Antibiotics for Bacterial Infection
Terms in this set (82)
What is an antimicrobial agent (AMA)?
Substance that kills or inhibits the growth of microorganisms such as bacteria, fungi or protozoans.
What is an antibiotic agent?
An antibacterial agent kills or inhibits the growth of bacteria
List the 4 categories of antibiotics:
List the 8 Abx classes for bacterial infections:
Why can a pt. be on a few different Abx?
Because each one works on different micro-organisms
What are the actions of abc drugs?
Affect target organism's structure, metabolism, or life cycle
Goal: eliminate pathogen
What is a bactericidal abx?
What is a bacteriostatic abx?
slow growth of bacteria
What is the most effective gram-positive bacteria?
What is beta-lactamase or penicillinase?
Enzyme allowing bacteria to be resistant
List 2 examples of penicillinase resistant penicillins:
List 2 abx that are a penicillin + beta-lactamase inhibitors:
Penicillin: Prototype drug?
Penicillin G Potassium
What is the mechanism of action of penicillin?
to kill bacteria by disrupting their cell walls
What is the primary use for penicillin?
What are some side effects of penicillin?
diarrhea, nausea, vomiting, pain at injection site
4 roles of the nurse regarding penicillins?
-assess previous drug rxns to pen
-use cephalosporins cautiously if client has history of severe penicillin allergy (15%)
-monitor CV stat, ECG changes
Which abx is similar in structure + fxn to penicillin?
Cephalosporins have a ____-____ ring and are ______
have a beta-lactam ring and are bactericidal
1st generation cephalosporin:
(oldest) bacteria-producing beta-lactamase are resistant
Ex. Cefazolin (ancef)
2nd generation cephalosporin:
-more resistan to beta-lactamase
Ex. Cefaclor (ceclor), Cefuroxime (keflex)
3rd generation cephalosporin:
-longer duration of action
-even broader spectrum
-resistant to beta-lactamase
-can enter CSF
Ex. Cefipime (Maxipime)
Prototype drug of cephalosporins?
What is the mechanism of action of cephalosporins?
inhibits cell wall synthesis
What is the primary use of cephalosporins?
broad-spectrum activity against gram-negative organisms; for serious infections of lower respiratory tract, CNS, genitourinary system, bones, blood, and joints
What are some side effects of cephalosporins?
-pain at injection site
List 3 roles of the nurse when giving cephalosporins:
-Assess for presence or history of bleeding disorders
-Cephalosporins may reduce prothrombin levels
-Assess renal and hepatic fxn
-Avoid alcohol (antabuse vom rxn)
What is one of the broadest spectrum and from any abx class?
Tetracyclines are unique because?
-large # of resistant bacterial strains
-drug of choose for only a few diseases
What diseases are tetras used for?
-Rocky Mountain spotted fever
-Peptic ulcers caused by H. pylori
Ex. doxycycline (Vibramycin), tetracycline
Tetracycline: Prototype drug:
What is the mechanism of action of tetras?
Inhibit bacterial protein synthesis with bacteriostatic effect
Primary use of tetracyclines?
broad-spectrum; effective against broad range of gram-positive and gram-negative organisms
What are some adverse effects of tetras?
-epigastric burning -diarrhea
-discoloration of teeth
What are some roles of the nurse using tetracyclines:
-Contraindicated for clients who are pregnant or lactating
(Effect on growth of fetus and child)
-Contraindicated in children less than 8 years of age
-Permanent mottling and discolouration of teeth
-decrease effectiveness of BC
-->Alternate birth-control method should be used while taking medication
-Use with caution in clients with impaired kidney or liver function
-Photosensitivity may result
-Do not take with milk products, iron supplements, magnesium-containing laxatives, or antacids
What abx is a safe alternative to penicillin?
-broad spectrum-superinfections may occur
Ex. azythromycin (Zithromax), clarithromycin (Biaxin) & EES (Erythromycin)
Macrolides: Prototype drug:
What is the mechanism of action of macrolides?
