Pharmacology Chapter 9: Antibiotics, Pharmacology Test 3 Review, Pharmacology Test 3, Pharm Exam 4 - Antibiotics / Antiinfectives / TB

Anti-Protozoals (2)

-Anti-Malarials (Quinine Chloroquine) -Other Anti-Protozoals (Atovaquone Metronidazole Pentamidine Tinidazole Benznidazole 9)

Antifungals (5)

-Polyene antibiotics (amphotericin B & nystatin) -systemic azoles (Fluconazole (prototype systemic anti-fungal), ketoconazole, miconazole, clotrimaxole, itraconazole) -topical azoles -Echinocandans (Anidulafungin, caspofungin, micafungin) -Other Anti-Fungals/Anti-Parasitics (pediculosis, lice, scabies) Flucytosine Griseoulvin Nystatin Permethrin Malathion Lindane)

how many rings do monobactams have

1 ring-narrow

client instructions for chloroquine (Aralen)

1, wearing sunglasses may help minimize visual effects 2. report any vision changes to provider 3. take just before or following meal to minimize GI effects

Cephalosporin drugs

1. 1st-4th generation 2. cephalexin 3. cefazolin 4. cefexitin 5. rocephin

Interactions of metronidazole

1. Alcohol causes a disulfiram-type reaction. 2. Citalopram (Celexa), ritonavir (Norvir), IV nitroglycerin, sulfamethoxazole, or trimethoprim may also cause disulfiram-type reactions. 3. Phenobarbital decreases blood levels. 4. Metronidazole increases lithium levels. 5. Fluorouracil and azathioprine may cause temporary neutropenia and increase risk for infection. 6. Disulfiram (Antabuse) may cause a psychotic reaction. 7. Multiple solution incompatibilities with IV form.

interactions with isoniazid (INH)

1. Alcohol increases the risk for toxicity and adverse reactions. 2. Disulfiram (Antabuse) may cause psychosis or ataxia. 3. Isoniazid with phenytoin may cause phenytoin toxicity. 4. Antacids containing aluminum (Amphojel, Maalox, Mylanta) decrease absorption. 5. Two other TB drugs, ethionamide and cycloserine, may increase CNS adverse symptoms.

contraindications for fluroquinolones (ciprofloxacin- Cipro)

1. Allergy to any fluoroquinolone 2. Tendon pain 3. Myasthenia gravis

contraindications of First generation cephalosporins (cephalexin-Keflex)

1. Allergy to cephalosporin antibiotics 2. Allergy to penicillin (possible cross-sensitivity) • Carnitine deficiency or milk protein allergy: cefditoren (Spectracef) only 3. Any alcohol use causes a disulfiram-like reaction: cefotetan (Cefotan) only

Aminoglycosides drugs

1. Amikacin 2. Gentamicin 3. Kanamycin 4. Neomycin 5. Streptomycin 6 Tobramycin

interactions of fluroquinolones (ciprofloxacin- Cipro)

1. Antacids, iron preparations, calcium (including dairy products), and sucralfate (Carafate) decrease oral absorption. 2. Increases theophylline levels and the risk for CNS symptoms. 3. Increases warfarin (Coumadin) levels. 4. Concurrent use of erythromycin, quinidine, some antipsychotics, and tricyclic antidepressants can increase the risk for torsade de pointes in those susceptible 5. Increased hypoglycemia may occur when taken concurrently with antidiabetic medication.

administration of monobactams (aztreonam-Azactam)

1. Available IM, IV, and for inhalation. 2. Administer IM injections into large muscle and rotate sites. 3. For IV, give as a slow bolus or infusion. Follow recommendations for dilution and rate. 4. Inhalation - Administer three times per day for 28 days

administration of isoniazid (INH)

1. Available as tablets and oral syrup. Give tablets in combination with rifampin. 2. Give IM dose in large muscle mass; rotate sites. 3. If IM form contains crystals, warm it to room temperature before using. 4. Give isoniazid with one or more other drugs for active TB to prevent resistance. 5. Give isoniazid by itself daily for latent TB (6- to 9-month treatment).

administration of macrolides (erythromycin)

1. Available in four forms: • Erythromycin base: tablets, capsules, topical, and ophthalmic ointment • Erythromycin stearate: tablets • Erythromycin ethylsuccinate (EES): tablets • Erythromycin lactobionate: IV form 2. Give erythromycin base and erythromycin stearate on an empty stomach 1 hr before or 2 hr after a meal for best absorption; give with 8 oz. of water. 3. If GI symptoms occur, may give with food. 4. Give EES enteric-coated forms of erythromycin with or without meals. 5. For IV form, follow dilution and rate recommendations to prevent thrombophlebitis.

macrolides/ ketolides drugs

1. Azithromycin 2. Clarithromycin 3. Erythromycin 4. Vancomycin

what are some drugs that interact with antimycobacterials

1. BCP 2. warfarin

what to monitor for in Amphotericin B

1. CBC-RBR/HCT (anemia) 2. bone marrow suppression 3. BUN 4. creatinine 5. I&O

Therapeutic uses for First generation cephalosporins (cephalexin-Keflex)

1. Cephalexin is a first-generation cephalosporin that treats infections caused by gram-positive cocci. 2. Subsequent generations of cephalosporins (drugs from the second to fifth generation) become: - more active against gram-negative bacteria. -more resistant to beta-lactamase (gram-positive) bacteria. -more able to penetrate cerebrospinal fluid to treat infections, such as meningitis

who is the Isoniazid (INH) and Rifapentine (RPT) regimen not recommended in

1. Children younger than 2 years old, 2. People with HIV/AIDS who are taking antiretroviral treatment, 3. People presumed to be infected with INH or RIF-resistant M. tuberculosis 4. Pregnant women or women expecting to become pregnant within the 12-week regimen.

Fluoroquinolones drugs

1. Ciprofloxacin 2. Gatifloxacin 3. Levofloxacin 4. Moxifloxacin 5. Norfloxacin 6. Ofloxacin

miscellaneous antibiotic drugs

1. Clindamycin 2. tigecycline 3. linezolid 4. Vancomycin 5. Chlorampheicol 6. Metronidazole 7. Quinupristin

interactions with macrolides (erythromycin)

1. Decreases blood levels of chloramphenicol and clindamycin antibiotics. 2. Increases blood levels of multiple drugs, including digoxin, warfarin, and theophylline. 3. Drugs that inhibit the enzyme CYP3A4 increase erythromycin levels (verapamil, azole antifungals, protease inhibitors for HIV, diltiazem).

adverse drug reactions for Aminoglycosides (gentamicin)

1. Elevated trough levels of drug (early signs include tinnitus, headache, and vertigo) can cause ototoxicity 2. Nephrotoxicity (polyuria, dilute urine, protein and casts in urine, elevated BUN, creatinine) 3. Ataxia

therapuetic use of macrolides (erythromycin)

1. First-line of treatment for: • Legionnaires' disease • Whooping cough • Acute diphtheria • Treatment of clients who are carriers of diphtheria • Some Chlamydia infections • Certain pneumonias 2. Treats common infections for clients who have a penicillin allergy 3. Ophthalmic ointment prevents eye infections in neonates•

interventions for carbapenems (imipenem- Primaxin)

1. Follow recommendation rate when infusing IV form. 2. Monitor for nausea during infusion; treat with antiemetic. 3. Monitor IV site for redness and swelling during infusion. 4. Assess for and report antibiotic allergy prior to infusing imipenem. 5. Monitor for secondary infections, such as oral candidiasis. 6. Lab testing should include AST, BUN, LDH, as well as testing for bilirubin and increased creatinine

what can occur with antiprotozoal medications when taken with high doses

1. GI 2. HA 3. visual disturbances

What should you monitor with Fluoroquinolones

1. GI 2. altered mental status in older adults 3. achilles tendon rupture

What to watch for when taking macroslides

1. GI 2. heart palpitations/fainting/ hearing loss 3. hypokalemia 4. hypomagnesia

complications of Metronidazole

1. GI discomfort 2. darkening of urine 3. neurotoxicity 4. pseudomembranous colitis

precautions in macrolides (erythromycin)

1. GI disorders 2. liver disorders

adverse drug reactions for First generation cephalosporins (cephalexin-Keflex)

1. GI symptoms (n/d) 2. C-diff may be from superinfection 3. possible cross allergy to penicillin 4. risk for hemorrhage with cefotetean (Cefotan) onlt 5. thrombophlebitis (cephalosporins IV only) 6. Cefotetan (Cefotan): disulfiram like reaction if client takes with alcohol

adverse drug reactions for carbapenems (imipenum- Primaxin)

1. GI symptoms (nausea, vomiting may occur if IV infusion is too rapid) 2. Thrombophlebitis at IV site 3. Possible cross-sensitivity with other antibiotics with beta-lactam ring (penicillins, cephalosporins) 4. Superinfection

adverse drug reactions for macrolides (erythromycin)

1. GI symptoms: nausea, vomiting, abdominal pain, and diarrhea 2. Cardiac symptoms: serious ventricular dysrhythmias can result in death 3. Ototoxicity: hearing loss, vertigo, and tinnitus (able to reverse when treatment ends) 4. Superinfection (C. diff-associated diarrhea, candidiasis)

adverse drug reactions in metronidazole (Flagyl)

1. GI symptoms: nausea/vomiting, diarrhea 2. CNS symptoms: mild to moderate includes headache, vertigo, or ataxia; severe includes seizures or peripheral neuropathy 3. Darkening of urine (harmless effect) • Anorexia, dry mouth

Monitor tetracyclines when...

