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What is Beta lactamase?
An enzyme secreted by bacterial cells that destroy beta-lactam antibiotics such as penicillin and cephalosporins.
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What are the 3 shapes that bacteria can take?
- Bacilli (elongated)
- Cocci (spherical)
- Spirilla (helical)
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What are bacteriostatic drugs?
- They inhibit the growth of bacteria
- May still need surgical debridement and wound care
- Tetracyclines and sulfonamides
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What are bactericidal drugs?
- They kill bacteria
- Penicillins and cephalosporins
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What type of drug is penicillin?
Bactericial
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What type of drug are cephalosporins?
Bactericidal
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What type of drug are tetracyclines?
Bacteriostatic
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What type of drug are sulfonamides?
Bacteriostatic
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What is pharmacokinetics?
- Time the drug remains at the binding sites
- Increases the effect of antibacterial action
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What are the four basic processes of pharmacokinetics?
- Absorption
- Distribution
- Metabolism
- Excretion
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What is pharmacodynamics?
- The biochemical and physiological effects of drugs
- Maximal effect with dose
- In antibiotics you want the minimum effective concentration to stop the growth of the organism
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What are human host defenses?
- Age
- Nutrition - protein, albumin
- Immunoglobulins
- WBCs
- Organ function (kidneys)
- Circulation - drug might not get to the right area
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What are the strategies used when a bacteria develops resistance to antibiotics?
- Use drugs that disable the resistance mechanism
- Use bacterial vaccines - pneumonia, Meningitis
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What is the minimum inhibitory concentration?
The least amount of antibiotic that will get rid of the infection
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What are the 5 antibiotic mechanisms for destruction of bacteria?
- Inhibit cell wall synthesis
- Inhibit protein synthesis
- Interference with cell metabolism
- Injury to cell membrane permeability
- Inhibition of bacterial DNA and RNA
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What do you see in a mild allergic reaction to antibiotics?
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What do you see in a severe allergic reaction to antibiotics?
- Anaphylactic shock
- Bronchospasm
- Laryngeal edema
- Vascular collapse
- BP drop
- Cardiac arrest
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What are the treatments for allergic reactions to antibiotics?
- Antihistamine
- Epinephrine
- Brochodilators
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What are the general adverse reactions to antibiotic therapy?
- Superinfection
- Ear, liver and kidney organ toxicity
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What is superinfection?
- When normal flora is killed off and a secondary infection occurs, usually when treated momre than 1 week.
- Sites: mouth, skin, respiratory tract, vagina, intestines
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What antibiotics inhibit cell wall synthesis?
Beta-lactams
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What antibiotics inhibit protein synthesis?
- Macrolides
- Ketolides
- Lincosamides
- Tetracyclines
- Glycylcycline
- Aminoglycosides
- Chloramphenicol
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What is the short-acting tetracycline?
Tetracycline
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What is the intermediate-acting tetracycline?
Demeclocycline
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What is the long-acting tetracycline?
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What drugs are aminoglycosides?
- Amikacin sulfate
- Gentamicin sulfate
- Kanamycin sulfate
- Neomycin sulfate
- Streptomycin sulfate
- Tobramycin sulfate
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What antibiotics inhibit bacterial DNA and RNA?
- Fluoroquinolones
- Metronidazole
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What antibiotics cause injury to cell membrane permeability?
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What antibiotics interfere with cell metabolism?
- Sulfonamides
- Trimethoprim
- Sulfamethoxazole
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What are the Beta-lactams?
- Penicillins
- Cephalosporins
- Monobactams
- Carbapenems
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What are broad-spectrum penicillins called and what are 2 examples?
- Aminopenicillins
- Amoxicillin
- Ampicillin
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What is the other name for penicillinase-resistant penicillins and 3 examples of them?
- Antistaphylococcal penicillins
- Dicloxacillin
- Nafcillin
- Oxacillin
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What are beta lactamase inhibitors typically combined with to prevent destruction of the beta-lactam ring?
Penicillinase-sensitive penicillins
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What are 4 examples of beta lactamase inhibitors?
- Amoxicillin-clavulanic acid
- Ampicillin-sulbactam
- Piperacillin-tazobactam
- Ticarcillin-clavulanic acid
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What are the nursing interventions for penicillins?
- C&S
- Monitor for bleeding
- Monitor closely during first dose
- Increase fluids
- Take 1 hr before or 2 hrs after meals
- Check for superinfection
- Safety
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What do first-generation cephalosporins treat, and what are 2 examples?
- Gram (+) bacteria
- E.Coli & Kelbsiella
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What do second-generation cephalosporins treat, and what are 3 examples?
- Gram (+) and (-)
- Neisseria gonorrhoeae
- Neisseria Haemophilus influenzae
- Neisseria meningitidis
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What do third-generation cephalosporins treat, and what is an example?
- Gram (+) and (-)
- Pseudomonas aeruginosa
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What do fourth-generation cephalosporins treat, and what are 2 examples?
