Antimicrobials Flashcards

Question

Gentamicin

Answer 1

Aminoglycoside MOA: Bacteriostatic & Bactericidal; binds to 30S ribosomal subunit to produce abnormal proteins which bind to cell wall & cause cell lysis - Post-antibiotic effect which causes bactericidal effects to linger even when serum levels have decreases Indications: - Gram + cocci & aerobic Gram - bacilli - E. coli, Klebsiella, & pseudomonas - Used for SERIOUS INFECTIONS Adverse Effects: - Nephrotoxicity - Ototoxicity Nursing Considerations: - Assess peak & troughs! (obtain 30 mins before/after admin) - Assess UOP & CMP for renal function - Assess hearing & balance (CN VIII) - Increase fluid intake unless contraindicated

Answer 2

Sulfonamide/Folate Synthesis Inhibitor MOA: bacteriostatic; inhibit tetrahydrofolate synthesis that is needed to make DNA, RNA, & proteins Indications: - Broad spectrum against Gram + and Gram - - Commonly used for UTI, otitis media, bronchitis, shigellosis, and P. jiroveci Adverse Effects: - Stevens-Johnson's & TENS (S-Sulfa/S-Stevens-J!) - Blood dycrasias - Megaloblastic anemia (RBC too large) - Hyperkalemia - Fetal damage Nursing Considerations: - Monitor for rash & stop immediately if present! - Cross allergies with other sulfa-containing meds - Monitor CBC & CMP

Answer 3

MOA: unknown; thought to interfere with bacterial carbohydrate metabolism and disrupt cell wall formation Indications: - Broad spectrum against Gram + and Gram - - Only used for tx & prophylaxis of acute lower UTI Adverse Effects: - GI effects most common - Pulmonary reactions - Various hematologic effects Nursing Considerations: - Not indicated for upper UTI! - Educate patient on UTI prevention

Answer 4

Fluoroquinolone "-floxacin" MOA: Inhibits two enzymes needed for DNA replication & cell division Indications: - Broad spectrum against most aerobic Gram - & some Gram + - Currently approved for infx of the respiratory tract, UTI, GI, bones, joints, & SSTI Adverse Effects: - Achilles tendon rupture! - CNS effects - QT prolongation - Phototoxicity - GI effects & C-diff infection Nursing Considerations: - Educate on tendon injury - Utilize sunscreen & protective clothing - Separate administration from dairy products

Answer 5

MOA: Once activated, interacts with bacterial DNA to cause strand breakage and loss of helical structure that results in inhibition of nucleic acid synthesis & cell death Indications: - Anaerobic bacterial infx, particularly C-diff - Also covers peptostreptrococcus, eubacterium, and bacteroides - Antiprotozoal coverage Adverse Effects: - GI effects - Headache, dry mouth, & fatigue - Neutropenia & thrombocytopenia - Increases toxicities of lithium, benzos, cyclosporine, CCB, mood stabilizers, & warfarin (bleeding & profound hypotension) Nursing Considerations: - Do not drink alcohol (disulfiram-like reaction) - Monitor closely for drug interactions from altered metabolism - Give with food to minimize GI upset

Answer 6

MOA: Causes efflux of intracellular K+ to depolarize the cell & inhibit synthesis of DNA, RNA, & proteins, leading to cell death Indications: - Gram + only! - MRSA & VRE - Approved for S. aureus blood stream infx & SSTI Adverse Effects: - GI effects common - Myopathy, especially if already on statin (can cause renal stress because of more things to filter) - Hypotension/HTN Nursing Considerations: - Monitor for any new onset muscle pain or weakness - Obtain baseline CK Monitor VS closely

Answer 7

Primary agent for treatment and prophylaxis of TB MOA: unclear; likely inhibits synthesis of mycelia acid, a component needed for mycobacterial cells walls - Bactericidal to actively dividing bacteria; bacteriostatic to dormant bacteria Adverse Effects: - Hepatotoxicity - Neuropathy - Optic neuritis & visual disturbances - Hyperglycemia Nursing Considerations: - Do not take with antacids due to decreased absorption - Monitor for hepatitis s/s & liver enzymes! ***TEST QUESTION*** - Neuropathy may be reversible with vitamin B6 - Report visual changes immediately! - Risk for non-adherence due to long-term treatment duration

