Pharm Exam 2
the nurse is preparing to administer famciclovir 500 mg prescribed orally once a day to a patient admitted with exacerbated chronic obstructive pulmonary disease who has developed shingles. the nurse reviews laboratory test results that include estimated glomerular filtration rate 35 mL/min. what should the nurse do?
administer the drug as ordered
the MAR has azithromycin listed to be administered at 0800. breakfast arrives on the nursing unit around 0800, lunch at 1230, and dinner at 1730. the patient does not receive any antacids. what should the nurse do?
administer the drug at 0800, as azithromycin may be administered with food
a patient with a penicillin allergy is prescribed erythromycin ethylsuccinate 250 mg every 6 hours for pneumonia caused by Haemophilus influenzae. the medication administration record has the medication scheduled at 0600, 1200, 1800, and 2400. on the second day of therapy, the patient complains that he does not like taking the drug because it causes heartburn. what would be an appropriate intervention by the nurse?
administer the drug with food
the nurse is reviewing new laboratory results, including estimated glomerular filtration rate (eGFR) 82 mL/min for a patient receiving cefotetan 2 g every 12 hours. what should the nurse do?
administer the medication
vancomycin is being administered by mouth for pseudomembranous colitis caused by Clostridium difficile. the nurse receives laboratory results on the patient that include creatinine 2.2 mg/dL. what should the nurse do?
administer the medication
a patient is prescribed adefovir 10 mg by mouth once a day. results of recent laboratory tests include CrCl 62 mL/min. what nursing action is warranted?
administer the medication as prescribed
erythromycin uses
against gram positive and some negative bacteria (legionella pneumonia, pertussis, diphtheria, chlamydia)
a patient with a history of hypertension controlled by an angiotensin-converting enzyme inhibitor is prescribed linezolid for a vancomycin-resistant enterococcal (VRE) infection. the patient should be instructed to avoid consuming what substance while on this antibiotic?
aged cheese
which laboratory result, if present, would be a reason to withhold administering cefotetan to an adult male and to notify the prescriber?
alanine aminotransferase (ALT) 245 international units/L
a 35 yo. woman reports a yellow-green vaginal discharge. she is diagnosed with trichomoniasis and prescribed metronidazole. it is important for the nurse to teach the patient the importance of not consuming
alcohol
cefazolin has been prescribed at discharge for a patient with pelvic inflammatory disease. due to the possibility of a disulfiram-like reaction, during discharge teaching it is important for the nurse to teach the patient to avoid consuming what?
alcohol
#1 adverse effect of Penicillin G
allergic reactions
most common adverse effects of cephalosporins
allergic reactions (patients allergic to PCN have about a 1% risk of reaction with these)
which assessment is of greatest priority for the nurse to complete before administering a penicillin antibiotic?
allergy history
adamantanes
amantadine, rimantadine
the prescriber has asked the nurse to provide teaching for a 34 yo. female patient who has requested a prescription for rifaximin before a trip to Central America. teaching should include not administering the drug if the patient experiences what issues
amenorrhea, bloody stool, fever
bactericidal inhibitors of protein synthesis
aminoglycosides
ejection fraction
amount of blood pushed out the ventricles, direct relationship with cardiac output
the nurse would be concerned about the increased possibility of an allergic reaction when administering which antibiotic(s) if the patient's allergy record includes penicillin allergy?
ampicillin/sulbactam, piperacillin/tazobactam
which patient would most likely have an infection that is resistant to antibiotic therapy?
an adult who developed a wound infection while in the hospital after surgery
penicillinase-resistant penicillins
anti staphylococcal penicillins
warfarin
anti-coagulant
phenytoin
anti-convulsant
drugs or chemicals used to treat infectious diseases
antimicrobials
antimicrobial agent
any agent that can kill or suppress microorganisms
non-opportunistic diseases occur in
any host
retrovirus
any of a group of RNA viruses that insert a DNA copy of their genome into the host cell in order to replicate
people who should get a flu shot
anyone older than 6 mo. of age
what is the first thing the nurse should do when preparing to administer caspofungin?
assess the IV site
a patient who is prescribed tobramycin complains of a headache. what is the priority nursing action?
assess the onset, characteristics, and associated symptoms of the headache
a patient who has been receiving ketoconazole for 5 days experiences nausea and vomiting. what should be the initial response of the nurse?
assess the skin, abdomen, urine, and stool
an alert and oriented patient with a history of penicillin allergy is prescribed cephalexin. what is the priority action by the nurse?
assess the type of reaction that the patient had to the penicillin
a patient who is prescribed rilpivirine reports loss of interest in usual activities. which nursing action is of greatest priority?
assessing for thoughts of harming self
which action by the nurse would be a priority for preventing the most common complications of IV acyclovir therapy?
assessing the IV site before infusing the drug
when should flu vaccines be administered?
at least 2 weeks prior to flu season beginning
which step is most important for a female nurse to follow when administering valganciclovir?
avoid touching the drug
treatment of chlamydia
azithromycin, doxycycline
alternative to amphotericin B for most systemic mycoses
azoles
tetracycline is active against the ________ that cause anthrax
bacilli
autolysins
bacterial degradative enzymes involved in the normal remodeling of the bacterial cell wall
cephalosporin characteristics
bactericidal, resistant to B-lactamases, activate against a broad spectrum of pathogens, practically all are eliminated by the kidney, well tolerated, rare adverse effects
do immune-deficient patients need bacteriocidal or static drugs?
bacteriocidals, because their immune system won't catch up with bacteriostatic drugs
the nurse is reviewing the other OTC products taken by a patient who has been prescribed methenamine. which of these home treatments might reduce the urinary antiseptic action of methenamine?
baking soda in water for heartburn
systemic preparation of sulfonamides
based on duration of action
cyclic lipopeptide pharmacokinetics
becomes apart of the cell wall and then can't replicate
which is an acceptable reason for giving antibiotic prophylaxis?
before cardiac surgery
protection in flu vaccines
begins 1 to 2 weeks after vaccination, generally lasts 6 months or longer
what are carbapenems resistant to
beta-lactamases
which pre-drug administration assessment finding would be of most concern when a patient is prescribed telavancin?
bibasilar crackles
how do penicillins work
bind to penicillin binding proteins of the bacteria and disrupt the bacteria's cell wall synthesis causing bacterial cell lysis, rupture, and death
NNRTIs cause inhibition by
binding to active center of reverse transcriptase
antivirals suppress
biochemical processes unique to viral reproduction
which signs would most likely indicate the start of Stevens-Johnson syndrome when a patient is receiving sulfonamides?
blisters in the mouth
how does Enfuvirtide work
blocks entry of HIV into CD4 T cells
an HIV-positive patient is prescribed trimethoprim-sulfamethoxazole as treatment for active PCP infection. a priority nursing action is to monitor which laboratory tests?
blood urea nitrogen (BUN) and creatinine, complete blood count (CBC) and differential
use of daptomycin
bloodstream infection with S. aureus, and complicated skin structure infections caused by susceptible strains of gram-positive bacteria
facultative bacteria survive in what condition?
both anaerobic and aerobic
adverse effect of broad-spectrum antibiotic
bothersome diarrhea
kernicterus
brain damage caused by excessive jaundice
the nurse is reviewing test results for a patient who is prescribed itraconazole. which result would warrant immediate consultation with the prescriber?
brain natriuretic peptide (BNP) 745 pg/mL
MAO inhibition
breaks down chatecholamines
carbapenems
broad spectrum, synthetic b-lactam antibiotics that are structurally related to penicillins
tetracyclines
broad-spectrum antibiotics that inhibit micro-organism growth by preventing protein synthesis (bacteriostatic)
linezolid and dalfopristin/quinupristin can treat
bugs that are resistant to vancomycin
how were Penicillinase-resistant penicillins made
by altering the penicillin side chain, they are highly resistant to inactivation of beta-lactamases
how to NNRTIs differ from NRTIs
by structure and mechanism of action
how do cephalosporins kill bacteria
by weakening the cell wall and promoting bacterial lysis
chelating agents
calcium supplements, milk products, iron supplements, magnesium-containing laxatives, and most antacids
resistance tests
can be used to guide drug selection, especially when changing a regimen that has failed
superinfection common with cipro
candida (vaginal or pharynx), c. diff
drugs used for systemic opportunistic mycoses
candidiasis, aspergillosis, cryptococcosis, mucormycosis
azoles principal adverse effects
cardiosuppression and liver damage
the nurse is caring for a patient who has repeated episodes of UTIs caused by e-coli treated with TMP/SMZ. what is the priority nursing action to prevent reoccurrence of infection?
carefully wiping from front to back during perineal care
which are valid reasons for prescribing two different antibiotics?
