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76 Cards in this Set
- Front
- Back
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The ____________ have been widely used to treat serious gram negative infections for many years.
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Aminoglycosides
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The __________ are older drug originally used only for treatment of urinary tract infections.
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Quinolones
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The _________ are synthesized by adding a fluorine molecule to quinolone structure.
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Fluoroquinolones
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Aminoglycosides are _________ agents with similar pharmacologic antimicrobial and toxicologic characteristics.
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Bactericidal
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Has been associated with hypoglycemic and hyperglycemic events more commonly than other fluoroquinolones
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Gatifloxacin
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May be given to suppress intestinal bacterial before bowel surgery and to treat hepatic coma
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Neomycin and kanamycin
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Is associated with severe liver injury leading to liver transplantation or death and should be reserved for serious infections only.
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Trovafloxacin
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Is not recommended for use in infants and children.
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Neomycin
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Is associated with increased risk for ototoxicity in older adults.
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Kanamycin
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The Fluoroquinolones are synthesized by adding a fluorine molecule to the quinolone structure. Explain how this addition changes the drug activity of this antibiotic
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The fluoroquinolones are synthesized by adding a fluorine molecule to the quinolone structure. This addition increases drug activity against gram negative microorganisms, broadens the antimicrobial spectrum to include several other microorganisms and allows use of the drugs in treating systemic infections.
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Give examples of microorganisms that amioglycosides are used to treat.
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Aminoglycosides are bactericidal agents with similar pharmacologic antimicrobial and toxicologic characteristics. They are used to treat infection caused by gram negative microorganisms such as pseudomonas and proteus species, escherichia coli, and klebsiella enterobacter and serratia species.
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Explain how aminoglycosides are absorbed.
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Aminoglycosides drugs are poorly absorbed from the gastrointestinal tract. When given orally the exert local effects in the GI tract. The are well absorbed from IM injections sites and reach peak effects in 30 to 60 mins. Plasma half life is 2 to 4 hrs with normal renal function.
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After parenteral administration aminoglycosides they are widely distributed throughout the body. Discuss the areas in the body where aminoglycosides are accumulated and the impact on body systems.
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After parenteral administration aminoglycosides are widely distributed in extracellular fluid and reach therapeutic levels in blood, urine, bone inflamed joints and pleural and ascetic fluids. They accumulate in high concentrations in the proximal renal tubules of the kidney is termed tubular necrosis. The is damage to the kidney is termed nephrotoxicity. The also accumulate in high concentrations in the inner ear damaging sensory cells in the cochlea and the vestibular apparatus. This damage to the inner ear is termed ototoxicity. They are poorly distributed to the CNS intraocular fluids and respiratory tract secretions.
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Where are aminoglycosides excreted in the body?
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Injected aminoglycosides are not metabolized; they are excreted unchanged in the urine, primarily by glomerular filtration. Oral aminoglycosides are excreted in feces.
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Mrs. Smith age 75 diagnosed with an infection. She is currently being treated for type 2 diabetes hypertension, benign prostatic hypertrophy and chronic congestive heart failure. The physician orders a fluoroquinolone to treat the infection. Fluoroquinolones are associated with which of the following?
a. Hypoglycemia and hyperglycemia b. Atrial Fibrillation c. Exacerbation of congestive heart failure d. Hypertensive crisis |
a
Rationale: Fluoroquinolones are associated with hyperglycemia and hypoglycemia and older patients my be more at risk for these glucose disturbances. |
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Mr. Bates is prescribed aminoglycosides for a bladder infection secondary to benign prostatic hypertrophy. These drugs reach higher concentration in which of organs? (select all that apply)
a. Kidneys b. Inner ears c. Pericardium d. Peritoneum |
a, b
Rationale: Aminoglycosides reach higher concentration in the kidneys and inner ears than in other body tissues; this is a major factor in nephrotoxicity and ototoxicity. |
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Mr. Johnson develops a wound infection and the physician orders once daily intravenous multiple dose regimens of aminoglycosides. Which of the following kinds of monitoring do you expect the physician to order?
a. Peak and trough serum levels b. A complete blood count every 48hrs c. A serum albumin determination every 48hrs d. Measurement of electrolytes every 48hrs |
a
Rationale: Multiple dose regimens (conventional dosing) of aminoglycosides must be carefully monitored with evaluation of peak through serum levels. Once daily regimens are monitored with random level (12hr) serum evaluation. |
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Mr. Gonzalez is a scheduled for a bowel resection secondary to an exacerbation of his Crohn's disease which did not respond to medical management. You would expect the physician to order _________ or _________ before surgery to suppress intestinal bacteria.
