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129 Cards in this Set
- Front
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antibiotics affecting bacterial cell wall |
penicillins cephalosporins carbapenems monobactams |
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penicillins narrow spectrum |
bacterial cell wall narrow spectrum penicillin G potassium penicillin G penicillin V |
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penicillin adverse effects |
allergies/anaphylaxis: wear bracelet, observe client for 30 min following administration renal impairment hyperkalemia/dysrhythmias (high doses of Pen G potassium) hypernatremia |
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contraindicated for penicillin |
severe hx of allergy to penicillin, cephalosporin, imipenem |
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caution for penicillin |
have/at risk for kidney dysfunction |
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interactions for penicillin |
inactivates ahminoglycosides when mixed in same solution probenecid: delays excretion of penicillin (can help prolong penicillin) |
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penicillin nursing |
pen V, amoxicillin: may be taken with meals all others: full glass of water, 1 h before or 2h after meals report signs of allergy IM injection: caution (avoid nerve, artery) |
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penicillin broad spectrum |
amoxicillin (po) ampicillin (po or iv) |
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cephalosporins |
bacterial cell wall: 1st gen: cephalexin (keflex) cephalosporin, cefaxolin 2nd gen: cefaclor, cefotetan 3rd: ceftriaxone 4th gen: cefepime |
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cephalosporin MoA |
beta-lactam abx: destroy cell walls-->destruction bactericidal broad spectrum UTIs, postop infections, pelvic infections, meningitis |
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advantage of later generations of cephalosporins |
with each subsequent gen: -more likely to reach CSF -less likely to be destroyed by beta-lactamase -more effective against gram-negative organisms and anaerobes |
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adverse effects of cephalosporins |
-allergy/hypersensitivity/anaphylaxis (penicillin) rash, puritis, fever -bleeding tendencies with cefotetan and ceftriaxone: (PT< bleeding time): give Vit K -n/v/d, anorexia, flatulence -Thrombophlebtitis with IV: diluted intermittent infusion (if bolus: 3-5min in dilute solution) -pain with IM injection: deep in large muscle mass -suprainfection: antibiotic-associated pseudomembranous colitis (notify: diarrhea) |
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how to administer IV cephalosporins |
rotate sites administer diluted intermittent infusion if bolus: slowly over 3-5min and in dilute solution avoid thrombophlebitis |
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CI for cephalosporins |
hx of severe allergic run to penicillins |
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caution with cephalosporins |
renal impairment bleeding tendencies |
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interactions with cephalosporins |
disulfiram reaction (alcohol intolerance) when combined with cefotetan, cefazolin, cefoperazeon, alcohol probenecid: delays renal excretion |
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nursing for cephalosporin |
PO with food store suspensions in refrigerator monitor renal and hepatic notify if diarrhea or allergic rxn observe for bleeding |
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carbapenems |
bacterial cell wall: imepenem-cilastatin meropenem |
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carbapenems MoA |
beta-lactam: destroy cell-walls-->destruction broad antimicrobial spectrum PNA, peritonitis, UTIs |
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adverse effects of carbapenems |
allergy/hypersensititvty: penicillin, cephalosporins GI: n/v/d, notify (i/o) suprainfection: colitits (diarrhea, thrush, vagyeast) |
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caution with carbapenems |
renal impairment pregnancy risk C |
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vancomycin MoA |
destroys bacterial cell walls--> destruction
MRSA, e. coli, staph epidermidis C. diff |
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vancomycin adverse effects |
ototoxicity: monitor van levels infusion reactions: rashes, flushing, tachy, hypotension, red man syndrome (slow rate over 60min) IV injection site thrombophlebitis: rotate site renal toxicity |
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interactions with vancomycin |
increased ototoxicity with loop diuretics, amino glycoside antibiotics |
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meds that cause ototoxicity |
vancomycin loop diuretics aminoglycoside antibiotis |