cases of infection with Mycobacterium tuberculosis, results of C&S indicate multiple organisms, severe infection in the immunocompromised patient
treatment of PID
caused by multiple organisms, so broad coverage and combination therapy are required
pseudomonas aeruginosa
causes pneumonia in immunocompromised patients
gonococcal infections in neonates
ceftriaxone one dose, topical eye antibiotic
outpatient treatment for PID
ceftriaxone or cefoxitin, should also include doxycycline, may be used with or without metronidazole
vancomycin
cell wall inhibitor, does NOT contain a beta-lactam ring
drugs work on
cell wall synthesis, cell membrane permeability, protein synthesis, nonlethal inhibitors of protein synthesis, synthesis of nucleic acids, antimetabolites, viral enzyme inhibitors
the nurse reached a patient who has been prescribed oral tetracycline that the medication should not be taken with which OTC medications
centrum silver, ferrous sulfate, TUMS
what is an often appropriate alternative of mild PCN allergy
cephalosporin
treatment of gonococcal infections
cephalosporins, quinolone
MRSA
certain bacterial strains known collectively as methicillin-resistant staphylococcus aureus
syphilis primary stage
chancre
influenza vaccines
changed yearly based on identification of strains by the CDC, FDA, and WHO
it would be logical that which populations should not receive influenza A or B nasal vaccine because it is a live attenuated virus and is administered by spraying into the respiratory tract?
children or adolescents receiving aspirin therapy, children younger than 5 years of age who have had recurrent episodes of wheezing with respiratory infections, people who are HIV-positive, people prescribed disease-modifying antirheumatic drugs for rheumatoid arthritis, people with asthma
people who should not get the flu shot
children younger than 6 mo., people with severe life-threatening allergies
most common bacterial STD in the US
chlamydia trachomatis
HIV is now considered a
chronic disease
drug choice for anthrax
cipro
fluoroquinolones prototype
ciprofloxacin (Cipro)
a patient received a neuromuscular blocking agent during surgery. in the post anesthesia care unit, the prescriber orders gentamicin 40 mg IV STAT. what is the most appropriate nursing action?
clarify the order
what drug causes fatal c. diff
clindamycin
topical drug of choice for dermatophytic infections and candidiasis of skin, mouth, and vagina
clotrimazole
major adverse effects of amino glycoside antibiotics include damage to the
cochlea, kidneys, vestibular apparatus
to achieve maximum absorption of itraconazole capsules, the nurse administers the drug with which liquid?
cola
Maraviroc use
combined use with other antiretroviral drugs to treat patients age 16 years and older who are infected with CCR5-tropic HIV-1 strains
what is the priority nursing action before administering an amino glycoside to a patient with an estimated glomerular filtration rate of 50 mL/min?
compare prescribed dose to recommended dose
symptoms in men with gonorrhoeae
complaints of burning sensation with urination and pus draining from penis
it would be a priority to monitor which laboratory test when a patient is prescribed a linezolid?
complete blood count (CBC) and differential
when performing shift assessment, the nurse notes a maculopapular rash over the trunk of a patient who has been taking a ceftriaxone for 4 days. what is the priority nursing action?
complete the assessment
a patient who is receiving IM ceftriaxone 250 mg x one plus azithromycin 1 g by mouth for disseminated gonococcal infection complains of a stiff neck. which of these nursing actions should be performed first?
complete the nursing assessment
ergosterol
compound on fungal cell membrane
neuromuscular blockade
concurrent use with neuromuscular blocking agents, general anesthetics, and in myasthenia gravis
older patient adverse effects with cipro
confusion, somnolence, psychosis, visual disturbances (CNS)
which assessment finding suggests hypokalemia and should be reported to the prescriber of moxifloxacin?
constipation and weakness
the nurse is preparing to administer an IV mini-bag of ceftriaxone in 50 mL of 5% dextrose to an infant. the infant has an IV of lactated Ringer's solution infusing at 35 mL/h. what should the nurse do?
consult with the prescriber
A consulting urologist orders ciprofloxacin 250 mg twice a day for a 72 year old woman with a UTI. The patient is also receiving ferrous sulfate 300 mg for anemia and calcium carbonate 400 mg 4 times a day for osteopenia. what should the nurse do?
consult with the provider for directions
the nurse would be concerned about toxicity if a patient receiving penicillin G had which laboratory result?
creatinine 2.6 mg/dL
the nurse is reviewing laboratory tests before preparing to administer a dose of amphotericin B. before administering the drug, it is a priority to review which lab result?
creatinine levels
CNS laboratory test
culture and sensitivity
a patient with a systemic fungal infection is prescribed amphotericin B and flucytosine. the nurse expects what drug interaction?
decreased risk of amphotericin toxicity
which assessment finding would be of greatest priority to report to the prescriber if identified in a patient who is receiving lamivudine, adefovir, or entecavir for hepatitis B because it suggests possible lactic acidosis?
deep, rapid breathing
Penicillins are able to _________ many bacteria when taken as prescribed
destroy
syphilis tertiary stage
develops 5 to 40 years after initial infection, fatal illness
Penicillins can cause _________ by altering the normal gastrointestinal (GI) flora
diarrhea
adverse effects of Linezolid
diarrhea, nausea, headache, myelosuppression
antibiotics have _________ penetrating an abscess
difficulty
tests to determine drug susceptibility
disk-diffusion test, serial dilution, gradient diffusion
how does selective toxicity work
disruption of bacterial protein synthesis and cell wall, inhibition of an enzyme unique to bacteria
ethacrynic acid
diuretic that's ototoxic so increases ototoxic effect if given with another ototoxic drug
PCN past allergic reaction
does not necessarily mean that an intense reaction will occur again
drugs with renal impairment
dosages must be lowered
what is the drug of choice for MRSA?
doxycycline
when to take trough levels for once-daily doses
draw a single sample 1 hour before the next dose
uses of Amphotericin B
drug of choice for most systemic mycoses
major groups of antifungal agents
drugs for: 1) systemic mycoses/infections 2) superficial mycoses/infections
bacteriostatic
drugs that can slow bacterial growth (until the immune system catches up) but do not cause cell death
the nurse is preparing to administer IV acyclovir. it would be a priority for the nurse to provide nursing interventions for which assessment finding?
dry, sticky oral mucous membranes
which of these assessment findings, if identified in a patient who is receiving nitrofurantoin, should the nurse report to the prescriber immediately?
dyspnea
which laboratory test result is of greatest priority to review before the nurse ministers nitrofurantoin?
eGFR
indicated for ringworm infections and superficial candidiasis
econazole
most oral tetracyclines should be taken on an ________ ___________
empty stomach
gentamicin and PCN
enhances bacterial effect bc gentamicin has to get into cell (but can't be given at the same)
the throat culture of a 6 yo. boy is positive for N. gonorrhoeae. what is the nursing priority in this situation?
ensuring the safety of the child
chlamydia in infants
erythromycin base or succinate for two weeks, eye ointment after birth
a patient is prescribed erythromycin. what is one reason why careful review of all drugs this patient is prescribed is important?
erythromycin can increase levels of warfarin and cause bleeding
what can aminoglycosides and gentamicin cause
nephrotoxicity and ototoxicity (inner ear), hypersensitivity reactions, neuromuscular blockade
adverse effects of amphotericin B
nephrotoxicity, hypokalemia (from kidney damage), bone marrow suppression, phlebitis
enzyme required for replication of the flu
neuraminidase
sulfonamides can cause the adverse effect of kernicterus. how does this present?
neurologic defects in neonates caused by deposition of bilirubin in the brain
superinfection
new infection that appears during the course of treatment for a primary infection, because they are caused by drug-resistant microbes, they are often hard to treat
how many flu vaccines on the market?
nine
how many protease inhibitors are there
nine
urinary tract antiseptics
nitrofurantoin (Macrobid), Methenamine, Pyridium
when administering drugs that are potentially nephrotoxic, the nurse should consult the prescriber before administering which OTC drugs?
non-steroidal anti-inflammatory drugs (NSAIDS)
antibiotics must
not be discontinued prematurely
the nurse is caring for a neonate whose mother has an active infection with N. gonorrhoeae. a priority nursing outcome for the neonate relating to possible infection during vaginal delivery is that the neonate will
not experience conjunctival discharge
a patient has been prescribed nitrofurantoin for recurrent UTIs. the nurse should teach the patient to do what?
not to take the drug if there is any chance that she might be pregnant, report any shortness of breath and coughing, report the onset of numbness or tingling, use caution when driving because the drug can cause drowsiness
methicillin
now obsolete due to staph bacterial resistance (PBP in the bacteria to which penicillinase-resistant PCN cannot bind), caused nephritis
the nurse should include in teaching to a patient who has been receiving linezolid to immediately report which symptom of a rare adverse effect that has been associated with prolonged therapy?
numbness of tingling in any extremity
the nurse has consulted the prescriber because a patient reports an allergy to the prescribed penicillin antibiotic. the prescriber is aware of the allergy, but the patient is experiencing a life-threatening infection and no other suitable antibiotic is available. what is the priority nursing action?
obtain orders for treatment of a possible allergic reaction
a prescriber's orders for a new admission include urine culture and sensitivity and ciprofloxacin 400 mg IV every 12 hours. what is a priority nursing responsibility?
