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Anti-infective l
tx of bacteria, virus, fungus, tb
| Question | Answer |
|---|---|
| Antibiotic | having pertaining to the ability to desroy or interfere with the development of a living organism |
| Antiseptic | chemical that inhibits the growth and reproduction of microorganisms without killing them |
| bactericidal | kills bacteria |
| bacteriostatic | inhibits growth |
| colonization | estabishment and growth of microorganisms on skin, open wounds or mucous membranes or in secretions without causing adverse clinica signs or symptoms |
| definitive therapy | administration of drugs based on known results of culture and sensitivity testing identifying the pathogen causing infection |
| disinfectant | a chemical applied to nonliving objects to kill micro organisms |
| empiric therapy | the administration of drug based on the praticioner s judcgment of the most likelly causing pathogen |
| prophylactic antibiiotic therapy | antibiotics taken before anticipataed exposure in an effort to prevent the develoopment of an infection |
| Subtherapeutic | referrring to antibiotic treatment that is ineffective |
| superinfection | an infection resulting from overgrowth of an organism not susceptivle t the antibiotic used |
| synergistic effect | drug interaction in which the bacterial killing effect of two antibiotics given together is greater thatn the sum of the individual effects of the same drugs given alone |
| gram positive- gram negative | significant in guiding choice of antibiotic therapy |
| Gram positive, purple stain | thick cell wall outer capsule |
| Gram negative, red stain | complex cell wal structure, more difficult to treat |
| Antibiotics categories | sulfonamides, penicicillins, cephalosporings, macrolides, quinolones, aminoglycosides, tetracyclines |
| Antibiotic mechanism of actions | interference with bacterial cell wall synthesis, interference with protein synthesis, interference with DNA and RNA replication, Antimetabolite action |
| Antimetabolite action | a drug that is similar enough to a natural chemical to participate in a normal biochemical reactin in cells but different enough to interfere with the normal division andfunctions of cells. So named because the drug inhibits a normal metabolic process |
| obtain a C&S because: | to reduce drug resistance strains and optimize drug selection |
| other labs to monitor | BUN Creatinine- levels of creatinine and urea are high due to failing kidneys. |
| If patient is on long term therapy: | eval monthly AST, ALT, CBC, HCT, and Bilirubin |
| AST | test for liver damage, low values are good , high values are not |
| ALT | alanine aminotransferase- damage or diseased test, low levels are normal in blood, when liver is damaged or diseased it releases more ALT's into blood stream |
| Bilirubin | checked to eval liver damage from antibiotics |
| antiinfectives are administered "around the clock" | to maintain therapeutic serum drug levels, meaning it should be evenly spaced through 24 hour cycles |
| pt teaching | take med around the clock and complete the course |
| signs of super infection | black, furry overgrowth on the tongue, vaginal itching or discharge(candidiasis), loose foul smelling stools (c-dif), allergic reaction |
| notify if | fever diarrhea, pus, blood, or mucus in stool |
| Sulfonamides | bacteriostatic- allows pts immune system to fight off existing bacteria without being overwhelmed |
| Sulfo are broad specrum antibiotic | act on both gram positive and gram negative bacteria |
| eliminatec through kidneys and are contraindicated in | KDA, pregnant women at term, and infants less than 2 mos. old |
| adverse effects of Sulfo | Steven-Johnson syndrome, photosensitivity, GI upse6t, hepatotoxicity, pancratitis, aplastic anemia, hemolytic anemia, thrombocytopenia |
| Interactions | potentiate hypoglycemic effects of sulfonylureas in diabetic treatment, potentiate anticoagulant effects of warfarin, leadint to possible hemorrhage, potentiate effects of phenytoin, reduce the efficacy of oral contracptives, |
| examples of sulfo | Bactrim, septra, |
