NUR 112 pharmacology : Antibiotics, Antifungals, Antivirals

Antibiotics Interaction

-Most decreased the effectiveness of birth control -Most can increase risk for bleeding if using other drugs that can cause bleeding

Antifungals side effects

-Nausea and Vomiting -Diarrhea

Antibiotic (subclass) Tetracyclines use for broad or narrow spectrum?

Broad spectrum

Antivirals Precautions/Contraindications

Caution with renal or hepatic impairment

Can Macrolides be used for children?

Macrolides are used in children for many indications because exhibit no serious side effects

Antibiotics side effects

Nausea/Vomiting Superinfection

Antibiotics use

Treatment and prophylaxis of various bacterial infections

Antibiotics treatment expectation

White blood cell count (Normal range 5,000-10,000)

Which information would the nurse provide to a client diagnosed with chlamydia and prescribed doxycycline?

- Report worsening symptoms - Refrain from sexual relations - Use barrier protection devices - Contact partners to be tested - Take the entire courses of antibiotics

Which assessment would the nurse perform before administering a dose of vancomycin to a client?

- creatinine - trough level - hearing ability - intravenous site (vancomycin can cause phlebitis =to check inflammation of a vein) - blood urea nitrogen

How to given Tetracyclines?

- given when empty stomach (1-2 hrs. before meal) - avoid drinking milk

Antibiotic (subclass) Penicillins side effects

- pancytopenia (less common) - allergy (most common)

Cephalosporins drugs

-Ancef (cefazolin)-1st generation -Keflex (cephalexin)- 1st generation -Rocephin (ceftriaxone)- 3rd generation

Fluoroquinolones drugs

-Cipro (ciprofloxacin) Drug of choice for anthrax exposure -Levaquin (levofloxacin)

A client is started on tetracycline antibiotic therapy. Which action would the nurse take when administering this medication? 1. Administer the medication with meals or snack 2. Provide orange or other citrus fruit juice with the medication 3. Administer the medication at least an hour before ingestion of milk products. 4. Offer antacids 30 minutes after administration if gastrointestinal side effects occur.

3. Administer the medication at least an hour before ingestion of milk products.

Ceftriaxone is prescribed for a client's infection. For which potential adverse effect would the nurse monitor the client? 1. Dehydration 2. Heart failure 3. Constipation 4. Allergic reaction

4. Allergic reaction Rash, urticaria, angioedema, and other signs and symptoms of an allergic response may occur a few days after therapy is instituted.

Which type of Penicillins are used more in pediatric patients?

Amoxil (amoxicillin)

Flagyl (metronidazole) side effects

Anabuse effects if taken with alcohol They can cause severe sick, nausea, and vomit if give with alcohol

Sulfonamides drugs

Bactrim (trimethoprim-sulfamethoxazole)

Bactrim (trimethoprim-sulfamethoxazole) interaction

Bactrim can increase effect with anticoagulant such as bleeding (such as Heparin, Levanox)

Macrolides E-mycin (erythromycin) how is it effect GI?

E-mycin- Does usually cause GI irritation so take with food but no serious, Can increase effects of warfarin and theophylline (Bronchodilator)

What is Levaquin (levofloxacin) side effects?

EKG Changes, Tendon Rupture Nurse action must do Nurse action to monitor EKG and heart rate

Can use Garamycin (gentamicin) with new born baby?

Gentamicin use a lot for new born baby or premature baby, but they can give they have Ototoxic Gent is the most common one used- broad spectrum

Antibiotic (subclass) Aminoglycosides for treatment?

High potential to cause serious toxicity - Effective against E. coli, Kelbsiella and Pseudomonas - effective against gram negative bacteria, mycobacteria and even some protozoans. for more serious infection

What are symptoms of Nephrotoxic?

