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Nursing106 Pharmacology Ivy Tech Antibiotics
questions with answers
Penicillin (Antibiotic) - CORRECT ANSWERS ✔✔Ampicillin/sulbactam (Unasyn) Amoxicillin/ clavulanic acid (Augmentin) Piperacillin/tazobactam (Zosyn) penicillin G (IM, IV), penicillin V naficillin Penicillin Indications - CORRECT ANSWERS ✔✔*Kills most gram+ and some gram - *wide variety of infections( Broad Spectrum): pneumonia, endocarditis, pharyngitis, meningitis, syphilis *Typically joined with beta-lactamase inhibitors prophylactic for endocarditis Penicillin Contraindications - CORRECT ANSWERS ✔✔Cephalosporin Cross Sensitivity *Allergic RX *Hypersensitivity to Procaine and Benzathine Precaution for pts. w/severe kidney impairment Penicillin Interactions - CORRECT ANSWERS ✔✔Probenecid increases penicillin levels,
- Bacteriostatic agents(ex: tetracyclines) may decreases effects Reduces effectiveness of Oral Contraceptives Penicillin Adverse Effects - CORRECT ANSWERS ✔✔ Allergies, anaphylaxis *Renal impairment
- GI effects: -Diarrhea ,N/V - C.Diff Superinfections- typically Candida albicans (yeast) Penicillin Administration/ Pt. Education - CORRECT ANSWERS ✔✔Take with food if GI upset- before meals *Finish all medicine, superinfections! *IV/IM: Monitor pt. in facility for at least 30 mins. post admin. tell pt. to report adverse effects immediately(black/tarry stools, watery diarrhea, vag.burning / discharge,etc) Cephalosporins (Antibiotic) - CORRECT ANSWERS ✔✔1st Gen: Cefazolin(Ancef), Cephalexin (Keflex) *2ngGen:Cefaclor(Ceclor) *3rd Gen: Ceftriaxone(Rocephin) *4th Gen: Cefepime( Maxipime), Ceftaroline(Teflaro; only cephalosporin for MRSA) *5th Gen: Ceftolozane/tazobactam(Zerbaxa)
*Bleeding/hemorrhage w/ Cefotetan Disulfiram rx if taken with alcohol (Cefazolan, Cefotetan) Cephalosporin Administration/education/interventions - CORRECT ANSWERS ✔✔Take PO cephalosporins w/food *Avoid alcohol- can increase GI upset/severe headache/hypotension. Can have bleeding risk/disulfiram rx risk with others *expect to administer Vitamin K if bleeding occurs Immediately report adverse side effects such as trouble breathing, watery stool Carbapenems (beta-lactam Antibiotic) - CORRECT ANSWERS ✔✔imipenem- cilastatin (IV or IM) meropenem (IV) ertapenem (IV or IM) Carbapenems Indications - CORRECT ANSWERS ✔✔Broad spectrum & can resist beta-lactamase *Reserved SERIOUS INFECTIONS *Route of administration is IV or IM UTI, pneumonia, peritonitis Carbapenems Contraindications/precautions - CORRECT ANSWERS ✔✔Allergy to others in class *allergy to penicillin *Inflammatory Bowel Disease & Meropenem( can be fatal!!!) *precaution: renal disease
- precaution :Cross sensitivity to other beta-lactam ring antibiotics ( cephalosporins too)
- precaution: Pt.s on Valproic acid for seizures; can decrease effectiveness of seizure meds Carbapenems Adverse Effects - CORRECT ANSWERS ✔✔*Allergy/Hypersensitivity( class, beta-lactam ring) *GI effects: N/V *Thrombophlebitis with IV Superinfection Carbapenems Interactions - CORRECT ANSWERS ✔✔Valproic acid (seizures) *Monobactam, penicillin, cephalosporins may decrease effects of Imipenem *Probenecid: decreases renal excretion Cyclosporine increases seizure risk Carbapenems Administration/education/ interventions - CORRECT ANSWERS ✔✔Lab tests: AST,BUN,LDH. test for bilirubin and increased creatinine *only available for IV/IM use (keep in mind) monitor for adverse rx Monobactams (beta-lactam Antibiotic) - CORRECT ANSWERS ✔✔Aztreonam (Azactam) IV,IM,& Inhalation Monobactams Indications - CORRECT ANSWERS ✔✔Only ONE beta-lactam ring. NARROW SPECTRUM
Macrolides(Bacteriostatic Antibiotic) - CORRECT ANSWERS ✔✔Azithromycin Clarithromycin Erythromycin if you are the MAC daddy, you are the ACE Fidaxomicin (Dificid)-ONLY for tx of C.diff Macrolides Indication - CORRECT ANSWERS ✔✔Upper and lower respiratory infections(1ST line for Whooping cough, Legionnaire's disease ,&Diphtheria) *Tonsillitis Skin and soft tissue infections(Chlamydia, gonorreah) Macrolide Adverse Reactions - CORRECT ANSWERS ✔✔GI effects *Prolonged QT intervals—caution with pre-existing heart conditions *Ototoxic at high doses Superinfections( C.diff/ candida infection) Macrolide Contraindications/Precautions - CORRECT ANSWERS ✔✔Hypokalemia *Hypomagnesemia *Hx of Prolonged QT-Syndrome *Allergy to drug class Precaution for GI disorder & Liver disorders Macrolide Interactions - CORRECT ANSWERS ✔✔Decreases blood levels of chloramphenicol, and clinidamycin antibiotics
- increases the blood levels in multiple drugs, including Digoxin, Warfarin, Theophylline.
