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Antimicrobial Drugs
Pharmacology- Exam IV
159
Nursing
Undergraduate 2
07/15/2012

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Cards

Term
what are the 3 steps of antimicrobial therapy?
Definition
1. All orders should have- dose, duration & indication
2. All orders should include micro. Request for labs
3. 24-48 hrs post lab eval., take an “antibiotic timeout” to assess efficacy & appropriateness of used antibiotics
Term
what is selective toxicity in reference to antimicrobial therapy?
Definition
ability to suppress or kill an infecting microbe without injury to the host (safe for humans)
Term
three forms of penicillin G
Definition
1---Penicillin G aqueous --- given IV or IM. Gastric acid destroys it so not given PO. The PO form is penicillin V (Pen-Vee K).

2---penicillin G benzathine is ONLY given IM.

3---penicillin G procaine is only given IM. This is the very viscous one.
Term
Penicillins

gen. info
Definition
first antibiotic introduce by fleming penicillium molds in 1929
effective for many type of microbs
called beta-lactam anitbiotics
Term
penicillin G

indications
Definition
infections caused by susceptible gram-positive basteria
Term
penicillin G

pharmacokinetics
Definition
highly protein bound!!! excreted in the kidneys
Term
penicillin G

MOA
Definition
inhibits the third and final stage of bacterial cell wall synthesis
Term
penicillin G

contra/precautions
Definition
knowns ALLERGIES to penicillin, cephalosporins, or imipenem (cross allergies)
Term
penicillin G

Adverse effects
Definition
GI upset- can be given with a little bit of food if stomach upset occurs
rash
fever
wheezing
possibly anaphylaxis and death
Term
penicillin G

drug interactions
Definition
tetracyclines, aminoglycosides, and probenecid- enhance penicillin
Term
penicillin G

health status
Definition
assess health history and ALLEGIES!!!

wheres your epi-pen?????
Term
penicillin G

life span and gender
Definition
drug contracts the effects of an oral contraceptive!
Term
penicillin G

lifestyle, diet, habits
Definition
administer drug around the clock!!!!
Term
penicillin G

nursing dx and outcomes
Definition
risk for injury r/t drug-related allergic reactions
--the pt will recognize the symptoms of allergy and contact the prescriber immediately!

imbalanced nutrition: less than body requirements r/t drug induced GI effects
--pt will???
Term
penicillin G

max therapeutic effects
Definition
review culture and sensitivity reports to make sure that penicillin G is appropriate for pts
therapy should continue for 7-10 days at least
Term
penicillin G

min adverse effects
Definition
provide small, frequent meals, mouth care, and ice chips
notify the prescriber if substantial change develops in the intake-output ratio
stress the importance of completingt the full course
need to take exactly as prescribed at evenly spaced intervals
Term
penicillin G

ongoing assessment and evaluations
Definition
monitor for signs of allergic reaction and for resolution of the presenting symptoms of infections
Term
monobactams

aztreonam (Azactam)
Definition
gram neg bacteria
little cross sensitivity with PCN allergy but still watch out
parenteral- watch IV site!
Term
carbapenems

cilastatin-impenem (Primaxin)
Definition
precautions in head trauma, brain lesions, seizures- increase risk of sz risk
Term
ertapenem (Invanz)

indications
Definition
intra-abdominal infection
Term
meropenem (Merrem)
Definition
slight decrease risk of sz
Term
cefazolin

indications
Definition
treatment of many types of infections
Term
cefazolin

pharmacokinetics
Definition
administered IM or IV (pre-surgicial antibiotic) peak 1.5-2 hours
Term
cefazolin

