Pharmacology In Nursing- Mod. 9; Drugs Used To Treat Infections

Front 1

Drugs used to treat infections are called what?

Back 1

anti-infectives or anti-microbials

Front 2

Anti-infectives, aka anti-microbials, are substances that inhibit the growth of or kill what 5 things?

Back 2

1. bacteria
2. viruses
3. fungi
4. protozoa
5. rickettsiae

Front 3

Anti-infective agents are designed to act on foreign organisms that have invaded the body without causing what?

Back 3

- damage to the host cell

Front 4

Anti-infectives exert one of two basic mechanisms to accomplish damage to foreign organisms. Describe each.

Back 4

1. destroying the structure that houses the invading organism
2. disabling the invading organism's ability to reproduce itself

Front 5

Most cells replicate through the replication of DNA. What is an example of a virus that replicates using RNA?

Back 5

HIV

Front 6

What is the best way to choose the appropriate anti-infective agent to treat an infection?

Back 6

obtain a specimen of infected material and perform a culture and sensitivity test on it

Front 7

To obtain a culture, infected material is spread on a Petri dish and the organism is allowed to grow for how long?

Back 7

24-72 hours

Front 8

In a C&S test, how do you determine the "sensitivity" of an organism?

Back 8

the organism is exposed to several pre-selected anti-infectives

Front 9

In a C&S test, an organism is considered to be _________ to those anti-infectives that inhibited it's growth.

Back 9

sensitive

Front 10

In a C&S test, an organism is considered _______ to those anti-infectives that failed to inhibit it's growth.

Back 10

resistant

Front 11

A specimen for a C&S test should be collected before an anti-infective agent is given to avoid what?

Back 11

false results

Front 12

Why is antibiotic therapy often begun before the results of a C&S are received?

Back 12

b/c it takes 24-72 hours to receive the results and the infection could worsen to a critical point

Front 13

How do physicians determine the anti-infective agent they will prescribe if it is not possible to obtain a specimen for a C&S test?

Back 13

they base the choice on the client's presenting signs and symptoms

Front 14

What should you ask a client if they state that they are allergic to a particular anti-infective?

Back 14

determine what signs and symptoms were experienced after taking the drug; clients often confuse common but harmless side-effects with allergic reactions

Front 15

Why is it important for a client to take the entire prescription of an anti-infective agent?

Back 15

to avoid having the organism gain a foothold again; many organisms have developed resistance to anti-infectives due to misuse

Front 16

What is an example of an organism that has developed resistance to anti-infectives due to misuse?

Back 16

MRSA (methicillin-resistant staphylococcus aureus)

Front 17

Most of the drugs used to fight infection are what class?

Back 17

antibacterial drugs

Front 18

(def)

an agent that inhibits the growth of bacteria

Back 18

bacteriostatic

Front 19

(def)

an agent that kills bacteria

Back 19

bactericidal

Front 20

Can a drug be both bacteriostatic and bactericidal?

Back 20

Yes, depending on the dose

Front 21

Antibacterial drugs either have a narrow-spectrum or broad-spectrum. Describe each.

Back 21

Narrow-spectrum = effective against a limited number of organisms

Broad-spectrum = effective against a wider variety of organisms that are both gram-positive and gram-negative

Front 22

Why do antibacterial drugs often cause superimposed infections?

Back 22

due to the loss (disruption) of normal flora

Front 23

Penicillins are usually used for what two type of infections? They can additionally be used to treat what 3 specific infections?

Back 23

- usually used for staphylococcal and streptococcal infections
- additionally can be used for gonorrhea, syphilis, and anthrax

Front 24

What type of structure does penicillin have?

Back 24

beta-lactum structure

Front 25

What are 3 major problems with penicillins?

Back 25

- high incidence of serious allergic reactions that can lead to anaphylactic shock or death
- drug resistance
- narrow spectrum of many of the preparations

Front 26

Resistance to penicillin occurs when staphylococcal organisms produce an enzyme called what?

Back 26

penicillinase (beta-lactamase)

Front 27

What 6 side effects might occur with the use of penicillins and cephalosporins?

