Pharmacology and the Nursing Process7: Antibiotics Flashcards


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created 6 years ago by jess_mf29
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MJC ADN 270 sp 2016 Unit 4 *Mostly from class lecture but based off pharm book
updated 6 years ago by jess_mf29
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1

community-associated infections

  • an infection that is acquired by a person who has not been hospitalized or had a medical procedure within the past year
2

health care-associated infections

  • contracted in a hospital or institutional setting
  • not present/incubated before a hospital admission
  • often more difficult to treat because causative microorganisms are often drug resistant and the most virulent
3

multi drug resistance

  • microbes/ pathogens have mutated to current meds changed adapted making medications/antibiotics less effective
4

therapeutic drug monitoring

  • labs: window of a high and low level in which Rx works the best
5

minimum inhibitory concentration (MIC)

  • concentration of the least amount of the drug that is in the body/blood and still working
6

what is time dependent killing?

  • A property of most antibiotic classes whereby prolonged high plasma drug concentrations are required for effective bacterial kill
7

What is an example of a time dependent killing antibiotics?

  • Z-pak (Azithromycin)
8

Concentration-dependent killing

  • how long a drug stays in the body, how much damage we can do to the pathogen in that period of time
  • constant amount of antibiotic in the body to kill that pathogen
9

multidrug-resistant organisms

  • organisms that are resistant to one or more classes of antimicrobial drugs
10

What are common multidrug-resistant organisms?

  • methicillin-resistant staphylococcus aureus (MRSA)
  • Vancomycin-resistant Enterococcus (VRE)
  • organism producing extended-spectrum betalactamases (ESBLs))
  • Organisms producing Klebsiella puemoniae carbapenemase (KPC)
11

Empiric therapy

  • treatment of an infection before specific culture information has been reported or obtained (generally broad spectrum antibiotic used until culture is received)
12

Definitive therapy

  • antibiotic therapy tailored to treat organism identified with cultures
  • have culture back, used antibiotics that microbe is sensitive to
13

Prophylactic therapy

  • treatment with antibiotics to prevent an infection, as in intraabdominal surgery or after trauma
14

Therapeutic response

  • decrease in specific s/s of infection are noted (decrease in fever, elevated WBC, redness, inflammation, drainage, pain)
15

Subtherapeutic response

  • s/s of infection do not improve
  • pt does not get better---->need to try different antibiotics
16

What are some antibiotic mechanisms of action?

  • interference with cell wall synthesis
  • interference with protein synthesis
  • interference with DNA replication
  • Acting as a metabolite to disrupt critical metabolic reaction inside the bacterial cell
17

Bactericidal

  • kill bacteria
  • action of some antibiotics
18

Bacteriostatic

  • inhibit growth of susceptible bacteria, rather than killing them immediately; will eventually lead to bacterial death
  • action of antibiotics
19

Sulfonamides

  • often combined with another drugs (synergistic)
  • Sulfamethoxazole w trimethoprim (non sulfa antibiotic)= Bactrim, Septra (commonly used)
20

Sulfonamides:

Mechanism of Action

  • bacteriostatic
  • prevents synthesis of folic acid required for synthesis of bacterial purines and nucleic acid
  • does not affect human cells or production of folic acid
  • only affects bacterial organisms that synthesize their own folic acid
21

Sulfonamides:

Indications

  • effective against both gram+ and gram - bacteria
  • often used for treatment of UTIs
  • URIs
  • commonly prescribed for outpatient staphylococcus infections, MRSA
22

Sulfonamides:

Adverse effects

  • Blood: thrombocytopenia
  • Integumentary: photosensitivity, Stevens-Johnson syndrome
  • GI: n/v, diarrhea, pancreatitis
  • other: hepatotoxicity, h/a,cough
23

Penicillins

  • Natural pcn: Penicillin G, Penicillin V
  • Penicillinase-resistant drugs: nafcillin, colxacillin, oxacillin, dicloxacillin
  • Aminopenicillins: amoxicillin (Amoxil), ampicillin (generic only)
  • Extended spectrum drugs: carbenicillin, piperacillin, ticarcillin

* generic all -cillins; some trade names don't include -cillin so be careful &know both

24

Penicillins

MOA

  • bactericidal
  • pcns enter bacteria via the cell wall
  • inside the cell wall they bind to pcn-binding protein
  • once bound, normal cell wall synthesis is disrupted
  • RESULT: BACTERIAL CELL DEATH by cell lysis
  • do not kill other cells in body
25

Pencillins:

Indications

  • prevention and tx of infections caused by susceptible bacteria
  • gram + bacteria, some gram - bacteria, some anaerobic bacteria and spirochetes
26

Pencillins:

Adverse effects

  • allergic reactions to pencilling occur in 0.7% to 4 % of treatment course (urticaria, pruritus angioedema)
  • n/v, diarrhea, abd pn
  • if pt has a hx of throat swelling/hives from pcn they should not receive cephalosporins; if allergic to pcn there is an ^ risk for allergy to other beta-lactam antibiotics
  • if a pt is going to have a reaction it is most likely to happen within the first 15 to 20 min of receiving the antibiotics, good to stay with pt for that period of time
27

Penicillins:

Interactions

  • MANY!
  • NSAIDS
  • Oral contraceptives
  • Warfarin
  • ex: coumadin: very loosely protein bound, main drugs knock it off its receptor site
28

Cephalosporins:

First generation

  • good gram+ coverage
  • poor gram - coverage
  • Parenteral and PO
  • examples: Cefazolin (Ancef) (IV or IM) & Cephalexin (Keflex) (PO)
  • used for surgical prophylaxis, and susceptible staphylococcal infections
29

Cephalosporins:

Second Generation

  • good gram + coverage
  • better gram- coverage than first generation but still not great
  • ex: Cefoxitin (Qefoxin) (IM &IV) : used prophylactically for abdominal or colorectal surgeries; also kills anaerobes
  • ex: Cefuroxime (Zinacef) (Ceftin): surgical prophylaxis, does not kill anaerobes
30

Cephalosporins:

Third generation

  • most potent group against gram- bacteria
  • less active against gram+
  • ex: Ceftazidime (Fortaz), Ceftriaxone (Rocephin)
31

Ceftriaxone (Rocephin)

  • cephalosporin 3rd generation
  • IV & IM
  • long half life,
  • once a day dosing
  • Elimination is primary hepatic
  • easily passes meninges and diffused into CSF t treat CNS infections
32

Ceftazidime (Ceptaz, Fortaz, Tazidime)

  • cephalosporin 3rd generation
  • IV & IM
  • excellent gram- coverage
  • resistance is limiting when we use it
33

Cephalosporins:

Forth generation

  • broader spectrum of antibacterial activity then 3rd generation, especially against gram+ bacteria
  • complicated/uncomplicated UTI >>> Cefepime(Maxipime)
34

Cephalosporins:
Fifth generation

Ceftaroline (Teflaro)

  • broader spectrum of antibacterial activity
  • effective against a wide variety of organisms (MRSA)
35

Cephalosporins:

Adverse Effects

  • Similar to pcn
  • mild diarrhea, abd cramping, rash, pruritus, redness, edema
  • potential cross-sensitivity with penicillins if allergies exist
36

Tetracyclines

  • wide spectrum: gram - and gram + organisms
  • natural and semisynthetic
  • bacteriostatic
  • inhibits bacterial protein synthesis
  • stops many essential functions of bacteria
  • binds (chelate) to Ca+++ , Mg++, & Al+++ ions to form insoluble complexes
  • dairy products reduce the absorption of tetracycline ^^^^^^^^
37

Commonly used Tetracyclines

  • oxytetracycline (Terramycin)
  • Tetracycline
  • doxycycline (Doryx, Vibramycin)
  • Tigecycline (tygacil)
38

Tetracyclines:

Adverse effects

  • strong affinity for calcium: discoloration of permanent teeth/tooth enamel in fetuses and children or if nursing infants
  • may retard fetal skeletal development if taken during pregnancy
  • alteration of intestinal flora: SUPER INFECTION >candida
  • diarrhea
  • pseudomembranous colitis
  • vaginal candidiasis
  • gastric upset
  • enterocolitis
  • maculopapular rash
  • others
39

Aminoglycosides

  • poor oral absorption
  • very potent antibiotics with serious toxicities
  • bactericida; prevent protein synthesis
  • kill mostly gram-; some gram +
40

commonly used Aminoglycosides

  • gentamicin
  • neomycin (neo-fradin)
  • tobramycin (TOBI)
  • amikacin
41

Aminoglycosides

Indications

  • used to kill gram - bacteria
  • often used in combination with other antibiotics for synergistic effects (often sulfas)
  • used for certain gram + infections that are resistant to other antibiotics
  • Poorly absorbed through GI tract, given parentally (exception neomycin)
42

Neomycin

  • given orally to decontaminate GI tract before surgical procedures
  • used as an enema for ^ purpose
  • used to treat hepatic encephalopathy----->liver induced brain disease come with severe cirrhosis
43