obtain the urine culture specimen before administering the antibiotic
symptoms in women with gonorrhoeae
often asymptomatic or mild cervicitis, serious infection may result in sterility
all patients are at risk for developing tendon rupture when prescribed a fluoroquinolone. which patients have an increased risk?
older adult patients, patients who are prescribed glucocorticoids, patients who are post-solid organ transplantation
when administering adefovir, which assessment would suggest that therapy could be toxic?
oliguria
how should an enteric-coated erythromycin base be administered?
on an empty stomach, whole, not chewed, with a full glass of water
why do we want to give ceftriaxone for patients with gonococcal infections
once and done
over time, what develops resistance
organisms
how might acquired resistance to antimicrobial drugs happened?
organisms may have been highly responsive and then became less susceptible to one or more drugs
topical antiviral drugs used for herpes labialis
penciclovir, docosanol
"the shot"
penicillin
drug of choice for all stages of syphilis
penicillin G
prototype of natural penicillins
penicillin G
PBP
penicillin binding proteins
beta-lacatamase inhibitor
penicillinase
cephalosporins are analogous to
penicillins (beta-lactam antibiotics)
these drug classes all weaken the cell wall
penicillins, cephalosporins, carbapenems, monobactams
gentamicin has interactions with
penicillins, ototoxic drugs, nephrotoxic drugs, skeletal muscle relaxants
the nurse would consult the prescriber regarding oral administration of linezolid oral suspension if the nurse discovered the patient has a history of which disorder?
phenylketonuria
the nurse reviews current laboratory test results before administering piperacillin/tazobactam. it would be a priority to report which laboratory result to the prescriber?
platelets 100,000/mL
systemic antifungals
polyene antibiotics, azoles, echinocandins, pyrimidines
a patient who takes glyburide for type 2 diabetes mellitus is prescribed trimethoprim-sulfamethoxazole for a urinary tract infection. because of the possibility of intensifying the effect of the glyburide, the nurse should assess for
sweating and irritability
the nurse is administering cipro to a patient who receives theophylline for asthma. because of the potential drug interactions, the nurse should monitor theophylline levels and assess for
tachycardia
weight-bearing exercise and adequate calcium intake are most important if antiretroviral therapy includes
tenofovir
usually going to be "second-line" drugs
tetracyclines
bacteriostatic inhibitors of protein synthesis
tetracyclines, macrolides, oxazolidinones, streptogramins
what is a potential problem of patients' self-prescribing OTC miconazole for vaginal discharge?
the cause may not be a yeast infection
where does the nurse obtain the most accurate information about nursing care of STIs?
the centers for disease control and prevention
why does long-acting clindamycin cream require only one dose vaginally to treat bacterial vaginosis?
the cream adheres to the vaginal mucosa for several days
what organ is most antibiotics harmful to
the kidneys
the recommended treatment for acute epididymitis is different depending on the age of the patient because usually
the method and organism of infection is different
why was PCN named penicillin?
the mold belonged to the genus penicillium
MRSA unique mechanism of resistance
the production of PBPs with a low affinity for PCN and all other beta-lactamase antibiotics
the nurse is taking a history from the spouse of a patient who was admitted in a septic state and prescribed an aminoglycoside antibiotic. which question is most important to ask the patient's spouse about the patient's history?
what medications is your spouse currently taking?
which assessment finding would be a priority to report to the prescriber if it occurred after administration of a large IV dose of penicillin?
wheezing
which new assessment finding would be most significant if noted in an infant who is receiving inhaled ribavirin for RSV?
wheezing throughout the lung fields
a child is prescribed amoxicillin. when asked if their son is allergic to penicillin, the child's parents state that the child has never received any medication except immunizations. why is it important to assess for an allergic response despite this history?
people can have an initial exposure to penicillin present in foods
which assessment finding would best indicate that antiretroviral therapy is currently effective?
plasma HIV RNA below 20-75 copies/mL
the nurse is administering trimethoprim to a patient who has a history of alcohol use disorder. because folate deficiency is associated with alcohol use disorder, the nurse should assess for symptoms of possible adverse effects of trimethoprim, which include
pallor and sore throat
c. difficile definition
passage of 3 or more unformed stools within 24 hours, and a positive stool test
due to cross sensitivity
patients allergic to one penicillin should be considered allergic to all penicillins
a hospitalized HIV-positive patient who is prescribed indinavir complains of sharp, colicky flank pain. in addition to notifying the prescriber, which nursing intervention would be most appropriate?
strain urine
Penicillin G is drug of choice for
strep pneumonia, meningitis, pharyngitis and endocarditis, helpful in prophylaxis in preventing syphilis
sulfonamide used for systemic intermediate preparations
sulfamethoxazole
sulfonamide used for systemic short acting preparations
sulfisoxazole
organisms with microbial drug resistance aka
super bugs
which statement about superinfections does the nurse identify as true?
superinfection is defined as a new infection that appears during the course of treatment for a primary infection
if chlamydia in children
suspect child abuse
when to sample trough levels for divided doses
take a sample just before the next dose
what is true about nitrofurantoin and methenamine?
therapeutic levels are achieved only in urine
why can protease inhibitors alter other drugs
they are metabolized by the P450 system
why do aminoglycosides have to be given IV
they are not absorbed in the GI tract
an HIV-positive patient who is receiving maraviroc reports to the nurse that he has vomited and is experiencing severe abdominal pain. assessment reveals a generalized pruritic rash. which action is appropriate?
withhold the maraviroc and contact the prescriber
a patient is prescribed an antibiotic to treat a urinary tract infection. what statement by the patient indicates a need for further teaching?
"I can stop the medication as soon as the symptoms have disappeared"
polyene systemic antifungal drugs
Amphotericin B
broad-spectrum PCNs
Ampicillin Amoxicillin
use of trimethoprim
initial therapy of acute, uncomplicated UTIs
first-generation cephalosporins are not effective against ___________________
methicillin-resistant MRSA
a patient taking lopinavir/ritonavir oral solution should not be prescribed which other drugs
metronidazole, disulfiram
topical drug of choice for dermatophytic infections and for cutaneous and vulvovaginal candidiasis
miconazole
the _________ becomes resistant, not the __________
microbe (organism), patient
some _________ can change so that they stop taking antibiotics into the cell
microbes
which organism was previously susceptible to penicillin, but has developed resistance to penicillin G?
Gonorrhea caused by Neisseria gonorrhoeae
small risk in flu vaccines for
Guillain-Barre syndrome
mores serious infections that can develop in the blood stream and lungs during MRSA which can be fatal
HCA-MRSA, CA-MRSA
when would UTI occurrence in males be likely
with associated complications (septicemia, pyelonephritis)
Raltegravir use
with other antiretroviral agents to treat adults infected with HIV-1
the extent of antibiotic use affects resistance
The more that antibiotics are used, the faster drug-resistant organisms emerge
which of these laboratory tests would be a priority for the nurse to assess when a patient is receiving an aminoglycoside?
creatinine
which action, when administering enfluviritide, would increase the risk of a severe injection-site reaction?
injecting the drug deep into a muscle
HCA-MRSA
spread in health care environment, risks include advanced age, surgery, dialysis, ICU, prolonged antibiotic therapy, indwelling catheters
what is the priority reason why the nurse teaches a patient who is prescribed sulfamethoxazole to take this medication with a full glass of water?
minimize crystal formation in the urine
the nurse is preparing to administer IV ciprofloxacin to a patient with septic arthritis after arthroscopic surgery. it would be a priority to review which ordered diagnostic test result as soon as it is available?
culture and sensitivity
________ reduces symptoms of rheumatoid arthritis
minocycline
the nurse is teaching a patient about the need for multiple-drug therapy for HIV. which statement, if made by the patient, would indicate a need for further teaching?
"the virus recognizes the antibiotic and is able to change to prevent being destroyed"
a college student who has been diagnosed with her first genital herpes infection is discussing the condition and prescribed topical acyclovir treatment with the college health center nurse. which statement, if made by the patient, would suggest that the patient needs teaching about this condition and drug therapy?