1. GI upset 2. take with non dairy foods 1 hr before/ 2 hr after meal 3. not given in pregnancy

therapeutic use of Aminoglycosides (gentamicin)

1. Gram-negative aerobic bacilli severe infections (all aminoglycosides). 2. Gentamicin (in combination with another antibiotic) treats severe infections that some gram-positive cocci cause. 3. Topical form for skin and eye infections.

who is considered positive for TB with this response from the TB skin test? an induration of 5 or more millimeters

1. HIV infected people 2. a recent contact with a person with TB 3. persons with fibrotic changes on chest radiograph consistent with prior TB 4. patients with organ transplants 5. persons who are immunosuppressed

precautions of monobactams (azetreonam- Azactam)

1. History of allergy to penicillins or cephalosporins, (although aztreonam has little cross-sensitivity to these antibiotics) 2. Decreased renal function 3. Older adults • Safety not established for pregnancy or lactation 4. Inhalation method not safe for children less than age 7

therapuetic use of metronidazole (Flagyl)

1. IV form treats anaerobic bacterial infections, such as in colorectal, abdominal, and vaginal surgeries. 2. Oral form treats some bacterial infections, which include: • Clostridium difficile-associated diarrhea (CDAD) • bacterial vaginal infections 3. Oral also treats protozoal infections, which include: • intestinal and systemic amebiasis • Giardiasis. • Trichomoniasis in both males and females

Carbapenem medications that are not absorbed in the GI tract

1. Imipenem 2. meropenem

Carbapenems, monobactams drugs

1. Imipnem 2. Metropenem 3. Ertapenem 4. Aztreonam

interactions for monobactams (azetreonam- Azactam)

1. Incompatible in IV solution with multiple other drugs. 2. Probenecid and furosemide can increase blood levels of aztreonam.

adverse drug reactions of isoniazid (INH)

1. Liver damage, including hepatitis, liver failure (especially common in older adults and clients with alcohol use disorder) 2. Peripheral neuropathy: numbness, tingling, pain in the hands or feet (especially common in clients who have diabetes or alcohol use disorder) 3. CNS symptoms: dizziness, ataxia, seizures, psychotic symptoms 4. GI symptoms: nausea/vomiting

adverse reactions to Azoles (Itraconazole)

1. Liver toxicity/GI symptoms (nausea/vomiting, constipation, or diarrhea) 2. Drowsiness, dizziness (decreases during duration of treatment)

What kind of diseases is vacomycin used to treat

1. MRSA 2. CDiff 3. alternative for PCN allergy

advers drug reactions for fluoroquinolones (cipreofloxacin-Cipro)

1. Mild CNS symptoms (dizziness, headache; confusion in older clients) 2. GI symptoms (nausea, vomiting, diarrhea) 3. Achilles tendon rupture (rare), especially in older clients, and clients taking glucocorticoids, and transplant recipients 5. Photosensitivity (sunburn-like reaction) even with indirect sun exposure, sunlamp exposure; may occur despite use of sunscreen 6. Severe adverse reactions include seizures, intracranial pressure, suicidal ideation, hepatotoxicity, anaphylaxis, and Clostridium difficileassociated diarrhea (CDAD)

adverse drug reactions of Fluoroquinolones (ciprofloxacin- Cipro)

1. Mild CNS symptoms (dizziness, headache; confusion in older clients) • GI symptoms (nausea, vomiting, diarrhea) • Achilles tendon rupture (rare), especially in older clients, and clients taking glucocorticoids, and transplant recipients • Photosensitivity (sunburn-like reaction) even with indirect sun exposure, sunlamp exposure; may occur despite use of sunscreen • Severe adverse reactions include seizures, intracranial pressure, suicidal ideation, hepatotoxicity, anaphylaxis, and Clostridium difficileassociated diarrhea (CDAD

interventions for macrolides (erythromycin)

1. Monitor for and report GI reactions (a decrease in the dose may stop symptoms). 2. Monitor for concurrent use of other drugs that increase erythromycin blood levels. 3. Question client about history of prolonged QT. 4. Monitor for and report signs of ototoxicity. 5. Monitor for and report superinfection. 6. Monitor liver function in long-term use

Interventions of isoniazid (INH)

1. Monitor for and report GI symptoms. 2. Work with client to encourage compliance with drug regimen. 3. Monitor levels of liver enzymes throughout therapy. 4. Monitor for and report signs of liver damage. 5. Administer pyridoxine (vitamin B6) as prescribed for neuropathy. 6. Monitor for and report CNS symptoms. 7. Monitor for signs of DRESS (fever, rash, lymphadenopathy, and/or facial swelling, associated with involvement of other organ systems (hepatitis, nephritis, hematologic abnormalities, myocarditis, myositis)

interventions for Aminoglycosides (Gentamicin)

1. Monitor for and report tinnitus and other symptoms of early ototoxicity. 2. Monitor peak and trough blood levels. 3. Monitor laboratory values (BUN, creatinine, urine for protein and casts) and report elevations. 4. Evaluation of eighth cranial nerve with audiometry 5. Monitor I&O

interventions of monobactams (aztreonam- Azactam)

1. Monitor site for redness, swelling, or pain. 2. Change IV sites if inflammation occurs. 3. Monitor for anaphylaxis. 4. Assess bowel function.

interactions of carbapenems (imipenem- Primaxin)

1. Monobactam, penicillin, and cephalosporin antibiotics may decrease the effects of imipenem. 2. Probenecid decreases renal excretion and cyclosporine increases the risk for seizures

therapuetic use of monobactams (aztreonam- Azactam)

1. Narrow-spectrum antibiotic that treats infections caused by gramnegative aerobic bacteria 2. Lower respiratory infections 3. Urinary tract infections 4.Abdominal and gynecologic infections

Urinary agents

1. Nitrofurantoin 2. Macrodantin 3. Trimethoprimm

S/sx of aminoglycosides

1. OTOTOXICITY 2. tinnitis 3. HA 4. ataxia 5. vertigo 6. NEPHROTOXICITY 7. polyuria 8. dilute urine 9. protein/casts 10. elevation BUN and Cr

interactions with aminoglycosides (gentamicins)

1. Other ototoxic drugs increase the risk for ototoxicity. • 2. Amphotericin B (Fungizone), NSAIDS, or other nephrotoxic drugs increase the risk for nephrotoxicity. 3. Cephalosporins, vancomycin, and penicillin enhance the bactericidal effect of gentamicin. 4. Don't mix multiple drugs in the same IV solution with gentamicin (penicillin, cephalosporins, heparin). 5. Can prolong respiratory paralysis in combination with neuromuscular blockers (pancuronium, succinylcholine [Anectine])

acyclovie (Zovirax) administration

1. PO (tabs, caps, susp.) 2. topical (cream and oitment) 3. IV 4. wear gloves and instruct clients to wear gloves to apply topically 5. IV= hydrate client as order during and after for 2 hr

interactions for First generation cephalosporins (cephalexin-Keflex)

1. Probenecid causes prolonged effect of most cephalosporins 2. Alcohol or any drug that promotes bleeding: cefotetan (Cefotan) only 3. IV calcium and ceftriaxone (Rocephin) only

What can macroslides cause in an EKG?

1. QT prolongation 2. dysrhythmias 3. increase QT intervals in Vtach (torsades)

client instructions for fluroquinolones (ciprofloxacin-Cipro)

1. Report CNS symptoms to provider. 2. Decrease caffeine use during treatment. 3. Report GI symptoms to provider. 4. Report tendon pain to provider. 5. Avoid exposure to sunlight or sunlamp. 6. Wear clothes that fully cover the body and apply sunscreen to remaining areas of exposure. 7. Take antacids, iron, calcium, dairy products, and sucralfate 2 hr after or 6 hr before oral ciprofloxacin. 8. Encourage patients to drink at least 1,500 to 2,000 mL of fluids/day

client instructions for isoniazid (INH)

1. Report jaundice, abdominal pain, and unusual fatigue to provider. 2. Report numbness, tingling, and pain in hands and feet to provider. 3. Report CNS symptoms to the provider.

client instructions for Carbapenems (imipenem- Primaxin)

1. Report nausea, especially when it occurs during IV infusion. 2. Report pain, swelling, or redness at IV site. • 3. Report all drug allergies to provider. 4. Report mouth pain and difficulty chewing and swallowing. 5. Report vaginal irritation and discharge

precautions of fluroquinolones (ciprofloxacin- Cipro)

1. Serious CNS disorders (seizure disorder) 2. GI disorders 3. Renal impairment 4. Coumadin therapy 5. Children under 18 6. Pregnancy risk

therapuetic use for Azoles

1. Severe systemic fungal infections (as a less toxic alternative to amphotericin B). • 2. Cutaneous fungal infections

What are some s/sx that are seen when using sulfonamides

1. Steven johnson syndrome 2. blood dyscrasias 3. C diff 4. renal crystals if not enough fluid 5. disuliram type reaction 6. Kernicterus in newborns 7. bili deposits in the brain

client instructions for metronidazole (Flagyl)

1. Take just before, with, or after a meal if GI symptoms occur. 2. Report severe GI symptoms to provider. 3. Report CNS symptoms to provider. 4. Do not be alarmed if darkening of the urine occurs during treatment. 5. Instruct clients they may experience a metallic taste, headache, and dizziness 6. Advise clients to avoid alcohol

client instructions with First generation cephalosporins (cephalexin-Keflex)

1. Take with food to decrease GI symptoms. 2. Report watery or bloody diarrhea to provider. 3. Stop drug and notify provider for possible allergic reactions. 4. Call 911 for severe symptoms, such as difficulty breathing. 5. Report unusual bruising or bleeding to provider. 6. Report burning, pain, or swelling at IV site during infusion of cephalosporin. 7. Inform client about the potential for nausea, vomiting, severe headache, and hypotension with the combination of the drug and alcohol

adverse drug reactions of monobactams (azotreonam- Azactam)

1. Thrombophlebitis, inflammation at IV site 2. Abdominal distress 3. Rash 4. Inhalation: upper respiratory symptoms: wheezing, nasopharyngeal pain, chest pain and bronchospasms

therapeutic use for fluoroquinolones (cipreofloxacin-Cipro)

1. Treats a wide range of bacterial infections, including severe urinary tract disorders. 2. Prevents anthrax (following inhalation of anthrax spores) in both adults and children.

therapeutic uses for Fluoroquinolones (ciprofloxacin- Cipro)

1. Treats a wide range of bacterial infections, including severe urinary tract disorders. 2. Prevents anthrax (following inhalation of anthrax spores) in both adults and children.

therapeutic use for cloroquine (Aralen)

1. Treats chloroquine-sensitive malaria caused by chloroquine-sensitive malaria. Combination with primaquine is necessary to cure malaria caused by two of the parasites 2. Prophylaxis for malaria in regions where chloroquine resistance is not widespread. 3. Treats amebiasis 4. Second-line therapy to treat rheumatoid arthritis and systemic lupus erythematosus.

What are some conditions that are treated with sulfonamides

1. UTIs 2. pneumocystitis pneumonia 3. Shilgella 4. AOM 5. chronic bronchitis

What is fluoroquinolones used to treat?

