antimicrobials pt 1 Flashcards
(115 cards)
1
Q
bacteria
A
single-celled organisms that lack a nucleus
2
Q
viruses
A
nonliving particles that reproduce by taking over living cells
3
Q
fungi
A
single organisms including mushrooms and yeast that grow as single cells or thread like filaments
4
Q
protozoa
A
single celled organism with nucleus
5
Q
Bacteriostatic
A
suppresses organisms growth
6
Q
bactericidal
A
directly destroys organism
7
Q
post antibiotic effect
A
*organisms do not grow for several hours even after discontinuation of medication
8
Q
selective toxicity
A
ability of medications to affect target organisms only without harming host cells
9
Q
narrow spectrum
A
active against only a few species of microorganisms
10
Q
broad spectrum
A
- active against a wide variety of microorganisms
11
Q
Empiric therapy
A
therapy started in absence of laboratory data
12
Q
minimum inhibitory concentration
A
lab measure of lowest drug concentration needed to prevent growth of certain bacteria
13
Q
peak
A
measurement of highest drug concentrations
14
Q
trough
A
measurement of lowest drug concentrations
15
Q
Penicillin G (benzylpenicillin) MOA
A
weakens bacterial cell wall
16
Q
Penicillin G (benzylpenicillin) indications
A
infections caused by gram positive bacteria (step, enterococcus, staph)
17
Q
Penicillin G (benzylpenicillin) adverse effects
A
allergic reactions but usually well tolerated
18
Q
Penicillin G (benzylpenicillin) nursing considerations
A
asses for hx of allergic reactions; possibly also allgeric to cephalosporins
-monitor CBC, vitals and infection s/s
-C-diff infections in possible, co admin with lactobacillus
19
Q
immediate penicillin allergies
A
reaction in 2-30 minutes
20
Q
accelerated penicillin allergy
A
reaction in 1-72 hours
21
Q
delayed penicillin allergy
A
reaction takes days or weeks to develop
22
Q
Treatment PCN Anaphylaxis
A
stop med, administer epi, and provide respiratory support
23
Q
piperacillin/tazobactam (zosyn) MOA
A
PCN action + inhibits bacterial beta-lactamase with tazobactam
24
Q
piperacillin/tazobactam (zosyn) indications
A
Extended spectrum (PCN susceptible organisms plus gram - and anaerobic coverage, including pseudomonas, enterobacter, Klebsiella)
25
piperacillin/tazobactam (zosyn) adverse effects
Low toxicity
Allergic reactions
26
piperacillin/tazobactam (zosyn) nursing considerations
same as pcn g
parenteral route only
monitor IV site and compatibility with other IV meds
27
Cephalosporins MOA
inhibit cell wall synthesis
28
cefazolin (ancef) indications
surgical prophylaxis
29
Cefepime (Maxipime)
resistant organisms
30
Ceftaroline (Teflaro)
skin infections and HCAP
31
Cephalosporins adverse effects
allergic reactions
bleeding due to interefence with vitamin K
disulfiram-like reactions with alcohol
32
Cephalosporins nursing considerations
monitor vitals, CBC, s/s of infection
c-diff possible
if allergic to PCN, prob allergic to cephalosporin
33
Imipenem/Cilastatin (Primaxin) MOA
weaken cell wall and can resist beta-lactamases
34
Imipenem/Cilastatin (Primaxin) indications
broad spectrum with activity against most pathogens
for bone, joint, SSTI, UTI, intraabdominal and pelvic infections
35
Imipenem/Cilastatin (Primaxin) adverse effects
GI effects most common (NVD)
seizures with renal impairement
superinfections
36
Imipenem/Cilastatin (Primaxin) nursing considerations
admin with cilastatin to prevent rapid imipenem breakdown in kidneys
seizure precaution
37
Vancomycin (Vancocin) MOA
weakens cell wall
38
Vancomycin (Vancocin) indications
gram positive coverage for bone, joint, and bloodstream infections
MRSA and C diff
39
Vancomycin (Vancocin) adverse effects
○Nephrotoxicity leading to renal failure
○Ototoxicity
○Red man syndrome
○VRE
40
Vancomycin (Vancocin) nursing cosiderations
usually IV, PO for C-Diff
monitor trough levels and CMP for kidney function
avoid concurrent use with nephrotoxic meds
C-DIff percautions
41
Doxycycline MOA
inhibits protein synthesis
42
Doxycycline indications
broad spectrum coverage against many gram postive and negative
43
Doxycycline adverse effects
GI most common
Bone growth suppression and teeth discoloration in peds
fatty liver infiltration and worsens renal impairment
alterations in normal flora and superinfections
photosensitivity
44
Doxycycline nursing considerations
decreased absorption when given with Ca, Fe, and Mg, admin on empty stomach
hepatic and renal monitoring
avoid prolonged sunlight exposure
