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Units 6-8
| Question | Answer |
|---|---|
| Mechanism of Action: Penicillins | interfere with cell wall synthesis - causing cells to take up water and lyse |
| Pencillins: Bacteriostatic or Bacteriocidal | Bacteriocidal |
| Side Effects: Penicillins | least SEs of all abx classes, allergic reactions, pain at injection site, hyperkalemia, hypernatremia, fluid overload, bleeding disorders |
| Toxity: Penicillins | neurotoxity |
| Nursing Considerations: Penicillins | monitor for reactions, administer Pen G slowly to avoid potassium overload, ticarcillin for fluid overload and bleeding, do not mix in IV with aminoglycosides, reduce in kidney disease |
| Other info: Penicillins | also called beta lactams, primarily renally eliminated, penicillinases, beta lactamases, cross allergenicity in class |
| Classes: Penicillins | Penicillin, Nafcillin, oxacillin, ampicillin, amoxicillin, carbenicillin, ticaricillin, augmentin, timentin, zosyn |
| Mechanism of Action: Cephalosporins | similar to penicillins. disrupt cell wall systhesis and activate autolysins. death by lysis. |
| Bactericidal or bacteriostatic: cephalosporins | Bactericidal |
| Side Effects: Cephalosporins | allergic reaction, bleeding disorders (vitamin K deficiency), alcohol intolerance, thrombophlebitis at IV stie, pain at IM site, pseudomembranous colitis, carnitine deficiency (Spectracef) |
| Toxity: Cephalosporins | neurotoxity in high does |
| Nursing Considerations: Cephalosporins | monitor for allergic reactions, bleeding, diarrhea, use caution in patient on blood thinners, do not give Spectracef if milk allergic, give IM injections deep into large muscle, alter dosages in renal impairment, monitor IV sites |
| Other info: Cephalosporins | also beta-lactamases, active against a broad spectrum of abx, major cause of ceph resistance is production of beta-lactamases, grouped into 4 generations |
| Cephalosporin Generations | progressing from 1-4 generation drugs, there is (1) increasing activity against gram negative bacteria (2) increasing resistance to destruction by beta-lactamases (3) increasing ability to reach the CSF |
| Impenem | aka Primaxin, also a beta-lactam, very broad spectrum, SEs: hypersensitivity, superinfection with fungi, seizures |
| Ertapenem | aka Ivanz, also a beta-lactam, very broad spectrum, SEs: diarrhea, rashes, nausea, seizures |
| Aztreonam | aka Azactam, only gram negatives, only half a ring so safe to give if allergic to other beta-lactams |
| Mechanism of Action: Macrolides | inhibits protein synthesis by binding to the 50S subunit - suppresion of RNA-dependent protein synthesis |
| Bactericidal vs Bacteriostatic: Macrolides | typically bacteriostatic, but may be bactericidal at high concentrations against susceptible organisms |
| Side Effects: Macrolides | nausea, vomitting, hepatitis, thrombophlebitis (IV azithro or clarithro), prolongation of QT interval, pyloric stenosis in infants |
| Toxicity: Macrolides | ototoxic in high doses, hepatotoxic |
| Nursing considerations: Macrolides | food decreases absorption of some oral forms, those oral forms that can should be given with food to minimize GI effects, don't administer with antacids, monitor IV site for redness, administer slowly, educate patient about long half-life of azithromycin |
| Drug interactions: Macrolides | Erthromycin and Clarithromycin ONLY - inhibitors of cytochrome p450 which may increase concentrations of theophylline, digoxin, carbamazepine, valproic acid, cyclosporin, allegra, phenytoin, warfarin, cisapride, ergot alkaloids |
| Mechanism of Action: Tetracyclines | inhibits protein synthesis by binding to the 30S subunit - suppression of RNA-dependent protein synthesis |
| Bacteriostatic vs. Bactericidal: Tetracyclines | Bacteriostatic |
| Forms of Tetracycline | tetracycline, doxycycline (Vibramycin), minocycline |
| Side Effects: Tetracyclines | heartburn, nausea, vomitting, diarrhea, staining of deciduous teeth if given during pregnancy, excessive urination, damage to vestibular system (minocyline), photosensitivity |
| Toxicity: Tetracyclines | Hepatotoxic at high doses, Nephotoxic in patient with renal impairment |
| Nursing Considerations: Tetracyclines | do not admin with Ca+, antacids, FE+ or MOM. patient education regarding protection from sun and food interactions, IV form should only be used when oral cannot due to increased GI side effects, monitor IV sites for redness, avoid in pregnancy |
