Pharm Protection/Adaption 1

Main Antibiotic Classes

Sulfonamides Penicillins Cephalosporins Carbapenems Macrolides Tetracyclines Aminoglycosides Quinolones Misc. Class

Macrolides(often end in -omycin

Bacteriostatic but bactericidal in high concentrations Inhibit protein synthesis

Carbapenems(often end in -penem)

Broadest antibacterial action of any antibiotics to date Bactericidal inhibit cell wall synthesis Reserved for complicated body cavity and connective tissue infections in acute illness Danger--drug-induced seizure activity All given parenteral

Tetracyclines: Nursing Implications

Do not take with dairy products, antacids, iron Do not use in children under age 8 or in lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth Do not take if pregnant, can retard fetal skull development Use sunscreen Use alternative contraception Take with water or food to minimize GI adverse effects

fluconazole (Diflucan)

Fungistatic or fungicidal depending on concentration -Treats rapidly growing fungi -Preferred over amphotericin B, better A/E profile -Can pass into the CSF, treats meningitis -Very effective against vaginal candidiasis usually with one dose 😨😵AE: N/V, diarrhea, stomach pain, increased liver enzymes Use with caution in patients with renal and liver dysfunction

doxycycline (many brand names) tigecycline (Tygacil): Tetracyclines

IV only, skin, soft tissue, abdominal, pneumonia, resistant infections, MRSA and vancomycin resistant bacteria

The nurse is assessing a patient who has developed watery diarrhea. After checking the patient's history, the nurse finds that the patient was recently treated with antibiotics. Which further testing might be needed in this patient? 1 Sputum test 2 Acinetobactertest 3 Clostridium difficile test 4 Culture and sensitivity test

If the patient was previously treated with antibiotics and developed watery diarrhea, then the patient needs to be tested for Clostridium difficileinfection. If the result of this test is positive, then the patient needs to be treated for a serious superinfection. Infections with C. difficile are increasingly becoming resistant to standard therapy. Watery diarrhea is a common symptom of C. difficileinfection. C. difficile bacteria are not present in sputum; therefore, a sputum test is not indicated. A test for Acinetobacter is not helpful in this situation because the symptoms are not suggestive of an infection caused by this bacterium. Culture and sensitivity testing is helpful to optimize drug selection in individual cases, but not in this situation.

Antiviral Drugs (non-HIV)

Impair viral replication which results in viral concentrations low enough to allow elimination by the patient's immune system Used to treat infections caused by viruses other than HIV such as influenza, Herpes Simples Viruses HSV, Varicella-Zoster Virus VZV and CMV Healthy cells are often killed also, resulting in serious toxicities

erythromycin-resp, gi, skin

Macrolides Bitter taste, degraded by stomach acid, can irritate gi tract, stimulate gi motility, can help in gastroparesis

Quinolones: Adverse Effects

Most concerning is prolongation of the QT interval on the ECG, seizures Interactions with antacids, iron, zinc

Tetracyclines: Adverse Effects

Photosensitivity Alteration in intestinal and vaginal flora Tooth discoloration

Cephalosporins: Adverse Effects

Similar to penicillins n/v, diarrhea, abdominal cramps, rash, pruritus....etc. Potential cross sensitivity with PCN if allergy exist, if anaphylaxis with PCN then patient cannot have cephalosporin

Imipenem/cilastatin (Primaxin) Carbapenems

cilastatin inhibits enzyme that breaks down imipenem Indicated for bone, joint, skin, and soft-tissue infections....etc. serious adverse effect is seizures-more common in elderly and renal impaired

Quinolones

ciprofloxacin (Cipro) levofloxacin (Levaquin)-most widely used

Penicillins: Nursing Implications

●Penicillin or Cephalosporin Allergy ●Monitor for an allergic reaction for at least 20-30 minutes after administration ●Orals take with water, not juice ●IM-large muscle, rotate locations ●Adverse effects-n/v, diarrhea, anemia's, rash, pruritus..etc. (Table 38-4)

