NRS 112 Antimicrobials

  1. Disinfectants
    • Kills organisms
    • Used only on non living objects.
  2. Antiseptics
    Inhibits growth of microorganisms but does not neccessarily kill them.

    Applied exclusively to living tissue.
  3. Bacteriocidal
    Kills or destroys microorganisms
  4. Bacteriostatic
    Retards growth of microorganisms
  5. Penicillinase
    used by bacteria to destroy PCN
  6. Beta-lactamase
    breaks down structure of the ABX and inactivates the drug
  7. Stevens-Johnson Syndrome
    Severe hypersensitivity reaction

    Inflammation of skin and mucous membranes progressing to necrosis. Can progress to lining of organs.
  8. Superinfection
    Secondary infections during ABX tx.

    Located in groin, axilla, mouth, unber breast tissue, ANY WARM MOIST AREA.

    Caused by yeast/bacteria.
  9. Broad spectrum ABX
    Effective against Gram neg and Gram pos.

    Includes carbapenems, extended spectrum cephalosporins, beta-lactam/beta-lactamase inhibitors, fluoroquinolones.
  10. Narrow spectrum ABX
    Effective against limited number of microorganisms.

    PCN G, Macrolides, Nitrofurantoin, Metronidazole, Aztreonam, Nalidixic Acid.
  11. Sulfonamides
    Sulfadiazine, Sulfamethoxazole, Sulfisolxazole

    Often combined w/ other ABX - combined with trimethoprim = Bactrim or Septra

    • Effective against Gram pos and neg
    • Used to tx UTI's and URI's.
  12. Sulfonamides: Mechanisms of Action
    Prevents synthesis of Folic Acid

    Does not effect human cells or certain bacteria, only organisms that synthesize their own folic acid
  13. Sulfonamides: Adverse effects
    Hemolytic or aplastic anemia, thrombocytopenia, agranulocytosis, photosensitivity, exfoliative SJS, epidermal necrosis, n/v/d, pancreatitis, convulsions, crystalluria, toxic neprhosis, h/a, peripheral neuritis, urticaria.
  14. Beta-Lactam ABX
    • PCNs
    • Cephalosporins
    • Carbapenems
    • Monobactams
  15. PCNs
    • Bacteriocidal: inhibit cell wall synthesis
    • Effective against wide variety of bacteria.
  16. Natural PCNs
    PCN G, PCN V K+.
  17. Penicillinase resistant drugs
    Cloxacillin, dicloxacillin, nafcillin, oxacillin.
  18. Aminopenicillins
    Amoxicillin, ampicillin
  19. Extended spectrum drugs
    Piperacillin, ticarcillin, barbenicillin

    Usually used with other drugs, rarely used alone.
  20. Penicillin lactamase inhibitor combinations
    Unasyn - Ampicillin + sulbactam

    Augmentin - Amoxicillin + clavulanic acid

    Timentin - Ticarcillin + clavulanic acid

    Zosyn - Piperacillin + tazobactam
  21. PCN MOA
    Enter via cell wall, disrupt normal bacterial cell synthesis.

    Does not kill other cells in body
  22. PCN Indications
    Prevention and tx of Gram pos, streptococcus, Enterococcus, Staphylococcus bacteria.
  23. PCN adverse effects
    Allergic reactions in .7 - 4% of cases.

    Allergic to PCN = four to sixfold higher risk of allergy to other beta-lactam ABX
  24. PCN Interactions
    NSAIDs, oral contraceptives, Warfarin (enhances anticoagulant effect r/t decrease in intestinal flora)

    Producing vitamin K
  25. Nursing considerations for PCN
    Take with full glass of water

    Don't skp doese

    Take all as prescribed

    Notify MD of adverse reactions
  26. Cephalosporins
    Structurally/pharmacologically r/t PCN


    Broad spectrum
  27. First Generation Cephalosporins
    Good gram pos coverage/poor gram neg coverage.

    Cefadroxil, cephradien, cefazolin, cephalexin (Keflex)

    Surgical prophylaxis and for susceptible staph infections.
  28. Second generation Cephalosporins.
    Good gram pos/better gram neg than 1st gen.

    Cefaclor, cefprozil, cefoxitin, cefuroxime, loracarbef, cefotetan.

    Cefoxitin IV and IM used prophylactically for ABD or colorectal surgeries. Kills anaerobes.

