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154 Cards in this Set

  • Front
  • Back
Drugs used to treat infections are called what?
anti-infectives or anti-microbials
Anti-infectives, aka anti-microbials, are substances that inhibit the growth of or kill what 5 things?
1. bacteria
2. viruses
3. fungi
4. protozoa
5. rickettsiae
Anti-infective agents are designed to act on foreign organisms that have invaded the body without causing what?
- damage to the host cell
Anti-infectives exert one of two basic mechanisms to accomplish damage to foreign organisms. Describe each.
1. destroying the structure that houses the invading organism
2. disabling the invading organism's ability to reproduce itself
Most cells replicate through the replication of DNA. What is an example of a virus that replicates using RNA?
What is the best way to choose the appropriate anti-infective agent to treat an infection?
obtain a specimen of infected material and perform a culture and sensitivity test on it
To obtain a culture, infected material is spread on a Petri dish and the organism is allowed to grow for how long?
24-72 hours
In a C&S test, how do you determine the "sensitivity" of an organism?
the organism is exposed to several pre-selected anti-infectives
In a C&S test, an organism is considered to be _________ to those anti-infectives that inhibited it's growth.
In a C&S test, an organism is considered _______ to those anti-infectives that failed to inhibit it's growth.
A specimen for a C&S test should be collected before an anti-infective agent is given to avoid what?
false results
Why is antibiotic therapy often begun before the results of a C&S are received?
b/c it takes 24-72 hours to receive the results and the infection could worsen to a critical point
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?
they base the choice on the client's presenting signs and symptoms
What should you ask a client if they state that they are allergic to a particular anti-infective?
determine what signs and symptoms were experienced after taking the drug; clients often confuse common but harmless side-effects with allergic reactions
Why is it important for a client to take the entire prescription of an anti-infective agent?
to avoid having the organism gain a foothold again; many organisms have developed resistance to anti-infectives due to misuse
What is an example of an organism that has developed resistance to anti-infectives due to misuse?
MRSA (methicillin-resistant staphylococcus aureus)
Most of the drugs used to fight infection are what class?
antibacterial drugs

an agent that inhibits the growth of bacteria

an agent that kills bacteria
Can a drug be both bacteriostatic and bactericidal?
Yes, depending on the dose
Antibacterial drugs either have a narrow-spectrum or broad-spectrum. Describe each.
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
Why do antibacterial drugs often cause superimposed infections?
due to the loss (disruption) of normal flora
Penicillins are usually used for what two type of infections? They can additionally be used to treat what 3 specific infections?
- usually used for staphylococcal and streptococcal infections
- additionally can be used for gonorrhea, syphilis, and anthrax
What type of structure does penicillin have?
beta-lactum structure
What are 3 major problems with penicillins?
- high incidence of serious allergic reactions that can lead to anaphylactic shock or death
- drug resistance
- narrow spectrum of many of the preparations
Resistance to penicillin occurs when staphylococcal organisms produce an enzyme called what?
penicillinase (beta-lactamase)
What 6 side effects might occur with the use of penicillins and cephalosporins?
1. nausea
2. vomiting
3. stomatitis
4. diarrhea
5. furry tongue
6. rash

Superimposed infections are common with penicillins and cephalosporins.
What might occur to the effectiveness of oral contraceptives with the use of penicillins or cephalosporins?
they might be reduced
When on penicillin or a cephalosporin, urine may show a false positive for what?
Most penicillins and cephalosporins are pregnancy category ____.
If giving penicillin or a cephalosporin in IV form, what must be done to it? Why?
it must be diluted b/c it is irritating to the veins
What should be done when injecting penicillin or a cephalosporin IM?
inject into a large muscle mass

Penicillin may cause blood dyscrasia.
Why would penicillin/cephalosporin be given with probenicid, an anti-gout drug?
to slow renal excretion and increase serum levels (basically extend the life of penicillin)
What are 3 drugs that may be given for penicillin/cephalosporin allergic reactions?
1. diphenhydramine (Benadryl)
2. epinephrine
3. glucocorticoid (such as hydrocortisone)

Penicillins and Cephalosporins have the same mechanism of action.
What structure do cephalosporins have?
beta-lactum structure
Why might a person who is allergic to penicillin be allergic to cephalosporins as well?
b/c of their structural similarities (beta-lactum structures)
What are 2 advantages of cephalosporins over penicillins?
1. broader antibacterial spectrum
2. resistance has not developed to the same extent

Resistance to cephalosporins is decreasing over time.
False- it is increasing
How many generations of cephalosporins are there? Which generation has the broadest spectrum?
4 generations

