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77 Cards in this Set
- Front
- Back
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Which classification of microorganisms do most people have?
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Aerobic
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Enterococcus
-Gram stain -Aerobicity -Reason for concern |
Gram positive
Aerobic Can live outside the body very well |
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VRE
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Vancomycin resistant enterococcus
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Which two organisms are very common on the skin?
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Staph & Strep
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What is the most common anaerobic bacteria we talked about during lecture? What is its gram stain?
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C. defficile - gram positive
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Which patients most commonly have mycobacterium AI?
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Immunocompromised patients
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Who gets the atypical mycoplasma pneumoniae?
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People in 20's and elderly
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What category does legionella belong to?
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Atypical organism
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Enterobacteriaceae
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Very common aerobic bacteria; includes e. coli
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Definition of colonized
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Means it exists already in the body, but is not causing an infection
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Penicillins
MOA |
Interfere with bacterial cell wall synthesis
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How do you know if it's a penicilin?
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If it ends with cillin
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Which class does penicillin belong to?
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B lactams
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Are there many drug-drug interactions with penicillins?
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No
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What does nafcillin treat?
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Nafcillin sensitive streptococcus aureus
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What are two emperic penicillins?
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piperacillin & ticarcillin
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What is the process for treating a new unknown infection?
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1. culture
2. emperic 3. gram stain/results 4. narrowing antibio choice within 72 hours based on results |
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Cephalosporins MOA
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Interferes with bacterial cell wall synthesis (same as penicillins)
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To what class do cephalosporins belong to?
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Beta lactams, just like penicillins
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How do you know it's a cephalosporin?
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Starts with cef/ceph
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What is the advantage of using a cephalosporin over a penicillin?
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Cephalosporins are more resistant to beta lactamases than penicillins are
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Should penicillins be used in pregnancy, children, and elderly?
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Yes, very safe drugs
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What if someone says they're allergic to penicillins or cephalosporins?
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First, find out if this is a real allergy.
If the person previously experienced life-threatening anaphylaxis, then don't give EITHER class. |
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What is the difference between 1st, 2nd, and 3rd generation cephalosporins?
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1st - treats gram pos
2nd - in between 3rd - treats gram neg |
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Will you ever use a cephalosporin and a penicillin simultaneously?
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No
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Why is renal function a concern when giving nafcillin?
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It's not.
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Carbapenems MOA
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Interfere with bacterial cell wall synthesis
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What class do carbapenems belong to?
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B lactams
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Again, what are the three b lactam subcategories?
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Carbapenems
Penicillins Cephalosporins |
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How do you know it's a carbapenem?
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Ends with penem
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Which drugs are broad spectrum/ last resort in the ICU?
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Carbapenems
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What's the key rule of giving B lactams?
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Don't give a b lactam with a b lactam
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The glycoprotein antibiotic
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Vancomycin
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Vancomycin MOA
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Inhibits bacterial cell wall synthesis in a different way than B lactams do
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What is the signature adverse effect of vancomycin? What's the problem and solution?
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Red man syndrome
Infusion rate is too high; need to slow rate to relieve symptoms; benadryl also helps |
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Nurse's number one priority with vancomycin administration
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Keep it on schedule to establish steady state
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Why is steady state so important when giving vancomycin?
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Because the drug is used to treat MRSA, you don't want the concentration to fall too low because that decreases its efficacy
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What is the MIC?
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Minimal inhibitory concentration (the minimum amount of drug needed to prevent growth of bacteria x)
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What dosage should a person on vanc receive?
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5-10x the MIC
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Besides giving vanc on time, what is another important nursing action?
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Draw trough and peak levels.
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When are peak and trough levels drawn and why?
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Peak drawn 30 min after admin.
Trough drawn 30 min before admin. This tells us the max and min concentrations of drug in body throughout administration. |
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Aminoglycosides MOA
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Inhibit bacterial protein synthesis by binding to ribosome
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How do you know if it's an aminoglycoside?
