T1: ANTIBACTERIAL DRUGS CONTINUATION Flashcards
(101 cards)
1
Q
First discovered in seawater-fungus called cephalosporium acremonium
A
CEPHALOSPORINS
2
Q
Are bacteriocidal and act by attaching to penicillin binding proteins to inhibit bacterial cell wall synthesis
A
CEPHALOSPORINS
3
Q
Have a beta lactam ring that is mostly responsible for their antimicrobial activity
A
CEPHALOSPORINS
4
Q
The primary therapeutic use as a class is for gram negative infection and the clients who cant tolerate the less expensive penicillin
A
CEPHALOSPORINS
5
Q
Effective against gram positive and gram negative bacteria and resistant to beta lactamase (an enzyme that acts against the beta lactam structure of penicillin)
A
CEPHALOSPORINS
6
Q
Cause bacteria cell lysis and bacterial cell dies
A
CEPHALOSPORINS
7
Q
Therapeutic Indication
1. respiratory tract (strep pneumonia)
2. otitis media and
3. skin infection
A
1ST GENERATION CEPHALOSPORINS
8
Q
- Cephalexin (Keflex)
- Cefazolin sodium ( Ancef, kefzol)
- Cefadroxil (duricef)
- Cephapirin(cefadyl)
A
1ST GEN CEPHALOSPORINS DRUG EXAMPLES
9
Q
More potent, more resistant to beta lactamase, and exhibit a broader spectrum against gram negative organisms (Haemophilus influenza, Neisseria gonorrhea, Neisseria meningitidis and several anaerobic organisms) than the first generation drugs.
A
2ND GENERATION CEPHALOSPORINS
10
Q
Less effective against gram positive bacteria
A
2ND GENERATION CEPHALOSPORINS
11
Q
- Cefaclor ( ceclor),
- Cefuroxime (ceftin, kefurox, zinacef)
- Cefmetazole(Zefazone).
A
2ND GEN CEPHALOSPORINS DRUG EXAMPLES
12
Q
Have a longer duration of action than 2nd generation agents
A
3RD GENERATION CEPHALOSPORINS
13
Q
Broader spectrum against gram negative organisms, and are resistant to beta lactamase
A
3RD GENERATION CEPHALOSPORINS
14
Q
Sometimes the drug of choice against infection by pseudomonas, klebsiella, neisseria, proteus, and haemophilus influenza
Less effective against gram positive bacteria
A
3RD GENERATION CEPHALOSPORINS
15
Q
- Cefixime( suprax)
- Cefdinir (Omnicef)
- Ceftriaxone(rocephine)
- Cefotaxime (claforan)
A
3RD GEN CEPHALOSPORINS DRUG EXAMPLES
16
Q
Effective against organisms that have developed resistance to earlier cephalosporins.
A
4TH GENERATION CEPHALOSPORINS
17
Q
are capable of entering the cerebrospinal fluid (CSF) to treat CNS infections
A
3rd and 4th generation CEPHALOSPHORINS agents
18
Q
Effective against E.coli, klebsiella, Proteus, streptococci, certain staphylococci, Psuedomonas aeruginosa
A
4TH GENERATION CEPHALOSPORINS
19
Q
Cefepime ( Maxipime)
A
4TH GEN CEPHALOSPORINS DRUG EXAMPLES
20
Q
monitor:
1. I/O
2. blood urea nitrogen (BUN)
3. serum creatinine
A
Cefepime ( Maxipime) NURSING INTERVENTION
21
Q
Gl SYSTEM
1. nausea
2. vomiting
3. diarrhea
4. anorexia
5. abdominal pain,
6. flatulence
A
CEPHALOSPORINS SIDE EFFECTS AND ADVERSE REAX
22
Q
CNS
1. headache
2. dizziness
3. lethargy
4. paresthesia (abn sensation of skin such as burning, tingling, prickling)
A
CEPHALOSPORINS SIDE EFFECTS AND ADVERSE REAX
23
Q
RENAL SYSTEM - Nephrotoxicity (most common kidney problem when body or kidney is exposed to drug/toxins) in individuals with existing renal disease
A
CEPHALOSPORINS SIDE EFFECTS AND ADVERSE REAX
24
Q
Fatigue, pruritus, pain on the injection site.
