52 Questions
Which type of infection is acquired by a person who has not been hospitalized or had a medical procedure within the past year?
Community-associated infection
What is a characteristic of health care–associated infections?
They are more difficult to treat because the causative microorganisms are often drug resistant
What is the term for an infection that occurs when antibiotics reduce or completely eliminate the normal bacterial flora?
Superinfection
What is an example of a superinfection caused by antibiotic therapy?
Vaginal yeast infection
What is the term for infections that occur in a hospital or institutional setting?
Health care–associated infections
What is a characteristic of normal flora?
They are needed to maintain normal function in various organs
What is a consideration for antibiotic dosing in the elderly?
Lower dose required due to kidney decline in function
What are two broad classes of antibiotics that people are commonly allergic to?
Penicillins and Sulfonamides
What is the mechanism of action of Sulfonamides?
Bacteriostatic
What is a common indication for the use of SMX-TMP?
Urinary tract infections
What is a side effect of Sulfonamides?
Photosensitivity
What is the mechanism of action of Penicillins?
Inhibit cell wall synthesis
What is a contraindication for the use of Penicillins?
Known drug allergy
What is a type of adverse reaction that can occur with Penicillins?
All of the above
What is a characteristic of Carbapenems?
Extended spectrum of activity
What is an example of a Combination Agent?
Ampicillin/sulbactam
What is essential to ask a patient about when prescribing antibiotics?
What kind of reaction occurred with an antibiotic
What is a common adverse effect of cephalosporins?
Nausea, vomiting, and diarrhea
Which generation of cephalosporins has the most potent activity against gram-negative bacteria?
Third generation
What is the main purpose of carbapenems?
To treat complicated body cavity and connective tissue infections
What is the main characteristic of fifth-generation cephalosporins?
Broader spectrum of antibacterial activity than third generation
What should patients taking cephalosporins be advised to do regarding oral contraceptives?
Use a barrier method
What is a potential adverse effect of carbapenems?
Seizure activity
Which antibiotic is used to treat bacterial endocarditis caused by S. aureus?
Imipenem/cilastatin (Primaxin)
What is the main difference between fourth-generation and fifth-generation cephalosporins?
Fifth generation has a broader spectrum of antibacterial activity
Why should patients with a history of throat swelling or hives from penicillin not receive cephalosporins?
Due to potential allergic reactions
Which of the following antibiotics is the only carbapenem currently indicated for treatment of bacterial meningitis?
Meropenem (Merrem)
What is the mechanism of action of macrolides?
Prevent protein synthesis within bacterial cells
Which macrolide is indicated only for the treatment of C. difficile–associated diarrhea?
Fidaxomicin (Dificid)
What is a common adverse effect of macrolides?
Gastrointestinal bleeding
Which of the following drugs interacts with macrolides through competition for hepatic metabolism?
All of the above
Which of the following statements about doripenem is true?
It is indicated for intraabdominal infections, pyelonephritis, and UTIs
What is the primary mechanism of action of aztreonam?
Inhibiting cell wall synthesis
Which of the following macrolides has minimal effects on the cytochrome P-450 enzymes?
Azithromycin (Zithromax)
What is the spectrum of activity of ertapenem?
Comparable to that of imipenem/cilastatin, but not active against Enterococcus or Pseudomonas species
Why should macrolides be used with caution when administered with statins?
To avoid increased risk of myopathy
What is the primary reason for avoiding milk products, iron preparations, antacids, and other dairy products when taking tetracyclines?
Due to the chelation and drug-binding that occur
What is the recommended time for monitoring patients after administration of penicillin for an allergic reaction?
At least 30 minutes
What is the reason for taking oral administered cephalosporins with food?
To reduce GI upset
What is the effect of taking macrolides on an empty stomach?
It enhances the absorption of the medication
What is a sign of therapeutic effect of antibiotics?
Return to normal vital signs
What is a potential interaction between certain cephalosporins and alcohol?
A disulfiram (Antabuse)-like reaction
What is the primary mechanism of action of tetracyclines?
Inhibiting protein synthesis
What is a common adverse effect of tetracyclines in children and pregnant or lactating women?
Tooth discoloration
Which of the following can reduce the oral absorption of tetracyclines?
Antacids and dairy products
What is a unique indication for demeclocycline?