Back 27

1. nausea
2. vomiting
3. stomatitis
4. diarrhea
5. furry tongue
6. rash

Front 28

True/False:

Superimposed infections are common with penicillins and cephalosporins.

Back 28

true

Front 29

What might occur to the effectiveness of oral contraceptives with the use of penicillins or cephalosporins?

Back 29

they might be reduced

Front 30

When on penicillin or a cephalosporin, urine may show a false positive for what?

Back 30

glucose

Front 31

Most penicillins and cephalosporins are pregnancy category ____.

Back 31

B

Front 32

If giving penicillin or a cephalosporin in IV form, what must be done to it? Why?

Back 32

it must be diluted b/c it is irritating to the veins

Front 33

What should be done when injecting penicillin or a cephalosporin IM?

Back 33

inject into a large muscle mass

Front 34

True/false:

Penicillin may cause blood dyscrasia.

Back 34

true

Front 35

Why would penicillin/cephalosporin be given with probenicid, an anti-gout drug?

Back 35

to slow renal excretion and increase serum levels (basically extend the life of penicillin)

Front 36

What are 3 drugs that may be given for penicillin/cephalosporin allergic reactions?

Back 36

1. diphenhydramine (Benadryl)
2. epinephrine
3. glucocorticoid (such as hydrocortisone)

Front 37

True/False:

Penicillins and Cephalosporins have the same mechanism of action.

Back 37

True

Front 38

What structure do cephalosporins have?

Back 38

beta-lactum structure

Front 39

Why might a person who is allergic to penicillin be allergic to cephalosporins as well?

Back 39

b/c of their structural similarities (beta-lactum structures)

Front 40

What are 2 advantages of cephalosporins over penicillins?

Back 40

1. broader antibacterial spectrum
2. resistance has not developed to the same extent

Front 41

True/false:

Resistance to cephalosporins is decreasing over time.

Back 41

False- it is increasing

Front 42

How many generations of cephalosporins are there? Which generation has the broadest spectrum?

Back 42

4 generations

- the 4th generation is the broadest spectrum

Front 43

Which generation of cephalosporin is often used peri-operatively as a prophylaxis?

Back 43

the first generation

Front 44

When issuing a cephalosporin, you should ask the patient if they are allergic to what other type of drug?

Back 44

penicillin

Front 45

Taking cephalosporins with alcohol can result in a specific adverse reaction known as what? What are 4 symptoms of this reaction?

Back 45

disulfiram reaction - consists of flushing, dizziness, headache, muscular weakness

Front 46

Clients with renal disease taking cephalosporins are at an increased risk for what?

Back 46

nephrotoxicity

Front 47

Macrolides, Lincosamides and Tetracyclines are often prescribed to a patient who has what type of allergy?

Back 47

a penicillin allergy

Front 48

What is the oldest macrolide?

Back 48

erythromycin

Front 49

Erythromycin is the drug of choice to treat what 3 diseases?

Back 49

- Legionnaires' Disease
- mycoplasmal pneumonias
- chlamydia

Front 50

Erythromycin is ________ active against some gram negative bacteria.

Back 50

moderately

Front 51

Erythromycin is active against most gram-positive bacteria except what?

Back 51

staphylococcus aureus

Front 52

Is resistance to erythromycin possible?

Back 52

yes

Front 53

Why are oral preparations of erythromycin designed to break down in the small intestine?

Back 53

b/c gastric acid destroys the drug

Front 54

What must be done to erythromycin IV preparations? Why?

Back 54

must be diluted with at least 100mL of normal saline because they are extremely irritating to the veins

Front 55

What is the biggest advantage of erythromycin and dirithromycin over other antibacterials?

Back 55

they are excreted in the bile and feces more than the urine, allowing them to be used in renal insufficiency

Front 56

Because erythromycin and dirithromycin are excreted in the bile/feces, they are contraindicated in what type of disease?

Back 56

liver disease

Front 57

What is a common and likely side effect to the use of macrolides (ex. erythromycin)?

