05 Meds: Antibiotics/anti-Infectives

Front 1

Examples of Aminoglycosides? (5)

Back 1

1. Gentamicin (Garamycin)
2. Neomycin
3. Streptomycin
4. Tobramycin (Tobrax)
5. Amikacin (Amikin)

Front 2

Aminoglycoside actions

Back 2

1. bacteriocidal
2. inhibits protein synthesis in GRAM - bacteria

Front 3

Aminoglycoside indications

Back 3

1. severe CNS inf
2. respiratory, GI, UT, bone, skin, soft tissue, PID
3. TB (streptomycin)*

Front 4

Aminoglycoside side effects

Back 4

1. ototox* (CN VIII)
2. nephrotox*
3. anoresia, N, V, D

Front 5

Aminoglycoside nursing considerations

Back 5

1. check hearing (CN VIII)
2. check renal fxn (BUN, CR)
3. rx for 7-10 days
4. encourage fluids
5. small, frequent meals
6. photosensitivity

Front 6

What should you teach pt receiving aminoglycosides in relation to their ototoxic potential effects?

Back 6

Immediately report: tinnitis, vertigo, nystagmus, ataxia

Front 7

To make sure an aminoglycosid eis at a therapeutic level, what should you check?

Back 7

1. peak: 2 h after med given
2. trough: at time of dose/prior to med

Front 8

What should you do if an aminoglycoside is given long term?

Back 8

audiogram

Front 9

Which aminoglycoside has opthalmic considerations? Describe admin

Back 9

Neomycin sulfate (Neobiotic): remove infective exudate around eyes before admin of ointment

Front 10

What is the potential side effect for opthalmic aminoglycoside?

Back 10

hypersensitivity rxn

Front 11

Give an example of each generation of cephalosporins (4)

Back 11

1st gen: Cephalexin (Keflex)
2nd gen: Cefaclor (ceclor)
3rd gen: Ceftriaxone (Rocephin)
4th gen: Cefepime (Maxipime)

Front 12

MOA of cephalosporins (2)?

Back 12

1. bacteriocidal
2. inhibit syn of bacterial cell wall

Front 13

Cephalosporin indications?

Back 13

1. pharyngitis, tonsilitis
2. otitis media
3. upper and lower RTI
4. derm inf
5. GONORRHEA
6. septicemia
7. meningitis
8. periop prophylaxis
9. UTI

Front 14

Side effects of cephalosporins?

Back 14

1. ab pain, N, V, D
2. increased risk of bleeding, hypoprothombinemia
3. rash
4. superinfection
5. thrombophlebitis (IV), abcess formation (IM, IV)

Front 15

Nursing considerations for cephalosporins?

Back 15

1. take w/ food*
2. admin in liquid form to kids (don't crush)
3. have vitamin K available for hypoprothrobinemia
4. cross allergy w/ PCN***
5. monitor renal and hepatic fxn
6. monitor for thrombophlebitis
7. may cause a false + Coombs' test: looks for antibodies that may bind to your RBCs to cause premature hemolysis

Front 16

3 examples of Fluroquinolones?

Back 16

1. Ciprofloxacin (Cipro)
2. Levofloxacin (Levequin)
3. Norfloxacin (Noroxin)

Front 17

Actions of fluroquinolones?

Back 17

1. bactericidal
2. interferes w/ DNA replication of GRAM - bacteria

Front 18

Indications for fluroquinolones (4)

Back 18

1. tx of e. coli infections
2. chronic bacterial prostatitis
3. acute sinusitis
4. postexposure inhalation anthrax

Front 19

Side effects of fluroquinolones?

Back 19

1. seizures, headache
2. GI upset: N,D
3. rash
4. photosensitivity
5. achilles tendon rupture*
6. High: BUN, AST, ALT, serum CR, alkaline phosphate
7. low: WBC, Hct

Front 20

Fluroquinolone nursing considerations?

Back 20

1. culture & sensitivity before therapy begins
2. take 1 hr before or 2 hr after meals w/ water*
3. encourage fluids
4. if needed give antacids or Fe prep 2 hr after meds
5. take full course
6. avoid caffeine
7. CI in kids less than 18*

Front 21

Example of a glycopeptide?

Back 21

Vancomycin (Vancocin)

Front 22

MOAs of glycopeptide (Vancomycin)

Back 22

1. bacteriocidal
2. binds to bacterial cell wall and stops synthesis

Front 23

Indications for vancomycin (a glycopeptide)

Back 23

1. resistant staph inf
2. pseudomembranous enterocolitis r/t c. diff

Front 24

Glycopeptide side effects?

Back 24

1. liver tox
2. thrombophlebitis, abcess formation
3. nephrotox
4. ototox

Front 25

Nursing considerations for glycopeptides?

Back 25

1. monitor renal fxn & hearing
2. poor absorption orally**
3. administer IV*: peak 5 min, doa 12-24 hr
4. avoid extravation during therapy (it may cause necrosis)
5. give anti-histamine if RED MAN SYNDROME devo*
6. contact HCP if signs of superinfection

Front 26

S&S of red man syndrome?

Back 26

low BP, flusing of face & neck

Front 27

Give an example of the Lincosamides

Back 27

Clindamycin HCl Phosphate (Cleocin)

Front 28

MOA of lincosamides like clindamycin

Back 28

1. BOTH bacteriostatic & bactericidal *
2. suppresses protein syn by preventing peptide bond formation

Front 29

Lincosamide indications?