Inhibit protein synthesis by binding to bacterial ribosome
-Bacteriostatic at LOW doses
-Bacteriocidal at HIGH doses
Primary use of macrolides?
Effective against most gram-positive and gram-negative bacteria
What are some side effects of macrolides?
2 Roles of the nurse using macrolides?
-Watch liver with (EES) erythromycin estolate
-Multiple drug-drug interactions occur with macrolides
Which abx are reserved for serious systemic infections caused by aerobic gram-negative bacteria (ie E.coli)?
Ex. Gentamycin & Tobramycin
IMPORTANT info about amino glycosides: (red flagged)
-More toxic than most antibiotics
-Have potential to cause serious adverse effects
-Ototoxicity, nephrotoxicity, neuromuscular blockage (including respiratory paralysis)
-Note difference in spelling "mycin" (erythromycin) and "micin" (gentamicin)
Aminoglycosides: Prototype drug:
Mechanism of action of aminoglycosides?
narrow-spectrum; bactericidal (Inhibit bacterial protein synthesis)
What is the primary use of aminoglycosides?
serious urinary, respiratory, nervous, or GI infections
-Often used in combination with other antibiotics
-Used parenterally or in eye drops (Genoptic)
Some side effects of aminoglycosides?
Role of the nurse using aminoglycoside?
-Monitor for ototoxicity and nephrotoxicity
-Hearing loss may occur after therapy has been completed
Neuromuscular function may also be impaired
-Increase fluid intake, unless otherwise contraindicated, to promote excretion
-Caution if hypersensitive to sulfites
Characteristics of Fluoroquinolones
-Decreased absorption of up to 90 percent if taken with multivitamins or minerals such as calcium, magnesium, iron, or zinc ions.
-No teenagers or athletes!!! - Tendon Rupture
Can cause C.Difficile *
-QT Prolongation/Arrythmias (IRR (irreg. rate. rhythm) vs. RRR)
ciprofloxacin (Cipro), levofloxacin, moxifloxacin (Avelox)
Fluoroquinolones: prototype drug:
ciprofloxacin (Cipro, Septra)
Mechanism of action of Fluoroquinolones?
inhibits bacterial replication and DNA repair (bactericidal)
Primary use of Fluoroquinolones?
-treat gram-negative but only newer drugs treat gram-positive microbes
-for respiratory infections, bone and joint infections, GI infections, ophthalmic infections, sinusitis, and prostatitis
Some side effects of Fluoroquinolones?
-GI side effects
Which abx do we do peaks + troughs with?
gentamyocin, vancomyocin, tobramyocin
Role of the nurse giving Fluoroquinolone ?
-Monitor wbc count
-Monitor clients with liver and renal dysfunction
-Teach that drugs may cause dizziness and lightheadedness
-Advise against driving or performing hazardous tasks during drug therapy
-Norfloxacin may cause photophobia
-Teach that drug may affect tendons, especially in children
-Do NOT give to athletes!
Characteristics of Sulfonamides:
-Widespread use leads to resistance.
Used in a combination to treat UTIs
-Anti-inflammatory properties can help with rheumatoid arthritis and ulcerative colitis
-Teratogenic (birth defects)**
-Do not take while breastfeeding or pregnant
Reaction to sulfonamide abx could mean..?
allergy to other sulfonamide medications.
*Allergy to these meds may cause sensitivity to abx - caution with 1st dose.
Sulfonamides: Prototype drug:
trimethoprim-sulfamethoxazole = tmp/smz = (Bactrim)
What is the mechanism of action of sulfonamides?
to kill bacteria by inhibiting bacterial metabolism of folic acid
Primary use of sulfonamides?
Are broad spectrum (TMP/SMX) for urinary tract infections, Pneumocystis carinii pneumonia, shigella, and bronchitis
Some side effects of sulfonamides?
skin rashes, nausea, vomiting, agranulocytosis or thrombocytopenia, photosensitivty
Role of the nurse giving sulfonamides?
