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Stops of inhibits growth of bacteria
Deals with bacterial infections
Gram + (aerobic or anaerobic?)
infection as a result of a procedure
implies that it's an infection developed in the hospital
Gram - (aerobic or anaerobic?)
infection were multiple organ are involved
bacteria in the blood
protective response to bacterial invasion
- localized microorganisms
- not necessarily an infection
invasion and multiple recpilcations of bacteria
Superinfection or Secondary infection
Assess for ____
- Vaginitis (because antibiotic will suppress flora)
- THRUSH (white patches in mouth/oralpharynx)
- Diarrhea (b/c antibiotic suppresses flora)
determines identity of microbe
Determines which antimicrobial agent will be therapeutic
Contributing factors to bacteria resistance
- Widespread use of anti-microbial drugs
- Interrupted treatment (Don't finish pills)
- Increase number of high risk pts (higher risk for developing infections)
- Location (ex. ICU, Lg hospital)
How to treat an anaphylactic reaction
epinephrine and corticosteroids
What are symptoms of a localized infection?
redness, heat, edema, pain, drainage
What are some symptoms of systemic infection?
- fever, increase HR, increased RR
- Anorexia, N/V
- Palpable lymphnodes
- high WBC (5,000-10,000)
- Watch culture and sensitivity
What is a high level of WBC?
Which antibiotics interfere with cell wall synthesis?
What are some problems with penicillin (PCN)
- Risk for severe allergic reactions
- PCN resistant bacteria
When does PCN (Penicillin) allergic reactions generally happen?
Not on the first dose
Does PCN (Penicillin) cross the BBB? Placenta? Breast Milk?
What category is penicillin?
Category B tetrogenicity
What are the uses of Penicillin?
- Tx Gram+ organisms
- Bacterial endocarditis (infection of the inner layer of the heart)
What is the prototype for PCN (Penicillin)
What does given on an empty stomach mean?
- 1 hour before your eat
- 2 hours after you eat
What are the ADE for PCN (Penicillin)?
- Common: N V D
- Severe: Allergic reaction
What is the black box warning on PCN (Penicillin)
Aqueous is the only one that can be given IV
Use PCN with caution when...
- Renal Disease
- Pregnancy and Lactation
What is the prototype for Cephalosporin?
How is Cephalosporin (cefazolin) given?
What is cephalosporin used for?
- Surgical prophylaxis
- (Given 30 min-2hrs pre op/ complete 30 mins per op)
has to be given for at least 30 mins, and has to be done prior to 30 mins before surgery
Placenta, breast milk
- Broad spectrum
- limited crossing
How is Cephalosporin (cefazolin) given?
- PO- with food
- IM - into a lg muscle
- IV- pharmacist will usually mix it for you
What are some ADEs of Cephalosporin (cefazolin)?
What are some contraindications of Cephalosporin (cefazolin)?
- anaphylactic reaction to PCN
What is Vancomycin used for?
- Tx severe infections
- Tx C.Diff
What is VRE?
Vancomycin resistant enterococci
What is the mechanisms of action for vancomycin?
Inhibits cell wall synthesis
What is the caution for giving Vancomycin IV?
- give SLOWLY
- 60-120 mins
- prevents red man syndrome: release of histamine that causes red rash from head to toe
What are ADE of vancomycin?
Common: Rash, "red man syndrom"
Serious: Ototoxicity (effects hearing), Nephrotoxicity (watch Creatine levels)
How do you administer Vancomycin?
What is the MoA of Aminoglycosides, Macrolides, tetracyclines?
- Inhibit protein synthesis of bacterial cell
- affect ribosomes of bacterial cells, not normal cells
What is the prototype for aminoglycosides?
What are the uses of aminoglycosides (gentamicin)
serious gram- infections
Bowel Prep- gets rid of all fecal activity in GIT, decreases flora (used for surgeries)
Tx of Hepatic Coma or Hepatic encephalopathy (decrease in consciousness assc with liver failure)
absorbed by GIT?
- poorly absorbed
- Does not cross
- Excreted unchanged by kidneys
- Category D
- Crosses placenta
When does serum aminoglycoside (gentamicin) peak and trough?
- Peak: 30-60 min after IV dose
- Trough: 30 min before next dose
What are the black box warning about aminoglycosides (gentamicin)
- Ototoxicity (ear)
- Nephrotoxicity (alt in urinary elimination)
- Potentiates anesthetic neuromuscular blockers (may take longer for paralysis due to surgery to wear off)
What are some nursing assessments for aminoglycosides (gentamicin)
- hearing function
- renal function (BUN 5-25, Creatine .5-1.5)
- Post-op: RR
What are normal levels for BUN?
What are normal Creatine levels?
What are some contraindication for aminoglycosides (gentamicin)
What are the Black Box warnings for Aminoglycosides (gentamicin)
- Neuromuscular blockade
What is the prototype for Macrolides?
What are some uses for Macrolides (erythromycin)
- Tx resp tract infections
- Skin infection
- Tx gram and infection
- Substitue for PCN allergies
What are some contraindications to Macrolides (erythromycin)
What are some ADE to Macrolides (erythromycin)
- Common: N/V/D
- Serious: Hepatotoxicity
What is the prototype for tetracycline?
What is tetracycline used for?
Tx of infection for: RT, GU, lyme, skin, acne
What are some contraindications of tetracycline?
- Renal Failure
- Pregnancy: mom-hepatic necrosis, fetus-effects bones and teeth
- Children < 8y/o
- Lactating Women
What are the MoA of Fluoroquinolones?
Antibiotic that inhibit nucleic acid synthesis
What is the prototype for Fluoroquinalones?
What are some contraindications of Fluoroquinalones (ciprofloxacin)
- Children <18 y.o
- Adults > 60 y.o - causes arthropathy
- Category C
- Pregnant or lactating
How is Fluoroquinalones (ciprofloxacin) taken?
What is the black box warning for Fluoroquinalones (ciprofloxacin)
avoid high impact exercise and strenuous wt lifting due to possibility of tendon rupture
What are some ADE of fluoroquinalones (ciprofloxacin)
What is the MoA of Sulfonamides?
- Antibiotis that inhibit metabolic pathways- antimetabolites
- inhibits nucleic acids
What is the prototype of Sulfonamides
What are the uses for Sulfonamides (sulfamethoxazole-trimethoprim)?
- Ulcerative Colitis
- Topically: Vaginal infection, Dermititis, Burns
- NOT for systemic infections
What are some contraindications of sulfonamides (sulfamethoxazole-trimethoprim)?
- Late pregnancy or to newborns > kernicterus: will displace the bilirubin and will rise and get to toxic levels
- lactating women
- < than 2 months old
- Hx of allergies to sulfa meds
- Renal or hepatic failure
- Category D
What are some ADE for sulfonamides (sulfamethoxazole-trimethoprim)?
- Common: N/V/D
- Serious: Rash, hives, itch, crystals in urine
What is stevens johnson syndrome?
JUST BE AWARE OF IT
- hypersensitivity syndrome r/t:
What antibiotic is associated with C. Diff?
What are the symptoms of C.Diff?
Mild: water diarrhea 3x or more per day, abd cramping and tenderness
- Severe: Watery diarrhea 10-15x a day
- blood, pus in stool
- dehydration, Wt Loss
What is treatment for C Diff
- Stop ABX
- Fecal Transplants?
What are the 6 steps to prevent C Diff?
- Question whether antibiotics are needed
- Test for C Diff right away
- Disinfect EVERYTHING with bleach
- Protect- PPE
- Isolate pt
- Alert- all health care providers involved