1. UTIs 2. wide range of bacteria 3. anthrax

adverse drug reactions for INH and RPT

1. Unexplained anorexia, nausea or vomiting, dark urine*, or icterus 2. Persistent paresthesia of hands or feet 3. Persistent weakness, fatigue, fever, or abdominal tenderness 4. Easy bruising or bleeding

contraindications of metronidazole (Flagyl)

1. active CNS disease 2. pregnancy risk (teratogenic)

contraindications for metronidazole

1. active CNS disorder 2. blood dyscrasias 3. during lactation or first trimester of pregnancy

interactions with metronidazole

1. alcohol causes disulfiram-like rx (facial flushing, n/v, dyspnea, tachycardia-- sick like a dog!) 2. treat partner (usually one time bigger dose) 3. encourage abstinence of sex 24-48 hr prior, during, and 24-48 hr after 4. inhibits activationg of warfarin, phenytoin and lithum 5. pts finish full course

contraindications of acyclovir (zovirax)

1. allergy to acylovir or valacyclovir 2. buccal form ( milk protein concentrate)

contraindications of aminoglycosides (gentramicin)

1. allergy to any aminoglycoside 2. pregnancy risk-teratogenic

contraindications of azoles (ketoconazole and itraconazole)

1. allergy to azoles

contraindications of carbapenems (imipenem- Primaxin)

1. allergy to carbapenems 2. allergy to pencillin

precautions of carbapenems (imipenem- Primaxin)

1. allergy to cephalosporins 2. seizures 3. renal impairement

Contraindications for chloroquine (Aralen)

1. allergy to drugs related to chloroquine 2. hx of visual changes caused by drugs r/t chloroquine 3. optic neuritis or psoriasis

Contraindications of macrolides (erythromycins)

1. allergy to erythromycin or other macrolide antibiotic 2. hx of prolonged QT syndrome 3. hypokalemia 4. hypomagnesemia

these penicillin drugs decreased GI effects with food

1. amoxicillin 2. amoxicillin-clavulanate

2 broad spectrum pencillin antibiotics

1. amoxicillin 2. clavulanic acid

SE of using antifungals

1. amphotericin 2. tachycardia 3. HA 4. hypotension 5. after infusion= anemia and thrombophlebitis

interactions with azoles (ketoconazole and itraconazole)

1. antacids, proton pump inhibitors and H2 antagonists greatly decrease absorption 2. take ketoconazole at least 2 hours before taking any of the above drugs 3. econazole (topical) may increase bleeding tendencies with clients taking warfarin.

Disorders that Metronidazole (cidal) can be used for

1. antibiotic induced C-diff 2. bacterial vaginosis (gardnerella) 3. Prophylaxis for surgical pts who are at risk for anaerobic infection (vaginal, abd, colorectal) 4. in combination for H. Pylori

who is considered positive for TB with this response from the TB skin test? an induration of 15 or more mm

1. any person with known risk factor for TB.

administration of metronidazole (Flagyl)

1. available as tablets, capsules, sustained release capsules, topical cream, vaginal gel, and IV infusion 2. IV powdered form is reconstituted and diluted as recommended for slow IV infusion. 3. Sustained-release form must be swallowed whole and not crushed or chewed. 4. Regular tablets may be crushed if client cannot swallow them. 5. Give oral dose 1 hr before or 2 hr after a meal for best absorption.

administration of carbapenems (imipenem- Primaxin)

1. available in IM and IV 2. IM and IV forms are not interchangeable-assure and use the correct form for prescription. 3. Follow recommendations for rate and dilution when infusing IV doses.

administration for First generation cephalosporins (cephalexin-Keflex)

1. available in capsules, tablets, or oral suspension 2. • Be careful to differentiate between cephalosporin prescriptions; generic names may be very similar.

Administration of fluroquinolones (ciprofloxacin- Cipro)

1. available in oral and IV forms 2. IV - infuse slowly over at least 60 minutes, following recommendations for dilution - incompatiable with multiple drugs in iv solution or iv tubing

administration for azoles (ketoconazole and itraconazole)

1. available in tablets, topical and shampoo 2. oral - requires acid medium for absorption in stomach (soda)

Acyclovir (Zovirax) client instructions

1. avoid scratching application site 2. avoid topical cream from eyes 3. report persistent skin symptoms 4. taken with food if GI symptoms occur 5. hydration with IV fluids 6. use condoms with genital herpes 7. instruct female clients with genital herpes to get yearly pap smear

Indications for use of penicillins

1. bacterial infections caused by susceptivble organisms 2. more effective in gram positive than gram negative infections 3. skin/soft tissue, respiratory, Gi, GU infections 4. incidents of resistance continue to increase

what are antiparasites used to treat

1. bacterial/ protozoal/ antiulcer infections

sulfonamides drugs

1. bacterim 2. triple antibiotic ointment

What are some labs that need to be monitored when taking sulfonamides

1. blood abnormality 2. I and O 3. CBC 4. rash 5. SJS

Amphotericin B is used in caution in..

1. bone marrow suppression 2. anemia 3. renal issues

adverse reactions for Azoles (ketoconazole)

1. burning 2. itching 3. redness 4. localized hypersensitivity

What are some things that interact with tetracyclines

1. calcium foods 2 meds with calcium 3. zinc

in life threatening allergic reactions to penicillin, which other two antibiotics classess should be avoided?

1. cephalosporin 2. carbapenem

What can tetracyclines be used to treat?

1. chlamydia 2. mycoplasma infections 3. tick fever 4. acne

precautions in isoniazid (INH)

1. chronic liver disease including hepatitis 2. HIV 3. adults older than 50 4. seizure disorder 5. renal disorders 6. alcohol use disorder

interactions with Rifapentine (RPT)

1. decrease blood levels of many drugs including oral contraceptives, warfarin, sulfonureas, and methadone 2. contraindicated in HIV infected pts being treated with protease inhibitors and most nonnucleoside reverse transcriptase inhibitors (NNRTIs)

what drug levels can increase with the use macroslides?

1. digoxin 2. warfarin 3. theophylline

what should be monitored in a patient taking antimycobacterials

1. fever 2. rash 3. lymphadenopathy 4. myocarditis 5. myositis

precautions of metronidazole (Flagyl)

1. heart failure 2. liver or renal failure 3. seizure disorders 4. hx of blood disorders

contraindiciations of isoniazid (INH)

1. hx of allergy to isoniazid 2. hx of liver damage from isoniazid 3. severe liver damage from any cause

when should baseline and routine lab monoitoring during treatment of Latent TB infection (LTBI) be taking

1. hx of liver disease 2. HIV infection 3. pregnancy (or within 3 months post deliever) 4. regular alcohol abuse

contraindications for pencillins

1. hypersensitivity/ allergic rx to any pencilin preparation 2. potential exists for cross allergenicity with cephalosporins and carbapenems

Interactions with Isoniazid (INH)

1. increases blood levels of phenytoin (dilantin) and disulfiram (antabuse)

when should metronidazole be used cautiously

1. kidney disease 2. cardiac problems 3. fungal or candida infections 4. seizure disorder 5. older adults 6. pts in their 2nd and 3rd trimesters or pregnancy

urinary tract antiseptics should not be used in..

1. kidney fx impairement 2. low Cr clearance 3. jaundice 4. >38 weeks gestation 5. breast feeding 6. asthma 7. liver disorder

contraindications of monobactams (azetreonam-Azactam)

1. known hypersensitivity

antifungals are contraindicated in..

1. lactacting women 2. bone marrow suppression 3. anemia 4. renal insuffient

antimycobacterials can be used to treat

1. leprosy 2. prevent H. influenzae 3. meningitis 4. legionella 5. S. aureus

precautions for chloroquine (aralen)

1. liver disease 2. pregnancy and lactation

what are some contraindications of taking antimycobacterials

1. liver dz 2. alcoholism 3. DM 4. other hepatotoxic drugs

what should you monitor in a patient who is taking antimycobacterials (TB) antitubercular drugs

1. liver fx 2. peripheral neuropathy 3. DOT 4. watch alcohol intake 5. watch for jaundice

s/sx of antimycobacterials

1. liver toxicity 2. hepatitis 3. may turn urine, saliva, tears and sweat red or orange

interventions for First generation cephalosporins (cephalexin-Keflex)

1. monitor and report bloody stools or watery diarrhea 2. Assess for cephalosporin or penicillin allergy before giving drug; inform provider. 3. Prepare to treat rash/hives with antihistamines; anaphylaxis with epinephrine and antihistamines. 4. Monitor prothrombin and bleeding time. 5. Expect to administer vitamin K if bleeding occurs. 6. Monitor for thrombophlebitis during IV infusion; for occurrence, stop infusion and change IV site. 7. Follow recommendations when diluting IV cephalosporins; infuse slowly.' 8. Inform client that a disulfiram-like reaction will occur with the combination of the drug and alcohol.

interventions for azoles (ketoconazole and itraconazole)

1. monitor and report changes in liver function tests during treatment 2. monitor for and report severe GI symptoms 3. monitor for and report CNS effects

Acyclovir (Zovirax) interventions

1. monitor and report severe skin reactions 2. monitor for and report severe symptoms 3. monitor BUN and Cr 4. infuse IV slowly, hydrate pt during and for 2 hr after 5. monitor and report CNS effects

interventions for chloroquine (Aralen)

1. monitor and report visual symptoms or GI symptoms

interventions for fluoroquinolones (ciprofloxacin- Cipro)

1. monitor for and report GI symptoms (a decrease in the dose may need to occur) 2. monitor for and report tendon pain during treatment (discontinue if pains occur) 3. Don't allow clients to go outdoors without covering their skin with clothing. They also need to apply sunscreen to areas of exposure

interventions of metronidazole (Flagyl)

1. monitor for and report severe GI symptoms 2. monitor for and report CNS symptoms; drugs will be discontinued for seizure or neuropathy

What are some general side effects of all antibiotics

1. n/v/d 2. thrush 3. C. Diff associated disease 4. allergic reactions

what is something that a patient will need to be educated on when they are taking Rifapentine (RPT) for latent TB infections

1. normal orange discoloration of body fluids (urine, tears) 2. contact lenses can be discolored

precautions of azoles (ketoconazole and itraconazole)

1. onychomycosis (fungal infection of nails) 2. pregnancy and lactation

administrations of chloroquine (Aralen)

1. oral and IM (oral preferred) 2. For clients traveling to regions of the world with malaria, take 500- mg tablets once weekly beginning 1 to 2 weeks before traveling and continuing 4 weeks after leaving the country containing malaria parasites. 3. Acute attacks are treated by giving 1 g of the drug orally. Then, a smaller dose of the drug is given 6, 24, and 48 hr later. 4. Doses for children are based on weight. 5. Give at least 4 hr before or after antacids or laxatives for adequate absorption. 6. Give with food to prevent GI effects.

