Antibiotics

Question 1

Difference of aerobic and anaerobic bacteria

Answer 1

Aerobic - requires O2 to multiply and survive

Anaerobic - doesn’t require O2 to survive Eg. E.coli (commensal) - harder to eliminate

Question 2

Antibacterial classes

Answer 2

Penicillin - amoxicillin, flucloxacillin

Cephalosporin - cefuroxime, ceftrixone, cefaclor

Macrolide - erythromycin, azithromycin, roxithromycin, clindamycin

Tetracycline - doxycycline, minocycline

Sulfonamide - trimethoprim +/- sulfamethoxazole

Aminoglycoside - gentamicin, streptomycin

Fluoroquinolone - ciprofloxacin, norfloxacin

Others: vancomycin, metronidazole

Question 3

Antibacterial agents inhibits/ interfere with:

Answer 3

bacterial cell wall synthesis
DNA/RNA replication
folic acid synthesis
protein synthesis

Question 4

difference of Bacteriacidal and Bacteriostatic actions

Answer 4

Bactericidal action - interfere with cell membrane and bacterial DNA synthesis of the microbe leading to its death Eg. beta-lactams

Bacteriostatic action - inhibits growth and spread of microbes by interfering with protein synthesis or metabolic processes Eg. tetracycline, trimethoprim

Question 5

test to determine the type of bacteria

Answer 5

Culture test

Question 6

test to determine what kind of antibiotics will work

Answer 6

Sensitivity test

Question 7

Always obtain _____________ before adm an antibiotic

Answer 7

cultures

Question 8

Nursing reminders for Antibiotics

Answer 8

Antibiotics are used for bacterial infections only
Complete the entire antibiotic prescription even if the pt is feeling better
DO NOT take alcohol while on antibiotics (antibiotics are extreme in the liver, alcohol can contribute to more nausea)
Always take cultures before prescribing and adm antibiotics

Question 9

Acute, spreading bacterial infection of the dermal tissue causing localised pain, swelling, erythema (skin rash/redness) and heat

Answer 9

Cellulitis

Question 10

caused by a rheumatic fever which is an inflammatory disease affecting connective tissues in the heart, joints, skin or brain. Heart valves get inflamed and scarred overtime.

Answer 10

Rheumatic Heart Disease

Question 11

Pharmacodynamics of Sulfonamides

Answer 11

Bacteriostatic action by inhibiting folic acid metabolism. Slows growth of the bacteria allowing the body to take over its own immunity (WBCs)

Used for:
UTIs (caused by E.coli)

Question 12

Sulfonamides meds

Answer 12

trimethoprim
sulfamethoxazole (bactrim)
sulfadiazine
sulfasalzine

Question 13

Adverse effects of Sulfonamides

Answer 13

GI upset - N&V, anorexia, diarrhoea, abdominal pain, stomatitis
Chills and fever
Crystalluria (crystals in urine)
Photosensitivity (risk of sunburn)

Question 14

Nursing considerations for Sulfonamides

Answer 14

increase FLUID intakes as sulfas can dry out the body
USE sunblock as sulfas cause photosensitivity
Take folic acid daily
Pt can bruise easily - monitor skin

Question 15

Pharmacodynamics of Fluoroquinolones

Answer 15

Bactericidal - Interferes with bacterial DNA synthesis leading to bacterial death

used for:
Lower respiratory infections
Bone and joints infections
UTIs
STIs
skin infections
eye infections

Question 16

Fluoroquinolone meds

Answer 16

Ciprofloxacin
gemifloxacin
ofloxacin
moxifloxacin
levofloxacin

Question 17

Adverse effects of Fluoroquinolones

Answer 17

GI upset - Nausea, diarrhoea, abdominal pain
Dizziness
Photosensitivity

Increased risk of tendonitis & tendon rupture (older adults taking corticosteroids)

Question 18

Nursing considerations for pts taking fluoroquinolone

Answer 18

USE sunblock for Photosensitivity
TAKE IT WITH EMPTRY stomach with full glass of water

Question 19

Pharmacodynamics of Penicillin

Answer 19

Broad spectrum antibiotic inhibiting the integrity of the bacterial cell wall

Used for:
Prophylaxis (prevention against diseases or secondary infections)
UTIs
Septicaemia (blood poisoning)
Meningitis
Intra-abdominal infections
STIs (syphilis)
Respiratory infections (pneumonia)

Question 20

Penicillin meds

Answer 20

Amoxicillin
Penicillin G and V
Ampicillin
Piperacillin
Oxacillin

Question 21

Penicillin contradictions

Answer 21

Allergic reactions to Cephalosporins or Penicillin

Renal disease
Asthma
Bleeding disorders
GI disease

Question 22

Adverse effects of Penicillin

Answer 22

GI upset: Stomatitis (inflamed and sore mouth), dry mouth, gastritis, N&V and abdominal pain
Glossitis (inflamed tongue)

Question 23

Nursing considerations for Penicillin

Answer 23

Safety precautions for pregnancy and breastfeeding
Disables oral contraceptives

Educate pt to take it WITH FOOD to decrease GI discomfort
Penicillin allergy is common!