Syndrome of inappropriate antidiuretic hormone secretion
What is a potential consequence of tetracycline use during pregnancy?
Fetal skeletal development retardation
What is a common interaction between tetracyclines and other medications?
All of the above
What is a common adverse effect of tetracyclines on the gastrointestinal system?
All of the above
What is an important nursing implication for patients taking tetracyclines?
All of the above
What is a characteristic of tetracyclines in relation to their interaction with calcium ions?
They bind to calcium ions, forming insoluble complexes
What is a potential consequence of altering the normal intestinal flora with tetracyclines?
Superinfection with Candida spp.
Study Notes
Community-Associated Infections
- Infections acquired by individuals who have not been hospitalized or undergone medical procedures (e.g., dialysis, surgery, catheterization) within the past year.
Health Care-Associated Infections
- Contracted in hospital or institutional settings.
- Not present or incubating in patients on admission to the facility.
- Occur more than 48 hours after admission.
- More difficult to treat due to drug-resistant and virulent microorganisms (e.g., MRSA).
Antibiotic Therapy: Superinfection
- Superinfection occurs when antibiotics reduce or eliminate normal bacterial flora.
- Normal flora consists of certain bacteria and fungi necessary for normal organ function.
- Killed bacteria or fungi allow other microorganisms to cause infection (e.g., vaginal yeast infections).
Allergic Reactions and Severe Reactions
- Allergic reactions: most common to penicillins and sulfonamides.
- Severe reactions: difficulty breathing, significant rash, hives, or skin reaction, and severe gastrointestinal intolerance.
Antibiotic Classes
Sulfonamides
- One of the first groups of antibiotics.
- Often combined with another antibiotic.
- Mechanism of action: bacteriostatic (inhibit bacterial growth).
- Indications: urinary tract infections (UTIs) caused by susceptible strains, pneumocystis jiroveci pneumonia.
- Adverse effects: hemolytic and aplastic anemia, thrombocytopenia, photosensitivity, nausea, vomiting, diarrhea, and hepatotoxicity.
Beta-Lactam Antibiotics
- Include penicillins, cephalosporins, carbapenems, and monobactams.
- Mechanism of action: bactericidal (kill bacteria).
- Indications: prevention and treatment of infections caused by susceptible bacteria.
Penicillins
- Examples: penicillin G, nafcillin, cloxacillin, oxacillin, dicloxacillin, amoxicillin, and piperacillin.
- Mechanism of action: inhibit bacterial cell wall synthesis, leading to cell death.
- Indications: gram-positive bacteria, including Streptococcus spp., Enterococcus spp., and Staphylococcus spp.
- Adverse effects: allergic reactions, nausea, vomiting, diarrhea, and abdominal pain.
Cephalosporins
- Examples: cefadroxil, cephalexin, cefaclor, cefprozil, and cefoxitin.
- Mechanism of action: bactericidal, similar to penicillins.
- Indications: surgical prophylaxis, susceptible staphylococcal infections, and gram-negative bacteria.
- Adverse effects: similar to penicillins, with potential cross-sensitivity.
Macrolides
- Examples: erythromycin, azithromycin, clarithromycin, and fidaxomicin.
- Mechanism of action: prevention of protein synthesis within bacterial cells, leading to bacterial death.
- Indications: streptococcal infections, mild to moderate upper and lower respiratory tract infections, and spirochetal infections.
- Adverse effects: nausea, vomiting, diarrhea, and abdominal pain.
Carbapenems
- Examples: imipenem, meropenem, ertapenem, and doripenem.
- Mechanism of action: broadest antibacterial action, reserved for complicated infections in acutely ill hospitalized patients.
- Indications: bone, joint, skin, and soft tissue infections, bacterial endocarditis, and intraabdominal infections.
Tetracyclines
- Examples: demeclocycline, oxytetracycline, tetracycline, doxycycline, minocycline, and tigecycline.
- Mechanism of action: bacteriostatic, inhibiting protein synthesis.
- Indications: wide spectrum, including gram-negative and gram-positive organisms, protozoa, and spirochetes.
- Adverse effects: tooth discoloration, superinfection, and photosensitivity.
Learn to distinguish between community-associated infections and health care–associated infections, including their definitions and key characteristics.
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