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Neomycin or Kanamycin
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The major clinical use for parental aminoglycosides is to treat serious systemic infection caused by susceptible __________ gram negative organisms.
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aerobic
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Before the selection of an aminoglycoside to treat Mr. Jones would infection which of the following would you expect the physician to order?
a. White blood count b. Electrolyte panel c. Complete blood count d. Culture and sensitivity |
d
Rationale: The choice of aminoglycoside depends on local susceptibility patterns and specific organisms causing an infection. |
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Mr. Adams is concerned that he cannot afford to have his wife's community acquired pneumonia treated in the hospital. He has limited health insurance and the cost of IV antibiotic therapy is prohibitive. According to the American college and Chest Physicians position statement where will Mr. Adam's wife be treated?
a. In the hospital using IV therapy. b. In the home using oral drugs c. In the hospital using oral medications d. In the home using IV therapy. |
b
Rationale: An increasing number of individuals with CAP are being treated at home for a number of reasons including increased availability and cost consideration of oral antibiotics. Oral drugs have demonstrated effectiveness and are the preferred route for individuals and family members but management with oral drugs has widely varied. The American College of chest physicians position statement cosponsored by the American Academy of home care physicians outlines recommendation for home care for patients with CAP and follow up. Recommendation in the position statement take into consideration the best plan of care incorporation the best available evidence with clinician judgment and patient preferences. |
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Mrs. Harrison age 80 is a type 2 diabetic whose condition is controlled by glyburide. She develops and infection and the physician orders fluoroquinolones as a treatment. With this combination of medications Mrs. Harrison is at risk for which of the following?
a. Hyperglycemia b. Diabetic ketoacidosis c. Severe hypoglycemia d. Diabetic shock. |
c
Rationale: Fluoroquinolones are associated with hyperglycemia and hypoglycemia. Older patients may be more at risk for these glucose disturbances. Severe hypoglycemia has occurred in patients receiving concomitant glyburide and fluoroquinolones. |
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You call a covering physician with the results of a culture and sensitivity test for Mrs. Harrison (as addressed in question 8) THe physician orders Gatifloxacin. Gatifloxacin increases Mrs. Harrison risk for which of the following conditions?
a. Hyperglycemia b. Diabetic ketoacidosis c. Severe hypoglycemia d. Diabetic shock. |
c
Rationale: Gatifloxacin has been associate with hypoglycemic and hyperglycemic events more commonly then other fluoroquinolones. The explanation for an increased association with gatifloxacin is not currently know. |
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Mr. Giles is NPO as a consequence of a cerebrovascular accident sustained 3yrs ago. His care is managed at home by his wife, and he receives all medications via gastrostomy tube. The physician orders a Fluoroquinolone for Mr. Giles to treat an infection. You would instruct Mrs. Giles to administer the medicatoin in which of the following ways?
a. With the enternal feeding b. On a full stomach c. With antacids d. On an empty stomach |
d.
Rationale: Fluoroquinolones are usually infused IV in critically ill patients. However, administration orally or by GI tube may be feasible in some patients. Concomitant administration of antacids or eternal feedings decreases absorption. |
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Mr. Walsh is a patients in your critical care unit. He is receiving aminoglycosides for an infectious process. Which of the following do you need to monitor?
a. Complete blood count b. Liver function tests c. Serum albumin concentration d. White blood count |
b.
Rationale: Because critically ill patients are at high risk for development of nephrotoxicity and ototoxicity with aminoglycosides guidelines for safe drug use should be strictly followed. Renal function should be monitored to assess the needed dosage reduction in patients with renal dysfunction receiving who are aminoglycosides or fluoroquinolones. Because fluoroquinolones may be hepatotoxic hepatic function should be monitored during therapy. |
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Aminoglycosides and fluoroquinolones are often used in ______________ patients because of this population has a high incidence of serious and difficult to treat infections.