Question 24

Pharmacodynamics of Cephalosporin

Answer 24

Bacteriocidal - kills bacteria entirely

Used for:
Prophylaxis for pre-opt, intra-opt, post-opt surgery infections

Otitis media (ear infection)
Respiratory infections
Bone infections
UTIs

Question 25

Cephalosporin meds

Answer 25

Cefuroxime Ceftriaxone Cefaclor

Question 26

Cephalosporin contradictions

Answer 26

Allergic reactions to cephalosporins and penicillins Adm with caution for pts with: renal disease hepatic impairment bleeding disorder

Question 27

Adverse effects of cephalosporins

Answer 27

GI upset: N&V, diarrhoea Dizziness Malaise (feeling of weakness) Heartburn Fever Nephrotoxicity (deterioration of kidney function due to toxicity of meds)

Question 28

Nursing considerations for cephalosporin

Answer 28

Disables oral contraceptives DO NOT drink alcohol while on cephalosporins

Question 29

CONFIRM ALLERGIC REACTIONS to ______________ and _________________ abx before adm either of them

Answer 29

Penicillin and Cephalosporin

Question 30

Pharmacodynamics of Tetracyclines

Answer 30

Used for: Skin and soft tissue infections Severe acne Rocky mountain spotted fever (tick bites)

Question 31

Tetracycline meds

Answer 31

Doxycycline Minocycline Demeclocycline

Question 32

Tetracycline contradictions

Answer 32

Allergic reactions to tetracyclines Lactation (toxic to developing foetus)

Question 33

Nursing considerations for Tetracyclines

Answer 33

USE SUNBLOCK for photosensitivity (fluoroquinolone) Disables oral contraceptives TAKE WITH EMPTY stomach with full glass of water CAUSES tooth discolouration (DO NOT GIVE to children < 9 yrs) SIT UP (DO NOT LAY DOWN 30 mins after taking the medication) - causes heartburn and scarring of oesophagus) AVOID calcium and dairy products (prevents absorption of the drug)

Question 34

Pharmacodynamics of Aminoglycosides

Answer 34

Bactericidal - kills bacteria by blocking the ribosome from reading the mRNA resulting in the inability of bacteria to multiply Used for: Bowel preparation: decreases normal flora in the GI for pts having abdominal surgery Hepatic coma: decreases ammonia in the intestines

Question 35

Aminoglycoside meds

Answer 35

Gentamicin Streptomycin Kanamycin Neomycin

Question 36

Aminoglycosides contradictions

Answer 36

Allergic reactions to aminoglycosides hearing loss musculoskeletal disorders location

Question 37

Adverse effects of aminoglycosides

Answer 37

GI distress: N&V, anorexia Rash and hives Nephrotoxicity (proteinuria hematuria and increases BUN and creatinine) Ototoxicity (tinnitus, vertigo, hearing loss) Neurotoxicity (numbness, tumours, convulsions, muscular paralysis)

Question 38

Unwanted effects of Antibiotics

Answer 38

Antimicrobial resistance Superinfection Hypersensitivity reactions

Question 39

Examples of antimicrobial resistance factors

Answer 39

Mutation Acquired resistance - Plasmids Repeated exposure to antimicrobial agents creating more opportunity to become resistant

Question 40

Bacterial resistance mechanism of action

Answer 40

Target modification - alter cell structure and their receptors Efflux - use pumps to eject Abx from inside the cell Immunity - attach a protein to Abx and prevent it to bind (making it ineffective) Enzyme-catalysed destruction - bacteria develops enzymes that destroys Abx Eg. beta-lactamases

Question 41

Bacterial resistance relevance

Answer 41

Economic and societal costs: mortality, length of hospital stay and cost of treatment No new antimicrobial in pipeline Diseases with bacterial resistance - TB, malaria, gonorrhoea, hospital-acquired pneumonia, MRSA

Question 42

Causes another infections from Abx

Answer 42

Superinfection

Question 43

Causes of superinfection

Answer 43

Broad-spectrum Abx

Question 44

Some Abx can disable the efficacy of taking oral ___________

Answer 44

contraceptives

Question 45

exaggerated or inappropriate immune response from Abx

Answer 45

Hypersensitivity

Question 46

Abx Hypersensitivity S&S

Answer 46

Urticaria (skin rash) Angioedema (swelling underneath skin) Bronchospasm (wheezing and coughing) Anaphylaxis (treat with adrenaline immediatley)

Question 47

Characterised by rapid onset of life-threatening respiratory and cardiovascular symptoms

Answer 47

Anaphylaxis (dial 111 or get adrenaline)

Question 48

Epinephrine or adrenaline pharmacodynamics

Answer 48

Non-selective agonist of adrenergic receptors A1 receptor action - vasoconstriction Beta1 receptor - increase HR and force of contraction Beta2 receptor - provides bronchodilation, reduces the release of histamine and other inflammatory mediators