Antimicrobials
The most significant statement when teaching strategies to reduce the risk for developing antibiotic-resistant infections?
"Do not skip any prescribed doses of your antibiotics." This is an umbrella answer to the question. Other statements regarding not saving unfinished antibiotics and not stopping medication when you feel better are included under this main statement. If clients do not skip any doses of the antibiotic, they are unable to save any doses for later use, and are not able to stop taking the antibiotics when they feel better.
After teaching a client measures to decrease the risk for antibiotic-resistant infections, which statements made by the client indicate understanding of content?
"I should wash my hands frequently." "I should avoid taking antibiotics to treat the common cold." "I should avoid taking antibiotics without asking the primary health care provider." Hand washing is necessary to prevent infections. Antibiotics are effective against bacterial infections but not viruses, which cause the common cold. Clients should take antibiotics only after asking the primary health care provider.
Generic names for Cephalosporins begin with
-cef
Generic Penicillin Name Ends in
-cillin
Generic names for Tetracycline ends in
-cycline
Erythromycin Nursing Implications
Common alternative to PCN if pt allergic Take on empty stomach Course of therapy may be shorter than other antibiotics using new macrolides There are a number of drug-drug interactions Can prolong QT interval Use if allergic to b-lactam
Name a prototype for Tetracycline
Doxycycline
Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis. Which instruction would the nurse include when providing medicaiton teaching?
Drink eight to ten glasses of water daily. A urinary output of at least 1500 mL daily should be maintained to prevent crystalluria.
Nystatin S/E
Hives or rash
Acyclovir MOA
Impairs viral replication
Oseltamivir MOA
Impairs viral replication
What are hypersensitivity reactions?
Laryngeal edema, bronchoconstriction, hypotension
Name a (Fluro)Quinolones prototype
Levofloxacin
Name 2 drugs that interfere with bacterial DNA replication
Levofloxacin and Metronidazole
Acyclovir and Oseltamivir Patient Teaching
May give with food Maintain adequate fluid intake
Name a prototype for Nitroimidazole
Metronidazole
A client currently taking medication for bacterial vaginosis complains of an unpleasant metallic taste, nausea, and vomiting. Which medication would be responsible for this condition?
Metronidazole Metronidazole is used to treat bacterial vaginosis. Common side effects include unpleasant metallic taste in the mouth, furry tongue, CNS reactions, and urinary tract disturbances.
Which 2 drugs can treat AAPMC?
Metronidazole and Vancomycin
Gentamycin Nursing Implications
Most poorly absorbed in the GI tract, so given IV/IM Monitor peak/trough levels to prevent nephro/oto-toxicity Assess for hearing changes Monitor RFTs Bactericidal
Antitubercular Nursing Implications
No alcohol Do not miss a dose Medication compliance is important Monthly clinic visits to monitor LFTs and RFTs Up to 24 months of treatment needed Interferes with BCP. Use alternative precautions.
Can a patient prescribed an anti-tubercular continue to drink alcohol while on this medication?
No.
A child is prescribed an intravenous (IV) antibiotic. Within 10 minutes of the initial infusion, the child's face and neck are flushed but the remainder of the body is unchanged. The nurse reviews the child's record. Which action would the nurse take next?
Notify the primary health care provider after stopping the infusion. The child is exhibiting a common vancomycin reaction called Red Man Syndrome. Flushing usually begins in the chest area and spreads upward to the neck and face, usually during the first 15 minutes of administration. This reaction is caused by a release of histamine, which results in vasodilation. If not treated, the syndrome can lead to circulatory collapse. The appropriate response is to stop the infusion and notify the primary health care provider.
Which effect has resulted in the avoidance of tetracycline use in children under 8 years old?
Permanent tooth discoloration Tetracycline use in children under the age of 8 years has been discontinued because it causes permanent tooth discoloration.
Chloroquine MOA
Prevention and treatment of malaria Used for travel to Mexico, Central America, and Caribbean only
Which medication might damage the cartilage of children?
Quinolone antibiotics Quinolone antibiotics are contraindicated during the growing years because they can cause permanent or destructive arthropathy.
Name a prototype for Antimetabolites
Sulfamethoxazole
Sulfamethoxazole Nursing Implications
Take with at least 2L Fluid/day to reduce risk of crystalluria - unless contraindicated Avoid sunlight and tanning beds Interferes with BCP. Use alternative precautions. Take with food or milk to reduce GI upset. Patients may have cross sensitivity to other sulfonamide drugs such as thiazide diuretics and oral hypoglycemics.
How is Nystatin administered?
Topical or rinse/spit/swallow
When a client with a health care-acquired respiratory tract infection asks the nurse what this means, what kind of response will the nurse give?
Your infection occurred because of exposure to a health care facility.
A pregnant adolescent reports painful vesicles in the labia minora. The adolescent is diagnosed with a herpes simplex virus infection. Which medication would the nurse expect the primary health care provider to prescribe?
Acyclovir
What are 2 Antivirals?
