Antimicrobials Flashcards
(96 cards)
1
Q
Penicillin G (benzylpenicillin) MOA
A
target PCN-binding proteins to weaken bacterial cell wall through inhibition of transpeptidases and dishinibition of autolysins
2
Q
Penicillin G (benzylpenicillin) indications
A
most used for infections caused my most gram + bacteria (i.e., strep, enterococcus, and staph)
3
Q
Penicillin G (benzylpenicillin) AEs
A
- generally well-tolerated
- allergic reactions possible (cross allergy with cephalosporins possible)
4
Q
Penicillin G (benzylpenicillin) nursing considerations
A
- assess for hx of allergic rxn S/S
- monitor CBC, V/S, and infection S/S
- c. diff possible
- consider co-administration with lactobacillus
5
Q
piperacillin/tazobactam (Zosyn) MOA
A
penicillin actions plus inhibition of bacterial beta-lactamase with tazobactam
6
Q
piperacillin/tazobactam (Zosyn) indications
A
extended spectrum (penicillin susceptible organisms plus gram - and anaerobic coverage including, pseudomonas, enterobacter, Klebsiella)
7
Q
piperacillin/tazobactam (Zosyn) AEs
A
- low toxicity
- allergic reactions
8
Q
piperacillin/tazobactam (Zosyn) nursing considerations
A
- same as Penicillin G plus:
- parenteral route only
- monitor IV infusion site and compatibility with other IV meds
9
Q
cephalosporins MOA
A
bind to penicilllin-binding proteins to disrupt cell wall synthesis and activate autolysins
10
Q
cephalosporins indications
A
- Cefazolin (Ancef) = surgical prophylaxis
- Cefepime (Maxipime) = resistant organisms
- Ceftaroline (Teflaro) = skin infections and HCAP
11
Q
cephalosporins AEs
A
- allergic reactions
- bleeding tendenies through interference with vitamin K metabolism
- Disulfiram-like rxns with alcohol
12
Q
cephalosporins nursing considerations
A
- assess for history of allergic rxn S/S
- monitor CBC, V/S, and infection S/S
- c. diff infection possible
13
Q
imipenem/cilastatin (Primaxin) MOA
A
binds specifically to PBP 1 & 2 to weaken cell wall and can resist beta-lactamases
14
Q
imipenem/cilastatin (Primaxin) indications
A
- very broad spectrum with activity against most pathogens including MDRO, for bone, joint, SSTI, UTI, intraabdominal, and pelvic infections
15
Q
imipenem/cilastatin (Primaxin) AEs
A
- generally well-tolerated
- GI upset most common
- seizures (mainly w/ renal impaired pts)
- superinfections
16
Q
imipenem/cilastatin (Primaxin) nursing considerations
A
- co-admin with cilastatin to prevent rapid imipenem breakdown in kidneys
- reserve use in pts with infections not covered by other antibiotics
- seizure precautions as needed
17
Q
Vancomycin (Vancocin) MOA
A
inhibits cell wall synthesis by binding to molecules that serve as precursors for cell wall biosynthesis
18
Q
Vancomycin (Vancocin) indications
A
include gram + coverage only for bone, joint, and bloodstream infections (MRSA, c. diff)
19
Q
Vancomycin (Vancocin) AEs
A
- nephrotoxicity leading to renal failure
- ototoxicity
- red man syndrome
- VRE
20
Q
Vancomycin (Vancocin) nursing considerations
A
- usually administered IV; PO admin for CDI
- monitor trough levels and CMP for renal function
- avoid concurrent use with other nephrotoxic medications
- appropriate hygiene and cleaning with active CDI pts
21
Q
doxycycline MOA
A
bacteriostatic abx that binds to 30S ribosomal subunit to inhibit binding of transfer RNA to mRNA to inhibit protein synthesis
22
Q
doxycycline indications
A
broad spectrum coverage against many gram + and - organisms
23
Q
doxycycline AEs
A
- GI upset most common
- bone growth suppression and teeth discoloration in peds pts
- fatty liver infiltration and renal impairment exacerbation
- alterations in normal flora and superinfections
24
Q
doxycycline nursing considerations
A
- decreased absorption if given with metal ions (Ca, Fe, and Mg; admin on empty stomach if tolerated)
