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NSG 313 Exam 3 Antibiotics, Antifungals, and
Antiparasitics With Solution
Amphotericin B Class and Prototype - ANSWER Antifungal (Abelcet or Amphotec)
Amphotericin B Treats... - ANSWER Systemic fungal infections
Amphotericin B Administration Process - ANSWER Given via IV over the course of 2-4 hours (now a lipid form available, more $, less side effects)
Amphotericin B MOA - ANSWER Broad spectrum
Amphotericin B Patient Education - ANSWER Potential discomfort at IV site, explain need for long duration therapy
Amphotericin B Nursing Interventions - ANSWER Call MD if creatinine levels rise over 3.5---indicates nephrotoxicity
Amphotericin B Adverse Reactions/Side Effects - ANSWER nephrotoxicity (reversible in 80%), fever, chills, nausea, headache (usually pretreated), electrolyte imbalance (Low K and Mg), anemia
Terbinafine Class and Prototype - ANSWER Antifungal (Lamisil)
Terbinafine Treats... - ANSWER Onychomycosis (fungal infection of the nail)
Terbinafine Administration Process - ANSWER Given orally for 3-6 months
Terbinafine MOA - ANSWER Inhibition of squalene epoxidase in the fungal cell membrane
Terbinafine Patient Education - ANSWER Patient should avoid caffeine and
wear sunscreen while on this medication
Terbinafine Nursing Interventions - ANSWER Inspect involved areas of skin and mucous membranes before and frequently during therapy. Increased skin irritation may indicate need to discontinue medication.
Terbinafine Adverse Reactions/Side Effects - ANSWER headache, N/V/D, hepatotoxicity, pruritis, change in taste, photophobia
Itraconazole Class and Prototype - ANSWER Antifungal (Sporanox)
Itraconazole Treats... - ANSWER Systemic fungal infections (less toxic than Amphotericin B)
Itraconazole Administration Process - ANSWER Given topically, orally, or parenterally.
Itraconazole MOA - ANSWER Broad spectrum (disrupts fungal cell membrane synthesis)
Itraconazole Patient Education - ANSWER This drug should be given with an acidic beverage (such as a Coca-Cola) to increase absorption but should be given 1 hour before any other drugs that raise gastric pH. (antacids = reduced absorption)
Itraconazole Nursing Considerations - ANSWER Assess for signs of infection and rash before and periodically during therapy. Monitor hepatic function especially in pts. with pre-existing hepatic abnormalities. Monitor serum potassium (may cause hypokalemia).
Itraconazole Adverse Reactions/Side Effects - ANSWER liver injury (indicated by pale stool, dark urine, jaundice), N/V/D, cardisuppression
Permethrin MOA - ANSWER Paralyzes the parasite, highly toxic to adult lice and mites but not so much to their eggs.
Permethrin Patient Education - ANSWER 1% Allow lotion to remain on hair for 10 min, thoroughly rinse and towel dry with a clean towel. Comb hair with a fine-toothed comb to re- move dead lice and eggs. 5% Massage thoroughly into the skin from head to soles of feet. Treat infants on the hairline, neck, scalp, temple, and forehead. Remove the cream by washing after 8-14 hr.
Permethrin Nursing Considerations - ANSWER Assess for lice or scabies prior to and after 1 week of therapy.
Permethrin Adverse Reactions/Side Effects - ANSWER Itching, erythema, edema, burning, stinging, numbness
Metronidazole Class and Prototype - ANSWER Antibiotic (Flagyl)
Metronidazole Treats... - ANSWER Bacterial infections (anaerobic only) and several protozoal species.
Metronidazole Administration Process - ANSWER Via IV over 1 hour or PO (do not refrigerate)
Metronidazole MOA - ANSWER Bactericidal; inhibits the bacteria synthesis of DNA/RNA (cell division.)
Metronidazole Patient Education - ANSWER ZERO alcohol use with this drug, notify promptly of rash occurs
Metronidazole Nursing Considerations - ANSWER Assess for rash periodically during therapy. Monitor three stool samples taken several days apart, beginning 3-4 wk after treatment.
