Antibiotics/Antivirals

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dsherman
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92157
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Antibiotics/Antivirals
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2011-06-29 09:38:14
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Antibiotics Antivirals
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Antibiotics/Antivirals
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  1. cephalosporins actions
    cephalosporins interfere with bacterial cell wall synthesis and are considered broad-spectrum. The cell wall weakens, swells, burst, and dies as a result of increased osmotic pressure inside the cell.
  2. Cephalosporins uses
    used widely in a variety of infections
  3. Contraindications to the uses of cephalosporins
    because of cross-sensitivity, clients with allergies to penicillins should not be perscribed cephalosporins
  4. Side effects of cephalosporins
    • rash, pruritus, fever
    • Anorexia, nausea, flatulence, vomiting, diarrhea
    • Third generation, medications: possable suprainfection
    • Cefmetazole, cefoperazone, and cefotetan may cause bleeding tendencies
  5. Nursing implications when administering cephalosporins
    • Evaluate intramuscular (IM) and intravenous (IV) sites for reaction, such as abscess and phlebitis
    • Monitor rate of infusion: check labeling for rate of IV infusion
    • Monitor renal and hepatic studies throughout therapy
    • Advise client to hydrate; notify health care provider if experiencing diarrhea
    • With medications that cause bleeding tendencies, monitor for bleeding (PTT, PT, INR). abnormal brusing
  6. Tetracyclines classification
    Antibiotic
  7. Tetracyclines action
    • Broad spectrum antibiotic
    • suppress bacterial growth and replication, but does not kill the bacterial cells outright
    • second line drug used for infections resistant to first-line drugs
  8. Most common uses for tetracycline
    • Rickettsial diseases
    • uncommon infections
    • tropical intestinal infections
    • peptic ulcer disease
    • Acne
    • sinusitis
    • cystitis
    • lyme disease
    • peridontal disease
  9. Percaution for the uses of tetracyclines
    • renal and hepatic dysfunction
    • do not give to children (<11) or pregnant women
    • may cause staining of developing teeth
  10. Side effects of tetracyclines
    • Nausea
    • abdominal cramping
    • vomiting
    • diarrhea
    • suprainfection
    • photosensitivity
  11. Nursing implications when administering tetracycline
    • take on an empty stomach; antacids, milk products, and iron supplements should not be comsumed until at least 2 hours after dose was taken
    • do not administer to pregnant women or children under age 8 to avoid tooth discoloration
    • monitor for diarrhea, as this may indicate a suprainfection of bowel (C-Diff)
    • check dose and rate when delivering IV
    • wear sunscreen and protective clothing
  12. Metronidazole (Flagyl) classification
    Antibacterial
  13. Metronidazole (Flagyl) uses
    • Asymptomatic and symptomatic trichomoniasis in female and male clients (Gonorrhea)
    • acute intestinal amebiasis and antibiotic-associated colitis (E-Coli)
  14. Contraindicatins to administering Metronidazole(Flagyl)
    • active CNS disease
    • blood dyscrasias (blood disorders)
    • first trimester of pregnancy and breastfeeding mothers
  15. Percautions to take when administering Metronidazole (Flagyl)
    • second and third trimesters of pregnancy
    • alcoholism
    • hepatic disease
  16. Side effects of Metronidazole (Flagyl)
    • nausea
    • headache
    • dry mouth
    • vomiting
    • anorexia
    • epigastric distress
    • metallic taste
    • darkening of the urine
    • seizures
  17. Nursing implications when administering Metronidazole (Flagyl)
    • Take on an empty stomach if possible; may be taken with food if nauseated.
    • Teach not to apply cologne, after shave lotion, or bath splashes or ingest alcohol products to avoid a disulfiram-type reaction (e.G., flushing, nausea and vomiting, Palpitations, tachycardia, psychosis).
