NCLEX: Pharm--Antibiotics Antivirals Flashcards

Terms Definitions
Name the generations of Cephalosporins.
Keflex: Cephalexin Sodium (1st generation)
Ceftin: Cefuroxime (2nd)
Claforan: Cefotaxime (3rd)
Maxipime: Cefepime (4th)
What are the most important side effects to watch for when administering cephalosporins?
Rash, anorexia, hypersenstivity (rash, pruritis, fever), N/V diarrhea, GI Pain.
What is important patient teaching for cephalosporins?
Advise client to hydrate, notify health care provider if experiencing diarrhea.
What antibiotic is contraindicated if a patient is allergic to penicillins?
Cephalosporins.
What are 1st generation cephalosporins and what are they used for commonly?
Keflex: Cephalexin

Used in severe infections: respiratory, GI, GU, endocarditis and meningitis
What are the 2nd generation cephalosporins and what are they used to treat?
Ceftin: Cefuroxime

Used in serious infections: speticemia, lower respiratory, bone, joint, skin and UTI.
What are the 3rd generation Cephalosporins and what are they used to treat?
Claforan: Cefotaxime sodium.

Used for serious infection: lower respiratory, bone, joint, CNS (meningitis), gonorrhea.
What are the 4th generation cephalosporins and what are they used to treat?
Maxipime: Cefepime.

Used in serious infecitons: pneumonia, urinary, GI
What are the main side effects to watch for when administering Tetracycline?
Epigastric discomfort, diarrhea, heartburn and photosensitivity.

Others: N/V, suprainfection( C. difficile), abdominal cramping.
What are Tetracyclines used for?
Chlamydia, Rocky Mountain Spotted Fever, Acne

Other:Rickettsial Disease, uncommon infections, tropical intestinal infections, peptic ulcer disease, sinusitis, cystitis, lyme disease, periodontal disease.
What patient teaching is necessary for Tetracyclines?
-Take on an empty stomach.
-Antacids, milk products and iron supplements should not be consumed until at least 2 hours after dose was taken.
-Wear sunscreen and protective clothing.
What precautions should be considered when giving tetracyclines?
-Do not give to children (<11 yr) or pregnant women.
-May cause staining of developing teeth.
What is the action of Cephalosporins?
-Interfere with bacterial cell wall synthesis.
-Cell weakens, swells, bursts, and dies as a result of increased osmotic pressure.
-BROAD SPECTRUM
What is the action of Tetracyclines?
-Bacteriostatic, broad spectrum.
-Suppresses bacterial growth and replication, but do not kill the bacterial cells outright.
What is the action of Metronidazole (Flagyl)?
-Direct trichomonacidal and amebicidal activity against Trichomonas baginalis, Entamoeba histolytica, Clostridium difficile, and Giardia lamblia.

Antibacterial against anaerobic bacteria, gram-negative anaerobic bacilli and clostridia.
What are the uses of Metronidazole (Flagyl)?
-Trichomoniasis, intestinal amebiasis and antibiotic-asssociated colitis.

