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what is antibiotic
Natural chemical produced by a microbe to inhibit or kill other microbes
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what is antimicrobial
includes any chemicals natural or syntheti which acts against microbes
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What is bacteriostatic
inhibit bacterial growth and reproduction but don't kill bacteriol
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what is bacteriostacidal
directly kills bacteria at adequate concentration
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Penicillins do what to cells
causeses cell lyses
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what type of drugs are preferred for lifethreatening or CNS infection
bacteriocidal
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what is beta lactamaze
enzyme produced by bacteria to descroy structures of penicillins and cephalosporin and inactivate drug
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resistance bacterial
acquired when bacteria survives to pass on genetic information.
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what are examples of frequent resistant organisms in health care
- Methicillin resistant staph aureus
- vancomycin resistan
- enteroccoccus
- c-diff
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best defense against resistant organismsq
- handwashing and equipment disinfection
- obtain specimin before therapy
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which organism cannot be eliminated by the use of antimicrobial gell
- strep, pseudomonas, e.coli, c.diff
- answer-cdiff because it forms spores to kill c.dif hand washing and dilute bleach is needed.
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what are teaching needs for patients on antibiotics
- symptoms management and transmission
- when antibiotics are not needed
- how to take
- timing for absorption
- side effects
- preventing and reporting complications
- prebiotic and probiotic to prevent antibiotic associated diarrhea/thrush/candidiasis
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what drugs inhibit cell wall synthesis
penicillins, cephalosporins, imipenens
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what antibiotic drugs inhibit intracellular protein synthesis
tetracyclines and macrolides
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what antibiotic inhibit enzyme activity insse the cell
fluoroquinolones, inhibits DNA synthesis
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Penicilin where does it come from
mold has beta lactam structure
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how does penicillins act
attach to proteins in bacterial cell wall and inhibit cell wass synthesis. kills bacteria by inhibiting cell wall synthesis
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4 groups of penicilin
natural, amino, penicilinase resistant and extended spectrum penicillins
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if strep throat has you chillin than you need a cillin
penicillin most effective agains gram positive aerobic bacteria
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extended spectrum anti psudomonal penicillins
has added chemicals to keep them from being broken dow. (ticarcillin and piperacillin)
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which penicillins have beta lactabase inhibitors
extended spectrum anti-pseudomonal penicillins to prevent bacterial inactivation
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pharmacokinetics of penicilins
- wide therapeutic index, short half life 4-6 hours, renal excretion,
- hyperkalemia may occur
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adverse effects of penicillin
- allergic reaction-maculopapular rash to severe anaphylaxyser
- monitor client after 1st dose
- Gi upset, diarrhea
- headaches, seizures (high dose)
- blood dyscrasias
- overgorwth of fungus or resistant bacteria
- penicillin is not metabolized in liver it is renally excreted
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Gentamycin and penicilin
gentamycin weakens cell wall, penicillin can howerver inactivate gentamycin and therefore they must be given in seperate tubing
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How is potassium penicillin G available
Only available IV
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how is procaine or banzathine "depot" penicillin available and what is it used for
- IM formulation
- Use for Gram positive cocci such as streptococcus pneumoniae and gram positive bacilli clostridium and anthrax; meningococcal meningitis; syphillis
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how should narrow specturm procaine and benzathine penicillin G be given
Deep in muscle because it causes seizures and respiratory arrest in if given IV
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what is penicillin V used for and how is it administered
- Oral formulation used for treating strep 25-50mg in children every 4 hours
- 500mg in adults
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What are narrow spectrum penicillins used for
Gram positive bacteria
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broad spectrum penicillin used for
gram negative pacteria such as E. coli, salmonella, shigella, flue
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Ampicillin how can it be given
can be given IV or PO. can be combine with sulabactam as IV (unasyn)
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when giving Ampicillin IV what must be done
it must be diluted with 0.9% (normal) saline and given over 30 minutes
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why should ampicillin be given slowly
given to fast or too high a dose can cause cns toxicity and seizures
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why is amoxicillin good when given PO
it causes less diarrhea and better blood control. and when combined with clavulanic acid it is called augmentin
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what to do to reduce resitance to amoxicilin
- absorb on empty somach 1 hour before or 23 hours after meals.