| adverse effects | rash, pruritis, hives, steven-Johnson, anaphuylacti c reaction, GI upset, abdominal pain, taste alterations, oral candidiasis, anemia, granulocytopenia, increased bleeding times, bone marrow depression, |
| interactions | reduce efficacy of oral contraceptives, potentiate antocagulant effects of warfarin, rifampin inhibits the ation of PC N, probenecid (gout med) prolongs the effects of PCN, |
| example | Natural PCN_PCN G, PCN V; Pinicillinase resistant- Nafcillin; Aminopencillins-Ampicillin, Amoxicillin; extended Spectrum- Piperacillin |
| Cephalosporing | Bactericidal antibiotic, broad spectrum, eliminated through kidneys, Contraindications the same as for PCN, |
| Adverse effects, | Rash, pruritis, hives, steven-Johnson syndrome, Anaphylactic reaction, GI upset, abdominal pain, taste alterations, oral candidiasis, |
| Interactions | reduce the efficacy of oral contraceptives, potentiate effects of alcohol intake, antacids and iron decrease effectiveness of cephlosporins, probenecid (gout med) prol9ongs the effects of cephalosporins |
| Examples | Cefazolin-Ancef, Kefzol; Ceftriaxone-Rocephin |
| Macrolides | Bacteriostatic, broad spectrum, metabolized in liver, contraindicated in KDA, |
| Adverse effects | Rash, pruritis, urticaria, thrombophlebitis at IV site, chest pain, palpitations, prolonged QT interval (rare), GI upset, hepatotoxicity, pancreatitis, Headache, vertigo, tinnitus, hearing loss |
| Interactions | Macrolides potentiate the effectsof carbamazepine (tegretol), cyclosporine, digoxin, theophyllline and may cause toxicity, potentiate anticoagulant effects of warfanin, contraindicated with meds prolonging QT interval, contraceptive drag |
| Example | Erythromycin-jEmycin, EES; Clarithromycin-Biaxin; Azithromycin-Zithromax |
| Quinolones | Flruoroquinolones, bactericidal, broad spectrum, leminated through kidneys (BUN & creatinine), Contraindicatied in KDA and prepubescent chilldren (cartilage development degen) |
| Adverse effects | Tendonitis, rash, pruritus, urticaria, photosensitivty rxn, flushing, GI upset, dysphagia, constiption, increase in AST and ALT, Aplastic anemia, hemolytic anemia, thrmbcytopenia, Fvr, chls, blrrd vision,tinnitus,prolon QT in class Ia, III antidysrhthmics |
| Interactions | no milk, antacids, iron, zinc salts,(due to reduced oral absorption), potentiate anticagvulant effctsof warfarin, take Ca, Mg prep one hr before or one hour after Quinolones, contraceptive drag, Tegretol recuces renal excrtion |
| Example | Ciprofloxacin-Cipro; Levofloxacin- Levaquin |
| Aminoglycosides | bactericidal, gram neg and specific bram positive cocci, eliminated through kidneys, highly nephrotoxic, ototoxic, caution in renal impairment, contraindicated in KDA, can cross placental barrier and cause fetal harm |
| Adverse effects | will see urinary casts, protein uria, increased BUN and serum cratinine, ototoxic not reversible, dose dependent, dizziness, tinnitus, rash, fever, h/a, paresthesia |
| Interactions | risk for nephrotoxicty in increase with nephrotoxic ddrugs aka vancomycin, amphotericin B, Risk for ototoxicy is increase with loop diuretics, potentiate anticagulant effects of warfarin, neuromusculr blocking ddrugs prolong duration of blocking action |
| example | Amikacin-Amikin;Gentamicin-Gramycin; Tobramycin-Nebcin |
| Tetracyclines | Bacteriostatic, broad spectrum, eliminated throughn kidneys and liver, contraindicated in KDA, pregnancy, peds, (tooth discolor) |
| adverse effects | discoloration and hypoplasia of tooth enamel in children/infants, retarded fetal skeltal develpment if taken during pregnancy, rash, photosensiv rxn (Demeclocycline) GI upset, hepatotoxic, pancreatits, aplastic anemia, hemolytic anemia, thrombocytopenia |
| interactions | no milk, antacics, iron salts (oral absorpytion drug reduced; potentiate anticoagulant effects of warfarin, reduce the efficacy of oral contraceptives |
| Examle | Demecolcycline-Declomycin; Doxycycline-Dryx |
| Before starting cl on antivacterial therapy, nurse should assess what findings? | hypersensitivity- penicillins associated with serious hypersensitivity rxn, a complete drug history helps id possible hypersensitvity or cross sensitivty |
