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Bonnie Cooley

on 17 March 2016

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Transcript of Anti-Infectives

Normally found in and around body
At risk:
another illness concurrently
frequent exposure (nurses)
very young
very old
break in barrier (skin)
Virus is an organism that usually needs another "host" cell in order to survive.
At risk:
diet high in sugar/carbs
people wearing wet bathing suits a lot (lifeguards) or constrictive clothes such as thongs/tight jeans

effective against bacteria
spectrum (broad or narrow)
generation (1st, 2nd, etc)
are becoming less effective with over-use
bactericidal vs bacteriostatic

Antiparasitic treatment
broad spectrum
"safest" antibiotic
used as prophylaxis to prevent endocarditis in patients with congenital heart disease and valve replacements
common problems: rash, allergy, anaphylaxis, angioedema
resistant strains--use Augmentin which is amoxicillin
clavulanic acid
decreases effectiveness of OCPs

Causes of Infection
Chapter 12
Lives in or on another organism
Uses the other organism for survival--food, etc.
Anti-virals covered in chapter 13
Antifungals covered in
chapter 13
The mother of a 7 year old brings her child in to the provider's office for treatment of a tick bite. The mother was treated earlier with doxycycline as prophylaxis for tick-borne disease. The child is given a prescription for a different antibiotic (not doxycycline). The mother asks why the child is given a different antibiotic.
What do you tell her?
You provide care to a hospitalized patient with an infection. Which of the following orders should be performed first?
a. gentamycin 150 mg q 8 hours IV
b. sputum culture
c. CBC with diff
d. reg diet
An 81 year old female is being treated for a sinus infection. She has been prescribed high-dose amoxicillin. She wants a prescription for ciprofloxacin, which she said "worked last time I had an infection"
What is your best response?
A patient has been prescribed tobramycin. Which of the following conditions, if in the patient's history, is a cause for concern?
a. cataracts
b. hepatitis B
c. chronic renal failure
d. alopecia
A patient has been prescribed Cipro (ciprofloxacin) for a UTI. Important information for the client is:
a. take on an empty stomach
b. take on a full stomach
c. don't take with your multivitamin
d. avoid spicy foods when taking this medication
ameoebas are one celled parasites
cause ameobic dysentary or liver abscess
use Flagyl (metronidazole)

considered an antiparasitic and antibacterial
disrupts DNA in cell (parasite/bacteria)
used to treat infections such as amebic liver abscess or intestinal amebiasis, PID, bacterial vaginosis, trichomoniasis, c-diff, H-pylori
*decrease dose with severe liver impairment
may produce anta-buse type reaction with alcohol
Meredith presents to her provider with complaints of green, frothy vaginal discharge and a vaginal odor which is worse after sex. She is prescribed Flagyl (metronidazole) for trichomoniasis. What is an
teaching point about this prescription?
a. this medication may cause tendon rupture
b. this medication should be taken with milk
c. this medication should not be taken with alcohol
d. this medication may cause constipation
Most common parasite in the US
treated with Albenza (albendazole) or Pin-X (pyrantel)
may need retreatment in 2 weeks (to kill hatching eggs)
easily spread amongst family members
side effects vary--include blood dyscrasias, renal and hepatic failure, meningeal signs, alopecia
malaria is caused by a protozoan Plasmodium
carried by infected mosquitoes
preventative: start 2 weeks prior to travel and 8 weeks after return
Plaquenil (also used for RA) may cause yellowing of skin, severe nausea, vomiting, anorexia, diarrhea, tinnitus, vision changes
doxycycline may also be used
The patient returns from a mission trip to Kenya. He returned two weeks ago and presents to the office for his physical exam. He asks if he can stop taking his malaria prevention now, since he didn't "get malaria". The nurse knows:
a. he can stop taking the medication since he is back
b. he should continue the medication in case he wants to go back within the next year
c. he should continue the medication for a total of 8 weeks
d. he should switch to doxycycline since he is back in the country
broad spectrum
used for Lyme, RMSF, (rickettsial), chlamydia, H pylori, acne
best taken on an empty stomach but may cause nausea
side effects:
discoloration of teeth
clarithromycin, azithromycin, erythromycin
broad spectrum
used to treat COPD exacerbation, CAP (community acquired pneumonia), sinusitis, strep (if patient is PCN allergic), chlamydia, PID, legionnaire's, pertussis
side effects:
liver failure
stomach upset (best if taken on an empty stomach)
skin rash

streptomycin, tobramycin, gentamicin, amikacin
broken down in stomach, so must be given IV/IM
bactericidal, broad/narrow spectrum
side effects:

Ciprofloxacin, Levaquin (levofloxacin)
synthetic antibiotic, broad spectrum
used to treat COPD exacerbation, CAP, prostatitis, pyelonephritis, sinusitis, UTI, anthrax
side effects: n,v,d, hepatotoxicity, nephrotoxicity, tendon rupture (especially in older adults), EKG abnormalities such as QT prolongation and torsades de pointes
*vitamin and mineral supplements decrease effectiveness of this medication and should be avoided while taking fluoroquinolones
avoid sucralfate and antacids
similar actions as PCN
used to treat COPD exacerbation, sinusitis, trep and staph infections, skin infections

divided into "generations"

examples: cefdinir, ceftriaxone, cefotaxime, cefaclor, cefuroxime
side effects:
n, h/a, rash
cross reaction/allergy to PCN
A patient is prescribed cefdinir (a cephalosporin) for a sinus infection. She has a history of an anaphylactic reaction to PCN. What is the best action for the nurse:
a. administer the cephalosporin
b. advise the patient to drink a full glass of water with the medication
c. hold the medication and inform the provider of the reaction
d. call the provider for a decreased dose of the medication
Bactrim/Septra (trimethoprim/sulfamethoxasole), Pediazole (erythromycin/sulfisoxazole
used to treat otitis, UTIs, bronchitis, traveler's diarrhea, pneumocystis
side effects: n, v, d, h/a
*watch for rash--possible Stevens Johnson

IV, may have order to mix IV powder with water
used for severe bacterial infections, c.diff
side effects:
lengthy list including superinfection, ototoxicity, nephrotoxicity, Stephens-Johnson, blood dyscrasias, tissue necrosis (IV site), hypotension (rapid administration), anaphylaxis, tinnitus, urticaria, n,v, rigors

drugs such as isoniazid, dapsone, rifampin
may or may not kill the organism
may be used as prophylaxis (INH)

methicillin resistant staphylococcus aureaus
spread by contact
May need vancomycin (skin, pneumonia)
Bactrim (trimethoprim/sulfamethoxasole) (UTI),
vancomycin resistant enterococcus
enterococci normally live in bowel
need to use combination of meds or Zyvox (linezolid) depending on culture results
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