Back 57

GI disturbances

Front 58

True/False:

You should take macrolides (ex. erythromycin) with food.

Back 58

False - you should take them 1-2 h AC or 2-3 h PC because food decreases absorption

Front 59

What is a likely side effect with erythromycin IV?

Back 59

phlebitis (inflammation of a vein)

Front 60

What pregnancy safety category do macrolides fall in?

Back 60

B & C

Front 61

Macrolides can be _________ in high doses.

What should be done b/c of this?

Back 61

hepatotoxic - monitor liver enzymes when administering high doses

Front 62

Which is more toxic, macrolides or lincosamides?

Back 62

lincosamides

Front 63

Lincosamides are effective against what 3 infections?

Back 63

1. streptococci
2. staphylococci
3. pneumococci

Front 64

What side effects may be experienced when taking Lincosamides?

Back 64

- GI disturbances
- Rash

Front 65

Lincosamides should be stopped immediately if what occurs? What might this be?

Back 65

if bloody diarrhea occurs - this may be psuedomembranous colitis

Front 66

What pregnancy category are lincosamides?

Back 66

B

Front 67

Are tetracyclines effective against gram-negative or gram-positive bacteria?

Back 67

both

Front 68

True/False:

Resistance to tetracyclines is increasing.

Back 68

true

Front 69

Tetracyclines should not be taken with products containing what? Why?

Back 69

aluminum, calcium, or iron b/c these will bind with the drug and inhibit absorption

Front 70

Tetracyclines are pregnancy category ___.

Back 70

D

Front 71

Why are tetracycline pregnancy category D.

Back 71

b/c they interfere with tooth and bone formation of the fetus

Front 72

What are some negative side effects that may be experienced with tetracyclines? (4)

Back 72

- photosensitivity
- nephrotoxicity
- hepatotoxicity
- blood dyscrasias

Front 73

What may happen with an out-of-date tetracycline?

Back 73

it can be toxic

Front 74

What must you advise a client on oral contraceptives who is prescribed a tetracycline?

Back 74

it may decrease effectiveness

Front 75

What is the primary drug to treat MRSA?

Back 75

vancomycin

Front 76

How is vancomycin given?

Back 76

IV

Front 77

Does vancomycin have a low or high therapeutic index?

Back 77

low- toxicity is a problem

Front 78

Vancomycin should be used with extreme caution with ______ impairment.

Back 78

renal

Front 79

What must be done with vancomycin due to it's low therapeutic index?

Back 79

peak and troughs must be drawn to monitor serum levels

Front 80

True/False:

Resistance to vancomycin is decreasing.

Back 80

False- it is increasing

Front 81

The PO form of vancomycin is not effective against MRSA and can predispose a person to what?

Back 81

VRE

Front 82

What 3 things MUST be monitored when a person is taking vancomycin?

Back 82

1. monitor for ototoxicty
2. monitor for nephrotoxicty
3. monitor for blood dyscrasias

Front 83

Peak and trough levels are usually drawn before the _______ dose of vancomycin is administered.

Back 83

third

Front 84

Vancomycin is pregnancy category ___.

Back 84

C

Front 85

What drug may cause erythema of the neck accompanied by fever, chills, and a decrease in BP (also known as red neck syndrome)?

Back 85

vancomycin

Front 86

What type of bacteria are aminoglycosides used to treat?

Back 86

gram-negative bacteria

Front 87

True/False:

Aminoglycosides have a high therapeutic index.

Back 87

False- they have a low therapeutic index, so toxicity is a problem

Front 88

Why are aminoglycosides still used if they have such a low therapeutic index?

Back 88

b/c they are effective and inexpensive

Front 89

How are aminoglycosides given? Why?

Back 89

parenterally b/c they are not absorbed by the GI tract

Front 90

What should be monitored in a person taking aminoglycosides?

Back 90

- monitor for toxicity of the drug (peak/troughs)
- monitor for ototoxicity
- monitor for nephrotoxicity

Front 91

What pregnancy category is aminoglycosides?

Back 91

C & D

Front 92

Fluroquinolones are effective against what type of organisms?