"using the ointment as soon as I get a sore will stop the outbreak"
adverse effects of tetracyclines
(1) G.I. Irritation (2) superinfection (3) photosensitivity (4) hepatic toxicity - especially in pregnancy (5) Renal toxicity -esp. in patients with kidney disease (6) depression of skeletal growth (esp. in premature infants) (7) dental enamel staining
purine nucleoside analogs mechanism
- DNA polymerase inhibitor - Suppress synthesis viral DNA - Incorporated into DNA
adverse effects of cipro
- GI irritation - CNS (headache, dizziness, confusion, restlessness - phototoxicity - superinfection - tendon rupture
Zidovudine (Retrovir)
- NRTI - inhibits replication by suppressing synthesis of DNA
adverse effects of zidovudine
- hematologic toxicity - lactic acidosis with hepatomegaly - myopathy - GI effects - CNS reactions
which infection would be classified as a superinfection?
monilial vaginal infection that develops during antibiotic therapy
how does the nurse prevent ototoxicity
monitor trough levels
broad-spectrum antibiotics kill _______ competing organisms than do narrow-spectrum drugs and do the most to facilitate emergence of ___________
more, resistance
metronidazole uses
- protozoal infections - infections caused by obligate anaerobes - Helicobacter pylori - C. diff
pyridium
- relieves urinary tract pain, burning, irritation, improves comfort - not an antibiotic (will not change course of infection) - turns urine reddish-orange
why is azithromycin ideal for chlamydia treatment
once and done
fidaxomicin use
only for diarrhea associated with C. diff infection
when ahminoglycosides are prescribed IV as a once-daily dose, it is important to monitor trough levels
1 hour before the next dose
what is vanco reserved for treating?
severe infections such as MRSA, C. diff, and others
the nurse reviews the laboratory results of a female patient who is prescribed voriconazole 200 mg by mouth. which laboratory result warrants withholding the drug and immediately notifying the prescriber?
human chorionic gonadotropin (hCG) 172 international units/mL
People can drastically reduce their chance of catching methicillin-resistant Staphylococcus aureus (MRSA) by simple _________ __________
hygiene measures
risk with MAO inhibitors
hypertensive
what is the most important role of the nurse when treatment failure occurs?
identifying factors that may have contributed to treatment failure
valacyclovir (valtrex) uses
shingles, genital herpes, cold sores, chickenpox
chelation
if given with one of the certain minerals, it will precipitate and not be absorbed
then nurse is preparing to administer daptomycin. who should the nurse withhold the medication and contact the prescriber?
if the patient reports sudden severe muscle pain
when would tetracyclines be first line drugs
if there is an allergy or resistance to the other first choice
infusion reaction from amphotericin B occurs
1-3 hours after start of infusion and last for about 1 hour
at what point is the patient most likely to experience fever, chills, rigors, nausea, and headache when receiving amphotericin B?
1-3 hours after the infusion begins
accelerated PCN reaction time
1-72 hours after
what should all patient who are candidates for penicillin therapy be asked
if they have PCN allergy
prototype of carbapenems
imipenem-cilastatin (Primaxin)
types of penicillin reactions
immediate, accelerated, delayed reaction
opportunistic diseases are in
immunocompromised host
immunoglobin that mediates anaphylaxis
immunoglobin E
how was PCN discovered?
in 1928, while studying staphylococcus variants in the laboratory of st. mary's hospital in london
transmission of HIV
in blood and all body fluids
types of penicillinase resistant penicillins
1. oxacillin 2. dicloxacillin 3. nafcillin 4. methicillin
advantage of azithromycin
short course of treatment
Penicillin G dosage in neurosyphilis
18-24 million units daily for 14 days, continuous infusion
_________ million doses of antibiotics are given in hospitals each day
190
when did modern antimicrobials arise?
1930's and 1940's
how to you administer cipro
orally or IV
penicillin G referred to as
simply Penicillin
Penicillin G dosage in early syphilis
single IM dose benzathine PCN 2.4 million units
fosfomycin
single PO dose for uncomplicated UTIs in women
ceftriaxone 1 g intramuscular is ordered for a 130 lb woman. the drug is reconstituted to a solution of 250 mg/mL. how should the nurse administer it?
2 mL each in the right and left ventrogluteal muscles
syphilis secondary stage
2 weeks after chancre heals, secondary syphilis develops
the germ that causes MRSA is commonly found on the ________
skin
what assesses current risk of PCN allergy
skin tests
gentamicin half life
2-3 hours
immediate PCN reaction time
2-30 minutes after drug is administered
which goal is the most appropriate when a patient is prescribed metronidazole for c-diff?
soft, formed stool
mechanisms for acquired resistance
spontaneous mutation, conjugation
Penicillin G dosage in late syphilis
2.4 million unions IM, every week for 3 weeks
percentage of UTIs in young sexually active women
25%-35% develop at least one a year
what type of organisms are susceptible to penicillins?
organisms that have a cell wall and are actively growing
HIV integrase use
inserts its DNA into mamilial cells
nursing interventions when administering cephalosporins include
instruct the patient to immediately report pain or warmth of IV site, store oral suspensions in the refrigerator
drug interactions of sulfonamides
intensifies: - warfarin - phenytoin - hypoglycemics
when used to treat colonized Methicillin-resistant staphylococcus aureus (MRSA), mupirocin is administered in which way?
intranasally
topical treatment of tinea infections
oxiconazole and sulconazole
a patient is admitted to the hospital with a diagnosis of PID. she asks the nurse why her prescriber has recommended hospitalization and IV antibiotics instead of antibiotic therapy at home. what is the basis of the nurse's response?
inadequately treated PID is more likely to cause scarring of the fallopian tubes
a nursing measure to prevent the most common adverse effect of daptomycin is to
include increased fiber and fluids in the patient's diet
PID
includes endometritis, pelvic peritonitis, tuba-ovarian abscess, and inflammation of the fallopian tubes
decreased excretion =
increase drug levels in the body
prototype of macrolides
erythromycin
when should samples of peak levels be taken
30 minutes after giving an IM injection or after completing a 30-minute IV infusion
percentage of UTI in older women in nursing homes
30%-50% have bacteria at any given time
which drug may prevent absorption of itraconazole, no matter when it is administered?
esomeprazole
tendon rupture with cipro
especially in children younger than 18, or people older than 60, patients on glucocorticoids, or organ transplant recipients
which result would be of greatest priority to report to the prescriber of cefotaxime?
estimated glomerular filtration rate (eGFR) 48mL/min
the nurse is aware that the risk of ototoxicity is significantly increased if a hypertensive patient is also receiving which medication?
ethacrynic acid
history of PCN by 1941
experiments were conducted on patients desperately ill with staphylococcal and streptococcal infections, some whom were on the oxford police force
drugs used for non-opportunistic systemic mycoses
sporotrichosis, blastomycosis, histoplasmosis, coccidioidomycosis
in most infections, the level of antibiotic at the site of infection needs to be
4-8 times the MIC
the nurse reached that to be well absorbed, which form of clarithromycin must be administered with food?
extended-release tablets
conjugation
extrachromosomal DNA is transferred from one bacterium to another, gram-negative bacteria, multiple drug resistance
cost of microbial drug resistance per year
5-24 billion
which laboratory result, if identified in a patient who is receiving dalfopristin/quinupristin, should the nurse report to the prescriber immediately?
ALT 250 IU/L
second-generation cephalosporins have _________ resistance to B-lactamases produced by gram-negative organisms
increased
which situation would warrant assessing for candida infection when the nurse is caring for a 6 mo., breast-fed infant who is prescribed cipro for pyelonephritis?
infants suckling is interrupted by crying
what are extended spectrum PCNs used primarily for
infections with pseudomonas aeruginosa
it would be a priority to report which symptoms in a patient who is prescribed the -azole antifungal drug fluconazole?
fever and blisters in the mouth
PCN cross sensitivity to cephalosporins
few patients, about 1%
used for oral therapy of vulvovaginal candidiasis, oropharyngeal candidiasis, and onchomycosis
fluconazole
thrombophlebitis
inflammation of a vein associated with a clot formation
the nurse assesses a 6 yo. child who is receiving cipro for a complicated UTI. what is a priority concern?