    Cefuroxime - Zinacef parenteral, Ceftin PO- surgical prophylaxis, does not kill anaerobes
  29. Third gen Cephalosporins
    Most potent agains gram neg/less active agains gram pos.

    Ceftibuten, cefotaxime, ceftazidime, cefdinir, ceftizoxime, ceftriaxone, ceftazidime
  30. Ceftriaxone (Rocephin)
    IV and IM, long half life, QD dosing

    Hepatic elimination

    Tx CSF and CNS infections
  31. Ceftazidime (Ceptaz)
    • IV and IM
    • Excellent gram neg coverage
    • Used for difficult to tx organisms such as pseudomonas
    • Renal eliminations
  32. Fourth gen Cephalosporins
    Broader spectrum, especially against gram pos.

    Used for UTI's- cefepime (Maxipime)
  33. Fifth gen Cephalosporins
    Ceftobipriole (not available)

    Broader spectrum- effective against MRSA, pseudomonas.
  34. Cepholosporins Adverse Effects
    Similar to PCN

    Potential cross sensitivity with PCNs
  35. Carbapenems
    Broad spectrum.

    Used for complicated body cavity and CT infections.

    May cause seizures

    Given parenterally

    Primaxin, Meropenem (Merrem), Ertapenem (Invanz), Doripenem (Doribax)
  36. Carbapenems - Imipenem (Primaxin)
    Used for tx of bone, joint, skin and soft-tissue infections.
  37. Cilastatin
    Inhibits enzyme that breaks down imipenem (Primaxin)
  38. Marcrolides
    Erythromycin, azithromycin (zythromax), clarithromycin (biaxin), dirithromycin

    Preven protein synthesis in bacteria

    Bacteriostatic but in high concentrations bacteriocidal
  39. Macrolides - Indications
    Strep infections

    Mild to moderate URI and LRI

    Spitochetal infection -syphillis and Lyme disease

    Gonorrhea, Chlamydia, Mycoplasma
  40. Azitrhomycin and clarithromycin
    approved for mycobaterium avium intracellular complex infection

    Clarithromycin used with omeprazole for ulcers assoc with H pylori
  41. Macrolides - adverse effects
    GI effects primarily with erythromycin

    n/v/d, hepatotoxicity, flatulenc, jaundice, anorexia

    Azithromycin and clirithromycin - fewer side effects, better efficacy, longer duration
  42. Tetracyclines
    Demeclocycline (Declomycin), Oxytetracylcin, tetracyline, doxycicline (doryix, vibramycin), minocycline, tigecycline (tygacil)
  43. Tetracyclines cont
    Natural and semisynthetic

    Obtained from strep cx

    Bacteriostatic, stop many essential functions of bacteria
  44. Tetracyclines indications
    Broad spectrum- gram neg and pos, protozoa, mycoplasma, rickettsia, chlamydia, syphilis, Lyme disease, acne.

    Used for SIADH by inhibiting ADH
  45. Tetracyclines - contraindications/warnings
    Dairy, antacids and iron salts redude oral absorption

    Don't use in children under 8 or in pregnant/lactating women due to teeth discoloration
  46. Tetracylcines - adverse effects
    Teeth discoloration, retardation of fetal growth

    Alteration in intestinal flora - may result in superinfection, diarrhea, pseudomembranous colitis

    Vaginal candidiasis, gastris upset, maculopapular rash
  47. Ototoxicity
    Temporary or permanent hearing loss, balance problems
  48. Nephrotoxicity
    • Reduced renal function
    • Rising serum Cretinine
  49. ABX toxicities
    Monitor levels every 5-7 days

    Monitor creatinine every 3 days
  50. Aminoglycocides
    Gentamicin, neomycin, tobramyicn, amikacin, kanamycin, streptomycin

    Natural and semisynthetic, from streptomyces, poor oral absorption, very potent, bacteriocidal, mostly gram neg
  51. Aminoglycosides - indications
    gram neg - pseudomonas, E coli, Proetus, Klebsiella, Serratia

    Often used with other ABS for synergistic effects

    Used for resistant gram pos infections
  52. Neomycin
    Only aminoglycoside given orally, used to decontaminate GI tract before surgery, also used as enema.
  53. Aminoglycosides - adverse effects
    Nephro and oto-toxicity ( most significant)

    h/a, paresthesia, fever, superinfetions, vertigo, skin rash, dizziness
  54. Quinolones
    Ciproflaxin, norfloxacin, levofloxacin, moxifloxacin