Back 92

gram-positive and gram-negative

Front 93

What type of infections are fluoroquinolones used to treat?

Back 93

UTIs, lower respiratory tract infections, skin, soft tissue, bone and joint infections

Front 94

Fluoroquinolones have been implicated in what (3) major side effects?

Back 94

- neurological damage
- behavioral changes
- joint and tendon problems (spontaneous rupture of achilles tendon)

Front 95

True/False:

Fluoroquinolones should be given on an empty stomach.

Back 95

True

Front 96

IV administration of fluroquinolones should be done over how long?

Back 96

a one hour period

Front 97

What are some side effects of fluroquinolones?

Back 97

- photosensitivity
- GI disturbances (common)
- nephrotoxicity

Front 98

As a nurse, what should you be alert to when a person is taking fluoroquinilones?

Back 98

- musculoskeletal problems such as joint pain or tendonitis
- behavioral changes (nervousness, insomnia)
- neurological problems (dizziness, seizures)

Front 99

What would you encourage a person to increase when taking fluroquinolones?

Back 99

fluid intake

Front 100

What pregnancy safety category are fluoroquinolones?

Back 100

C (X at term)

Front 101

What were the first group of drugs used against bacteria?

Back 101

Sulfonamides

Front 102

Sulfonamides are used primarily for the treatment of what? What can they also be used for?

Back 102

- primarily for UTIs
- also given for ear infections and frequently given to HIV clients for prevention or treatment of pneumonia

Front 103

Topical sulfonamides are used for what? What about ophthalmic?

Back 103

burns
eye infections

Front 104

____ disturbances are common with sulfonamides.

Back 104

GI

Front 105

Why should sulfonamides be followed by at least 8 oz of water?

Back 105

b/c crystalluria may occur (kidney stones)

Front 106

What are 5 side effects that may occur with sulfonamides?

Back 106

- hematuria
- blood dyscrasias
- rashes
- photosensitivity
- headache/dizziness

Front 107

Sulfonamides should never be administered with what?

Back 107

antacids

Front 108

The use of sulfonamides may increase the effects of what 3 drug categories?

Back 108

- anti-coagulants
- anti-diabetic agents
- anti-seizure agents

Front 109

Sulfonamides are pregnancy category ___.

Back 109

C

Front 110

Of the macrolides, which is the most irritating?

Back 110

Zithromax

Front 111

Even after finishing the medication, fluroquinolones may cause what?

Back 111

psychosis

Front 112

What type of drugs are used to fight tuberculosis?

Back 112

anti-tubercular agents

Front 113

True/False:

Tuberculosis always infects the lungs.

Back 113

False - although it "usually" infects the lungs, it can infect other agents

Front 114

What single drug can fight tuberculosis?

Back 114

None- there is not a drug that can act alone against tuberculosis; usually 2-3 drugs are given in combination

Front 115

How long does TB therapy usually last?

Back 115

9 months - 2 years

Front 116

A single drug called ________ is often given as a prophylaxis for a person who's TB skin test has recently converted from neg. to pos.

Back 116

Isoniazid (INH)

Front 117

How long does prophylactic treatment for TB usually last?

Back 117

6 months

Front 118

What are the 2 categories for anti-tubercular agents?

Back 118

- first-line agents
- second-line agents

Front 119

In the 1980's, TB strains began to evolve and have developed into what?

Back 119

multi-drug resistant strains of TB

Front 120

Clients with a multi-drug resistant strain of TB may need to be treated with what?

Back 120

a combination of first-line and second-line anti-tubercular drugs; this may be 5-7 different drugs

Front 121

What is the largest problem with the treatment of TB?

Back 121

compliance

Front 122

INH (prophylaxis for potential TB) has what major side effect? What should be taken to help prevent this?

Back 122

peripheral neuropathy - take B6 with INH to help prevent this

Front 123

In HIV, there is a frequently occurring opportunistic infection called what?

Back 123

MAC (Mycobacterium Avium Complex)

Front 124

What type of toxicity can occur with INH therapy?

