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Guided Note Antibiotics Complete the following study guide for your own note taking Key terms: Frandsen Chapter 18:
- beta-lactamases:
- cross-allergenicity: occurs when the proteins in one substance are like the proteins in another. As a result, the immune system sees them as the same. In the case of food allergies, cross - reactivity can occur between one food and another. Cross - reactivity can also happen between pollen and foods or latex and foods.
- extended spectrum: antibiotic is one that, as a result of chemical modification, affects additional types of bacteria, usually those that are gram-negative. o Carbenicillin – gram - , especially pseudomonas
- superinfection: New/secondary infections due to disruption in normal flora or growth of resistant Frandsen Chapter 19:
- concentration-dependent bactericidal effect: As the drug concentration decreases, the rate of bactericidal activity will decrease. Higher doses of the drug will increase not only the rate of reduction of bacteria but also the length of time of drug exposure to bactericidal concentrations.
- ototoxicity: the property of being toxic to the ear (oto-), specifically the cochlea or auditory nerve and sometimes the vestibular system, for example, as a side effect of a drug. The effects of ototoxicity can be reversible and temporary, or irreversible and permanent
- post antibiotic effect: Ability to continue killing MOs at low serum concentrations
- extended-interval dosing: Multiple daily doses – every 6 hours, every 8 hours, every 12 hours
- peak and trough levels: o Peak = maximum amount in blood 30 – 60 minutes after dose o Trough = lowest amount in blood, draw before dose Key Learning Objectives – Complete the tables for each medication listed. Be concise, such as, what are the 3-5 top adverse effects or nursing implications. We will focus on the Prototypes and key drugs from these chapters. I have completed the first one for you. Chapter 18
Guided Note Antibiotics Complete the following study guide for your own note taking Beta-Lactam Antibacterial Agents Ampicillin (Prototype for Penicillins) Cefazolin (Prototype) Action Inhibit bacterial cell wall synthesis by binding to one/multiple penicillin-binding proteins. Bactericidal action, broad-spectrum, inhibits cell wall synthesis Use Broad spectrum activity for endocarditis, skin, soft tissue, respiratory, GI, GU infections. Treats Gram + and Gram – Surgical prophylaxis (First Generation) Respiratory, skin, GU, bone, joint, blood infections Adverse Effects Most common: hypersensitivity or allergic reaction. Common: GI. Infrequent: Nephropathy, hepatotoxicity, CNS symptoms (confusion, lethargy, twitching, dysphagia, seizures, coma) Black box warning- cardiopulmonary arrest/death if give IM med thru IV route.
CNS: SEIZURES (HIGH DOSES)
GI: CLOSTRIDIUM DIFFICILE-
ASSOCIATED DIARRHEA
(CDAD), diarrhea, nausea, vomiting, cramps Derm: STEVENS-JOHNSON SYNDROME, rash, pruritis, urticaria Hemat: leukopenia, neutropenia, thrombocytopenia Local: pain at IM site, phlebitis at IV site Misc: allergic reactions including anaphylaxis and serum sickness, superinfection Contraindications Caution in liver or renal disease. Hypersensitivity. Cross-allergenicity. Hypersensitivity to cephalosporins Serious hypersensitivity to penicillins. Nursing Implications/patient teaching Culture & sensitivity test first. PO, IM, or IV routes. Oral form on empty stomach (1 hr before or 2 hr after meal) with full glass of water. Many meds/herbs interact. Do not take with OJ or other acidic fluids (destroys drug). Take full course of treatment. Take at even spaced intervals. Report adverse effects. Monitor BUN, creatinine. Chemically related to PCN >Assess for cross-sensitivity Give oral meds with food or milk risk of pseudomembranous Colitis (C. diff) risk of nephrotoxicity when given with aminoglycosides and loop diuretics (excreted by kidneys) Chapter 19 Aminoglycosides & Fluoroquinolones Gentamicin (Prototype) Ciprofloxacin (Prototype)
Guided Note Antibiotics Complete the following study guide for your own note taking Most parenteral products contain bisulfites and should be avoided in patients with known intolerance Pedi: Products containing benzyl alcohol should be avoided in neonates. weakness and breathing problems)
- Use with tizanidine
- OB: Do not use unless potential benefit outweighs potential fetal risk
- Pedi: Use only if no alternatives in children 1–17 years due to possible arthropathy. Nursing Implications/patient teaching Serious AE Nephrotoxicity : especially if combined with cephalosporins or diuretics May be given orally Not at same time as dairy products Encourage increased fluid intake Ototoxicity : may be permanent (if pt states he has decreased hearing, dizziness, tinnitus– do not give- need to call provider) Not at same time as antacids, Multivitamins, any calcium, iron, zinc Avoid sun exposure Neurotoxicity : if combined with neuromuscular blocker or anesthesia Contraindicated in children, associated with joint/cartilage damage (Achilles tendon rupture ) Use caution in elderly o r with renal impairment (especially in DM) Chapter 20 Tetracycline and Sulfonamide Tetracycline (Prototype) Trimethoprim-sulfamethoxazole (Prototype) Action Bacteriostatic action, broad- spectrum Inhibits bacterial protein synthesis at the level of the 30S bacterial ribosome. Bacterio static action, broad spectrum (gram + and - ) Combination inhibits the metabolism of folic acid in bacteria at two different points. Use Often used for unusual diseases: Cholera, typhus, Rocky Mountain Spotted Fever, Used mainly for UTIs, burns (topical), chronic bronchitis-use Bactrim
