of CH-bearing age need back-up BC b/c interferes with oral contraceptives
  27. S/S of allergic/anaphylactic response?
    • 1. throat discomfort of any kind
    • 2. sunburn-like rash
    • 3. itching
  28. 2 drugs that are highly likely to have cross allergy with each other?
    penicillin and cephalosporins
  29. Which ABX is the only drug in its class?
    vancomycin
  30. 5 ABX that affect the bacterial cell wall?

    They are all ______ & may have ______ ______.
    • 1. penicillin
    • 2. cephalosporins
    • 3. monobactams
    • 4. carbapenems
    • 5. vancomycin

    • similar
    • cross allergies
  31. Which ABX that affects the cell wall is least like the other ABX in this family?

    Implication?
    monobactams

    can be taken with penicillin allergy
  32. What type of ABX are penicillins?
    beta lactam
  33. What is beta lactam?
    special ring chemical structure of penicillins and their family that is essential for their ABX activity
  34. 4 different types of penicillin?
    • 1. narrow-spectrum penicillinase sensitive
    • 2. narrow spectrum penicillinase resistant
    • 3. broad-spectrum
    • 4. extended spectrum
  35. Penicillin elixer?

    Consideration for admin?
    Pen VK

    give on empty stomach
  36. What type of penicillin may be used IV?
    penicillin aqueous
  37. Most common AE of penicillin?
    NVD
  38. Most serious AE of penicillin?
    allergic reaction/anaphylaxis
  39. Contraindications with with penicillin?
    contraindicated with allergies to penicillin, cephalosporins, and imipenem
  40. Assess pt carefully for ____ ______ especially with the ______ dose. 

    When should pt be monitored most closely for allergic reactions?
    allergic responses

    1st

    within the first 30 minutes of admin
  41. What should be kept close when admin ABX?
    EPI & resusitation equipment
  42. 2 things nurse should do prior to the admin of penicillins?
    • 1. check for allergies to penicillin, any other "cillins", or cephalosporins
    • 2. check C&S
  43. 3 nursing responsibilities after the admin of penicillins?
    • 1. Evaluated effectiveness of drug/improvement
    • 2. monitor for suprainfections:  candida
    • 3. monitor I&O & s/s of allergic response
  44. Why monitor I&O with penicillins?
    make sure kidneys not affected
  45. Beta-lactamase inhibitors?
    drugs that may be given with penicillins or other beta-lactam drugs

    binds to beta-lactamase produced by bacteria that stops the action of penicillin

    allows penicillin to reach target site so it can act
  46. Infections that may be Tx with penicillins?
    pneumonia, pharyngitis, tonsillitis, endocarditis, scarlet fever, tetanus, anthrax, meningitis, syphilis, diptheria,
  47. 3 types of betalactam ABX besides penicillin?
    • 1. monobactams
    • 2. carbapenems
    • 3. cephalosporins
  48. What type of bacteria are monobactams best for?

    They have no action with ____ or ______ microbes
    gram negative aerobic bacteria

    gram + or anaerobe
  49. Diff b/t monobactams & other beta-lactams?
    have very diff chem structure from others
  50. Drug that is a monobactam?
    aztreonam/Azactam
  51. Carbapenems end with ______.
    penem
  52. Carbapenems are _____ spectrum
    broad
  53. 2 most commonly seen carbapenems?
    • 1. ertapenem/Invanz
    • 2. meropenem/Merrem
  54. 2 uses for carbapenems like ertapenem & meropenem?
    • 1. abdominal infections like peritonitis
    • 2. nosocomial infections
  55. Ertapenem & meropenem require decreased dose with _____ ______.
    renal insufficiency
  56. What type of microbes do cephalosporins Tx?
    gram positive & anaerobes
  57. Use for cephalosporins?
    GI or GU surgery
  58. Why does cross sensitivity occur b/t cephalosporins an penicillins?
    they are very similar in structure
  59. Drug of choice for penicillin allergies?
    macrolides/erythromycin
  60. Why are cephalosporins the most commonly prescribed ABX?