THESE Invaders:
Entamoeba histolytica, Giardia lamblia, Trichomoniasis, intestinal amebiasis, H. Pylori (peptic ulcers), Gardnerella.
What is an important direction to give patients taking Metronidazole (Flagyl)?
No alcohol products 48 after treatment. This includes mouthwash, aftershave, deodorant and bath splashes.
What side effects should be watched for for Metronidazole (Flagyl)?
Headache, dry mouth, fatigue, metallic/bitter taste, GI distress, N/V.
What is important patient teaching for the use of Metronidazole?
-No cologne, aftershave, bath splases, or do not ingest alcohol products to avoid a disulfiram-type reaction (eg: flushing, nausea, projectile vomiting, palpitations, tachycardia, psychosis)
-Mothers should wait 3 days after last dose of drug to resume breast-feeding
-Harmless darkening of the urine may occur.
What is Isoniazid (INH)?
Antituberculosis Agent.
What is the action of Isoniazid
Bacteriostatic to "resting organisms" and bactericidal to actively dividing organisms. Interferes with biosynthesis of bacterial protein, nucleic acid and lipids.
What test is important to do while the patient is on Isoniazid and why?
Liver function tests: this drug can cause drug-induced hepatitis.
What needs to be watched for when taking Isoniazid (INH)?
Epigastric distress, jaundice, peripheral neuritis (neuropathy).
What are the important nursing teaching for a patient taking Isoniazid?
-Take orally on an empty stomach 1 hour before and 2 hours after meals.
-Teach clients to reduce or eliminate consumption of alcohol to reduce risk of hepatotoxicity.
What are the important nursing implications when administering Isoniazid?
-Depletes vitamin B6 (pyridoxine) and will need supplementation during treatment.
-Peripheral neuritis, the most common adverse effect, is preceded by paraesthesias (eg. numbness, tingling, burning, pain) or the feed and hands.
-Antituberculosis treatment always involves 2 or more medications; INH is often combined with rifampin.
What antibiotics are used in TB?
STRIPE:
ST=Streptomycin
R=Rifampin
I= isoniazid
P= Pyrizinamide
E= ethambutol.
Give examples of types of aminoglycosides?
Garamycin, Amikacin, Neomycin, Tobramycin, Gentamicin and Amikin.
What are the two prominent infections that aminoglycosides are used for?
Serious infections: Meningitis and Peritonitis.
What are the two most important adverse of aminoglycosides?
Ear and Kidney Damage (Nephrotoxicity and Ototoxicity)
What type of tests need to be done when administering aminoglycosides?
PEAKS and TROUGHS
What are common adverse effects of aminoglycosides?
Nephrotoxicity, ototoxicity, tremors, urticaria, pruritus, rash.
What is the action of aminoglycosides?
-Bactericidal against a wide variety of gram negative bacteria (narrow spectrum) and certain gram-positive organisms.
-Disrupts bacterial protein synthesis.
What type of infections are aminoglycosides used for?
-Parenteral use for serious infections: GI, respiratory, GU. CNS, bone, skin and soft tissue (including burns)
-Topical application for primary and secondary skin infection.
What adverse side effect can occur if a patient is taking skeletal muscle relaxants with aminoglycosides?
Neuromuscular blockade leading to flaccid paralysis and fatal respiratory depression.

<>Anticipate antidote of IV calcium gluconate for treatment of neuromuscular blockade.
What is important patient teaching when taking aminoglycosides?
Report tinnitus, high-frequency hearing loss, persistent headache, nausea, dizziness, vertigo. (Be aware of loss of hearing!!--this is irreversible injury that can be caused by aminoglycosides)
What are the types of antiretrovirals?
Zidovudine [Azidothymidine -AZT]: reverse transcriptase inhibitor (terminates viral replication)

Efavirenz [Sustiva]--Nonnucleoside reverse transcripatse inhibitor. (Blocks enzyme activity)

Saquinavir mesylate [Invirase]--Protease inhibitor (inhibits and prevents maturation of HIV)
How to antiretrovirals work?
Search for the virus, interrupt and hider growth, but are unable to kill the virus totally. The retrovirus can take on different shapes and forms, which fools the antiviral agents.
What is HAART?
Stands for Highly Active Antiretrovial Therapy--in which the infection is a treatment that involves 3 or 4 drugs.
Give an example of an retrovirus.
HIV
Describe HIV fusion inhibitor.
Antiretroviral--Blocks the entry of virus into CD4-T cells.
--It is a new category with only one drug, Enfuvirtide [Fuzeon].
-Used when resistance to other medications occur.
What are the most frequent side effects of antiretrovirals?
NNRTI: CNS symptoms (dizziness, insomnia, drowsiness), Rash
PI: Hyperglycemia
HIV infusion inhibitor: Injection site reactions.
What is important nursing teaching for clients taking antiretrovirals?
+Take the full dose and complete treatment regimen.
+Report symptoms related to severe rash, CNS issues, diabetes, pneumonia.
What is important to know about antiretrovirals and pregnancy?
Pregnant women should receive antiretroviral therapy regardless of pregnancy status.
What are the various antiviral medications?
REMEMBER: VIR at the start, middle or end of the word means used for virus:

AcycloVIR, EfaVIRenz, InVIRase, EnfuVIRtide, RetroVIR, SaquinarVIR
What two antibiotics need to be avoided in pregnant women?

