What is a Super infection/supra-infection
A supra-infection is simply a special example of the emergence of drug resistance.
� Define Supra-Infection
A new infection that appears during the course of treatment for a primary infection.
� Give an example of a supra-infection?
Oral thrush
� What do we do before we give antibiotics?
Culture and sensitivity (blood, urine, feces, emesis)
� What is the reason why the patient needs to be compliant with antibiotics
o Because it can make the patient resistant to the antibiotic in the future and create a supra-infection.
� What are the reasons a doctor would prescribe two different antibiotics at the same time?
Prescribing two antibiotics would create an additive, potentiate and antagonistic affect.
� What are some disadvantages of combining antibiotics?
Risk of allergic response is increased with two antibiotics
� Why do you give anti-biotic before surgery
o Prophylaxis (prevention)
� Factors that can effect anti-biotic therapy
o The site of infection, the age of the individual, pregnant or lactating, previous allergic reaction, and genetic factors.
� What is the specific mechanism of action of penicillin's?
They weaken the cell wall causing bacteria to take up excessive water and rupture. Penicillin's are only active in bacteria that are undergoing growth and division.
� What is the time frame for an immediate reaction to occur?
2-30 minutes
� What is the time frame for an accelerated reaction to occur?
1-72 hours
� What is the time from for a late reaction to occur?
Late reactions can take days or weeks to occur
� What do administer when an allergic reaction occurs from an antibiotic
o Give epinephrine
� Before you give any antibiotic, what's the first thing you ask the patient
o Do you have drug allergies?
� What is Steven/Johnson syndrome?
The most severe hypersensitivity response to sulfonamides with a mortality rate of 25 %.
� What are the signs and symptoms of Steven/Johnson syndrome?
Wide spread lesions of the skin and mucous membranes, combined with fever, malaise and toxemia.
� What kind of sulfonamides are most likely to induce Steven/Johnson syndrome?
Long acting sulfonamides which are now banned in the United States however, intermediate acting sulfa drugs such as Bactrim can cause this reaction
� Who should you not give sulfonamides too?
Individuals with hypersensitivity to chemically related drugs including thiazide diuretics, loop diuretics , certain hypoglycemic.
� What happens when a nurse gives an antibiotic such as Bactrim and Coumadin?
o Sulfa drugs increase the intensity of blood thinners such as Coumadin.
� What are some side effects and adverse effects of Bactrim
Steven/Johnson syndrome, C-Diff, Renal damage, and blood dyscrasias ( anemia, leukopenia)
� When do you administer nizorale (antifungal) and a PPI or H2 receptor antagonist ?
o Nizorale should be administered on an empty stomach to increase the absorption. It should NOT be given with H2 antagonists or antacids
� Why is nizorale not absorbed well when given with an antiacid or H2 antagonist?
Because absorption of nizorale requires gastric acidity
� Adverse effects for amphotericin B (anti-fungal agent) intravenously?
Produces fever, chills nausea and headache these reactions are caused by the release of pro inflammatory cytokines and macrophages. These effects begin 1-3 hours after starting infusion. Nephrotoxicity is huge!!!
� What is the maximum dose and individual should receive of amphotericin B?
No more than 4 grams total
� What is an additional side effect of Amphotericin B?
Hypokalemia, potassium supplements may need to be given to correct the problem.
� When you give amphotericin B (antifungal) what do you pre medicate with?
o Benadryl, Tylenol, Demerol.
� What is the mechanism of action for penicillin's?
Penicillin's work by weakening the cell wall causing bacteria to take up excessive water and rupture.
� What needs to be specific about the bacteria in order for penicillin to work?
Penicillin is only active against bacteria that are undergoing growth and division
� What are some mechanisms of bacteria resistance against penicillin?
1. Inability of penicillin's to reach their targets
2. Inactivation of penicillin's by bacterial enzymes
3. Production of penicillin-binding proteins that have a low affinity for penicillin's.
� Give some examples of broad spectrum penicillin's?
Amino-penicillin's such as ampicillin and amoxicillin
� What are some adverse reactions to broad spectrum penicillin's?
Rash and diarrhea
� What is Ticarcilin?
