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Pharmacology Chapters 17-19

Terms in this set (46)

1. What is the action of vancomycin?
Inhibits cell wall synthesis, it is a bactericidal medication.
2. You are administering an aminoglycoside. Which organism does an aminoglycoside treat?
EFFECTIVE in treating aerobic Gram (-) bacilli. For example, Escherichia coli, Klebsiella pneumonia, and Serratia marcescens. They are used for empiric therapy in serious infections from Gram (-); usually with another antibiotic (septicemia, respiratory infections, UTI's, and intra-abdominal infections). Aminoglycosides are INEFFFECTIVE with Most Gram (+) bacteria.
3. What is the action of an aminoglycoside?
disrupt bacterial protein synthesis, which causes the production of abnormal proteins. It is a bactericidal medication.
4. What is the drug of choice for the treatment of C.Diff?
Metronidazole which can be given orally, but usually is given IVPB ( IV Piggy Back). If Metronidazole is not effective, second choice is vancomycin (only if needed).
5. What oral medication is administered for C. Dff?
Vancomycin is only given orally for C-Difficile, but with all other infections it is given IV. It is not absorbed from the GI Tract, which is good because that is where the C-Diff infection is.
6. How is vancomycin eliminated and what is it used to treat?
Vancomycin is eliminated unchanged by the kidneys, and does must be reduced if there is renal impairment. No dose reduction if given p.o. because drug isn't absorbed from GI tract and doesn't reach kidneys. It is used to treat antibiotic-associated pseudomembranous colitis caused by Clostridium difficile; methicillin-resistant Staphylococcus aureus infections; serious infections in patients allergic to penicillin (vancomysic-resistant enterococcus (VRE) infections must be treated with other drugs).
7. Describe ototoxicity.
Ototoxicity is toxicity to the ear, specifically to the cochlea or auditory nerve and sometimes the vestibular system (disrupting hearing and balance). It is sometimes reversible, but not always. The risk increases with high dose, lengthy treatment, renal impairment, concurrent use of other ototoxic drugs (especially aminoglycosides).
8. What is red man syndrome?
Red Man Syndrome is an adverse effect of Vancomycin. It presents with flushing and rash of the face, neck, and upper chest; can occur if IV administration occurs too quickly.
9. What is the purpose of neomycin sulfate preoperatively?
It preoperatively prevents gram-negative microorganisms, like pseudomonas, proteus, E. coli, Klebsiella, enterobactor, and serratia from infecting through the surgical sites.
10. What is the advantage of administering fluoroquinolones?
They are broad spectrum drugs that are active against aerobic gram negative and gram positive organisms. They are also bacteriocidial agents that cause cell death.
11. Describe the peak and trough. What is the purpose of the peak and trough?
Trough is the lowest level of the drug. It is used to determine if the interval between doses. The Peak is the highest drug level available. This is used to determine if the dose is to low or to high. If the trough levels are to high, then you are at a greater risk for adverse effects.
12. What is the action, use, therapeutic effect, nursing implications, and adverse effects of phenazopyridine (Pyridium)?
Pyridium has no antibacterial activity, but has a local anesthetic effect in urinary tract. It is a urinary analgesic that is administered to provide pain relief related to burning, urgency, frequency, and irritation off the lower urinary tract mucosa. Metabolism occurs in the liver. It is necessary to adminiter the medication with food to decrease GI distress. This medication will result in bright orange-red urine color and it is important to provide patient education for this. An adverse effect of this medication is yellow skin, which should be reported to a healthcare provider immediately. It is also necessary to report sore throat, fever, bruising, or bleeding.
13. What patient teaching will you provide when administering tetracycline or any drugs in the class?
Take around the clock because it inhibits bacteria rather than kill the bacteria. Avoid sunlamps, tanning beds, and intense or prolonged sun exposure. Wear sunscreen and protective clothing when in the sun. Take the drug on an empty stomach at least 1 hour before or 2 hours after meals. Do not take with dairy products, antacids, or iron supplements. Birth control effectiveness is decreased while taking this medication. This medication also becomes toxic after its expiration date.
14. What is the drug of choice for a tick bite that has caused Lyme disease?
Tetracylcine is the first drug of choice.
15. In what population is tetracycline contraindicated, and why?
Do not give to children under the age of 8 years or pregnant women. This is do to the deposits of the drug into bone and teeth. TCN binds to calcium in the teeth resulting in a brown discoloration.
16. What is the rationale for not administering antibiotics with antacids?
Antacids decrease the absorption of antibiotics making them less effective.
17. What are the adverse effects of tetracycline?
GI irritation: epigastric burning, abdominal cramps, nausea, vomiting, mild diarrhea
effects on bone and teeth: not given under age 8 or to pregnant women

-suprainfection: C. dif diarrhea, fungal overgrowth (Candida albicans)

-hepatotoxicity

-renal toxicity: avoid with renal impairment, worsens pre-existing renal disease
18. What is the action of the macrolides?
Inhibit bacterial protein synthesis
19. What organisms are macrolide administered to treat?
Active against: most gram +, some gram -

-organisms: Corynebacterium diptheriae (gram +), bordetella pertussis (gram -), legionella pneumophilia, Chlamydia, mycobacterium avium, mycobacterium leprae, treponema pallidum (syphilis), Borrelia burgdorferi (Lyme disease)
20. Which drugs cause photosensitivity?
fluoroquinoles
21. How are macrolides metabolized?
It is metabolized in the liver into an active metabolite and then excreted in the bile.
22. What is the drug of choice for Legionnaire's Disease?
Erythromycin
23. What is the cardiac adverse effect of the macrolides?
Cardiac affects include possible ventricular dysrhythmias with the IV form of this drug.
24. How should tellithromycin (Ketek) be administered?
600mg PO once daily for 7-10 days.
25. What are the adverse effects of clindamycin?
Possibility of severe fatal colitis so if patient has diarrhea stop drug immediately and allergic rash.
26. What drugs are administered for H. pylori?
Tetracycline combined with other drugs.
27. What is the action, use, adverse effects, and nursing implications for chloramphenicol?
ACTION: Inhibits protein synthesis in susceptible bacteria at the level of the 50S ribosome.

