NUR 239/Pathophysiology and Pharmacotherapeutics in Nursing I Guided Note Antibiotics (complete Study guide)
NUR 239/Pathophysiology and Pharmacotherapeutics in Nursing I Guided Note Antibiotics 1 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 NUR 239/Pathophysiology and Pharmacotherapeutics in Nursing I Guided Note Antibiotics Complete the following study guide for your own note taking 2 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 warningcardiopulmonary arrest/death if give IM med thru IV route. CNS: SEIZURES (HIGH DOSES) GI: CLOSTRIDIUM DIFFICILEASSOCIATED 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) NUR 239/Pathophysiology and Pharmacotherapeutics in Nursing I Guided Note Antibiotics Complete the following study guide for your own note taking 3 Action Bactericidal, broad-spectrum, causes defective cell membrane Bactericidal action, broad-spectrum (aerobic, gram -) Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme. Use Used IM or IV Empirical therapy for serious systemic aerobic gram – infections, MDR infections (pseudomonas, TB) Oral form (neomycin) used to sterilize GI tract (not absorbed systemically from GI tract) Respiratory Infections (sinusitis, pneumonia, lower resp infections), GI, GU (UTI, prostatitis), bone, joint, skin, soft tissue First line treatment for anthrax until culture results known (example of empiric treatment) Adverse Effects CNS: ataxia, vertigo EENT: ototoxicity (vestibular and cochlear) GU: nephrotoxicity MS: muscle paralysis (high parenteral doses) Misc: hypersensitivity reactions CNS: ELEVATED INTRACRANIAL PRESSURE (INCLUDING PSEUDOTUMOR CEREBRI), SEIZURES, SUICIDAL THOUGHTS, agitation, confusion, depression, dizziness, drowsiness, hallucinations, headache, insomnia, nightmares, paranoia, toxic psychosis, tremor GI: HEPATOTOXICITY, CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA (CDAD), abdominal pain, diarrhea, nausea, ↑ liver enzymes GU: vaginitis Derm: photosensitivity, rash Endo: hyperglycemia, hypoglycemia Hemat: eosinophilia Local: phlebitis at IV site MS: arthralgia, myalgia, tendinitis, tendon rupture Neuro: peripheral neuropathy Misc: hypersensitivity reactions including : ANAPHYLAXIS Contraindications Hypersensitivity to gentamicin or other aminoglycosides • Hypersensitivity (cross-sensitivity within class may exist) • History of myasthenia gravis (may worsen symptoms including muscle NUR 239/Pathophysiology and Pharmacotherapeutics in Nursing I Guided Note Antibiotics Complete the following study guide for your own note taking 4 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 or with renal impairment (especially in DM) Chapter 20 Tetracycline and Sulfonamide Tetracycline (Prototype) Trimethoprim-sulfamethoxazole (Prototype) Action Bacteriostatic action, broadspectrum Inhibits bacterial protein synthesis at the level of the 30S bacterial ribosome. Bacteriostatic 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 ***********************************CONTINUED********************
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nur 239pathophysiology and pharmacotherapeutics in nursing i
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nur 239pathophysiology and pharmacotherapeutics in nursing i guided note antibiotics
