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Safety Meds Antimicr
NP2 - Unit 1, Safety in Meds - Antimicrobials (Dehouske)
| Question | Answer |
|---|---|
| In what five ways do antimicrobials act upon microorganisms? | 1. Inhibit cell wall synthesis 2. Inhibit protein synthesis 3. Distribution or alteration of membrane permeability 4. Inhibition of nucleic acid synthesis (antivirals) 5. Inhibition of other specific biochemical pathways |
| What are the five steps to choosing an antimicrobial? | 1. Suspected infected site (where is the infection) 2. Host factors (i.e. how sick they are, what meds they're on) 3. Which organism is causing infection 4. Treat according to preliminary info until C&S comes back 5. Use antibiotic combinations if nee |
| What are the adverse effects associated with antimicrobials? | Allergic reaction, superinfection, GI upset |
| What symptoms go along with a rash due to an allergic reaction to antimicrobials? | urticaria, runny nose. |
| What should you do if a patient develops a rash after receiving an antimicrobial? | Stop med, give antihistamine |
| What symptoms go along with anaphylactic shock in reaction to an antimicrobial? | Low BP, Bronchoconstriction, Laryngeal edema, Cardiovascular collapse. |
| What should you do if a patient shows signs of anaphylactic shock after receiving an antimicrobial? | Stop med, give epinephrine (with MD order), oxygen, supportive care. |
| In choosing an antimicrobial, what is the importance of the infected site? | How serious the infection is, location - how close area is to other structures, how much vasculature the area has that could carry bacteria to another location, etc. |
| In choosing an antimicrobial, what sort of host factors are important? | How sick the patient is, what meds they are on, etc. |
| If the doctor orders ampicillin and a culture, what should you do? | Culture FIRST, then give ampicillin. |
| What is the cornerstone for determining which organism you are dealing with? | Culture and Sensitivity (C&S) |
| Before the specific organism is determined, what will the doctor often do? | Place the patient on a broad-spectrum antibiotic until the C&S comes back. |
| IM and PO antimicrobials vs. IV? | IM and PO less expensive, IV more effective. |
| If a patient says he is allergic to an antimicrobial, what should you ask him, and why? | What happens when you take that medication? Because the patient may be confusing a side effect, like GI upset, for an allergy. A side effect isn't justification for not taking a med if it's needed. |
| Administering IV antimicrobials | On time, accurate dose, correct method, check compatibilities, check site |
| Administering IM antimicrobials | Appropriate muscle, good circulation, not a common route of administration |
| Nursing responsibilities for administering antimicrobials | Know particulars about drug given including classification |
| Patient teaching in regards to the administration of antimicrobials | Take entire round as prescribed to prevent reinfections |
| Penicillin - action | Interferes with protein formation in bacterial cell wall |
| Penicillin - types of infections treated | meningitis, pneumonia, sepsis, SBE (subacute bacterial endocarditis) |
| Natural penicillin treats gram ___ bacteria | + |
| If a bacteria produces an enzyme (penicillinase) that destroys penicillin, what class of penicillin should be used? | Penicillinase-resistant methicillin |
| Aminopenicillins differ from natural penicillin in that... | They have an added amino group which allows them to treat gram neg. organisms |
| Trade name for Aminopenicillin | Ampicillin |
| Extended spectrum penicillin | Related to ampicillin, but covers gram neg. better. |
| Which organism does extended spectrum penicillin specifically work better against? | Pseudomonas |
| Trade names - extended spectrum penicillin | carbenicillin, ticarcillin |
| Suffix for penicillins | -cillin |
| Which antibiotic has the highest incidence of allergic reaction? | Penicillins |