Nursing Implications for Antiviral Drugs

●Proper application technique for ointments, aerosol powders, etc. ●Emphasize hand washing before and after administration of medications ●Instruct patients to wear a glove or finger cot when applying ointments or solutions to affected areas □Instruct patients to consult their physician before taking any other medication, including OTCs □Emphasize the importance of good hygiene Antiviral drugs are not cures but do help to manage symptoms □Instruct the importance of taking these medications exactly as prescribed and for the full course of treatment □To start therapy with antiviral drugs at the earliest sign of recurrent episodes of genital herpes or herpes zoster

oseltamivir (Tamiflu)

●Stops virions from escaping from infected cells and spreading ●Active against influenza types A and B ●Treatment of uncomplicated acute illness caused by influenza ●Reduce duration of illness, oral use only AE: N/V □Treatment should begin within 2 days of influenza symptom onset

vancomycin (Vancocin)

☆Bactericidal ☆destroys cell wall ☆MRSA ☆Not active against gram - ☆Oral used for treatment of CDIFF ☆Must monitor blood levels to ensure ☆therapeutic levels and prevent toxicity ☆May cause ototoxicity and nephrotoxicity ☆Should be infused over 60 minutes at least ☆Rapid infusions may cause hypotension

Cephalosporins(often includes cef, cefa, cepha in the name)

♧Assess for PCN allergy ◇Bactericidal ♤interfere with cell wall synthesis ☆5 generations of cephalosporins ◇Gram +, gram - or anaerobic depending on generation

Ethambutol

《Primary or 1st line drug 《Bacteriostatic, inhibits protein synthesis 《Used in combination with other drugs in treatment of TB A/E: neuritis, blindness 《Baseline eye exam

Tetracyclines (often end in -cycline)

》Bacteriostatic inhibit bacterial protein synthesis 》Gram-negative and gram-positive organisms 》Acne, chlamydia, mycoplasma pneumonia, rickettsia, H pylori...etc.

Sulfanomides MOA

》Bacteriostatic 》Prevent bacterial synthesis of folic acid 》Broad spectrum 》High concentration in kidneys-UTIs 》Synergistic effect -Other indications-URI, prophylaxis, HIV infections, outpatient staph infections from MRSA in the community =Resistance

Antitubercular Drugs

》Drugs used to treat infection caused by Mycobacterium 》Primary or 1st line drugs, Secondary or 2nd line drugs (Box 41-2, 41-3) 》The mostly widely used drug is Isoniazid or INH Treament plan: ◇Patient is started on a 4 drug regimen: isoniazid, rifampin, pyrazinamide, ethambutol or streptomycin (aminoglycoside) ◇Drug susceptibilty test performed on the 1st patient specimen, regimen adjusted if needed ◇Adherence to the drug plan is imperative

Misc. Antibiotics: clindamycin (Cleocin)

》bactericidal or bacteriostatic 》inhibits protein synthesis 》Indications: chronic bone infections, GU infections, intra-abdominal infections, pneumonia, septicemia, serious skin and soft tissue infections Adverse effect: serious pseudomembranous colitis

nystatin: Nursing Implications

》given as an oral lozenge or troche should be slowly and completely dissolved in the mouth , DO NOT chew or swallow whole 》nystatin suspension should be swished thoroughly in the mouth as long as possible before swallowing

linezolid (Zyvox)

》new class of antibiotics known as oxazolidinones 》Inhibits bacterial protein synthesis 》Treats VRE, hospital acquired pneumonia, complicated skin infections caused by MRSA 》Avoid tyramine-containing foods..can raise BP

Anthelmintic

🐛worm infections 》drugs destroy structures 》specific to the worm they kill 👥Transmitted by person to person contact, 🚱🍉ingestion of contaminated water or food, direct contact with parasite 💩💉😷Analyze feces, urine, blood, sputum, tissue from infected host **Most important is that the causative worm in the infected host must be accurately identified before treatment is started