Metronidazole Adverse Reactions/Side Effects - ANSWER N/V/D, neurotoxicity, suprainfection, does not interact well with alcohol, headache, insomnia, vertigo, weakness, urine may turn to a red/brown color, leaves a metallic taste. RARE = SJS, encephalopathy, aseptic meningitis
Penicillin/PCN Class and Prototype - ANSWER Antibiotic (Penicillin G) (Beta-Lactam)
Penicillin/PCN Treats... - ANSWER Bacterial infections
Penicillin/PCN Administration Process - ANSWER Must be given via parenteral route (IM or IV), occasionally given via salts or respiratory prep
Penicillin/PCN MOA - ANSWER Bactericidal; weakens bacterial cell wall (inhibits cell wall synthesis) and allows water to flood into them and cause them to explode.
Penicillin/PCN Patient Education - ANSWER Notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise pts. taking oral contraceptives to use an additional nonhormonal method of contraception during therapy with penicillin and until next menstrual period.
Penicillin/PCN Nursing Considerations - ANSWER Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing) and discontinue drug and notify physician immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction.
Penicillin/PCN Adverse Reactions/Side Effects - ANSWER Allergy!!! Cross-sensitivity to cephalosporins- ask patient about history of allergy to both. Ask about prior testing for allergies. If the patient has a prior VERY
lactated ringers, Probenecid delays renal excretion, many drugs in this group have an intolerance to alcohol.
Cephalosporin Adverse Reactions/Side Effects - ANSWER Allergy!! Cross-sensitivity to penicillin, low prothrombin causes a bleeding risk(monitor for this when using Cefotetan), N/V/D/abd cramps, rash pruritus, thrombophlebitis
Cephalosporin Generations - ANSWER 1 st - G+, 2 ND - G+ and G-, 3 RD - Broader G+ and G- and is able toaccess the CSF, 4 TH - G+ and G- and CSF and highly resistance to beta-lactamases (enzymes that destroy the beta-lactam ring
Sulfonamides Class and Prototype - ANSWER Antibiotic (Trimethoprim-sulfamethoxazole [TMP-SMX] [Bactrim])
Sulfonamides Treats... - ANSWER Bacterial infections. (Broad spectrum antibiotic- treats G+, G-. fungi, and protozoa. Some common conditions treated include UTIs, Otitis media, Bronchitis, Pneumocystis carnii pneumonia.)
Sulfonamides Administration Process - ANSWER PO (oral and tablet)
Sulfonamides MOA - ANSWER Bacteriostatic; inhibits the synthesis of folic acid in bacteria (this doesn't affect the folic azsxacid supply in humans because we can supplement ours with food- bacteria can't do that).
Sulfonamides Patient Education - ANSWER Patients should use second form of birth control (ANY ANTIBIOTIC USE), wear sunscreen when outside, and increase fluid intake.
Sulfonamides Nursing Considerations - ANSWER Should not be given to a
patient with a sulfa ("sulfer") allergy, interactions with other highly protein bound drugs (i.e. Warfarin, Dilantin), poses a risk for suprainfections (unless patient is on a probiotic, such as acidophillis), contraindications for pregnancy and breastfeeding
Sulfonamides Adverse Reactions/Side Effects - ANSWER GI symptoms (N/V), rash, steven-johnson's syndrome, blood dyscrasias (hemolytic anemia, bone marrow suppression, kernicterus (under 2 months), renal impairment from crystalluria, photophobia, CNS effects.
Aminoglycosides Class and Prototype - ANSWER Antibiotic (Gentamicin)
Aminoglycosides Treats... - ANSWER G- Bacterial infections ( E. coli, serratia, proteus, klebsiella, and pseudomonas.)
Aminoglycosides Administration Process - ANSWER Usually via IV.
Aminoglycosides MOA - ANSWER Bactericidal; inhibits protein synthesis which inhibits bacterial growth and reproduction.