Back 124

hepatotoxicity

Front 125

___________ can occur with streptomycin and capreomycin, anti-tubercular drugs.

Back 125

ototoxicity

Front 126

What might occur if you discontinue anti-tubercular drugs prematurely?

Back 126

the disease can be reactivated and it may make the remaining bacteria resistant

Front 127

What is the purpose of sputum tests for acid-fast bacilli?

Back 127

to diagnose TB and to evaluate drug effectiveness

Front 128

Metronidazole and Atovaquone are both examples of what type of drugs?

Back 128

Anti-protozoal agents

Front 129

Metronidazole is both antibacterial and anti-protozoal. What are 5 infections it is used to treat?

Back 129

1. systemic trichomoniasis
2. vaginal trichomonas
3. amebiasis
4. helicobacter pylori
5. "other" anaerobic bacterial infections

Front 130

Metronidazole, an anti-protozoal agent, is often used prophylactically for what?

Back 130

colorectal and abdominal surgeries

Front 131

Atovaquone, an anti-protozoal agent, is used for the treatment of mild to moderate ________ _______ ________.

Back 131

pneumocystis carinii pneumonia

Front 132

Atovaquone, an anti-protozoal agent, is often given to patients who are allergic to what?

Back 132

Bactrim

Front 133

What is a common side effect for anti-protozoal agents?

Back 133

GI disturbances (nausea, vomiting, diarrhea)

Front 134

A _________ taste may occur when taking metronidazole, an anti-protozoal agent.

Back 134

metallic

Front 135

_________ superinfections might occur with the use of anti-protozoal agents.

Back 135

candidiasis

Front 136

Atovaquone, an anti-protozoal agent, has _________ (increased/decreased) absorption when taken with food.

Back 136

increased

Front 137

What pregnancy category is atovaqone? metronidazole?

Back 137

metronidazole = B
atovaquone = C

Front 138

Do fungal infections occur systemically or just to the skin/mucous membranes?

Back 138

can occur both ways

Front 139

Systemic fungal infections are often opportunistic and occur when?

Back 139

when there is a decrease in immunity (HIV, cancer)

Front 140

What are the 3 categories of antifungal drugs?

Back 140

1. polyenes
2. imidazoles
3. antimetabolites

Front 141

Antifungal drugs exert their effect on the ________ of the fungi.

Back 141

membrane

Front 142

Which class of antifungals is often given "swish and swallow" for GI candidiasis? (sometimes given "swish and swallow")

Back 142

Polyenes

Front 143

True/False:

Viruses are easier to eradicate than other organisms.

Back 143

False- they are more difficult b/c they penetrate host cells

Front 144

What is released by host cells in response to an infection by a virus?

Back 144

interferons

Front 145

What is sometimes useful in helping a host cell fight off a virus?

Back 145

genetically engineered interferons

Front 146

How do antivirals exert their action?

Back 146

they prevent replication of the virus

Front 147

What are 6 viral infections that antivirals are used to treat?

Back 147

1. influenza
2. herpes
3. HIV
4. RSV
5. cytomegalovirus (CMV)
6. hepatitis C

Front 148

True/False:

Antivirals to treat RSV are reserved for extremely bad cases because the drugs are extremely toxic.

Back 148

True

Front 149

What are the 3 types of drugs used to reduce the viral loads in HIV infections?

Back 149

1. reverse transcriptase inhibitors
2. protease inhibitors
3. fusion inhibitors

Front 150

How do reverse transcriptase inhibitors interfere with HIV replication?

Back 150

alters the RNA of HIV

Front 151

How do protease inhibitors decrease HIV replication?

Back 151

disabling protease (an enzyme that makes viral particles)

Front 152

How does a fusion inhibitor decrease the viral load of HIV?

Back 152

prevents the fusion of HIV with the human membrane

Front 153

What drug should always be avoided when an HIV person is taking a protease inhibitor? Why?

Back 153

St. John's Wort - decreases the effectiveness of protease inhibitors

Front 154

Why is compliance so important for HIV clients?

Back 154

b/c the virus replicates very quickly; missed doses can lead to an increase in viral load