| Mechanism of Action: Clindamycin | inhibits protein synthesis by binding exclusively to 50S subunit |
| Bacteriostatic vs. Bactericidal: Clindamycin | typically bacteriostatic, but maybe bactericidal in high concentrations against susceptible organisms |
| Side Effects: Clindamycin | PSEUDOMEMBRANOUS COLITIS, nausea, vomiting, rashes, blood dyscrasias, allergic reaction |
| Toxicity: Clindamycin | hepatoxicity (rare) |
| Nursing Considerations: Clindamycin | monitor for diarrhea, instruct patient to report loose stools, monitor LFTs and blood counts, avoid rapid IV admin. |
| Mechanism of Action: Linezolid | inhibitor of protein synthesis |
| Bactericidal vs. bacteriostatic: Linezolid | bacteriostatic |
| General information: Linezolid | trade name Zyvox, new class called oxazolidinones, designed to have activity against MRSA and VRE, FDA approved only for these infections |
| Mechanism of Action: Fluoroquinolones | inhibit bacterial DNA synthesis |
| Route of Elimination: Fluoroquinolones | renal and hepatic |
| Side Effects: Fluoroquinolones | nausea, vomiting, diarrhea, HA, agitation, dizziness, insomnia, hallucinations and seizures (elderly), variable prolongation of QT, achilles tendon rupture, long bones (children), photosensitivity |
| Toxicity: Fluoroquinolones | hepatoxicity |
| Nursing Considerations: Fluoroquinolones | cautionary use in children and pregnant women, monitor for neuro SEs in elderly, do not admin with Zn, Fe, Ca, Al, Mg, antacids, sucralate, or enteral feedings, IV admin over 60 minutes, reduce doses in renal failure |
| Mechanism of Action: Sulfonamides | suppress bacterial growth by inhibiting synthesis of folic acid |
| Bactericidal vs. bacteriostatic: Sulfonamides | bacteriostatic |
| Other info: Sulfonamides | broad spectrum, resistance of many bacteria to sulfonamides, renal excretion |
| Side Effects: Sulfonamides | hypersensitivity (stevens-johnson syndrome), hemolytic anemias (esp in G6PD deficiency), megaloblastic anemias (folate def), kernicterus in infants, photosensitivity |
| Toxicities: Sulfonamides | renal toxicity from crystal formation, contraindicated in pregnancy due to theoretical of folate |
| Nursing Considerations: Sulfonamides | caution in pregnancy, lactation, neonates, alcoholics, malnourished, admin slow IV infusion, allergic reaction, patient teaching avoid sun and maintain fluid intake, monitor for anemias, blood counts |
| Mechanism of Action: Aminoglycosides | multifactorial inhibition of protein synthesis - bind to 30S subunit |
| Bactericidal vs. bacteriostatic: Aminoglycosides | bactericidal |
| Route of elimination: Aminoglycosides | renal excretion |
| Side Effects: Aminoglycosides | allergic reactions, neuromuscular blockade (fatal respiratory distress), blood dyscrasias, neurologic disorders (parasthesias, optic nerve dysfunction) |
| Toxicity: Aminoglycosides | ototoxicity and nephrotoxicity |
| Nursing Considerations: Aminoglycosides | caution in elderly, renal failure, slow IV piggyback, do not mix in solution (esp penicillins), BUN/creatinine levels, monitor for toxicities, peak and trough level 30-60 mins after IV dose, monitor respiratory status, strict I and Os |
| Mechanism of Action: Vancomycin | inhibition of cell wall synthesis. death by lysis. similar to beta lactams. gram positive bacteria only |
| Bacteriostatic vs. bactericidal: Vancomycin | bactericidal (except for enterococcus) |
| Route of elimination: Vancomycin | Renal excretion |
| Side Effects: Vancomycin | Red-Man Syndrome: flushing, pruritis, erthematous rash on face and upper torso, infuse over 60 min, resolves spontaneously. Also, rash, neutropenia, thrombocytopenia, thrombophlebitis |
| Toxity: Vancomycin | Ototoxicity and nephrotoxicity |
| Nursing Considerations: Vancomycin | caution in renal impairment, caution with other ototoxic/nephrotoxic drugs, admin over 60 mins, peak and trough levels, BUN/creatinine/CBC, monitor IV site for redness |
| Mechanism of Action: Rifampin | inhibits RNA synthesis |
| Bactericidal vs. bacteriostatic: Rifampin | Bacteriocidal |
| Primary Uses: Rifampin | TB, leprosy and MRSA |
| Route of metabolism/elimination: Rifampin | primarily hepatic |
| Toxicity: Rifampin | hepatoxic |
| List pertinent antifungal agents | Amphotericin B, azole antifungals, griseofulvin |
| Mechanism of Action: Amphotericin B | increased permeability of fungal cell walls, decreased viability of the microbe |
| Preferred use: Amphotericin B | systemic fungal infections |
