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Questions and Answers
What should be monitored when administering aminoglycosides to minimize adverse effects?
What is a significant interaction to avoid when taking tetracyclines?
Which of the following adverse effects is associated with aminoglycosides?
What common medication should not be taken with sulfonamides due to potential interactions?
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What is the recommended method to minimize the risk of adverse effects when taking trimethoprim/sulfamethoxazole?
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What is one of the primary uses of amiodarone?
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Which adverse effect is specifically associated with the use of amiodarone?
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What should a patient on prednisone be cautious about regarding their immune system?
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Which of the following is a patient teaching point for someone taking amiodarone?
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Which condition is a contraindication for administering prednisone?
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What is a possible significant adverse effect of long-term prednisone use?
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What should patients on amiodarone monitor to manage potential adverse effects?
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What condition can exacerbate the complications associated with prednisone treatment?
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Why do antibiotics not harm human cells while targeting bacteria?
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When should cultures be obtained in the context of initiating antibiotic therapy?
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What is a common cause of a superinfection during antibiotic therapy?
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What should patients be instructed to do regarding the completion of their antibiotic course?
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What is a benefit of combination antibacterial therapy?
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What is the primary mechanism of action for penicillins?
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Which symptom represents an allergic reaction to penicillin?
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What should patients take into consideration while on cephalosporins?
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What is the primary purpose of using multiple drugs in the treatment of active tuberculosis?
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What is a common adverse effect of isoniazid that patients should be made aware of?
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What should patients taking rifampin be advised to do regarding their diet?
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Which of the following mechanisms of action is associated with ciprofloxacin?
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What adverse effect is commonly associated with the use of metronidazole?
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What is the primary mechanism of action of zidovudine in treating HIV?
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Which of the following statements about efavirenz is true?
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What adverse effect should patients taking protease inhibitors be monitored for?
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What is a major difference between first-generation and second-generation antihistamines?
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Which of the following is an adverse effect of diphenhydramine?
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What should patients receiving acyclovir IV be monitored for?
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What is the recommended timing for administering oseltamivir for effectiveness?
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What should patients be advised regarding alcohol consumption while taking isoniazid?
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Which adverse effect is NOT typically associated with erythromycin?
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Study Notes
General Principles of Antimicrobial Therapy
- Antibiotics work by targeting bacterial components like cell walls, which human cells do not have.
- Broad-spectrum antibiotics should be used before culture/sensitivity results are available to control the infection while waiting for pathogen identification.
- Cultures should be obtained before initiating antibiotic therapy.
- Superinfections can occur when antibiotics kill both good and bad bacteria, leading to opportunistic infections like C. difficile and thrush.
- Patients and families should be advised to finish the entire course of antibiotics, even after symptoms improve, to prevent bacterial resistance.
- Combination therapy is used for serious infections, TB, and to prevent resistance.
Penicillins
- Inhibit bacterial cell wall synthesis, hindering bacteria's ability to close their cell wall.
- Common adverse effects include liver and kidney disease, and allergy.
- Allergic reactions can manifest as hives, angioedema, shortness of breath, and throat closing.
- Treat allergic reactions with epinephrine.
- Patients should finish the medication course and call 911 if they experience allergic or superinfection symptoms.
Cephalosporins
- Inhibit bacterial cell wall synthesis, commonly used for surgical prophylaxis.
- Adverse effects include allergy (similar to penicillin), possible kidney damage, and superinfections.
- Patients should finish the medication course and drink plenty of fluids.
Vancomycin
- Weakens the bacterial cell wall.
- IV administration should be slow, while oral administration requires monitoring of renal function and trough level.
- Adverse effects include renal toxicity, Red Man Syndrome, and ototoxicity.
- Interactions include NSAIDs and Aspirin.
Tetracyclines
- Adverse effects include allergy, GI upset, superinfections, photosensitivity, and tooth discoloration.
- Minimize adverse effects by taking Tetracyclines with a glass of water, wearing sunscreen, and staying covered.
- Interactions include metallic compounds and oral contraceptives.
- Patients should wear sunscreen, stay covered, take the medication with a glass of water, and finish the entire course.
Aminoglycosides (Gentamicin)
- Penetrates the cell membrane and kills bacteria.
- Adverse effects include peripheral neuropathy, nephrotoxicity, and ototoxicity.
- Minimize adverse effects by monitoring peak and trough levels.
- Patients should finish the medication course.
- Peak levels are drawn after the medication dose, while trough levels are drawn before the next dose is administered.