When IV monobactam is given, what can occur?

1. pain 2. thrombophlebitis 3. inflammation at site 4. SIVP usually through bolus 5. infusion-diluted

Penicillin Drugs

1. penicillin G 2. penicillin V 3. Piperacillin 4. Ticarcillin 5. unasyn 6. augmentin

s/sx of fluoroquinolones

1. photosensitivity (30 SPF) 2. dizziness 3. HA 4. confusion 5. seizures 6. severe rx can cause increased ICP 7. suicidial ideation 8. hepatoxicity 9. anaphylaxis

antiparasites should be used in precaution with

1. pregnancy 2. lactation 3. dyscrasias 4. heart/ liver/ renal failure 5. seizures

goals of antibiotic therapy

1. prevent/ treat infections caused by pathogenic organisms

contraindications for use of cephalosporins

1. previous anaphylactic reaction to penicillin 2. cross sensitivity low in those with delayed reactions to penicillin 3. skin rash 4. cephalosporin allergy 5. watch for GI upset/ bleeding

precautions for aminogylcosides (gentamicin)

1. prior damage to acoustic nerve causes increased risk of hearing loss 2. presence of tinnitus or vertigo 3. renal disorders 4. chronic neuromusclar disorders 5. dehyrdation

interactions with acyclovir

1. probenecid increases blood levels 2. zidovudine increases CNS effects 3. drugs that are nephrotoxic increase risk for renal toxicity

adverse reactions of urinary tract antiseptics

1. pulmonary distress 2. damage 3. fibrosis

who is considered positive for TB with this response from the TB skin test? an induration of 10 or more mm

1. recent immigrants (<5 years from high prevelance countries) 2. injection drug users 3. residents and employees of high risk congregate settings 4. mycobacteriology lab personnel 5. persons with clinical conditions that place them ar high risk 6. children <4 years old 7. infants, children and adolescents exposed to adults in high risk categories

precautions for First generation cephalosporins (cephalexin-Keflex)

1. renal failure 2. GI disease

what labs should be monitored while taking penicillins

1. renal function 2. I&O

Labs that need to be monitored when taking antifungals

1. renal fx 2. electrolytes (especially K) 3. dysrhytmias 4. CBC 5. anemias

labs to be monitored with tetracycline

1. renal fx 2. liver fx

What are some ways that vancomycin is toxic

1. renal fx (nephrotoxicity) 2. ototoxicity 3. Red man syndrome

precautions with acyclovir (zovirax)

1. renal insufficency 2. neurological disorders 3. dehydration

client instructions for azoles (ketoconazole and itraconazole)

1. report abdominal pain, jaundice, fatigue or anorexia 2. take with food to minimize GI symptoms 3. dont take with antacids due to poor absorption of ketoconazole 4. do not drive or perform other hazardous activities if drowsiness or dizziness occurs

client instructions of monobactams (aztreonam- Azactam)

1. report pain, redness or swelling at IV site

client instructions for Aminoglycosides (gentamicin)

1. report tinnitus, HA, vertigo, or hearing loss 2. report increase in output of dilute urine

clinical indications for the use of cephalosporins

1. surgical prophylaxis 2. tx of infections (respiratory tract, urinary tract, skin, soft tissues, bones, joints, brain, spinal cord)

client instructions for macrolides (erythromycin)

1. take with food if GI symptoms occur 2. report continuing symptoms to providers 3. report palpitations and fainting spells to the provider 4. report hearing loss, vertigo, and tinnitue to provider 5. report bloody or watery diarrhea 6. report mouth pain with white patches on the oral mucosa or vaginal discomfort and discharge

Tetracyclines drugs

1. tetracycline 2. doxycycline 3. minocycline

What does drug selection of antibiotics depend on?

1. the organism causing the function 2. severity of infection 3. other factors

therapeutic use of Isoniazid (INH)

1. treatment of active TB 2. treatment of latent TB (positive TB skin test, disease not yet active)

therapuetic use of carbapenems (Imipenem-Primaxin)

1. treats serious infections caused by multiple types of organisms

What are some reasons why someone would not be able to take fluorquinolones?

1. under 18 2. MG symptoms 3. antiarrhthmic drugs that can prolong the QT interval

Antiprotozoal drugs should be used in caution with..

1. visual problems already (optic neuritis) 2. psoriasis 3. liver damage

adverse drug reactions of chloroquine (Aralen)

1. visual symptoms 2. GI symptoms (n,d)

What are some s/sx to watch for when giving carbapenems

1. watch IV rate 2. GI symptoms 3. watch site 4. monitor for superinfections 5. labs: liver fx, renal fx. LDH 6. watch for pain, swallowing issues 7. has cross sensitivity

What are some things you should educate your patient on when they are taking antiprotozoal drugs

1. wear sunglasses 2. dec. visual disturbances

administration of aminoglycosides (gentamicin)

1.ADMINISTRATION • Available in topical, ophthalmic, IM/IV, and intrathecal forms 2. opthalmic drops - gently press in inner canthus for 1-2 min after instilling drops - instruct to keep eyes shut for 1-2 minutes after 3. topical - dont apply to large skin areas - risk for toxicity with systemic absorption 4. IM -inject deeply into large muscle 5. IV -give as intermittent infusion, using recommendations for rate and dilution 6. intrathecal - use a preventive free form for intrathecal; discard portions you dont use

what do you need to monitor for monobactams

1.anaphylaxis 2. GI irritation 3. cross sensitivity

a nurse is preparing to administer clindamycin 300 mg by intermittent IV bolus over 30 minutes to a client who has a staph infection. Available is clindamycin premixed in 50 ml 0.9% NaCl. the nurse should set the IV pump to deliever how many ml/hr

100 ml/hr

Cephalosporins (4)

1st Generation-cephalexin 2nd -Cefaclor 3rd -Ceftriaxone 4th -Ceftolozane-tazobactam

a nurse is caring for a client who is prescribed tetracycline 2 grams daily PO in four divided doses every 6 hr. Available is tetrycycline 350 mg capsules. How many capsules should the nurse administer per dose?

2 capsules

a nurse is preparing to administer amoxicillin 250 mg PO every 8 hr. The amount available is amoxicillin 125 mg tablets. how many tablets should the nurse administer with each does

2 tablets

a nurse is preparing to administer amoxcillin 30 mg/kg/ day divided equally every 12 hours to a toddler who weighs 33 lb. available is amoxicillin 200 mg/5 ml.how many ml should the nurse administer?

30mg/kg/day x 15 kg= 450 mg/day 450mg/x= 200mg/5ml 2250mg/ml=200mgx =11.25 ml 11.25ml/ bid= 5.6 ml ans= 5.6 ml

what cranial nerve is affected by aminoglycosides

8th cranial nerve; vestibularcochlear

A nurse is caring for a 52-year-old client who has been diagnosed with a latent tuberculosis infection. The health care provider is considering ordering isoniazid (INH). The preexistence of what condition would require cautious use of INH in this client? A. cirrhosis of the liver B. folic acid deficiency C. hypertension D. glaucoma

A. Because hepatotoxicity is a potentially serious adverse effect of INH, the drug should be used cautiously in clients with liver disease.

The nurse is caring for a client who is taking tetracycline for Rocky Mountain spotted fever. The nurse notices that the client has developed painful mouth ulcers. The nurse knows that the client has developed what adverse reaction to the medication? A. Stomatitis B. Acne C. Hypersensitivity reaction D. Gastritis

A. Stomatitis is the development of ulcers in the mucous membranes of the oral cavity. It is an adverse reaction seen in clients taking tetracycline. Epigastric distress is another adverse reaction but is an inflammation of the stomach. A hypersensitivity reaction is usually seen as hives or wheals on the skin, and tetracycline is used in the treatment of acne.

A client is prescribed rifampin. What information should the nurse include in the client's medication education? A. The urine, tears, sweat, and other body fluids will be a discolored red-orange. B. It decreases hepatic enzymes and decreases metabolism of drugs. C. It has an increased serum half-life, so it is more effective than rifabutin. D. When taking it with warfarin, an increased anticoagulant effect occurs.

A. The client's urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the client should be instructed on this adverse effect. The administration of this medication with warfarin will decrease the anticoagulant effect. The medication increases hepatic cytochrome P-450 3A4 enzyme and decreases serum concentrations. The serum half-life of rifampin is shorter than that of the medication rifabutin.

A client is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which medication will most likely be administered? A. erythromycin B. flumazenil C. acamprosate calcium D. atazanavir

A. A client who is diagnosed with a genitourinary infection that is caused by trachomatis and who is allergic to penicillin should be administered erythromycin since there is no known cross-reaction. Acamprosate calcium is administered as a substance abuse deterrent, not in place of penicillin. Atazanavir is an antiviral agent that is used to treat HIV infection, not Chlamydia trachomatis. Flumazenil is a benzodiazepine antagonist and not used for Chlamydia trachomatis.

A child has been diagnosed with acute otitis media. Before the child begins antibiotic treatment, what assessment should the nurse perform? A. Assess the child for allergies to penicillins. B. Assess the child for allergies to salicylates. C. Assess the child's immunization status. D. Assess whether the child has ever had tuberculosis skin test.

A. Amoxicillin is the preferred antibacterial agent for the treatment of acute otitis media. Because this medication is a penicillin, it is necessary to assess for allergies to these antibiotics. The child's immunization status, history of TB skin tests, and allergies to salicylates are not central to the child's care.

For what client would a broad-spectrum antibiotic be most appropriate? A. A client who has symptoms of infection but whose culture and sensitivity results are not yet available B. A client who has an oral temperature of 100.2° F (37.9° C) but no other signs or symptoms of infection C. A client whose urinary tract infection has been attributed to Escherichia coli D. A client with a respiratory infection who is 84 years old

A. Broad-spectrum antibiotics are often used to treat infections while awaiting the results of culture and sensitivity testing. The presence of a fever with no other signs of infection would not be an indication for the use of broad-spectrum antibiotics. Narrow-spectrum antibiotics are generally preferred when the causative microorganism of an infection is known. Advanced age is not an indication for broad-spectrum antibiotic use.

The nurse understands that which is the highest priority when teaching about antitubercular medications? A. Taking medications as prescribed B. Eating a well balanced diet C. Staying hydrated D. Monitoring sputum

A. For medications to be effective, it is most important that the nurse reinforce to the client that medications should be taken as prescribed and there should be no missed doses. Eating a well balanced diet, keeping hydrated and monitoring sputum are not medication priorities.

