Podcast
Questions and Answers
What is the primary mechanism of action of antimicrobial therapy?
What is the primary mechanism of action of antimicrobial therapy?
- Directly attacking and destroying host cells
- Enhancing the host's immune response
- Selectively targeting microbes without harming host cells (correct)
- Creating a physical barrier against microbial invasion
Which outcome is a direct consequence of bacterial conjugation?
Which outcome is a direct consequence of bacterial conjugation?
- Decreased mutation rate in microorganisms
- Increased susceptibility to existing antimicrobials
- Transfer of genetic material, leading to antimicrobial resistance (correct)
- Reversal of antimicrobial resistance
What is a superinfection?
What is a superinfection?
- An infection caused by multiple resistant bacteria simultaneously
- An infection that is easily treated with first-line antibiotics
- A secondary infection that emerges due to the disruption of normal flora by antibiotics (correct)
- A bacterial infection that enhances the body’s natural immune response
Which characteristic differentiates broad-spectrum from narrow-spectrum antibiotics?
Which characteristic differentiates broad-spectrum from narrow-spectrum antibiotics?
How do bacteriostatic medications work?
How do bacteriostatic medications work?
What is the most important factor when selecting an appropriate antimicrobial medication?
What is the most important factor when selecting an appropriate antimicrobial medication?
Which laboratory test involves examining a sample of body fluid under a microscope to identify micro-organisms?
Which laboratory test involves examining a sample of body fluid under a microscope to identify micro-organisms?
Why is a culture preferred over a Gram stain in some situations?
Why is a culture preferred over a Gram stain in some situations?
Why should nurses obtain specimens for culture prior to initiating antimicrobial treatment?
Why should nurses obtain specimens for culture prior to initiating antimicrobial treatment?
What is the purpose of a disk diffusion test?
What is the purpose of a disk diffusion test?
What is the Minimum Inhibitory Concentration (MIC)?
What is the Minimum Inhibitory Concentration (MIC)?
When should providers adjust the antibiotic dosage?
When should providers adjust the antibiotic dosage?
What is the primary consideration when selecting antimicrobials for immunocompromised patients?
What is the primary consideration when selecting antimicrobials for immunocompromised patients?
Why is it difficult for antimicrobials to reach infections in cerebrospinal fluid?
Why is it difficult for antimicrobials to reach infections in cerebrospinal fluid?
What is the effect of new thrombus formation in bacterial endocarditis?
What is the effect of new thrombus formation in bacterial endocarditis?
Why are purulent abscesses difficult to treat with antimicrobials?
Why are purulent abscesses difficult to treat with antimicrobials?
Why are infants at increased risk for antimicrobial toxicity
Why are infants at increased risk for antimicrobial toxicity
How do sulfonamides harm a developing fetus?
How do sulfonamides harm a developing fetus?
What condition can tetracyclines cause in a developing fetus?
What condition can tetracyclines cause in a developing fetus?
What is a key concern when combining multiple antimicrobials?
What is a key concern when combining multiple antimicrobials?
Which of these situations is an appropriate indication for prophylactic antimicrobial use?
Which of these situations is an appropriate indication for prophylactic antimicrobial use?
What is the primary mechanism of action for penicillins?
What is the primary mechanism of action for penicillins?
A client reports an allergy to penicillin. Which medication should the nurse question if prescribed?
A client reports an allergy to penicillin. Which medication should the nurse question if prescribed?
Why should Probenecid not be taken with some antibiotics?
Why should Probenecid not be taken with some antibiotics?
A client is prescribed tetracycline. What instruction should the nurse include in the teaching?
A client is prescribed tetracycline. What instruction should the nurse include in the teaching?
Which adverse effect should the nurse monitor for in a client taking erythromycin?
Which adverse effect should the nurse monitor for in a client taking erythromycin?
A client is prescribed gentamicin. What is a critical adverse effect that the nurse should teach the client to monitor for?
A client is prescribed gentamicin. What is a critical adverse effect that the nurse should teach the client to monitor for?
What is the most serious adverse effect of amphotericin B?
What is the most serious adverse effect of amphotericin B?
A client is prescribed ciprofloxacin. The nurse should instruct the client to report which adverse effect immediately?
A client is prescribed ciprofloxacin. The nurse should instruct the client to report which adverse effect immediately?
Which of these drugs is an appropriate drug to prescribe to pregnant women?
Which of these drugs is an appropriate drug to prescribe to pregnant women?
Which route of medication administration is LEAST likely to be affected by a client's decreased kidney function?
Which route of medication administration is LEAST likely to be affected by a client's decreased kidney function?
A client undergoing treatment for tuberculosis asks why they need to take multiple medications. What is the best response?
A client undergoing treatment for tuberculosis asks why they need to take multiple medications. What is the best response?
Which statement accurately describes the action of bactericidal antibiotics?
Which statement accurately describes the action of bactericidal antibiotics?
What is a primary concern when administering aminoglycosides to clients?
What is a primary concern when administering aminoglycosides to clients?
A client is prescribed metronidazole for treatment of trichomoniasis. What instruction is most important to emphasize?
A client is prescribed metronidazole for treatment of trichomoniasis. What instruction is most important to emphasize?
What is the rationale for prescribing prophylactic antibiotics before certain surgeries?
What is the rationale for prescribing prophylactic antibiotics before certain surgeries?