| If a patient is allergic to penicillin, he is often also allergic to ____. | Cephalosporins. |
| From what are cephalosporins produced? | A fungus |
| How many kinds of cephalosporins are there? | Three, titled "generations" - 1st, 2nd, and 3rd generation. |
| First generation cephalosporins | Cefazolin, Ancef |
| Second generation cephalosporins | Cefoxitin, Mefoxin |
| Third generation cephalosporins | Cefotaxime, Claforan |
| Cephalosporins - adverse reactions | Blood dyscrasias - bleeding, neutropenia, leukopenia, thrombocytopenia May be CNS irritant if given intraventricularly. |
| Aminoglycosides - names | Gentamycin Kanamycin Amikacin |
| Aminoglycosides treat gram ___ bacteria | Neg. and Pos. |
| T or F - Aminoglycosides aren't very popular, because they don't work too well in treating bacteria. | False. They are both popular and very good at treating bacterial infections. |
| How do aminoglycosides work? | Changes protein synthesis, acts only on actively growing bacteria. |
| What are aminoglycosides not good for? | Prophylaxis |
| Aminoglycosides - indications | Serious infections, especially pseudomonas |
| How are aminoglycosides excreted? | through glomerular filtration |
| Aminoglycosides - adverse effects | *OTO AND RENAL TOXIC* High doses can cause muscular weakness or paralysis. |
| How does penicillin interact with aminoglycosides? | Penicillin inactivates aminoglycosides, and vice versa. |
| Aminoglycosides - Nursing Considerations | Assess patients for fullness in ears or balance problems. OTOTOXIC. RENAL TOXIC. Do not give too quickly. Watch peak and trough levels. |
| When should you measure peak level for aminoglycosides? | About 30 minutes after infusion is complete. |
| When is the trough level measured for aminoglycosides? | Just before next dose, no more than 45 minutes before usually. |
| What was the first broad-spectrum antibiotic? | Tetracyclines. |
| tetracyclines treat gram ___ bacteria | Both pos. and neg. |
| How do tetracyclines work? | They are bacteriostatic. They cause cell leakage, can be "cidal" in large doses. |
| What type of infections do tetracyclines treat? | Acne, chlamydial infections |
| Tetracyclines - dietary considerations | Food and dairy products reduce absorption. Take on empty stomach. |
| Tetracycline - adverse effects | Drug binds to newly formed bone and teeth (don't use in pregnancy or for kids under age 8) |
| Erythromycins treat gram ___ bacteria | both pos. and neg., but better for gram pos. |
| How do erythromycins work? | They are bacteriostatic |
| What antibiotics have the least incidence of toxicity? | erythromycins. |
| T or F - Erythromycins often cause allergic reactions. | False. Hardly anyone has an allergic reaction to them. |
| What side effect is erythromycin notorious for? | GI upset. |
| Off-label use for erythromycin | Gastric emptying in patients with delayed gastric emptying |
| Why are erythromycin tablets coated? | So that the medicine is not destroyed by the stomach acid |
| Erythromycin dietary considerations | Take on an empty stomach |
| Sulfonamide names | Gantrisin Bactrim Septra Azulfidine |
| What was the first safe and low-cost antibiotic? | Sulfonamide |
| How do sulfonamides work? | They are bacteriostatic. In a high bladder concentration, they may be "cidal" |
| What infections are sulfonamides used for? | Mostly for UTI's. |
| Sulfonamides - adverse reactions | Cause crystalluria. Can cause hemolysis and aplastic anemia in toxic doses. |
| Sulfonamides - nursing considerations | Watch I&O, keep urine alkaline, keep urine dilute. |
| Sulfonamides - patient teaching | Must drink at least 2-3 liters of water per day. |
| Chloramphenicol uses | CNS infections Haemophilus influenzae infections |
| How does chloramphenicol work? | Bacteriostatic. "Cidal" for vulnerable organisms, or in high doses. |
| Why is the use of chloramphenicol limited? | Serious toxicity - *APLASTIC ANEMIA* |
| What are the limitations for chloramphenicol use? | Not to be given for more than 14 days. Only to be used in severe infections. |