A
CEPHALOSPORINS SIDE EFFECTS AND ADVERSE REAX
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1. Psuedomembranous colitis
2. nephrotoxicity,
3. anaphylaxis
CEPHALOSPORINS SERIOUS ADVERSE REAX
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CEPHALOSPORINS If taken with alcohol may result to
disulfiram (Antabuse)
27
1. Severe vomiting
2. weakness
3. blurred vision
4. profound hypotension
5. nausea
6. flushing
7. dizziness
8. headache
DISULFIRAM (Antabuse) SYMPTOMS
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a drug that causes an adverse reaction to alcohol
Disulfiram like drug
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1. C/S should be done before the therapy
2. Assess for the presence or history of bleeding disorders because cephalosporins may reduce prothrombin levels through interference with vitamin K metabolism
3. Assess the renal and hepatic function, because most cephalosporins are eliminated by the kidney, and liver function is important in vit.K production
4. Use with caution on clients with penicillin allergy
5. Use with caution in pregnant or lactating because the drug can be transfer to the fetus
CEPHALOSPORINS NURSING INERVENTIONS
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1. Avoid alcohol use
2. Eat cultured dairy products to help discourage superinfection like yogurt, kefir
3. May cause false positive urine glucose test
4. Keep drugs out of reach of small children
5. Use childproof containers
6. Report signs of superinfection- mouth ulcers, discharge from genital or anal area
7. Ingest buttermilk or yoghurt to prevent superinfection of intestinal flora
8. Take complete course of medication even if infection have ceased
9. Observe for hypersensitivity reaction
CEPHALOSPORINS CLIENT TEACHINGS
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Acts by inhibiting bacterial protein synthesis, by binding to the bacterial ribosome and have a bacteriostatic effect
TETRACYCLINES
32
Is isolated from streptomyces aureofaciens in 1948
TETRACYCLINES
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The first broad spectrum antibiotics effective against gram positive and gram negative bacteria and many other organisms - mycobacteria, rickettsiae, spirochetes and clamydiae
TETRACYCLINES
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1. Demeclocycline(Dectomvcin)
2. Doxycycline(Vibramycin,others)
3. Minocycline (Minocin)
4. Methacycline (Rondomycin)
5. Tetracycline (Achromycin,others)
6. Tigecycline(Tygacil)
TETRACYCLINES DRUG EXAMPLES
35
1. Rocky mountain spotted fever
2. Typhus
3. Cholera
4. Lyme disease
5. Peptic ulcers
6. Chlamydial infections
TETRACYCLINES THERAPEUTIC EFFECTS
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bacterial disease spread through bite of infected tick
Rocky mountain spotted fever
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spread to humans by flies, lice
TYPHUS
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severe diarrheal illness caused by vibrio cholerae bacteria which infects the intestines.
CHOLERA
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caused by bacterium borella; bc of black-legged tick.
LYME DISEASE
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caused by helicobacter pylori
PEPTIC ULCER
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AN STD
Chlamydial infections
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1. Gl system - N/V, diarrhea are the common, abdominal pain
2. Muscoloskeletal - tetracycline accumulate on teeth and bones leading to weakening of the bones/teeth and permanent staining and discoloration
3. Skin - photosensitivity and rashes Photosensitivity - an extreme sensitivity to ultraviolet rays from the sun and other light sources
TETRACYCLINES ADVERSE EFFECTS
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1. Penicillin - decrease effectiveness
TETRACYCLINES Drug to drug interactions:
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2. Oral contraceptives - decrease effectiveness. Advice alternative methods of contraception
TETRACYCLINES Drug to drug interactions:
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3. Digoxin - toxicity rises
TETRACYCLINES Drug to drug interactions:
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1. Dairy products - render unabsorbable
2. Give on an empty stomach
3. Ca and Fe bind - decrease drug absorption
TETRACYCLINES Drug- food interaction
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tetracycline can treat all these disease
1.acne vulgaris
2. actinomycosis
3. anthrax
4. malaria
5. syphilis
6. UTI
7. Ricketstial infection
8. lyme disease
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1. Assess for a history of hypersensitivity to tetracyclines
2. Obtain C/S results before therapy is initiated
3. Assess for the presence or history of acne vulgaris, actinomycosis, anthrax, malaria, syphilis, UTI, ricketstial infection, and lyme disease. Tetracycline can treat all this disease