A client taking tetracycline reports experiencing photosensitivity. What guidance should the nurse provide?
A client taking tetracycline reports experiencing photosensitivity. What guidance should the nurse provide?
Why is it important to complete the entire course of an antibiotic prescription?
Why is it important to complete the entire course of an antibiotic prescription?
Which finding is most indicative of a client experiencing an infusion reaction to amphotericin B?
Which finding is most indicative of a client experiencing an infusion reaction to amphotericin B?
What is the primary action of acyclovir in treating viral infections?
What is the primary action of acyclovir in treating viral infections?
A client is prescribed isoniazid (INH) for latent tuberculosis. What supplement is often administered concurrently to prevent a common side effect?
A client is prescribed isoniazid (INH) for latent tuberculosis. What supplement is often administered concurrently to prevent a common side effect?
Which tetracycline antibiotic is generally considered safe for clients with kidney disease because it is primarily eliminated by the liver?
Which tetracycline antibiotic is generally considered safe for clients with kidney disease because it is primarily eliminated by the liver?
A nurse is caring for a client receiving IV vancomycin. Which finding requires the most immediate intervention?
A nurse is caring for a client receiving IV vancomycin. Which finding requires the most immediate intervention?
What is the primary reason for using multiple medications in HAART (highly active antiretroviral therapy) for HIV?
What is the primary reason for using multiple medications in HAART (highly active antiretroviral therapy) for HIV?
A client on warfarin is prescribed trimethoprim-sulfamethoxazole for a UTI. What adjustment to the warfarin dosage should the nurse anticipate?
A client on warfarin is prescribed trimethoprim-sulfamethoxazole for a UTI. What adjustment to the warfarin dosage should the nurse anticipate?
What is a key teaching point for a client taking rifampin?
What is a key teaching point for a client taking rifampin?
What is the mechanism of action of nitrofurantoin in treating urinary tract infections?
What is the mechanism of action of nitrofurantoin in treating urinary tract infections?
Which antimicrobial agent is effective against methicillin-resistant Staphylococcus aureus (MRSA)?
Which antimicrobial agent is effective against methicillin-resistant Staphylococcus aureus (MRSA)?
A client is taking erythromycin and reports new onset of hearing loss. What action should the nurse take first?
A client is taking erythromycin and reports new onset of hearing loss. What action should the nurse take first?
Which statement correctly describes the antimicrobial spectrum of cephalosporins across generations?
Which statement correctly describes the antimicrobial spectrum of cephalosporins across generations?
Which medication is contraindicated in a client with a known allergy to sulfonamides?
Which medication is contraindicated in a client with a known allergy to sulfonamides?
A client is diagnosed with Clostridium difficile-associated diarrhea. Which medication is most likely to be prescribed?
A client is diagnosed with Clostridium difficile-associated diarrhea. Which medication is most likely to be prescribed?
Which instruction is crucial for a client prescribed ciprofloxacin?
Which instruction is crucial for a client prescribed ciprofloxacin?
What is the most accurate method to evaluate the effectiveness of antimicrobial therapy for a bloodstream infection?
What is the most accurate method to evaluate the effectiveness of antimicrobial therapy for a bloodstream infection?
A client taking an oral cephalosporin reports diarrhea. What action should the nurse recommend?
A client taking an oral cephalosporin reports diarrhea. What action should the nurse recommend?
Which nursing intervention is most important when administering aminoglycosides to prevent nephrotoxicity?
Which nursing intervention is most important when administering aminoglycosides to prevent nephrotoxicity?
A client taking metronidazole reports that their urine has turned dark. What information should the nurse provide?
A client taking metronidazole reports that their urine has turned dark. What information should the nurse provide?
Which medication requires the client to use additional non-hormonal birth control? (Select all apply)
Which medication requires the client to use additional non-hormonal birth control? (Select all apply)
What is a Disulfiram reaction?
What is a Disulfiram reaction?
A client who is taking a cephalosporin reports urticaria. What is the nurses's best action?
A client who is taking a cephalosporin reports urticaria. What is the nurses's best action?
What medication should be avoided concurrently with valproic acid (select all that apply)?
What medication should be avoided concurrently with valproic acid (select all that apply)?
Isoniazid includes multiple complications. Select all that apply.
Isoniazid includes multiple complications. Select all that apply.
True or false: TB meds are safe for pregnant people to take.
True or false: TB meds are safe for pregnant people to take.
A client is prescribed tetracycline for acne and is also taking oral contraceptives. What client's understanding of the effect of pregnancy is correct?
A client is prescribed tetracycline for acne and is also taking oral contraceptives. What client's understanding of the effect of pregnancy is correct?
What medications do you need to avoid giving to clients consuming alcohol?
What medications do you need to avoid giving to clients consuming alcohol?
A client is taking Isoniazid as their TB medication, what foods will interfere with the medication? (Select all that apply)
A client is taking Isoniazid as their TB medication, what foods will interfere with the medication? (Select all that apply)
A client with mild renal impairment is being prescribed Cephalexin. What is the best action by the nurse?
A client with mild renal impairment is being prescribed Cephalexin. What is the best action by the nurse?
Which is accurate about nitrofurantoin?
Which is accurate about nitrofurantoin?
What is an accurate statement on how to take penicillin?
What is an accurate statement on how to take penicillin?
Which medications are safe to use during pregnancy?