    What problem does this cause?
    they are effective and cheap

    resistance is developing
  61. How are the generations of cephalosporins different?
    • 4 generations & with each generation:
    • 1. increased activity against gram-neg bacteria
    • 2. increased resistance to beta-lactamase
    • 3. increased ability to reach CSF
  62. Prototype cephalosporin?
    cefazolin/Ancef
  63. Use for cefazolin/Ancef?
    prophylaxis for surgery & artificial parts like pacemakers
  64. Most common AE of cefazolin/Ancef?
    NVD & decreased appetite
  65. Most serious AE of cefazolin/Ancef?
    hypersensitivity/anaphylaxis
  66. Interactions with cefazolin/Ancef?
    can have acute alcohol intolerance if used with alcohol
  67. 3 nursing actions to do before admin of cefazolin/Ancef?
    • 1. check for allergy to cephalosporins/"ceph"/"kef" drugs
    • 2. check for allergy to penicillin/"cillins"
    • 3. check C&S
  68. 3 things to monitor with admin of cefazolin/Ancef?
    • 1. effectiveness of med/improvement
    • 2. monitor for suprainfections
    • 3. monitor for s/s of allergic response
  69. Interactions with cefazolin/Ancef?
    can interfere with some tests
  70. Action of vancomycin?
    • 1. alters cell wall permeability -> inhibits cell wall synth
    • 2. inhibits RNA synth
  71. Why is vancomycin usually used as a last resort?
    strong and toxic
  72. Use for vancomycin?
    serious infections when other ABX have failed
  73. Prob with vancomycin?
    vancomycin resistance is increasing
  74. Vancomycin is limited by?
    its ability to produce toxic effects
  75. 3 potential serious AE of vancomycin therapy?
    • 1. ototoxicity
    • 2. nephrotoxicity
    • 3. red-man syndrome
  76. S/S of ototoxicity?
    tinnitus, decreased hearing
  77. Monitoring for nephrotoxicity in vancomycin pt?
    monitor I&O & creatinine
  78. What causes red-man syndrome?

    S/S?
    anaphylactoid reaction caused by histamine release when the med is given too fast

    diffuse redness & blisters
  79. Nursing responsibilities when admin vancomycin IV?
    • 1. admin slowly over at least 60 minutes (more if possible)
    • 2. use the largest access/vein possible
    • 3. Avoid extravasation
  80. Why does vancomycin need to admin very slowly and monitored closely for extravasation?
    it is very caustic
  81. 3 assessments/monitoring for vancomycin?
    • 1. monitor peak and trough levels
    • 2. monitor I&O & creatinine for renal failure
    • 3. assess for s/s of ototoxicity
  82. 6 antibiotic types that affect protein synthesis?
    • 1. aminoglycosides
    • 2. lincosamides
    • 3. oxazolidinones
    • 4. streptogramins
    • 5. tetracyclines
    • 6. macrolides
    • 7. miscellaneous
  83. 2 types of action of antibiotics that affect protein synthesis?
    bactericidal or bacteriostatic
  84. Antibiotics that affect protein synthesis are used for what type of infections?
     
    (aminoglycosides, lincosamides, oxazoladinones, streptogramins, tetracyclines, miscellaneous)
    reserved for more serious infections
  85. ______ may occur with the use of antibiotics that affect protein synthesis.

    (aminoglycosides, lincosamides, oxazalidinones, streptogramins, tetracyclines, and misc.)
    superinfections
  86. Action of aminoglycosides?
    • enter bacterial cell wall -> bind to ribosomes -> prod. wrong amino acids ->
    • 1. prevents bacterial reproduction
    • 2. weakens the cell wall
    • 3. cell wall rupture & death
  87. Prototype aminoglycoside?
    gentamicin
  88. Resistance that may occur with aminoglycosides like gentamicin?
    many bacteria are resistant to aminoglycosides entering their cell walls
  89. Why is gentamicin often given with other meds?
    increase effectiveness or allow it to enter cell walls
  90. Trough level?
    lowest conc. in pt blood

    should be drawn 30 minutes before the next dose
  91. Peak level?
    drug is at its highest conc.