Antimalarial Drugs

🐩+ lab test 🚳work during the asexual cycle which takes place within the human body -Treatment guided by: the infecting plasmodium species, clinical status of the patient, drug susceptibility of the infecting parasite as determined by the geographic area -antimalarial prophylaxis

Aminoglycosides(often end in -cin)

gentamicin (Garamycin)-most common tobramycin (Nebcin)-common for pulmonary infections amikacin (Amikin)-used to treat infections resistant to gentamicin or tobramycin

Anthelmintic Drugs

pyrantel (Pin-X) or (Antiminth) treat roundworm Causes paralysis of worm and it expelled in GI tract Contraindicated in liver disease Oral use, OTC A/E: headache, dizziness, insomnia, rash, anorexia, abdominal cramps, diarrhea, N/V Assess baseline liver function, stool specimens, food eaten, other members in the house

Sulfonamides: Nursing Implications

~Sulfa Allergy-fever, rash ~Photosensitivity-sunburn ~Can potentiate the glucose lowering mechanism of sulfonylureas ~Adverse effects-n/v, abd pain, pseudo colitis, renal failure, anemias ~Crystalluria-force fluids ~Superinfection ~Take with food if GI upset ~Use alternative contraception

Vancomycin General Nursing Implication Reminders

¤Monitor therapeutic goals ¤Monitor labs, testing, adverse effects, secondary infections ¤Teach patients when to take with food or not ¤Always use alternate birth control ¤Take complete round of antibiotics

Macrolides: Nursing Implications

¤These drugs are highly protein-bound and will cause severe interactions with other protein-bound drugs ¤Can cause hepatotoxicity, hearing loss, palpitations ¤The absorption of oral erythromycin is enhanced when taken on an empty stomach ¤Do not give immediately before/after fruit juices

Rifampin

》Primary or 1st line drug 》Bactericidal, interferes with protein synthesis 》Used in more advanced disease 》Used in combination with other drugs in treatment of TB, for prevention in patients exposed to isoniazid-resistant M. tuberculosis 》AE: hepatitis, hematologic disorders, red-orange-brown urine, tears, sweat, sputum, (reversible except with contacts) 》Oral contraceptives are ineffective

vancomycin (Vancocin) Nursing

•Monitor IV site closely-extravasation •Red man syndrome may occur if infusion too fast •Ensure adequate hydration-at least 2L/24 hours

Penicillins (often end in -cillin)

■Bactericidal ■Inhibit cell wall synthesis ■Combo meds with PCN to prevent breakdown of ■beta-lactam ring (figure 38-4) 》pencillin G/V-natural pcn Beta-lactamase inhibitors: 》ampicillin/sulbactam (Unasyn) 》amoxicillin/clavulanic acid (Augmentin) 》piperacillin/tazobactam (Zosyn)-extended spectrum

Antiretroviral Drugs: Adverse Effects

■Drug therapy may need to be modified because of adverse effects ■Goal: find the regimen that will best control the infection with a tolerable adverse effect profile ■Medication regimens change during the course of the illness Before therapy: ◇Assess - underlying disease and medical history, including allergies, VS, nutritional status ◇Contraindications

acyclovir (Zovirax)

■Used to suppress replication of: HSV-1, HSV-2, VZV ■Drug of choice for treatment of initial and recurrent episodes of these infections ■A/E: nausea, diarrhea, headache, burning with topical application

hydroxychloroquine (Plaquenil)

□Inhibits DNA and RNA, destruction of the parasite □Antiinflammatory effects-used to treat Rheumatoid Arthritis, Lupus 💩☠💇‍♂️A/E: N/V, diarrhea, anorexia, dizziness, headache, seizures, alopecia, rash

isoniazid (INH)

□Primary or 1st line drug □Bactericidal, kills mycobacteria by disrupting cell wall synthesis □Used alone or in combination with other drugs in treatment and prevention of TB □Metabolized in the liver through acetylation—watch for "slow acetylators" 》A/E: peripheral neuropathy, hepatotoxicity, optic neurtis, visual disturbances, pyridoxine deficiency ♤Contraindicated with liver disease ♤May need pyridoxine (vitamin B6) supplement to treat or prevent peripheral neuropathy