4. Perform CBC and kidney and liver functions studies.
5. Monitor the clients body temperature and WBC and C/S results to determine the effectiveness of the treatment and observe for superinfections
TETRACYCLINES NURSING CONSIDERATIONS
49
6. Protect the patient from exposure to the sun with adequate clothing and sunscreen
7. Instruct the patient to take the meds without food and with full glass of water
8. Provide alternative contraceptives methods during the course of therapy
9. Use with caution in clients with impaired kidney or liver function
10. Contraindicated to pregnancy or lactation and children below 8 years old.
TETRACYCLINES NURSING CONSIDERATIONS
50
1. Do not save medication, because toxic effects may occur if it is taken past the expiration date
2. Do not take these medications with milk products, iron supplements, magnesium-containing laxatives or antacids
3. Wait 1 to 3 hours after taking tetracyclines before taking antacids
TETRACYCLINES Client Teachings
51
4. Wait at least 2 hours before or after taking tetracyclines before taking lipid profile drugs such as colespitol (Colesid) and cholestyramine (Questran)
5. Complete the full course of treatment.
6. Immediately report abdominal pain, loss of appetite, nausea and vomiting, visual changes and yellowing of the skin
7. Avoid exposure to direct sunlight: use sunscreen and protective clothing to decrease the effects of photosensitivity.
TETRACYCLINES Client Teachings
52
Inhibit protein synthesis by binding to the bacterial ribosome.
MACROLIDES
53
Bind to the bacterial cell ribosomes and change or alter protein production function leading to impaired cell metabolism and division
MACROLIDES
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Effective against most gram positive and many gram negative species
MACROLIDES
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Indicated for the pharmacological treatment of respiratory disorders
MACROLIDES
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Safe alternative to penicillin
MACROLIDES
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1. Azithromycin (Zithromax) - has extended haft life that is administered only for 3 to 4 days; BSA
2. Clarithromycin ( Biaxin)- BSA
3. Dirithromycin(Dynabac)
4. Erythromycin (E-mycin, Erythromycin) - the first macrolides, was derived from the fungus- like bacteria Streptomyces erythreus in 1950: BSA
MACROLIDES DRUG EXAMPLES
58
the first macrolides, was derived from the fungus- like bacteria Streptomyces erythreus in 1950: BSA
Erythromycin (E-mycin, Erythromycin)
59
1. For the treatment of Whooping cough, legionnaires disease and infection by streptococcus, H. influenza, and Mycoplasma pneumoniae
2. Used against bacteria inside host cells such as listeria, chlamydia, dyptheria, pertussis and gonorrhea
MACROLIDES INDICATIONS
60
1. Gl system - diarrhea and abdominal cramps are the most common side effects, anorexia, vomiting and pseudomembranous colitis.
2. CNS - reversible hearing loss, tinnitus, vertigo
3. Skin - rashes, urticaria
4. Hepatoxicity- if taken in large dose with other hepatoxic drugs.
MACROLIDES ADVERSE EFFECTS
61
Anaphylaxis, ototoxicity, hepatoxicity, superinfection
MACROLIDES SERIOUS ADVERSE EFFECTS
62
Macrolides can increase serum level of theophylline (bronchodilator), carbamazepine (Anticonvulsant), and warfarin (anticoagulant) - closely monitor the drug serum level
MACROLIDES Drug interactions:
63
should not be used with other macrolides to avoid severe toxic effect.
Erythromycin
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may reduce zithromycin peak levels when taken at the same time with macrolides