fluid and electrolyte balance
what is bacterial growth determined by
food and space
if possible granulo/thrombo cytopenia is possible what laboratory tests need to be done
CBC
drug interactions in dalfopristin/quinupristin
CYP3A4
why would you have to give acyclovir through IV
for faster treatment with no limitations of absorption
Clarithromycin
for respiratory tract, skin, and other diseases
antimicrobial effects of antibiotic combinations
Additive, potentiative, antagonistic
tinea corporis
fungal infection of the body
tinea pedis
fungal infection of the foot; athlete's foot
tinea cruris
fungal infection of the groin
empiric therapy
Antibiotic therapy for patients before causative organism is positively identified
drug of choice for chlamydia
Azithromycin (bc one time dose)
monobactam prototype
Aztreonam (Azactam)
what viruses can cause chronic hepatitis
B, C, and D
lab tests for aminoglycosides to watch for adverse effects
BUN, creatinine, serum levels
transpeptidases
Bacterial enzymes involved in the cross-linking of linear peptidoglycan chains, the final step in bacterial cell wall synthesis
____________ is the only cephalosporin with activity against MRSA
Ceftaroline
most widely used antibiotics
Cephalosporins
other macrolides
Clarithromycin (Biaxin) Azithromycin (Zithromax)
metronidazole inhibits
DNA synthesis in certain microbes
tinea capitis
fungal infection of the scalp
low doses of doxycycline can be used to prevent destruction of ___________ connective tissue
gingival
adverse effects of nitrofurantoin
GI upset, brown/rust color urine, peripheral neuropathy
what do we do sometimes to avoid penicillinase from breaking down PCN's
give PCN with another antibiotic
how antibiotic use promotes resistance
Drugs make conditions favorable for overgrowth of microbes that have acquired mechanisms for resistance, kill off competing organisms that would make organisms resistant
bacteriocidal
Drugs that are directly lethal to bacteria at clinically achievable concentrations
preferred agent for treating HIV, only NNRTI for first-line HIV therapy
Efavirenz (Sustiva) - NNRTIs
only HIV fusion inhibitor
Enfuvirtide (Fuzeon)
80% of uncomplicated and community-acquired UTIs caused by
Escherichia coli
adverse effects of fluconazole
GI irritation symptoms
e-mycin adverse effects
GI irritation, prolongs QT interval, cholestatic hepatitis, superinfections, phlebitis
why do cephalosporins need to be given IV or IM
GI sensitivity, must monitor for thrombophlebitis
host factors
Host defenses Site of infection Previous allergic reactions Genetic factors
administration of daptomycin
given only once daily through IV, no laboratory work needed
second leading STD in US
gonorrhoeae
causes of PID
gonorrhoeae, chlamydia
what are most hospital-acquired UTIs caused by
Klebsiella, Proteus, Enterobacter, Pseudomonas, staphylococci, enterococci, E. coli
many people have _______ in their nose and don't know
MRSA
multi-drug resistant infections
MRSA, VRE
Non-Nucleoside Reverse Transcriptase Inhibitors
NNRTIs
Nucleoside Reverse Transcriptase Inhibitors
NRTIs
0.4 - 7% of people have some type of
PCN allergy
which are among the safest antibiotics
PCNs, they are not very toxic
public health action plan to combat antimicrobial resistance Focus Area II:
Prevention and Control
public health action plan to combat antimicrobial resistance Focus Area IV:
Product Development
HIV integrase strand transfer inhibitors
Raletgravir (Isentress)
extended spectrum PCN good at killing
gram negative bacteria
public health action plan to combat antimicrobial resistance Focus Area I:
Surveillance
disulfiram reaction
Symptoms include flushing of the skin, accelerated heart rate, shortness of breath, nausea, vomiting, throbbing headache, visual disturbance, mental confusion, postural syncope, and circulatory collapse
Enfuvirtide is widely known as
T-20
what is frequently the treatment of choice for oral therapy of UTIs
TMP-SMZ and nitrofurantoin
Staphylococcus aureus
gram positive bacteria, often colonizes on the skin and nostrils of healthy people
what type of bacteria is harder to treat
gram-negative
serious side effects of ganciclovir
granulocytopenia, thrombocytopenia
extended spectrum penicillins
Ticarcillin Piperacillin
what is syphilis caused by
Treponema pallidum
history of PCN in 1942
US began its PCN use with the first clinical trials at Yale and the Mayo Clinic
what is an example of a complicated UTI?
UTI caused by prostatic hypertrophy
uses of TMP-SMZ
UTI, Pneumocystis carinii, shigellosis, OM, bronchitis, pertussis
what are sulfonamides mostly used for
UTIs
principal indication of dalfopristin/quinupristin
VRE
drug of choice for MRSA
Vancomycin
how is Amphotericin B highly toxic
infusion reaction and renal damage occur in many patients, must be given IV, no oral administration
many drugs that are prescribed for HIV infection _________ enzymes needed for viral reproduction
inhibit
disadvantages of azoles
inhibit P450 drug-metabolizing enzymes and can increase levels of many other drugs
Penicillins are only active against bacteria that are undergoing ______ and ___________
growth, development
Cephalosporins are often resistant to ____________
beta-lactamases
neuraminidase inhibitors
inhibits enzyme needed for viral replication, Oseltamivir, Zanamivir
the nurse would withhold ganciclovir and notify the prescriber if patient lab test results included
hCG 2775 mIU mL
chancre
hard, red, protruding, painless sore
the nurse is caring for a patient who is receiving gentamicin twice a day. peak and trough levels were drawn after the fourth dose. results were peak 3 mcg/mL and trough 0.6 mcg/mL. what should the nurse do?
continue nursing care
a patient who is receiving ceftazidime has three loose, brown bowel movements in 24 hours. what should the nurse do?
continue to administer the drug and notify the prescriber of the change in BMs
how could someone have a PCN allergy without being on the medication?
could have been exposed through foods and water
mechanism of oseltamivir
inhibits enzyme required for replication of the flu
what test results should the nurse monitor when caring for a patient who is at risk for a G6PD deficiency who is prescribed a sulfonamide antibiotic?
hemoglobin and hematocrit
first members of streptogramins
dalfopristin/quinupristin
a patient experiences sudden onset shaking chills after receiving a dose of amphotericin B. which drug, ordered as-needed for this patient, should the nurse administer?
dantrolene
delayed reaction PCN reaction time
days or weeks after
allergy to penicillin can __________ over time
decrease
four basic actions of microbial drug resistance
decrease the concentration of a drug at its site of action (intracellularly), inactivate a drug, alter the structure of drug target molecules, produce a drug antagonist
what is the major advantage of tigecycline in treating VRE?
decreased development of antibiotic resistance
what is a major goal of therapy with famciclovir for genital herpes?
decreasing length of active episodes
what viruses can cause acute hepatitis
hepatitis A, B, C, D, E, and G
non-HIV viral infections
hepatitis, influenza, varicella-zoster, herpes
adverse effect of dalfopristin/quinupristin
hepatotoxicity
peak levels must be
high enough to kill bacteria
topical preparations of sulfonamides
high incidence of hypersensitivity (not used routinely)
why do PCNs have good selective toxicity?
mammalian cells lack a cell wall and PCNs act specifically on enzymes that affect cell wall integrity, the PCNs have virtually no direct effects on the cells of the host
the nurse is preparing to administer 8 am medications to a patient who is to receive nafcillin 2 g via secondary IV infusion. the drug is dissolved in 100 mL of normal saline solution. the drug handbook states that the drug should be infused over 30-90 minutes. just before the nurse hangs the nafcillin, the nurse is informed the patient is to be placed on a cart to go off unit for a diagnostic test in 30-45 minutes. the patient is expected to be off the floor for 30 minutes. what should the nurse do?
hold the drug infusion until the patient returns from the test
why would doxycycline not be prescribed for a female patient for whom pregnancy status is unknown?
it can damage fetal bones
a physician who is on call for another physician gives a verbal order for TMP/SMZ for a patient. the nurse would consult the prescriber about this order if the patient had a history of what condition?
megaloblastic anemia
PCN undergoes minimal
metabolism and is excreted relatively unchanged by the kidneys
the nurse is administering itraconazole to a patient who also is prescribed simvastatin. because of the effect of itraconazole on hepatic isoenzyme CYP3A4, the combination increased the risk of rhabdomyolysis from simvastatin. the nurse should monitor the patient for what symptoms?
muscle pain and dark urine
laboratory results for a patient who is prescribed foscarnet including fasting blood glucose (FBG) 90 mg/dL, aspartate aminotransferase (AST) 87 units/L, potassium 3.6 mEq/L, calcium 8.2 mg/dL, and magnesium 2 mEq/L. the nurse should assess for what symptom of electrolyte imbalance?
muscle spasms
what must be done before someone can take a narrow-spectrum drug
must have culture done to make sure the drug will actually be effective
fungal disease
mycosis
piperacillin
narrow spectrum, can cause bleeding due to disrupt in platelet function
adverse effects of daptomycin
possible muscle injury
a patient is prescribed a tetracycline antibiotic. which patient information is a reason for the medication to be withheld by the nurse and the prescriber consulted?
pregnancy status of the patient is unknown
the patient has been receiving macenide application to second-degree burns on the anterior of a 7-year-old patient's arms, upper legs, and trunk. what is the priority nursing action, aimed at preventing the common adverse effect relating to application of this drug?
prevent pain
prophylaxis
prevention of disease
parents ask why their son has been prescribed amoxicillin and clavulanate if amoxicillin has been ineffective in the past. the nurse's response is based on the addition of clavulanate
prevents penicillinase from inactivating the amoxicillin
mechanism of amantidine
prevents virus entry into cells, and uncoating of virus
antibiotic has to be
produced from another microbe
gentamicin and ototoxic drugs
produces ethacrynic acid
amantidine
prophylaxis and treatment of influenza A
what teaching can the nurse provide regarding administration of antibiotics that helps decrease the development of resistance?
when prescribed, take the full course as directed even if symptoms are gone
a common symptom of suprainfection that can occur with extended cipro therapy is
white patches in the mouth
uses of cipro
wide variety of infections throughout most of the body
a patient who was admitted with severe abdominal pain has been diagnosed with Helicobacter pylori-associated peptic ulcer. Tetracycline 500 mg, metronidazole 250 mg, and bismuth subsalicylate 524 mg have been prescribed 4 times a day. the nurse notes that the patient's 24-hour fluid intake has been approximately 2500 mL and urine output has been 600-800 mL for each of the past two days. what should the nurse do?
withhold the medication and notify the prescriber of the changes
your patient on amiodarone for hypertrophic cardiomyopathy and self-medicating with St. John's wort has recently been diagnosed with HepC genotype 2. he asks why he can't take one of the combination NS5A or 5B inhibitors. what is your response?
you may develop symptomatic bradycardia, NS5A inhibitors are not effective for your genotype
if you get the flu virus but you had the flu shot
you will have a more mild case of it
a 32-yo. woman develops septic arthritis. when obtaining a history, it is important to evaluate for which previous infection?