Antiretroviral Drugs (HIV) HAART Highly active antiretroviral therapy

▪︎Combination or "cocktails" of antiretroviral drugs, at least 3 drugs ▪︎Started as soon as confirmation +HIV ▪︎These medications work in different ways to reduce the viral load. What is an undetectable viral load? ▪︎New drug combos prolong lives, significant toxicities, ▪︎No cure, many classes of antiretroviral drugs

Macrolides: Adverse Effects

▪︎GI effects, primarily with erythromycin ▪︎Nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia ▪︎Newer drugs, azithromycin and clarithromycin: fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration

Quinolones(often end in -floxacin)

◇Also called "fluoroquinolones" ◇Bactericidal ◇Alter bacterial DNA ◇Excreted in the kidney as mostly unchanged drug-complicated UTI ◇Black box warning: tendonitis, tendon rupture

zidovudine (Retrovir) AZT

◇First anti-HIV medication and for a long time the only one □Blocks the enzyme reverse transcriptase so no new viral DNA molecules can be formed from the RNA genome ♡Can be given to pregnant HIV-positive women and newborn babies to prevent maternal transmission of HIV ◇Major dose-limiting adverse effect: bone marrow suppression =Usually given in combination with other drugs

Pryrazinamide (PZA)

◇Primary or 1st line drug ◇Bactericidal or bacteriostatic depends on drug concentration ◇Used in combination with other drugs in treatment of TB □A/E: hepatotoxicity, hyperuricemia □Contraindicated in hepatic disease or acute gout □Monitor uric acid baseline levels

Antiretroviral Drugs

○Combinations of multiple antiretroviral medications are common ○Adverse effects vary with each drug and may be severe; monitor for dose-limiting toxicities ○Monitor for signs of opportunistic diseases ○Lifelong therapy is crucial, keep follow-up appts ○Teach to wear gloves, wash hands. ○Avoid crowds with immunosuppression. ○No cure

nitrofurantoin (Macrodantin)

○Disrupts cell wall formation ○Primarily used for UTI ○Reduced dose if renal function is impaired or elderly ○Drug concentrates in the urine ○May cause fatal hepatotoxicity but rare ○Usually well-tolerated if patient is kept well-hydrated

nystatin (Mycostatin)

○Topical for candidal diaper rash ○Oral as prophylaxis against candidal infections in neutropenia ○Used in treatment of oral and vaginal candidiasis 😡A/E: N/V, diarrhea, rash, local irritation Oral or topical only

Antifungals: Nursing Implication

💔If taking for vaginal infection. Abstain from sexual intercourse until treatment complete, continue medication even during menstruation Handwashing!! Use applicator with vaginal troches, wear gloves 🛀‍♀️‍♂️Keep body clean, dry, wear light, cool clothing 👁👃Avoid topical contact with eyes, mouth, nose or other mucous membranes

The nurse is assessing a patient who is prescribed sulfamethoxazole/trimethoprim (SMZ-TMP) for the treatment of shigellosis enteritis. For which reason does the nurse instruct the patient to increase fluid intake up to 3000 mL per day? 1. To prevent hypotension 2. To prevent drug-related crystalluria 3. To prevent mucosal irritation and dryness of the mouth 4. To maintain the fluid and electrolyte balance in the body

2 Sulfamethoxazole/trimethoprim (SMZ-TMP) is a sulfonamide antibiotic, which may cause crystalluria in the patient. Therefore the nurse instructs the patient to increase fluid intake up to 3000 mL per day to prevent drug-related crystalluria. Sulfamethoxazole/trimethoprim (SMZ-TMP) does not cause fluid loss; therefore, it does not cause hypotension. Sulfamethoxazole/trimethoprim (SMZ-TMP) does not cause mucosal irritation, dryness of the mouth, or electrolyte imbalance.