MOA
Definition
binds with PBP's (?) which disrupts bacterial cell wall synthesis
Term
cefazolin

contra/precautions
Definition
known allergy to cephalosporins
Term
cefazolin

adverse effects
Definition
maculopapular rash (in the skin but not necessarily an allergy), GI symptoms (can be given with food), headache, dizziness, lethargy, paresthesia, and nephrotocicity (watch renal fx and output!)
Term
cefazolin

drug interactions
Definition
aminoglycosides
Term
cefazolin

health status
Definition
assess history and allergies
Term
cefazolin

lifespan and gender
Definition
assess for pregnancy and lactation
Term
cefazolin

lifestyle, diet, habits
Definition
assess lifestyle to ensure ability to comply with therapy
Term
vancomycin

gen. info
Definition
use ONLY when other antibiotics fail (do not want to build up resistant bacteria)
produces lots of toxic effects- renal, hepatic, and ear ringing
gram-postivie pathogens
Term
vancomycin

indicated for
Definition
treating bacterial septicemia, endocardidits, bone and joint infections
Term
vancomycin

pharamacokinetics
Definition
oral (usually for c. diff) or IV
excreted in the kidneys and feces
peak 1 hour
Term
vancomycin

MOA
Definition
inhibits cell wall synthesis by altering the cell's permeability
Term
vancomycin

contra/precautions
Definition
hypersensitivy and pregnancy
Term
vancomycin

adverse effects
Definition
ototoxiity and nephrotoxicity (change in output)
Term
vancomycin

drug interactions
Definition
antihyperlipidemic drugs and nondepolarizing muscle relaxants
Term
vancomycin

health status
Definition
assess for contraindications to therapy
Term
vancomycin

lifespan and gender
Definition
assess pregnancy and lactation status
Term
vancomycin

max therapeutic effects
Definition
ensure that the pt receives the full course of vancomycin as prescribed
culture and sensitivity results should be monitored
Term
vancomycin

min adverse effects
Definition
administer vancomycin over at least 250 mL over 60 mins
assess the IV site frequently for signs of phlebitis
Term
vancomycin

pt and family teaching
Definition
advise the pt of the importance of completeing therapy
explain the potential adverse effects and need for periodic blood monitoring
Term
vancomycin

ongoing assessment and evaluation
Definition
monitor for signs of ototoxicity
for pts receiving long-term or high-dose therapy, coordinate periodic audiometric testing and lab tests
Term
aminoglycosides

gentamicin: gen info
Definition
can cause serious injury to inner ear and kidney
narrow spectrum antibiotic!!!!
must monitor peak and trough levels
Term
aminoglycosides

gentamicin: used for
Definition
aerobic gram-negative bacilli
Term
aminoglycosides

gentamicin: MOA
Definition
affects protein synthesis in bacteria- transcription and translation
Term
aminoglycosides

gentamicin: adverse effects
Definition
nephrotoxicity
ototoxicity
hypersensitiviy reactions
neuromuscular blockage
Term
aminoglycosides

gentamicin: drug interaction
Definition
acyclovir, amphotericin B, cephalothin, cisplatin, cyclosporine, loop diuretics, prostaglandin synthetase inhibitors, and vancomycin
Term
aminoglycosides

gentamicin: max therapeutic effects
Definition
make sure pts receive the full course of prescribed at around the clock interverals
do not give at the same time as extended penicillin
Term
aminoglycosides

gentamicin: min therapeutic effects
Definition
maintian blood levels of gentamicin within a therapeutic margin that is very narrow
monitor for signs of ototoxicity or nephrotoxicity
Term
Lincosamides

clindamycin (Cleocin): used for
Definition
aerobic gram-pos cocci and several anareobic gram-neg and gram-pos organisms
Term
Lincosamides

clindamycin (Cleocin): pharmacokinetics
Definition
varies with route of administration, metabolized in the liver, excreted in the bile and urine
Term
Lincosamides

clindamycin (Cleocin): contra/precautions
Definition
hypersensitivity and pregnancy and lactation
Term
Lincosamides

clindamycin (Cleocin): adverse effects
Definition
if they get diarrhea you probably killed off all normal bacteria

pseudomembranous colitis, maculopapular rash, erythema, pruritus
Term
Lincosamides

clindamycin (Cleocin): drug interactions
Definition
neuromuscular blockers, aluminum salts, cyclosporine, benzoyl peroxide, tretinoin and salicylic acid
Term
Lincosamides

clindamycin (Cleocin): max therapeutic effects
Definition
make sure that the patients receives the full course of clindamycin as prescribed
Term
Lincosamides