- hepatic and renal monitoring
- avoid prolonged sunlight exposure and apply protective measures
- interactions with oral contraceptives and anticoagulants
25
erythromycin MOA
bacteriostatic abx that binds to 50S ribosomal subunit to block addition of new amino acids to growing peptide chain
26
erythromycin indications
most gram + and some gram - coverage
27
erythromycin AEs
- GI upset most common
- QT prolongation
- hepatotoxicity and ototoxicity
- numerous medication interactions
28
erythromycin nursing considerations
- often first alternative to PCN sensitive bacterial infections if allergy is present
- administer PO on empty stomach to maximize absorption; can give with food if upset stomach persists
- avoid in pts with pre-existing QT prolongation; monitor on tele
- can increase half lives of several medications (theophylline and warfarin)
29
clindamycin (Cleocin) MOA
similar to macrolides; bacteriostatic abx that binds to 50S ribosomal subunit to block addition of new amino acids to growing peptide chain
30
clindamycin (Cleocin) indications
gram + and gram - anaerobes and most gram + aerobes
31
clindamycin (Cleocin) AEs
- severe to fatal c. diff colitis (characterized by abd pain, leukocytosis, and fever)
- non-c. diff diarrhea
32
clindamycin (Cleocin) nursing considerations
- monitor and educate pts on monitoring stool and fluid status
- > 5 loose stools per day concerning for CDAD and consider D/C treatment
- vigorous fluid and electrolyte replacement with vancomycin treatment
33
linezolid (Zyvox) MOA
bacteriostatic abx that binds to 23S portion of 50S ribosomal subunit to block formation of intitiation complex
34
linezolid (Zyvox) indications
very broad spectrum coverage including MDRO
35
linezolid (Zyvox) AEs
- HA, GI upset
- myelosuppression (anemia, leukopenia, and/or thrombocytopenia)
- optic and peripheral neuropathy
36
linezolid (Zyvox) nursing considerations
- monitor CBC and I/O
- give w/ food to limit GI upset
- monitor for drug interactions with MAOIs and SSRIs
37
gentamicin MOA
binds to 30s ribosomal subunit to inhibition protein synthesis, premature termination of protein synthesis, and production of abnormal proteins; causes bactericidal activity effects that persist via postantibiotic effect
38
gentamicin indications
gram + cocci and aerobic gram - bacilli (e. coli, Klebsiella, pseudomonas); primarily used for serious infections
39
gentamicin AEs
- nephrotoxicity (due to proximal renal tubule injury)
- ototoxicity (impairing both hearing and balance)
40
gentamicin nursing considerations
- assess serum peak and trough, UOP, and CMP
- neuro focused (hearing, balance especially if concurrent use of ototoxic agents)
41
sulfamethoxazole/trimethoprim (Bactrim) MOA
bacteriostatic medications that inhibit tetrahydrofolate synthesis that is needed to make DNA, RNA, and proteins
42
sulfamethoxazole/trimethoprim (Bactrim) indications
broad spectrum against gram + and gram - (UTI, nocardiosis, Listeria, and P. jiroveci)
43
sulfamethoxazole/trimethoprim (Bactrim) AEs
sulfonamide AEs
- photo and hypersensitivity rxns (SJS/TENS)
- hemolytic anemia
- Kernicterus in newborns
- renal damage from crystalline aggregates
trimethoprim AEs
- megaloblastic anemia
- hyperkalemia
44
sulfamethoxazole/trimethoprim (Bactrim) nursing considerations
- monitor for rash and stop immediately if present
- cross allergies with other sulfa-containing meds
- monitor CBC and CMP and progression of infection S/S
45
nitrofurantoin (Macrobid) MOA
after conversion to reactive form, causes bacterial injury due to inhibition of protein, DNA, RNA, and protein synthesis, as well as energy metabolism
46
nitrofurantoin (Macrobid) indications
broad spectrum against gram + and gram - (treatment and prophylaxis of acute lower UTI)
47
nitrofurantoin (Macrobid) AEs