Guided Note Antibiotics Complete the following study guide for your own note taking STIs & PID Uses: acne treatment/prevention (doxycycline, minocycline), chronic bronchitis, gonorrhea, syphilis - if allergic to PCN, small animal bites, Lyme disease Most commonly used: Bactrim or Septra (sulfamethoxazole & trimethoprim combination) Adverse Effects CNS: intracranial hypertension, dizziness GI: diarrhea, nausea, vomiting, esophagitis, hepatotoxicity, pancreatitis Derm: photosensitivity, rashes Hemat: blood dyscrasias Misc: hypersensitivity reactions, superinfection CNS: fatigue, hallucinations, headache, insomnia, mental depression, kernicterus in neonates CV: hypotension Derm: ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash, photosensitivity Endo: hypoglycemia F and E: hyperkalemia, hyponatremia GI: CLOSTRIDIUM DIFFICILE- ASSOCIATED DIARRHEA (CDAD), HEPATIC NECROSIS, nausea, vomiting, diarrhea, stomatitis, hepatitis, cholestatic jaundice, pancreatitis GU: crystalluria Hemat: AGRANULOCYTOSIS, APLASTI C ANEMIA, hemolytic anemia, leukopenia, megaloblastic anemia, thrombocytopenia Local: phlebitis at IV site Misc: fever Contraindications Renal Impairment, Pregnant women, Children (stains tooth enamel, bones in people still growing) Contraindicated for renal failure (renal insufficiency), pregnancy, children Patient Teaching Nursing Implications Do not give with food or dairy products, antacids, iron (give 1 hour before or 2 hours after) Throw away old medication, it decomposes and becomes toxic Ask about sulfa allergy – cross sensitivity with thiazide (diuretics) & sulfonylureas (anti-diabetic drug) Give on an empty stomach with water
Guided Note Antibiotics Complete the following study guide for your own note taking PO Amebicide in the management of amebic dysentery, amebic liver abscess, and trichomoniasis: Treatment of peptic ulcer disease caused by Helicobacter pylori. Topical Treatment of acne rosacea. Vag Management of bacterial vaginosis. Adverse Effects CNS: seizures (rare) CV: TORSADES DE POINTES, VENTRICU LAR ARRHYTHMIAS, QT interval prolongation Derm: rash EENT: ototoxicity GI: CLOSTRIDIUM DIFFICILE- ASSOCIATED DIARRHEA (CDAD), nausea, vomiti ng, abdominal pain, cramping, diarrhea, hepatitis, infantile hypertrophic pyloric stenosis, pancreatitis (rare) GU: interstitial nephritis Local: phlebitis at IV site Misc: HYPERSENSITI VITY REACTIONS (INCLUD ING ANAPHYLAXIS) CNS: SEIZURES, dizziness, headache , aseptic meningitis (IV), encephalopathy (IV), psychosis Derm: STEVENS-JOHNSON SYNDROME, rash, urticaria topical only: burning, mild dryness, skin irritation, transient redness EENT: optic neuropathy, tearing (topical only) GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Hemat: leukopenia Local: phlebitis at IV site Neuro: peripheral neuropathy Misc: superinfection Adverse effect- Red-man syndrome Begins after IV infusion started Red rash, flushing on neck, face, upper body, hypotension Reason- infusing too fast Action- stop and notify HCP Contraindicati ons
- Hypersensitivity;
- Concurrent use of dihydroergotamine, ergotamine, lovastatin, pimozide, or simvastatin;
- Long QT
- Hypersensitivity;
- Hypersensitivity to parabens (topical only);
- OB: First trimester of pregnancy. Hypersensitivity
Guided Note Antibiotics Complete the following study guide for your own note taking syndrome
- Hypokalemia
- Hypomagnesemi a
- Heart rate < bpm;
- Known alcohol intolerance (most topicals);
- Tartrazine sensitivity (some products contain tartrazine–FDC yellow dye #5);
- Products containing benzyl alcohol should be avoided in neonates. Patient Teaching Nursing Implications PO Administer around the clock. Erythromycin film-coated tablets (base and stearate) are o PO Administer on an empty stomach, or may administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing. Swallow extended- release tablets whole; do not break, crush, or chew. Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results. o Monitor neurologic status during and after IV infusions. Inform health care professional if numbness, paresthesia, weakness, ataxia, or seizures occur. o Monitor intake, output, and daily weight, especially for patients on sodium restriction. Each 500 mg of premixed injection for dilution contains 14 mEq of sodium. IV – give very slowly (1 - 2 hours) to avoid “red-man syndrome” (hypotension, flushing and skin rash) Nephrotoxic – use cautiously in renal impairment Oral Vancomycin is NOT absorbed into bloodstream Used only to treat GI infection such as absorbed better on an empty stomach, at least 1 hr before or 2 hr after meals; may be taken with food if GI irritation occurs. Enteric-coated erythromycin (base) may be taken without regard to meals. Erythromycin ethyl succinate is best absorbed when taken with meals. Take each dose with a full glass of water. o Use calibrated measuring device for liquid preparations.