Sulfonamides
- Inhibit bacterial growth and replication.
- Adverse effects include hypersensitivity (Stevens-Johnson Syndrome), GI upset, jaundice, and headache.
- Allergy can cause Stevens-Johnson Syndrome, a painful red rash and blisters.
- Interactions include digoxin.
Trimethoprim/Sulfamethoxazole (Bactrim)
- Used for UTIs (e.coli) and Pneumocystis jirovecii pneumonia (common in HIV).
- Adverse effects include Stevens-Johnson syndrome, renal, skin, GI, and hematologic problems.
- Minimize adverse effects by encouraging fluid intake.
- Monitor for Stevens-Johnson syndrome (fever, rash, blistering, peeling skin) and electrolyte abnormalities.
Treatment Regimens for Tuberculosis
- Latent TB: Treated with one drug for 9 months or two drugs for 3 months.
- Active TB: Treated with four drugs for 2 months or two drugs for 4 months.
- Drug-resistant TB: Treated with a combination of drugs for a longer period.
- Multiple drugs are used to prevent resistance.
Isoniazid (Nydrazid)
- Bactericidal: disrupts bacterial cell wall formation.
- Adverse effects include peripheral neuropathy, resistance, and hepatotoxicity.
- Minimize adverse effects by avoiding alcohol, taking vitamin B6 if needed, and monitoring liver function.
- Interactions: Inhibits drug metabolism (Phenytoin and Carbamazepine), increases hepatotoxicity risk (Rifampin, Pyrazinamide, Rifambin).
Rifampin (Rifadin)
- Inhibits bacterial DNA, RNA, and protein synthesis.
- Adverse effects include hepatotoxicity and discoloration of bodily fluids.
- Take Rifampin on an empty stomach.
- Monitor for liver function abnormalities.
Ciprofloxacin (Cipro)
- Interacts with bacterial DNA synthesis.
- Adverse effects include allergy, photosensitivity, tendonitis, CNS effects, and peripheral neuropathy.
- Minimize adverse effects by avoiding use in children and older adults, metallic compound drugs/foods (steak).
- Patients should use sunscreen, monitor for tendon issues, and avoid antacids.
Metronidazole (Flagyl)
- Inhibits DNA synthesis, killing bacteria.
- Used to treat C. diff and prevent GI infections.
- Watch for side effects like nausea and vomiting.
Erythromycin
- Inhibits microbial protein synthesis.
- Adverse effects include GI and CNS effects, dysrhythmias, allergy, and hepatotoxicity.
- Monitor for cardiovascular and GI symptoms.
- Women using contraceptives should consult healthcare providers about potential drug interactions.
Acyclovir (Zovirax)
- Inhibits viral replication and suppresses DNA synthesis.
- Used for herpes, varicella-zoster, and shingles.
- Adverse effects include phlebitis, nephrotoxicity, neurotoxicity (IV), nausea, vomiting, diarrhea, headache, dizziness, malaise (PO).
- Minimize adverse effects by rotating IV sites, monitoring fluid balance, encouraging fluids, and monitoring creatine and BUN levels.
- Topical use can cause burning and stinging.
Oseltamivir (Tamiflu)
- Must be started within 2 days of symptom onset for effectiveness, and within 12 hours for maximum benefit.
- Reduces severity and length of symptoms by 3 days when started early.
- Adverse effects include nausea, vomiting, hypersensitivity reactions, and nosebleeds.
HIV Drugs
Zidovudine (Retrovir)
- Inhibits DNA synthesis by installing faulty information into the virus, injuring the cell.
- Adverse effects include anemia, thrombocytopenia, neutropenia, lactic acidosis, hepatic steatosis (nausea, vomiting, abdominal pain, malaise, fatigue, anorexia).
- Minimize adverse effects by taking B12 supplements and monitoring lactic acid levels and ABGs.
- Patients should be aware of symptoms and report them promptly.
Efavirenz: Sustiva
- Binds to HIV reverse transcriptase and disrupts its function.
- Adverse effects include dizziness/headaches, insomnia/nightmares, delusions and depression, hallucinations.
- Minimize adverse effects by discontinuing the drug if symptoms occur.
- Pregnant women should not take this medication.
Protease Inhibitors
- Prevent the virus from fusing with CD4 cells, inhibiting replication.
- Adverse effects: hyperglycemia (polydipsia, polyuria, polyphagia), fat maldistribution, hyperlipidemia, bone marrow suppression, neuropathy, depression, suicidal ideation, rash, and pruritus.