Neisseria gonorrhoeae
when planning nursing interventions and teaching for the most common adverse effects of efavirenz, which nursing problem should be the focus for the nurse?
safety
HIV treatment in pregnancy
same principles of antiretroviral therapy in non pregnant adults
tetracycline tooth discoloration and decay
should not be given to pregnant women or children under the age of 8
serum levels dosing
single large doses each day or 2 or 3 smaller doses
the nurse is aware that the most significant factor in determining the effectiveness of oseltamivir in treating influenza is
starting therapy as soon as symptoms occur
tetracycline can caused esophageal ulceration. what can the nurse teach to minimize the risk of this adverse effect?
stay upright for at least 30 minutes after taking the medication
bacterial cell membranes lack
sterols
mechanisms of bacterial resistance in PCNs
- inability of PCN to reach their targets (PBPs) - inactivation of PCN by bacterial enzymes - production of PBPs that have a low affinity for PCNs
uses of tetracyclines
- infections with susepctible organisms - chlamydia trachomatis (doxycycline) - peptic ulcers - acne - anthrax - mycoplasma pneumonia - lyme disease (doxy) periodontal disease
trimethoprim/sulfamethoxazole (TMP-SMZ)
- inhibits consecutive steps in tetrahydrofolic acid synthesis - less resistance when used together - broad spectrum against gram positive and negative organisms
trimethoprim
- inhibits dihydrofolate which suppresses bacterial synthesis of DNA and RNA proteins
drug interaction with metronidazole
- inhibits warfarin metabolism - alcohol causes disulfiram reaction
adverse effects of Raltegravir
- insomnia - headache - rare hypersensitivity - FDA pregnancy risk: Category C
Penicillin (PCN)
- known as a beta-lactam because of characteristic four-membered lactic ring - they are bacteriacidal agents
why is itraconazole an alternative to amphotericin B for systemic mycoses
- less toxic and only somewhat less effective - slower effects - more useful in suppressing chronic infections than in treating severe, acute infections
antiviral therapy
- limited - difficult to suppress viral replication without doing significant harm to the host
sulfonamides microbial resistance
- many bacterial species have developed resistance - especially high among gonococci, meningococci, streptococci, and shigellae - resistance by multiple mechanisms
identifying the infectious organism
- match the drug with the bug - gram-stained preparation - determining drug susceptibility
cytomegalovirus (CMV)
- member of the herpesvirus group - can remain dormant for life - 50% to 80% of Americans age 40 years or older harbor the virus - transmitted by body fluids
ainoglycosides
- narrow spectrum - bactericidal - disrupts protein synthesis by binding to ribosomes
gentamicin
- narrow spectrum antibiotic - bactericidal - (Garamycin)
fidaxomicin
- narrow-spectrum - bactericidal - macrocyclic antibiotic - inhibits RNA polymerase
interferon alfa
- natural in the body - alpha, beta, and gamma - alpha used to treat hepatitis - none can be administered orally - conventional interferons
properties of individual penicillins
- natural penicillins - penicillinase-resistant penicillins - broad spectrum penicillins - extended spectrum penicillins - penicillins combined with beta-lacatamase inhibitor
adverse effects of metronidazole
- neurotoxicity - nausea - disulfiram-type reaction - overgrowth of candida (superinfection)
echinocandins systemic antifungal drugs
- newest class of antifungal drugs - must be given IV - narrow antifungal spectrum
methenamine
- no resistance - readily absorbed - eliminated by the kidneys - relatively safe and generally well tolerated
Monobactams
- only one available - used for UTIs - contains a beta ring, not fused to a second ring - narrow spectrum - active against gram (-) bacteria - resistant to beta-lactamases
how do PCNs cause cell death
- penicillins inhibit the bacteria's transpeptidases which prevents the bacteria from being able to build cell wall - penicillins activate release of autolysins in bacteria, which break down the bacterial cell wall
adverse effects of ganciclovir
- reproductive toxicity - CNS symptoms - Nausea, fever, rash, anemia, liver dysfunction
how do some antiretroviral drugs inhibit enzymes required for HIV
- reverse transcriptase inhibitors - integrase inhibitors - protease inhibitors
UTIs
- second most common infection - sexually active young women - older adult women in nursing homes - less frequent in males
oseltamivir
- suppresses influenza A and B
ganciclovir
- synthetic antiviral agent
telavancin
- synthetic derivate of vancomycin - does not have a B-lactam ring - active only to gram + organisms - reserved for Vanco resistant microbes
tetracycline four available systemic therapies
- tetracycline - demeclocycline - doxycycline - minocycline
adverse effects of Efavirenz
- transient advere CNS effects in 50% of patients - rash - teratogenicity
pyrimidine analog (flucytosine) systemic antifungal drugs
- used for serious infections - development of resistance common - narrow antifungal spectrum - hematologic adverse effects as well as hepatotoxicity
famciclovir (famvir)
- used to treat acute herpes zoster or genital herpes infections - benefits are equivalent to those of acyclovir - adverse effects are minimal
antibiotic must be present
-At the site of infection -For a sufficient length of time
first choice for HSV (herpes simplex virus both genitalis and mucocutaneous) or VZV (varicella-zoster virus) infection
Acyclovir
misuses of antimicrobial drugs
-Attempted treatment of viral infections -Treatment of fever of unknown origin -Improper dosage -Treatment in the absence of adequate bacteriologic information -Omission of surgical drainage
prophylactic use of antimicrobials
Agents are given to prevent infection rather than to treat an established infection: - Surgery - Bacterial endocarditis - Neutropenia - Other indications
pharmacokinetics of tetracyclines
absorption can be affected by chelation
purine nucleoside analogs
acyclovir (Zovirax)
drugs for influenza
adamantanes and neuraminidase inhibitors
how to reduce drug and food interactions with cipro
administer 6 hours before or 2 hours after taking chelating agents
a patient with hospital-acquired pneumonia has just been prescribed cefotaxime and probenecid. the patient has no history or evidence of gout. what should the nurse do?
administer both medications as ordered
The nurse finds the pharmacy prepared mini bag of metronidazole in the patient's medication drawer and notes that it has been mixed to a concentration of 5 mg/mL. what should the nurse do?
administer the drug
the nurse is preparing to administer trimethoprim 50 mg prescribed orally every 12 hours. laboratory test results include estimated glomerular filtration rate 30 mL/min. what should the nurse do?
administer the drug
how do cephalosporins work?
inhibit bacterial cell wall synthesis by: - binging to specific PBP - blocking transpeptidase step of peptidoglycan synthesis - activation of autolytic enzymes
e-mycin drug interactions
inhibits metabolism of many drugs
adverse effects of Enfuvirtide
injection-site reactions, pneumonia, hypersensitivity reactions
the medication administration record lists clotrimazole troche to be administered at 0900. the nurse administers this medication by
instructing the patient to let it dissolve in the mouth
two classifications of antimicrobial drugs
susceptible organism, mechanism of action
it would be of greatest priority to consult the prescriber of enfuvirtide if the patient experienced
weakness and tingling in extremities
metronidazole works ______ with penicillins
well
the results of the 1942 PCN clinical trial
were so impressive that the US Surgeon General of the US Army authorized a trial in a military hospital, and soon used throughout the medical services of the US Armed Forces
before amphotericin B, systemic fungal infections
were usually considered fatal
delaying emergence of drug resistance
- Promote adherence to appropriate prescribing guidelines - Reduce demand for antibiotics among healthy adults and parents of young children - Emphasize adherence to prescribed antibiotic regimens
three beta-lactamase inhibitors used in the US
- Sulbactam - Tazobactam - Clavulanic acid
acyclovir (zovirax)
- active only against members of the herpesvirus family
aminoglycoside and gentamicin uses
- against aerobic gram-negative bacilli - can be used to sterilize gut
azoles systemic antifungal drugs
- alternative drug - lower toxicity - can be given PO - inhibit P450 - raise gastric pH
drug and food interactions with cipro
- aluminum and magnesium antacids, iron and zinc salts, sucralfate, products that contain calcium (reduced absorption and increased levels of theophylline and warfarin)
penicillins combined with a beta-lactamase inhibitor
- ampillin/sulbactam (unasyn) - amoxicillin/clavulanate (augmentin, clavulin) - ticarcillin/clavulanate (timentin) - piperacillin/tazobactam (zosyn, tazocin)
fluconazole
- azole group - fungistatic - inhibits ergosterol - good PO absorption (IV and PO dosage the same) - single dose for vaginal candidiasis
itraconazole
- azole group of antifungal agents - inhibits ergosterol
metronidazole (Flagyl)
- bactericidal (taken up into the cell to be activated)
Nitrofurantoin
- bacteriostatic in low concentrations - bactericidal in high concentrations
mechanism of action for amphotericin B
- binds to ergosterol in fungal cell membrane - increases permeability - cell leaks intracellular cations (especially potassium) - fungistatic or fungicidal
Ciprofloxacin
- broad spectrum antibiotic - inhibits bacterial DNA gyrate which disrupts DNA replication and cell division - bactericidal
sulfonamides
- broad spectrum antibiotics - suppresses bacterial growth by inhibiting folic acid synthesis
Amphotericin B
- broad-spectrum antifungal agent - highly toxic
azoles
- broad-spectrum antifungal drugs - lower toxicity - can be given orally
itraconazole adverse effects
- cardiosuppression (decreases ejection fraction) - GI irritation - Hepatotoxicity - Rash, headache, abdominal pain, edema
people who should not get the live flu shot
- children younger than 2 yo. - adults older than 50 yo. - pregnant women - history of allergic reaction - children 2-17 yo. receiving aspirin or salicylate medications - immunocompromised - children 2-4 yo. with asthma or h/o wheezing in past 12 mo.
