Antibiotic Drugs

The patient is ordered daily divided doses of gentamycin. The patient received an intravenous dose of gentamycin at 4:00 PM. When should the nurse obtain the peak level?

4:30 PM IM is measured an hour after IV is measured 30 minutes after

A patient is receiving amphotericin to treat a systemic fungal infection. To prevent renal damage, it is most important for the nurse to do what?

Administer 1000 mL of 0.9% saline

Which patient does the nurse identify as most likely to need treatment with trimethoprim/sulfamethoxazole [Bactrim] for a period of 6 months?

A female patient with recurring acute urinary tract infections

Which patient would most likely need intravenous antibiotic therapy to treat a urinary tract infection?

A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain

Aminoglycosides: Gentamicin, tobramycin, amikacin

Adverse effects Nephrotoxicity Montior pt for kidney decline--want to monitor fluid intake and output/ BUN, CREATINIE, I&O AE:Nephrotoxicity Ototoxicity (total cumulative and trough levels) Hypersensitivity reactions Neuromuscular blockade: Concurrent use with neuromuscular blocking agents, general anesthetics, and in myasthenia gravis

Vancomycin

Adverse effects: Ototoxicity, "Red man" syndrome due to too rapid IV infusion, nephrotoxicity-effects kidneys *Thrombophlebitis -- check for redness, swelling, warmth, (common),Thrombocytopenia (rare) Allergy

Which statement about allergic reactions to penicillin does the nurse identify as true?

Anaphylactic reactions occur more frequently with penicillins than with any other drug.

Dosage Size and Duration

Antibiotic must be present: At the site of infection For a sufficient length of time Antibiotics must not be discontinued prematurely(only exception is an allergic reaction) Teach patients to complete full prescription to help resistance and reoccurance of infection

A patient who takes warfarin is prescribed itraconazole [Sporanox] to treat a fungal infection. The nurse will teach the patient to do what?

Avoid taking esomeprazole [Nexium] with itraconazole therapy

Amphotericin B

Broad-spectrum antifungal agent drug of choice to treat most systemic mycoses:Candidiasis, aspergillosis, cryptococcosis, mucormycosis Infusion reaction: Fever, chills, rigors, nausea, and headache Caused by release of proinflammatory cytokines Symptoms begin 1 to 3 hours after start of infusion and last for about 1 hour Before administration, healthcare provider prescribes histamine, bendryl, antipyretic Tylenol, and antiemetic *always check IV site because phlebitis can occur every 15-20min *there can be damage to kidneys so provider will order NS 1L to prevent kidney damage days to help minimize chances of kidney damage • Avoid concurrent use of other nephrotoxic drugs o Aminoglycosides, cyclosporines • Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided • Monitor serum creatinine every 3 or 4 days

Fifth generation cephalosporin:Ceftaroline

Infections associated with methicillin-resistant Staphylococcus aureus (MRSA)

Which statement by a new nurse about intravenous administration of amphotericin B indicates the nurse needs more education?

Diphenhydramine plus acetaminophen can minimize rigors associated with amphotericin B therapy

Tetracyclines

Drug interactions: Calcium supplements, milk products, iron supplements, magnesium-containing laxatives(maylox or milk of mag), and most antacids bc it will decrease absorption Adverse effects Gastrointestinal irritation Effects on bone and teeth Superinfection Hepatotoxicity Renal toxicity Photosensitivity and other effects Can cause teeth discoloration; do not give to children under the age of 8.

Erythromycin

Drug interactions: effects the CYP450 system there will be drug interactions with warfarin increases toxicity, plasma strength and halflife QT prolongation and sudden cardiac death Superinfections, thrombophlebitis, transient hearing loss

A patient is prescribed doxycycline (tetracycline) [Vibramycin]. If the patient complains of gastric irritation, what should the nurse do?

