chapter 38 Antibiotics Part 1

Question 1

Bactericidal antibiotics

Answer 1

Antibiotics that kill bacteria

Question 2

Bacteriostatic Antibiotics

Answer 2

Antibiotics that do not actually kill bacterial but rather inhibit their growth

Question 3

The administration of antibiotic based on known results of culture and sensitivity testing identifying the pathogen causing infection

Answer 3

Definitive therapy

Question 4

The administration of antibiotics based on the practitioner’s judgment of the pathogens most likely to be causing an apparent infection; it involves the presumptive treatment of an infection to avoid treatment delay before specific culture information has been obtained

Answer 4

Empiric therapy

Question 5

Antibiotic taken before anticipated exposure to an infectious organism in an effort to prevent the development of infection

Answer 5

prophylactic antibiotic therapy

Question 6

Pseudomembranous colitis

Answer 6

A necrotizing inflammatory bowel condition that is often associated with antibiotic therapy. It also term antibiotic-associated colitis. This happens because antibiotics disrupt the normal gut flora and can cause an overgrowth of Clostridium difficile.

Question 7

Antibiotic treatment that is ineffective in treating, a given infection. Possible causes include inappropriate drug therapy, insufficient drug dosing, and bacterial drug resistance

Answer 7

Subtherapeutic

Question 8

antibiotic therapy that results in sufficient concentrations of the drug in the blood or other tissues to render it effective against specific bacterial pathogens

Answer 8

Therapeutic

Question 9

Superinfection

Answer 9

1. An infection occurring during antimicrobial treatment for another infection, resulting from overgrowth of an organism not susceptible to the antibiotic used
2. A secondary microbial infection that occurs in addition to an earlier primary infection often due to weakening of the patient’s immune system function by the first infection

Question 10

MOA of Sulfonamides

Answer 10

1. Inhibit bacteria growth (bacteriostatic)

2. prevent bacteria synthesis of folic acid

Question 11

What are the indications of Sulfonamides

Answer 11

1. work against both gram-positive and gram-negative organisms
2. Achieve very high concentrations in the kidneys, through which they are elminated.
3. Treatment of UTIs, respiratory tract infections.
4. prophylaxis and treatment of opportunistic infections in patients with HIV infection
5. Tx of Stenotrophomonas maltophilia
6. Tx for outpatient Staphylococcus infections

Question 12

Use of sulfonamides is contraindicated?

Answer 12

Known drug allergy to sulfonamides
chemically related drugs such as; sulfonylureas, thiazide and loop diuretics, carbonic anhydrase inhibitors
cyclooxygenase-2 inhibitor celecoxib (celebrex)

Question 13

Adverse Effects of Sulfonamide drugs

Answer 13

1. common cause of allergic reaction
2. delayed cutaneous reactions (fever, rash: morbilliform eruptions, erythema multiforme, or toxic epidermal necrolysis)
3. photosensitivity, mucocutaneous, GI, hepatic, renal and hematologic complications.

Question 14

Medications which interact with Sulfonamides

Answer 14

potentiate the hypoglycemic effects of sulfonylureas in diabetes Tx
toxic effects of phenytoin, warfarin
cyclosporine-induced nephrotoxicity
reduce the efficacy of oral contraceptives

Question 15

Co-trimoxazole (Bactrim)

Answer 15

a fixed-combination drug product
5:1 ration of sulfamethoxazole to trimethoprim
available in both oral and injectable dosage forms.

Question 16

A person is normally able to remain healthy and resistant to infectious microorganisms because of?

Answer 16

existence of certain host defenses.