- contact prescriber if symptoms dont resolve in 48-72 hours
- complete all drug therapy
- reduce risk of superinfection by takin with active bacterial/yeast cultures to prevent overgrowth of resitant organisms
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What are cephalosporins how to they act
- They are bacterialcidal, low toxicity and wide therapeutic index; and are renally excreted
- they have a beta lactam structure
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what generation of cephalosporins are used propholactically
1st generation (cefazolin (ancef), cephalexin)
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3rd generation cephalosporins
Cefixime, cefotaxime, cetriaxoone (rocephin) they have a browad spectrum of activity and long halp life. anare are eliminated in bile
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what are the adverse effects for cephalosporins
- 1% of those allergic to penicillin are allergic to cephalosporins
- if allergic to penicillin avoid cephalosporin
- vein wall erritation and thrombophlebitis are common with IV- can be prevented by slow administration and monitoring of iv site
- bleeding can occure with cefotetan (cefotan)
- if renal impaired need dose adjustment exception is ceftriaxone (rocephin) which is excreted through liver
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what is 1st generation cephalosporins used for
given for surgical prophylaxis, it is used for gram positive bacteria. they are an alternative to penicillin
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side effects and nursing implication with cephalosporins 1st generation
- Nausea, Canida growth
- Diarrhea -if severe or accompanied with abdominal bloatting or fever test for c dif.
- cefazolin (ancef) long acting
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what are 1st generation cephalosporins good for
Gram + infection and surgical prophylaxi for skin organisms
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What are 3rd generation cephalosporins used for and characteristics
- Active gram negative organism.
- Good CNS penetration
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what are 3rd generation cephalosporins used for
to treat gonorrhea (cefixime (supra))
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How is ceftriaxone excreted
via liver rather than kidneys. can bind calcium (not good)
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describe ceftriaxone
- active agains gram - bacteria, good CNS penetration,
- can form fatal precipitate if given with calcium or IV solutions containing calcium (ringers or ringers lactate)
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describe 4th generation cephalosporins
- Cefepime (maxipine)
- Good CNS activity
- reserve for serious infection to prevent resistance
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what should you look for in treatment with 4th generation cephalosporins
Signs of AAPC and fungal overgrowth.
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describe imipenem
- they have a beta lactam structure. and are very broad spectrum bacteriocidal
- resistant to beta lactamase enzymes. when combine with cilastatin it prevents its distruction by renal enzymes and improves efficacy
- they have good CNS penetration
- cross sensitivity with penicillin
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what are the use of imipenes; carbapenems
infections with mixed organisms and anearobes
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what are adverse effects of Impinem and carbapenems
- Gi upset
- diarrhea
- alergic reactio n may occur
- suprainfection.
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describe vancomycin (vancocin)
- Active agains MRSA and G+bacteria.
- it is a glycopetide
- Poorly absorbed in GI but useful PO for treatment of C.Diff
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what can happen if vancomycin is rapidly infused
- can cause histamine release with hypotension
- tachycardia
- flushing and hives
- thrombophlebitis-monitor iv site
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what are the dangers of vancomycin
at serum blood levels >30 ototoxicity can occur . therefore serum blood levels must be monitored 1.5 -2.5 hours after dose completed.
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how is vancomycin given
- Po 125-500mg
- Iv- 1gm over 60-90 minutes every 12-24 hours.
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antibiotics that inhibit protein synthesis
tetracylines, macrolides, aminoglycosides
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characteristics of tetracylines
- broad spectrum antibiotic which inhibits protein synthesis
- has a transport system that allows tetracycline to enter bacterial cell but not human
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what is tetracycline used for
- rickettsial diseases (rocky mt. spotted fever, typhus)
- chlamydia infections
- cholera
- mycoplasma pneumonia
- lyme disease
- anthrax
- H. Pylori treatment
- topical for acne and peiodontal rinses
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characteristics of short acting tetracyclines
- poorly lipid soluble, forms insoluble complex with calcium, iron, magnesium aluminum and zyinc
- Ca, Mg, Fe, Al, Zn
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how should tetracycline be taken
- absorption is reduced by food. must be taken 1 hour before or 2 hours after meals.