- the 4th generation is the broadest spectrum
Which generation of cephalosporin is often used peri-operatively as a prophylaxis?
the first generation
When issuing a cephalosporin, you should ask the patient if they are allergic to what other type of drug?
Taking cephalosporins with alcohol can result in a specific adverse reaction known as what? What are 4 symptoms of this reaction?
disulfiram reaction - consists of flushing, dizziness, headache, muscular weakness
Clients with renal disease taking cephalosporins are at an increased risk for what?
Macrolides, Lincosamides and Tetracyclines are often prescribed to a patient who has what type of allergy?
a penicillin allergy
What is the oldest macrolide?
Erythromycin is the drug of choice to treat what 3 diseases?
- Legionnaires' Disease
- mycoplasmal pneumonias
- chlamydia
Erythromycin is ________ active against some gram negative bacteria.
Erythromycin is active against most gram-positive bacteria except what?
staphylococcus aureus
Is resistance to erythromycin possible?
Why are oral preparations of erythromycin designed to break down in the small intestine?
b/c gastric acid destroys the drug
What must be done to erythromycin IV preparations? Why?
must be diluted with at least 100mL of normal saline because they are extremely irritating to the veins
What is the biggest advantage of erythromycin and dirithromycin over other antibacterials?
they are excreted in the bile and feces more than the urine, allowing them to be used in renal insufficiency
Because erythromycin and dirithromycin are excreted in the bile/feces, they are contraindicated in what type of disease?
liver disease
What is a common and likely side effect to the use of macrolides (ex. erythromycin)?
GI disturbances

You should take macrolides (ex. erythromycin) with food.
False - you should take them 1-2 h AC or 2-3 h PC because food decreases absorption
What is a likely side effect with erythromycin IV?
phlebitis (inflammation of a vein)
What pregnancy safety category do macrolides fall in?
B & C
Macrolides can be _________ in high doses.

What should be done b/c of this?
hepatotoxic - monitor liver enzymes when administering high doses
Which is more toxic, macrolides or lincosamides?
Lincosamides are effective against what 3 infections?
1. streptococci
2. staphylococci
3. pneumococci
What side effects may be experienced when taking Lincosamides?
- GI disturbances
- Rash
Lincosamides should be stopped immediately if what occurs? What might this be?
if bloody diarrhea occurs - this may be psuedomembranous colitis
What pregnancy category are lincosamides?
Are tetracyclines effective against gram-negative or gram-positive bacteria?

Resistance to tetracyclines is increasing.
Tetracyclines should not be taken with products containing what? Why?
aluminum, calcium, or iron b/c these will bind with the drug and inhibit absorption
Tetracyclines are pregnancy category ___.
Why are tetracycline pregnancy category D.
b/c they interfere with tooth and bone formation of the fetus
What are some negative side effects that may be experienced with tetracyclines? (4)
- photosensitivity
- nephrotoxicity
- hepatotoxicity
- blood dyscrasias
What may happen with an out-of-date tetracycline?
it can be toxic
What must you advise a client on oral contraceptives who is prescribed a tetracycline?
it may decrease effectiveness
What is the primary drug to treat MRSA?
How is vancomycin given?
Does vancomycin have a low or high therapeutic index?
low- toxicity is a problem
Vancomycin should be used with extreme caution with ______ impairment.
What must be done with vancomycin due to it's low therapeutic index?
peak and troughs must be drawn to monitor serum levels

Resistance to vancomycin is decreasing.
False- it is increasing
The PO form of vancomycin is not effective against MRSA and can predispose a person to what?
What 3 things MUST be monitored when a person is taking vancomycin?
1. monitor for ototoxicty
2. monitor for nephrotoxicty
3. monitor for blood dyscrasias
Peak and trough levels are usually drawn before the _______ dose of vancomycin is administered.
Vancomycin is pregnancy category ___.
What drug may cause erythema of the neck accompanied by fever, chills, and a decrease in BP (also known as red neck syndrome)?
What type of bacteria are aminoglycosides used to treat?
gram-negative bacteria

Aminoglycosides have a high therapeutic index.
False- they have a low therapeutic index, so toxicity is a problem
Why are aminoglycosides still used if they have such a low therapeutic index?
b/c they are effective and inexpensive
How are aminoglycosides given? Why?
parenterally b/c they are not absorbed by the GI tract
What should be monitored in a person taking aminoglycosides?
- monitor for toxicity of the drug (peak/troughs)
- monitor for ototoxicity
- monitor for nephrotoxicity
What pregnancy category is aminoglycosides?
C & D
Fluroquinolones are effective against what type of organisms?
gram-positive and gram-negative
What type of infections are fluoroquinolones used to treat?
UTIs, lower respiratory tract infections, skin, soft tissue, bone and joint infections
Fluoroquinolones have been implicated in what (3) major side effects?
- neurological damage
- behavioral changes
- joint and tendon problems (spontaneous rupture of achilles tendon)

Fluoroquinolones should be given on an empty stomach.
IV administration of fluroquinolones should be done over how long?
a one hour period
What are some side effects of fluroquinolones?
- photosensitivity
- GI disturbances (common)
- nephrotoxicity
As a nurse, what should you be alert to when a person is taking fluoroquinilones?
- musculoskeletal problems such as joint pain or tendonitis
- behavioral changes (nervousness, insomnia)
- neurological problems (dizziness, seizures)
What would you encourage a person to increase when taking fluroquinolones?
fluid intake
What pregnancy safety category are fluoroquinolones?
C (X at term)
What were the first group of drugs used against bacteria?
Sulfonamides are used primarily for the treatment of what? What can they also be used for?
- primarily for UTIs
- also given for ear infections and frequently given to HIV clients for prevention or treatment of pneumonia
Topical sulfonamides are used for what? What about ophthalmic?
eye infections
____ disturbances are common with sulfonamides.
Why should sulfonamides be followed by at least 8 oz of water?
b/c crystalluria may occur (kidney stones)
What are 5 side effects that may occur with sulfonamides?
- hematuria
- blood dyscrasias
- rashes
- photosensitivity
- headache/dizziness
Sulfonamides should never be administered with what?
The use of sulfonamides may increase the effects of what 3 drug categories?
- anti-coagulants
- anti-diabetic agents
- anti-seizure agents
Sulfonamides are pregnancy category ___.
Of the macrolides, which is the most irritating?
Even after finishing the medication, fluroquinolones may cause what?
What type of drugs are used to fight tuberculosis?
anti-tubercular agents

Tuberculosis always infects the lungs.
False - although it "usually" infects the lungs, it can infect other agents
What single drug can fight tuberculosis?
None- there is not a drug that can act alone against tuberculosis; usually 2-3 drugs are given in combination
How long does TB therapy usually last?
9 months - 2 years
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.
Isoniazid (INH)
How long does prophylactic treatment for TB usually last?
6 months
What are the 2 categories for anti-tubercular agents?
- first-line agents
- second-line agents
In the 1980's, TB strains began to evolve and have developed into what?
multi-drug resistant strains of TB
Clients with a multi-drug resistant strain of TB may need to be treated with what?
a combination of first-line and second-line anti-tubercular drugs; this may be 5-7 different drugs
What is the largest problem with the treatment of TB?
INH (prophylaxis for potential TB) has what major side effect? What should be taken to help prevent this?
peripheral neuropathy - take B6 with INH to help prevent this
In HIV, there is a frequently occurring opportunistic infection called what?
MAC (Mycobacterium Avium Complex)
What type of toxicity can occur with INH therapy?
___________ can occur with streptomycin and capreomycin, anti-tubercular drugs.
What might occur if you discontinue anti-tubercular drugs prematurely?
the disease can be reactivated and it may make the remaining bacteria resistant
What is the purpose of sputum tests for acid-fast bacilli?
to diagnose TB and to evaluate drug effectiveness
Metronidazole and Atovaquone are both examples of what type of drugs?
Anti-protozoal agents
Metronidazole is both antibacterial and anti-protozoal. What are 5 infections it is used to treat?
1. systemic trichomoniasis
2. vaginal trichomonas
3. amebiasis
4. helicobacter pylori
5. "other" anaerobic bacterial infections
Metronidazole, an anti-protozoal agent, is often used prophylactically for what?
colorectal and abdominal surgeries
Atovaquone, an anti-protozoal agent, is used for the treatment of mild to moderate ________ _______ ________.
pneumocystis carinii pneumonia
Atovaquone, an anti-protozoal agent, is often given to patients who are allergic to what?
What is a common side effect for anti-protozoal agents?
GI disturbances (nausea, vomiting, diarrhea)
A _________ taste may occur when taking metronidazole, an anti-protozoal agent.
_________ superinfections might occur with the use of anti-protozoal agents.
Atovaquone, an anti-protozoal agent, has _________ (increased/decreased) absorption when taken with food.
What pregnancy category is atovaqone? metronidazole?
metronidazole = B
atovaquone = C
Do fungal infections occur systemically or just to the skin/mucous membranes?
can occur both ways
Systemic fungal infections are often opportunistic and occur when?
when there is a decrease in immunity (HIV, cancer)
What are the 3 categories of antifungal drugs?
1. polyenes
2. imidazoles
3. antimetabolites
Antifungal drugs exert their effect on the ________ of the fungi.
Which class of antifungals is often given "swish and swallow" for GI candidiasis? (sometimes given "swish and swallow")

Viruses are easier to eradicate than other organisms.
False- they are more difficult b/c they penetrate host cells
What is released by host cells in response to an infection by a virus?
What is sometimes useful in helping a host cell fight off a virus?
genetically engineered interferons
How do antivirals exert their action?
they prevent replication of the virus
What are 6 viral infections that antivirals are used to treat?
1. influenza
2. herpes
3. HIV
4. RSV
5. cytomegalovirus (CMV)
6. hepatitis C

Antivirals to treat RSV are reserved for extremely bad cases because the drugs are extremely toxic.
What are the 3 types of drugs used to reduce the viral loads in HIV infections?
1. reverse transcriptase inhibitors
2. protease inhibitors
3. fusion inhibitors
How do reverse transcriptase inhibitors interfere with HIV replication?
alters the RNA of HIV
How do protease inhibitors decrease HIV replication?
disabling protease (an enzyme that makes viral particles)
How does a fusion inhibitor decrease the viral load of HIV?
prevents the fusion of HIV with the human membrane
What drug should always be avoided when an HIV person is taking a protease inhibitor? Why?
St. John's Wort - decreases the effectiveness of protease inhibitors
Why is compliance so important for HIV clients?
b/c the virus replicates very quickly; missed doses can lead to an increase in viral load