Which medications are safe to use during pregnancy?
Which laboratory finding is most concerning for a client receiving amphotericin B?
Which laboratory finding is most concerning for a client receiving amphotericin B?
A client is prescribed isoniazid (INH) for tuberculosis. Which vitamin supplement is crucial to prevent peripheral neuropathy?
A client is prescribed isoniazid (INH) for tuberculosis. Which vitamin supplement is crucial to prevent peripheral neuropathy?
Why are combination antimicrobial therapies typically used when treating tuberculosis?
Why are combination antimicrobial therapies typically used when treating tuberculosis?
A client is taking rifampin. What information is most important to tell the client?
A client is taking rifampin. What information is most important to tell the client?
A client who is prescribed metronidazole reports consuming a glass of wine. What is the priority nursing action?
A client who is prescribed metronidazole reports consuming a glass of wine. What is the priority nursing action?
What is the intended therapeutic effect of phenazopyridine?
What is the intended therapeutic effect of phenazopyridine?
A client with a UTI is prescribed ciprofloxacin. What should clients be instructed about taking antacids?
A client with a UTI is prescribed ciprofloxacin. What should clients be instructed about taking antacids?
Which outcome indicates effective teaching about tetracycline?
Which outcome indicates effective teaching about tetracycline?
A client develops a skin rash while taking amoxicillin. What is the nurse's best initial action?
A client develops a skin rash while taking amoxicillin. What is the nurse's best initial action?
A client receiving gentamicin reports tinnitus and difficulty hearing. What is the priority nursing intervention?
A client receiving gentamicin reports tinnitus and difficulty hearing. What is the priority nursing intervention?
What is a crucial teaching point for a client prescribed erythromycin?
What is a crucial teaching point for a client prescribed erythromycin?
Which antibiotic is typically reserved for severe infections when other antibiotics are ineffective due to its potential for serious adverse effects?
Which antibiotic is typically reserved for severe infections when other antibiotics are ineffective due to its potential for serious adverse effects?
A client is prescribed acyclovir for genital herpes. What should the nurse emphasize in client education?
A client is prescribed acyclovir for genital herpes. What should the nurse emphasize in client education?
A client taking trimethoprim-sulfamethoxazole (Bactrim) develops a widespread blistering rash. What is the nurse's priority action?
A client taking trimethoprim-sulfamethoxazole (Bactrim) develops a widespread blistering rash. What is the nurse's priority action?
A nurse is preparing to administer penicillin G intravenously. What is the most important assessment prior to administration?
A nurse is preparing to administer penicillin G intravenously. What is the most important assessment prior to administration?
Which instruction should the nurse provide to a client taking nitrofurantoin?
Which instruction should the nurse provide to a client taking nitrofurantoin?
A client is prescribed fluconazole for a vaginal yeast infection. What should the nurse include in the teaching?
A client is prescribed fluconazole for a vaginal yeast infection. What should the nurse include in the teaching?
What is the primary goal of highly active antiretroviral therapy (HAART) in managing HIV infection?
What is the primary goal of highly active antiretroviral therapy (HAART) in managing HIV infection?
Which of the following findings should be promptly reported to the provider for a client on aminoglycoside therapy?
Which of the following findings should be promptly reported to the provider for a client on aminoglycoside therapy?
Why is probenecid sometimes administered with penicillin?
Why is probenecid sometimes administered with penicillin?
A nurse is caring for a client receiving IV vancomycin. Which adverse effect requires the most immediate intervention?
A nurse is caring for a client receiving IV vancomycin. Which adverse effect requires the most immediate intervention?
A client taking warfarin is started on trimethoprim-sulfamethoxazole (Bactrim) for a UTI. What adjustment to the warfarin dosage should the nurse anticipate?
A client taking warfarin is started on trimethoprim-sulfamethoxazole (Bactrim) for a UTI. What adjustment to the warfarin dosage should the nurse anticipate?
A client with a penicillin allergy is prescribed cephalexin. What is the nurse's best action?
A client with a penicillin allergy is prescribed cephalexin. What is the nurse's best action?
A client is receiving amphotericin B for a systemic fungal infection. What premedication is most appropriate to prevent infusion-related reactions?
A client is receiving amphotericin B for a systemic fungal infection. What premedication is most appropriate to prevent infusion-related reactions?
Which of the following instructions is crucial for a client prescribed ciprofloxacin?
Which of the following instructions is crucial for a client prescribed ciprofloxacin?
A client taking isoniazid reports darkening of urine. What information should the nurse provide?
A client taking isoniazid reports darkening of urine. What information should the nurse provide?
A nurse is preparing to administer cefazolin intravenously. Which action is most appropriate?
A nurse is preparing to administer cefazolin intravenously. Which action is most appropriate?
Vancomycin is prescribed for a client who weighs 220 lbs. What nursing action is most appropriate?
Vancomycin is prescribed for a client who weighs 220 lbs. What nursing action is most appropriate?
Which statement provides the best rationale for obtaining a culture and sensitivity test before initiating antimicrobial therapy?
Which statement provides the best rationale for obtaining a culture and sensitivity test before initiating antimicrobial therapy?
Select the appropriate instruction that should be given to a client taking tetracycline:
Select the appropriate instruction that should be given to a client taking tetracycline:
A client is prescribed metronidazole for treatment of trichomoniasis. What instruction is most important to emphasize to the client?