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precautions with vancomycin |
renal impairment hearing impairment older adults |
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CI with vancomycin |
corn/corn products previous allergy to vanc |
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nursing admin with vancomycin |
monitor thought levels IV dose may be adjusted based on creatine clearance if renal insufficiency |
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antibiotics affecting protein synthesis |
bacteriostatic: tetracyclines, macrolides bacteriocidal: aminoglycosides |
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tetracyclines |
tetracycline doxycycline minocycline demeclocycline affect protein synthesis |
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Tetracycline MoA |
broad spectrum inhibit growth by preventing protein synthesis 1st line tx: typhus fever, rocky mountain, anthrax, chlamydia, Lyme's, H. pylori |
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adverse effects of tetracycline |
Gi discomfort: avoid qHS, n/v/d, esophageal ulceration, cramps, doxycycline can be with meals yellow/brown tooth and/or hypoplasia of tooth enamel (avoid in kids<8 and pregnant) hepatotoxicity: avoid high daily doses IV photosensitivity supra infection of bowel: pseudomembranous colitis-notify dizziness, lightheadedness with minocycline: caution ambulating |
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how to give vancomycin |
over 60min |
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precautions with tetracyclines |
pregnancy risk D (after 4th month, can stain teeth, not permanent teeth) caution: liver, renal disease (doxycycline ok with renal dis) |
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interactions with tetracycline |
milk products, calcium/iron supplements, laxatives with magnesium, antacids: chelation means decreased absorption of tetracycline-take on empty stomach oral contraceptives: decreases efficacy of digoxin toxicity: minocycline, doxycycline |
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nursing administration with tetracycline |
tetracycline: empty stomach with full glass of water (1h before and 2 h after) do not lie down afterwards 2hr from chelating agents: dairy, calcium/iron supplements, laxatives with magnesium, antacids |
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macrolids |
affect protein synthesis erythromycin azithromycin clarithromycin |
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macrolides MoA |
slows growth by inhibiting protein synthesis (bacteriostatic) bactericidal at high doses for penicillin allergy (rhematic fever and bacterial endocarditis prophylaxis) legionnaiers', whooping, acute diphtheria chlamydia, RTI, group A strep pyogenes |
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adverse effects of macrolides |
GI discomfort: n/v epigastric pain-notify prolonged QT: dysrhythmias, possible sudden cardiac death. avoid with meds that affect hepatic drug metabolizing enzymes ototoxicity with high-dose therapy |
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CI macrolides |
pre-existing liver disease prolonge dQT |
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interactions with macrolides |
erythromycin: inhibits metabolism of theophylline, carbamazepine, warfarin digoxin--> toxicity of those meds verapamin, diltiazem, HIV protease inhibitors, antifungal meds, nefazodone: erythromycin toxciity antacids decrease absorption |
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erythromycin toxicity |
tachydysrhythmia possible cardiac arrest d/t prolonged QT verapamil, diltiazem, HIV protease inhibitors, antifungal meds, nefazodone: inhibit hepatic drug-metabolizing enzymes |
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inhibit hepatic drug-metabolizing enzymes |
verapamil diltiazem HIV protease inhibitors antifungal meds nefazodone erythromycin toxicity |
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nursing administration for macrolides |
oral prepartion on empty stomach with full glass of water unless GI upset azithromycin can be with food IV erythromycin: only for severe infections or cannot take oral carefully monitor PT/INR if warfarin LFTs if therapy is >1-2weeks |
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aminoglycosides |
gentamicin amikacin tobramycin neomycin streptomycin paromycin affect protein synthesis |
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aminoglycoside MoA |
bactericidal, destroy by disrupting protein synthesis aerobic gram-negativ e bacilli: E. coli, klebsiella pna, pseudomonas aeruginosa meningitis, peritonitis |
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indications for streptomycin |
active TB |
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adverse effects of aminoglycosides |