    draw 45 min (IV) to 1h (IM) after admin of a med
  92. 3 AE of gentamicin?
    • 1. ototoxicity
    • 2. nephrotoxicity
    • 3. neurotoxicity
  93. 5 things to assess/monitor with admin of gentamicin?
    • 1. hearing
    • 2. I&O, creatinine, and BUN
    • 3. neurovascular assessments
    • 4. draw peak & trough levels
  94. Why do gentamicin levels need to be monitored closely?
    has a narrow therapeutic index
  95. Important consideration with lincosamide?
    very toxic
  96. Prototype lincosamide?
    clindamycin
  97. Action of clindomycin?
    enters cell -> binds to ribosomes -> suppresses protein synth -> cell death
  98. Use for clindamycin?
    serious to life-threatening infections
  99. Prototype lincosamide?
    clindamycin
  100. ABX group that should always be taken with food?
    sulfa ABX
  101. When a drug works by inhibiting protein synthesis it will usually be used for _____ infections.
    life-threatening/serious
  102. Story for clindamycin?
    Clinda loves Zelda.  She is Link from Zelda (lincosamide).  All she does is play vid games and eat.  She eats so much she gets GI upset that causes pseudomembranous colitis, and is so sedentary that her blood has pooled (blood abnormalities).
  103. Clindamycin common AE?
    GI disturbances
  104. Serious AE of clindamycin?
    • pseudomembranous colitis
    • blood abnormalities
  105. Type of infections Tx by clindamycin?
    serious/life-threatening infections
  106. S/S of pseudomembranous colitis?
    • diarrhea
    • abd cramps/tenderness
  107. Remembering prototype for macrolides?
    macrolide - macro means big and ends with E

    big E - erythromycin
  108. Action of macrolides/erythromycin?
    inhibits RNA-dependent protein synth at chain elongation step -> prevent reproduction
  109. Interaction with macrolides/erythromycin?
    absorption is diminished by food, dairy, & antacids

    decrease effects of drug
  110. Which ABX causes azotemia?
    tetracycline
  111. Contraindication with erythromycin?
    hypersensitivity
  112. Common AE of erythromycin?
    GI distress even when admin IV
  113. Nursing intervention to decrease GI AE in erythromycin?
    small frequent meals, but remember to time them so they are not close to med admin b/c decrease med effects
  114. 4 serious AE of erythromycin?
    • 1. hepatotoxicity
    • 2. pseudomembranous colitis
    • 3. QT prolongation
    • 4. ventricular tachycardia
  115. Monitoring/assessment for pt on erythromycin?
    • 1. monitor liver enzymes
    • 2. have on telemetry if poss. or monitor frequently & educate pt what to look for
    • 3. monitor for s/s of pseudomembranous colitis
    • 4. HR for tachycardia
  116. Admin of erythromycin IV?
    admin very slowly to decrease irritation to the veins - at least 60 minutes
  117. Prototype oxazolididones?
    oxazolididones - zyvox
  118. oxazolidinones/zyvox were the first new type of drugs dev to treat ____ & _____.
    • MRSA
    • VRE
  119. Diff b/t zyvox and other protein inhibiting ABX?
    blocks early stages of protein synth - may prevent the dev of resistance & cross resistance
  120. 2 actions of zyvox?
    • 1. inhibits protein synth in bacteria
    • 2. nonselective MAOI actions
  121. Interactions with Zyvox?
    has serious drug & food interactions r/t MAOI actions:

    Avoid:  tyramine, alcohol, & caffeine
  122. Common AE of Zyvox?
    GI disturbances
  123. 2 serious AE of Zyvox?
    • 1. thrombocytopenia
    • 2. pseudomembranous colitis

    Zyvox - Ox guts someone (pseudomembranous colitis) & they bleed so much they don't have platelets
  124. What needs to be done if pt is an alcoholic and needs to take zyvox?
    will need to call MD to see what to do r/t concern for W/D if don't take alcohol

    can't take alcohol with zyvox
  125. What are streptogramins designed to Tx?
    superbugs
  126. Prototype streptogramin?
    Synercid
  127. Assessment that should be done prior to admin of zyvox?
    assess platelets - if low don't give
  128. Action of Synercid/streptogramins?
    irreversibly blocks ribosome functioning -> inhibits protein synth
  129. Use for Synercid/streptogramins?
    Tx superbugs:  VRE & MRSA
  130. What may be required prior to admin of Synercid/streptogramins?
    may need approval from infectious disease department before using
  131. 2 things that occur as ABX get more powerful?
    have more AE & get more expensive
  132. Why do streptogramins/Synercid have increased risk for drug interactions?
    potent inhibitor of P450
  133. 3 common AE of Synercid?
    • 1. injection site reaction/pain
    • 2. thrombophlebitis
    • 3. NVD
  134. Serious AE of Syndercid?
    hepatotoxicity - very hepatotoxic