When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route? A. Oral B. Topical C. Intramuscular D. Subcutaneous

A. Most fluoroquinolones are administered orally; levofloxacin and moxifloxacin may also be given intravenously.

The health care provider is preparing to order rifampin and pyrazinamide for a female client with active tuberculosis. What question should the provider ask this client before confirming this order? A. "Are you pregnant?" B. "Have you ever experienced a miscarrage?" C. "Do you have a family history of diabetes?" D. "Are you allergic to penicillin?"

A. Pyrazinamide and streptomycin are contraindicated in pregnancy. A regimen of INH, rifampin, and ethambutol is usually used in the treatment of pregnant women.

A nurse is caring for a 6-year old child with a severe case of typhoid fever. The client was mistakenly administered tetracycline, which can cause adverse reactions. What could be a permanent effect in the child? A. Discoloration of the teeth B. Epigastric distress C. Visual disturbances D. Abdominal pain or cramping

A. Tetracyclines cause permanent yellow-gray-brown discoloration of the teeth in children less than 9 years of age. Epigastric distress is not a permanent effect of the drug. Abdominal pain or cramping and visual disturbances are adverse reactions of macrolides.

A client is to receive rifampin. Which would be most important for the nurse to include in the teaching plan for this client? A. "Your urine or sweat may become orange in color." B. "The drug can cause an allergic reaction." C. "You might experience some nausea or stomach upset." D. "Call your health care provider if you experience headache or dizziness."

A. This drug causes body fluids to turn orange. The client needs to be informed of this to avoid being frightened when it occurs. Any drug can cause a hypersensitivity reaction. Although this information is important, it is not the priority. GI adverse effects are common. Although this instruction would be important, it would not be the priority. Headache and dizziness are common CNS effects of the drug that do not need to be reported.

Anti-Helmintics (6)

Albendazole Ivermectin Mebendazole Praziquantel Pyrantel Metronidazole

Aminoglycosides (6)

Amikacin Gentamicin Kanamycin Neomycin Streptomycin Tobramycin

Extended Spectrum Penicillins (3)

Ampicillin/sulbactam Amoxicillin/clavulanate Piperacillin/tazobactam

What decrease the absorption of fluoroquinolone?

Antacids, drugs containing iron or zinc

Anti-Protozoal drugs work by:

Antiprotozoal agents destroy protozoa or inhibit their growth and ability to reproduce. They damage the protozoal DNA to limit the spread of infection. They inhibit a fundamental pathway of energy metabolism (inhibition of parasite dehydrogenase activity) in the protozoa, thus making them unable to grow and reproduce.

Macrolides/Ketolides (3)

Azithromycin Clarithromycin Erythromycin

Mono-bactams (1)

Aztreonam

A client has been prescribed INH for the treatment of tuberculosis. The nurse teaches the client about dietary restrictions while taking this medication. What is the most important instruction? A. "Avoid excessive caffeine intake because this could increase the side effects of the medication." B. "Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur." C. "Make sure to limit your protein intake, as increased protein delays absorption of the medication." D. "Take the medication with a full glass of water to prevent the mouth from becoming dry during therapy."

B. Because INH has some monoamine oxidase inhibitor activity, interactions may occur with tyramine-containing foods. INH may also interact with foods containing histamine. Clients should refrain from excessive intake of foods rich in tyramine, which include cheese and dairy products, beef or chicken liver, beer and ale, red wine, avocados, bananas, figs, raisins, caffeine, and chocolates. Because most people consume these food items, the diet is difficult to maintain.

A client has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the client's first scheduled dose, the client develops a pronounced rash on the chest and arms. How should the nurse respond initially to this event? A. Slow down the rate so that the infusion takes place over 2 hours. B. Discontinue the infusion and inform the care provider promptly. C. Administer oral diphenhydramine to the client during the infusion. D. Administer an STAT dose of acetylcysteine.

B. Severe hypersensitivity reactions have occurred with the administration of fluoroquinolones. The nurse discontinues the antibiotic immediately if skin rash or other signs or symptoms occur. Administration of acetylcysteine or diphenhydramine is not indicated. Slowing down the rate of infusion would not address the problem as it relates to exposure to the medication. Neither the administration of acetylcysteine nor diphenhydramine is indicated initially. Acetylcysteine is prescribed to treat thick mucus lung secretions. Treatment with diphenhydramine would be ineffective if the ciprofloxacin were not first discontinued.

The drug's effect on what best reflects the major reason for avoiding the use of tetracyclines in children under 8 years of age? A. Kidneys B. Teeth C. Hearing D. Vision

B. Tetracyclines should be used with caution in children younger than age 8 years because the drugs can potentially damage developing teeth and bones. They do not affect hearing or vision. They are excreted in the urine, so caution is necessary if the client has underlying renal dysfunction; however, this is not the main reason for avoiding use in children.

gram-negative

Bacteria that accept a negative strain and are frequently associated with infections of the genitourinary and gastrointestinal tract.

Anaerobic

Bacteria that can survive without oxygen, which are often seen when blood flow is cut off to an area of the body.

Aerobic

Bacteria that depend on oxygen for survival.

gram-positive

Bacteria that take a positive strain and are frequently associated with infections of the respiratory tract and soft tissues.

A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize? A. Coagulation studies B. Signs of disulfiram-like reaction C. Serum BUN and creatinine levels D. Complete blood count

C. Explanation: The nurse would need to assess renal function indicated by serum BUN and creatinine levels because combining cephalosporins with aminoglycosides increases the client's risk for renal toxicity. Coagulation studies would be important if the client was receiving a cephalosporin with an oral anticoagulant because there is an increased risk for bleeding. Combining cephalosporins with alcohol could result in a disulfiram-like reaction. Assessing the client's complete blood count would not be directly indicated by the combination of cephalosporins and aminoglycosides.

Antibiotic

Chemical that is able to inhibit the growth of specific bacteria or cause the death of susceptible bacteria.

malaria treatment

Chloroquine

Fluroquinolones (6)

Ciprofloxacin Gatifloxacin Levofloxacin Moxifloxacin Norfloxacin Ofloxacin

Miscellaneous (7)

Clindamycin Tigecycline Linezolid Vancomycin Chloramphenicol Metronidazole Quinupristin

Pyrazinamide and Streptomycin.

Contraindicated in pregnancy. A regimen of INH, rifampin, and ethambutol is usually used in the treatment of pregnant women.

A client, hospitalized with active tuberculosis, is receiving antitubercular drug therapy. When it becomes apparent that the client is not responding to the medications, what condition will the primary health care provider identify as a possible cause? A. vancomycin-resistant Staphylococcus aureus B. methicillin-resistant Staphylococcus aureus C. human immunodeficiency virus (HIV) D. drug-resistant tuberculosis.

D. A client who is being treated with antitubercular drug therapy and is not responding to the medication regime is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly. This scenario does not provide any indication that the tuberculosis is related to the diminished client response. The scenario does not identify methicillin-resistant or vancomycin-resistant Staphylococcus aureus.

A client diagnosed with Chlamydia is allergic to penicillin. What medication could be used as a substitute for penicillin in this situation? A. chloramphenicol B. tetracycline C. doxycycline D. erythromycin

D. Erythromycin is used as a penicillin substitute in clients who are allergic to penicillin and for prevention of rheumatic fever, gonorrhea, syphilis, pertussis, and chlamydial conjunctivitis in genitourinary infections caused by Chlamydia trachomatis and intestinal amebiasis caused by Entamoeba histolytica. None of the other options are typically used as a substitute to account for an allergy to penicillin when treating chlamydia.

Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection? A. narrow spectrum B. bactericidal C. bacteriostatic D. broad spectrum

D. One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora, allowing opportunistic pathogens to invade tissue and cause a superinfection. Narrow-spectrum anti-infectives are less likely to kill normal flora, although it is not impossible. A drug may be bactericidal, meaning it kills the pathogen; or bacteriostatic, meaning it prevents reproduction of the pathogen, but this is not related to superinfections.

A group of nursing students are reviewing information about penicillins. The students demonstrate understanding of the information when they identify the action of penicillinase as causing bacterial resistance by which mechanism? A. destruction of the beta-lactam ring of the penicillin B. destruction of the penicillin cell wall C. rupture of the penicillin membrane D. enzymatic inactivation of the penicillin

D. Penicillinase is an enzyme produced by certain bacteria that inactivates the penicillin. Some bacteria produce other enzymes called beta lactamases which destroy the beta-lactam ring of penicillin. Penicillin is a drug that attaches to the bacteria receptor site on the bacterial wall; penicillin does not have a cell wall or membrane.

A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections? A. Administer streptomycin to promote nutrition. B. Monitor patient's vital signs each morning. C. Monitor signs of liver dysfunction weekly. D. Rotate injection sites for frequent parenteral injections.

D. The nurse should be careful to rotate injection sites when administering frequent parenteral injections. At the time of each injection, the nurse inspects previous injection sites for signs of swelling, redness, and tenderness. The nurse should monitor any signs of liver dysfunction monthly in patients who are being administered antitubercular drugs. The nurse should ensure that pyridoxine, and not streptomycin, is administered to the patient to promote nutrition, but this is only administered if the patient has been living in impoverished conditions and is malnourished. The nurse should monitor patient's vital signs every four hours and not once every morning.

A 9-year-old client has been admitted to the pediatric unit after being diagnosed with pertussis. The pediatric nurse is processing the client's admission orders and notes that IV demeclocycline has been prescribed. After beginning this treatment, the nurse should confirm the results of what laboratory test? A. mean corpuscular volume (MCV) B. d-dimer C. bilirubin D. blood urea nitrogen (BUN)

D. When administering demeclocycline, it is important to monitor the client's BUN. Increases in the BUN are secondary to antianabolic effects. Bilirubin levels would only be important in the presence of liver toxicity. A d-dimer test is a blood test that measures a substance that is released when a blood clot breaks up. Health Care Providers prescribe the d-dimer test, along with other lab tests and imaging scans, to help check for blood-clotting problems. Mean corpuscular volume (MCV) laboratory test, as part of a standard complete blood count (CBC), is used along with other RBC indices (MCH and MCHC) to help classify the cause of anemia based on red cell morphology. Neither a d-dimer nor MCV values are relevant to this situation.

Synergistic

Drugs that work together to increase drug effectiveness.