Question 17

assessment for patient taking sulfonamides

Answer 17

drug allergies to sulfa-type drugs (sulfonylureas) and thiazide diuretics.
skin assessment to look for Stevens-Johnson syndrome.
Red blood cell counts (anemias)
Renal function because of crystalluria

Question 18

assessments for patient taking penicillins

Answer 18

history of asthma
sensitivity to multiple allergens
aspirin allergy
sensitivity to cephalosporins 
procaine hypersensitivity 
neurologic, abdominal and bowel 
Na and K assessment
immediate accelerated or delayed allergic reaction 
superinfections (colitis)

Question 19

carbapenems assessments

Answer 19

neurologic functioning
seizure disorders
tremors
abdomen and GI functioning

Question 20

assessments for patient taking cephalosporins

Answer 20

allergy to penicillins-cross-sensitivity
CBC, bleeding and clotting times
severe diarrhea, bloody stools and abdominal pain

Question 21

Tetracyclines assessments

Answer 21

culture and sensitivity
whitish sore patches on the oral mucosa (due to candidiasis or yeast infection.
vaginal itching, pain and cottage cheese like discharge (vaginal candidiasis)
superinfections

Question 22

macrolides assessments

Answer 22

cardiac function
renal and liver function
concurrent use with warfarin
contraceptives use

Question 23

implementation for macrolides

Answer 23

should not be given with or immediately before or after fruit juices to avoid interaction with the drug.
patient should report severe rash, itching, hives, difficulty swallowing, jaundice, dark urine and or pale stools to the prescriber immediately

Question 24

implementation for tetracyclines

Answer 24

photosensitivity-avoid sun exposures and tanning bed.
oral doses should be given with at least 8 oz of fluids and food to minimize GI upset
should not be given with dairy products, antacids, sodium bicarbonate, kaolin or pectin or iron.
The interacting foods and drugs may be given 2 hours before or 3 hours after the tetracycline.
patient should report abdominal pain, N/V visual changes and or jaundice.

Question 25

implementation of sulfonamides

Answer 25

should always be taken with forcing of fluids (2000 to 3000 mL/24 hr) to prevent drug related crystalluria. oral dosage forms should be taken with food to minimize GI upset.

Question 26

implementation of penicillins

Answer 26

take oral with at least 6 oz of water (no juices) Penicillins V, amoxicillin, and amoxicillin/clavulanate should be taken with water 1 hour before or 2 hours to maximize absorption. should anaphylactic reaction occurs, epinephrine and o2 should be available at all times.

Question 27

foods that may help prevent superinfections

Answer 27

yogurt buttermilk kefir probiotics

Question 28

which beverages should be avoided when taken penicillins

Answer 28

``` caffeine-containing beverages citrus fruit cola beverages fruit juices tomato juice ```

Question 29

what is the most common symptom of C. difficile colitis?

Answer 29

watery diarrhea abdominal pain fever

Question 30

What are the broad group of beta-lactam antibiotics

Answer 30

penicillins cephalosporins carbapenems monobactams

Question 31

what are the indications for penicillins?

Answer 31

prevention and treatment on infections caused by susceptible bacteria. gram-positive The extended spectrum have excellent gram-postive, gram-negative and anaerobic coverage.

Question 32

Which of the penicillins are used to treat many hospital associated infections such as pneumonia, intraabdominal infections and sepsis

Answer 32

piperacillin/tazobactam (Zosyn)

Question 33

Contraindications for penicillins

Answer 33

drug allergy it is important to note the drug trade names, because they do not always end in "cillin" (Zosyn, Augmentin, Timentin, Unasyn)

Question 34

bacterial that have acquired the capacity to produce enzymes capable of destroying penicillins

Answer 34

beta-lactamases | penicillinases

Question 35

what are the four penicillins subgroups

Answer 35

natural penicillins ( Penicillin G and V) penicillinase-resistant penicillins (cloxcillin, oxacillin) aminopenicillins (amoxicillin, ampicillin) extended-spectrum penicillins (ticarcillin, carbenicillin, piperacillin)

Question 36

Most common reactions to penicillins

Answer 36

``` urticaria pruritus angioedema idiosyncratic reactions such as; maculopapular eruption eosinophilia Stevens-Johnson syndrome exfoliative dermatitis ```

Question 37

Which patient should not receive cephalosporins because of allergic reactions to penicillins

Answer 37

patients with a history of throat swelling or hives

Question 38

which generation of the cephalosporins has anaerobic coverage

Answer 38

second generation drugs.