Increased BUN, Creatinine, decreased urine output, dark urine-usually reversible. must check peak and through zone

Antibiotics action

Kill (bactericidal) or inhibit growth of (bacteriostatic) susceptible bacterial pathogens

What is Methicillin-resistant Staphylococcus aureus (MRSA)?

Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a type of staph bacteria that's become resistant to many of the antibiotics used to treat ordinary staph infections.

Why do we have to access culture before begin antibiotic therapy?

Obtaining cultures before antibiotic use improves the chances of identifying the offending microorganism, which improves patient care. Inappropriate antibiotic use can result in prolonged hospital stays and increased costs, but it can also have adverse consequences on the patient's prognosis.

Aminoglycosides side effects

Ototoxic and Nephrotoxic

Which type of Penicliins are usually given in labor?

Penicillin G

Vancocin (vancomycin) side effects

Red Man Syndrome, Ototoxic, Nephrotoxic

How to prevent Red Man Syndrome when given Vancocin (vancomycin)?

Slow IV infusion rate

Miscellaneous Antibiotics Drugs Flagyl (metronidazole) treat for

Used for anaerobic bacteria Effective against protozoan

Miscellaneous Antibiotics Drugs Vancocin (vancomycin) treatment for

Used for serious infections-MRSA -Usually given IV, but PO is available

Tetracyclines drugs

Vibramycin (doxycycline) Panmycin (tetracycline)

Cephalosporins drugs: Keflex (cephalexin) use for?

first generation, has increased coverage against gram negative organisms, resp and GU infections

What are symptoms of ototoxic?

hearing loss, ringing in ears, balance issues, headache- usually not reversible. This drug can cause permanent hearing loss

If patient has PCN allergy, usually it is likelihood from....

higher likelihood of cephalosporin allergy because they are contraindicated with severe PCN allergy

Antihistamines use

-relief of symptoms associated with allergies and as adjunctive treatment of anaphylactic reaction. -May also be used to treat motion sickness, insomnia, and Parkinson-like reactions. -Antihistamines can use for seasonal allergy, rash because of penicillin, they are supplement to the other drugs.

Trimethoprim-sulfamethoxazole is prescribed for a client with cystitis (inflammation of the bladder). Which instruction would the nurse include when providing medication teaching? 1) Drink eight to ten glasses of water daily 2) Take this medication with orange juice 3) Take the medication with meals 4) Take the medication until symptoms subside

1) Drink eight to ten glasses of water daily A urinary output of 1500 mL daily should be maintained to prevent crystalluria (crystal in urine).

The nurse notes an older adult's admission orders include gentamicin for the treatment of osteomyelitis. Which laboratory reports will the nurse review before beginning the medication? Select all that apply 1. Blood urea nitrogen (BUN) and creatinine 2. Electrolytes and urinalysis 3. Erythrocyte count 4. Blood platelet count 5. Serum thyroxin levels

1. Blood urea nitrogen (BUN) and creatinine 2. Electrolytes and urinalysis Because gentamicin can increase the risk of nephrotoxicity.

Which assessment findings during the administration of intravenous penicillin prompt the nurse to stop the infusion? Select all that apply 1. Hives 2. Itching 3. Nausea 4. Skin rash 5. Shortness of breath

1. Hives 2. Itching 4. Skin rash 5. Shortness of breath

Which action would the nurse take to avoid red man syndrome when preparing to administer a vancomycin infusion? 1. Infuse slowly 2. Change the intravenous (IV) site 3. Reduce the dosage 3. Administer vitamin K

1. Infuse slowly Vancomycin should be infused slowly to avid the occurrence of he reaction known as 'red man syndrome'.

Which issue related to antibiotic use is an increased risk for the older adult? 1. Allergy 2. Toxicity 3. Resistance 4. Superinfection

2. Toxicity Because the older adult reduced metabolism and excretion of medications.

Antibiotic (subclass) Cephalosporins use

Very effective against gram-negative infections

Macrolides Zithromax (azithromycin) how is it effect GI?

less GI irritations, can take with food to further decrease GI upset, extended half life so you can take for 3-4 days instead of 7-10

Cephalosporins drugs: Rocephin (ceftriaxone) use for?

long acting- can be given once daily, one of few cephalosporings that can be used to treat meningitis due to the ease in passing through the blood brain barrier primarily eliminated by the liver, contraindicated with severe live disease. cross blood brain barrier, can treat CNS infection

Use of which medication would the nurse identify as a potential risk for hearing impairment in a child? 1. Amoxicillin 2. Gentamicin 3. Clindamycin 4. Ciprofloxacin

2. Gentamicin Gentamicin can be ototoxic because of its effects on the eighth cranial nerve.

Antibiotic (subclass) Sulfonamides treat for?

-Very effective against UTIs -Used to treat UTIs and pneumocystis carinii

Antibiotic (subclass) Fluoroquinolones caution

-don't take with multivitamin. use a lot in hospital -Cipro can cause GI upset, may take with food, drug of choice for Anthrax exposure, can increase effects of warfarin, avoid caffeine (tachycardia and nervousness)

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 antibiotic. The nurse schedules the blood sample to be obtained at which time. 1. Just before the medication is administered 2. Between 30 and 60 minutes after the infusion is completed 3. Six hours after the dose is completely infused 4. In the morning before the client eats breakfast.

1. Just before the medication is administered Trough levels are measured in relation to the time a medication is administered. The trough level for a medication is drawn just before a medication is given, when the medication's level is at its lowest.

Antifungal Drugs

1. Nilstat (nystatin) 2. Diflucan (fluconazole) 3. Amphotericin B (fungizone)

Penicillins drugs

1. Omnipen (ampicillin) 2. Amoxil (amoxicillin), 3. Pentids (penicillin G), 4. Zosyn (piperacillin/tazobactam)

Antibiotic (subclasses)

1. Penicillins 2. Cephalosporins 3. Tetracyclines 4. Macrolides 5. Aminoglycosides 6. Fluoroquinolones 7. Sulfonamides

The nurse identifies which antimicrobial medications as safe during breast-feeding? select all that apply 1. Penicillins 2. Macrolides 3. Tetracyclines 4. Cephalosporins 5. Chloramphenicol

1. Penicillins 2. Macrolides 4. Cephalosporins

When would the nurse have the laboratory obtain sample to determine the peak level of an antibiotic administered by intravenous piggyback (IVPB)? 1. Halfway between two doses of the medication 2. Between 30 and 60 minutes after a dose 3. Immediately before the medication is administered 4. Anytime it is convenient for the client and the laboratory.

2. Between 30 and 60 minutes after a dose Because the medication was administered by IV, the blood IV, the blood level of the medication will be at its highest shortly after administration.

A pregnant client with an infection tells the nurse that she has taken tetracycline for infections in the past and prefers to take it now. Which response would the nurse give regarding the avoidance of Tetracyclines administration during pregnancy? 1. It affects breast-feeding adversely 2. Tetracyclines causes fetal allergies 3. It alters the development of fetal teeth buds 4. It increases fetal tolerance to the medication

3. It alters the development of fetal teeth buds

A client receiving intravenous vancomycin reports ringing in both ears. Which initial action would the nurse take? 1. Notify the primary health care provider 2. Consult an audiologist 3. Stop the infusion 4. Document the finding and continue to monitor the client

3. Stop the infusion The first action the nurse would take is to stop the infusion immediately. Vancomycin can cause temporary or permanent hearing loss.

Which effect has resulted in the avoidance of tetracycline use in children under 8 years old? 1. Birth defects 2. Allergic response 3. Severe nausea and vomiting 4. Permanent tooth discoloration

4. Permanent tooth discoloration

Cephalosporins drugs: Ancef (cefazolin) use for?