Carbapenems, Monobactams (4)

Ertapenem Imipenem Meropenem Aztreonam

Natural Penicillins

Exert a bactericidal effect on bacteria it targets the bacterial cell wall to destroy the bacteria

mechanism of action of carbapenems

Inhibit synthesis of bacterial cell walls by binding with penicillin-binding proteins

What does the nurse need to monitor when clients taking Demeclocycline?

Is important to monitor the client's BUN

What is a drug that is used to treat latent TB infection that can be used one a day for 9 months. (270 doses minimum) or it be used twice weekly for 9 months (76 doses minimum)

Isoniazid

Anti-TB drugs (2)

Isoniazid Rifampin

The 12-dose regimen of ____ and _____ does not replace other recommended LTBI treatment regimens; it is another effective regimen option for otherwise healthy patients aged ≥12 years who have predictive factor for greater likelihood of TB developing, which includes recent exposure to contagious TB, conversion from negative to positive on an indirect test for infection (i.e. interferon-γ release assay or tuberculin test), and radiographic findings of healed pulmonary TB.

Isoniazid (INH) and Rifapentine (RPT) regimen

what is a drug(s) that is used to treat latent TB infection that can be used to treat latent TB infections that can be taken once weekly for 3 months (12 doses).

Isoniazid and rifapentine

The standard treatment regimen for LTBI is nine months of daily _____. This regimen is very effective and is the preferred regimen for HIV-infected people taking antiretroviral therapy, and children aged 2-11 years of age.

Isonizaid (INH)

prototype for antihelmintics

Mebendazole (Vermox)

trichomoniasis treatment

Metronidazole (Flagyl)

Side Effects (general side effects of antibiotic treatment)

N/V, Diarrhea, Thrush (candidiasis), C. Diff, Allergic reactions / hypersensitivity reactions

Urinary Agents (2)

Nitrofurantoin methanamine

Aminoglycosides toxicity

Ototoxicity and nephrotoxicity

Secondary TB Drugs

Para-aminosalicylic acid, cycloserine, and ethionamide. Used when there is a resistance to the primary anti-TB drugs

PCN (Penicillins) (4)

Penicillin G, V Amoxicillin Piperacillin Ticarcillin

Beta-Lactams (11)

Penicillins Cephalosporins Monobactams Carbapenems Vancomycin Tetracyclines Macrolides Aminoglycosides Fluroquinolones Sulfonamides Urinary Tract antiseptics

prototype for scabies and pediculosis

Permethrin (Nix-OTC) topical

bathe, lather on, leave 8-14 hours, rinse (usually done at night); if scabies scabs-cream to area daily, for pediculosis-lotion-leave on x 10 min, rinse (head, pubic);

Permetrhin (Nix-OTC)

Ciprofloxacin

Photosensitivity.

Amphotericin B is the prototype for what kind of antibiotics

Polyene antibiotics (antifungals)

-Used for systemic fungal infections -Candida (skin/bladder) -IVPB-toxic, Benadryl sometimes given prior to decrease reaction (T/HA/N/chills)

Polyene antibiotics-- Amphotericin B

Primary TB Drugs

Pyrazinamide, rifampin and ethambutol are primary drugs

Vancomycin adverse effects

Red man syndrome. With this syndrome, the client's face and upper trunk becomes bright red, and it has led to cardiovascular collapse.

Tetracyclines

Should always be administered with a full glass of water and on an empty stomach (except minocycline and tigecycline may be taken with food).

Aminoglycosides and potent diuretics

Should avoid being combined. It increases the incidence of ototoxicity, nephrotoxicity, and neurotoxicity

INH (Isoniazid)

Should avoid eating tyramine, histamine-rich foods, and foods containing caffeine. Also, the client should be told to avoid consuming alcohol on a daily basis. Cheese, dairy products, chicken liver, beer, ale, bananas, and figs are rich in tyramine. May cause hyperglycemia (high blood sugar).

Rifampin and Isoniazid drugs

Should be used during the second phase of standard treatment.

Sulfonamides (2)

Sulfamethoxazole/trimethoprim Triple antibiotic ointment

Tetracyclines (3)

Tetracycline Doxycycline Minocycline

Disulfiram-like reaction

The client should avoid consuming alcoholic beverages for at least 72 hours after completing the drug course. Flushing, throbbing in the head and neck, respiratory difficulty, vomiting, sweating, chest pain, and hypotension are symptoms a nurse might observe in a client having this reaction.

What is Tetracycline used for?

To treat Mycoplasma, Chlamydia, and Rickettsia

Acyclovir (Zovirax) Adverse Effects

Topical: 1. burning, itching at application site Oral: 1. GI (n/v/d) 2. HA 3. vertigo IV: 1. renal toxicity 2. CNS toxicity ( rare; restlessness, tremors, psychosis, seizures) 3. thrmbophlebitis

Ototoxicity

Toxic to ear

Nephrotoxicity

Toxic to kidneys

Neurotoxicity

Toxic to nerves and nerve tissue

Hepatotoxicity

Toxic to the liver

Tuberculosis

Tuberculosis is an infectious disease that usually affects the lungs but may involve most parts of the body, including lymph nodes, meninges, bones, joints, kidneys, and the gastrointestinal tract. The nurse should obtain baseline liver function test values and schedule several liver function tests throughout therapy. In addition, a nurse should ensure a baseline A1C evaluation for clients who are diabetics, because INH may cause hyperglycemia. Clients with preexisting anemias should have a baseline complete blood count (CBC), because they are at risk for blood disorders.

Rich in histamine

Tuna, brine, and yeast extracts

Dapsone

Used for leprosy and cannot be used in combination with Isoniazid or any other drug for TB.

Cephalosporins

Used to treat urinary tract infections, skin infections, and hospital-acquired pneumonias.

Glycopeptides (1)

Vancomycin

MRSA treatment

Vancomycin

When do prescribers order tetracycline

When penicillin is contraindicated to treat infections caused by Klebsiella, Neisseria gonorrhoeae, Treponema pallidum, Listeria monocytogenes, Clostridium, Bacillus anthracis, Fusobacterium fusiforme, and Actinomyces.

a nurse is caring for a client who is about to begin taking isoniazid to treat tuberculosis. The nurse should instruct the client to report which of the following adverse effects of the drug. select all that apply a. jaundice b. numbness of the hands c. dizziness d. hearing loss e. oral ulcers

a,b,c

a client is prescribed itraconazole for treatment of systemic mycoses. the provider should include which information when instructing the client about the administration of itraconazole. select all that apply a. take with food to reduce gastric distress b. take in the morning to avoid insomnia c. take with 8oz of acidic liquid. like cola or orange juice to increase absorption d. take with an antacid to reduce dyspepsia e. increase fluid intake to 2-3 L/day if tolerated

a,c rationale: taken with food to reduce gastric distress such as n/v/d. can cause drowsiness, so avoid activities with lots of attentions. an acid medium is needed for absorption. allow 2 hour after taking the drug before taking an antacid.

IV vancomycin has been prescribed to treat meningitis. When administering this drug IV, which of the following actions should the health professional take. Select all that apply a. do no mix it with other drugs b. administer it rapidly via IV bolus c. monitor the IV insertion site for phlebitis d. monitor the vital signs during the infusion e. dilute the drug before administering it

a,c,d, e rationale: diluted and infused slowly over at least an hour.

a nurse is caring for a child who is allergic to penicillin. the nurse should verify which of the following perscriptions with the provider a. amoxicillin-clavulanate b. gentamicin c. erythromycin d. amphotericin B

a. amoxicillin-clavulanate

a nurse is caring for a client who is takin warfarin and has a new prescription for trimethoprium/ sulfamethoxazole to treat a UTI. The nurse should clarify the presciptions with the provider because taking this two drugs concurrently can increase the clients risk for which of the following a. bleeding b. thrombosis c. ECG changes d. ototoxicity

a. bleeding

a nurse in a providers office receives a call from a client who has been taking penicillin V three times daily and reports abdominal cramping with bloody diarrhea for several days. which of the following instructions should the nurse give the client a. bring in the stool for testing b. take the drug only once a day c. use an OTC anti diarrheal medication d. return to the clinic for blood work

a. bring in the stool for testing

a nurse is reviewing a clients presciption prior to administering gentamicin to the client to treat a systemic infection. The nurse should clarify the use of gentamicin with the provider if the client is taking which of the following drugs a. ethacrynic acid b. diphenhydramine c. acetaminophen d. levothyroxine

a. ethacrynic acid

a nurse is assessing a client who is taking oxacillin to treat an infection. the nurse should recognize which of the following findings is a manifestation of an allergic reaction a. pruritus b. diarrhea c. dark urine d. fever

a. pruritus rationale: an immune response that can manifest as pruritus and uticaria can progess to anaphylaxis

A client is prescribed amoxicillian to treat an ear infection. The health care provider instructs the client to monitor and report which of the following a. rash b. blurred vision c. peripheral edema d. insomnia

a. rash rationale: monitor for indication of an allergy-- rash, itching, hives or wheezing. discontinue if these appear

a nurse is caring for a client who is about to begin taking metronidazole to treat an anaerobic intra abdominal bacterial infection. The nurse should recognize that cautious use of the drug is indicated if the client also has which of the following conditions a. seizure disorder b. hearing loss c. asthma d. anemia

a. seizure disorder

Imipenem should be used with caution in which of the following clients? A client with a. seizure disorder b. thyroid disease c. diabetes d. immunosuppression

a. seizure disorder rationale: can cause seizures, dizziness or confusion. can cause hyponatremia, hperkalemia,

a nurse in a providers office receives a call from a client who is taking ciprofloxacin to treat a respiratory tract infection and reports dyspepsia. which of the following instructions should the nurse give the client a. take an antacid at least 2 hours after taking the drug b. take the drug with acup of coffee c. take an iro supplement with the drug d. take the drug with 240 ml of milk

a. take an antacid at least 2 hours after taking the drug

a nurse is providing teaching to a client who has a skin infection and a new prescription for gentamicin topical cream. which of the following instructions should the nurse provide a. wash the affected area with soap and water before applying cream b. increase intake of fluids while using this medication c. the medication might cause temporary blurred vision d. apply the cream to large areas around the infection

a. wash the affected area with soap and water before applying cream

treatment for viral infections

acyclovir

used to decrease pain and speed the healing of sores or blisters in people who have varicella (chickenpox), herpes zoster (shingles; a rash that can occur in people who have had chickenpox in the past), and first-time or repeat outbreaks of genital herpes (a herpes virus infection that causes sores to form around the genitals and rectum from time to time)

acyclovir (Zovirax)