A client is prescribed metronidazole for treatment of trichomoniasis. What instruction is most important to emphasize to the client?
Why is it crucial for clients taking antimicrobial medications to complete the entire prescribed course of treatment?
Why is it crucial for clients taking antimicrobial medications to complete the entire prescribed course of treatment?
Before administering IV vancomycin, the nurse should prioritize which action?
Before administering IV vancomycin, the nurse should prioritize which action?
Which of the following is an important property of cephalosporins related to their ability to reach cerebrospinal fluid?
Which of the following is an important property of cephalosporins related to their ability to reach cerebrospinal fluid?
What is the most significant rationale for frequent monitoring of liver function tests in clients receiving long-term isoniazid therapy?
What is the most significant rationale for frequent monitoring of liver function tests in clients receiving long-term isoniazid therapy?
After administering a first dose of penicillin, the client reports shortness of breath and a rash. What is the nurse's priority intervention?
After administering a first dose of penicillin, the client reports shortness of breath and a rash. What is the nurse's priority intervention?
Considering the potential for drug interactions, what specific dietary teaching should be provided to a client newly prescribed isoniazid (INH)?
Considering the potential for drug interactions, what specific dietary teaching should be provided to a client newly prescribed isoniazid (INH)?
Which statement BEST explains the action of HAART?
Which statement BEST explains the action of HAART?
What is a plausible, yet not commonly known, mechanism by which long-term antibiotic use can lead to vitamin K deficiency?
What is a plausible, yet not commonly known, mechanism by which long-term antibiotic use can lead to vitamin K deficiency?
Which of the following is not a common side effect of Trimethoprim-sulfamethoxazole?
Which of the following is not a common side effect of Trimethoprim-sulfamethoxazole?
An organism's resistance to multiple drugs due to changes in its DNA is known as what?
An organism's resistance to multiple drugs due to changes in its DNA is known as what?
A client has a compromised immune system, which type of antibiotic is contraindicated?
A client has a compromised immune system, which type of antibiotic is contraindicated?
The provider has prescribed an antibiotic for a client with bacterial endocarditis. What makes it difficult for the antibiotic to kill the infectious micro-organisms?
The provider has prescribed an antibiotic for a client with bacterial endocarditis. What makes it difficult for the antibiotic to kill the infectious micro-organisms?
A client with recurring UTIs is prescribed prophylactic antimicrobials. What is the purpose of this intervention?
A client with recurring UTIs is prescribed prophylactic antimicrobials. What is the purpose of this intervention?
A client is prescribed penicillin and gentamicin IV at the same time. What action should the nurse take?
A client is prescribed penicillin and gentamicin IV at the same time. What action should the nurse take?
A client is prescribed cefotetan. What should the nurse instruct the client to avoid while taking this medication?
A client is prescribed cefotetan. What should the nurse instruct the client to avoid while taking this medication?
A client is diagnosed with pneumonia and prescribed Imipenem-cilastatin. What should the nurse implement in the plan of care?
A client is diagnosed with pneumonia and prescribed Imipenem-cilastatin. What should the nurse implement in the plan of care?
What is the rationale for routinely monitoring vancomycin trough levels?
What is the rationale for routinely monitoring vancomycin trough levels?
A female client of childbearing age is prescribed tetracycline. What should the nurse include in the teaching?
A female client of childbearing age is prescribed tetracycline. What should the nurse include in the teaching?
What is the benefit to taking doxycycline and minocycline with meals?
What is the benefit to taking doxycycline and minocycline with meals?
A client is prescribed erythromycin. What concurrent use should the nurse question with the client?
A client is prescribed erythromycin. What concurrent use should the nurse question with the client?
What findings should the nurse frequently assess for with a client taking aminoglycosides concurrently with ethacrynic acid?
What findings should the nurse frequently assess for with a client taking aminoglycosides concurrently with ethacrynic acid?
A client is prescribed trimethoprim-sulfamethoxazole. What allergies should the nurse assess the client for?
A client is prescribed trimethoprim-sulfamethoxazole. What allergies should the nurse assess the client for?
Why is nitrofurantoin contraindicated for clients with chronic kidney disease?
Why is nitrofurantoin contraindicated for clients with chronic kidney disease?
What drug interaction information is important to teach clients who are prescribed ciprofloxacin?
What drug interaction information is important to teach clients who are prescribed ciprofloxacin?
To minimize this adverse effect, what should the nurse teach a client about taking phenazopyridine?
To minimize this adverse effect, what should the nurse teach a client about taking phenazopyridine?
Why are at least two medications needed to treat tuberculosis?
Why are at least two medications needed to treat tuberculosis?
While on isoniazid, which foods should the client avoid?
While on isoniazid, which foods should the client avoid?
Which finding should the nurse identify with a client that has a resolution of a parasitic infection when prescribed metronidazole?
Which finding should the nurse identify with a client that has a resolution of a parasitic infection when prescribed metronidazole?
A client is prescribed both gentamicin and amphotericin B. What adverse effect could occur?
A client is prescribed both gentamicin and amphotericin B. What adverse effect could occur?
Flashcards
Antimicrobial Therapy
Antimicrobial Therapy
Medications to treat antimicrobials (natural or synthetic) that kill or control microbes without destroying host cells.
Conjugation
Conjugation
Changes of DNA in microorganisms that produce resistance to multiple existing medications, leading to the need for new antimicrobials.