interacts with oral contraceptives and anticoag
45
Erythromycin MOA
inhibits protein synthesis
46
Erythromycin indications
most gram positive and some gram neg coverage
47
Erythromycin adverse effects
GI most common including epigastric pain
QT prolongation
hepatotoxicity and ototoxicity
numerous med interactions
48
Erythromycin nursing considerations
1st alt to PCN sensitivity
admin PO on empty stomach to max absorption
avoid in pt with pre-exisiting QT prolongation
can increase half life of several meds
49
Clindamycin (Cleocin) MOA
inhibits protein synthesis
50
Clindamycin (Cleocin) indications
gram positive and neg
anaerobes and most gram positive aerobes
51
Clindamycin (Cleocin) adverse effect
sever- fatal C diff, ab pain, fever, leukocytosis
non Cdiff diarrhea
52
Clindamycin (Cleocin) nursing considerations
monitor stool and fluid status
vigorous fluid and electrolyte replacement w/ vanc treatment
53
Linezolid (Zyvox) MOA
inhibits protein synthesis
54
Linezolid (Zyvox) indications
very broad spectrum
55
Linezolid (Zyvox) adverse effects
headache NVD
myelosuppression (anemia, leukopenia, thrombocytopenia, pancytopenia)
optic and peripheral neuropathy
56
Linezolid (Zyvox) nursing considerations
-Monitor CBC and I/O
-Give with food to limit GI upset
-Monitor for drug interactions with MAO (hypertensive crisis) and SSRI (serotonin syndrome)
57
Gentamicin MOA
Protein synthesis inhibitor
58
Gentamicin indications
primarily used for serious infections
59
Gentamicin adverse effetcs
nephrotoxicity due to proximal renal tube injury
ototoxicity impairing both hearing balance
60
Gentamicin nursing considerations
assess serum peak and trough
neruo focused assessment
increase fluid intake unless contraindicated
dont mix with PCN
61
Sulfamethoxazole/Trimethoprim (Bactrim) MOA
bacteriostatic
inhibits synthesis of DNA, RNA, and protein
62
Sulfamethoxazole/Trimethoprim (Bactrim) indications
broad spectrum against gram positive and gram neg
63
Sulfamethoxazole/Trimethoprim (Bactrim) adverse effects
○Sulfonamide AE
■Photo- & hypersensitivity reactions, including SJS/TENS
■Hemolytic anemia
■Kernicterus in newborns
■Renal damage from crystalline aggregates
○Trimethoprim AE
■Megaloblastic anemia
■Hyperkalemia
64
Sulfamethoxazole/Trimethoprim (Bactrim) nursing cosniderations
monitor for rash and stop immediately if present
cross allergies w/ sulfa meds
monitor CBC and CMP and progression of infection
65
Nitrofurantoin (Macrobid) MOA
causes bacterial injury by inhibiting DNA, RNA, and protein synthesis and energy metabolism
66
Nitrofurantoin (Macrobid) indications
● Broad spectrum against gram + and gram -
○Currently only used for treatment and prophylaxis acute lower UTI
67
Nitrofurantoin (Macrobid) adverse effects
GI most common
pulmonary reactions (dyspnea, cough, malaise)
hematologic effects
68
Nitrofurantoin (Macrobid) nursing considerations
- not indicated for upper UTI
- encourage increased water intake and cranberry juice and avoid other potential nephrotoxic drugs
69
Ciprofloxacin (Cipro) MOA
inhibit DNA replaication/cell division
70
Ciprofloxacin (Cipro) indications
braod spectrum against most aerobic gram -, some gram +
71
Ciprofloxacin (Cipro) adverse effects
CNS effects
*Tendon rupture, achilles*
QT prolongation
Phototoxicity
GI effects
72
Ciprofloxacin (Cipro) nursing considerations
edu on tendon inury
suncreen
separate admin from dairy products, at least 6 hrs before or 2 hrs after
73
Metronidazole (Flagyl) MOA
DNA strand breakage and loss of structure which causes inhibition of nucleic acid synthesis and cell death
74
Metronidazole (Flagyl) inidcations
anaerobic bacteria infections (CDI)
peptostreptococcus
eubacterium
bacteriudes
antiprotozoal coverage
75
Metronidazole (Flagyl) adverse effects
○GI effects
○HA, dry mouth, & fatigue
○Neutropenia and thrombocytopenia
○Increases toxicities of lithium, benzos, cyclosporine, CCB, mood stabilizers, and warfarin
76
Metronidazole (Flagyl) nursing cosniderations
○Educate not to drink alcohol while on therapy; can cause disulfiram-like reactions
○Monitor closely for drug interactions from altered metabolism
○Give with food to minimize GI upset
77
Daptomycin (Cubicin) MOA
inhibit synthesis of DNA, RNA, and protein to cause cell death
78
Daptomycin (Cubicin) indications
gram + bacterial infections only
79
Daptomycin (Cubicin) adverse effects
○GI effects common
○Myopathy, especially if already on statin
○Hypotension and hypertension
