Pharm 103 Test 3 Antimicrobial Agents

Front 1

penicillins mechanism of action

Back 1

inhibits bacterial cell wall synthesis/bactericidal, spectrum varies

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penicillins side effects

Back 2

**allergic reaction: rash, hives, anaphylaxis, serm sickness, >incidence w/ ampicillin when patient has concomitant infectious mononucleosis. hemolytic anemia, neutropenia, thrombocytopenia, coagulation disorders. N/V, diarrhea, C-diff. increase in liver function enzymes, hepatitis. interstitial nephritis, electrolyte disturbances. seizures in patients w/ renal impairment (high doses). phlebitis, thrombophlebitis. candida infections

Front 3

penicillins drug interactions

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-incompatible w/ aminoglycosides
-oral contraceptives-need bacteria to break down estrogen, increased risk of pregnancy.
-warfarin (Coumadin)-can elevate INR

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nursing considerations for penicillins

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-narrow to broad spectrum
-assess allergies
-check for electrolyte disturbances
-monitor for adverse reaction, superinfection
-check for yeast overgrowth, thrush
-diarrhea
-administer aminoglycosides separated from penicillins

Front 5

Monobactams name

Back 5

aztreonam (Azactam); used for patient allergic to penicillin

Front 6

monobactams mechanism of action

Back 6

inhibits cell wall synthesis/bactericidal; narrow coverage for gram-negative organisms. used when allergic to penicillin

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carbapenems names

Back 7

imipenem-cilastatin (Primaxin)
meropenem (Merrem)
ertapenem (Invanz)

Front 8

carbapenems mechanism of actino

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inhibits cell wall synthesis/bactericidal, broad spectrum

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carbapenems adverse reactions

Back 9

allergies-drug fever, pruritis, urticartia, rashes. N/V, hypotension, dizziness, diarrhea. seizures >elderly, hx seizures, high dose, RF. increase liver function test.

Front 10

cephalosporins names

Back 10

cefepime (Maxipime)
ceftaroline (Teflaro)-MRSA coverage

Front 11

cephalosporins mechanism of actino

Back 11

inhibits cell wall synthesis/bactericidal. broad spectrum

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cephalosporins adverse reactions

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DO NOT use in patients w/ immediate hypersensitivity or anaphylaxis. increase in liver enzymes. diarrhea, colitis. disulfiram (Antabuse) like reactions. PLT aggregation, hypoprothrombinemia.

Front 13

cephalosporins drug interactions

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oral contraceptives, alcohol

Front 14

cephalosporin nursing considerations

Back 14

appropriate allergy assessment
monitor diarrhea
monitor for yeast overgrowth

Front 15

aminoglycosides names

Back 15

streptomycin
neomycin
kanamycin (Kantrex)
gentamycin (Garamycin)
amikacin (Amikin)
tobramycin (Nebcin)

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aminoglycosides mechanism of action

Back 16

intereferes w/ protein synthesis by binding to ribosomal units. bactericidal. gram pos & neg bacilli.

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aminoglycosides adverse reactions

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nephrotoxicity. ototoxicity. neuromuscular blockade (IV bolus).

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aminoglycosides drug interactions

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drugs that cause nephrotoxicity, penicillins**

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aminoglycosides nursing considerations

Back 19

document exact time dose was administered.
do NOT administer at same time as penicillin
observe for signs of hearing impairment, dizziness.
observe for signs of renal toxicity (decreased U/O)

Front 20

fluoroquinolones names

Back 20

norfloxacin (Noroxin)
ciprofloxacin (Cipro)
ofloxacin (Floxin)
gemifloxacin (Factive)
levofloxacin (Levaquin)
lomefloxacin (Maxaquin)
moxifloxacin (Avelox)

Front 21

fluoroquinolones mechanism of action

Back 21

inhibits DNA-gyrase, bactericidal. broad spectrum

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fluoroquinolones adverse reactions

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neuropsychotic reactions, HA, dizziness, agitation, sleep disturbances, use avoided in patients w/ seizure history.
photosensitivity.
EKG changes, prolonged QT interval
impairs cartilage formation--not recommended in children
arthropathy, tendinitis, tendon rupture

Front 23

fluoroquinolones drug interactions

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do not administer w/ antacids, carafate, iron, zinc, bismuth salts, dairy products, enteral feeds--decreases absorption. **separate doses by at least 2 hrs

may increase INR (warfarin)

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fluoroquinolones nursing considerations