- Gram (+) and (-)
- Streptococci
- Staphylococci
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What are the side effects of treatment with cephalosporins?
- Pruritus
- GI Distress
- With high doses: increased bleeding, seizures, nephrotoxicity
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What do you check when there is suspected nephrotoxicity?
- BUN/creatinine
- Liver fxn enzymes
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What types of bacteria do glycopeptides fight?
Gram (+)
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What are 2 examples of glycopeptides?
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What are the side effects of vancomycin?
- Red neck or red man syndrome
- Ototoxicity
- Nephrotoxicity
- Blood dyscrasias
- Stevens-Johnson syndrome
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What is red man syndrome and its symptoms?
- Toxic reaction that occurs when antibiotic IV is too rapid
- S/S: severe hypotension, red blotching of the face, neck, chest, extremities
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What are the nursing interventions for vancomycin therapy?
- C&S
- Monitor vanco levels
- Admin over 1-2 hours IV
- Rotate sites
- Monitor BP
- Monitor IV site
- Monitor renal fxn tests and hearing
- Monitor patient for superinfection
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What are the side effects of erythromycin?
- Tinnitus
- Ototoxicity
- GI Distress
- Superinfection
- Hepatotoxicity
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What are 3 examples of macrolides?
- Erythromycin
- Clarithromycin
- Azithromycin
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Macrolides increase the levels of what 3 drugs?
- Warfarin
- Theophylline
- Carbamazepine
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How do antacids interact with Azithromycin?
Levels of azithromycin reduce
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What kind of drug is Telithromycin?
A ketolide
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What are the side effects of ketolides?
- Visual disturbances
- GI distress
- Constipation
- Exacerbation of myasthenia gravis
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What are 2 examples of lincosamides?
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What type of bacteria do lincosamides fight?
Gram (+)
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What are the side effects of lincosamides?
- Rash
- GI distress
- Colitis
- Anaphylactic Shock
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What types of bacteria do tetracyclines fight?
Gram (+) and (-)
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What are the side effects of tetracyclines?
- Photosensitivity
- Discoloration of teeth
- Stomatitis (painful mouth)
- GI distress
- Pseudomembranous colitis
- Blood dyscrasia
- Superinfection
- CNS toxicity
- Hepatotoxicity
- Nephrotoxicity
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What are the drug-food interactions for tetracyclines?
- Milk products and antacids
- Oral contraceptives
- Digoxin absorption is increased, leading to toxicity (slows down metabolism of dig)
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What type of drug is Tigecycline?
Glycylcycline
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What type of bacteria do the aminoglycosides fight?
Gram (-)
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What are the side effects of aminoglycosides?
- Photosensitivity
- Superinfection
- Ototoxicity
- Nephrotoxicity
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What drug decreases aminoglycoside effectiveness?
Penicillin
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What are the nursing interventions for aminoglycosides?
- C&S
- Monitor renal fxn, hearing loss
- Warn pt to use sunscreen
- Monitor for superinfection
- Monitor peak and trough levels
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What types of bacteria does Chloramphenicol fight?
Gram (+) and (-)
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What drug is only used in dire situations because it decreases mitochondrial activity in the host, and what are the effects it causes?
- Chloramphenicol
- Bone marrow suppression
- Anemia, leukopenia, thrombocytopenia
- Aplastic anemia
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What type of bacteria do fluoroquinolones fight?
Gram (+) and (-)
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What are 4 examples of fluoroquinolones?
- Ciprofloxacin
- Norfloxacin
- Levofloxacin
- Moxifloxacin
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What are the nursing interventions for fluoroquinolones?
- C&S
- Infuse IV over 60-90 minutes
- Increase fluid intake to > 2000mL
- Avoid caffeine
- Check for superinfection
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What type of drug is daptomycin?
Lipopeptide
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What are the side effects of lipopeptides?
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What type of bacteria do sulfonamides fight?
Gram (-)
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What are the side effects of sulfonamides?
- GI distress
- Stomatitis
- Photosensitivity
- Crystalluria
- Renal failure
- Blood dyscrasias
- Stevens-Johnson Syndrome
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What are the nursing interventions for sulfonamides?
- Increase fluid intake to at least 2000mL
- Monitor CBC and renal fxn
- Monitor for rash, superinfection
- Avoid during 3rd trimester
- Avoid antacids
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What are the side effects of trimethoprim and sulfamethoxazole?
- Moderate rash
- Anorexia
- Nausea
- Vomiting
- Diarrhea
- Stomatitis
- Crystalluria
- Photosensitivity
- Agranulocytosis
- Aplastic anemia
- Allergic myocarditis
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What are the nursing interventions for trimethoprim/sulfamethoxazole?
- Admin with full glass of water 1 hour before meals or 2 hours after meals
- Increase fluid intake
- Monitor for sore throat, bruising, bleeding
- Monitor CBC
- Check for superinfection
- Avoid antacids
- Avoid direct sunlight
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