ototoxicity: cochlear damage, vestibular damage (tinnitus, HA, hearing loss, nausea, dizziness, vertigo)-notify and stop, baseline hearing test nephrotoxicity r/t high cumulative dose--> ATN (proteinuria, casts in urine, dilute urine, elevated BUN/crt)-report hematuria and cloudy urine intensified neuromuscular blockade resulting in respiratory depression or muscular weakness: closely monitor if MG, skeletal muscle relaxants, general anesthetics hyeprsensitivity neurologic disorder: peripheral neuritis, optic nerve dysfunction, tingling/numbness-immed notify tremors |
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caution with aminoglycosides |
kidney impairment, pre-existing hearing loss, myasthenia graves if taking: ethacrynic acid, neuromuscular blocking agents (tubocurarine) kidney impairment: reduce doses |
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interactions with aminoglycosides |
penicillin: inactivates aminoglyc in same solution avoid concurrent ototoxic meds: loop diuretics, vancomycin |
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nursing admins with aminoglycosides |
most: IM or IV neomycin: PO or topically measure levels based o dosing schedules: - 1x/day: only trough level -divided doses: peak is 30min after administration of IM or 30min after IV finishes trough: right before next dose |
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UTI meds |
sulfonamides trimethoprim urinary antiseptics penicillines, aminoglycosides, cephalosporins, fluoroquinolones |
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sulfonamids and trimethoprim |
sulfamethoxazole-trimethoprim (Bactrim, Septra) sulfadiozine trimethoprim |
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sulfanomids and trimethoprim MoA |
inhibit bacterial growth by preventing synthesis of folic acid (essential for prod of DNA, ran, prot) UTI: e. coli, klebsiella, proteus, enterobacter, Neisseria gonorrhea otitis media, bronchitis, shigellosis, Pneumocystitis jiroveci pna |
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adverse effects of sulfonamides and trimethoprim |
hypsersensitivity: SJS (sulfanomides, thiazides, sulfonylurea-type oral hypoglycemia, looper diuretics) blood dycrasias cyrstalluria: crystalline aggregates in kidneys--> AKI: fluid intake 2-3L/day; u/o >1200/day kernicterus: jaundice, cinreased bilirubin is dangerous to infants photosensitiviity: wear sunscreen |
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interactions with sulfonamides and trimethoprim |
can increase the effects of warfarin, phenytoin, sulfonylurea oral hypoglycemics, tolbutamide |
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CI for sulfonamides and trimethoprim |
folate deficiecny |
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cuation: sulfanomides and trimethoprim |
renal dysfunction pregnancy |
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pregnancy and sulfanomides and trimethoprime |
kernicterus: jaundice, icncreased bili avoid if near term or breastfeeding avoid infants <2mo avoid 1st term |
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nursing considerations and sulfanomides and trimethoprime |
empty stomach with glass of water |
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kernicterus |
jaundice, increased bilirubin yellow brain dangerous for fetus/infant sulfanolamides and trimethoprimes |
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urinary tract antiseptics |
nitrofurantoin methanamine |
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urinary tract antiseptic: nitrofurantoin MoA |
broad spectrum urinary antiseptic bacteriostatic and bactericidial by damaging DNA acute UTIs, prophylaxis for recurrent |
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adverse effects of urinary tract antiseptic nitrofurantoin |
GI discomfort: with milk/meals; decrease dosage or use microcrystalline tablet hypersensitivity reactions with severe pulmonary manifestations: stop and notify, should subside within days after d/c blood dycrasias: baseline CBC, notify peripheral neuropathy: N/T hands and feet, muscle weakness-notify HA, drowsiness, dizziness |
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precautions with urinary tract antiseptic nitrofurantoin |
renal dysfunction and creatine clearance <40ml/min: increased risk of toxicity |
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nursing considerations for urinary tract antiseptics nitrofurantoin |
urine: brownish with food if GI discomfort avoid crushing tablets (stain teeth) avoid while pregnant |
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blood dyscrasias |
agranulocytosis leukopenia thrombocytopenia megaloblastic anemia hepatotoxicity |
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fluoroquinolones |
ciprofloxacin levofloxacin |
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fluoroquinolones MoA |
bactericidal: inhibit enzyme for DNA replication broad spectrum urinary, resp, GI infection infections of bone, joints, skin, soft tissue prevent anthrax if inhaled |
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adverse effects of fluorquinolones |