Also include other antibiotics that one must be cautious about in pregnancy.
Quinolones and Tetracyclines

The TWO QT's (cuties) say no to OBs.

<>MCAT:
-Metronidazole (in first trimester, category B in 2nd and 3rd timester)
-Cloramphenicol (Category C)
-Aminoglycosides (Caterogy C)
What are the FDA pregnancy risk Categories?
A: Remote risk of fetal harm
B: Slightly more risk than A
C: Greater risk than Category B
D: Proven risk of fetal harm; labeled as warming.
X: proven risk of fetal harm; labeled as contraindicated.
What is the action of Ciprofloxacin (Cipro)?
Inhibits DNA, inhibits enzymes in susceptible microorganisms, interfering with replication.
-It is bactericidal.
What type of infections is Ciprofloxacin [Cipro] used for?
Bacterial infection of the urinary, respiratory and GI tracts, as well as with bone, joint and ophthalmic infections.
<>Preferred drug treatment of inhaled anthrax
"For those hard to reach chronic bacterial infections"
When should caution be takenfor administering Ciprofloxacin (Cipro)?
Renal or CNS disorders. Seizures or those taking Theophylline.
What adverse side effects should be monitored for for a patient on Ciprofloxacin (Cipro)?
Can cause N/V, diarrhea, dyspepsia, constipation and flatulence, tendon rupture.
Heachaches, dizziness, restlessness and confusion.
Who should not be administered Ciprofloxacin (Cipro)
Individuals under the age of 18 should not be given Cipro.
What should a patient be taught who will be on Ciprofloxacin [Cipro]?
-avoid antacids, iron supplements and dairy products for at least 2 hours after taking medication.
-Teach client to report any tendon pain or inflammation.
-Adequate fluid intake is necessary, 6-8 glasses a day.
What are important nursing implications for administering Ciprofloxacin (Cipro)?
-Administer IV over 60 minutes.
-Dosage regimen for anthrax inhalation is over a 60-day period.
What are the uses of Penicillin (PCN)
Gonorrhea, UTI, pneumonia and other respiratory infections, Septicemia, Peritonitis, Meningitis.
What are the adverse reactions of Penicillins (PCN)?
GI distress, Oral or vaginal candidiasis, Generalized rash, Anaphylaxis.
What is the mechanism of action of Penicillins?
Bactericidal disrupts and weakens the cell wall, leading to cell lysis and death.
What are the patient teaching instructions for Penicillins?
Instruct client to check label with regard to administering with food.
-Instruct client to wear medication-alert bracelet if allergic to penicillin.
What are the important nursing implications for Penicillins?
-Monitor client for 30 minutes when given parenterally; administer epinepherine if anaphylaxis occurs.
-Collect any laboratory culture specimens before initiating penicillin therapy.
-Monitor for circulatory overload and bleeding tendencies when client receives ticarcillin and carbenicillin.
Azithromycin (Zithromax) can be used to treat what?
-Upper Respiratory tract bacterial infections: Pharyngitis, Tonsillitis
-Uncomplicated skin or skin structure infections
-Lower Respiratory Tract infections: Pneumonia, Mucobacterium avius complex (MAC), Exacerbations of COPD, Chlamydia.
Sexually Transmitted Diseases: Nongonoccocal urethritis, gonorrhea, chancroid in men.
What is the mechanism of action of Azithromycin (Zithromax)?
Azithromycin binds with ribosomal receptor sites in susceptible organisms to inhibit protein synthesis.
What adverse reactions needs to be watched for with Azithromycin (Zithromax)?
N/V, Diarrhea, abdominal pain and suprainfections.
How is Azithromycin (Zithromax) packaged?
It is packaged in a 7-day dose pack.
What are important nursing implications for Azithromycin (Zithromax)?
-Administer 1 hour before or 2 hours after food or antacids.
-Observe for development of signs of syprainfection.
What is important patient teaching for Azithromycin (Zithromax)?
-Take medication 1 hour before or 2 hours after food or antacids.
-Instruct to take prescribed course of therapy, although symptoms may improve or disappear.
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