Aminoglycosides Patient Education - ANSWER Look out for and report any adverse reactions to provider
Aminoglycosides Nursing Considerations - ANSWER This medication needs to be monitored closely- trough levels are drawn before dose is administered and peak is usually drawn approximately 30 minutes after IV administration.
Aminoglycosides Adverse Reactions/Side Effects - ANSWER Ototoxicity (can be reversed if stopped early), nephrotoxicity (25% of patients-monitor for BUN and creatinine, usually reversible), and can trigger a neuromuscular blockade in Myasthenia gravis and Parkinson patients.
fever, leukocytosis- can be deadly in fragile patients) put pts. on contact precautions and use hand-washing.
Fluoroquinolones Class and Prototype - ANSWER Antibiotic; Ciprofloxacin (Cipro)
Fluoroquinolones Treats... - ANSWER Bacterial infection (Broad spectrum; It is used to treat respiratory tract infections, UTIs, infections of the bones, joints, skin/soft tissues, and prevents anthrax.)
Fluoroquinolones Administration Process - ANSWER Preferred routes are PO and IV.
Fluoroquinolones MOA - ANSWER Bactericidal; inhibits the synthesis/replication of DNA and RNA and inhibits cell division of the bacteria.
Fluoroquinolones Patient Education - ANSWER Advise to avoid aluminum, magnesium, iron, zinc, calcium, and milk/dairy products for at least 6 hrs before and 1-3 hrs after administration (absorption can be reduced by 90%) Wear sunscreen when going outside while using this drug.
Fluoroquinolones Nursing Considerations - ANSWER Monitor for anaphylaxis
and bowel function. Known to interact with sucralfate, theophylline, warfarin, and tinidazole so it should not be taken with those.
Fluoroquinolones Adverse Reactions/Side Effects - ANSWER N/V/D, CNS effects, tendon rupture, photosensitivity, dysrhythmias.
Macrolides Class and Prototype - ANSWER Antibiotic (Erythromycin [E-mycin])
Macrolides Treats... - ANSWER Bacterial infections. (Broad spectrum- treats G+ and G-. Usually used for common conditions such as pertussis or diphtheria.) DRUG OF CHOICE FOR PEOPLE WHO ARE ALLERGIC TO PENICILLIN.
Macrolides Administration Process - ANSWER Variable routes depending on treatment
Macrolides MOA - ANSWER Bacteriostatic; inhibits protein synthesis which inhibits bacterial growth and reproduction.
Macrolides Patient Education - ANSWER Take with full glass of water (no juice or soda). Report adverse reactions to provider.
Vancomycin Patient Education - ANSWER Advise pt. to notify if pregnant/breastfeeding or if experiencing any signs of adverse reactions.
Vancomycin Nursing Considerations - ANSWER Assess bowel status, monitor renal function, peak and trough levels need to be monitored frequently and reported to the physician if out of range
Vancomycin Adverse Reactions/Side Effects - ANSWER Potentially be renal toxic and ototoxic (big ears and kidneys), can cause Red Man Syndrome (flushing, rash, pruritis, tachycardia, hypotension) if pushed through IV too quickly, can lead to thrombophlebitis.
Carbapenems Class and Prototype - ANSWER Antibiotic (Imipenum [Primaxin]) (Beta-Lactam)
Carbapenems Treats... - ANSWER Bacterial infections (broad spectrum; Used to treat serious infections. Can target G+, G-, and anaerobic bacteria. Can treat mixed infections. Can be used in combination with other drugs to fight P. aeruginosa.)
Carbapenems Administration Process - ANSWER Parenteral (IM and IV)
Carbapenems MOA - ANSWER Bactericidal; weakens the bacterial cell wall (inhibits cell wall synthesis) and allowing water to flood into them and explode the cell.
Carbapenems Patient Education - ANSWER Notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus.
Carbapenems Nursing Considerations - ANSWER Observe for signs of anaphylaxis.