- GI upset most common
- pulmonary rxns (dyspnea, cough, malaise)
- hematologic effects (leukopenia, thrombocytopenia, and megaloblastic anemia)
48
nitrofurantoin (Macrobid) nursing considerations
- not indicated for upper UTI
- encourage increased water intake and cranberry juice to avoid other potential nephrotoxic drugs
49
ciprofloxacin (Cipro) MOA
inhibits two enzymes needed for DNA replication and cell division
50
ciprofloxacin (Cipro) indications
broad spectrum against most aerobic gram - and some gram +
51
ciprofloxacin (Cipro) AEs
- CNS effects
- tendon rupture
- QT prolongation
- phototoxicity
- GI upset
52
ciprofloxacin (Cipro) nursing considerations
- educate on tendon injury and report early signs
- utilize sunscreen and protective clothing
- separate administration from dairy products by at least 6 hours before or two hours after
53
metronidazole (Flagyl) MOA
after activation into active form, interacts with bacterial DNA to cause strand breakage and loss of helical structure that result in inhibition of nucleic acid synthesis and cell death
54
metronidazole (Flagyl) indications
anaerobic bacteria infections (CDI, peptostreptococcus, eubacterium, and bacteroides); antiprotozoal coverage
55
metronidazole (Flagyl) AEs
- GI effects
- HA, dry mouth, fatigue
- neutropenia and thrombocytopenia
- increases toxicities of lithium, benzos, cyclospoine, CCB, mood stabilizers, and warfarin
56
metronidazole (Flagyl) nursing considerations
- educate to not drink alcohol while on therapy (can cause disulfiram-like rxns)
- monitor closely for drug interaction from altered metabolism
- give with food to minimize GI upset
57
daptomycin (Cubicin) MOA
causes efflux of intracellular potassium to depolarize the cell and inhibit synthesis of DNA, RNA, and protein to cause cell death
58
daptomycin (Cubicin) indications
gram + bacterial infections only
59
daptomycin (Cubicin) AEs
- GI upset
- myopathy
- hypotension and hypertension
60
daptomycin (Cubicin) nursing considerations
- monitor for any new onset of muscle pain or weakness and baseline CPK
- HGM-CoA reductase inhibitors (statins) may be stopped while taking daptomycin
- monitor V/S closely (especially BP changes)
61
isoniazid (INH) MOA
suppresses bacterial growth by inhibiting synthesis of mycolic acid (bactericidal to actively dividing bacteria and bacteriostatic to dormant bacteria)
62
isoniazid (INH) indications
tuberculosis
63
isoniazid (INH) AEs
- hepatotoxicity
- neuropathy
- pyridoxine deficiency
- optic neuritis and visual disturbances
64
isoniazid (INH) nursing considerations
- don't take with antacids (decreased absorption)
- educate and monitor for S/S of hepatitis
- monitor liver enzymes and limit ETOH use
- educate on S/S peripheral neuropathy (reversible with vitamin B6 prophylaxis)
- report visual changes immediately
- risk for non-adherence due to long term treatment duration
65
rifampin (Rifandin) MOA
inhibits DNA-dependent RNA polymerase to suppress RNA synthesis and protein synthesis
66
rifampin (Rifandin) indications
- TB in combination with at least one other agent due to resistance
- Leprosy
- MAC (with ethambutol and macrolide)
67
rifampin (Rifandin) AEs
- hepatotoxicity
- body fluid red-orange-brown discoloration
- hematologic disorders
- effects r/t accelerated metabolism of oral contraceptives, warfarin, PI, and NNRTI
68
rifampin (Rifandin) nursing considerations
- educate on and monitor for S/S hepatitis
- monitor liver enzymes and CBC
- education on fluid discoloration
- child-bearing age females need additional BC
69
pyrazinamide MOA
metabolized to pyrazinoic acid to lower pH, inhibits m. tuberculosis enzyme
70
pyrazinamide indications
part of multi-drug regimen for active TB
71
pyrazinamide AEs
- hepatotoxicity
- hyperuricemia (possible development of gouty arthritis)