Acyclovir and oseltamivir
Ceftriaxone is prescribed for a client's infection. For which potential adverse effect would the nurse monitor the client?
Allergic reaction. Rash, urticaria, pruritus, angioedema, and other S/S of an allergic reaction response may occur a few days after therapy is instituted.
What are 2 Antifungal prototypes?
Amphotericin B and Nystatin
Patients who are taking b-lactams are at high risk for what?
Antibacterial-Associated Pseudomembranous Colitis especially if they are a carrier for C. diff. Monitor patient for diarrhea, weight loss, and a darkened tongue.
Sulfamethoxazole MOA
Antimetabolite
Chloroquine Nursing Implications
Begin treatment 2 weeks before travel and continue for 8 weeks after
Rifampin Patient Teaching
Best taken on an empty stomach No use of contact lenses (orange-red/brown tears and urine)
A client with an infection is receiving vancomycin. Which type of elevated laboratory blood test would the nurse be monitoring for and reporting on?
Blood Urea Nitrogen (BUN) Vancomycin is a nephrotoxic medication. An elevated BUN can be an early sign of toxicity.
Amphotericin B S/E
"Shake and Bake" Most Common: N/V/D Hypotension Chest pain Nephrotoxicity Neurotoxicity Less Common: Chills Fever
Sulfamethoxazole S/E
"Sulfa Rash" N/V/D Photosensitivity Crystalluria Nephrotoxic Rare: Stevens-Johnson Syndrome
Amphotericin B Nursing Implications
Can pre-medicate to prevent hypersensitivity rxns: Aspirin, antipyretics, antihistamines, antiemetics Given IV or Topically May take weeks-months of therapy
Nystatin MOA
Candidas infections
Antimalarial Prototype
Chloroquine
Name a prototype for Macrolides
Erythromycin
Rifampin S/E
Flu-like symptoms Leukopenia (decrease in WBC)
Acyclovir and Oseltamivir S/E
GI Side Effects Crystalluria Seizures Confusion
Name a prototype for Aminoglycosides
Gentamycin
Use of which medication would the nurse identify as a potential risk for hearing impairment in a child?
Gentamycin Gentamycin can be ototoxic because of its effects on the eighth cranial nerve.
Which 2 antimicrobial prototypes require peak/trough levels?
Gentamycin and Vancomycin
How is amphotericin B administered?
Given IV or Topically
Acyclovir and Oseltamivir Nursing Implications
Influenza Considerations: Begin at first symptoms within first 48 hours Herpes Considerations: Begin at first sign of outbreak
Doxycycline MOA
Inhibit protein synthesis
Which MOA applies to penicillin?
Inhibits cell wall synthesis
Gentamycin MOA
Inhibits protein synthesis
Levofloxacin MOA
Interferes with DNA replication
Metronidazole MOA
Interferes with DNA replication
What are two antituberculars?
Isoniazid and Rifampin
What kind of mouth infection would the nurse anticipate administering nystatin as an oral suspension?
Moniliasis Moniliasis is a fungal infection caused by Candida albicans. Nystatin is an antifungal medication used to treat fungal infections.
Vancomycin Nursing Implications
Oral treatment for AAPMC if Metronidazole is ineffective If given IV should be infused over 60 minutes Monitor IV site closely Must monitor blood peak/trough levels to ensure therapeutic levels and prevent toxicity 2L fluids/24 hour to ensure adequate hydration if not contraindicated to prevent nephrotoxicity Monitor I&O
Isoniazid Patient Teaching
Take 1 hour before or 2 hours after meal (need to take on empty stomach) Vitamin B6 supplements will help decrease numbness and tingling
After several days of intravenous (IV) therapy for chloroquine-resistant malaria, the health care provider replaces the IV medication with oral quinine, 2 g per day in divided doses. The nurse advises the client to take this medication immediately after meals for which purposes?
To minimize gastric irritation Quinine administered orally can cause gastric irritation, resulting in nausea and vomiting. Administration of the medication immediately after meals minimizes its irritating effect.
What are common allergic reactions to Sulfamethoxazole, Erythromycin, Gentamycin, and Doxycycline?
Urticaria (hives) Pruritus (itch) Edema
If Metronidazole is ineffective in treating AAPMC, what other antibacterial medication can potentially be prescribed?
Vancomycin
Name a prototype for Tricyclic Glycopeptides
Vancomycin
Which antibacterial drug is used to treat MRSA?
Vancomycin
What are nursing assessments for Amphotericin B?
Vitals (BP & P) Fever Chills Headache Anorexia N/V IV site Seizures Parasthesias Renal function
Is Amphotericin B toxic?
Yes. 80% of patients have some sort of renal function issue.
A client is admitted with cellulitus of the left leg and a temp of 103 degrees F. The primary health care provider prescribes intravenous (IV) antibiotics. Which action is the priority before administering the antibiotics?
Determine the client's allergies.