GI discomfort Achilles tendon rupture: pain,swelling, redness-notify and d/c-do not exercise until inflame stop suprainfection: thrush, vaginal yeast inf phototxicity: sunscreen, d/c immediately C. diff: destroys normal flora |
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CI for fluoroquinolones |
under 18yo (achilles rupture) unless child is treated for E. coli of UT or inhalation of anthrax (only ciprofloxacin is ok) |
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fluoroquinolone approved for children |
ciprofloxacin |
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caution for fluoroquinolin |
affects the CNS: caution older adults with CV disorders |
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interactions with fluoroquinolones |
cationic compounds (aluminum-mag antacids, iron salts, sucralfate, dairy) decrease absorption of chipper plasma levels of tehophylline and warfarin increase |
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nursing admit with fluoroquinolones |
PO and IV d/c other IV infusions or use another IV site dilute solution slowly over 60 min in large being 6h before or 2h after cationic compounds: aluminum-mag antacids, iron salts, sucralfate, dairy |
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urinary tract analgesic |
phenzopyridine |
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phenazopyridine MoA |
azo dye that functions as a local anesthetic on mucosa of UT relieve burning, pain, frequency, urgency |
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CI: phenazopyridine |
AKI or CKD |
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nursing admin: phenazopyridine |
urine may stain clothes with or without meals |
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antimycobacterial |
antituberculosis isoniazid pyrazinamide ethambutol rifapentine |
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isoniazid MoA |
highly specific for mycobacteria inhibits growth of mycobacteria by preventing synthesis of mycelia acid in cell wall |
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latent TB med regimen |
isoniazid only: 6-9mo isoniazid with rifapentine: 1x/week for 3mo CI: 2yo, have HIV, pregnant, resistant to toerh meds |
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active TB med regimen |
multiple medicaiton therapy with isoniazid: 6mo min initial phase (induction phase): eliminating active bacili__> noninfectious sputum continuation phase: eliminating other pathogens up to 24 mo |
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adverse effects of isoniazid |
peripheral neuropathy; deficiency of pyridoxine (vit B6), take 50-600mg Vit B6 daily hepatotoxiciity hyperglycemia and decreased glucose control if DM |
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CI for isoniazid |
liver disease |
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caution for isoniazid |
older DM alcohol use |
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interactions with isoniazid |
inhibits metabolism of phenyton--> toxicity (ataxia and incoordination) |
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phenytoin toxicity |
ataxia incoordination avoid with isoniazid |
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nursing admit with isoniazid |
usually PO when IM: solution must be free of crystals, inject deeply into large muscle active Tb: direct observation therapy take isoniazid 1h before meals or 2h after (can take with meals if GI discomfort |
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Rifampin |
antimycobacterial, anti TB bactericidal: inhibit protein synthesis broad-spectrum abs: gram-pos and gram-neg M tb and M leprae |
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adverse effects of Rifampin |
discoloration of body fluids: orange urine/saliva/sweat/tears hepatotoxicity mild GI discomfort |
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caution with Rifampin |
liver dysfunction |
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interactions with Riampin |
accelerates metabolism of warfarin, OC< protease inhibitors, NNRTIs--> diminished effects concurrent with isoniazid and pyrazinamide: increased risk of hepatotoxicity |
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nursing admin with rifampin |
PO or IV oral: 1h before or 2h after meals (decreased absorption with food) |
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antiprotazoals |
metronidazole (Flagyl) |
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metronidazole MoA |
bactericidal intestinal amebiasis, giardiasis, trichomoniasis obligate anaerobic bacteria: C. diff, gardnerella vaginalis prophylaxis: surgical procedures and high-risk for anaerobic infection tx of H pylori with tetracycline and bismuth salicylate |
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adverse effects of metronidazole |
GI discomfort: notify dark urine: harmless CNS sxs: numbness of extremities, ataxia, szrs-stop |