Give the patient food, such as crackers or toast, with the medication

Piperacillin/tazobactam [Zosyn]

Given along with gentamycin to treat pseudomonas

Ketoconazole

Inhibits CYP450 so drug interactions occur so give with food can increase gastric PH so should not be taken with antacids Hepatotoxicity: Rare but potentially fatal hepatic necrosis so monitor liver function before giving

Fluoroquinolones: Ciprofloxacin/Levofloxacin

MOA: Inhibits bacterial DNA gyrase and topoisomerase II Drug of choice for anthrax Side effects:Increased risk of Clostridium difficile infection (CDI) Older adult patients Confusion, somnolence, psychosis, visual disturbances Increased risk of Clostridium difficile infection (CDI) Older adult patients Confusion, somnolence, psychosis, visual disturbances Drug interactions: Theophylline (used for asthma) Warfarin (an anticoagulant) Myasthenia gravis Absorption reduced by Aluminum antacids Magnesium antacids Iron salts Zinc salts dairy products

Penicillins

MOA: Weaken the cell wall, causing bacteria to take up excessive water and rupture Principle adverse effect: allergies; would not be a good candidate for cephalosporin bc it is in the same family a lot of bacterial resistance to penicillin antibiotics which can cause allergies se: n/v dirreha

Fluoroquinolones

MOA:Disrupt DNA replication and cell division All can be administered orally or IV Side effects generally mild but can cause tendon rupture (low risk) Usually affects Achilles tendon--will report heel pain Avoid in patients younger than 18 years

Zyvox

May also cause myelosuppression--all cells produced by bone marrow; suppressions of platelets, RBC, WBC Assess for complete blood count and looking at the WBCs, may be at risk for bleeding Drug interaction with monoamine oxidase inhibitors (MAOIs)--used for depression

A patient is diagnosed with C. difficile infection. The nurse anticipates administering which medication?

Metronidazole/flagyl

It is most important for the nurse to avoid administering oral ciprofloxacin to this patient with which food?

Milk; administer 6 hrs before the cipro or 2 hrs after if they need to take an antacid

A patient has been prescribed ciprofloxacin for treatment of a urinary tract infection with Escherichia coli. Before administering the drug, it is most important for the nurse to assess the patient for a history of what?

Myasthenia gravis -bc it can exacerbate muscle weakness

Superinfection

NEW infection that appears during the course of treatment for a primary infection Because super-infections are caused by drug-resistant microbes, they often are difficult to treat ex) yeast infection

Adverse effects of gentamycin

Nephrotoxicity Ototoxicity Given with Zozen kills pseudomas typically occurs at peak levels

Which drug does the nurse identify as a urinary tract antiseptic

Nitrofurantoin

UTI antiseptics

Nitrofurantoin Methenamine

A patient is prescribed vancomycin orally for antibiotic- associated pseudomembranous colitis. The nurse will monitor the patient for what?

Ototoxicity

A prescriber states that a patient will need to receive penicillin intravenously. The nurse anticipates administering which drug

Potassium penicillin G

Third generation cephalosporin:Cefotaxime

Preferred therapy for several infections Highly active against gram-negative organisms Able to penetrate to cerebrospinal fluid (CSF)

Risk factors for vulvovaginal candidasis

Pregnancy, diabetes, debilitation, HIV, oral contraceptives, systemic glucocorticoids, anticancer agents, and systemic antibiotics Onychomycosis-nails

Sulfonamides

Primary use now: Urinary tract infection (UTI) Used to suppress bacterial colonization in patients with second- and third-degree burns; usually pain free Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin." pts should drink 8-10 glasses of water a day it is not safe to take while pregnant

Peak and trough levels

Samples for peak levels should be taken 30 minutes after giving an IM injection or after completing a 30-minute IV infusion Sampling for trough levels depends on the dosing schedule Divided doses(given more than once a day): Take sample just before(30 minutes before)the next dose Once-daily doses: Draw a single sample 1 hour before the next dose value should be very low ‒ preferably close to zero

Serum dosing levels for aminoglycosides

Single large dose each day or 2 or 3 smaller doses throughout the day *Peak levels must be high enough to kill bacteria; trough levels must be low enough to minimize ototoxicity

A patient is prescribed cefixime. The nurse should teach the patient to immediately report any signs of what?

Skin rash, hives, or itching; diarreha associated with antibiotics- pseudomembranous cholitis -- bloody diarrhea, abdominal pain and fever

Fluoroquinolones should be discontinued immediately if what happens?