Superinfection
Superinfection
Resistance resulting from antibiotic use killing normal flora, favoring new infections.
Narrow-spectrum antibiotics
Narrow-spectrum antibiotics
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Broad-spectrum antibiotics
Broad-spectrum antibiotics
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Bactericidal
Bactericidal
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Bacteriostatic
Bacteriostatic
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Identification of causative agent
Identification of causative agent
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Gram Stain
Gram Stain
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Culture
Culture
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Organism sensitivity testing
Organism sensitivity testing
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Disk diffusion test
Disk diffusion test
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Serial dilution
Serial dilution
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Minimum inhibitory concentration (MIC)
Minimum inhibitory concentration (MIC)
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Minimum bactericidal concentration
Minimum bactericidal concentration
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Gradient diffusion
Gradient diffusion
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Timing of Culture
Timing of Culture
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Immune system consideration
Immune system consideration
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Compromised Immune
Compromised Immune
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Difficult to Reach Infection Site
Difficult to Reach Infection Site
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Bacterial infiltration in heart (endocarditis)
Bacterial infiltration in heart (endocarditis)
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Phagocyte limitations
Phagocyte limitations
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Infant Antimicrobial Risks
Infant Antimicrobial Risks
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Older Adult Toxicity
Older Adult Toxicity
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Sulfonamides in pregnancy
Sulfonamides in pregnancy
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Gentamicin in pregnancy
Gentamicin in pregnancy
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Tetracyclines in pregnancy
Tetracyclines in pregnancy
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Prophylaxis
Prophylaxis
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Preventative measures
Preventative measures
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Penicillins' Pharm Action
Penicillins' Pharm Action
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Bactericidal medications
Bactericidal medications
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Bacteriostatic medications
Bacteriostatic medications
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Minimum Bactericidal Concentration (MBC)
Minimum Bactericidal Concentration (MBC)
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Antimicrobials in Cerebrospinal Fluid
Antimicrobials in Cerebrospinal Fluid
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Sulfonamides
Sulfonamides
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Penicillin G Potassium
Penicillin G Potassium
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Cephalosporins
Cephalosporins
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Cefotetan/Cefazolin
Cefotetan/Cefazolin
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Carbapenems
Carbapenems
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Vancomycin
Vancomycin
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Vancomycin Administration
Vancomycin Administration
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Vancomycin Trough Levels
Vancomycin Trough Levels
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Tetracyclines
Tetracyclines
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Tetracycline Complication
Tetracycline Complication
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Tetracycline Interactions
Tetracycline Interactions
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Erythromycin
Erythromycin
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Prolonged QT Interval
Prolonged QT Interval
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Macrolides and Pregnancy
Macrolides and Pregnancy
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Aminoglycosides
Aminoglycosides
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Aminoglycoside Risks
Aminoglycoside Risks
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Penicillin with Aminoglycosides
Penicillin with Aminoglycosides
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Ototoxicity Monitoring
Ototoxicity Monitoring
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Trimethoprim-sulfamethoxazole Therapeutic Uses
Trimethoprim-sulfamethoxazole Therapeutic Uses
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Crystalluria Precaution
Crystalluria Precaution
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Nitrofurantoin Effects
Nitrofurantoin Effects
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Fluoroquinolones
Fluoroquinolones
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Achilles Tendon Rupture
Achilles Tendon Rupture
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Cationic Compounds and Cipro
Cationic Compounds and Cipro
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Phenazopyridine
Phenazopyridine
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Cranberry Juice
Cranberry Juice
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Mycobacterium Tuberculosis
Mycobacterium Tuberculosis
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Isoniazid
Isoniazid
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Latent Tuberculosis Treatment
Latent Tuberculosis Treatment
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Peripheral Neuropathy
Peripheral Neuropathy
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Rifampin
Rifampin
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Rifampin Discoloration
Rifampin Discoloration
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Metronidazole
Metronidazole
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Metronidazole/Alcohol Interaction
Metronidazole/Alcohol Interaction
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Amphotericin B
Amphotericin B
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Amphotericin B Considerations
Amphotericin B Considerations
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Acyclovir / Ganciclovir
Acyclovir / Ganciclovir
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Acyclovir
Acyclovir
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HAART
HAART
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Study Notes
- Antimicrobial therapy uses medications to treat antimicrobials and selective toxicity to kill or control microbes without destroying host cells.
- Conjugation changes DNA in microorganisms, leading to medication resistance and a need for new antimicrobials.
- Superinfection results in antibiotic resistance when normal flora is killed, which favors new hard-to-eliminate infections.
Narrow-spectrum vs. Broad-spectrum Antibiotics
- Narrow-spectrum antibiotics target only a few types of bacteria.
- Broad-spectrum antibiotics target a wide variety of bacteria.
Bactericidal vs Bacteriostatic Medications
- Bactericidal medications are directly lethal to microorganisms.
- Bacteriostatic medications slow the growth of microorganisms, the immune system destroys bacteria via phagocytic cells (macrophages, neutrophils).
Selection of Antimicrobials
- Prescribing for clinical use depends on multiple factors (antibacterial, antifungal, or antiviral medication).
- Important factors: the identity of the causative agent, the sensitivity of the infecting organism to antimicrobials, and other factors (location of the infection, age, allergies, and immune status of the host).