One of the broadest antimicrobial spectra of all penicillin's.
Patients taking ticarcilin are at high risk for sodium overload, watch CHF patients closely.
� Describe sulfonamides:
The first drugs available for universal treatment of bacterial infections (most commonly used to treat UTI's)
Define antiseptic (living) :
Controlling infection: reducing or preventing infections especially in the growth of microorganisms that cause disease or decay - APPLIED TO LIVING TISSUE!
� Define disinfectant (non-living) :
Chemical that kills germ: a chemical that destroys or inhibits the growth of microorganism that cause disease- APPLIED TO OBJECTS, TO HARSH FOR LIVING TISSUE!
� Describe an ideal antiseptic?
Safe
Effective
Selective
Germicidal
Broad spectrum of antimicrobial activity
� Define sterilization:
Complete destruction of all microorganisms
� Define sanitization:
Contamination has been reduced
� What does germicidal mean?
Decreases the growth and replication but does not kill germs
� Proper hand washing techniques
The CDC recommends alcohol based hand rubs for routine hand antisepsis
� What is DKA?
Diabetic Ketoacidosis, a severe manifestation of insulin deficiency
� Signs and Symptoms of DKA?
o Symptoms evolve quickly, Hyperglycemia, acidosis
o Ketones in urine, acidotic.
� How do you treat DKA?
Insulin replacement
Bicarbonate for acidosis
Water and sodium replacement using normal saline
Potassium replacement
Normalization of glucose levels
� Most reliable test to diagnose diabetes
o A1C
� How would you mix regular insulin with NPH insulin?
Put the air in both vials first, then draw up regular insulin fallowed by drawing up NPH (R before N, because we are ALL going to be RN's?)
� What is hyperthyroidism? And what are two of the most common forms of hyperthyroidism?
Over production of the thyroid
Graves' disease and Toxic Nodular Goiter (Plummer's disease)
� Describe Graves' disease?
Most common among women of ages 20-40 cause's exophthalmos (eyes balls popping out of the head)
� Describe Toxic nodular goiter (Plummer's disease)
Caused by thyroid stimulating immunoglobulin's
Treated by surgical removal of thyroid tissue
And suppression of thyroid synthesis
� How long is an individual on thyroid replacement therapy?
For the rest of their lives
� What is Cushing's Syndrome?
The hyper secretion of the adrenocorticotropic hormone (ACTH)
Hyper secretion of glucocorticoids
� What are the presenting signs and symptoms of Cushing's syndrome?
Obesity, Hyperglycemia, Glycosuria, hypertension and fluid and electrolyte imbalances.
� What are some ways to treat Cushing's syndrome?
Surgical removal of the adrenal gland
Replacement therapy with glucocorticoids
What is Addison's syndrome.
It is a primary adrenocortical insufficiency
� What are the clinical symptoms present for Addison's disease?
Weakness and hypotension
Skinniness (emaciation)
Hypoglycemia, hypokalemia, hypernatremia
Increased pigmentation of the skin and mucous membranes
� When should medications for adrenal replacement therapy be given?
At bedtime so they peak during the waking hours
� How do you remove someone of a glucocorticoid medication?
You taper them, do not remove them abruptly.
� What are some examples of penicillin's derivatives?
Ticarcillin, Piperacillin Amoxacillin ( Amoxila, Dispermax, moxatag and trimax)
What are some Signs and symptoms of a UTI ?
Dysruria, urinary urgency and frequency
Suprapubic discomfort
Pyuria
Bacteriuria
� Adverse effects of macrodantin?
Can cause Steven/Johnson syndrome
Do not use if pregnant
� What is the drug of choice for MRSA?
o Vancomyicin
� Describe a complicated UTI?
Most common in males or females with structural or functional abnormality of the urinary tract
Such as: prostatic hypertrophy, renal calculi, nephrocalcinosis, indwelling catheter
� What is the bacteria that causes 80% of UTI's?
� What is the bacteria that causes� What is the bacteria that causes 80% of UTI's? 80% of UTI's?
Escherichia coli
� What are some common drug therapy's for an uncomplicated UTI?
Trimethoprim/Sulfamethoxazole