Carbapenems Adverse Reactions/Side Effects - ANSWER GI hypersensitivity(n/v/d), rash
Tetracyclines Class and Prototype - ANSWER Antibiotic (Tetracycline [Achromycin])
Tetracyclines Treats... - ANSWER Bacterial infections (G+, G-, and some protozoa. Common conditions treated include: RMSF, typhus, cholera, Lyme disease, H. pylori, chlamydia, acne) Common drug of choice for empiric therapy because it is so broad spectrum. It's wide-spread use and broad treatment spectrum has caused resistance by many bacteria.
Tetracyclines Administration Process - ANSWER Oral or Parenteral
Is there a particular order to this lab work and administration of the antibiotics ordered? When are antibiotics indicated? - ANSWER While waiting on the results, a broad-spectrum antibiotic will be ordered. Once the results are in for the specific microorganism, a narrow-spectrum antibiotic will be ordered to fight it directly.
What do you recall about Vitamin K? - ANSWER Vitamin K helps make various proteins needed for blood clotting. It should not be given via IV if possible because it can result in shock or death. It is often given in cases bleeding due to overdose of blood thinners.
What do you recall about St. Johns Wart? - ANSWER St. John's Wart treats mild to moderate depression. It is not safe to take with prescription anti-depressants.
What do you recall about Garlic? - ANSWER Garlic helps to lower blood pressure and cholesterol. It is only effective when eaten raw and in large amounts. It can increase the risk of bleeding.
What do you recall about Ginger root? - ANSWER Ginger root helps with motion sickness and nausea as well as treats the pain/swelling/stiffness of rheumatoid arthritis. It can increase the risk of bleeding.
Pinworms - what do you remember about Mebendazole? - ANSWER Mebendazole is the drug used to treat most intestinal round worm infestations (primarily nematodes and pinworms). It works by preventing the uptake of glucose by the susceptible intestinal worms with causes them to slowly starve to death. This treatment can take up to three days. It is contraindicated for use during the first trimester of pregnancy.
Pork tapeworm-What do you recall about treatment with Albendazole? - ANSWER Albendazole is the drug used to treat cestodes, AKA tapeworms. It works by inhibiting the ability of the worms to uptake glucose and makes them slowly starve to death. This is a teratogenic drug so it cannot be used during pregnancy but is generally well tolerated by the rest of the population.
What antibiotic is commonly given when first line drug of choice is PCN and the patient has an allergy to PCN? - ANSWER Macrolides- Erythromycin
What are beta lactam antibiotics? - ANSWER They are antibiotics with a beta-lactam ring around them (think Penicillin)
What are beta lactamases? AKA- Penicillinases? - ANSWER Enzymes that are able to break the beta-lactam rings that surround penicillin ( or other penicillin class drugs) and cause the penicillin to become inactive, rendering it useless. **penicillin drugs are often combined with other drugs to protect
of an itch and never broke out into a rash, it is acceptable.
Birth Control and Antibiotics? What is a concern when these 2 meds are given together? - ANSWER Antibiotics reduce the effectiveness of birth control. Females should ALWAYS use a secondary form of birth control when on antibiotics or practice abstinence until the course of medicine is completed and out of their system.
Med Math Review - ANSWER 5mL=1tsp 15mL=1tbsp 30mL/2tbsp=1oz 240mL=1 cup Kilo Hecto Deca (Base) Deci Centi Milli .. .. Micro 1kg= 2.2lb 1in=2.54cm
What are some antibiotics that weaken bacterial cell wall? - ANSWER Penicillin, Cephalosporin, Carbapenems, Primaxin, and Vancomycin (NOT beta-lactam antibiotic)
All bactericidal
What are some antibiotics that inhibit protein synthesis? - ANSWER Tetracyclines, Macrolides, Clindamycin, Linezolid (all bacteriostatic), and Aminoglycosides (bactericidal)
What are some antibiotics that inhibit bacteria synthesis of RNA/DNA? - ANSWER Flagyl and Fluroquinolones (bactericidal)
