NUR151 - Anti-Infectives
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| Aminoglycosides Action | Bactericidal - Effective against aerobic gram-negative infections and protozoal infections
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| Aminoglycosides uses | Bowel prep for surgery, Prevent absorption of ammonia in hepatic encephalopathy
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| Preferred route of aminoglycosides is | IV – oral is poorly absorbed
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| Never piggy back or mix Aminoglycosides with | other meds because it can interfere
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| Bleeding may increase because the aminoglycosides | decrease synthesis of vitamin K in the intestinal tract – normal flora are disrupted
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| How does Aminoglycosides interfere with synthesis of vit k? | kills off bacteria in the colon and this reduces amount of vit k
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| Adverse effects/toxicity of aminoglycosides | Nephrotoxicity and ototoxicity – wouldn’t want to mix with vancomyocin because they are both nephrotoxic
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| Superinfection | secondary infection caused by destruction of normal flora – Candidiasis, Pseudomembranous colitis – due to aminoglycosides
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| peak and trough levels are drawn from blood to make sure | they are receiving therapeutic levels of the drug.
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| Peak drug level | blood specimen drawn 15 – 30 min. after IV infusion is completed – drawn after
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| Trough drug level | blood specimen drawn immediately prior to next IV infusion
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| Serum creatinine and blood urea nitrogen (BUN) to monitor | renal function
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| WBC count | tells if infection is being controlled or not
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| Differential | neutrophils are monitored as well as bands – should decline
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| Empiric therapy | propholactic – broad spectrum is started until causative organism identified
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| How much water to drink daily with aminoglycosides? | 2-3 liters per day
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| Cephalosporins Action | Bactericidal, Structurally and chemically related to penicillins, Cross-sensitivity may occur between the penicillins and cephalosporins
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| First through third generations of cephalosporins good against | gram-negative organisms
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| Fourth generation of cephalosporins good for | increased activity against gram-positive cocci and gram negative bacilli
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| Uses for cephalosporins | STDs, Respiratory infections, Urinary tract infections and skin/tissue infections, Used prophylactically and therapeutically in ortho disorders, Endocarditis
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| Administer cephalosporins how? | Administer PO with food or milk if complains of gastric irritation
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| Monitor what side effects of cephalosporins | lethargy, hallucinations, anxiety, depression, N/V, anemia, - Pseudomembranous colitis (super infection)
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| Biggest side effect of cephalosporins | renal toxicity
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| Monitor for superinfections | thrush in mouth, yeast infections
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| What delays absorption of cephalosporins orally | If patient receiving H2, iron supplements, antiacids - 2 hrs before or after – same with bread
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| Fluoroquinolones Action | Broad-spectrum bactericidal antibiotics, Used against gram – and gram + organisms
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| Use of Fluoroquinolones | Lower respiratory infections, sinusitis, bone & joint infections, soft tissue infections, abdominal infections
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| Fluoroguinolones are not given with | food – better on empty stomach
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| Best absorption of fluoroguinolones | PO and IV are same
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| Fluoroguinolones interact with | Oral antacids, iron, zinc preparations
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| What do you want to monitor when giving antibiotics due to dead flora | Monitor PT, INR
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| Antibiotic that causes photosensitivity | Fluoroguinolones -Wear sunglasses, long-sleeves and long legged garments – protect from direct sunlight
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| Macrolides and Lincosamides Action | Bacteriostatic (inhibiting the growth of bacteria) but can be bactericidal in high doses
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| Uses for Macrolides and Lincosamides | Lower respiratory tract infections, skin and soft tissue infections, syphilis, gonorrhea
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| Macrolides and Lincosamides side effects | Erythromycin – tears up stomach, NV, thrombophlibitis tendency (infection of IV site) – monitor IV site for infiltration
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| Vancomycin (Vancocin) Action | Bactericidal
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| Antibiotic of choice for methicillin-resistant Staphlococcus aureus (MRSA) and other gram positive bacteria, yeast, and fungi | vancomycin – vancocin
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| Oral use of Vancomycin | C Difficile
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| IV Vancomycin (vancocin) used for | Bone and joint infections or septicemia caused by staphlococcal organisms
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| IV side effects of Vancomycin | IV administration should be through a central line, causes phlebitis and can cause necrosis if extravasates
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| What labs to monitor for giving Vancomycin | Peak and Trough, Liver enzymes – ALT, AST, bilirubin, Kidney function
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| “Red neck (or man) syndrome” | too rapid IV Vancomycin infusion results in profound hypotension and erythematous rash - Nausea, hypotension, flushing
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| Extravasates | when tissue becomes necrotic
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| Ototoxicity is adverse effect of | vancomycin and aminoglycosides
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| Penicillins Action | Bactericidal, bacteriostatic - Gram positive organisms - derived from fungus or mold evidenced on bread or fruit
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| Use of penicillins | Pneumonia, upper respiratory infections, STD’s, prophylactically against endocarditis for oral, GI, pulmonary procedures when bacteria may enter circulation, used in beta-hemolytic streptococci Group A infections
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| Why larger PO dose than IM for penicillins | hepatic first-pass effect and the instability of PCN in a acidic environment
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| Penicillin Drug interactions | Loop & thiazide diuretics may exacerbate hypokalemia & rash, Decreased efficacy of oral contraceptives
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| Sulfonamides Action | First effective group of antibiotics (1935) – bacteriostatic
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| Use of sulfonamides | UTI, pneumonia, brain abscesses, ulcerative colitis, rheumatoid arthritis
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| Bactrim is a | sulfonamide
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| Nursing Implications for sulfonamides | Increase oral intake to promote urine output to prevent crystalluria/stone formation - Empty bladder every 2 hours – C & S
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| Alkoline/Ash diet is good to use with | sulfonamide - Fruits, except for plums, prunes, or cranberries, vegeies, milk
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| Stevens/Johnson syndrome (SJS) | type of rash that looks like 2nd degree burn – common with sulfonamides
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