- Drinking grapefruit juice causes adverse effects
- Drugs that contain the enzyme CYP3A4(verapamil, azole antiinfungals, protease inhibitors for HIV and diltiszem) INCREASE erythromycin levels. Macrolide Nursing Considerations - CORRECT ANSWERS ✔✔*newest macrolide, Fidaxomicin (Dificid)- ONLY for tx of C-diff,N/V,GI-bleed. avoid use in pregnant women(category B) **Erythromycin and azithromycin should be taken on an empty stomach (1 hour before or 2 hours after a meal) to enhance absorption. *Monitor for liver damage, utilize liver protection interventions *Report for ototoxic symptoms monitor cardiac Tetracyclines (Antibiotic) - CORRECT ANSWERS ✔✔tetracycline Doxycycline (Vibramycin) Tigecycline (Tygacil)—can be used for MRSA Tetracycline Indications - CORRECT ANSWERS ✔✔Chlamydia *Lyme disease *Rickettsia - Rocky Mountain spotted fever *H. pylori - peptic ulcer disease *Syphillis - alternative if PCN allergy
Amikacin Tobramycin Streptomycin GNATS are AMIGOs! Aminoglycoside Indications - CORRECT ANSWERS ✔✔Treatment of systemic infections, synergistic effect w/many antibiotics *Treats gram - bacteria such as E. coli, K. pneumoniae, Pseudomonas aeruginosa Neomycin can be administered topically for infections of skin, eyes, and ear. Aminoglycoside Adverse effects - CORRECT ANSWERS ✔✔Ototoxic *Nephrotoxic Intense neuromuscular blockade (Ataxia) Aminoglycoside Contraindications/Precautions - CORRECT ANSWERS ✔✔Use cautiously if kidney impairment, hearing impairment, or myasthenia gravis *Pregnancy category C or D; may cause congenital deafness Allergy to class Aminoglycoside Interactions - CORRECT ANSWERS ✔✔Other Ototoxic/Nephrotoxic drugs( ex:Amph.B., NSAIDS)
- Gentamycin Synergetic w/ Cephalosporins, Vancomycin, Penicillin (increases bactericidal properties) *Neuromuscular blockers can prolong resp. depression
Aminoglycoside Nursing Considerations - CORRECT ANSWERS ✔✔- Requires therapeutic drug monitoring (peak and trough blood levels). High risk of nephrotoxicity and ototoxicity.
- Nephrotoxicity: Monitor for decreased urine output. Monitor daily creatinine level. Notify MD if creatinine is elevated.
- Ototoxicity: Monitor for complaints of tinnitus and hearing loss. Notify MD if occurs. Fluoroquinolones - CORRECT ANSWERS ✔✔Ciprofloxacin Moxifloxacin Levofloxacin Fluoroquinolone Indications - CORRECT ANSWERS ✔✔*Can be administered IV for severe infections *Mostly for gram (-), some gram (+) *Resistance is common *Urinary, respiratory, GI infections *Infections of bones, joints, skin and soft tissues UTI, prostatitis, traveler's diarrhea, sinusitis, DOC for all types of anthrax Fluoroquinolone Adverse Effects - CORRECT ANSWERS ✔✔Black box warning: risk for tendonitis and tendon rupture *More common in older adults, patients with renal failure, and concurrent use of corticosteriods *Phototoxicity (severe sunburn) *GI effects- can cause C.Diff *CNS effects- seizures, intra-cranial pressure
Vancomycin Indications - CORRECT ANSWERS ✔✔*Antibiotic of choice for MRSA infections and many other gram (+) infections Including bone, joint, and systemic infections Oral administration for pseudomembranous colitis due to C. Difficile Vancomycin adverse effects - CORRECT ANSWERS ✔✔nephrotoxicity, ototoxicity, red man syndrome Vancomycin Contraindications/Precautions - CORRECT ANSWERS ✔✔hypersensitivity/Allergy *caution w/hearing impairment/renal impairment *caution w/colitis pregnancy(class B) use only if needed Vancomycin Interactions - CORRECT ANSWERS ✔✔Ototoxic/Nephrotoxic drugs Incompatible with most IV drugs Vancomycin Nursing Considerations - CORRECT ANSWERS ✔✔Infuse slowly (60 min) to avoid "Red Man" syndrome; Drug peak and trough levels(Narrow TI) *Monitor vital signs while infusing *BUN/Creatinine levels *resistance/ symptom education Sulfonamides - CORRECT ANSWERS ✔✔