Ancef- used for respiratory and skin infections, also effective against intra-abdominal infections - may be used for prophylactic's treatment before surgical procedures Limited effectiveness against gram negative bacteria. use a lot in hospital

Sulfonamides side effects

Aplastic anemia

what is Aplastic anemia?

Aplastic anemia is a form of bone marrow failure. In aplastic anemia, the bone marrow does not produce new cells, leaving the body susceptible to bleeding and infection.

How to give Vancocin (vancomycin) at trough level?

Before giving drugs 30 minute, check trough level -<10mcg/mL (mild/moderate infection) -15-20 mcg/mL for Severe infection

Antibiotic (subclass) Macrolides is consider broad or narrow spectrum?

Considered broad spectrum

Antihistamines Side Effects

Drowsiness Anticholinergic Effects: constipation, urinary retention, dry mouth, blurred vision

Antibiotic (subclass) Fluoroquinolones for treatment?

Effective against most respiratory, GI, gynecologic, skin and soft tissue infections

Antibiotics Precautions/Contraindications

Hypersensitivity Avoid if allergic Caution with renal and hepatic impairment

Antivirals action

Increases cell resistance to virus and suppresses virus absorption, not cure virus

Antibiotic (subclass) Macrolides is useful alternatives for which type of Antibiotic?

Macrolides share a similar spectrum of antimicrobial activity with benzylpenicillin making them useful alternatives for people with a history of penicillin (and cephalosporin) allergy.

What is the nurse action when giving Sulfonamides?

Monitor lab test for check CBC, H&H

Macrolides is used for?

Often used to treat pertussis (whooping cough), Legionnaires and strep infections and H. influenza

Antifungals use

Treatment of fungal infections Many antifungals are available in several different forms

Antivirals use

Treatment of significant viruses (not HIV)

Macrolides drugs

Zithromax (azithromycin) E-mycin (erythromycin)

Which type of Penicillins are combination of 2 antibiotic medications?

Zosyn (piperacillin/tazobactam)

Antivirals drugs

Zovirax (acyclovir) Valtrex (valacyclovir) Tamiflu (oseltamivir)

Antihistamines action

blocks the effects of histamine at the receptor, DOES NOT INHIBIT HISTAMINE RELEASE

Antivirals drugs Valtrex (valacyclovir)

can give PO

Antifungal Drugs How to use Diflucan (fluconazole)?

-Oral or IV -Can be tetrogenic if prolonged use in early pregnancy (first trimester). Any maternal exposure to fluconazole during pregnancy — whether in low or high doses — may increase the risk for spontaneous abortion

Tetracyclines side effects

-Photosensitivity- BOARDS -Decrease effective of birth control -Permanent yellow-brown discoloration of teeth (children) -Pregnancy Category D because it may affect tooth and bone development in the unborn baby

Which statement by the client indicates that the nurse's teaching was effective regarding intravenous gentamicin therapy? 1) I should drink lots of water if I'm retaining urine 2) I should use eyeglasses if I develop vision problems 3) I should stop the medication when the symptoms have subsided? 4) I should report any hearing loss to the primary health care provider

4) I should report any hearing loss to the primary health care provider

Antihistamines Nursing Actions/Teaching

-Monitor pulse and respiration, monitor consciousness. -Maintain adequate fluid intake -Inform patient that drowsiness may occur. teach for safety, avoid if they have sedation. They can dry area and make constipation -Avoid alcohol

Antihistamines Precautions/Contraindications

-Avoid if hypersensitivity, narrow-angle glaucoma, should not be used in premature or newborn infants -Caution with elderly

Antihistamines drugs

-Benadryl (diphenhydramine), 1st generation -Zyrtec (cetirizine), 2nd generation less sedation -Claritin (loratadine), 2nd generation less sedation

Antivirals drugs Tamiflu (oseltamivir) side effects

-Can cause insomnia -Can cause serious mood changes (unusual behavior, confusion, agitation or self injury). This is more likely in children

Tetracyclines is treatment for?

