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49 Cards in this Set
- Front
- Back
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when are antibiotics prescribed?
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based on the type of organism causing infection or by the affected area.
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If AB works when is the signs of infection decrease?
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within 48 hours.
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when should AB be discontinued?
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when client feels well or is afebrile for 2-3 days.
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What test do you do to get the specific treatment?
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a culture and sensitivity to identify the bacteria and what AB most likely to affect it.
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What is emperic therapy?
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is based on clinician's experience or observation alone.
Dr start with broad spectrum until they know what bacteria it is then uses narrow spectrum. |
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What is therapeutic therapy?
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targets the isolated pathogen
Dose and route and length of tx are determined on individual basis |
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give an example of Prophylaxis?
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Prior to dental extraction in those who have diabetes/ cardiac condition
Preoperative |
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what are the 3 major factors that cause resistance?
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AB may be unable to penetrate potential target site
the microorganism may produce an enzyme that reduces/eliminates the toxic effects of the AB on the cell wall decreased host defense mechanisms |
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What are 2 types of adverse reactions produced by AB?
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Hypersensitivity reactions
Super infections |
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What is the best defense against an infection?
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Healthy immune system
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What are nurse intervention for AB?
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nurse watch client for at least 30 min. after AB initiated
First sign of allergic reaction (hives, choking sensation, chest tightness, SOB, restlessness) Stop AB immediately |
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What is given for an allergic reaction of an AB?
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Epinephrine 1:1000 maybe given SQ
If in shock epinephrine given IV with IV fluids. An antihistamine or steriod may also be prescribed. |
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when does Super infection occur?
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large dose of AB are used
more than one AB is given or when broad-spectrum AB are concurrently used |
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How do you manage Super infections?
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AB is D/C or replaced with another to which the organism is sensitive.
Probiotic may also be used (active microrganism that help replenish normal flora) |
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What is AAMC?
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Antibacterial-associated membranous colitis
is inflammation of bowel wall and is manifested by loose stool, abdominal tenderness/ cramping, fever |
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How is AAMC managed?
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oral metronidazole or vancomycin, with fluids and electrolyte replacement
Antidiarrheals are not recommended they can retain the toxin within the bowel. |
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What is a way to measure the therapeutic effect of AB?
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By measuring the Peak and trough levels
(these levels are important for AB that have narrow therapeutic index ex. aminoglycosides) |
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What is the peak and trough?
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P and T levels determine whether the drug is within therapeutic range for its desired effect.
(If peak too ^ drug toxicity, If trough is below therapeutic range, the client is not getting enough adequate dose). |
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What are the different groups of AB?
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beta lactam
glycopeptides (Vancomycin) MLSKO's Fluroquinolones tetracyclines aminoglycosides miscellaneous and newer drugs |
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What is the major group of AB?
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Beta lactam
this group share a similar mechanism of action and share the potential for adverse reactions. |
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What is penicillin?
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it is a bactericidal, it kill a wide range of gram-& gram+ bacteria.
It is best taken on empty stomach. If taken will food stomach irritation will occur. chemical is structure is similar to cephalosporin the incidence of cross- sensitivity is as high as 16-18%. |
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what is the most serious hypersensitivity reaction?
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anaphylactic shock
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what are the 3 beta lactamase inhibitors?
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sulbactam
tazobactam clavulanic acid |
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what is cephalosporin?
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it interfere with bacterial cell wall synthesis, used mostly on gram - infections.
Pseudomonas super infection is associated with this should be taken with food when taken orally, not taken with alcohol it could produce anatabuse-like reactions. |
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what are the 4 generation of AB?
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1st- against g+ like beta lactamase producing staph
2nd-ant gram- ( E.coli,H influenza) 3rd-effective against gram - (cefobid, Fortaz)Advantage is ability to reach high concentration in CSF (drug of choice for bacterial menigitis) Fortaz used for pseudomonas 4th-broader spectrum G+; R to beta lactamases ( Maxipime is only in 4th gen. used for UTI's, skin infections, and pneumonia) |
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What is Vancomycin?
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it is a non-beta lactam that destroys bacteria by inhibiting cell wall synthesis and causing its death.
used on MRSA, strep and enterococcal infection (to remain effective against MRSA and other drug resistant infections the cdc issued strict guidelines for use. |
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what is the adverse effect of Vancomycin?
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red man's syndrome characterized by pruritus, redness of face, neck, and chest, tachycardia, and fall in BP.
(it is a psuedoallergic reaction secondary to rapid IV admin. of Vanco) |
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How could the allergic reaction of Vanco be prevented?
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slow infusion (4 hr)or by giving an antihistamine beforehand.