clindamycin (Cleocin): min adverse effects
Definition
clindamycin should be administered on an empty stomach with a full glass of water
report diarrhea to the provider immediately
Term
macrolide antibiotics

erythromycin: used for?
Definition
treating Legionnaire diseas, mycoplasma pneumoniae pneumonia (erythomycin works on bacteria that does NOT have a cell wall), diphtheria, chlamydial infections and chancroid
Term
macrolide antibiotics

erythromycin: pharmacokinetics
Definition
drug is easily inactived by gastric acid
peak 1-4 hours
metabolized in the liver
excreted in the urine or bile
IV- reconstituted with sterile water
Term
macrolide antibiotics

erythromycin: MOA
Definition
inhibiting RNA-dependent protein synthesis
Term
macrolide antibiotics

erythromycin: contra/precautions
Definition
allergy to medication
Term
macrolide antibiotics

erythromycin: adverse effects
Definition
gi symptoms (give them food), urticaria, maculopapular rash, erythema, and interstitial nephritis
Term
macrolide antibiotics

erythromycin: drug interaction
Definition
astemizole and terafenadine
Term
macrolide antibiotics

erythromycin: max therapeutic effects
Definition
reconstitute erythromycin with sterile water only
prepared infusion solutions that are stored at room temp must be used within 8 hours
Term
macrolide antibiotics

erythromycin: min adverse effects
Definition
because erythromycin can be very irritating to veins, it is important to adminsiter IV infusions over 30 to 60 mins
Term
Oxazolidinones

linezolid (Zyvox): used for
Definition
treatment of VRE and MRSA
Term
Oxazolidinones

linezolid (Zyvox): pharmacokinetics
Definition
administered oral and IV
metabolized in liver
excreted in the kidneys
Term
Oxazolidinones

linezolid (Zyvox): MOA
Definition
blocking the early stages of the process bacteria use to make proteins
Term
Oxazolidinones

linezolid (Zyvox): contra/precautions
Definition
hypersensitvity
Term
Oxazolidinones

linezolid (Zyvox): adverse effects
Definition
diarrhea (killing normal flora), headache, nausea, and vomiting
Term
Oxazolidinones

linezolid (Zyvox): drug interactions
Definition
adrenergic and serotonergic agents
Term
Oxazolidinones

linezolid (Zyvox): max therapeutic effects
Definition
administer at evenly spaced intervals
Term
Oxazolidinones

linezolid (Zyvox): min adverse effects
Definition
to avoid hypertensive crisis, monitor the pts intake of food or beverages containing tyramine, caffeine or alcohol
serial blood pressure readings should be obtained throughout therapy
Term
Oxazolidinones

linezolid (Zyvox): pt and family teaching
Definition
explain dietry restricitions, focusing on food or beverages containing tyramine, caffeine or alcohol
teach pts the signs and symptoms of thrombocytopenia and pseudomembranous colitis
Term
Oxazolidinones

linezolid (Zyvox): ongoing assessment and evaluation
Definition
monitor for efficacy of treatment and resolution of the presenting infection
Term
tetracyclines: used for?
Definition
rickettsia species, mycoplasma pneumoniae, and chlamydia trachomatis
Term
tetracyclines: pharmacokinetics
Definition
oral
excreted in the kidneys
needs to be given 1 hr before means or 2 hours after meals
Term
tetracyclines: MOA
Definition
inhibits or retard the growth of bacteria but do not kill them
Term
tetracyclines: contra/precautions
Definition
allergy, pregnancy, or lactation
not used in children <8 yrs (can effect teeth causing graying of enamel)
Term
tetracyclines: adverse effects
Definition
GI upset, photosensitivity and rash
Term
tetracyclines: drug interactions
Definition
penicillin G, aluminum, bismuth, calcium, iron, magnesium, and zinc salts
Term
tetracyclines: max therapeutic effects
Definition
to max absorption, oral prepartaions should be administered on an empty stomach either 1 hour before or 2 hours after any meals or other drugs
Term
tetracyclines: min adverse effects
Definition
monitor the pt to ensure that adequate fluids are given to replace fluid lost with diarrhea
wear protective clothing and sunscreen when outdoors
Term
tetracyclines: pt and family education
Definition
advise women of childbearing age that tetracycline should not be taken during pregnancy or breast-feeding
advise pts to take tetracycline on an empty stomach
Term
tetracyclines: ongoing assessment and evaluation
Definition
monitor renal status to detect and prevent hepatotoxicity and to observe for any signs of superinfection
Term
Fluoroquinolones