Which instruction will the nurse include in the discharge teaching for a patient receiving tetracycline? 1. "Take the medication until you feel better." 2. "Use sunscreen and protective clothing when outdoors." 3. "Keep the remainder of the medication in case of recurrence." 4. "Take the medication with food or milk to minimize gastrointestinal upset."

2. Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns. The medication is taken when sick, not well. The medication should not be taken with milk and should be completely finished.

amphotericin B

"ampho-terrible" □drug of choice for severe, systemic fungal infections □Binds to sterols in cell membrane lining resulting in cell death A/E: cardiac dysrhythmias, neurotoxicity, visual disturbances, numbness, tingling, renal toxicity, hepatotoxicity, hypokalemia □Infusion related: fever, chills, headache, n/v, malaise, anemia, hypotension, muscle and joint pain □Premed-antiemetics, antihistamines, antipyretics, antiinflammatory □Weight based

Other Antiprotozoal Drugs -metronidazole (Flagyl) antiprotozoal, antibacterial, anthelmintic

-Treats several protozoans, anaerobic bacterial infections, intra-abdominal and gynecologic infections, antibiotic induced pseudomembranous colitis 💀Directly kills protozoans by damaging DNA 😵😕😫A/E: headache, dizziness, confusion, neuropathy, weakness, blurred vision, dry mouth, metallic taste, N/V, 💩diarrhea, 👂hearing loss, tinnitus 🚫🍷Avoid alcohol, 🍗 take with food 🚫💏Avoid sexual intercourse 🚫Do not crush or chew ER, enteric coated

Antiviral Drugs(often end in -vir)

-kill or suppress the virus -never fully eradiate virus from host -healthy immune system works synergistically with meds -Immunocompromised patients are at risk for opportunistic infection

Sulfanomides

-sulfamethoxazole combined with another non-sulfonamide antibiotic called trimethoprim to create: -sulfamethoxazole/trimethoprim or co-trimoxazole Trade name is Bactrim or Septra (5:1)

Which time range is the elimination half-life of amoxicillin? 1 6 to 8 hours 2 1 to 2 hours 3 0.5 to 1 hour 4 1 to 1.5 hours

1

The nurse is caring for a postoperative patient. Which antibiotic is used for prophylaxis against infection in surgical patients? 1 Cefazolin 2 Cefoxitin 3 Cefepime 4 Ceftriaxone

1 First-generation cephalosporins, such as cefazolin, are used as prophylaxis against infection in surgical patients. First-generation agents are preferred to second- and third-generation cephalosporins for surgical prophylaxis because they are as effective as the newer drugs, are less expensive, and have a narrower antimicrobial spectrum. Cefoxitin is a second-generation cephalosporin, ceftriaxone is a third-generation cephalosporin, and cefepime is a fourth-generation cephalosporin.

How does penicillin work to destroy bacteria? 1 It interferes with cell wall synthesis. 2 It binds irreversibly to the cell wall. 3 It interrupts bacterial DNA processes. 4 It interrupts bacterial RNA processes.

1 Penicillin inhibits transpeptidases and activates autolysins. This disrupts the synthesis of the cell wall and promotes active destruction of the cell wall. These combined actions result in cell lysis and death. Penicillin irreversibly inactivates a key enzyme in bacterial cell wall synthesis, but it does not bind irreversibly to the cell wall. Penicillin does not interrupt bacterial DNA or RNA processes to destroy bacteria.

A patient with type 2 diabetes mellitus is started on sulfamethoxazole/trimethoprim. Which nursing intervention is a necessary priority for this patient? 1 Assess blood sugar. 2 Monitor platelet count. 3 Assess hemoglobin and hematocrit. 4 Take blood pressure every 4 hours.

1 Sulfamethoxazole/trimethoprim increases the hypoglycemic response when taken with sulfonylureas (oral hypoglycemic agents). The nurse would assess blood sugar and determine what oral hypoglycemic the patient is taking. The remaining choices are not the priority.