    synercid - sinner drink too much and damage their liver
  135. 2 things to do prior to the admin of Synercid?
    • 1. check C&S
    • 2. assess liver LFT & bilirubin
  136. Testing with Syndercid?
    need bilirubin and LFT twice in first week then weekly
  137. Considerations for admin of Synercid?
    • 1. flush IV before & after admin with D5W - interacts with saline & heparin
    • 2. prefer central line for admin
    • 3. if no central line dilute in 250mL D5W & infuse over 1 h in largest vein possible
  138. Action of tetracyclines?
    retards bacterial growth by inhibiting protein synth
  139. 3 uses for tetracyclines?
    • 1. serious infections when penicillin cannot be used:  lyme disease, rocky mnt. spotted fever
    • 2. acne vulgaris
    • 3. chlamydia & other STD's
  140. Problem with frequent use of tetracycline?
    resistance is occurring
  141. Interaction with tetracycline?
    dairy products, vitamins/supplements, & antacids interfere with the absorption
  142. Contraindications for tetracycline?
    • 1. pregnant/breast feeding
    • 2. CH < 8
  143. Why is tetracycline contraindicated in pregnancy?
    causes skel retardation
  144. 3 most common adverse effects with tetracycline?
    • 1. GI distress:  NVD & heartburn
    • 2. photosensitivity
    • 3. tooth discoloration
  145. 2 serious AE of tetracycline?
    • 1. skel. retardation in infants
    • 2. azotemia
  146. What is azotemia? 
    S/S?

    Monitoring?
    • high levels of nitrogenous wastes build up (urea, creatinine)
    • decreased UO & LOC, increased HR, dry mouth, edema, ortho BP, uremic frost

    monitor I&O & creatinine
  147. Prototype misc. antibiotic affecting protein synth? (2)
    chloramphenical & fluoroquinolones
  148. What type of ABX is chloramphenicol?

    What type of microbe does it work on?
    true broad spectrum ABX

    gram positive & gram negative
  149. What type of infections is chloramphenicol used for?
    serious infections:  meningitis, brain abscesses, rickettsial infections, and acute typhoid fever
  150. Black Box warning with chloramphenicol?
    blood dyscrasias
  151. What are rickettsial infections?
    infections caused by bacteria from ticks:  rocky mnt spotted fever, lyme disease, ricketsia ricketsii, etc
  152. Contraindications for chloramphenicol?
    hypersensitivity & breastfeeding
  153. Common AE of chloramphenicol?
    • 1. HA
    • 2. NVD
  154. Serious AE of chloramphenicol?
    • 1. blood dyscrasias
    • 2. grey-baby syndrome

    chloramphenicol - bleaches babies & blood
  155. What causes grey-baby syndrome to occur with chloramphenicol therapy?
    breastfeeding
  156. What babies are most at risk for grey-baby syndrome?
    preemies and/or underdeveloped liver
  157. S/S of grey-baby syndrome?
    grey/blue skin, feeding probs
  158. Admin of oral chloramphenicol?
    give on empty stomach
  159. Nursing interventions with admin of chloramphenicol?
    • 1. monitor peak, trough, and levels
    • 2. teach pt s/s of bone marrow suppression/blood dyscrasias & importance of telling MD immediately
    • 3. monitor clotting & CBC
  160. Fluoroquinolones end with ______.
    floxacin
  161. 3 fluoroquinolones?
    • ciprofloxacin/Cipro
    • levafloxacin/levaquin
    • moxafloxacin/Avelox
  162. Action of ciprofloxacin?
    inhibits DNA gyrase (enzyme needed for bacterial DNA replication)