Cephalosporin MOA
inhibit cell wall synthesis
Penicillin MOA
inhibits cell wall synthesis
Vancomycin MOA
inhibits cell wall synthesis
Erythromycin MOA
inhibits protein synthesis
Generic names for (Fluro)Quinolones end in
-oxacin or -floxacin
Chloroquine S/E
N/V/D Abdominal Pain Anorexia
Metronidazole S/E
N/V/D Abdominal pain Dizziness Metallic taste Toxic with alcohol Superinfection Peripheral neuropathy CNS toxicity Seizures Pancreatitis
Levofloxacin S/E
N/V/D Abdominal pain Tendonitis/rupture Dizziness Insominia Photosensitivity Seizures Crystalluria
Penicillin S/E
N/V/D Abdominal pain relieved with food
Erythromycin S/E
N/V/D At high doses: hepatotoxicity and ototoxicity
Doxycycline S/E
N/V/D Dizziness Tooth discoloration in 8 y.o. and younger Photosensitivity Less common: Superinfection AAPMC
Cephalosporin S/E
N/V/D Rash Rare: anaphylaxis Superinfection risk when used for extended period of time
Metronidazole Nursing Implications
Treats AAPMC Do not take with alcohol or OTC meds that contain alcohol (intensifies S/E, alters BP, causes liver damage, and tingling sensation) Monitor for candidas Monitor neurovascular status
True/False: A patient who is allergic to penicillin will also be likely allergic to cephalosporins.
True
An older client asks, "How do I know that the medications that I take are safe?" How could the nurse respond?
"Ask your health care provider how and when you should be taking your medication." "Check the name, dose, and instructions about administration of medications each time before leaving the pharmacy." "Inform your health care provider of the OTC medications, recreational drugs, and amount of alcohol you ingest." If unsure about any information, the client should be encouraged to ask for further instructions and more information. A client needs to be proactive and should check all aspects of the prescription with the pharmacist before leaving the pharmacy. A pharmacist may have permission to substitute a generic form of the medication or may change the number of pills that deliver the prescribed dose, both of which can confuse the client.
Rifampin Class and MOA
Antitubercular Inhibits bacterial RNA synthesis
Isoniazid Class and MOA
Antitubercular Inhibits cell wall synthesis
If a patient is allergic to b-lactams, what is an alternative antibiotic they can be potentially be prescribed?
Erythromycin
Gentamycin S/E
Ototoxicity Nephrotoxicity
What are 4 common mechanisms of Antimicrobials?
1. Interference with cell wall synthesis 2. Disruption of bacterial metabolic processes (antimetabolites) 3. Interference with DNA replication (quinolones) 4. Interference with Protein synthesis (macrolides, aminoglycosides, tetracyclines)
PCN Nursing Implications and Teaching
1. Oral PCN may be taken with or without food. 2. Shake suspensions well before measuring doses. 3. Take extended release on empty stomach. 4. Rotate injection sites in IM. 5. Monitor patients for 30 minuters after injection. 6. Monitor all patients for hypersensitivity rxns. 7. May interfere with BCP. Use alternative precautions.
Doxycycline Nursing Implications
Do NOT give to children 8 y.o. and younger Avoid sunlight and tanning beds Interferes with BCP. Use alternative precaution. Do NOT take with dairy, calcium, or antacids. Monitor for candidas. Discard outdated drug - becomes toxic as they decompose.
Levofloxacin Nursing Implications
Do NOT take with antacids or calcium fortified orange juice (decreases absorption) Do NOT use for children 18 y.o. or younger Avoid sunlight and tanning beds Take with full glass of water Increase fluid intake (drugs become insoluble when the pH >6.8 causing urine to crystalize - crystalluria)
Isoniazid S/E
Drowsiness Blurred vision Photosensitivity Neuropathy Seizures
The nurse is caring for a client who is receiving intermittent intravenous piggyback (IVPG) doses of vancomycin every 12 hours. The primary health care provider prescribes trough levels of the antibiotic. The nurse schedules the blood sample to be obtained at which time?
Just before the medication is administered.
Which nursing interventions would help prevent medication errors in pediatrics?
Knowing information about the medication Avoiding verbal telephone orders Checking the medication label and client's information three times before giving the medication Using authoritative resources as references The nurse would know all about the information of the medication (such as the action, dosage, route, uses, and adverse effects) to avoid medication errors. The nurse would avoid the use of verbal telephone orders because of the high risk of miscommunication. The nurse would check the medication label and the client's information three times before administering the medication. The nurse would use authoritative resources such as the medication handbooks as a reference. The nurse woudl avoid the use of abbreviations and acronyms because they lead to confusion.
Cephalosporin Nursing Implications
Orals with food to decrease GI upset Monitor for candidas Avoid alcohol or OTC meds containing alcohol (alcohol increases the amount of acetaldehyde in blood causing a reaction: N/V, HA, decreased BP, increased HR, SOB, flushing) Nephrotoxicity with LG doses
Vancomycin S/E
Ototoxicity Nephrotoxicity "Red Man Syndrome" - decreased BP, flushing of neck and face