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