types of STDs
- chlamydia trachomatis - nongonococcal urethritis - gonococcal infections - PID - acute epididymitis - syphilis - AIDS - trichomoniasis - chancroid - herpes simplex - bacterial vaginosis - condyloma acuminata - proctitis - pediculosis pubis and scabies - HPV
drug selection for empiric therapy is based on
- clinical evaluation - knowledge of microbes most likely to have caused infection
daptomycin (Cubicin)
- cyclic lipopeptide - kills virtually all gram-positive bacteria, including MRSA - no significant drug interactions
precautions and indications of flu vaccine
- egg allergy - minor illnesses with or without fever do not preclude vaccines - acute febrile illness would preclude vaccines
adverse effects of interferon alfa
- flu-like symptoms - neuropsychiatric effects, especially depression - fatigue, thyroid dysfunction, heart damage, bone marrow suppression manifesting as neutropenia and thrombocytopenia
how do some antiretroviral drugs block viral entry into cells
- fusion inhibitors - CCR5 antagonists
s/s of chlamydia
- genital tract infections - proctitis - conjunctivitis - ophthalmia and pneumonia in infants - PID and infertility
Neisseria gonorrhoeae
- gram-negative diplococcus - transmitted almost exclusively by sexual contact - 700,000 new cases each year
uses of purine nucleoside analogs
- herpes simplex viruses - varicella-zoster virus
uses of ganciclovir
- herpes simplex viruses including CMV - prevention and treatment of CMV infection in immunocompromised patients, including transplant patients, those with HIV infection, and those receiving immunosuppressive drugs
adverse effects of protease inhibitors
- hyperglycemia/diabetes - fat redistribution - hyperlipidemia - reduced bone density - increased bleeding in people with hemophilia - reduced bone mineral density - elevation of serum transaminase
adverse effects of sulfonamides
- hypersensitivity reactions (Stevens-Johnson syndrome) - hemolytic anemia - kernicterus - crystalluria - phlebitis
selection of antibiotics
-Identify organism -drug sensitivity of organism -host factors -drug may be ruled out owing to (allergy, inability to penetrate the site of infection, patient variables)
monitoring of antimicrobial therapy
-Monitor clinical responses and lab results -frequency of monitoring should increase with severity of infection -clinical indicators of success -serum drug levels for toxicity
Linezolid
-Oxazolidinone -Inhibit protein synthesis - Bacteriostatic - MOA inhibition
protease inhibitor drug ending
-navir
c. difficile
1) gram-positive, spore-forming bacteria found in the bowel 2) preceded by the use of antibiotics 3) superinfection 4) acquired by ingesting C. diff spores
Vancomycin adverse effects
1) ototoxicity 2) nephrotoxicity 3) Red Man's Syndrome
live, attenuated flu vaccine administration
nasal spray
types of antimicrobial agents
natural or synthetic
antibiotics that promote resistance
Broad-spectrum agents do the most to facilitate the emergence of resistance
almost all antibiotic adverse effect
nausea, vomiting, diarrhea, GI upset
because of myelosuppresion in Linezolid this laboratory test much be done frequently
CBC
Maraviroc (Selzentry)
CCR5 antagonist
target cells of HIV
CD4 T cells (helper lymphocyte)
it would be a priority to report which laboratory result to the prescriber if a patient is prescribed valacyclovir?
CD4 less than 100/mm^3
which isoenzyme of Creatine phosphokinase would be most helpful when monitoring for the rare but serious adverse effect if a patient is prescribed daptomycin and simvastatin?
CPK-3
third-generation cephalosporins are considerably more active against gram-___________ aerobes
negative
which laboratory results of an adult male patient suffuse bone marrow suppression caused by amphotericin B?
Hgb 10 g/dL, hematocrit 30%, MCV 89 mcg^3, MCH 28 pg/cell, MCHC 36 g/dL
inactivated flu vaccine administration
IM
which international normalized ratio (INR) result would be a reason to contact the prescriber in a patient with atrial fibrillation taking warfarin who has also been prescribed a sulfonamide?
INR 3.5
metronidazole administration
IV and PO
treatment of hospitalized patients with PID
IV cefoxitin or cefotetan and doxycycline, follow with oral doxycycline
Amphotericin B administration
IV only
Penicillin G dosage in congenital syphilis
IV or IM with PCN G or benzathine PCN
acyclovir adverse effects
IV: phlebitis, reversible neurotoxicity, neurotoxicity Oral: GI, vertigo (preferred route) Topical: stinging sensations
public health action plan to combat antimicrobial resistance Focus Area III:
Research
when imipenem and valproate are prescribed for a patient, what is the priority nursing concern?
safety
antibiotic
a chemical produced by one microbe that can harm other microbes
history of PCN by 1940
a crude preparation was found to produce dramatic therapeutic effects when administered parenterally to mice with streptococcal infections
how did Alexander fleming observe PCN first
a mold contaminating one of his cultures caused the bacteria in its vicinity to undergo lysis
where did cephalosporins originate from?
a natural fungus called Cephalosprium acremonium
which patient should receive prophylactic antibiotic therapy?
a patient who is scheduled for a hysterectomy
mammalian cells don't have what?
a rigid cell wall
a patient receiving standard antiretroviral therapy with three drugs develops a sore throat and cough. the nurse should consult the prescriber immediately if the therapy includes which drug?
abacavir
selective toxicity
ability to disrupt microbe and not the mammalian cells, toxic to microbes but harmless to host
hemolytic anemia
abnormal breakdown of RBCs
what are the known adverse effects of raltegravir?
facial edema and angioedema, flulike symptoms, painful rash that blisters followed by shedding of the epidermis
Red Man's Syndrome
facial flushing and hypotension due to rapid infection, thought to be caused by histamine release
the prescriber has informed a patient who has been prescribed a nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) of the risk of hepatic steatosis. the patient asks the nurse "what is hepatic steatosis?" the nurse should explain that this is a possible severe adverse effect involving
fatty degeneration of the liver
adverse effects of infusion reaction of amphotericin B
fever, chills, rigors, nausea, headache, caused by release of pro inflammatory cytokines
a female patient has been prescribed an antibiotic for 3 days. what are some advantages of shorter-course therapy?
fewer adverse effects, less potential for antibiotic resistance, lower cost, greater likelihood of patients completing therapy as prescribed
how many types of antiretroviral drugs are there
five
methenamine used
for chronic infection of lower urinary tract
how are cephalosporins subdivided?
from the first generation to fifth
penetration of cerebrospinal fluid by fourth-generation cephalosporins is _______
good
where is cytomegalovirus infection common in
healthcare workers
nosocomial infections
hospital acquired infections (HAI)
it would be a priority to report which test result if a patient is prescribed tetracycline?
human chorionic gonadotropin (hCG) 5325 mIU/mL
HIV
human immunodeficiency virus (1 and 2)
patients who are prescribed NNRTIs should be instructed to not self-prescribe the herbal product St. Johns wort. what is the possible effect of this combination?
increase in metabolism and excretion of the NNRTI
from the first generation to the fifth in cephalosporins
increase in: 1) activity against gram-negative bacteria and anaerobes 2) resistance to destruction by beta-lactamases 3) in ability to reach the CSF
the nurse reviews the CBC of a patient who is prescribed flu cytosine and notes neutrophils 27%. this patient is especially at risk for which issue?
infection
STDs
infectious or parasitic diseases that are transmitted primarily through sexual contact
it is important for the nurse to assess for suicidal ideation if a patient is prescribed which drug?