Identification of Causative Agent
- Laboratory testing of body fluids (blood, urine, sputum, and wound drainage) identifies the micro-organism causing the infection.
- Gram stains have technicians examine a body fluid aspirate under a microscope to identify micro-organisms directly.
- With cultures, technicians apply the aspirate to a culture medium to grow colonies of the microorganism over several days.
- A culture is preferable when a gram stain does not yield a positive identification.
- Nurses collect specimens for culture prior to treatment with antimicrobials, and collect fluid for culture carefully to prevent contamination.
Sensitivity Testing
- For organisms commonly resistant, technicians test the sensitivity of the organism to antimicrobials.
- In Disk diffusion tests (Kirby-Bauer test), the infecting organism is placed on several disks impregnated with different antimicrobiotics and the bacteria-free zone determines medication sensitivity.
- Serial dilution is a quantitative method to determine the amount of antimicrobial needed for a specific infection, using several test tubes with varying concentrations of the antimicrobial
- Minimum inhibitory concentration (MIC) is the lowest concentration of antibiotic that inhibits bacterial growth, while Minimum bactericidal concentration the lowest concentration that kills 99% of the bacteria.
- Providers adjust the antibiotic dosage to produce a concentration equal to or greater than the MIC of the same antibiotic.
- Gradient diffusion uses a disk and strips with varying concentrations of the same antibiotic and no further growth of bacteria identifies the essential antibiotic concentration.
- Cultures identified the causative pathogen when obtained before antimicrobial therapy.
- Administering antibiotics before cultures can lead to false-negative results or hinder pathogen identification.
- In emergency cases (sepsis), draw cultures as soon as possible before administering the first antibiotic dose.
- Proper timing guides targeted therapy and reduces unnecessary broad-spectrum antibiotic use and resistance risks.
Host Factors
- Immune system: Antimicrobials work with host defense systems to suppress micro-organisms while people with intact immune systems either bactericidal or bacteriostatic antibiotics.
- People with immune-system compromise need strong bactericidal antibiotics.
- For the infection site: some sites are difficult for antimicrobials to reach, like infections in cerebrospinal fluid or bacterial infiltration within the heart (endocarditis)
- Purulent abscesses anywhere within the body due to poor blood supply need surgical removal of purulent drainage to increase the effect of antimicrobials.
- Phagocytes that attack foreign objects become less able to destroy micro-organisms that colonize around the foreign object.
- Infants are at increased risk for antimicrobial toxicity due to undeveloped kidney and liver function and older adult clients easily develop toxicity because of reduced medication metabolism and excretion.
- In pregnant patients, antimicrobials can harm a developing fetus, sulfonamides can produce kernicterus, gentamicin causes hearing loss, and tetracyclines cause discoloration of teeth.
- Lactation is usually a contraindication for antimicrobials.
- History of severe allergic reactions (especially with penicillin) narrows the antibiotic choices for those clients.
- Combination therapy when combining antimicrobials can cause additive, potentiating, or antagonistic effects.
- Use combination therapies to treat severe infections, treat infections from more than one micro-organism, prevent bacterial resistance, decrease the risk of toxicity or produce more effective treatment.
- Combining antimicrobials can cause increased resistance and costs, more adverse or toxic reactions, antagonistic effects between antimicrobials resulting in decreased effectiveness, or increased risk for a superinfection.
Prophylaxis and Preventative Measures
- Indications for prophylactic use include prevention of infections for clients undergoing certain surgeries and sexually transmitted infections following sexual exposure.
- Use antimicrobials for individuals who have prosthetic heart valves or recurring urinary tract infections.
- Preventative measures include performing hand hygiene, recognizing invasive procedures, encouraging up-to-date immunization status, instructing clients to take the entire course of antimicrobials, using infection-control procedures, and evaluating the effectiveness of treatment.
Penicillins
- Penicillin's Pharm action destroys bacteria by weakening the bacterial cell wall and it is considered a beta-lactam antibiotic.
- Penicillins are used to treat infections due to gram-positive cocci or meningitis, and extended-spectrum penicillins are effective against organisms.
- Complications involve allergies (allergy identification bracelet) or renal impairment, and contraindications are a history of severe allergic reactions to penicillin, cephalosporins, or imipenem.
- Penicillin interacts with aminoglycosides and Probenecid delays the excretion of penicillin.
- Observe for allergic reactions for 30 minutes following parenteral administration of penicillin.
- Ensure epinephrine and respiratory support equipment are easily accessible.
- Monitor cardiac status and electrolyte levels.
- Instruct clients to report findings of an allergic response (dyspnea, skin rash, itching, hives)
- Give IM injections cautiously to avoid injecting into a nerve or artery, which can cause sensory and motor dysfunction or neurotoxicity.
- Penicillin V, amoxicillin, and amoxicillin-clavulanate can be taken with meals. Take all others with 8 oz of water 1 hr or 2 hr before meals.
- Complete the entire course of therapy, even if manifestations resolve.
- Use additional non-hormonal contraceptive methods when taking penicillins, as penicillins can cause a decrease in effectiveness.
- Examples of Medications:
- Narrow spectrum: Penicillin G benzathine, Penicillin V
- Broad spectrum: Amoxicillin, Amoxicillin-clavulanate, Ampicillin
- Antistaphylococcal: nafcillin, oxacillin
- Antipseudomonal (extended spectrum): piperacillin tazobactam
Cephalosporins
- Cephalosporins are beta-lactam antibiotics that destroy bacterial cell walls with 5 generations, and used to treat a wide variety of infections.