Tendon pain or inflammation develops

The nurse is caring for a patient receiving intravenous gentamicin for a severe bacterial infection. Which assessment finding by the nurse indicates the patient is experiencing an adverse effect of gentamycin therapy?

Tinnitus Headache(early signs of ototoxicity)

Oral candidiasis (thrush)

Topical: nystatin "swish and swallow" Immunocompromised patients may need oral therapy with fluconazole or ketoconazole frequent yeast/oral infections should be assessed for DM or HIV

The nurse is reviewing laboratory values from a patient who has been prescribed gentamicin. To prevent ototoxicity, it is most important for the nurse to monitor which value(s)?

Trough drug levels of gentamicin--ototoxity occurs due to contantly elevated trough levels instead of elevated peak levels

Sulfonamides: silver sulfadiazine/ "silverdine"

Used to suppress bacterial colonization in patients with second- and third-degree burns; usually pain free Avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin."

Nitrofurantoin

Uses: Lower UTIs, prophylaxis, recurrent lower UTIs Adverse effects Gastrointestinal effects Pulmonary reactions: Acute and subacute Hematologic effects Peripheral neuropathy: numbness and tingling Hepatotoxicity:jaundice Birth defects

Before administering erythromycin to a patient for an upper respiratory tract infection, it is most important for the nurse to determine if the patient is also prescribed which drug

Verapamil [Calan]

A patient who was taking sulfonamides develops Stevens-Johnson syndrome. Upon assessment, the nurse expects to find what?

Widespread skin lesions

Metronidazole [Flagyl]

given for anaerobe type of infections anabuse type of reaction can occur--make them feel deathly ill. Patients cannot consume any alcohol, including mouthwash before or while taking this drug.

Cephalosporin: Rosefin/Ceftriaxone

has long half-life and given IM injection - 3rd generation - preferred therapy for several infection- STD Drug interactions with calcium bc it causes calcium percipitate in the kidney and the lungs

broad spectrum penicillians --Ampicillin Amoxicillin

high risk of superinfection, bc it can cause a greater risk of infection bc it can inhibit natural flora Adverse effects Rash Diarrhea

bacterialcidal drugs

kills bacteria

Second generation cephalosporin

not used for active bacteria

bacteriostatic

slows down bacteria but doesn't kill it.

Classification of cephalsporins

First generation Cephalexin Second generation Cefoxitin Third generation Cefotaxime Fourth generation Cefepime Fifth generation Ceftaroline

Bacteria that cephalosproins act against

First generation: Widely used for prophylaxis against infection in surgical patients; rarely used for active infections Second generation: Rarely used for active infection Third generation Preferred therapy for several infections Highly active against gram-negative organisms Able to penetrate to cerebrospinal fluid (CSF) Fourth generation Commonly used to treat health care‒ and hospital-associated pneumonias, including those caused by the resistant organism Pseudomonas Fifth generation Infections associated with methicillin-resistant Staphylococcus aureus (MRSA)

cephalosporins

MOA:Bind to penicillin-binding proteins (PBPs), disrupt cell wall synthesis, and cause cell lysis Cant give this drug if they have had a severe allergic to penicillin bc they will also have an allergic reaction Adverse effects Allergy Bleeding- so you do not want a drug to take warfarin or heparin or any other drug that promotes bleeding Thrombophlebitis rocephin-

what drug that has penicillin with oxyicillin with a culminate acid??

augmitin

augmentian

combination antibiotic that has amoxycillian and clavilanix acid that has a fixed dose MOA:inhibit beta lactamase enzymes so that the penicillian can do its work and kill the bacteria

Fourth generation cephalosporin:Cefepime

• Commonly used to treat health care‒ and hospital-associated pneumonias, including those caused by the resistant organism Pseudomonas

Sulfonamides: Trimethoprim/Sulfamethoxazole

drug interactions: warfarin, dilatin, oral sulfaurea(bactram)--can decrease blood sugar even more when given withg hypoglycemic drug like glypizide, therefore dosage needs to be cutback to reduce risk of hypoglycemia

epinephrine

drug of choice for anaphylaxis and allergic reactions to penicillians