ciprofloxacin (Cipro): what do the 4 generations treat?
Definition
1st- used only to treat uncomplicated UTI
2nd- have increased gram-neg and systemic activity
3rd- have extended activity against gram-pos pathogen
4th- have extended activity against pseudomonas (green stuff comes out)
Term
Fluoroquinolones

ciprofloxacin (Cipro): used for
Definition
active against aerobic gram-negative organsims
Term
Fluoroquinolones

ciprofloxacin (Cipro): pharmacokinetics
Definition
oral, parenteral and topical
metabolized in the liver
excreted in the urine and feces
Term
Fluoroquinolones

ciprofloxacin (Cipro): MOA
Definition
inhibits DNA gyrase, an enzyme needed for bacteria DNA replication
Term
Fluoroquinolones

ciprofloxacin (Cipro): contra/precaution
Definition
allergy, pregnancy, and lactation
Term
Fluoroquinolones

ciprofloxacin (Cipro): adverse effects
Definition
arthropathy (joint pain, sometimes does not go away), GI upset (can give with food), headache, and restlessness
Term
Fluoroquinolones

ciprofloxacin (Cipro): drug interactions
Definition
many potential drug-drug interactions due to metabolism
Term
Fluoroquinolones

ciprofloxacin (Cipro): max therapeutic effects
Definition
coordination the administration of drugs to decrease potential drug-drug interactions
Term
Fluoroquinolones

ciprofloxacin (Cipro): min adverse effects
Definition
institute safety measures to protect the patients if CNS effects occur. For pts with adverse GI effects, provide small, frequent meals as tolerated
Term
Fluoroquinolones

ciprofloxacin (Cipro): pt and family ed
Definition
it is important to explain that cirpofloxacin is prescribed for a particular infection
it is important to instruct patients to complete the full course of drug therapy, even when they feel better
Term
Fluoroquinolones

ciprofloxacin (Cipro): ongoing assessment and evaluation
Definition
due to the possibility for overgrowth of candidal organisms with ciprofloxacin therapy, monitor pts closely during treatment
Term
sulfonamides

Sulfamethoxazole-Trimethoprim (Bactrim, Septra): used fo
Definition
uncomplicated UTIs and systemic infections
Term
sulfonamides

Sulfamethoxazole-Trimethoprim (Bactrim, Septra): pharmacokinetics
Definition
administered oral
metabolism in liver
peak in 4 hours
Term
sulfonamides

Sulfamethoxazole-Trimethoprim (Bactrim, Septra): MOA
Definition
interferes with the synthesis of folic acid
Term
sulfonamides

Sulfamethoxazole-Trimethoprim (Bactrim, Septra): contra/precautions
Definition
hypersensitivity, deficiency of G6PD or folate
Term
sulfonamides

Sulfamethoxazole-Trimethoprim (Bactrim, Septra): adverse effects
Definition
nausea, vomiting, diarrhea, hematologic effects, allergic reactions and crystalluira
Term
sulfonamides

Sulfamethoxazole-Trimethoprim (Bactrim, Septra): drug interactions
Definition
interacts with other protein-bound drugs
Term
sulfonamides

Sulfamethoxazole-Trimethoprim (Bactrim, Septra): max therapeutic effects
Definition
administer 1 hour before or 2 hours after a meal with a full glass of water to enhance the absorption of the drug
Term
sulfonamides

Sulfamethoxazole-Trimethoprim (Bactrim, Septra): min adverse effects
Definition
administer witha f ull glass of water
fluid intake should increase by 1.5L/day
Term
sulfonamides