| Antifungals | infections caused by fungus are MYCOSIS, (yeast-single cell fungi, molds-multicellular fungi) mild - life threatening ( athlete's foot-life threatening systemic fungal infections) inhaled, ingested, or cutaneous |
| Categories | Superficial/topical, sytemic, terbinafine- Lamisil |
| Mechanism of action | Interference with cell replication, cell wall structure, fungistatic, fungicidal, newer antifungals have fewer/less serious S/E, cultures may be obtained before treatment intiated, |
| superficial or topical antifungal ddrugs | Terbinafine- lamisil-interferes with cell wall synthesis, treats-tinea pedia, cruris, corporis, onychomycoses of fingernails/toenails, contraindicated KDA/hypersensitivity/liver diseas, alcoholism, opical or PO |
| adverse effects of Terbinifine | H/A, dizziness, GI upset, RAsh, pruritis, Alopecia, fatigue, |
| Interactions of terbinifine | Rare given with anohter nephrotoxic drug increased nephrotoxicity |
| Systemic antifundal drugs | Amphotericin B-drug- choice for severe systemic fungal infections, oldest antifungal drug and has major adverse effects, metabolized in liver, contraindicated in Known Hypersensitivity, renal impairment, bone marrow suppression, injectable, oral,topical |
| adverse effects | fever, chills, malaise, h/a; tachycardia, hypotension; GIupset; joint and muscle pain; premedication with antiemetics, antihistamines, antipyretics, corticosterioids, minimize infusion related reactions, reduced by extending infusion times (slower) |
| Interactions | give with digoxin, pmphotericin induced hypokalemia my increase the potential digitalis toxicity, given with nefphrotoxics increase nephrotoxicity, given with thiazide diuretic will increase potential for hypokalemia |
| fluconazole (Diflucan) | excellent coverage against many fungi with less adverse effects, metabolized in liver, contraindicated in known hypersensitivity, caution with renal/hepato impaired, injectable or oral, |
| adverse effects | GI upset, increasedliver enzymelevels, dizziness |
| Interactions | cyclosporine, phytoin (dilantin) or immunosuppressant there is increased plasma conscentration of both drugs, potentiates anticoagulant effects of warfarin,given with oral hypoglycemic there is reduced metabolism of hypoglycemic drugs |
| Nursing Implications | Asess VS/labs before and throughout: CBC, K, Na, CA, Mg, Liver function, BUN (>40mg/dl), creatinie (>3mg/dl) indicate reanal toxicity, AST, ALT, alk phos, bilirubin indicated hepatotoxicity, monitor weight for renal involvement, |
| weight monitoring | 2lbs or more in 24 hrs, 5lbs or more in one week, |
| administration by any route | always use a IV infusion pump ( imf medication is given IV) monitor VS, every 15 min, cardiac dysrythmias, resp difficulty, pain, paresthesia, IV site for phlebitis, I/O's |
| Pt teaching | med form, full course of therapy, report skin irritation/lack of therapeutic response |
| Eval | s/s infection, length of time for complete resolution depends on organism and site of infection, deep seated fungal ingections may require prolonged therapy (weeks-months), recurrent fungal infections may be a sign of serious systemic illness. |
| a cl with a fungal infectin is taking diflucan, the nurse explains although this drug is generally well tolerated, possible adverse effects include which of the followig? | Gastro intestinal upset-fluconazole is well tolerated. adverse effects include h/a, gi upset, and dizziness |
| Viruses | small microorganisms that can only reproduce or replicate inside a cell of a host which can be human, animal or plant, entering via inhalation, ingestion, transplacentally or inoculation through skin or mucous membrane, |
| inoculation route includes(sex, blood trnfx) | inoculationroute (sex, blood trnfx, use of shared needles, organ transplantation, or bites of animal, insect, spider, human etc) |
| where do classes of viruses replicate? | host DNA or RNA |
| Immunoglobulins | concentrated antibodies that attach and destroy viruses |
| interferons | simulate the body's immune system to kill viruses |
| Antiviral | drugs used to treat non HIV viral infections, block the synthesis of new viral genomes-interferes iwth replication, contraicnidation in KDA, pregnant, lactating, peds |