| Drug interactions: Amphotericin B | numerous drug interactions and IV incompatibilities (causes precipitates easily) |
| Metabolism/elimination: Amphotericin B | unknown mechanisms - has been found in tissue 1 year after treatment |
| Side Effects: Amphotericin B | infusion reactions, renal toxicities, hypokalemia, bone marrow suppression, phlebitis |
| Nursing Considerations: Amphotericin B | IV admin only, 1st does should be given with caution (most need pre-treatment with benadryl and tylenol), usually give concurrent infusions of IV saline to hydrate kidneys |
| Mechanism of Action: Azole antifungals | inhibits synthesis of ergogesterol in cell membrane |
| Drug interactions: Azole antifungals | potent inhibitor of cytochrome p450 (increases levels of other drugs) |
| Side Effects: Azole antifungals | GI reactions, rash, phlebitis, cardiac suppression and liver failure (itrakonazole), hepatoxicity, visual disturbances, teratogenic (vorikonazole), inhibition of sex hormones (ketokonazole) |
| Definition of Antibiotic | substance produced by a microorganism that in small amounts inhibits the growth of another microbe |
| Uses of Antibiotics | treat active infections, prophylactic use to prevent infections |
| Improper uses of Antibiotics | treatments of infections that cannot be treated, treatment of fever of unknown origin, improper/incomplete dosages/ treatment of abcesses with omission of surgical drainage |
| Definition of Selective Toxicity | ability of a drug to injure a target cell or target organism without injuring other cells or organisms that are in intimate contact with the target |
| How is Selective Toxicity achieved? | differences in cellular chemistry, selectively interfere with microbial processes |
| Antibiotic Resistance | natural resistance, acquired resistance (organism no longer susceptible to drug, serious clinical problem) |
| Mechanisms of Microbial Drug Resistance | microbes increase production of enzymes that inactivate the drug, reduce drug uptake, drug receptor may change and drug cannot bind, microbes synthesize antagonists to drug |
| Nosocomial Infection | infection acquired in the hospital |
| Suprainfection | new infection that appears during the course of treatment for the primary infection |
| Broad Spectrum | effective against many different types of bacteria (both gram negative and gram positive) |
| Narrow Spectrum | effective against a subset of bacteria |
| List of Gram Positive Cocci | staphylococci, S. pneumoniae, viridans streptococci, Enterococcus sp. |
| List of Gram Positive Bacilli | Corynebacterium sp., Listeria monocytogenes, Nocardia sp. |
| List of Gram Negative Cocci | Moraxella catarrhalis, Neisseria gonnorhoeae, Neisseria meningitidis, Haemophilius influenzae |
| List of Gram Positive Bacilli | E. coli, Enterobacter sp., Citrobacter, Klebsiella, Proteus, Serratia, Salmonella, Shigella, Acinetobacter, Helicobacter, pseudomonas aeruginosa |
| Bacteriocidal | lethal to bacteria at clinically achievable serum concentrations |
| Bacteriostatic | slow microbial growth, but do not cause cell death. must work with body defenses (phagocytes) to eliminate bacteria |
| Host factors that Modify Drug Choice, Route, or Dosage | host defenses, site of infection, severity of infection, age, pregnancy, previous allergic reaction, genetic factors, underlying kidney or liver disease |
| Safety Concerns with the Use of Antimicrobials | toxicity, interactions with other medications, hypersensitivity reactions, fetal damage/risk to pregnant women, antibiotic resistance |
| Bacteriostatic Inhibitors of Protein Synthesis | Tetracyclines, Macrolides, Clindamycin, Linezolid |
| Bactericidal Inhibitors of Protein Synthesis | Aminoglycosides (gentamycin, tobramycin, amikacin) |
| Aging-related organ decline can change: | drug absorption, distribution, metabolism, and especially excretion |
| Factors in the increase of adverse reactions in the elderly | polypharmacy, severe illness, multiple pathologies, and treatment with dangerous drugs |
| Measures to reduce adverse drug reactions in the elderly | thorough drug hx, accounting for pharmokinetic/pharmodynamic changes in elderly, initiating with low doses, simplest regimen possible, monitoring for drug-drug interactions and iatrogenic illness, avoiding drugs on Beers list |
| Reasons for nonadherence in elderly | expense, side effects, thinking drug unnecessary, dosage too high |
Created by:
rjcrompton
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