interferon alfa
it is important for the nurse to monitor which laboratory test when a patient is prescribed azithromycin or erythromycin and warfarin?
international normalized ration (INR)
a patient is admitted to a medical unit and prescribed IV ampicillin/sulbactam after a specimen was sent for culture and sensitivity (C&S) from the ER. the nurse knows the priority reason for notifying the prescriber of culture results as soon as they are available is that ampicillin/sulbactam
is a broad-spectrum antibiotic, and there may be an effective narrow-spectrum antibiotic
a patient is receiving 50 mg of nitrofurantoin at bedtime for prophylaxis of recurrent cystitis. this means that the patient
is taking low doses of the drug to prevent reinfection
what is true of itraconazole?
it is capable of impairing the liver metabolism of other drugs
cefuroxime is prescribed for a patient diagnosed with pneumonia caused by Klebsiella pneumococci, type 2 DM, Gastroesophageal reflux disease (GERD), and Chronic Kidney Disease (CKD). why is this antibiotic a good choice for this patient?
it may be administered orally, it's effective against K. pneumococci, it's inexpensive, and it has a once-a-day dosing
why is folic acid crucial in pregnancy
it prevents neural tube issues in the fetus
the nurse would be concerned that a patient who is receiving micafungin is experiencing a histamine reaction and might have an anaphylactic reaction if the patient reports a sudden feeling of
itching
adverse affects of trimethoprim
itching, rash, GI irritation, hematologic anemia, decreased WBC count, not used in pregnancy due to folic acid inhibition
used for oral therapy of onchomycosis of the toenails or fingernails
itraconazole
oral and topical therapy of superficial mycoses
ketoconazole
characteristics of anaphylaxis
laryngeal edema, bronchial constriction, hypotension
PCN G characteristic
least toxic of all antibiotics
CA-MRSA
less dangerous, many people are asymptomatic carriers
what is a benefit of TMP/SMZ over the components used alone?
less resistance has developed
how is Stevens-Johnson syndrome treated
like a burn (risk of infection due to lots of pain and weeping from no epidermis)
Azithromycin
like e-mycin, for respiratory infections
the nurse is assessing for adverse effects of IV tobramycin. which change would be a priority to report to the prescriber?
limp, weak muscles
trough levels must be
low enough to minimize toxicity
uses for nitrofurantoin
lower tract UTIs
hypoglycemics
lowers blood sugars
erythromycin
macrolide, broad-spectrum, OK to use if allergic to penicillin
when a patient is prescribed a fluoroquinolone that is known to cause prolongation of the QT interval on ECG, the nurse should monitor the electrolytes for which result that is most likely to increase risk of this adverse effect?
magnesium less than 1.3 mEq/L, potassium less than 3.5 mEq/L
what does the nurse do when assisting with skin testing for penicillin allergy with the minor determinant mixture (MDM)?
make respiratory support and epinephrine available
goal of antibiotic treatment
maximize anti microbial benefit with minimum harm to the host
differences in the cellular chemistry of mammals and microbes
microbes have rigid walls, mammalian cells do not
how many Americans are infected with hepatitis
millions
the nurse should assess for adverse effects of lightheadedness and dizziness when a patient is receiving which medication?
minocycline
indications of antibiotic combinations
mixed infections, prevention of resistance, decreased toxicity, enhanced bacterial action
HIV drug resistance most of the time
most cases emerges over the course of treatment as a result of nonadherence to the prescribed
principles of treating HIV-seropositive pregnant women include
prophylaxis is recommended for the infant/neonate, benefits of treatment normally outweigh risks
the nurse would be most concerned that a patient may not adhere to therapy with which class of antiviral drugs if the patient verbalized that body image is an important priority?
protease inhibitor (PI)
among the most effective antiretroviral drugs
protease inhibitors
Penicillins must bind to special _______ on the outer surface of ______________ membrane to be effective
proteins, cytoplasmic
microscopic examination of gram-stained preparations has the advantages of
providing rapid results, being a simpler test
spontaneous mutation
random changes in a microbe's DNA, resistance to one drug
which drug must be taken 12 hours apart from rilpivirine?
ranitidine
when a patient who is receiving nevirapine or delavirdine complains of conjunctivitis or muscle and joint pain, it would be a priority to assess for
rash
if a bacterium changes its ___________, an antibiotic may not be able to bing to the microbe and exert effects
receptors
which laboratory test result would be a priority to report the prescriber of a sulfonamide?
red cell distribution width 18.4%
what do gram-negative microbes stain as
red stain due to thin cell wall
what did modern antimicrobials do?
reduced morbidity and mortality from infection
why do we use protease inhibitors with an NRTI
reduces viral load to an undetectable level
clinical indicators of success in monitoring antimicrobial therapy
reduction of fever, resolution of signs/symptoms related to the affected organ
when emptying a urinal from an HIV-seropositive patient, the nurse splashes urine on intact skin. what should the nurse do?
report the incident immediately to a supervisor
Linezolid (Zyvox) uses
reserved for multi-drug resistant infections
_________ to tetracycline is ___________
resistance, increasing
bacteria can become ___________ to antibiotics by producing enzymes that inactivate the antibiotic
resistant
a neonate was delivered vaginally to a mother with an active chlamydia trachomatis infection. relating to this exposure, what is the priority system wen caring for the neonate?
respiratory
HIV drug resistance rarely
results from primary infection with drug-resistant HIV variant
mother-to-child transmission HIV
risk for transmission can be greatly reduced by ART, which minimizes maternal viral load
a friend tells the nurse that a sexual partner has informed her that he has gonorrhea. she has a refillable prescription of cipro for recurrent cystitis. she tells the nurse she knows that she has used this drug in the past for gonorrhea. what is the most important reason why the nurse should discourage using this cipro?
this drug is no longer effective against Neisseria gonorrhoeae
syphilis develops in _______ stages
three
"wash-out"
time when ears and kidneys would get a break from aminoglycosides
Ototoxicity symptoms
tinnitus, hearing loss, severe headache, ataxia, balance disturbances
HIV reverse transcriptase use
to convert RNA to DNA
why did we have to tweak PCN so much
to fit into protein binding sites of bacteria
the carbapenem antibiotic imipenem is a combination of the antibiotic and cilastatin. what is the purpose of the additive cilastatin
to prevent inactivation by an enzyme present in the kidney
a diabetic patient is receiving clindamycin for gas gangrene. which drug, if also taken by this patient, could decrease bowel motility and prevent the body's attempt to rid the colon of C-diff?
tolterodine
how do you get ototoxicity and nephrotoxicity from vanco
too rapid of IV administration
Stevens-Johnson syndrome aka
toxic epidermal necrolysis
the nurse teaches that the primary cause of recurrent STIs caused by the same organism is failure to
treat the sexual partner
topical antiviral drugs used for ocular herpes infections
trifluridine, ganciclovir
administration of Enfuvirtide
twice-daily subQ (makes it harder for HIV to adhere to CD4 T cell)
carbapenems use
typically for infections considered critical
because of the risk of prolonged QT interval and torsades de points, the nurse would consult the prescriber before administering erythromycin to a patient who has experienced
unexplained fainting
what should the nurse teach regarding condom use to a patient who is currently in a long-term relationship and who has been prescribed continuous oral acyclovir therapy for recurrent genital herpes?
use a condom with every sexual contact except if conception is desired; conception should be planned when symptoms are absent
the nurse is discussing planned care with the CNA who is assigned to a patient receiving ganciclovir. because of the possible serious adverse effects, which precaution would the nurse include in instructions regarding care?
use an electronic razor to shave the patient
how to viruses reproduce
use biochemical machinery of host cells
if chlamydia while pregnant
use erythromycin base or azithromycin
an HIV-positive patient who has recently been prescribed efavirenz calls the prescriber's office and reports experiencing drowsiness and dizziness. an appropriate recommendation by the telephone triage nurse is for the patient to do what?
use safety precautions and take efavirenz at beditme
theophylline uses
used in therapy for COPD and asthma
infection with MRSA
usually involves the skin and soft tissues, causing abscesses, boils, cellulitis, and impetigo
Guillain-Barre syndrome
usually reversible, symmetrical paralysis
primary strategy for influenza management
vaccine
what should trough levels be when drawn
very low -- preferably close to zero
what do gram-positive microbes stain as
violet stain due to thicker cell wall = better staining
most common liver disorder
viral hepatitis
which nursing assessment finding would be most significant if a patient was receiving didanosine?
vomiting
what to do before and after application of topical drugs
wash your hands
a patient is prescribed tetracycline for Chlamydia trachomatis. which change in assessment findings would be a priority to report to the prescriber?
watery stool
benefits of combining beta-lactamase inhibitor with PCN
we can extend the antimicrobial spectrum of the PCN
how do antibiotics work
weakens cell wall, sucking out bacterial cell material and causes it to burst
because of the risk of hyperkalemia when prescribed trimethoprim, it is a priority for the nurse to teach the patient to report what symptom?
weakness