Normal infusion 1-2hr. Peak should not exceed 40 mcg/ml and trough is maintained between 5-15mcg/ml |
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What is Sulfonamides?
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used widely for UTI. It is a bacteriostatic (inhibit bacterial growth)
cross sensitivity with other drugs (ex. sulfonylureas and loop diuretics) decrease the effect of oral contraceptives and interact with Vit. C and aspirin |
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what is the S/E of sulfonamides?
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N/V, ash/urticaria
Stevens-Johnson syndrome in HIV pts. Hypersensitive reaction is form of rash or anaphylaxis |
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How should Sulfonamides be taken?
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taken on an empty stomach with a full glass of H20 ,but if irritates stomach may take with food
Take at least 2400ml of fluid/ day b/c the drug cause crystalluria. |
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What is trimethoporin?
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it is classified as a UT antiinfective agent and is combined with sulfamethoxazole to prevent bacterial resistance to sulfonamide drugs and obtain better response against many organism
(TMP-SMZ used on Pneumocystis carinii, large dose can treat MRSA) |
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What is tetracyclines?
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it inhibit protein synthesis in susceptible bacteria, interfering with the growth of the bacteria.(non-effective against Staph aureus)
TX- syphillis,gonorrhea, and chlamydia, severe acne and with other drugs have been useful in treatment of peptic ulcer disease. (alternatives to fluoroquinolones for management of anthrax exposure) |
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How should Tetracyclines be taken?
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taken with a full glass of water at least one hr before or after takin antacid or iron tabs or after a meal containing dairy products
(Vibramycin maybe taken with food or milk) |
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who should not take tetracyclines?
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children when teeth are forming- b/c they discoloration of the teeth
Pregnant women |
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what are all AB s/e?
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N/V and diarrhea
they all decrease the effectiveness of birth control pills so other protection should be used. |
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what is hyperlipidemia?
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metabolic disorder characterized by increased concentration of cholesterol and triglycerides.
It may develop as a result of ^ dietary of fat intake, systemic disease (ex.DM), or genetic factors |
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what is the goal of anti hyperlipidemic or antillipemics?
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decrease cholesterol levels especially LDL
drugs given if after 6 months of diet and exercise, and hyperlipidemia still exist. |
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what does Niacin do to LDL?
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lowers by as much as 60%
mechanism of action unknown it enhances the effect of lipid lowering drugs |
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what does unusual bleeding mean?
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vit K deficiency
Sequestrants interfere with the absorption of vit k(and A,D,E), the fat soluble vitamins. |
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what is HMG-CoA REDUCTASE INHIBITORS (statins)?
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decrease cholesterol by blocking liver production of cholesterol
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What are the S/E of Statin?
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indigestion, cramps, gas, nausea, diarrhea and constipation.
hepatoxicity- monitor liver fxn test; watch for ^ serum tansaminase rhabdomyolsis-pt report unexplained muscle tenderness or pain or brown urine to their physician Signs of rhabdomyolysis complication that produce fever, cramps, unusual tiredness and renal failure. |
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what is Bile acid binding?
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resins work in the GI tract by binding to bile and preventing its reabsorption.
Bile acid sequestrants will decrease LDL and can increase HDL by 5%. Powder should be mixed thoroughly with food, crushed fruit (apple sauce) or at least 2 oz fluid. Take one hour before meals or 4-6 hours after meals.Sequestrant therapy may produce GI side-effects. |
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What is Fibric acid derivatives?
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not very effective in lowering LDL but could lower triglycerides
S/E-dyspepsia, abdominal pain, N/V, diarrhea, flatulence, increased hypoglycemic effects of antidiabetes drugs They interact with anticoagulants. They are not used with statins because they could damage muscles or cause gall stones. |
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what is New classification-azetidinones?
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Helps block intestinal absorption of cholesterol that comes from food (Ex. Zetia)
Decreases LDL and triglycerides Contraindicated in nursing women, pregnant women, and those with liver problems. Could cause rhabdomyolysis |
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what is the S/E of New classification-azetidinones?
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Side-effects- Dizziness, joint pains, tiredness
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How should Zetia be used?
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may be used alone or in combination with statins (e.g. Vytorin)
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What can Garlic do hyperlipidemia?
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Natural/fresh garlic taken orally has lipid-lowering effects oInactivates enzymes
involved in lipid synthesis |
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Nursing implications for anti hyperlipidemia drugs?
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Monitor for effectiveness. Is LDL decreased?
High-risk <100 Low risk <160 Teach non-drug interventions Diet and exercise Do not discontinue the drug. Contraindications Hypersensitivity reactions Biliary obstruction Liver disease Monitor liver function Watch for s/s of rhabdomyolysis Never give a powder form of antilipemics plain. |