    Excellent oral absorptoin

    Absorptoin reduced by antacids

    Gram neg and some gram pos

    Bacteriocidal, alters DNA of bacteria, does not affect human DNA
  55. Quinolones - indications
    • Gram neg - pseudomonas
    • Respiratory infections
    • Bone and joint infections
    • GI infections
    • Skin infections
    • STD
  56. Quinolones- adverse effects
    h/a, dizziness, fatigue, depression, restlessness, insomnia, n/v/d, constipation, thrush, increased liver functions studies, prolonged QT interval, rash, pruritus, urticaria, flushing, photsensitivity, fever, chills, blurred vision, tinnitus.

  57. Clindamycin
    Chornic bone infections, GU infections, intra abdominal infections.

    May cause pseudomembranous coliits
  58. Linezolid (Zyvox)
    • New class: oxazolidinones
    • Tx vancomycin resistant enterococcus faecium (VREF, VRE), hospital acquired infections, MRSA

    May cause HYPOtension, serotoniin syndrome if taken with SSRI's and reactions if taken with tyramine containing foods.
  59. Metronidazole (flagyl)
    Anaerobic organisms, intra abdominal and gynecologic infections, protozoal infections.

    Several drug interactions
  60. Nitrofurantoin (Macrodantin)
    • UTI's
    • use carefully if renal function impaired
    • Concentrates in urine
    • May cause fatal hepatotoxicity
    • Tolerated well if pt is hydrated
  61. Quinupristin and dalfopristin (Synercid)
    30:70 combo

    • Used for bacteremia and infections caused by VRE and skin infections
    • May cause arthralgias, myalgias
  62. Daptomycin (Cubicin)
    New class: lipopeptide

    Tx complicated skin and soft tissue infections
  63. Vancomycin
    • Natural
    • Tx of choice for MRSA and gram pos
    • Monitor blood for therapuetic levels
    • INFUSED OVER 60 MINUTES-rapid infusion may cause hypotension
    • Red man syndrome may occur
    • Ensure adquate hydration
  64. Nursing implications - ABX
    • Allergies, hepatic, renal and cardiac function.
    • s/sx of superinfections, fever, itching, cough, lethargy or unusual discharge.
  65. Nursing implications - aminoglycocides
    Monitor peak and trough blood levels

    Monitor for therapuetic and adverse effects
  66. S/sx of ototoxicity
    dizziness, tinniuts, hearing loss
  67. S/sx nephrotoxicity
    urinary casts, proteinuria, increased BUN and creatinine
  68. Opportunistic infections- Protozoal
    Toxoplasmosis of the brain
  69. Opportunistic infections - Fungal
    Candidiasis of the lungs, esophagus and trachea
  70. Opportunistic infections- Viral
    CMV disease, HSV infections
  71. Opportunisitc Infections- bacterial
    Various mycobacterial infecitons

    Extrapulmonary TB
  72. Opportunistic neoplasias
    Karposi's sarcoma
  73. Nursing implications- Antiretrovirals
    Instruce pt to wear gloves when aplying ointment to affected areas
  74. Antitubercular drugs
    Treat all forms of myobacterium
  75. Common Mycobacterium infection sites
    • Lung - primary
    • Brain
    • Bone
    • Liver
    • Kidney
  76. Mycobacterium infections
    • Aerobic bacillus
    • Passed from infected humans, cows, birds
  77. First line Antitubercular drugs
    • INH
    • Rifapetine
    • Ethambutol
    • Rifabutin
    • Pyrazinamide (PZA)
    • Rifampin
    • Steptomycin
  78. Second line Antitubercular drugs
    • Caperomycin
    • Amikacin
    • Cycloserine
    • Levofloxacin
    • Ethionamide
    • Ofloxacin
    • Kanamyicn
    • Para-aminosalicylic acid (PAS)
  79. Antitubercular drugs MOA
    Protein wall synthesis inhibitiors-streptomycin, kanamycin, capreomycin, rifampin, rifabutin