- Minimize adverse effects through oral medication: diabetic medications, insulin, healthy diet, regular exercise, lipid-lowering drugs.
- Interactions: Avoid grapefuit juice, ketoconazole, clarithromycin (decreases protease inhibitor levels). Rifampin, phenytoin, carbamazepine (decrease protease inhibitor levels, loss of therapeutic effect). St. John's Wort, garlic (decrease saquinavir levels). Decreases levels of Cisapride, benzodiazepines, ergotamine, lovastatin, simvastatin, sildenafil, tadalafil, vardenafil.
Antihistamines
Diphenhydramine: Benadryl
- Adverse effects: drowsiness, anticholinergic side effects (dry mouth, constipation, blurred vision, urinary retention).
- Interactions: anything that causes drowsiness (opioids), tricyclic antidepressants, MAO inhibitors, alcohol.
- Used for minor allergies.
Fexofenadine: Allegra
- Adverse effects: headache, nausea, vomiting, fatigue, drowsiness if not taken as prescribed.
- Interactions: alcohol, marijuana, oxycodone (drowsy).
- Used for seasonal allergies, urticaria, cold and allergy symptoms. Antacids can interfere with absorption.
Promethazine: Phenergan
- Adverse effects: can damage surrounding tissues if infiltrated, extrapyramidal side effects.
- Used as an antiemetic (nausea).
- Monitor for side effects and ensure proper administration.
First vs. Second Generation Antihistamines
- 1st generation antihistamines cross the blood-brain barrier, while 2nd generation target peripheral histamine receptors.
- 1st generation: Used for contact dermatitis.
- 1st generation adverse effects: drowsiness, fatigue, impaired alertness.
- 2nd generation: Used for seasonal allergies.
- 2nd generation adverse effects: headache, nausea, vomiting, fatigue.
Epinephrine (EPI-Pen)
- Mechanism of action: vasoconstriction (alpha 1), increased cardiac output and perfusion (beta 1), open airways (beta 2).
- Adverse effects: hypertension, increased heart rate, dysrhythmias, angina, increased glucose levels.
- Patient teaching: proper administration, care and maintenance of the pen, monitoring glucose levels for diabetic patients.
Antidysrhythmics
- Antidysrhythmics can themselves cause abnormal heart rhythms.
Diltiazem (Cardizem)
- Slows conduction by decreasing calcium movement, used for supraventricular tachycardia (SVT) and rate control for atrial fibrillation (A fib).
- Adverse effects: bradycardia, AV block, flushing, peripheral edema.
- Patients should monitor their pulse and blood pressure.
Amiodarone (Cordarone)
- Used for atrial fibrillation/flutter, ventricular tachycardia/fibrillation; prolongs heart rate and contractility, prolongs conduction.
- Adverse effects: CNS effects (dizziness, fatigue, tremors, ataxia).
- Interactions: beta-blockers, anticoagulants, digoxin, phenytoin. Can cause pulmonary toxicity, hepatotoxicity, photosensitivity, vision changes.
- Patient teaching: monitor for signs of liver issues, manage vision changes, monitor cough, dyspnea, crackles, pleuritic angina, cover up and wear sunscreen.
Prednisone
- Action: Decreased inflammation.
- Uses:
- Allergic reactions
- Autoimmune diseases
- Endocrine disorders
- Neurologic conditions
- Arthritis
- Cancer (can help with appetite retention)
- COPD, asthma
- Adverse effects:
- Adrenal insufficiency
- Adrenal excess
- CNS effects
- Decreased immunity
- Fluid and electrolyte imbalance
- Blood glucose elevation
- Skin issues
- Osteoporosis
- Increased risk for infections.
- Can cause Cushing's Syndrome if used excessively.
- Contraindications:
- Immunosuppression
- Caution in Children: can cause slowed growth and diminished adult height (except inhaled steroids for asthma).
- Systemic fungal infections, hepatitis B, varicella.
- Caution:
- Kidney, liver, and GI issues (GI ulcerations, kidney/liver disease).
- Diabetes (due to glucose elevation).
- Nursing responsibilities:
- Monitor blood glucose and other adverse effects.
- Monitor for improvement (signs will vary depending on medication use).
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Description
This quiz covers the fundamental principles of antimicrobial therapy, including the function of antibiotics and their impact on bacterial infections. It emphasizes the importance of culture sensitivity, completion of antibiotic courses, and the potential risks of superinfections. Additionally, it discusses penicillins and their mechanism of action against bacterial cell walls.