- Allergy, hypersensitivity, anaphylaxis, Bleeding tendencies, Thrombophlebitis, Renal insufficiency, and Pain with IM injection are complication involving cephalosporins.
- Disulfiram reaction (from alcohol), and interactions with Probenecid or calcium and ceftriaxone are contraindications and precautions with nursing administration.
- If indications of allergy appear (urticaria [raised, itchy, and red welts], stop the cephalosporin immediately and notify the provider.
- Question clients carefully about a history of allergy to penicillin or another cephalosporin and notify the provider if present.
- Observe clients for bleeding.
- Monitor prothrombin and bleeding times and administer parenteral vitamin K.
- Observe the injection site for findings of phlebitis.
- Administer IM injection deep into a large muscle mass (into the ventrolateral site).
- Cephalosporins are mainly eliminated by the kidneys.
- Risk for developing C. diff by consuming broad-spectrum antibiotics.
- Complete the entire course of therapy, even if manifestations resolve
- Take oral cephalosporins with food
- Store oral cephalosporin suspension in a refrigerator.
- Examples of Medications:
- First gen: cefazolin
- Second gen: cefaclor, cefotetan
- Third gen: ceftriaxone, cefotaxime
- Fourth gen: cefepime
- Fifth gen: ceftaroline, only cephalosporin that is effective against MRSA
Carbapenems
- Carbapenems destroy bacterial cell walls (beta-lactam antibiotics) and have broad-spectrum for serious infections (pneumonia, peritonitis, and urinary tract infections).
- Allergy, hypersensitivity (like penicillins or cephalosporins) are complications and imipenem-cilastatin can reduce blood levels of valproic acid.
- Resistance develops from using imipenem alone to treat pseudomonas aeruginosa infections. Complete the course of therapy.
- Carbapenems should be reserved for clients who cannot be treated with a more narrow-spectrum antibiotic.
- Monitor for indications of colitis (diarrhea), oral thrush, black furry overgrowth on the tongue, and vaginal yeast infection.
- Monitor I&O.
- Examples of Medications:
- Imipenem-cilastatin, Meropenem
Vancomycin
- Vancomycin destroy bacterial cell walls in serious infections due to methicillin-resistant staphylococcus aureus, staphylococcus epidermidis, and streptococcal infections or antibiotic-associated pseudomembranous colitis (C.difficile).
- Complications include ototoxicity (hearing loss) and red man syndrome (rapid infusions, rashes, itching, flushing) & renal toxicity, therefore assess for hearing loss
- Complete the course of therapy.
- Monitor for indications of hearing loss, and notify the provider if changes in hearing acuity develop
- Assess for hearing loss
- Administer vancomycin slowly over 60 minutes
- Commonly used in hospitals, poor absorption through the GI tract.
- Dilute med according to pharmacy instructions.
- Rotate injection sites and monitor the infusion site for redness, swelling, and inflammation.
- Monitor I&O and kidney function tests
- Monitor vancomycin trough levels
- Major toxicity is renal failure.
- Vancomycin for PO, IV, or rectal use.
- Reduction of manifestations (fever, pain, inflammation, and adventitious breath sounds).
- Resolution of infection.
Tetracyclines
- Tetracyclines are broad-spectrum antibiotics that inhibit microorganism growth (bacteriostatic), and treats acne, periodontal disease, typhus fever, chlamydia trachomatis
- Complications are GI discomfort, yellow or brown tooth discoloration, hypoplasia of tooth enamel, photosensitivity, and superinfections.
- Tetracyclines decreases effectiveness of oral contraceptives.
- Avoid taking at bedtime to reduce the risk of esophageal ulceration.
- Wear protective clothing and use sunscreen with an. SPF of 30 or higher while outdoors in sunlight.
- Monitor for GI symptoms, Monitor I&O, and suggest taking doxycycline and minocycline with meals, although food can reduce absorption.
- Decreases effectiveness of oral contraceptives, clients should use an alternative or nonhormonal form of contraception.
- Male clients who are prescribed minocycline should use a form of contraception while taking this medication
- Ensure that any milk products and antacids are separated by at least 2 hours of tetracycline ingestion.
- Take tetracyclines on an empty stomach with 8 oz of water (1 hr before or 2 hr after meals). Clients may take tetracyclines with food if gastric distress occurs, but this will decrease absorption. Minocycline may be taken with food.
- Doxycycline increases the risk of digoxin toxicity, monitor digoxin level carefully if taking concurrently.
- If this med is given to treat an STD, clients should abstain from intercourse until they finish their medication, manifestations have resolved, and partners have been treated.
- A decrease in the manifestations of infection (fever, pain, inflammation, and adventitious breath sounds).
- Resolution of yeast infection of the mouth, vagina, or bowels
- Resolution of acne vulgaris
- Examples of Medications:
- Doxycycline, Minocycline, Demeclocycline
- Complete entire course of therapy, even though manifestations may resolve sooner/
- Utilize additional contraception.
Macrolides
- Macrolides contain Erythromycin slows microorganism growth (bacteriostatic) or is bactericidal, treating infections in penicillin-allergic clients or legionnaires' disease.