    • Mothers should wait 3 days after last dose of drug to resume breastfeeding
    • Teach client that harmless darkening of the urine may occur
  18. Isoniazid (INH) classification
    Antituberculosis agent
  19. Isoniazid (INH) actions
    interferes with biosynthesis of bacterial protein, nucleic acid, and lipids
  20. Uses for Isoiazid (INH)
    • Treatment of all forms of active turberculosis
    • Preventive in high-risk persons (e.g., those with a positive tubeculosis skin test or exposure)
  21. Contraindications and precautions when administering Isoniazid (INH)
    • Renal and liver problems
    • convulsive disorders
    • alcoholism
  22. Side effects of Isoniazid (INH)
    • peripheral neuritis (numbness, tingling, burning, pain, loss of sensation in the nerves)
    • clumsiness, unsteadiness, muscle ache
    • epigastric distress, jaundice, drug-induced hepatitis
  23. Nursing implications when administering Isoniazid (INH)
    • Teach to take orally on an empty stomach 1 hour before or 2 hours after meals
    • Depletes vitamin B6 (pyridoxine) and will need supplementation during treatment
    • peripheral neuritis, the most common adverse effect, is preceded by paresthesias (e.g., numbness, tingling, burning,pain) of the feet and hands
    • Teach clients to reduce of eliminate consumption of alcohol to reduce risk of hepatotoxicity
    • Antituberculosis treatment always involves 2 or more medications; INH is often combined with rifampin
  24. The mnemonic for antibiotics used in TB (tuberculosis) STRIPE stands for
    • ST-streptomcin
    • R-rifampin
    • I-isoniazid
    • P-pyrizinamide
    • E-ethambutol
  25. Actions of aminoglycosides
    • narrow-spectrum against a wide variety of gram-negitive bacteria and certain gram-positive organisms
    • disrupts bacterial protein synthesis
  26. Uses for aminoglycosides
    • parenteral use restricted to treatment of serious infection of gastrointestinal, respiratory, and urinary tracts; CNS; bone; skin and soft tissue, including burns
    • Topically-primary and secondary skin infections
    • Meningitis, Peritonitis
  27. Contraindication when administering aminoglycosides
    hypersensitivity or toxic reaction to aminoglycoside antibotics
  28. Precautions to be taken when administering aminoglycosides
    • renally impaired clients
    • history of eighth cranial nerve impairment
    • Myasthenia gravis clients (autoimmune muscle diseases example MS)
    • possible fetal damage when given to pregnant and lactating women
  29. Side effects of aminoglycosides
    • Nephrotoxicity (reversible injury)
    • ototoxicity (irreversible injury)
    • Neuromuscular blockade leading to flaccid paralysis and fatal respiratory depression can occur in clients receiving skeletal muscle relaxants
    • rash, urticaria, pruritus
  30. Nursing implications when administering aminoglycosides
    • Peak and trough levels should be assessed. Ototoxicity associated with persistent high trough levels, rather then high peak levels
    • Monitor renal function (e.g., blood urea nitrogen and creatinine levels)
    • Monitor sensory problems (e.g., loss of hearing).
    • instruct clients to report tinnitus, high-frequency hearing loss, persistent headache, nausea, dizziness, vertigo)
    • Anticipate antidote of intravenous (IV) calcuim gluconate for treatment of neuromuscular blockade
  31. Uses for Antiretrovirals
    • Treat retrovirus
    • terminates viral replication
    • blocks enzyme activity
    • inhibits and prevents maturation of HIV
  32. Action of antiretrovirals
    • Nucleoside/nucleotide reverse transcriptase inhibitors (NRTI)-inhibit human immunodeficiency viral (HIV) replication
    • Nonnucleoside reverse transcriptase inhibitors- (NNRTI)-disrupt enzyme activity
    • Protease inhibitor (PI)-inhibits and prevents maturatuon of virus
    • HIV fusion inhibitor-blocks entry of virus into CD-4-T cells; new category with only one drug, enfuvirtide (Fuzeon); used when resistance to other medications occurs
  33. Contraindications and percautions when administering antiretrovirals
    hemophilia (inability ot form blood clots)
  34. Most common side effects of antiretrovirals
    • anemia, neutropenia, gastrointestinal upset, rarely lactic acidosis and hepatic steatosis
    • dizziness, insomnia, drowsiness, rash
    • hyperglycemia, fat maldistribution (Pseudo-cushing's syndrom), hyperlipidemia, bone loss, elevation serum transaminases (liver injury)
    • injection site reactions, pneumonia, hypersensitivity
  35. Nursing implications when administering antiretrovirals
    • Check to see if should be given with or with out food this varies with the calssifications
    • instruct client to take the full dose and complete treatment regimen
    • pregnant woman should receive antiretroviral therapy regardless of pregnancy status
    • teach client to report symptoms related to severe rash, CNS issues, diabetes, pneumonia
    • monitor CD4-T cell count
  36. Association to remember the antiretroviral drugs
    • vir is in the word and means virus
    • Acyclovir
    • Efavirenz
    • Invirase
    • Enfuvirtide
    • Retrovir
    • Saquinavir
  37. FDA pregnancy risk categories
    • Category:
    • A-remote risk of fetal harm
    • B-slightly more risk than category A
    • C-greater risk than category B
    • D-proven risk of fetal harm; labeled warning
    • X-proven risk of fetal harm; labeled as contraindicated