-Assess for anemia or other hematological disorders
-Assess renal function; sulfonamides may increase risk for crystalluria
-Ensure if on OCP that pt uses alternate form of BC *
-Contraindicated in clients with history of hypersensitivity to sulfonamides
-Can induce skin abnormality (Stevens-Johnson syndrome) (same as with ASA)
-Teach client how to decrease effects of photosensitivity- sunscreen
-Breaks down amino acid wall
-Used to treat C-Diff *
-Clinidamycin (IV only)
-Can cause + C-Diff ***
Vacomycin (vancocin) mechanism of action:
bactericidal, inhibits cell wall synthesis
What is the primary use of vancomycin?
reserved for severe or resistant gram-positive infection; effective for MRSA infections, used to treat C.Difficile
Side effects of vancomycin?
ototoxicity, nephrotoxicity, red man syndrome, anaphylaxis
How does Nitroimidazole work?
-Treats anaerobic bacterial infections and protozoal infections (GI)
-Inhibits DNA synthesis
Ex. Flagyl (metronidiazole)
Some side effects of Nitroimidazole?
-metallic taste in the mouth
-encephaopathy/seizures -N/V/D, SJS
Superinfections are also known as?
As antibiotics are used, they destroy sensitive bacteria. Only ______ bacteria remain
Insensitive (mutated) bacteria
3 things that occur with acquired resistance?
1. Free from competition from bacteria that were sensitive to the drug, the mutated bacteria thrives.
2. The client now develops an infection that is resistant to conventional therapy.
3.This resistant bacteria can be transmitted to others.
Culture and sensitivity testing:
-lab tests are conducted prior to anti-infective therapy
-organisms are grown in the laboratory
-Several abx are tested for effectiveness
-may take days or weeks for results
-using a single, specific antibiotic may:
What are superinfections?
Are secondary infections that occur when too many host flora are killed by an antibiotic
What occurs with superinfections?
-host flora (good guys) stop growth of pathogenic organisms (bad guys) by
-making antibacterial substances
-competing for space and nutrients
-host flora killed by abx, microorganisms multiply
S & S of superinfections?
-Abnormal vaginal discharge
When should you suspect C-Diff?
-3 or more episodes of unformed stool in 24 hours and elevated WBC
-Diarrhea during or up to 6 weeks after antibiotic therapy
-Diarrhea following hospital discharge or 72 hours after admission
With C-Diff, why should all antidiarrheals, antibiotics and proton pump inhibitors be stopped?
-Antidiarrheals may mask treatment failure or worsening diarrhea
-Overuse of Antibiotic therapy for coexisting conditions may lead to C. Difficile
-Proton Pump inhibitors may increase risk for C.Difficile
If antibiotic overuse can lead to C. Difficile, then why is it ordered for treatment?
-For mild to moderate C. Diff, Metronidazole PO/NG routes mean it will stay longer in the gut thus provide the best treatment. IV routes are not as effective.
-Once it becomes severe, Oral Vancomycin is the best treatment
Nurses non-pharmacological role in bacterial infxns?
-Prevention: hand washing, asepsis, sterile technique
-Educate clients regarding the importance of taking entire antibiotic drug regimen
-Monitor client's condition
-Provide client education
-Obtain medical, surgical, and drug history
-Assess lifestyle and dietary habits
-Obtain description of symptomology and current therapies
Some pharmacological mgmt?
-Obtain specimens for culture and sensitivity prior to start of therapy
-Monitor for indications of response to therapy
--Normal white blood count
--Absence of symptoms such as cough
-Monitor for super infections
--Replace natural colon flora with probiotic supplements or cultured dairy products
-After parenteral administration, observe closely for possible allergic reactions (anaphylaxis)
Teach clients to...
-Wear medic-alert bracelets if allergic to antibiotics
-Report symptoms of allergic reaction
-Not stop taking drug until complete prescription has been taken d/t development of resistance
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