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Critically Ill
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A black box warning reports that ______________ is associated with severe liver injury leading to liver transplantation or death and should be reserved for serious infection only. Clinical manifestation range from abnormalities in liver enzyme test results to hepatitis liver necrosis and hepatic failure.
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Trovafloxacin
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Mr. Wallace, a ventilator dependent patient is admitted to your critical care unit. His current diagnoses include respiratory arrest, diabetes type 2, hepatitis C, and chronic obstructive pulmonary disease. They physician orders aminoglycosides. Which of the following statements is true in this case?
a. Risk for hepatic impairment is significant because the drug is metabolized in the liver. b. Risk for hepatic impairment is significant because of a higher risk for toxicity. c. Risk for hepatic impairment is not significant because of the drug is excreted through the kidneys. d. Risk for hypertensive crisis in increased. |
c.
Rationale: With aminoglycosides, hepatic impairment is not a significant factor because the drugs are excreted through the kidneys. |
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Which fluoroquinolones, reported renal effects include which of the following? (select all that apply)
a. Glycosuria b. Azotemia c. Crystalluria d. Hematuria |
b, c, d
Rationale: With aminoglycoside reported renal effects include azotemia, crystalluria, hematuria, interstitial nephritis, nephropathy, and renal failure. |
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Aminoglycosides are ______________ and must be used very cautiously in patients with renal impairment.
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Nephrotoxic
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Aminoglycosides must be used cautously in children as in adults. Dosage must be accurately calculated according to which of the following factors?
a. Weight and renal function b. Height and weight c. Age and weight d. Weight and Leukocytosis |
a.
Rationale: Aminoglycosides must be used cautiously in children as with adults. Dosage must be accurately calculated according to weight and renal function. |
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A patient who is receiving aminoglycosides must be kept well hydrated for which of the following reasons?
a. Hydration increases drug concentration in serum and body tissues. b. Hydration decreases drug concentration in serum and body tissues. c. Hydration stabilizes peak serum levels d. Hydration stabilizes trough serum levels. |
b
Rationale: Guidelines to decrease the incidence and severity of adverse effects when administering aminoglycosides including the following: Keep patients well hydrated to decrease drug concentration in serum and body tissues. |
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With impaired renal function, dosage of aminoglycosides must be ______________
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Reduced
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_______ doses are based on serum drug concentrations.
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Maintenance
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What are the GFR Lab values to check for Renal function?
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60 -130 umol/l
Less than 60 indicates renal problems. |
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Name the common Aminoglyscosides (very nephrotoxic)
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Amikacin
Gentamicin Kanamycin Neomycin Streptomycin Tobramycin |
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Name the common Fluoroquinolones
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Ciprofloxacin
Gatifloxacin Gemifloxacin Levolfloxacin Moxifloxacin Norfloxacin Ofloxacin |
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What is the main route of elimination of fluoroquinolones?
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Kidneys
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Creatinine lab values are from _____ to ____ mg/100mL or _______ to _______ umol/L?
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0.7 -1.4mg/100mL
60-100umol/L |
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If patient falls below _______ mL per hr output when does the nurse suspect renal trouble.
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30mL
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What are the normal Potassium lab values?
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3.5 - 5 mEq/L
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What are the normal Sodium (Na+) lab values?
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135 - 145 mEq/L
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What are the normal Chloride(Cl-) lab values?
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97 - 107 mEq/L
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What are the normal Calcium (Ca+) lab values?
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8.6 - 10.2mg/dl
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What are the normal Magnesium (Mg) lab values?
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1.3 - 2.3 mEq/L
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What are the normal Phosphate lab values?
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2.5 - 4.5mg/dl
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What are the normal arterial blood pH lab values?
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7.35 - 7.45
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What are the normal HCO3 lab values?
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22-26 mEq/L
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What are the normal PaCO2 lab values?
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35- 45mm Hg
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What are the normal PaO2 lab values?
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70 - 100 mmHg
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Normal Oxygen saturation is?
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90 - 95%
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Creatinine clearance for males is ?