Back 24

administer 2 hours from calcium, zinc, iron
watch for EKG changes

Front 25

sulfonamides name

Back 25

trimethoprim/sulfamethoxazole (Bactrim)

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sulfonamides mechanisms of action

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inhibits enzyme activity in bacterial synthesis of tetrohydrofolic acid which disrupts nucleic acid synthesis.
gram positive & negative spectrum.
used for UTI, etc

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sulfonamides adverse reactions

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rashes--may become Steven Johnson's syndrome-sunlight.
anemia
crystalluria (adequate hydration)

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sulfonamides drug interactions

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coumadin************************* increases INR-watch for bleeding
methotrexate-bone marrow suppression

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sulfonamides nursing considerations

Back 29

ensure adequate fluid intake to prevent crystalluria
observe for rashes
watch INR
use sunscreen

Front 30

macrolides names

Back 30

erythromycin
clarithromycin (Biaxin)
azithromycin (Zithromax)

Front 31

macrolides mechanism of action

Back 31

inhibits RNA dependent protein synthesis
gram pos, gram neg coverage

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macrolides adverse reactions

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abdominal pain, cramping, N/V, diarrhea. *may be used to cause GI motility
should not be used in pregnancy & liver disfunction

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macrolides drug interactions

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inhibits cytochrome P450 (pathway in liver)

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macrolides nursing considerations

Back 34

do not crush enteric coated products
IV formulation (erythromycin) may cause phlebitis--may need to be further diluted
GI upset is common

Front 35

ketolides name

Back 35

telithromycin (Ketek)

Front 36

ketolides mechanism of action

Back 36

inhibits protein synthesis/bactericidal, gram pos, gram neg, atypical coverage

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ketolides adverse reactions

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CNS-dizziness, headache, syncope
diplopia
contraindicated in patients w/ myasthenia gravis-life threatening including fatal respiratory failure

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ketolides nursing considerations

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watch for potential drug interactions

Front 39

lincosamide name

Back 39

clindamycin (Cleocin)

Front 40

lincosamide mechanism of action

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inhibits bacterial protein synthesis/bactericidal
gram pos/anaerobic, no gram neg coverage

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lincosamide adverse reactions

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c diff

Front 42

tetracyclines names

Back 42

short acting-tetracycling
intermediate-demeclocycline
long acting-doxycycline, minocycline

Front 43

tetracylcines spectrum

Back 43

used for acne (gram pos)
gram neg

Front 44

tetracyclines adverse reactions

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allergy-anaphylaxis, urticaria, periorbital edema, rash, photosensitivity
****do not administer to pregnant women or children under 8 yrs old-discoloration of baby teeth, depression of skeletal growth (fetus)
GI-esophageal ulcerations, N/V, epigastric distress, diarrhea
light headedness, dizziness, sclerosis

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tetracyclines nursing considerations

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administer w/ full glass of water to avoid esophageal ulceration
outdated meds can cause renal toxicity
separate from antacids, calcium, milk, iron containing products

Front 46

glycylclyclines name

Back 46

tigecycline (Tygacil)

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glycylclyclines spectrum

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***only IV
gram pos, gram neg, anaerobic

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glycylclyclines nursing considerations

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do not give to pregnant women or children under 8--may cause discoloration of teeth
watch for injection site pain, inflammation, phlebitis

Front 49

glycopeptide name

Back 49

vancomycin (Vancocin)

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glycopeptide spectrum

Back 50

gram pos, c diff

Front 51

glycopeptide adverse effects

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nephrotoxicity, ototoxicity
red man syndrome-not considered allergic reaction, flushing response. pruritis, tingling, hypotension, tachycardia. turn off infusion, give benadryl

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glycopeptide nursing considerations

Back 52

monitor for signs of red man syndrome
document time dose was given
monitor for ototoxicity & nephrotoxicity

Front 53

metronidazole name

Back 53

Flagyl

Front 54

metronidazole spectrum

Back 54

anaerobic, C Diff

Front 55

metronidazole adverse reactions

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peripheral neuropathy--stop drug
GI-epigastric distress, metallic taste

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metronidazole drug interactions

Back 56

inhibits liver enzymes--coumadin, etc
alcohol-disulferan like reaction--can drink 72 hrs after stopping

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metronidazole nursing considerations

Back 57

urine may be discolored to a dark or reddish brown
notify MD if patient experiences numbness or tingling in extremities
avoid products that contain alcohol
coumadin--watch for signs of bleeding, closely monitor INR