Sulfamethoxazole-Trimethoprim (Bactrim, Septra): pt and family ed
Definition
teach pts the optimal way to take
teach interventions to decrease the risk for adverse effects
Term
sulfonamides

Sulfamethoxazole-Trimethoprim (Bactrim, Septra): ongoing assessment and evaluation
Definition
monitor pt for signs of hematolgic dysfunction, such as a sore throat, fever, bruising, bleeding
Term
nitrofurantoin (Furadantin, Macrodantin, Macrobid)
Definition
UTI drug
interefers with several bacterial enzyme systems
not an effective systemic drug bc it is rapidly excreted by the kidneys
contraindicated in pts with renal impairment
Term
urinary tract analgesic

phenazopyridine (Pyridium)
Definition
does not have antibacterial activity
excreted in urine where it exerts a topical analgesic effect
for the symptomatic relief of pain, burning, frequency and urgency
contra for pts with known hypersensitivity or renal insufficiency
orange pee!!!!!!!!
Term
isoniazid (INH)

used for?
Definition
used to treat or prevent TB
Term
isoniazid (INH)

pharmacokinetics
Definition
oral or IM
metabolized in the liver
excreted in the urine and feces
peak 12 hours
Term
izoniazid (INH)

MOA
Definition
disrupts the synthesis of the bacterial cell wall
Term
izoniazid (INH)

contra/precautions
Definition
acute hepatic disease
Term
izoniazid (INH)

adverse effects
Definition
hepatotoxicity, peripheral neuropathy, and encephalopathy
Term
izoniazid (INH)

drug interactions
Definition
antiseziure drugs, alcohol, aluminum-based antacids, benzodiazepines, disulfiram, enflurane, ketoconazole, meperidine, warfarin, and raifampin
Term
izoniazid (INH)

max therapeutic effect
Definition
administered INH to the pt with an empty stomach 1 hr before or 2 hr after meals to increase absorption
Term
izoniazid (INH)

min adverse effects
Definition
advise pts to report any of the prodromal symptoms of hepatitis, including anorexia, malaise, fatigue, jaundice, or nausea
Term
izoniazid (INH)

ongoing assessment and evaluation
Definition
monitor for signs of adverse effects, especially hepatitis
Term
amphotericin B (Fungizone)

used for
Definition
treat progressive and potentially fatal systemic fungal or protozoal infections
Term
amphotericin B (Fungizone)

pharmacokinetics
Definition
IV or oral
metabolism in unknown
t 1/2- 24 hours
Term
amphotericin B (Fungizone)

MOA
Definition
binds to sterols in fungal cell membranes
Term
amphotericin B (Fungizone)

contra and precautions
Definition
preexisting anemia, hypokalemia, and hypomagnesemia
Term
amphotericin B (Fungizone)

adverse effects
Definition
nephrotoxicitym hypokalemia, hypomagnesemia, hypochloremia, and hypocalcemia
Term
amphotericin B (Fungizone)

drug interactions
Definition
antineoplastic agent, cyclosporine, tacrolimus, or aminoglycosides
Term
amphotericin B (Fungizone)

max therapeutic effects
Definition
to reduce the potential for infusion reactions, flucytosine may be prescribed concurrently to decrease the dosage of amphotericin B
Term
amphotericin B (Fungizone)

min adverse effects
Definition
be prepared for the possibility of an infusion reaction
administer amphotericin B in central line
Term
amphotericin B (Fungizone)

pt and family education
Definition
describe and explain the possibility of an infusion reation
another important area to discuss with pts and family is the importance of an accurate fluid intake and output record
Term
amphotericin B (Fungizone)

ongoing assessment and evaluation
Definition
during the first dose of amphotericin B, take vital signs every 15 mins. evaluate for possible infusion reactions
Term
fluconazole (Diflucan)

used for
Definition
candidiasis and cryptococcal meningitis
can treat simple vaginal yeast infection with 1 oral dose
Term
fluconazole (Diflucan)

pharmacokinetics
Definition
oral or IV
excreted by the kidneys
peak 1-2 hours
Term
fluconazole (Diflucan)