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85 -125mL/min 1.42 - 2.08 mL/s
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Creatinine clearance for females is?
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75 - 115 mL/min 1.25 - 1.92 mL/s
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What is a normal blood glucose fasting level?
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60 - 100 mg/dL 3.9 -5.6 mmol/L
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What is a normal protein level?
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6.0 - 8.0g /100mL 60-84g/L
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What is a normal albumin level?
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3.5 -5g/100 mL 33-50g/L
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What is a normal Globulin level?
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1.5 -3.0g/100mL 23 - 35g/L
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What are aminoglycosides mainly used for?
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To treat serious gram negative infections
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What are were fluoquinolones originally used for?
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To treat UTI's
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Pseudomonas, Proteus, E. Coli, Klebsiella, Enterobacter, and Serratia can be treated with?
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Amikacin (Amikin)
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This drug retains a broader spectrum of antibacterial activity then other aminoglycosides because it resists degradation by most enzymes that inactivate gentamicin and totramycin. Major clinical use is in infections caused by organisms resistant to other aminoglycosides whether community or hospital acquired.
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Amikacin (Amikin)
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____________ penetrate the cell walls of susceptible bacteria and bind irreversibly to 30S ribosomes, intracellular structures that synthesize proteins. As a result the bacteria cannot synthesize the proteins necessary for their function and replication.
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Aminoglycosides
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This drug is effective against gram negative organisms and some strains have become resistant. Acts synergistically with antipseudomonal penicillins against pseudomonas aeruginosa and ampicillin or vancomycin against enterococci.
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Gentaminicin
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An _________ is based on patient weight and the desired peak serum concentration.
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Initial loading dose
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True or false?
If a patient is obese, or lean ideal body weight should be used to calculate dose because aminoglycosides are not significantly disturbed in body fat. |
True
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Occasionally used to decrease bowel organisms before surgery,treat hepatic coma,or treat multidrug-resistant tuberculosis
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Kanamycin
(Kantrex) |
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Given orally or topically to prepare GI tract for surgery Although poorly absorbed from GI tract,toxic levels may accumulate in presence of renal failure.Used topically,often in combination with other drugs,to treat infections of the eye,ear,and skin (burns,wounds,ulcers,der-matoses)When used for wound or bladder irriga-tions,systemic absorption may occur if thearea is large or if drug concentration exceeds 0.1%.
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Neomycin
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May be used in a 4- to 6-drug regimen for treatment of multidrug-resistant tuberculosis
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Streptomycin
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Similar to gentamicin in antibacterial spectrum,but may be more active against
Pseudomonas organisms Often used with other antibiotics for septicemia and infections of burn wounds,other soft tissues,bone,the urinary tract,and the central nervous system |
Tobramycin
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1.Effective in respiratory,urinary tract,gastrointestinal tract,and skin and soft-tissue infections as well as sexually transmitted diseases caused by chlamydiae and Neisseria gonorrhoeae
organisms 2.Used as one of 4 to 6 drugs in treatment of multidrug-resistant tuberculosis 3.Used to treat anthrax infections |
Ciprofloxacin
(Cipro) |
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Indicated for pneumonia,bronchitis,sinusitis,skin and soft tissue infections,urinary infections,pyelonephritis, and gonorrhea
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Gatifloxacin
(Tequin) |
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Indicated for acute bacterial exacerbation of chronic bronchitis and community-acquired pneumonia (mild to moderate severity)
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Gemifloxacin
(Factive) |
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A broad-spectrum agent effective for treatment of bronchitis,cystitis,pneumo-nia,sinusitis,skin and skin-structure infections,and pyelonephritis
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Levofloxacin
(Levaquin) |
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Indicated for community-acquired pneu-monia,sinusitis,bronchitis,skin and soft-tissue infections
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Moxifloxacin
(Avelox) |
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Used only for UTI
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Norfloxacin
(Noroxin) |
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True or false
Avoid exposure to sunlight during and for several daysafter taking one of these drugs.Stop taking the drug andnotify the prescribing physician if skin burning,redness,swelling,rash,or itching occurs.Sunscreen lotions do notprevent photosensitivity reactions |
True
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