| What is aplastic anemia? | Shutdown of bone marrow. |
| PO vs. IV administration of chloramphenicol? | With PO use, bone marrow suppression is irreversible. With IV use, it *may* be reversible. |
| Quinolones - names | Ciprofloxacin Floxin |
| What is the newest group of antibiotics? | Quinolones |
| Quinolones treat gram ___ bacteria | both gram pos. and neg. |
| Quinolones are especially effective against ___. | Pseudomonas |
| How do quinolones work? | Prevents DNA replication of organism |
| Quinolones | Broad-spectrum antibiotic with good oral absorption and few side effects. |
| Quinolones - side effects | Few side effects. Nausea, can be nephrotoxic, can cause allergic reaction. |
| Amphotericin B indications | severe systemic antifungal infections |
| Amphotericin B administration | Should be given slowly, over 2-4 hours. Monitor electrolytes (potassium). Can lower electrolytes. Shivering and rigors during treatment treated with Demerol. Very, very nephrotoxic. Causes light sensitivity - protect from light. |
| How does amphotericin B work? | Alters cell wall permeability. |
| How long is amphotericin B treatment? | 4-8 weeks. Treatment is slow. |
| What is the main concern with amphotericin B? | It's very, very nephrotoxic. |
| Amphotericin B adverse effects | Very nephrotoxic, CV toxicity possible. |
| Acyclovir | Antiviral used primarily for herpes infections |
| Acyclovir routes | IV or PO |
| Acyclovir IV administration considerations | Give over 1 hour to prevent renal dysfunction Make sure patient is well-hydrated. |
| Gancyclovir | Antiviral used primarily for treatment of CMV (Cytomegalovirus). |
| Gancyclovir route | IV |
| Gancyclovir adverse effects | neutropenia, thrombocytopenia, seizures. |
| Gancyclovir precautions | Antineoplastic precautions - carcinogenic. Do not touch. Wear gloves, gown, mask, goggles. Can alter DNA. |
| Clindamycin indications | Bone infections (osteomyelitis), respiratory infections, PCP (pneumocystic pneumonia). |
| Clindamycin is often used along with what other antibiotic? | Aminoglycosides |
| Clindamycin can cause ____ ___ in high IV doses. | Pseudomembranous colitis. |
| Clindamycin belongs to the ___ class of antibiotics. | Lincosimides. |
| What type of organisms is clindamycin really good for treating? | Anaerobic organisms. |
| Primaxin - name | Impanem |
| What class of antibiotics does Primaxin belong to? | Carbapenems |
| What is the broadest and most potent new class of antibiotic? | Carbapenems like Primaxin |
| If you are allergic to ____, you can easily be allergic to primaxin. | Penicillins. |
| What antibiotic is often used along with Primaxin to treat pseudomonas? | Aminoglycosides |
| What is the danger of Primaxin use for renal impaired patients? | Seizures |
| Vancomycin indications | Used increasingly for MRSA infections. Poorly absorbed in GI tract, so oral form is usable for C. diff infections. |
| Red man's syndrome | Can occur with vancomycin use. Causes a red skin rash. Can be prevented with pre-treatment of Tylenol and Benadryl. |
| Vancomycin adverse reactions | Ototoxic, nephrotoxic. Administer slowly. |
| Flagyl/Metronidazole | Antiprotozoal, antiamoebic good for GI perforations |
| Flagyl/Metronidazole considerations | Doses need adjusting in renal/liver disease. May cause CNS sensitivity/seizures *IV over 1 hour* |
| Linezolid/Zyvox indications | VRE (vancomycin-resistant enterococci), staph, strep infections. Penicillin-resistant infections. |
| Linezolid/Zyvox metabolization and excretion. | Metabolized by liver, excreted by kidneys. |
| Linezolid/Zyvox cannot be used with ____, because Zyvox contains ____. | Phenylketonurics, aspartame. |
| Linezolid side effects | Thrombocytopenia, diarrhea, lactic acidosis, pseudomembranous colitis. |
| Linezolid nursing considerations | Monitor for diarrhea, lactic acidosis (N/V), and bone marrow suppression (CBC) |
| Linezolid has ____ ____ properties | MAO inhibitor |
Created by:
christyness
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