    Cell wall synthesis inhibitors-cycloserine, ethionamide, INH
  80. INH
    • Drug of choice for TB
    • Metabolized in liver -watch for slow acetylators
    • Contraindicated with liver disease
  81. INH advers effects
    • Peripheral neuropathy
    • hepatotoxicity
  82. Ethambutol adverse effects
    • Retrobulbar neuritis
    • blindness
  83. Rifampin- adverse effects
    • Hepatitis
    • discoloration of urine, stools and body fluids
    • interferes with oral b/c
  84. Nursing implications- Antituberculars
    • perform liver function studies on pt rx'd INH and rifampin
    • -especially older/high alcohol use pt's
    • -Therapy may last up to 2 years
    • -Pt's are contagious during initial phase of illness
    • -do not consume alcohol while taking ATB's
    • -take meds one hour before or two hours after meals
    • -Pyridoxine may be used to combat neurologic effects
  85. Antituberculars - adverse effects
    fatigue, n/v, numbness and tingling of extremities, fever, loss of appetite, depression, jaundice
  86. Nursing implications - ATB's
    • Isolation-
    • negative airflow room
    • micron filter masks
  87. Antifungal drugs-indications
    Systemic and topical fungal infections

    Amphotericin B is druge of choice

    Drug choice depens on type and location of infection
  88. Amphotericin B - adverse effects
    • Main concern is renal toxicity and neurotoxicity - seizures and paresthesias
    • Fever
    • chills
    • dysrhythmias
    • nausea, gi upset
    • renal toxicity
    • h/a
    • malaise
    • hypotension
    • tingling and numbness in hands and feet
    • Lowered K+ and Mg levels
  89. Nursing implications - amphotericin B
    Antipyretic and corticosteriods may be given to reduce effects of infusion reaction