80
Daptomycin (Cubicin) nursing cosniderations
monitor new onset muscle pain/weakness and baseline CPK
○HGM-CoA reductase inhibitors (statins) may be stopped while on daptomycin
monitor Vitals
81
Isoniazid (INH) MOA
suppress bacterial growth by inhibits the synthesis of mycolic acid
82
Isoniazid (INH) indications
TB
83
Isoniazid (INH) adverse effects
HEPTATOXICITY
neuropathy
pyridoxine deficiency
optic neuritis and visual disturbances
84
Isoniazid (INH) nursing considerations
taking with antacids causes decreased absorption
educate on monitoring for s/s of hepatitis
monitor liver enzymes and limit alcohol
educate on s/s of peripheral neuropathy (may be reversible with vitamin B6 prophylaxis)
risk for non-adherence
85
Rifampin (Rifandin) MOA
suppress RNA synthesis and protein synthesis
86
Rifampin (Rifandin) indications
TB in combination with at least one other agent
leprosy (1/month)
MAC ( with ehtabutol and macrolide)
87
Rifampin (Rifandin) adverse effects
HEPATOTOXICITY
body fluid red/organe/brown
hematologic disorders
deactivates oral contraceptives, warfarin, PI, & NNRTI
88
Rifampin (Rifandin) nursing considerations
educate on & monitor s/s hepatitis
monitor liver enzymes and CBC
educate on fluid discoloration
child-bearing women need additional birth control
89
Pyrazinamide MOA
Inhibits m. tuberculosis enzyme
90
Pyrazinamide indications
multi-drug regimen for active TB
91
Pyrazinamide adverse effects
HEPATOTOXICITY
hyperuricemia
GI disturbances (NVD)
photosensitivity
92
Pyrazinamide nursing considerations
educate on/monitor s/s hepatitis
monitor liver enzymes and serum uric acid
report any gout like s/s
use NSAIDs PRN
93
Ethambutol (Myambutol) MOA
promotes bacteriostatic action which impaires mycobacterial cell wall synthesis
94
Ethambutol (Myambutol) indications
combo therapy for TB
MAC
95
Ethambutol (Myambutol) adverse effects
Hepatotoxicity
GI tract disturbances
Optic neuritis, resulting in blurred vision, constriction of visual field, and disturbance of color discrimination
96
Amphotericin B (Abelect ) MOA
binds to fungal cell membrane to reduce viability
97
Amphotericin B (Abelect ) indications
broad spectrum fungal coverage
98
Amphotericin B (Abelect ) adverse effects
infusion rx
dysrhythmias
nephrotoxicity and hypokalemia
neurotoxicity
99
Amphotericin B (Abelect ) nursing considerations
Minimize infusion reaction with antipyretics, antihistamines, antiemetics, and/or corticosteroids
Monitor VS closely
Every 15 minutes
Monitor heart rhythm on telemetry
Monitor CMP, I/O, kidney function
100
Itraconazole (Sporanox) MOA
inhibits synthesis of ergosterol to cause cellular leakage
101
Itraconazole (Sporanox) indications
broad spectrum fungal coverage
102
Itraconazole (Sporanox) adverse effects
GI effects most common
cardiac suppression
liver injury
103
Itraconazole (Sporanox) nursing considerations
Assess medication use due to possible drug interactions
Administer with food to enhance absorption
Monitor s/s liver injury and heart failure
104
Nystatin MOA
binds to fungal cell to reduce viability
105
Nystatin indications
broad spectrum fungal coverage but limited use due to toxicity
used mainly for oropharyngeal candidiasis prevention and treat of oral and vaginal candidiasis
106
Nystatin adverse effects
GI most common with PO
rash and urticaria with topical
107
Nystatin nursing considerations
watch Po route carefully with kids
educate on proper administration with oral suspensions
108
Chloroquine MOA
interferes with metabolism and hemoglobin utilization by parasite
109
Chloroquine indications
mild to moderate acute attacks of P. vivax and P.falciparum
prophylaxis for erythrocytes
110
Chloroquine advers effects
rare with prophylacyic low dose
GI effects/ab discomfort
visual disturbances and headache
pruritis
111
Chloroquine nursing considerations
watch pts with hepatic disease closely
not able to prevent primary infection of liver
112
quinidine gluconate MOA
concentrates heme in parasitized erythrocytes to produce lethal effect
113
quinidine gluconate indication
IV therapy for severe malaria
114
quinidine gluconate adverse effects
hypotension
acute circulatory failure
cardiotoxicity from bradycardia and hypokalemia/hypomagnesemia
115
quinidine gluconate nursing considerations
slow Iv admin after loading dose
watch heart rhythm and BP frequently
watch electrolytes (K and Mg)
co-admin with doxycycline, tetracycline, or clindamycin for enhancement