- avoid taking with calcium or iron supplement or antacids
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how is tetracycline illiminated
kidney and bile
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example of long acting tetracyclines
- doxycycline; minocycline
- they have increased liid solubility
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how are long acting tetracyclines excreted
through bile they are lipid soluble. fewer problems with concurrent renal disease
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what are adverse effects of tetracyclines
- Gi upset,
- esophagitis
- they bind to bones and teeth and cause discoloration. should not be used in children younger than 8 or during pregnancy
- photosensitivity
- hepatoxicity at high does >2gm/day
- thrombophelbitis with IV admin and muscle irritation with IM admin
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how is IV tetracycline given
- given slowly cause it causes thrombophlebitis
- give slowly over 1-4 hours diluted in >100ml 0.9% saline
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client teaching for tetracycline
- avoid sunlight,
- take with a full glass of water to prevent esophagitis and sit up
- take with food. take 2 hours apart from anacids and mineral supplements
- report rash, yellow skin/jaundice, easy bruising or bleeding, fever chills or mouth sores
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characteristics of macrolides
- big bacteria protein inhibitors
- alternative for those with penicillin alergy.
- bacteriostatic at low dose bacteriocidal at high dose
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what disease are macrolides used for
- respiratory illness; legionnairs disesease,
- perstussis
- diphtheria
- chlamydia
- mycoplasmial
- pneumonia
- strep infection
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how is macroclides excreted
- metabilized by liver and excreted in bile
- has poor CNS penetration
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what are adverse effects of macrolides
- gi upset - nausea; because it increases gi motility
- diarrhea - may be severe
- life threathning arrhythmias
- thrombophelibitis with IV administration
- inhibits metabolism of other drugs---inceased risk for drug toxicity
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characteristics of azithromycin (zithromax)
- Bacteriocidal against respiratory infections
- long half life. daily dosing
- loading dose given initially
- poor absorption when given with food
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what infections are zithromycin used for
- influenza
- N. Gonorrhea
- Mycoplasma pneumonia
- chlamydia
- legionelle pneumonia
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effects of azithromycin
- does not inhibit metabolism of other drugs
- less gi upset and diarrhea than other macrolides and
- does not prolong cardiac conduction or contribute to arrhythmia
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macrolides side effects
- Gi upset, diarrhea,
- abdominal pain
- jaundice
- increased liver enzymes
- photosensitivity; rash
- blood dyscrasia ; rare
- dizziness
- superinfection - candida, c. diff
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how is macrolides taken
1 hour before and 2-3 hours after meals avoid taking with antacids
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what should pt taking macrolides report
- yellow skin or eyes
- abdominal pain
- diarrhea
- palpitations
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erythromycin how is it given
- 1 hour before or 2-3 hours after meals (except azithromycin);
- avoid giving with antacids
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what to monitor with erythomycin
- liver function
- CBC and electrolytes
- bruising
- bleedings
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how does erythromycin (macrolide effect liver)
ihibits liver enzymes by erythromycin can raise the blood level of other durgs.
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erythromycin drug interactions
- digoxin
- tehophylline
- phenytoin
- carbamazepine
- warfarin
- ***blood levels of these drugs will increase with erythromycin or
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Linezolids characteristics
- new drug for used against multidrug resitance vancomycin resistant enterococci (VRE and MRSA)ein
- ribosomal prot ein inhibitor- bacteriostatic against Gram + aerobic bacteria
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how is linezolid (zyvox) given
- PO
- IV- potential for hypertensive crisis if combined with sympathomimetics like ephedrine or food containing large amounts of tyramine
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what happen if linezolid (zyvox) is used long term
peripheral neuropathy
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what does tyramine do
- vasoconstriction.
- it is found in aged products.
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aminoglycosides "Mycin" drugs
- Is a narrow spetrum bacteriocidal antibiotics
- active against aerobic Gram - bacteria
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what is aminoglycoside used to treat
- e.coli
- klebsiella
- proteus,
- pseudomonas
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how is aminoglycosides absorbed
- poorly absorbed in GI
- Polar molecules
- parenteral admin for serious infection
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effects of aminoglycosides
renal and ototoxicity requires blood levels to be obtained dosing need adjustment to prevent renal damage and hearing loss
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example of a drug that is an aminoglycoside
gentamycin
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characteristics of sulfonamides
- broad specturm antibiotics which inhibits folic acid synthesis in bacterial cells.