| adverse effects | drug dependent, |
| Acyclovir S/E | GI upset, h/a, transient, burning when used topically |
| Ribavirin(Viraxzole)- used to treat respiratory syncctial virus | S/E include rash , conjunctivitis, anemia, bronchospasms |
| interactions | acyclovir may have additive CNS and nephrotoxicity with drugs causing similar adverse reactions. ; ribavirin- increased risk of hepatotoxicity and lactic acidosis if given with another antiviral drug |
| Nursing Implicaitons of Antiviral drugs | ... |
| Parasite, | organism that lives in or on another organism without contributing to the surviva or well being of the host |
| helminthiasis | invasion of the body by worms (helminthes) |
| malaria: | infectioous disease cause by a protozoan and transmitted to humans through the bite of an infected mosquito |
| Amebiasis | invasion of the body by ameba |
| Malaria- | protozoal disease with worldwide death rate of 1-2 million per year |
| plasmodium protozoa- | causative of malaria, four species of, life cycle has two stages-sexual inside mosquito asexual inside host liver and erythrocytes |
| Antimalarial drugs | only affect the asexual lifecycle, and are dependent on the species and its susesceptibility, dosing instructions depend on whether the drug is use to treat thedsiease or for prophylaxis. |
| mechanism of action | interferes with parasite protein synthesis, parasites ability to use erythrocyte hemoglobin, |
| contraindication | KDA, caution in pregnant women, tinnitus, renal, hepatic, hematologic dysfunction |
| Adverse effects | chloroquine,-GI upset, diarrhea, abd distress, dizziness, anxiety h/a, reduced sizure threshold, alopecia, rash pruritus |
| Mefloquine adverse effects | GI upset abd pain, dizziness, h/a, insomina, cvisual disturbances, anxiety, depression, psychosis Primaquine-gi upset abd distress, h/a, pruritus, ddark urin, hemolytic anemia |
| Interactions; | Chloroquine-if given with anti-seizure meds will result in the loss of seizure control, |
| Mefloqquine interactns | with beta blockers, calcium channel blockers or quinidine will increase the risk of dysrhythmias, seizures and cardiac arrest |
| primaquine interaactions | if given with other hemolytic crugs will increas risk for myelotoxic effects(muscle weaknes) |
| implementation | start treatment two weeks prior to exposure an continue for 4-6 weeks after leaving malarious area, administer with milk, or meals t0 minimize GI distress, taablets may be crushed |
| pt teaching | take med exactly as directed and continue full course of therapy, methods of minimizing exposure to mosquitoes ( use repellent, wear long-sleeved shirt and long trousers, use screen or netting) |
| antihelmintic drugs that affect parasitic helminthic infections | worldwide problem most common in undelveloped countries with poor sanitary conditions, causative agents reside in intestines of host but can migrate to other tissue, |
| causative agens include | platyhelminthes-flatworms, cestodes-tapeworms, trematodes-flukes, nematodes-roundwormds |
| antihelmintic drugs are specific in their action and require that the causative work be identified before treatment is begun | true |
| Contraindications | KDA, caution with liver disease, seizure disorder or pregnant women, |
| adverse effects | GI distress, abd discomfort, specific effects are drug dependant |
| Nursing Implications | assessment: stools during entire treatment; specimen sent to lab while warm and 1-3 weeks post treatment. Diarrhea during expulsion of worms (avoid contamination with pt feces) Lab ; AST, ALT, alk phos, BUN CBC druing treatment |
| implementation | may be crushed, chewed, swallowd whole, mixed with food, may take by mouth after meals to avoid GI symptoms, |
| pt teaching | prevent einections and infection of others in the household, change and launder bed linens, and undergarments daily, separately from the other members of the family. Daily bathing is recommended (shower) disinfect shower after use, disinfect toilet daily |
| Eval | expulsion of worms, three negative stool cultures ater completion of treatment. |
Created by:
redhawk101
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