USE: Bacteriostatic action. Specific infections include meningococcal, pneumococcal, or Heamophilus pneumoniae type b meningitis in penicillin-allergic patients; anaerobic brain abcess; Bacteriodes fragillis infections, and rikettsial infections.

ADVERSE EFFECTS: Confusion, headache, blurred vision, diarrhea, bitter taste (if given IV), rashes. Black Box Warning: serious and fatal blood dyscrasias with chloramphenicol use.

NURSING IMPLICATIONS: Monitor a complete blood count, platelet count, reticulocyte count, and serum iron test every 2 days.
28. What is the action of linezolid?
Linezolid is a synthetic antibiotic belonging to a new class of antimicrobials known as oxazolidinones. It is effective against gram-positive bacteria including certain drug resistant enterococcus, staphylococcus, and pneumonococcous strains. Linezolid disrupts bacterial growth by inhibiting the initiation process of protein synthesis. The drug binds to the bacterial 23S ribosomal RNA of the 50S subunit, thus preventing an essential component of the bacterial translation process.
29. What is the action, distribution, metabolism, and excretion of ciprofloxacin?
Action: bactericidal agent that causes cell death by interfering with enzymes required for synthesis of bacterial DNA and therefore necessary for bacterial growth and replication.

Distribution: well absorbed from the upper GI tract and achieves 70% bioavailability; achieves therapeutic concentrations in most body fluids

Metabolism: partially metabolized in the liver as four forms of metabolites, which have limited activity; 10-20% is converted by liver (hepatic conversion) into active metabolites for elimination

Elimination: kidneys are main route of elimination, approx. 30-60% of oral doses are excreted unchanged in urine, additional excretion is achieved via the feces
30. What is the action, use, adverse effects, nursing implication, and drug interactions with sulfonamides?
Sulfisoxazole and other sulfonamides act as antimetabolites of para-aminobenzoic acid (PABA), which microorganisms require to produce folic acid. In turn, folic acid is necessary for the production of bacterial intracellular proteins. Sulfonamides enter into the reaction instead of PABA, compete for the enzyme involved, and cause formation of nonfunctional derivatives of folic acid. Sulfonamides halt multiplication of new bacteria but do not kill mature, fully formed bacteria. When administering sulfisoxazole to older adults, it is important to assess the patients renal function. It is used in the treatment of UTI's. This drug may also be a part of adjunctive therapy for trachoma, Chloroquine- resisitant malaria, acute otitis media, and meningococcal meningitis caused by H. influenza. It has several adverse effects including: GI effects, Hematological effects, Dermatological effects, and Urinary effects. When administering sulfonamides, it is important to monitor the pH of the urine. Alkalinization may be necessary; this involves giving sodium bicarbonate. Alkaline urine increases drug solubility and helps prevent crystalluria. Many medication and herbs interact with sulfisoxazole increasing or decreasing its effects. The combination of phenytoin with sulfisoxazole leads to increased CNS depression.
True or False: Vancomycin can be used to treat meningitis
False; it does not penetrate CNS
What is a drug alternative for tetracycline-responsive infection if renal failure is a factor for the pt?
Doxycycline
What is Brucellosis and who was theoryed to come back with it from Turkey?
Brucellosis is caused by several Brucella species transmitted in intracellular parasites. Effects principally cattle and other species as well as humans. There is a theory that the chronic illness which affected Florence Nightingale after her return from the Crimea was brucellosis. She was ill with what was called "Crimean fever" when she was in Turkey.
What does anthrax cause? And what is it treated with?
Causes a fatal pneumonia. They can also cause black skin lesions.
Treated initially with doxycycline IV, then switching to the oral route when inhaled.
Cutaneous anthrax is treated with oral doxycycline. Duration of treatment for both is 60 days!
What should be done with tetracycline when it is outdated?
Tetracycline should be discarded if it is outdated. It becomes toxic as it decomposes.
What is an adverse effect for all fluroquinolones?
Tendon rupture
Which of the following classes of antibiotics is a direct inhibitor of DNA synthesis in bacteria?
Fluoroquinolones
What do you not give with people with QT prolongation
QT prolongation, sudden cardiac death. High concentrations, prolong QT interval, produce possibly fatal ventricular dysrhythmias. Don't give with:
---Congenital QT prolongation.
---Class IA, class III antidysrhythmics.
---Drugs that inhibit e-mycin metabolism (diltiazem, verapamil, protease inhibitors, azole antifungals).
What two drugs are not used together?
Inhibits bacterial protein synthesis. Binds at same sites as e-mycin and chloramphenicol (Chloromycetin); antagonizes their effects. Not used together.
Erythromycin
Alternative to penicillin G if allergic.
Risk for toxicity from E-mycins:
E-mycin increases plasma levels, half-lives of several drugs. Risk is toxicity from those drugs:
---theophylline (used for
---carbamazepine (anit-seizure)
---warfarin (anticoagulated)
Clindamycin
Used for serious anaerobic infections outside CNS.
Prototype aminoglycides
Gentamicin (P)
Prototype fluroquinolones
Ciprofloxacin (P)
Prototype tetracycline
Tetracycline hydrochloride (P)
Prototype sulfonamides
Sulfisoxazole (P)
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