The nurse is performing a follow-up assessment of a patient who was prescribed tetracycline for a respiratory infection. The nurse finds that the infection is still present; however, the patient reports taking the drug as prescribed. Which question does the nurse ask the patient to determine the cause of drug ineffectiveness in this situation? 1 "Did you take the drug with spicy food?" 2 "Did you coadminister iron supplements?" 3 "Did you take the drug with a full glass of water?" 4 "Did you take the prescribed dosage of the drug?"

2 Tetracycline may not be compatible with all foods and drugs. Iron, calcium, and magnesium may chelate the drug, making it unavailable for absorption. Therefore the nurse would ask the patient about the use of iron supplements. The drug should be taken with food or with a full glass of water to avoid gastrointestinal upset. The drug, when taken as prescribed, should exhibit its therapeutic effect. The patient's history is not suggestive of nonadherence with the prescribed regimen because the patient reports taking the medications as prescribed.

A primary health care provider prescribes a medication along with ampicillin to enhance the effectiveness of the antibiotic. Which medication will be added to enhance the effectiveness of the ampicillin? 1. Calcium citrate 2. Clavulanic acid 3. Acetaminophen 4. Carbamazepine

2 - Clavulanic acid is a beta-lactamase inhibitor. Administered concurrently, it augments the therapeutic effect of antibiotics such as ampicillin. When ampicillin is administered by mouth, concurrent administration of calcium citrate can diminish its absorption. Acetaminophen and carbamazepine do not affect the pharmacokinetics of ampicillin.

A patient with a respiratory infection is treated with doxycycline. At the follow-up visit, the nurse finds that the signs and symptoms of infection have not subsided. Which patient action might have caused a reduction in the therapeutic effect of the drug? 1 The patient took the medication with salt crackers. 2 The patient refrained from going out in the sunlight. 3 The patient took the medication with a glass of milk. 4 The patient refrained from taking antacids along with the medication.

3 Doxycycline is a tetracycline antibiotic. The absorption of the medication may be reduced if it binds with calcium, magnesium, or iron. Therefore the patient should stay away from dairy products, antacids, and iron supplements when taking this medication. Taking medications with salt crackers helps to reduce gastrointestinal irritation. Direct exposure to sunlight may cause photosensitivity reaction but does not reduce the drug efficacy. Antacids should be avoided with the medication because they can reduce its efficacy.

A patient is prescribed sulfamethoxazole/trimethoprim (co-trimoxazole) for a urinary tract infection. Which instruction does the nurse give to the patient to prevent complications associated with sulfamethoxazole/trimethoprim (co-trimoxazole)? 1."Limit your fluid intake." 2."Avoid eating citrus fruits." 3."Avoid exposure to sunlight." 4."Limit your intake of milk products."

3 Sulfamethoxazole/trimethoprim (co-trimoxazole) is a sulfonamide antibiotic and may cause photosensitivity. The nurse would instruct the patient to avoid exposure to sunlight during sulfonamide therapy because it may cause a photosensitivity reaction or another type of skin reaction in the patient. The nurse instructs the patient to increase fluid intake to avoid the risk of crystalluria. Sulfonamide antibiotics do not have any interaction with milk products or citrus fruits, so these can be consumed.

Which medication may sometimes be overlooked when considering penicillin allergies in patients? 1. Amoxicillin (Amoxil) 2. Ampicillin (Totacillin) 3.Penicillin V potassium (V-Cillin K) 4.Piperacillin/tazobactam (Zosyn)

4. The brand name of Zosyndoes not have the suffix "-cillin." For amoxicillin (Amoxil), ampicillin (Totacillin), and V potassium (V-Cillin K), "amoxil" or "-cillin" is mentioned in the brand name.

A nursing student asks the nursing instructor about the mechanism of bacteriostatic action of tetracycline. Which answer by the nursing instructor is correct? 1. "Tetracycline blocks RNA synthesis." 2. "Tetracycline binds to magnesium ions." 3. "Tetracycline inhibits protein synthesis." 4. "Tetracycline degrades the bacterial cell wall."

3. Tetracyclines are bacteriostatic drugs that inhibit bacterial protein synthesis by binding to the 30S bacterial ribosome. The antibiotic rifamycin blocks synthesis of RNA from a DNA template. When administered with magnesium, tetracyclines bind to the magnesium and the therapeutic action of the tetracycline is reduced; magnesium binding has no role in the bacteriostatic action of tetracycline. Tetracycline does not break down bacterial cell walls; penicillin does.

How does superinfection occur in a patient? 1. When the serum level of an antibiotic is too high 2. When the patient has a gram-positive bacterial infection 3.When the patient has a gram-negative bacterial infection 4. When the antibiotic eliminates the normal bacterial flora

4. The normal bacterial flora consists of certain bacteria and fungi that are needed to maintain normal function in various organs. Superinfection can occur when antibiotics completely eliminate the normal bacterial flora. When these bacteria or fungi are killed by antibiotics, then other bacteria or fungi cause infection, which is known as superinfection. When the serum level of the antibiotic is too high, it causes a toxic reaction. Gram-positive and gram-negative bacterial infections do not cause superinfection.

Which condition is the principal indication for sulfamethoxazole-trimethoprim (SMZ-TMP)? 1. Meningeal infection 2. Bacterial pneumonia 3. Bacterial endocarditis 4. Urinary tract infection

4. The primary indication for sulfonamide therapy is urinary tract infection because these drugs achieve high concentrations in the kidneys. The combination of these two drugs allows for a synergistic antibacterial effect. Furthermore, sulfonamides are indicated in the treatment of infections with Escherichia coli, Klebsiella, Proteus vulgarisand Proteus mirabilis, Staphylococcus aureus, Pneumocystis jirovecii, and Stenotrophomonas maltophilia. Extended-spectrum penicillins are used to treat many health care-associated infections, including pneumonia. Ceftriaxone is administered in meningeal infection. Amoxicillin is used as a dental prophylaxis for bacterial endocarditis.

The nurse is assessing a patient who is prescribed sulfamethoxazole/trimethoprim (co-trimoxazole). Which instruction does the nurse give to the patient before the administration of sulfamethoxazole/trimethoprim (co-trimoxazole)? 1. "Eat more high-protein foods." 2. "Avoid eating high-calorie foods." 3. "Avoid consumption of dairy products." 4. "Use any method other than oral contraception for birth control."

4. Sulfamethoxazole/trimethoprim (co-trimoxazole) is a sulfonamide antibiotic. Sulfonamide antibiotics reduce the efficacy of oral contraceptives, which may result in unintended pregnancy. Therefore the nurse would instruct the patient to switch over to another method of contraception to prevent unwanted pregnancy. Sulfamethoxazole/trimethoprim (co-trimoxazole) does not interact with high-protein foods. Dairy products and high-calorie foods do not interfere with metabolism of sulfamethoxazole/trimethoprim (co-trimoxazole).

Aminoglycosides

A "mean old glycoside" Bactericidal: kills mostly gram - Prevent protein synthesis in bacteria Potent antibiotics, drug of choice for virulent infections Therapeutic drug monitoring due to nephrotoxicity and ototoxicity

When instructing a patient about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy? 1. Organ toxicity 2.Superinfection 3. Hypersensitivity 4.Rebound toxicity

Antibiotic therapy can destroy the normal flora of the body, which typically inhibit the overgrowth of fungi and yeast. When the normal flora are decreased, these organisms can overgrow and cause infections. Organ toxicity, hypersensitivity, and rebound toxicity are not a disturbance in the normal flora associated with antibiotic therapy.

A patient receiving antibiotics for chronic tonsillitis has been experiencing abdominal pain and cramps associated with frequent watery stools. Which infection does the nurse suspect? 1. Klebsiella infection 2.Clostridium infection 3. Acinetobacter infection 4. Enterococcus infection

Antibiotic-associated diarrhea may be a result of superinfection due to the use of antibiotics in the treatment of tonsillitis. Here, the antibiotics disrupt the gut flora growth and promote Clostridium difficile growth. C. difficile infection is associated with watery diarrhea, abdominal pain, and fever. Klebsiella, Acinetobacter, and Enterococcus are common pathogens that lead to health care-associated infections such as pneumonia and urinary tract infections.

Antibiotics therapy

Antibiotics Empiric therapy Definitive therapy Prophylactic therapy Therapeutic Subtherapeutic Toxicity Superinfection Pseudomembranous colitis Host factors

Cephalosporins: Nursing Implications

Assess-PCN allergy Oral with food-minimize GI upset Avoid alcohol or alcohol containing products-acute alcohol intolerance Use alternate contraception Complete antibiotic course

ADPIE Antimalarial Drugs

Assessment: -Medication history, physical assessment, VS, monitor for s/s of malaria. Travel? -Baseline visual acuity needed due to adverse effect of visual field problems, optic neuritis Implementation: 💦💦-💧💧Take with 6-8 oz of water or other fluid, food -Complete entire course of treatment -Encourage follow-up appt to monitor liver function

Antitubercular drugs: Nursing Implications

Assessment: ■Medical and medication history, physical assessment, PPD test results, CXR, sputum results ■Labs: BUN, creatinine, liver enzymes, CBC, uric acid level ■Vision and hearing test ■Age—toxicity is increased in elderly Implementation: ◇Patient must adhere!! Take at same time everyday, finish entire prescription, ◇do not miss a dose ◇Take with food to decrease GI effects ◇Monitor for therapeutic response

Cephalosporins

First generation (gram + bacteria) Used for surgical prophylaxis, and for susceptible staphylococcal infections □cefazolin (Ancef): iv route only cephalexin (Keflex): po only Second generation (gram + and some -) □cefoxitin (Mefoxin) used for surgical prophylaxis in abdominal surgery because it kills intestinal bacteria Third generation (gram -, less active against gram +) □ceftriaxone (Rocephin) Long acting, given once daily, passes through the BBB so indicated for meningitis

Aminoglycosides: Adverse Effects

Ototoxicity Injury to 8th cranial nerve, vestibular damage temporary or permanent hearing loss, dizziness, tinnitus, fullness in the ears Baseline and continuing hearing test Nephrotoxicity Reduced renal function, urinary casts, proteinuria Increased BUN, serum creatinine Monitor baseline and continuing labs CT scan with contrast may not be possible

The nurse is caring for a patient who is taking penicillin antibiotics. The patient reports flushing, itching, hives, anxiety, and throat and tongue swelling. The nurse finds that the patient has a rapid, irregular pulse. Which condition may the patient have as a result of taking the antibiotic? 1 Tolerance to the antibiotic drugs 2 An allergic anaphylactic reaction 3 Clostridium difficilebacterial infection 4 Glucose-6-phosphate dehydrogenase deficiency

The patient has developed an allergic anaphylactic reaction to the penicillin antibiotics. Flushing, itching, hives, anxiety, and throat and tongue swelling are symptoms associated with an allergic anaphylactic reaction. In this condition, the patient's pulse rate may become rapid and irregular. The described reaction is not a tolerance to the antibiotic. Watery diarrhea, abdominal pain, and fever are the symptoms of a Clostridium difficileinfection. The administration of antibiotics to patients with glucose-6-phosphate dehydrogenase deficiency leads to hemolysis. The patient has no symptoms associated with hemolysis and therefore does not have glucose-6-phosphate dehydrogenase deficiency.

meropenem (Merrem) Carbapenems

less seizure potential

azithromycin (Zithromax)-GU, resp tract, MAC clarithromycin (Biaxin)-GU, resp tract, MAC, H Pylori

more widely used, longer duration of action, fewer GI adverse effects, better efficiacy:

Antifungals (often end in -azole)

😄Drugs used to treat fungal infections 😀Small group of drugs 😅Fungi are hard to kill 😊Indications are drug specific 😶Contraindicated in liver or kidney failure 🎲Many antifungal drugs are metabolized by the cytochrome P-450 enzyme system Co-administration of two drugs that are metabolized by this system may result in competition for these enzymes, and thus higher levels of one of the drugs