- GI upset
- photosensitivity
72
pyrazinamide nursing considerations
- educate on and monitor for S/S hepatitis
- monitor liver enzymes and serum uric acid levels
- report any gout-like S/S (use NSAID PRN)
73
ethambutol (Myambutol) MOA
promotes a bacteriostatic action by inhibiting arabinosyl transferase resulting in impaired mycobacterial cell wall synthesis
74
ethambutol (Myambutol) indications
first-line agent used in combo theraoy for TB
75
ethambutol (Myambutol) AEs
- hepatotoxicity
- GI tract disturbances
- optic neuritis (blurred vision, constriction of visual field, disturbance of color discrimination)
76
ethambutol (Myambutol) nursing considerations
- educate and monitor for s/s of hepatitis
- monitor liver enzymes
- take w/ good to minimize GI upset
- monitor for acute visual changes
77
amphotericin B (Abelect) MOA
binds to components of fungal cell membrane to increase permeability, with resultant leakage leading to reduced viability
78
amphotericin B (Abelect) indications
broad spectrum fungal coverage and often DOC for most systemic mycoses
79
amphotericin B (Abelect) AEs
- infusion reactions
- dysrhythmias
- nephrotoxicity and hypokalemia
- neurotoxicity
80
amphotericin B (Abelect) nursing considerations
- minimize infusion reactions with antipyretics, antihistamines, antiemetics, and/or corticosteroids
- monitor V/S closely
- monitor heart rhythm on telemetry
- monitor CMP, I/O, and kidney function
81
itraconazole (Sporanox) MOA
inhibits synthesis of ergosterol to cause increased membrane permeability and cellular component leakage
82
itraconazole (Sporanox) indications
broad spectrum fungal coverage for mycoses of esophageal, oropharyngeal, peritoneal, urinary tract, vaginal, and systemic candida
83
itraconazole (Sporanox) AEs
- GI upset most common
- cardiac suppression
- liver injury
84
itraconazole (Sporanox) nursing considerations
- assess medication use due to many possible drug interactions
- admin with food to enhance medication absorption
- monitor s/s of liver injury an heart failure
85
nystatin MOA
binds to components of fungal cell membrane to increase permeability with resultant leakage leading to reduced viability
86
nystatin indications
coverage similar to amphotericin B, but limited due to toxicity; mostly used for: oropharyngeal candidiasis prophylaxis in pts with neutropenia, treatment of oral and vaginal candidiasis
87
nystatin AEs
- GI upset most common with PO formulation
- rash and urticaria with topical formulation
88
nystatin nursing considerations
- monitor PO route carefully with pediatric pts as it can be given via lozenge/troche
- educate pts on proper administration with oral suspensions
89
chloroquine MOA
concentrates heme in parasitized erythrocytes and interferes with metabolism and hemoglobin utilization by the parasite
90
chloroquine indications
DOC for mild to moderate acute attacks caused by P. vivax and P. falciparum and prophylaxis of infection in erythrocytes
91
chloroquine AEs
- rare with prophylaxis low dose
- GI upset
- visual disturbances and headache
- pruritis
92
chloroquine nursing considerations
- monitor pts with hepatic disease closely due to actions in liver
- not able to prevent primary infection of liver
93
Quinidine Gluconate MOA
concentrates heme in parasitized erythrocytes to produce lethal effect
94
Quinidine Gluconate indications
IV therapy is DOC for severe malaria
95
Quinidine Gluconate AEs
- hypotension
- acute circulatory failure
- cardiotoxicity from bradycardia and hypokalemia/hypomagnesemia
96
Quinidine Gluconate nursing considerations
- slow IV admin after loading dose
- monitor heart rhythm and BP frequently; slower admin if changes noted
- monitor electrolytes (K and Mg)
- co-admin with doxycycline, tetracycline, and clindamycin for effect enhancement