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Ends with mycin/micin and it's NOT vancomycin
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Why are aminoglycosides the most dangerous antibiotic?
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Because very nephrotoxic and can cause acute renal failure when given in excess
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Besides nephrotoxicity, what is another main side effect of aminoglycosides?
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Ototoxicity
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Why do we draw trough and peak levels for aminoglycosides? how does this differ from vanc draws?
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We draw these to make sure the levels aren't toxic (too high); unlike vanc, where you draw to make sure its not too low
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What is notable about the effect of aminoglycosides in different parts of the body?
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The penetration varies from organ to organ; eg high penetration of kidneys, low penetration of lungs
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What is another way to monitor the adverse effects of aminoglycosides?
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Draw serum creatinine levels
If creatinine rises and urine output decreases, this is BAD |
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Whose kidneys are we less worried about?
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Young peoples; it's old kidneys that can't handle this because organ function decreases with age
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What if a person is in renal failure and they need an aminoglycoside?
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You can give one dose and that's it - it won't be eliminated
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Macrolides MOA
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Attaches to ribosome and interferes with bacterial protein synthesis
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How do you know it's a macrolide?
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Ends with thromycin
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What are adverse effects of macrolides?
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1. GI upset b/c increases the secretion of motilin --- diarrhea
2. dysgusia (taste disturbance)/metallic taste 3. dysrhythmias |
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Two notables about macrolides?
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They have the worst drug-drug interactions
Also great for treating atypical organisms |
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What are macrolides an alternative to?
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Penicillins
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What is an alternative use of erythromycin?
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Used to advance a feeding tube into the GI tract because the motilin secretion causes helpful peristalsis
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Are macrolides safe during pregnancy?
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Yes
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Tetracyclines MOA
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Inhibits bacterial protein synthesis by binding to ribosomes
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Who should not take tetracyclines?
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-Pregnant ladies because complexation will cause infant teeth discoloration
-Nursing mothers -Children under 12 |
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What is the main adverse effect of tetracyclines?
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Photosensitivity - susceptibility to sunburn easy
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How do you know it's a tetracycline?
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Ends with cycline
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What should a nurse teach a patient about tetracyclines?
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Complexation
If patient takes the antibiotic with anything that has 2+ or 3+ cations, the drug won't be absorbed -No milk: Ca2+ -No multivitamin |
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When is complexation an issue?
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ONLY when both the tetracycline and the cations are taken PO in the same hour range
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What other class of drugs has the complexation problem?
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Fluoroquinolones
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How do you know it's a fluoroquinolone?
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Ends with floxacin
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Fluoroquinolones MOA
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Inhibits bacterial DNA gyrase to stop replication
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Adverse effects of fluoroquinolones
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Cardiac conduction abnormalities
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Who cannot receive fluoroquinolones?
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Pregnant women or children
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Sulfa drugs MOA
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Prevents bacterial utilization of paramino benzoic acid which is necessary for bacterial production of folic acid and DNA synthesis
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What are sulfa drugs used for? (2)
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Tx of community acquired UTI
Prophylaxis of immunocompromised --- HIV/organ transplant |
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Flagyl class & MOA
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Other
Produces cytotoxic effects in anaerobic bacteria by depriving the organisms of necessary substances |
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Two common uses for flagyl
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C diff & gynecological STDs
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Main adverse effect of flagyl
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Disulfiram reaction:
If any alcohol taken with the drug, will cause deathly N/V. Don't drink until several days after last dose. |
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Azoles MOA
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Inhibits fungal cytochrome P 450 ergosterol synthesis
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What are azoles used to treat?
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Fungal infections, often vag infections
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Can a topical antifungal treat a nail fungus?
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No
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Three tips for using an azole in the vag:
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1. use in evening when lying down
2. don't use tampons 3. find out if it's really a yeast |