: Ingested food or water contaminated with feces; poor sanitation

amebiasis

-Gentamicin, amikacin, tobramycin, neomycin -Inhibit RNA to bind with RNA

aminoglycosides

You shouldn't mix IV penicillin with..

aminoglycosides

are used in the treatment of severe infections of the abdomen and urinary tract, as well as bacteremia and endocarditis. They are also used for prophylaxis, especially against endocarditis. Resistance is rare but increasing in frequency.

aminoglycosides (gentimicin)

systemic candidiasis treatment

amphotericin B

what drug class are azoles

antifungals

-Treats latent and active TB -Interferes with lipid, RNA/DNA synthesis, inhibits cell wall; static specifically on tubercle bacilli, higher doses-cidal.

antimycobacterials (TB) antitubercular drugs

-Kills parasite by preventing heme conversion -May need this med if traveling PRIOR to certain areas x 1-2 weeks then continue x 4 weeks. Based on weight

antiprotozoal (antimalarial)

what drug class is acyclovir (Zovirax) in

antivirals

antifungal agents can be used to treat fungal infections of the body and skin, including athlete's foot, onychomycosis (fungal nail infections), ringworm, and vaginal candidiasis.

azoles

a client is prescribed oral tetracycline for treatment of ance vulgaris. When instructing the client about tetracycline, which of the following information should the provider include (select all that apply) a. increase weight bearing activities b. report mouth pain c. take 1 hr before meals d. wear sunscreen and protective clothing e. swallow pill with 8oz of milk

b,c,d rationale: should be taken on an empty stomach, 1 hour before meals or 2 hours after meals. can cause photosensitivity. wear protective clothing and sunscreen. avoid taking with milk products because they can reduce drug absorption. take with 8oz of water

a nurse in a providers office receives a call from a client who is taking tetracycline orally to treat a chlamydia infection and reports severe blood tinged diarrhea. The nurse should suspect the client is experiencing which of the following a. hemorrhoids b. C diff. diarrhea c. diverticular disease d. small bowel obstruction

b. C diff. diarrhea

a nurse is caring for a client who has a streptococcal pharyngitis and an allergy to penicillin. The nurse should recognize that which of the following drugs can be safely administered to this client a. nafcillin b. azithromcyin c. cephalexin d. amoxicillin/ clavulanic acid

b. azithromcyin

a nurse is caring for a client who is about to begin receiving acyclovir IV to treat a viral infection. The nurse should recognize that cautious use of the drug is essential if the client also has which of the following conditions a. heart failure b. dehydration c. asthma d. tinnitus

b. dehydration

clients receiving vancomocin should be closely monitored for the following a. visual disturbances b. hearing loss c. perioral numbness d. metallic taste

b. hearing loss rationale: ototoxicity is less likely with blood vanc levels below 30 mcg/ml.

A client is prescribes rifampin for treatment of TB. the health care provider should instruct the client to monitor and report which of the following, which may indiciate a serious adverse effect of the rifampin a. tremors b. jaundice c.sweating d. insomnia

b. jaundice rationale: can cause liver toxicity and hepatitis. monitor live enzymes and report abdominal pain, nausea and jaundice

a nurse is teaching a client who taking metroidazole. which of the following sense alterations should the nurse include as an adverse effect of metronidazole a. olfactory changes b. metallic taste c. alterations in touch d. hearing loss

b. metallic taste

A client is prescribed trimethoprim/ sulfamethoxazole for treatment of a UTI. the health provider should instruct the client to monitor and report which of the following, which may indicate a serious adverse effect of trimethoprim/ sulfamethoxazole a. blurred vision b. sore throat c. insomnia d. swelling in calf

b. sore throat rationale: can cause thrombocytopenia, leukopenia and other blood dyscrasias. monitor for signs of infection

a nurse in a providers office recieves a call from a client who was recently hospitalized and treated with imipenem IV for a bacterial infection and reports an inability to eat due to mouth pain. The nurse should identify that the client might be experiencing which of the following as an adverse effect of this drug a. malabsorption b. superinfeciton c. anorexia d. dental caries

b. superinfeciton

a nurse is caring for a client who has a new diagnosis of bacterial meningitis. The nurse should expect the provider to prescribe a drug from which of the following classifications of antibiotics a. first generation cephalosporins b. third generation cephalosporins c. monobactams d. macrolides

b. third generation cephalosporins

why shouldnt you mix IV penicillin with aminoglycosides

because it inactivates aminoglycosides

-Very little antibacterial activity -Bind with and inactivate beta-lactamase -Protects PCN from destruction -Extends PCN's spectrum of efficacy

beta lactamase inhibitors

where is the name for Beta-Lactam Antibacterials derived from?

beta-lactem ring around cells that is essential for antibacterial activity

a nurse is preparing to administer amphotericin B IV to a client who has a systemic fungal infection. Which of the following drugs should the nurse prepare to administer prior to the infusion to prevent or minimize adverse reactions. select all that apply a. asprin b. hydorcortisone c. acetaminophen d. diphenhydramine e. ibuprofen

c,d

a nurse is caring for a client who has a new prescription for acyclovir to treat a herpes simplex infection. Which of the following lab values should the nurse monitor for this client a. prothrombin time b. Hct c. BUN d. aspartate aminotransferase

c. BUN

a nurse is caring for a client who has a fungal infection and has a new prescription for amphotericin B. Which of the following lab values should the nurse report to the provider before initiating the medication a. sodium 140 b. potassium 4.5 c. BUN 55 d. glucose 120

c. BUN 55

a nurse in a providers office receives a call from a client who is taking amoxicillin to treat a respiratory infection and reports a rash and wheezing. which of the following instructions should the nurse give the client a. wait 1 hour and contact the provider if there is no improvement b. skip todays dose of amoxicilliin and resume taking the drug tomorrow c. call emergency service immediately d. take an NSAI to reduce skin and airway inflammation

c. call emergency service immediately

a nurse is caring for a client who is about to begin taking nitrofurantoin to treat a UTI. the nurse should tell the client to report which of the following adverse effects of the drug a. constipation b. dark brown urine c. cough d. tremors

c. cough

a nurse is assessing a client who is receiving IV vancomycin. the nurse notes a flushing of the neck and tachycardia. which of the following actions should the nurse take a. document that the client experienced an anaphylactic reaction to the medication b. change the infusion rate on the IV c. decreased the infusion rate on the IV d. apply cold compresses to the neck area

c. decreased the infusion rate on the IV

a nurse is caring for a client who has an infections and a prescription for gentamicin intermittent IV bolus every 8 hr. a peak and trough is required with the next dose. which of the following actions should the nurse take to obtain an accurate gentamicin serum level a. draw a trough level at 0900 and a peak level at 2100 b. draw a peak level 90 minutes prior to administering the medication and a trough level 90 minutes after the dose c. draw a trough level immediately prior to administering the medication and a peak level 30 minutes after the dose d. draw a peak level at 0900 and a trough level at 2100

c. draw a trough level immediately prior to administering the medication and a peak level 30 minutes after the dose

which of the following interventions may prevent a serious adverse reaction to acyclovir a. premedicate with NSAID b. ambulate after infusion c. increase fluid intake d. remain flat for 2 hours after infusion

c. increase fluid intake rationale: may cause renal toxicity due to accumulation in renal tubules. Increase fluid to hydrate and flush the kidneys

a nurse is caring for a client who has a prescription for rifampin to treat TB. the nurse should expect the provider to prescribe which of the following drugs to the client to prevent possible resistance to rifampin a. gentamicin b. vancomycin c. isoniazid d. metronidazole

c. isoniazid

a nurse is teaching a client who has a new prescription for erythromycin. Which of the following information should the nurse include a. take this medication with a glass of grapejuice b. expect your skin to turn yellow c. monitor for ringing in your ears d. increase fiber intake to prevent constipation

c. monitor for ringing in your ears

a nurse is caring for a client who is about to begin taking itraconazole to treat a fungal infection. The nurse should instruct the client to report which of the following adverse effects of the drug a. tingling in the hands and feet b. joint pain c. swelling of the hands or feet d. excessive sweating

c. swelling of the hands or feet

A nurse is caring for a client who is about to begin gentamicin therapy to treat an infection. The nurse should monitor the client for an alteration in which of the following a. bowel function b. peripheral pulses c. urine output d. level of consciousness

c. urine output

Broad-spectrum, bactericidal beta-lactam antimicrobials

carbapenems

class of highly effective antibiotic agents commonly used for the treatment of severe or high-risk bacterial infections. This class of antibiotics is usually reserved for known or suspected multidrug-resistant (MDR) bacterial infections.

carbapenems

-pnem, -penem drugs

carbapenems, monobactams

First generation cephalosporins

cefazolin, cephalexin capsules, tablets, oral suspension

treatment of gram positive infections

cephalexin

-Widely used group of medications (generations) -Derived from a fungus -Broad-spectrum ATB with activity against gram(+) and gram(−) bacteria -Weaken/destroy cell wall of bacteria—kills bad bacteria and good bacteria in GI -Widely distributed into most body fluids and tissues -Maximum concentration in the liver and kidneys

cephalosporins

ceph-, cef- drugs

cephalosporins

used to prevent or treat malaria caused by mosquito bites. Chloroquine belongs to a class of drugs known as antimalarials.

chloroquine

prototype for antimalarials

cloroquine

prevents/used prophylactically, take once weekly, same day each week when traveling 1-2 weeks prior, during, and 4 weeks after returning); from mosquitos, can cause visual issues, GI issues Monitor for visual disturbances, PO/IM, give w food, Don't give to optic neuritis/psoriasis. Monitor liver functions.