-First line treatment for Rocky Mountain spotted fever, -cholera (อหิวา), -lyme disease. -Also used to treat H.pylori and -chlamydial infections (bacteria from sexually transmitted infection (STI))

Aminoglycosides drugs

-Garamycin (gentamicin) -Tobramycin- very effective against pseudomonas -Neomycin- used to sterilize the gut prior to colon surgery

Antifungal Drugs How to use Amphotericin B (fungizone)?

-Given IV -Reserved for severe fungal infections -Side Effects: Fever, phlebitis, nephrotoxicity -Use caution if giving other drugs that cause nephrotoxicity

Antivirals side effects

-Headaches -Nausea and Vomiting

Antivirals drugs Zovirax (acyclovir) side effects

-May be given PO/IV -Can cause nephrotoxicity

Antifungal Drugs How to use Nilstat (nystatin)?

-May be given topically or orally -Nystatin when taken by mouth is used to treat yeast infections in the mouth or stomach

Antihistamines Interactions

-May cause increased sedation if given with other drugs that cause sedation -This classification has anticholinergic properties

The health care provider prescribes peak and trough levels after initiation of intravenous antibiotic therapy. The client asks why these blood tests are necessary. Which reason would the nurse provide? 1) They determine if the dosage of the medication is adequate 2) They detect if you are having an allergic reaction to the medication 3) The tests permit blood culture specimens to be obtained when the medication is at it lowest level. 4) These allow comparison of your fever to changes in the antibiotic level

1) They determine if the dosage of the medication is adequate

The nurse completes medication reconciliation in preparation for discharge of a client recovering from osteomyelitis and a ruptured Achilles tendon. For which medication would the nurse contact the primary health care provider? 1. Gentamicin 2. Levofloxacin 3. Acetaminophen 4. Cyclobenzaprine

2. Levofloxacin Tendon rupture (especially the Achilles tendon) can occur with use of fluoroquinolones.

Intravenous (IV) vancomycin is schedule to infuse over 30 minutes. Ten minutes after the start of the infusion, the client appears flushed and complains of palpitations. Which action will the nurse take? 1. Stop the infusion 2. Continue the infusion but monitor the client 3. Contact the primary health care provider to obtain a prescription to decrease the infusion rate 4. Contact the primary health care provider to obtain a prescription for an antianxiety medication

3. Contact the primary health care provider to obtain a prescription to decrease the infusion rate Administering vancomycin too rapidly can produce 'red man syndrome', characterized by flushing, an increased heart rate, and decreased in blood pressure. Usually slow the rate of infusion of the dose at least 1 hour per dose.

A breast-feeding teenage mother is diagnosed with syphilis. Which would be the medication of choice for this client? 1. Doxycycline 2. Tetracycline 3. Azithromycin 4. Benzathine penicillin

4. Benzathine penicillin Benzathine penicillin is safe to use for syphilis in lactating women.

A client with an infection is receiving vancomycin. Which laboratory blood test result would the nurse report? 1. Hematocrit: 45% 2. Calcium: 9.0 mg/dl (2.25 mmol/L) 3. White blood cells (WBC): 10,000 mm3 (10x 10 9/L 4. Blood urea nitrogen (BUN): 30 mg/dl (10.2 mmol/L)

4. Blood urea nitrogen (BUN): 30 mg/dl (10.2 mmol/L) Vancomycin is a nephrotoxic medication. An elevated BUN can be early sign of toxicity. The BUN of a healthy adults is 10 to 20 mg/dL (3.6-7.1 mmol/L). A creatinine level of greater than 1.2 for women and greater than 1.4 for men may be an early sign that the kidneys are not working properly.

What are allergic symptoms of Sulfonamides?

A sulfa allergy is a rash or more serious reaction to sulfa drugs. Nurse must check allergic of sulfur before giving