    use IV infusion pumps and most distal veins possible
  90. Patient scheduled for colorectal surgery, does not have sepsis, WBC count is normal, pt is afebrile and in good health. There is an order to administer an antibiotic before surgery. Why?
    To provide prophylactic therapy.
  91. Teenage pt taking tetracycline for acne.What is most important information to give pt when educating her about the drug?
    Pt should use sunscreen or avoid exposure to sunlight because tetracycline may cause photosensitivity.
  92. Newly admitted pt reports PCN allergy and provider has ordered a second-generation cephalosporin. Which nursing action is appropriate?
    Call prescriber to clarify the order because of the pt's allergy.
  93. During pt education regarding an oral macrolide such as erythromycin, the nurse should include which information?
    The pt may take the drug with a small snack to reduce GI irritation.
  94. A woman has been taking an antibiotic for a UTI and calls her NP to c/o of severe vaginal itching and thick whitish vaginal discharge. The NP suspects that...
    A superinfection has developed
  95. The nurse is reviewing orders for the use of an antiseptic. Which statement best describe the use of antiseptics?
    • Antiseptics are appropriate for use on living tissue
    • The pt's allergies should be assessed before using the antiseptic
    • Antiseptics are used to inhibit the growth of microorganisms
  96. While assessing a woman who is receiving an antibiotic for community acquired pneumonia,the nurse notes that the pt has thick, white vagina discharge. Pt is also c/o perineal itching. The nurse suspects the pt has.....
    a superinfection
  97. Pt has been admitted for tx of an infected leg ulcer and will be started on intravenous linezolid. The nurse is reviewing the list of the pt's current medcitions. Which type of medication would be of most concern if taken with linezold?
  98. When administering vancomycin, the nurse knows that which of the following is the most important thing to assess before giving a dose?
    Renal function
  99. During therapy with an intravenous aminoglycoside, the pt calls the nurse and says, " I'm hearing some odd sounds, like ringing, in my ears." Which is the best action of the nurse at this time?
    Stop the infusion immediately and notify the prescriber
  100. When giving intravenous quinalones the nurse needs to keep in mind that these drugs may have serious interactins with which drugs?
    Oran anticoagulants
  101. The nurse is adminstering an IV aminoglycoside to apt who has had GI surgery. Which nursing measures are appropriate?
    • Monitor serum creatinine levels
    • Instruct the pt to report dizziness or a feeling of fullness in the ears.
  102. The nurse is teaching a pt who is starting antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see?
    Reddish brown urine
  103. During antitbuercular therapy with INH the pt received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this secone medication?
    The helps to preven neurologic side effects
  104. When the nurse is counseling a woman who is beginning antitubercular therapy with rifampin, which staetement by the nurse is most important regarding potential drug interactions?
    If you are taking bc pills, you will need to switch to another form of bc.
  105. When counselingt a pt who has been newly diagnosed with TB the nusre should make sure that the pt realizes that he or she is contagious....
    during the initial period of the illness and its diagnosis
  106. While monitoring a pt, the nurse knows that a therapeutic response to antitubercular drugs woud be....
    There is a decrease in sx, along with improved CXR and sputum cx results.
  107. The nurse is monitoring for liver toxicity in a pt who has been receiving long-term INH therapy. Manifestations of liver toxicity include.....
    • Darkened urine
    • Fatigue
    • Jaundice
  108. The nurse is assessing a pt who is about to receive antifungal drug therapy. Which problem would be of most concern?
    Hepatic disease
  109. While monitoring a pt who is receiving IV amphotericin B, the nurse expects to see which adverse effects?
    Fever and chills
  110. When administering antifungal drug therapy, the urse knows that a problem that contributes to many of the drug interactions with antifungals is....
    cytochrome P-450 enzyme system
  111. During an infrusion of ampphotericin B the nurse knows that which adminstartion techniqaue may be used to minimize infusion-related adverse effects?
    Infusing the medication over a longer period of time
  112. When the nurse is teaching a pt who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct?
    Dissolve the lozenge slowly and completely in your mouth
  113. When monitoring a pt who is receiving caspofungin, the nurse should look for which serious adverse effects?
    • Blood dyscrasias
    • Hypotension
    • Hepatotoxicity
  114. The nurse is reviewing the medication history of a pt who is taking hydroxychloroquine. However, the pt's chart does not reveal a history of malaria or travel out of the country. the pt is most likely taking this medcation for......
    Rheumatoid arthritis
  115. Which teaching point would be appropriate to include when the nurse is informing pt's about the adverse effects of antimalarials?
    These medications may cause anorexia and ABD distress
  116. When teaching a pt about the potential drug interactions with antiprotozoal drugs, the nurse should include information about.....
  117. Before adminstering antiprotozoal drugs, the nurse should review which baseline assessment?
    Hemoglobin level
  118. The nurse know that anitmalarial drugs are used to treat pts with infections caused by which protozoans?
    Plasmodium spp.
  119. When giving metronidazole, the nurse implements appropriate adminstration technicques, including
    • Giveing oral forms with food
    • Infusing IV doses over 30 to 60 minutes
    • Obtaining ordered specimens before starting the medication
  120. PCN interacts with what drugs?
    Oral contraceptives, NSAIDs, warfarin
  121. Tetracyclines should be taken with
    8 oz of water
  122. Drug of choice for MRSA
  123. What effects of vancomycin should be reported immediately?
    • Ringing in ears
    • Dizziness
    • Hearing loss
    • Fullness in ears
  124. Colistin infusion should be stopped if these effects are noticed.
    Numbness, Vertigo, Dizziness
  125. What lab test should be done prior to and monitored during INH therapy?
    Liver enzyme levels
  126. Single cell fungi that reproduce by budding
  127. One of the major groups of antifungal drugs; includes amphotericin B and nystatin.
  128. A very large, diverse group of eukaryotic, thallus-forming microorganisms that requires an external carbon source.
  129. One of the major groups of antifungal drugs, includes ketoconazole and miconazole.
  130. A term for yeast infection of the mouth
  131. One of the older antifungal drugs that acts by preventing susceptible fungi from reproducing.
  132. The oldens antifungal drug
    Amphotericin B
  133. An antifungal drug commonly used to treat candidal diaper rash
  134. An infection casued by fungi
  135. Multicullular fungi characterized by long branching filaments called hyphae which entwine to form a mycelium.
  136. What affects are watched for with Amphotericin B?
    Malaise, fever, chills
  137. Before beginning antiprotozoal therapy the nurse should check for which contraindications?
    Underlying renal, cardiac, thyroid or liver disease and pregnancy.
  138. Mintezol can cause which adverse affect?
    Urine with an asparagus-like odor
  139. Which drug is used mainly for the management of Pneumocystis jirovecii pneumonia?
    Pentamidine or Atovaquone
Card Set
NRS 112 Antimicrobials
Pharm test 2