Antacids
65
1. Assess for the presence of respiratory infections
2. Assess for Gl tract infections, skin and soft- tissue infections, otitis media, gonorrhea
3. Examine the patient for a history of cardiac disorders, because macrolide may exacerbate existing heart disease.
4. Assess for history of hypersensitivity
5. Obtain C/S testing before initiating macrolide therapy.
6. Do not administer macrolides to client with serious hepatic impairment
MACROLIDES NURSING CONSIDERATION
66
7. Used cautiously in pregnant or breastfeeding woman to avoid harm to the fetus or newborn
8. Macrolides should be used cautiously in clients receiving Cyclosporine (Sandimmune w/c is used as a chemo drug) and drug level must be monitored because of high risk for Nephrotoxicity
9. Perform coagulation laboratory studies such as international normalized ratio (INR)
10. Closely monitor client receiving warfarin (Coumadin) because macrolides may decrease warfarin metabolism and excretion
11. Anesthetic agents (Alfentanil) may interact with macrolides causing serum drug level to rise and result to toxicity
MACROLIDES NURSING CONSIDERATION
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1. Complete the full course of treatment
2. Do not take macrolides with fruit juices
3. Do not take other prescription drugs or OTC medications, herbal medicines, vitamins and minerals without informing health care providers.
4. Immediately report severe skin rashes, itching or hives, DOB, yellowing of skin or eyes, dark urine, or pale stools.
MACROLIDES CLIENT TEACHING
68
Are bacteriocidal and act by inhibiting bacterial protein synthesis and causing synthesis of abnormal proteins
AMINOGLYCOSIDES
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first aminoglycosides and was named after Streptomyces griseus, the soil
organism from it was isolated in 1942.
Streptomycin
70
1. Used to treat tuberculosis
2. Drug of choice to treat tularemia and bubonic pneumonic forms of plaque
Streptomycin
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1. Reserved for serious systemic infections caused by aerobic gram negative organisms including those caused by E coli, serratia, proteus, klebsiella and pseudomonas
2. Sometimes administered concurrently with penicillin, cephalosporins, or vancomycin for treatment of enterococci infections.
3. When used for systemic bacterial infection, aminoglycosides are given parenterally (IM, IV) because they cannot be absorbed from Gl tract and cannot cross into the placenta
AMINOGLYCOSIDES THERAPEUTIC USES
72
Neomycin - frequently used as preoperative bowel antiseptic
Paromomycin - useful in treating intestinal amebiasis and tapeworm manifestation given orally
AMINOGLYCOSIDES THERAPEUTIC USES
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frequently used as preoperative bowel antiseptic
Neomycin
74
useful in treating intestinal amebiasis and tapeworm manifestation given
orally
Paromomycin
75
1. Amikacin (Amikin)
2. Gentamicin (Garamycin, others)
3. Kanamycin (kantrex)
4. Neomycin (Mycifradin)
5. Netilmicin (Netromycin)
6. Paromomycin (Humantin)
7. Streptomycin
8. Tobramycin (Nebcin)
AMINOGLYCOSIDE DRUG EXAMPLES
76
Pain on the injection sites, rash, fever, nausea, diarrhea, dizziness, and tinnitus
AMINOGLYCOSIDE adverse reactions:
77
1. Nephrotoxicity
2. Ototoxicity
3. Anaphylaxis
AMINOGLYCOSIDE SERIOUS ADVERSE REAX
78
Is recognized by abnormal urine function test such as elevated serum creatinine or BUN
Nephrotoxicity
79
recognized by hearing impairment, dizziness, loss of balance, persistent headache and ringing in the ear (tinnitus)
Ototoxicity
80
1. Assess the client for a history of previous allergic reaction to aminoglycosides
2. Monitor for nephrotoxicity and ototoxicity during the course of the therapy
3. Assess baseline auditory and vestibular functions prior administration and through out the therapy
4. Assess baseline renal function and obtain results of urinalysis
5. Used with caution in neonates, infants and elderly clients.
AMINOGLYCOSIDE Nursing Considerations
81
1. Increase fluid intake
2. Complete the full course of treatment
3. Immediately report tinnitus, high frequency hearing loss, persistent headache, nausea or vertigo
4. Monitor clients for diarrhea, stomatitis, glossitis and vaginal discharge. her risk of nephrotoxicity and ototoxicity
AMINOGLYCOSIDE Client Teachings:
82
Are bacteriocidal and affect DNA synthesis by inhibiting two bacterial enzymes: DNA gyrase and topoisomerase
FLUOROQUINOLONES
83
To interfere with the enzyme DNA gyrase, which is needed to synthesize bacterial deoxyribonucleic acid (DNA)
FLUOROQUINOLONES
84
Once reserved only for UTI's because of their toxicity
FLUOROQUINOLONES
85
1. Effective against some gram positive organisms, such as Streptococcus pneumonia and against Haemophilus influnzae, P. aeruginosa, Salmonella and Shigella
2. Useful in the treatment of UTI, bone and joint infection, bronchitis, pneumonia, gastroenteritis, gonorrhea, thypoid.
FLUOROQUINOLONES Therapeutic Use:
86
are highly effective against anaerobes
Moxifloxacin (Avelox) and Trovafloxacin (Trovan)-
87
an agent of choice for postexposure prophylaxis of bacillus anthracis.