    human DNA is not affected b/c uses diff enzyme
  163. What type of bacteria is ciprofloxacin most effective against?
    gram negative aerobes
  164. Resistance to ciprofloxacin?
    some has developed
  165. Common AE of ciprofloxacin?
    • 1. a lot of GI probs
    • 2. secondary infection by candida
  166. Why do a lot of secondary infection with candida occur with ciprofloxacin?
    b/c normal flora in the body are mostly gram neg. & ciprofloxacin is effective against them
  167. 2 types of infections ciprofloxacin is used for?
    • UTI
    • resp. infection
  168. Serious AE of ciprofloxacin?
    • 1. arthropathy (joint disease)
    • 2. achilles tendon rupture

    cipro - pro athletes are hard on their joints and may rupture their achilles tendon
  169. Why is ciprofloxacin not usually given to CH?
    b/c arthropathy AE is more common in ppl under 18 years old
  170. Ciprofloxacin during pregnancy?
    do not give - increased risk for arthropathy
  171. IV admin of ciprofloxacin?
    • 1. admin slowly over at least 60 minutes
    • 2. use large vein

    reduces venous irritation
  172. Intervention for ciprofloxacin bad GI AE?
    eat small frequent meals
  173. Prototype cyclic lipopeptide?
    daptomycin/Cubicin
  174. daptomycin/Cubicin uses?
    complicated skin infections like staph infections
  175. Type of microbe affected by daptomycin/Cubicin?
    antibiotic-resistant gram positive

    resistant to penicillins which also work on gram positive
  176. Common AE of daptomycin/Cubicin?
    GI distress
  177. Serious adverse effects of daptomycin/Cubicin?
    myopathy - muscle pain/damage
  178. What needs to be done prior to the admin of daptomycin/Cubicin?
    obtain C&S
  179. Admin of IV daptomycin/Cubicin?
    admin over at least 30 minutes to mnimize AE
  180. Monitoring with daptomycin/Cubicin?
    monitor weekly CK

    CK - creatinine kinase - will increase with muscle damage
  181. 3 ABX that should not be taken during pregnancy?
    CQT's = No OB's

    chloramphenicol, tetracycline, quinolones
  182. Pt education for daptomycin/Cubicin?
    notify MD if have diarrhea, muscle pain, or tingling
  183. 5 drugs used to Tx UTI's?
    • 1. cephalosporins
    • 2. fluoroquinolones
    • 3. penicillins
    • 4. tetracycline
    • 5. bactrim
  184. Abbreviations for bactrim?
    SMZ-TMP or TMP-SMZ
  185. Action of bactrim?
    interferes with the synthesis of FA needed for synth of RNA/DNA & proteins -> prevents formation of new bacteria
  186. Contraindication for bactrim
    folate deficiency disorders
  187. Uses for bactrim? (4)
    • 1. UTI
    • 2. resp infections - pneumocystis carinii pneumonia in AIDS pt
    • 3. GI infection
    • 4. STI's
  188. Common AE of bactrim?
    NVD
  189. What can cause increased risk for AE in bactrim?
    immunocompromised pt such as AIDS pt
  190. 5 serious AE of bactrim?
    • 1. renal damage caused by crystalluria
    • 2. allergic reactions
    • 3. Stevens Johnson Syndrome
    • 4. blood dyscrasias
    • 5. photosensitivity
  191. 4 nursing considerations for admin of bactrim?
    • 1. monitor immunocompromised closely r/t increased risk for AE
    • 2. give with food
    • 3. increase fluid intake to at least 1.5L/day unless CI to decrease crystalluria
    • 4. avoid ETOH
  192. Monitoring for pt taking bactrim?
    • 1. I&O & creatinine
    • 2. CBC
    • 3. s/s of stevens johnson/hypersensitivity
  193. Teaching for pt taking bactrim?
    wear sunscreen
  194. 2 urinary antiseptic drugs?
    • 1. methanamine
    • 2. nitrofurantoin/Macrodantin/Macrobid
  195. Action of urinary antiseptic drugs?
    work locally in the urinary tract
  196. Advantage of metanamine & nitrofurantoin?
    do not achieve high serum levels b/c work in urinary tract -> have few systemic effects
  197. Drug that is a urinary analgesic?
    phenazopyridine/Pyridium
  198. Action of phenazopyridine/Pyridium?
    no antibacterial activity

    relieves pain, burning, frequency, & urgency r/t irritation of the urinary tract due to infection
  199. Teaching for pt taking phenazopyridine/Pyridium?
    discolors urine orange/red

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