Question 39

A person who has allergic reaction to penicillin may also have allergic reaction to a cephalosporin. True or false

Answer 39

True | cross-sensitivity

Question 40

what are some adverse effects of cephalosporins

Answer 40

``` mild diarrhea abdominal cramps rash pruritus redness edema ```

Question 41

The use of cephalosporins are contraindicated in patients

Answer 41

who have shown a hypersensitivity to them. | patient with a history of life threatening allergic reaction to penicillins

Question 42

first generation cephalosporins

Answer 42

``` active against gram positive bacteria Eg. cefadroxil cefazolin(Ancef) cephalexin (Keflex) cephradine ```

Question 43

use of Cefazonlin (Ancef)

Answer 43

surgical prophylaxis susceptible staphylococcal infections gram-positive

Question 44

which antibiotic will be a good prophylactic in patients undergoing abdominal surgery?

Answer 44

second generation cephalosporin -cefoxitin (Mefoxin) it provides excellent gram-positive and gram-negative coverage. it can effectively kill intestinal bacterial, including anaerobes.

Question 45

A third-generation cephalosporins used to Tx meningitis

Answer 45

Ceftriaxone (Rocephin) it able to pass easily through the blood brain barrier should not be given to hyperbilirubinemic and patients with severe liver dysfunction. should not be administered with calcium infusions.

Question 46

indication for fourth generation cephalosporin cefepime (Maxipime)

Answer 46

Tx of uncomplicated and complicated UTIs skin infections pneumonia

Question 47

Carbapenems

Answer 47

bactericidal beta-lactam antibiotics hazard is drug-induced seizure activity

Question 48

Monobactams

Answer 48

synthetic beta-lactam active against aerobic gram-negative (eg, E.coli, klebsiella, pseudomonas). Tx of moderately severe systemic infections and UTIs. combined with other antibiotics for the Tx of intraabdominal and gynecologic infections. advantage of preserving normal gram-positive and anaerobic flora.

Question 49

what is an advantage in using monobactams

Answer 49

it preserves the normal gram-positive and anaerobic flora.

Question 50

Common adverse effects of monobactams

Answer 50

rash N/V diarrhea

Question 51

What are some indications for macrolides

Answer 51

mild to moderate upper and lower respiratory tract infections STDs diabetic gastroparesis mycobacterium avium-intracellulare complex infections active ulcer associated with Helicobacter pylori infection

Question 52

Adverse effects of macrolide

Answer 52

rash, pruritus, urticaria, thrombophlebitis hearing loss, tinnitus stomatitis, cholestatic, jaundice, N/V, hypatotoxicity palpitations, chest pain

Question 53

Drug interactions with macrolides

Answer 53

carbamazepine, cyclosporine, digoxin, theophylline and warfarin oral contraceptives clarithromycin and erythromycin should not be used with moxifloxacin, pimozide, thioridazine. simvastatin or lovastatin.

Question 54

why are Clarithromycin and erythromycin not given with moxifloxacin, pimozide, thioridazine

Answer 54

because malignant dysrhythmias can occur

Question 55

indications for Tetracyclines

Answer 55

acne STDs Rickettsia

Question 56

Contraindications for tetracyclines

Answer 56

drug allergy pregnant and nursing women should not be given to children younger than 8 years

Question 57

Adverse effects of tetracyclines

Answer 57

discoloration of permanent teeth and tooth enamel hypoplasia photosensitivity (taking demeclocycline) alteration of the intestinal and vaginal flora (vaginal candidiasis) thrombocytopenia hemolytic anemia exacerbation of systemic lupus erythematosus GI upset, enterocolitis and maculopapular rash

Question 58

Tetracyclines interactions

Answer 58

``` antacids antidiarrheal drugs dairy products calcium enteral feedings iron preparations oral anticoagulants bactericidal antibiotics oral contraceptives ```

Question 59

what is the most serious adverse effect associated with imipenem-cilastatin?

Answer 59

seizures

Question 60

what should be the nurse's best action when a patient list "penicillin" as one of his allergies?

Answer 60

careful assessment of the patient's description of what happened when he had the allergic response. notify the prescriber of the patient's allergy and response.

Question 61

what is the rational behind the use of tazobactam with piperacillin in Zosyn

Answer 61

Tazobactam is a beta-lactamase inhibitor that inactivates the beta-lactamase enzyme. using it along with the piperacillin make penicillin more effective against infection.