Antivirals & Antifungals
Acyclovir is both nephrotoxic and _________________?
neurotoxic
What are the 3 general ADRs to abx that NEED to be reported to the PCP?
superinfections, allergic/hypersensitivity rxns and anaphylaxis, organ toxicity (the big three- ototoxicity, nephrotoxicity, hepatotoxicity)
4 Parts: What are the 2 ADRs listed on your slides for azithromycin? and what class is this medication? what labs do we monitor? and should the patient take other hepatotoxic drugs?
hepatotoxicity and SJS; macrolides; LFTs; no
Nitrofurantoin
Aminoglycosides are ototoxic and nephrotoxic. what 2 things related to hearing should we assess at baseline?
hearing and balance
Those on high-dose acyclovir need to increase their intake of PO fluids in order to prevent what potential ADR? Bonus: what are we monitoring to let us know that the kidneys are starting to potentially become damaged?
crystalluria; urine output
True or False. Taking amoxicillin is CI'd if the patient has an allergy/sensitivity to other PCNs and if the patient has an allergy/sensitivity to cephalosporins.
TRUE. Both are CI's and should be reported to the PCP if ordered.
Why do we give IV vancomycin (glycopeptide antibiotic) slowly over 60-90 minutes?
to prevent red man/neck syndrome
This is an antibiotic that is used for a lot of GI and GU infections. Patient education includes abstinence from alcohol during treatment and for 72 hours post treatment.
metronidazole
These two labs are critical when a patient is taking IV vancomycin and IV gentamicin because of the narrow TI which can cause toxicity quickly in patients.
bonus: what is our first action if we see decreased urine output or if the patient tells us there's ringing in their ears/they feel dizzy and off-balance?
peak and trough levels; bonus- get a drug level!
nystatin; fluconazole
Abx should not be taken with what types of juices and fruits?
citrus juice and fruits. ex) grapefruit juice, orange juice, lemon juice, lime juice, lemons, limes, grapefruits, oranges, etc.
what two organs is vancomycin toxic to?
ears and kidneys
Phenazopyridine is a urinary analgesic that can cause what harmless side effect?
red/orange urine and secretion discoloration
Ciprofloxacin has a BB warning for what?
tendon rupture
2 Part: High doses for prolonged periods of time of which antifungal medication can be hepatotoxic and what labs are we monitoring?
fluconazole; LFTs (AST, ALT)
True or False. Ceftriaxone is a cephalosporin that we use for bacterial infections and for pre-operative and post-operative prophylaxis.
True.
what are the 2 main ADRs of doxycycline (tetracyclines)?
photosensitivity and tooth/nail discoloration
True or False. Phenazopyridine must be used with an antibiotic when treating a UTI.
True- this is a urinary analgesic and NOT an antibiotic.
True or False. Ciprofloxacin should be avoided in children under the age of 14 because of the potential for arthropathy (fancy word for "any type of disease that affects the joint. usually, it damaged cartilage. but this is only proven in animals models and not really in kids...)
true
2 Parts: what are my expected outcomes if I give a patient acyclovir or if I give them fluconazole (bonus- and nystatin)?
resolution in viral symptoms/remission of the viral shedding/ remission of the exacerbation of the virus; resolution of perineal (OR other systemic) fungal infections; bonus- resolution of oral candidiasis
This is a resistance that happens when the bacteria is repeatedly exposed to the same antibiotic. bacteria grow and mutate quickly and are able to develop ways around the antibiotic so that the antibiotic can't kill them anymore. (think simple terms/explanations here)
True or False. The patient taking tetracyclines should not take them with antacids, milk/calcium-containing products, or iron because these substances bind to the antibiotic and decrease absorption of the medication.
True
A patient taking doxycycline or TMP-SMX (trimethoprim- sulfamethoxazole) is at risk for what SE? (bonus question- think...what does the patient need to know about this SE?)
photosensitivity...(bonus answer- not gonna give it!)
The RN needs to monitor ANY patient taking ANY antibiotic medication (or ANY medication in general) for the development of what 2 life-threatening ADRs?
anaphylaxis and angioedema