- It is known to cause GI discomfort, Prolonged QT intervals or Ototoxicity with high-dose therapy.
- Administer with meals, if indicated, and monitor for and report adverse GI effects.
- Avoid use in clients who have prolonged QT intervals. -Monitor for and report hearing loss, vertigo, and tinnitus.
- Erythromycin inhibits the metabolism of antihistamines, theophylline, carbamazepine, warfarin, and digoxin, which can lead to toxicity.
- Verapamil, diltiazem, HIV protease inhibitors, antifungal medications, and nefazodone inhibit the metabolism of erythromycin, which can lead to toxicity and cause tachydysrhythmias and possible cardiac arrest.
- If given for an STD, clients should abstain from intercourse until they finish their meds, manifestations have been resolved, and partners have been treated.
- Except for azithromycin, administer oral preparations on an empty stomach (1 hr before meals or 2 hr after) with 8 oz of water, unless GI upset occurs.
- Administer erythromycin IV only for severe infections or for clients who cannot take oral doses.
- Carefully monitor PT or INR of clients who take warfarin concurrently with erythromycin.
- Monitor liver function tests for therapy lasting linger than 2 weeks.
Aminoglycosides; Gentamicin
- Aminoglycosides are bactericidal antibiotics that destroy micro-organisms in aerobic gram-negative bacilli.
- Ototoxicity, Nephrotoxicity (monitor I&O) and Hypersensitivity like rash, pruritus (assess for hearing loss).
- Penicillin inactivates aminoglycosides when in the same IV solution.
- Cochlear damage (hearing loss), vestibular damage (loss of balance)
- Notify the provider if tinnitus, hearing loss, or headache occur.
- Monitor I&O, BUN, and creatinine. Report hematuria and cloudy urine.
Trimethoprim-sulfamethoxazole
- Trimethoprim-sulfamethoxazole inhibits bacterial growth by tetrahydrofolate with adverse effects of hypersensitivity (including Stevens-Johnson syndrome) & blood dyscrasias.
- Crystalluria is a complications and pregnancy increases the risk of kernicterus.
- Obtain blood samples for baseline and monitor urine output (should be at least 1,200 mL/day)
- Monitor potassium levels.
Nitrofurantoin
- Nitrofurantoin is a broad-spectrum urinary antiseptic with bacteriostatic and bactericidal action used to treat UTIs.
- Complications are Gl discomfort, hypersensitivity reactions causing pulmonary issues & peripheral Neuropathy and alters kidney conditions. -Administer nitrofurantoin with milk or meals, reduce dosages, and use microcrystal capsules.
- Stop taking the medication and report reactions. Pulmonary manifestations should subside within several days after stopping nitrofurantoin. Do not take again.
- Report neuropathy and avoid chronic use of nitrofurantoin.
Fluoroquinolones
- Fluoroquinolones are antimicrobial alternatives as alternative antibiotics, and treat infections in bones, joints, skin & soft tissues or used as prevention or anthrax.
- Ciprofloxacin increases the risk of C. diff infection because it destroys the intestinal flora, and affects the CNS.
- Take with food (except dairy products) if discomfort occurs.
- Ciprofloxacin and several other fluoroquinolones can affect the CNS (dizziness, headache, restlessness, and confusion). Use cautiously with older adults and clients who have cardiovascular disorders.
Phenazopyridine
- Phenazopyridine is a medication and is an Azo dye, relieving burning with urination, and changes color.
- Take with or after meals to minimize GI discomfort.
Complementary Therapies for UTIs
- Cranberry juice is used to prevent urinary tract infections (UTIs), and Probiotics can help reestablish intestinal flora.
Antimycobacterials
- Treatment for tuberculosis requires at least two medications (Isoniazid and rifampin).
Isoniazid
- Isoniazid is highly specific for mycobacteria that inhibits the growth in active and latent.
- Complications may result on vitamin function.
- Observe for manifestations and notify the provider of they occur.
- Isoniazid inhibits the metabolism of phenytoin, leading to the buildup of medication and toxicity. Ataxia and incoordination can indicate toxicity.
- Monitor levels of phenytoin. Adjust dosages based on phenytoin levels.
Rifampin
- Rifampin is an antimicrobial antibiotic that prevents resistance with body fluids and can show jaundice.
- There is an expected orange color of urine, saliva, sweat, and tears
Metronidazole
- Metronidazole is used in surgeries, with GI and CNS effects.
- Metallic taste is a noted GI effect. -Metronidazole inhibits activation of warfarin, phenytoin, and lithium.
Antifungals
- Antifungals are useful with fungal infections in mucosa/nails with potential infusion reactions.
- Pretreat with diphenhydramine and acetaminophen.
- Observe infusion site for edema and erythema.
- Rotate injection site. Administer in a large vein.
Antivirals
- Acyclovir and ganciclovir prevent can with treatment for therapy .
- Rotate sites and monitor injection site with administration of acyclovir.
HAART
- Highly active antiretroviral therapy reduces damage in viral levels with treatment.
- Antiretroviral agents act by preventing the virus from entering cells (fusion/entry inhibitors and CCR5 antagonists).
- Others act by inhibiting enzymes needed for HIV replication (nucleoside reverse transcriptase inhibitors [NRTIs], nonnucleosides reverse transcriptase inhibitors [NNRTIs], protease inhibitors [PIs], and integrase inhibitors [INSTI]).
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