cloroquine (Arlen) antimalarials

a nurse is caring for a client who has a gynecologic infection and a history of alcohol use disorder. The nurse should identify that which of the the following drugs can cause a reaction similar to disulfiram if the client drinks alcohol while taking it. Select all that apply a.nitrofurantoin b. amoxicillin c. aztreonam d. cefotetan e. metronidazole

d,e

a nurse is planning to administer ceftriaxone IM to an adult client. which of the following actions should the nurse plan to take a. administer the medication using a 5/8 in needle b. administer the medication at a 45 degree angle c. administer the medicaiton in the deltoid d. administer the medication using a Z track technique

d. administer the medication using a Z track technique

a nurse is assessing a client after administering IV vancomycin . which of the following findings is the nurses priority to report to the provider a. localized redness at the catheter insertion site b. client report of a headache c. client report of tinnitus d. auditable inspiratory stridor

d. auditable inspiratory stridor

When administering oral erythromycin to a client who has acute diptheria, a nurse should monitor for which of the following adverse effects a. hypothermia b. blurred vision c. constipation d. cardia dysrhytmias

d. cardia dysrhytmias

While receiving vancomyocin, the client becomes flushed and warm. Which of the following additional adverse reactions to vancomyocin should be expected a. muscle weakness b. pupil changes c. ecchymosis d. hypotension

d. hypotension rationale: rapid infusion causes flushing and hypotension

a nurse is caring for a client who has active pulmonary TB and a new presciption for IV rifampin. the nurse should instruct the client that they should expect to experience which of the following manifestations while taking this medication a. constipation b. black colored stools c.staining of teeth d. red colored urine

d. red colored urine

a nurse is caring for a client who has a new presciption for azotreonam to treat a respiratory tract infection. which of the following findings in the clients medical record should the nurse recognize as requiring cautious use for this presciption a. glaucoma b. closed head injury c. heart failure d. renal impairment

d. renal impairment

the nurse is preparing a medication for a client and observes the date of expiration on the vial occurred 2 months ago. which of the following actions should the nurse take a. give the medication b. discard the medication c. notify the provider d. return the medication to the pharmacy

d. return the medication to the pharmacy

a nurse is administering cefotetan IV to a client to treat an intra abdominal infection. Then nurse notes that the IV insertion site is warm, edematous and painful to the touch. Which of the following actions should the nurse take a. decreased the rate of the cefotetan infusion b. administer diphenhydramine to the client c. request a prescription for another antibiotic d. stop the infusion

d. stop the infusion

a nurse is caring for a client who is taking ciprofloxacin to treat a UTI. the client also takes prednisolone to treat rheumatoid arthritis. recognizing the adverse effects of ciprofloxacin, the nurse should instruct the client to report which of the following adverse effects a. tachycardia b. hair loss c. insomnia d. tendon pain

d. tendon pain

A client is prescribed gentamicin for treatment of a respiratory tract infection. The provider instructs the client to monitor and report which of the following adverse effects of gentamicin a. blurred vision b. tremors c. sweating d. tinnitis

d. tinnitis rationale:can cause ototoxicity and hearing loss. Report tinnitis, vertigo or headache. risk for hearing loss is greater with higher doses and extended use.

a nurse is providing discharge teaching to a client who has pulmonary TB and a new perscription for rifampin. which of the following information should the nurse provide a. treatment with this medication will last for 1 month b. this medication can cause insomnia c. it is best to take the medication with meals d. urine and other secretions might turn orange

d. urine and other secretions might turn orange

a nurse is providing teaching for a client who takes an oral contraceptive and is about to being rifampin therapy to treat tuberculosis. Which of the following instructions should the nurse include a. increase the rifampin dose b. increase the oral contraceptive dose c. allow 2 hours between taking the 2 drugs d. use a non hormonal form of contraception

d. use a non hormonal form of contraception

a nurse is caring for a client whose sputum culture results indicate methicillin resistant Staphylococcus aureus (MRSA). the nurse should recognize that which of the following medications will likely be administered to this client? a. trimethoprim/ sulfamethoxazole b. tetracycline c. cephalexin d. vancomycin

d. vancomycin

because the client is allergic to penicillin, which of the following antibiotics is appropritae to prescribe for meningitis a. cephalexin b. amoxicillin c. cefotetan d. vancomyocin

d. vancomyocin rationale: cephalexin is a first generation cephalosporin. Cefotetan is a second generation cephalosporin. Cephalosporins are similar in structure to penicillins, so clients who are allergic to penicillins may also be allergic to these. Amoxicillin is a penicllin, therefore clients allergic to penicillin shouldnt take this durg. Vancomycoin is an appropriate choice for trating bacterial infections for clients who are allergic to penicillin

a nurse is teaching a client who has a UTI and is taking ciproflaoxacin. which of the following instructions should the nurse give to the client a. if the medicine causes an upset stomach, take an antacid at the same time b. limit your daily fluid intake while using this medication c. this medication can cause photophobia so be sure to wear sunglasses outside d. you should report any tendon discomfort you experience while taking this medication

d. you should report any tendon discomfort you experience while taking this medication

What is the typical ipreferred regimen for basic TB disease treatments initially

daily INH RIF, PZA and EMB for 56 doses INH= isoniazid RIF- rifampin EMB= ethambutol PZA= pyrazinaminde

Beta-lactam antibiotics work by:

exerting their effect by interfering with the structural crosslinking of peptidoglycans in bacterial cell walls. Because many of these drugs are well absorbed after oral administration, they are clinically useful in the outpatient setting.

True or false Vancomycin has a beta lactam ring

false

true or false alcohol can be consumed in small quantities when taking antiparasites

false

A broad-spectrum cephalosporin antibiotic used for the treatment of serious bacterial infections in various locations, such as the urinary tract, skin, bone, and lower respiratory tract. used to treat certain susceptible bacterial infections.

first generation cepalosporin

-Inhibit DNA replication, gram - bacteria -Ciprofloxacin, ofloxacin, moxifloxacin

fluoroquinolones

-cin drugs

fluoroquinolones

are antibiotics that are commonly used to treat a variety of illnesses such as respiratory and urinary tract infections.

fluoroquinolones

antibiotics that are commonly used to treat a variety of illnesses such as respiratory and urinary tract infections.

fluroquinolones

Intestinal parasite from contaminated water; children more than adults; from well water (Takes 1-2 weeks to develop diarrhea/cramping)

giardiasis

monobactams only work against what type of bacteria

gram -

parasitic worms, usually in GI tract; Multiple types of worms (tape,pin, roundworms)

helminthiasis

Beta-Lactam Antibacterials

inhibit formation of cross-linking peptides in peptidoglycan 1. penicillins 2. cephalosporins 3. miscellaneous (carbapenems/monobactams)

mechanism of action for beta lactam antibacterials

inhibits synthesis of bacterial cell wall. binds with proteins-> produces defective cell wall (weakens), which destroys microorganisms

an antibiotic used for the treatment of tuberculosis. For active tuberculosis it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol. For latent tuberculosis it is often used by itself.

isoniazid

treatment of TB highly specific for mycobacterium tuberculosis

isoniazid

what is a drug(s) that is used to treat latent TB infection that can be used to treat latent TB infections that can be used once a day for 6 months (180 doses) or twice weekly for 6 months (52 doses)

isoniazid

the most commonly used anti-TB drug and the prototype, is bactericidal, relatively inexpensive, and nontoxic. Although use by itself for treatment of latent TB is appropriate, use with other anti-TB drugs is essential for treatment of active TB

isonizaid (INH)

oral prototype for Azoles

itraconazole

topical prototype for Azoles

ketoconazole

treatment for cutaneous fungal infections

ketoconazole

what lab should be monitored when taking antimycobacterials

liver function

used to treat infections caused by Gram-positive bacteria (e.g., Streptococcus pneumoniae) and limited Gram-negative bacteria (e.g., Bordetella pertussis, Haemophilus influenzae), and some respiratory tract and soft-tissue infections.

macrolides

-mycin drugs

macrolides/ ketolides drugs or aminoglycosides

-Alternate to PCN allergy -Meds: erythromycin (PO, eye, IV), azithromycin (PO,IV) -Inhibit protein synthesis; inhibit RNA to bind to other RNA -Block reproduction of bacteria, if large enough dose, can be cidal

macroslides (Static)

tropical regions; only human beings can be hosts from mosquitoes; eventually chills and fever

malaria

used to treat skin infections, rosacea and mouth infections (including infected gums and dental abscesses). It's used in the treatment of conditions such as bacterial vaginosis and pelvic inflammatory disease.

metronidazole

what drug is commonly used to treat Giardiasis

metronidazole

what is the prototype for amebicides

metronidazole

-Active against many strains that are ATB resistant -Does not cause kidney damage or hearing loss (as can aminoglycosides) -Indications for use -Urinary tract, skin/skin structures, lower respiratory tract, intra-abdominal, and gynecologic infections, septicemia

monobactams

its use include infections of the urinary tract or lower respiratory tract, intra-abdominal and gynecologic infections, septicemia, and cutaneous infections caused by susceptible organisms.

monobactams

amoxicillin and clavulanic acid are used especially against what type of gram infection

negative

interactions for chloroquine (Aralen)

no known interactions

-cillin drugs

penicillin

What was the first ATB developed

penicillin

what drug delays the excretion of penciliin PO

probenecid

what is a drug(s) that is used to treat latent TB infection that can be used to treat latent TB infection and can be used daily for four months (120 doses)

rifampin

Parasitic infections of the skin; Skin infections: itch mite or 3 types of lice; Highly communicable and transmitted by direct contact; causes extreme pruritus

scabies and pediculosis

action of Isoniazid

selective for mycobacteria, inhibiting formation of bacterial cell walls. The drug not only kills actively growing intracellular and extracellular organisms but also inhibits the growth of dormant organisms in macrophages and tuberculous lesions.

Inhibits folic acid synthesis-req for DNA, RNA, and cellular synthesis

sulfonamides

-cycline drugs

tetracyclines

Inhibit protein synthesis-inhibit RNA to bind to other RNA

tetracyclines

Anti-helmintic medications work by:

these drugs function either by destroying the worms on contact or by paralyzing them, or by altering the permeability of their plasma membranes. The dead worms then pass out of the body in the feces.

ingesting undercooked meats, cat feces; serious infection in AIDS patients; (pyrimethamine and sulfadiazine, plus folinic acid)

toxoplasmosis

acyclovir (Zovirax) IV therapeutic uses

treats severe viral infections in clients who are immunocompromised

acyclovir (Zovirax) oral therapeutic use

treats symptoms of severe viral infections in clients with normal immune systems.

acyclovir (Zovirax) Topical therapeutic use

treats symptoms of viral infections such as cold sores, initial genital herpes outbreaks, and mild viral skin infections for clients who are immunocompromised.

Single-cell protozoan; STD (Metronidazole) Treat partner(s)Use a condom!

trichomoniasis

true or false antimycobacterials (TB) antitubercular drugs cant be taken with antacids

true

-No action inside urinary tract -Interfere with RNA/DNA producing enzymes

urinary trach antiseptics

mechanism of action of monobactams

weaken/destroy cell wall

Antifungal medications work by:

work by inhibiting the growth of new fungi and killing the existing ones.

what is a common condition that antifungals are used to treat

yeast (candida)