Aminoglycosides:

Adverse Effects

  • Nephrotoxicity (renal damage)
  • Ototoxicity (auditory impairment and vestibular impairment @ eighth cranial nerve, high frequency)
  • h/a
  • paresthesia
  • fever
  • superinfections
  • vertigo
  • skin rash
  • dizziness
44

Amino glycosides (serum)

card image
  • must monitor drug levels to prevent toxicities
  • MIC
45

Metronidazole (flagyl)

  • used for anaerobic organisms
  • given often in hospital
  • intraabdominal and gynecologic infections
  • protozoal infections
46

Vancomycin (Vancocin)

  • treatment choice for MRSA and other Gram+ infectionS
  • oral vancomycin is indicated for treatment of antibiotic induced colitis (C.Difficle) and for the treatment of staphylococcal enterocolitis
  • must monitor blood levels to ensure therapeutic level and prevent toxicity
  • MAY CAUSE OTOTOXICITY AND NEPHROTOXICITY
47

Vancomycin serum levels

  • Therapeutic: Peak: 20-40 mpg/mL ; trough 5-10mcg/mL
  • Toxic level greater than 40 mph/mL
48

Vancomycin

  • red man syndrome may occur: flushing/itching of head, neck, face, upper trunk; antihistamine may be ordered to reduce effect (often occurs if vancomycin is given too fast, pt will almost turn purple from nipple line up, should be given with a pump to prevent this )
  • additive neuromuscular blocking effects in pt receiving neuromuscular blockers
  • should be infused over 60 min
  • rapid infusion may cause hypotension
49

NURSING IMPLICATIONS:

Before beginning therapy what should be assess?

  • #1: contradictions to any drug: DRUG ALLERGIES
  • LABS: BUN, cretinine, liver function tests
  • current medications, supplements, diet, pt health history included immune system status
  • any prior health condition that my contraindication to antibiotic use or indicate cautious use
  • assess for potential drug interactions
50

NURSING IMPLICATIONS:

What specimen should be obtained prior to beginning antibiotic therapy?

card image
  • CULTURE!!!
  • 2 separate sites if obtaining blood culture
  • if swab culture directly from site of infection
51

NURSING IMPLICATIONS:

What are some s/s of superinfections?

  • fever
  • perineal itching
  • cough
  • lethargy
  • any unusual discharge
52

NURSING IMPLICATIONS:

Sulfonamides

  • take with 2000-3000 mL of fluid / 24 hr
  • assess RBCs prior to beginning therapy
  • take oral does with food
53

NURSING IMPLICATIONS:

Penicillins

  • take oral does with water not juice as acidic fluids may nullify drugs antibacterial actions
  • monitor patients taking penicillin for an allergic reaction for at least 30 minutes after administration
54

NURSING IMPLICATIONS:

Cephalosporins

  • assess for penicillin allergy; may have a cross allergy
  • give orally administered forms with food to decrease GI upset, even though this will delay absorption
  • some of these drugs may cause disulfiram (antabuse) like reaction when taken with alcohol
55

NURSING IMPLICATIONS:

Macrolides

  • highly protein bound and will cause severe interactions with other protein bound drugs
  • the absorption of oral erythromycin is enhanced when taken on an empty stomach, and because of the high incidence of GI upset, may drugs are taken after a meal or snack
56

NURSING IMPLICATIONS:

Tetracyclines

  • avoid milk products, iron preparations, antacids, and other dairy products because of the chelations and drug binding that occurs
  • take all medications with 6 to 8 oz fluid
  • because of photosensitivity avoid sunlight and tanning beds
57

WBC, total

  • Adult: 4,500-10,000 microliters (mm^3)
  • child: newborn : 9,000-30,000microliters (mm^3) , 2y/o: 6,000-17,000 microliters (mm^3) ; 10 y/o: 4,500 to 13,500 microliters (mm^3)
58

WBC, diff

  • Neutrophils (total): 50-70%; 2,500-7,000 microliters (mm^3)
  • segments: 50-65%; 2,500-6,500 microliters (mm^3)
  • bands: 0-5%; 0-500 microliters (mm^3)
  • Eosinophils: 1-3%; 100-300 microliters (mm^3)
  • Basophils: 0.4-1.0%; 40-100 microliters (mm^3)
  • monocytes: 4-6%; 200-600 microliters (mm^3)
  • lymphocytes: 25-35% 1,700-3,500 microliters (mm^3) ,