  38. The mnemonic to remember antibiotics that are contraindicated suring pregnancy is MCAT
    • M-Metronidazole (contraindicated in first trimester; caregory B-second and third trimesters)
    • C-Cloramphenicol (category C)
    • A-Aminoglycoside (category C)
    • T-tetracycline (category D)
  39. Ciprofloxacin (Cipro)
    • Can be given IV or PO
    • Action: inhibits bacterial replication (broad spectrum)
    • used: to treat bacterial infections in urinary, respiratory and GI tracts as well as with bone, joint, and ophthalmic infections
    • Contraindications and precautions:
    • avoid in children under age of 18 years
    • caution should be taken with renal and CNS disorders, seizures, or those taking theophlline
    • Side effects: nausea, vomiting, diarrhea, abdominal pain, dizziness, headache, restlessness, dyspepsia, constipation, flatulence
    • in older adults significant risk of confusion, visual disturbances
    • Photosensitivity reactions, primarily with ofloxacin (Floxin), Lomefloxacin (Maxaquin, sparfloxacin (Zagam)
    • Tendon rupture, seizures (rarely)
    • Nursing implications:
    • teach client to avoid antacids, iron supplements, and milk and dairy products for at least 2 hours after taking medication
    • teach client to report any tendon pain or inflammation
    • encourage adequate fluid intake, 6 to 8 classes daily
    • administer intravenous (IV) Cipro over 60 minutes
    • dosage regimen for anthrax inhalation is over a 60-day period
  40. Pencillin (PCN)
    • Can be given IV, IM, PO
    • Actions: disrupts and weakens the cell wall, leading to cell lysis and death
    • Uses: Gonorrhea, UTI, Pneumonia and other respiratory infections, septicemia, Peritonitis, Meningitis, treatment of infections caused by bacteria
    • contraindications and precautions:
    • hypersensitivity to penicillin, cephalosporins, or carbepenems, neonates
    • Side effects: allergic responce- rash, itching, hives, anaphylaxis
    • with ticarcillin and carbenicillin-sodium overload (heart failure), bleeding as a result of the inteference with platelet function
    • Nursing implications:
    • instruct client to check label with regard to administering with food
    • instruct client to wear medication-alert bracelet if allergic to penicillin
    • monitor renal function to avoid toxic levels
    • monitor client for 30 minutes when given parenterally; administer epinephrine if anaphylaxis occurs
    • collect any laboratory culture specimens before initiating penicillin therapy
    • do not mix aminoglycosides with penicillin in the same intravenous (IV) infusion as penicillin deactivates the aminoglycoside
    • monitor for circulatory overload and bleeding tendencies when client recieves ticarcillin and carbenicillin
  41. Azithromycin (Zithromax)
    • Can be given IV, PO (7 day dose pack)
    • Actions: inhibit bacterial protein synthesis; is a derivative of erythromycin
    • Uses: Lower respiratory tract bacterial infections (pneumonia, exacerbations of COPD, chlamydia), Upper respiratory tract bacterial infections (pharyngitis, tonsillitis), uncomplicated skin of skin structure infections, sexually transmitted diseases (nongonoccocal urethritis, gonorrhea, chancroid in men)
    • Contraindications and precautions for administration:
    • Liver dysfunction
    • Side effects: nausea, vomiting, diarrhea, abdominal pain, and suprainfections
    • Nursing implications:
    • take medication 1 hour before or 2 hours after food or antacids
    • aluminum and magnesium antacids reduce the rate of absorption but not the extent
    • observe for development of signs of suprainfecitions
    • instruct client to take prescribed course of therapy, although symptoms may improve or disappear
  42. Major toxic effects of aminoglycosides
    amikacin
    neomycin
    tobramycin
    gentamicin
    • ototoxicity and nephrotoxicity
    • Actions: narrow-spectrum
    • Used: for serious infections
    • Contraindications and precautions:
    • history of hypersensitivity or toxic reaction with aminoglycoside antibiotics
    • renally impaired clients, history of eigth cranial nerve impairment
    • clients with myasthenia gravis
    • neonates
    • Toxicity:
    • Nephrotoxicity (reversible injury)
    • ototoxicity (irrversible injury)
    • neuromuscular blockade can lead to flaccid paralysis, and fatal respiratory depression can occur in clients reciving skeletal muscle relaxants
    • Drug Interactions:Ethacrynic acid (Edecrin) significantly increasis ototoxicity
    • Amphotercin B, cephalosporins, polymixins, vacomycin, cyclosproine, acetylsalicylic acid (ASA), and non steroidal antinflammatory drugs (NSAID's) increase risk of nephrotoxicity
    • skeletal muscle relaxants and neuromuscular-blocking agents used in surgery increase the risk of neuromuscular blokade
    • Nursing implications when administeing aminoglycoside antibiotics:
    • peak and trough levels should be assessed ototoxicity is associated with persistent high trough levels, rather than high peak levels
    • monitor renal function (BUN and creatinine levels) for renal impairment
    • monitor for sensory problems (e.g., loss of hearing)
    • instruct clients to report tenitus, high-frequency hearing loss, persistent headache, nausea, dizziness, vertigo
    • anticipate antidote of intravenous (IV) calcium gluconate for treatment of neuromuscular blockade

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