Back 29

1. staph
2. strep

Front 30

Side effects of Lincosamides?

Back 30

1. D, N
2. rash
3. liver tox
4. vaginitis
5. colitis may occur 2-9 days or several weeks after starting meds

Front 31

Nursing considerations for Lincosamides?

Back 31

1. admin PO med w/ full glass of water to prevent esophageal ulcers
2. monitor for persistent V, D, fever, ab pain, cramping, superinfections

Front 32

Give 2 examples of Macrolides?

Back 32

1. Erythromycin (Erythrocin)
2. Azethromycin (Zithromax)

Front 33

Actions of Macrolides?

Back 33

1. bacteriostatic AND bactericidal
2. binds to cell membrane and causes change in protein fxn

Front 34

Macrolide Indications?

Back 34

1. acute infection
2. acne, skin inf
3. URTI
4. prophylaxis before dental procedures for pt allergic to PCN and w/ valvular heart disease*

Front 35

Macrolide side effects?

Back 35

1. GI: ab cramps, D, N
2. CNS: confusion, uncontrollable emotions
3. hepatotox
4. superinfections

Front 36

Macrolide nursing considerations?

Back 36

1. can be used in pt w/ renal dysfxn because they are primarily excreted through the bile
2. monitor liver fxn
3. take around the clock to max effectiveness
4. take PO 1 hr before or 2-3 hr after meals w/ full glass of water

Front 37

Give examples of PCNs (6)

Back 37

1. Amoxicillin (Amoxil)
2. Ampicillin (Omnipen)
3. Methicillin
4. Nafcillin (unipen)
5. PCN G
6. PCN V

Front 38

PCN actions

Back 38

1. bactericidal
2. inhibit cell wall syn

Front 39

indications for PCN?

Back 39

1. effective against GRAM + orgs
2. moderate-severe inf tx
3. SYPHILLIS
4. GONOCOCCAL INF
5. lyme dz

Front 40

PCN side effects

Back 40

1. glossitis, stomatitis
2. gastritis, D
3. superinfection
4. hypersensitivity, skin rashes
5. renal, hepatic, heme abnormalities

Front 41

PCN nursing considerations.

Back 41

1. obtain C&S before first dose
2. take careful hx of PCN rxn
3. observe for 20 min post-inj
4. give 1-2 hr ac or 2-3 h pc to reduce gastric acid during drug destruction
5. monitor for loose, foul-smelling stool & change in tongue
6. check for hypersensitivity to ther drugs, esp cephalosporins!
7. monitor serum electrolytes & cardiac status if given IV
8. monitor and rotate injection sites
9. good mouth care
10. yogurt or buttermilk helps D

Front 42

3 examples of Sulfonamides?

Back 42

1. Sulfisoxazole (Gentrisin)
2. Sulfasalazine (Azulfidine)
3. Trimethoprim/Sulfamethoxazole (Bactrim, Septra)

Front 43

Actions of Sulfonamides

Back 43

1. bacteriostatic
2. competitively antagonizes paraminobenzoic acid (essential component of folic acid synthesis)-->causes cell death

Front 44

Indications for Sulfonamides (7)

Back 44

1. UC, Chron's dz
2. otitis media
3. conjunctivitis
4. meningitis
5. toxoplasmosis
6. UTIs
7. rheumatoid arthritis

Front 45

Sulfonamide side effects

Back 45

1. peripheral neuropathy
2. crystalluria, proteinuria
3. photosensitivity
4. GI upset
5. stomatitis

Front 46

NC for Sulfonamides

Back 46

1. C&S before therapy
2. take on EMPTY stomach w/ a full glass of water
3. take around the clock
4. encourage fluid intake (8 glasses of water/day--3000mL/day)
5. protect from sun exposure
6. good mouth care
7. avoid vitamin C (which acidifies urine)--bicarbonate may be indicated to elevate urine pH

Front 47

Special considerations for Bactrim in terms of administration?

Back 47

IV solution must be given slowly over 60-90 minutes

NO IM!!

Front 48

3 examples of Tetracyclines

Back 48

1. Doxycycline (Vibramycin)
2. Minocycline (Minocin)
3. Tetracycline HCl (Panmycin)

Front 49

Actions of Tetracyclines (2)

Back 49

1. bacteriostatic
2. inhibits protein synthesis of susceptible bacteria

Front 50

Indications for Tetracyclines

Back 50

1. STIs: syphilis, chlamydia, gonorrhea
2. malaria prophylaxis
3. chronic peridontitis
4. acne
5. tx of anthrax (Vibramycin)
6. part of combo therapy for H. pylori inf
7. tetracycline: drug of choice for stage 1 Lyme dz

Front 51

Side effects of tetracyclines:

Back 51

1. photosensitivity
2. discoloration of deciduous *baby* teeth, enamel hypoplasia, discoloration and inadequate calcification of primary teeth of fetus if taken during pregnancy
3. glossitis, dysphagia
4. D, renal, hepatic, hematological abnl
5. rash, superinfections

Front 52

NC for tetracyclines

Back 52

1. take 1 h before or 2-3 h after meals
2. do NOT take w/ antacids, milk, iron preps (give 3 hr after med)--foods high in ca interfere w/ absorption
3. good oral hygiene
4. avoid during tooth and early devo periods (4th mo prenatal to 8 years of age)
5. monitor I&O
6. avoid sun exposure
7. look at expiration date: nephotoxic w/ age and exposure to sun light
8. topical applications may stain clothes