Ciprofloxacin (Cipro
88
is used primarily to treat respiratory problems such as CAP, chronic bronchitis, acute sinusitis, and UTI
Levofloxacin (Levaquin)
89
3. Ciprofloxacin (Cipro) - an agent of choice for postexposure prophylaxis of bacillus anthracis.
4. Moxifloxacin (Avelox) and Trovafloxacin (Trovan)- are highly effective against anaerobes
5. Levofloxacin (Levaquin)- is used primarily to treat respiratory problems such as CAP, chronic bronchitis, acute sinusitis, and UTI
FLUOROQUINOLONES Therapeutic Use:
90
Nalidixic acid (Neogram)
1ST GENERATION FLUOROQUINOLONES
91
- The first drug in 1st gen fluoroquinolones, approved in 1962.
- Had a narrow spectrum of activity and was restricted use to UTI
Nalidixic acid (Neogram)
92
1. Ciprofloxacin(Cipro)
2. Norfloxacin(Noroxin)
3. Ofloxacin (Floxin)
4. Lomefloxacin(Maxaquin)
2ND GENERATION FLUOROQUINOLONES
93
1. Gatifloxacin (tequin)
2. Levofloxacin (Levaquin)
3RD GENERATION FLUOROQUINOLONES
94
1. Gemifloxacin (Factive)
2. Moxifloxacin (Avelox)
3. Trovafloxacin mesylate (Trovan)
4TH GENERATION FLUOROQUINOLONES
95
1. Gl system: nausea, vomiting and diarrhea the most common side effects
2. Dry mouth, rash, restlessness, pain and inflammation at the insertion site, local burning, stinging and corneal irritation(ophthalmic)
3. CNS - dizziness, insomnia, headache and depression
4. Hema - bone marrow depression, photosensitivity
FLUOROQUINOLONES Adverse effects:
96
1. Dysrhythmias (Gatifloxacin and Moxifloxacin) and
2. Liver failure (Trovafloxacin)
FLUOROQUINOLONES SERIOUS Adverse effects:
97
1. Found to cause significant damage to the cartilages that they are given cautiously to growing children and adolescents less than 18 years old example Ciprofloxacin (Cipro)
2. Pregnancy and lactation
3. Caution to client with epilepsy, cerebral atherosclerosis
Contraindications and Precaution of
Fluoroquinolones
98
1. Assess for allergic reaction to fluoroquinolones
2. Monitor WBC count - because the agent may decrease leukocytes
3. Obtain culture and sensitivity test
4. Monitor clients with liver and renal dysfunction -because the drug is metabolize in the liver and excreted in the kidney
5. Antacids and ferrous sulfate may decrease the absorption of fluoroquinolones reducing antibiotic effectiveness
Fluoroquinolones Nursing Considerations:
99
6. Give enoxacin (Penetrex) and Norfloxacin (Noroxin) on an empty stomach
7. Administer fluoroquinolones at least 2 hours before these drugs
8. Frequently monitor coagulation studies if these antibiotics are administered concurrently with Warfarin (Coumadin) - because of interactions that may lead to increase anticoagulation effects
9. Monitor urine output and report quantities of less than 1000 ml in 24 hours.
10. Inform clients receiving Norfloxacin (Noroxin) that photophobia is possible
Fluoroquinolones Nursing Considerations:
100
URINE OUTPUT/HR
30-60ml
101
1. Wear sunglasses, avoid exposure to bright lights and direct sunlight when taking Norfloxacin(Noroxin)
2. Complete the full course of treatment
3. Immediately report signs of tendon pain or inflammation
4. Immediately report dizziness, restlessness, stomach distress, diarrhea, psychosis, confusion or irregular or fast heart rate
Fluoroquinolones Client Teaching:
