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Safety Meds Antimicr

NP2 - Unit 1, Safety in Meds - Antimicrobials (Dehouske)

QuestionAnswer
In what five ways do antimicrobials act upon microorganisms? 1. Inhibit cell wall synthesis 2. Inhibit protein synthesis 3. Distribution or alteration of membrane permeability 4. Inhibition of nucleic acid synthesis (antivirals) 5. Inhibition of other specific biochemical pathways
What are the five steps to choosing an antimicrobial? 1. Suspected infected site (where is the infection) 2. Host factors (i.e. how sick they are, what meds they're on) 3. Which organism is causing infection 4. Treat according to preliminary info until C&S comes back 5. Use antibiotic combinations if nee
What are the adverse effects associated with antimicrobials? Allergic reaction, superinfection, GI upset
What symptoms go along with a rash due to an allergic reaction to antimicrobials? urticaria, runny nose.
What should you do if a patient develops a rash after receiving an antimicrobial? Stop med, give antihistamine
What symptoms go along with anaphylactic shock in reaction to an antimicrobial? Low BP, Bronchoconstriction, Laryngeal edema, Cardiovascular collapse.
What should you do if a patient shows signs of anaphylactic shock after receiving an antimicrobial? Stop med, give epinephrine (with MD order), oxygen, supportive care.
In choosing an antimicrobial, what is the importance of the infected site? How serious the infection is, location - how close area is to other structures, how much vasculature the area has that could carry bacteria to another location, etc.
In choosing an antimicrobial, what sort of host factors are important? How sick the patient is, what meds they are on, etc.
If the doctor orders ampicillin and a culture, what should you do? Culture FIRST, then give ampicillin.
What is the cornerstone for determining which organism you are dealing with? Culture and Sensitivity (C&S)
Before the specific organism is determined, what will the doctor often do? Place the patient on a broad-spectrum antibiotic until the C&S comes back.
IM and PO antimicrobials vs. IV? IM and PO less expensive, IV more effective.
If a patient says he is allergic to an antimicrobial, what should you ask him, and why? What happens when you take that medication? Because the patient may be confusing a side effect, like GI upset, for an allergy. A side effect isn't justification for not taking a med if it's needed.
Administering IV antimicrobials On time, accurate dose, correct method, check compatibilities, check site
Administering IM antimicrobials Appropriate muscle, good circulation, not a common route of administration
Nursing responsibilities for administering antimicrobials Know particulars about drug given including classification
Patient teaching in regards to the administration of antimicrobials Take entire round as prescribed to prevent reinfections
Penicillin - action Interferes with protein formation in bacterial cell wall
Penicillin - types of infections treated meningitis, pneumonia, sepsis, SBE (subacute bacterial endocarditis)
Natural penicillin treats gram ___ bacteria +
If a bacteria produces an enzyme (penicillinase) that destroys penicillin, what class of penicillin should be used? Penicillinase-resistant methicillin
Aminopenicillins differ from natural penicillin in that... They have an added amino group which allows them to treat gram neg. organisms
Trade name for Aminopenicillin Ampicillin
Extended spectrum penicillin Related to ampicillin, but covers gram neg. better.
Which organism does extended spectrum penicillin specifically work better against? Pseudomonas
Trade names - extended spectrum penicillin carbenicillin, ticarcillin
Suffix for penicillins -cillin
Which antibiotic has the highest incidence of allergic reaction? Penicillins
If a patient is allergic to penicillin, he is often also allergic to ____. Cephalosporins.
From what are cephalosporins produced? A fungus
How many kinds of cephalosporins are there? Three, titled "generations" - 1st, 2nd, and 3rd generation.
First generation cephalosporins Cefazolin, Ancef
Second generation cephalosporins Cefoxitin, Mefoxin
Third generation cephalosporins Cefotaxime, Claforan
Cephalosporins - adverse reactions Blood dyscrasias - bleeding, neutropenia, leukopenia, thrombocytopenia May be CNS irritant if given intraventricularly.
Aminoglycosides - names Gentamycin Kanamycin Amikacin
Aminoglycosides treat gram ___ bacteria Neg. and Pos.
T or F - Aminoglycosides aren't very popular, because they don't work too well in treating bacteria. False. They are both popular and very good at treating bacterial infections.
How do aminoglycosides work? Changes protein synthesis, acts only on actively growing bacteria.
What are aminoglycosides not good for? Prophylaxis
Aminoglycosides - indications Serious infections, especially pseudomonas
How are aminoglycosides excreted? through glomerular filtration
Aminoglycosides - adverse effects *OTO AND RENAL TOXIC* High doses can cause muscular weakness or paralysis.
How does penicillin interact with aminoglycosides? Penicillin inactivates aminoglycosides, and vice versa.
Aminoglycosides - Nursing Considerations Assess patients for fullness in ears or balance problems. OTOTOXIC. RENAL TOXIC. Do not give too quickly. Watch peak and trough levels.
When should you measure peak level for aminoglycosides? About 30 minutes after infusion is complete.
When is the trough level measured for aminoglycosides? Just before next dose, no more than 45 minutes before usually.
What was the first broad-spectrum antibiotic? Tetracyclines.
tetracyclines treat gram ___ bacteria Both pos. and neg.
How do tetracyclines work? They are bacteriostatic. They cause cell leakage, can be "cidal" in large doses.
What type of infections do tetracyclines treat? Acne, chlamydial infections
Tetracyclines - dietary considerations Food and dairy products reduce absorption. Take on empty stomach.
Tetracycline - adverse effects Drug binds to newly formed bone and teeth (don't use in pregnancy or for kids under age 8)
Erythromycins treat gram ___ bacteria both pos. and neg., but better for gram pos.
How do erythromycins work? They are bacteriostatic
What antibiotics have the least incidence of toxicity? erythromycins.
T or F - Erythromycins often cause allergic reactions. False. Hardly anyone has an allergic reaction to them.
What side effect is erythromycin notorious for? GI upset.
Off-label use for erythromycin Gastric emptying in patients with delayed gastric emptying
Why are erythromycin tablets coated? So that the medicine is not destroyed by the stomach acid
Erythromycin dietary considerations Take on an empty stomach
Sulfonamide names Gantrisin Bactrim Septra Azulfidine
What was the first safe and low-cost antibiotic? Sulfonamide
How do sulfonamides work? They are bacteriostatic. In a high bladder concentration, they may be "cidal"
What infections are sulfonamides used for? Mostly for UTI's.
Sulfonamides - adverse reactions Cause crystalluria. Can cause hemolysis and aplastic anemia in toxic doses.
Sulfonamides - nursing considerations Watch I&O, keep urine alkaline, keep urine dilute.
Sulfonamides - patient teaching Must drink at least 2-3 liters of water per day.
Chloramphenicol uses CNS infections Haemophilus influenzae infections
How does chloramphenicol work? Bacteriostatic. "Cidal" for vulnerable organisms, or in high doses.
Why is the use of chloramphenicol limited? Serious toxicity - *APLASTIC ANEMIA*
What are the limitations for chloramphenicol use? Not to be given for more than 14 days. Only to be used in severe infections.
What is aplastic anemia? Shutdown of bone marrow.
PO vs. IV administration of chloramphenicol? With PO use, bone marrow suppression is irreversible. With IV use, it *may* be reversible.
Quinolones - names Ciprofloxacin Floxin
What is the newest group of antibiotics? Quinolones
Quinolones treat gram ___ bacteria both gram pos. and neg.
Quinolones are especially effective against ___. Pseudomonas
How do quinolones work? Prevents DNA replication of organism
Quinolones Broad-spectrum antibiotic with good oral absorption and few side effects.
Quinolones - side effects Few side effects. Nausea, can be nephrotoxic, can cause allergic reaction.
Amphotericin B indications severe systemic antifungal infections
Amphotericin B administration Should be given slowly, over 2-4 hours. Monitor electrolytes (potassium). Can lower electrolytes. Shivering and rigors during treatment treated with Demerol. Very, very nephrotoxic. Causes light sensitivity - protect from light.
How does amphotericin B work? Alters cell wall permeability.
How long is amphotericin B treatment? 4-8 weeks. Treatment is slow.
What is the main concern with amphotericin B? It's very, very nephrotoxic.
Amphotericin B adverse effects Very nephrotoxic, CV toxicity possible.
Acyclovir Antiviral used primarily for herpes infections
Acyclovir routes IV or PO
Acyclovir IV administration considerations Give over 1 hour to prevent renal dysfunction Make sure patient is well-hydrated.
Gancyclovir Antiviral used primarily for treatment of CMV (Cytomegalovirus).
Gancyclovir route IV
Gancyclovir adverse effects neutropenia, thrombocytopenia, seizures.
Gancyclovir precautions Antineoplastic precautions - carcinogenic. Do not touch. Wear gloves, gown, mask, goggles. Can alter DNA.
Clindamycin indications Bone infections (osteomyelitis), respiratory infections, PCP (pneumocystic pneumonia).
Clindamycin is often used along with what other antibiotic? Aminoglycosides
Clindamycin can cause ____ ___ in high IV doses. Pseudomembranous colitis.
Clindamycin belongs to the ___ class of antibiotics. Lincosimides.
What type of organisms is clindamycin really good for treating? Anaerobic organisms.
Primaxin - name Impanem
What class of antibiotics does Primaxin belong to? Carbapenems
What is the broadest and most potent new class of antibiotic? Carbapenems like Primaxin
If you are allergic to ____, you can easily be allergic to primaxin. Penicillins.
What antibiotic is often used along with Primaxin to treat pseudomonas? Aminoglycosides
What is the danger of Primaxin use for renal impaired patients? Seizures
Vancomycin indications Used increasingly for MRSA infections. Poorly absorbed in GI tract, so oral form is usable for C. diff infections.
Red man's syndrome Can occur with vancomycin use. Causes a red skin rash. Can be prevented with pre-treatment of Tylenol and Benadryl.
Vancomycin adverse reactions Ototoxic, nephrotoxic. Administer slowly.
Flagyl/Metronidazole Antiprotozoal, antiamoebic good for GI perforations
Flagyl/Metronidazole considerations Doses need adjusting in renal/liver disease. May cause CNS sensitivity/seizures *IV over 1 hour*
Linezolid/Zyvox indications VRE (vancomycin-resistant enterococci), staph, strep infections. Penicillin-resistant infections.
Linezolid/Zyvox metabolization and excretion. Metabolized by liver, excreted by kidneys.
Linezolid/Zyvox cannot be used with ____, because Zyvox contains ____. Phenylketonurics, aspartame.
Linezolid side effects Thrombocytopenia, diarrhea, lactic acidosis, pseudomembranous colitis.
Linezolid nursing considerations Monitor for diarrhea, lactic acidosis (N/V), and bone marrow suppression (CBC)
Linezolid has ____ ____ properties MAO inhibitor
Created by: christyness
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