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CI for metronidazole |
active CNS blood dycrasias during lactation first trimester of pregnancy who have trichomoniasis |
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caution for metronidazole |
renal, cardiac, seizure disorders in older adults |
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interactions for metronidazole |
alcohol: disulfiram-like reaction inhibits inactivation of warfarin |
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antifungals |
amphotericin B ketoconazole flucystosine nystatin miconazole terbinafine fluconazole |
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erythromycin azithromycin clarithromycin |
macrolides |
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ciprofloxacin |
fluoroquinolones |
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gentamicin |
aminoglycosides |
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doxycycline |
tetracycline |
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red man syndrome |
flushing of torso, pruritis, erythema hypotension/angioedema
reaction to vancomycin infusion within the first 4-10min |
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probenacid |
for gout, gouty arthritis
uremic excretion delays excretion of penicillins and cefalosporins |
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cocci definition |
bacteria round balls |
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cocci examples |
streptococcus staphylococcus diplococcus |
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bacilli definition |
bacteria rods |
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Gram Positive |
blue gram stain |
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gram positive examples |
Staphylococcus aureus Streptococcus pyrogenes (GABHS) Streptococcus pneumoniae (pneumococcus) |
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Gram negative stain |
RED gram stain |
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Gram negative examples |
Escherichica coli and other enterics (coliforms, enterobacteriacea) Haemophilus influenzae--pleomorphic rods Neisseria: diplococcus (N. gonorrhea, N. menigitidis) Pseudomonas |
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adverse effects of almost any abx |
allergy rashes candida vaginitis diarrhea Less commonly: hepatotoxicity, neutropenia, c.diff, serum sickness, jarish-herxheimer reaction |
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serum sickness |
adverse reaction from antibiotic fever, rash, arthralgia onset after 1-2wks of tx |
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jarisch-herxheimer reaction |
adverse effect from abx: fever, HA, myalgia occur within 24h of tx for syphilis or early lyme disease |
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symptoms suggestions of Ige mediated allergic rxn |
hives, angioedema, dyspnea, anaphylaxis, anaphylactic death |
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types of possible drug-induced rashes |
urticaria morbilliform (maculopapular) photosensitivity fixed drug eruption erythema multiforme (target lesions) stevens-johnson and toxic epidermal necrolysis:painful, mucosal involvement, vesicles/bullae |
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antibiotic use in pregnancy |
almost all are catgory b or c (ok to use w/o reservations) a few are Category D |
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antibiotics Category D |
erythromycin estolate sulfonamides at term tetracyclines (ok in certain cases) nitrofurantoin: at term or in premature labor NO IN PREGNANCY (confirmed risk) |
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never developed resistance to penicillin |
syphilis strep pyogenes (strep throat) |
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"coagulase-negative" Staph in cultures |
are usually contaminants EXCEPT: may cause IV cath-related infeciton, endocarditis; S. saprophyticus may cause UTI |
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Main bacteria of skin/soft tissue infections |
Streptococcus pyogenes (GABHS) Staphylococcus aureous |
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Strep Antibiotics |
penicillins!! cephalosporins, clindamycin, macrolids, vancomycin |
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Strep: antibiotics that don't work |
sulfonamides tetracyclines quinolones |
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Staph Antibiotics |
Trimeth-sulfam (septra, bactrim) tetracyclines clindamycin (usually) Vancomycine, etc (big guns Rifampin only if not MRSA: cephalospornis macrolides, methicillin, Augmentin, fluoroquinolones |
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Penicillinase |
enzyme produced by >90% staph inactivates penicillin |
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beta-lactamases: which abx |
penicillins cephalosporins imipenem aztreonam |