- Folic acid is necessary for DNA, RNA and protein synthesis
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how is sulfonamides excreted
metabolized in liver and renally excreted
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what drugs are sylfonamides
- Sulfamethoxazole/trimethorpim/SMX-TMP (bactrim/septra)
- combines to folic acid ihibitors in one drug preparation
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what is sulfamethoxazole trimethroprim/TMP/SMZ (bactrim/Septra) used for
- Urinary tract infection
- Chlamydia
- listeria
- pneumocystis pneumonia
- toxoplasmosis and malaria
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Hos is bactrim/septra given
- IV or PO
- Po given with food
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adverse effects of bactrim /septra (sulfonamides)
- nausea/vomitting; rash
- Photosynsitivity
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what are special concern with treatment with bactrim / septra
hemolytic anemia with G-6pd deficiency and megaloblastic anemia with folate deficientcy
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why is bacrtrim and septra not given to children under 2
may cause kirnicterus.
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what are nursing implication with bactrim/sepra (sulfonamides
- encourage adequate fluids and folic acid
- sun protection
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what is kinecterus
billirubin get into CNS and stains brain tissue
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adverse effects of bactrim and septra
- severe skin reaction, rash
- gi upset
- diarhea
- hepatitis
- jaudice
- blood dyscrasias
- phlebitis at IV site
- crystaluria
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nursing consideration with sulfas
- assess allergy
- monitor CBCor Iv
- urinalysis and liver function tests
- increase fluid intake to 2-3 liters daily
- teach food sources of folic acid
- monitor iv for phlebitis
- give drug over 60-90 min diluted in dextrose
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Fluoroquinolones
broad spectrum antibiotics which disrupts bacterial DNA by ihibiting enzymes needed for replication; bacteriocidal activity
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how is fluoroquinolones affected by body
metabolized by liver and excreted by kineys
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what are fluoroquinolones used for
- UTI, gynecological infections
- bone and join infections
- intra abdominal
- respiratory and skin infections
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fluroquinolones effects
- effects cartilage formation so it is not used in pregnancy of kids.
- floixins for infection reign..but watch out for the muscle pain
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what is criprofloxacin used for
- UTIs
- gonorrhea
- traverles diarhea
- pseudomonas
- antrhax
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what can cipro be given with
do not give with dairy. it causes decreased absorption, antacids, or mineral supplements. give supplement 2 hours afer. can bound cations.
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adverse effects of cipro
- abdominal pain,
- nausea
- diarhea
- CNs- dizziness, drowsiness confusion especially elderly
- achilles tendon or tendon rupture
- photosensitivity
- hypo or hyperglycemia in diabetics
- phlebitis with iv- given slowly because of vein wall irritation.
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client teaching for cipro
- use sunscreen
- avoid taking with vitamin/mineral supplements or antacids
- avoid excessive sun exposure
- report new muscle pain/tenderness
diarrhea, vaginitis or other signs of superinfection
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nursing consideration with cipro
- assess pregnancy
- assess for new muslce or tendon pain
- monitor liver and renal function
- oral forms binds cat ion avoid giving with vitamin/mineral supplements or antacids
- assess for dizziness or confusion esp elderly
- monitor for superinfection
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Metronidazole (flagyl) what does it do
- causes DNA breakage and interferes with nucleic acid synthesis in anaerobic organisms only
- bacteriocydal for anaerobic bacteria and protozoa
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what does metronidazole treat
- given for variety of intra abdominal , CNS, genitoruinary, soft tissue and bone/joint infections often with other aerobact bacteria drugs
- c.dif overgrowth and AAPC
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how is metronidazole given
- po or IV
- IV loading dose is given at least 1 hour then every 6hrs.
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adverse effects of metronadazole
- nausea, metallic taste, darkening urine
- Headaches , dizziness,seizures, neuropathy, metallic taste, gi upset, dairrhea
- Antabuse like reaction (sweating, flushing, nausea) when taken with alcohol---bad bad bad reaction.
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nursing consideration with metronidazole
- assess for pregnancy
- monitor CBC
- assess for neurologic problems or changes
- monitor GI effects
- evaluate response to therapy
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client teaching with metronidazole
- take with meals to avoid nausea
- may cause metallic taste chewing gum may help
- urine will turn reddish brwon during treatment
- avoid alcohol while taking and 48 hours after
- report numbness and tinglin in extremities, extreme weakness, fer/vhills, mouth sores and call provider if symptoms do not improve
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antimicrobial is effective therapy for ?
against bacterial organisms (not viral)
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