Answer 8

Primary agent for treatment and prophylaxis of TB MOA: Inhibits DNA-dependent RNA polymerase to suppress RNA and protein synthesis Indications: - DOC for TB in combination with at least one other agent due to resistance - Leprosy (once a month dosing) - MAC (with ethambutol & macrolide) Adverse Effects: - Hepatotoxicity - Blood fluids turn red/orange/brown - Hematologic disorders - Effects r/t accelerated metabolism of oral contraceptives, warfarin, PI, and NNRTI Nursing Considerations: - Monitor for hepatitis s/s & liver enzymes! - Education on fluid discoloration - Child-bearing female patients need additional contraceptives!

Answer 9

First-line agent used in combo treatment for TB MOA: unknown; possibly inhibits lipid and nucleic acid synthesis Indications: - Part of multi-drug regimen for ACTIVE TB Adverse Effects: - Hepatotoxicity - Hyperuricemia (Gout-like syndrome) Nursing Considerations: - Monitor for hepatitis s/s & liver enzymes - Monitor uric acid levels - Report any gout-like s/s; use NSAID PRN

Answer 10

First-line agent used in combo treatment for TB; also used for MAC MOA: Diffuses into mycobacterium and suppresses RNA synthesis to inhibit protein synthesis Adverse Effects: - Hepatotoxicity - GI tract disturbances - Optic neuritis Nursing Considerations: - Monitor for hepatitis s/s & liver enzymes - Take with food to reduce GI upset - Monitor for acute visual changes

Answer 11

``` MOA: binds to components of fungal cell membrane to increase permeability, with resulting leakage leading to reduced viability Indications: - Broad spectrum fungal coverage - DOC for systemic mycoses Adverse Effects: - Infusion reactions - Dysrhythmias - Nephrotoxicity & hypokalemia - Neurotoxicity Nursing Considerations: - Minimize infusion reactions with antipyretics, antihistamines, antiemetics, and/or corticosteroids - Monitor VS closely (every 15 minutes) - Monitor heart rhythm on telemetry - Monitor CMP, I/O, & renal function ```

Answer 12

MOA: binds to components of fungal cell membrane to increase permeability, with resulting leakage leading to reduced viability Indications: - Broad spectrum fungal coverage (limited due to toxicities) - Used mostly for oropharyngeal candidiasis prophylaxis in patients with neutropenia - Treatment of oral & vaginal candidiasis Adverse Effects: - GI most common - Rash & urticaria Nursing Considerations: - Monitor PO route carefully with pediatric patients as it is often given via lozenge/troche - Educate patients on proper administration with oral suspensions

Answer 13

MOA: inhibits synthesis of ergosterol to cause increased membrane permeability and cellular component leakage Indications: - Broad spectrum fungal coverage for mycoses of esophageal, oropharyngeal, peritoneal, urinary tract, vaginal, & systemic candida - DOC for blastomycosis & sporotrichosis infections Adverse Effects: - GI most common - Renal & liver injury Nursing Considerations: - Assess for BUN, creatinine, & liver enzymes - Monitor I/O & UOP - Assess for renal & liver injury s/s

Answer 14

MOA: Concentrates heme in parasitized erythrocytes to produce lethal effect Indications: - Mild-moderate acute attacks caused by P. vivid & P. falciparum and prophylaxis of infection in erythrocytes Adverse Effects: - Rare with prophylactic low dose - GI effects - Visual disturbances Nursing Considerations: - Monitor patients with hepatic disease closely - Not able to prevent primary infection of the liver

Answer 15

MOA: Concentrates heme in parasitized erythrocytes to produce lethal effect Indications: - IV tx is DOC for severe malaria Adverse Effects: - Hypotension - Acute circulatory failure Nursing Considerations: - Slow IV administration - Monitor heart rhythm and BP frequently; slower administration if changes noted - Watch for wide QRS complexes & prolonged QT intervals - Monitor electrolytes, particularly K+ & Mg

Antimicrobials Flashcards

(39 cards)