MOA
Definition
inhibits synthesis of ergosterol, an enzyme that is an essential componenet of the fungal membrane
Term
fluconazole (Diflucan)

contra and precautions
Definition
no absolute contraindications exist to fluconazole
Term
fluconazole (Diflucan)

adverse effects
Definition
diarrhea, nausea, vomiting, abdominal pain, headache, rash, and dizziness
Term
fluconazole (Diflucan)

drug interactions
Definition
many drug-drug interactions are possible due to the metabolism of the drug
Term
fluconazole (Diflucan)

max therapeutic effects
Definition
admisister fluconazole in evenly divided internals throughout the day
Term
fluconazole (Diflucan)

min therapeutic effects
Definition
carefully screen pts for pre-exisiting disorders, which may increase the risk of adverse reactions
Term
fluconazole (Diflucan)

pt and family teaching
Definition
explain that fluconazole is prescribed for a particular infection and should not be used to self-medicate or treat any other infection
remind pts of the importance of remaining well hydrated
Term
fluconazole (Diflucan)

ongoing assessment and evaluation
Definition
monitor the effectiveness of therapy
Term
nystatin
Definition
for candidiasis (thrush)
"swish and swallow"
Term
terbinafine (Lamisil)
Definition
topical or oral
contra in renal or liver disease
monitor LFT's with oral
Term
acyclovir (Zovirax)

used for?
Definition
treatment of herpes viruses
Term
acyclovir (Zovirax)

pharmacokinetics
Definition
topical, oral, or IV
Term
acyclovir (Zovirax)

MOA
Definition
undergoes phosphorylation. in an infected cell, it is converted by the viral enzyme thymidine kinase. once incorporated into the virus, it terminates DNA synthesis
Term
acyclovir (Zovirax)

contra and precautions
Definition
use caution in pts with ganciclovir hypersensitivity
Term
acyclovir (Zovirax)

adverse effects
Definition
lightheadedness, anorexia, nausea, vomiting, abdominal pain, and headache
Term
acyclovir (Zovirax)

drug interactions
Definition
valproic acid, hydantoins, theophyllines, and probenecid
Term
acyclovir (Zovirax)

max therapeutic effects
Definition
with a full glass of water with or without food
Term
acyclovir (Zovirax)

min adverse effects
Definition
advise the pt to drink at least eight 8-oz fluid glass of water a day
administer IV acyclovir over 60 min
Term
acyclovir (Zovirax)

pt and family ed
Definition
advise pt to notify the prescriber if they are pregnant or breast-feeding.
emphasize that acyclovir does not prevent the transmission of infection to another person and does not cure the infection
Term
acyclovir (Zovirax)

ongoing assessment and evaluation
Definition
monitor for the effectiveness of therapy, making sure to document new lesions and assess for possible secondary bacterial infections
Term
metronidazole (Flagyl)

used for
Definition
the treatment of trichomoniasis, amebiasis, and giardiasis
Term
metronidazole (Flagyl)

pharmacokinetics
Definition
oral, IV and topically
metabolized in the liver
Term
metronidazole (Flagyl)

MOA
Definition
acts against anaerobic bacteria by inhibiting DNA synthesis
Term
metronidazole (Flagyl)

contra/precautions
Definition
alcohol and pregnancy
Term
metronidazole (Flagyl)

adverse effects
Definition
nausea, vomiting, dry mouth, altered sense of taste (dysgeusia), anorexia and abdominal pain
Term
metronidazole (Flagyl)

drug interactions
Definition
ethanol
Term
metronidazole (Flagyl)

max therapeutic effects
Definition
to avoid reinfection, pts being treated for trichomonas infection need to understand the their sexual partners must be treated too
Term
metronidazole (Flagyl)

min adverse effects
Definition
emphasize the importance of potential adverse effects resulting from the interation of ethanol and metronidazole
Term
metronidazole (Flagyl)

pt and family education
Definition
create teaching plans that focus on explaining the potential adverse effects
discuss the importance of refraining from ethanol or disulfiram use during therapy
Term
metronidazole (Flagyl)

ongoing assessment and evaluation
Definition
when administering IV metronidazole, monitor for thrombophlebitis and signs of edema or CHF
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