Unit 6 antibiotics - Faculty Sites
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Transcript Unit 6 antibiotics - Faculty Sites
Metropolitan Community College
Nursing Program
Nancy Pares, RN, MSN
Before Antibiotics
◦ Infections treated topically with ‘poultice’ or
surgically removed
1936…Sulfonamide discovered
◦ Beginning of understanding of microbes
1941…Penicillin introduced
◦ WWII had great results with high volume data
Present ….
◦ Man vs. microbe= resistant pathogens
Peak effect
◦ 15-30 min after infusion has begun
Trough effect
◦ Lowest point of medication effect
◦ Draw blood just before the next scheduled dose
Barriers/prevention
◦ Intact skin, adequate nutrition, respiratory cilia,
immune system
Seek and Destroy
◦ WBC, adequate blood supply, intestinal flora,
vaginal flora, stomach acids
Virulence of the pathogen
Number of pathogens
Chronic illness
Poor nutrition
Diseases/drugs that decrease the immune
system
Entry point
Super infections
Status of immune system
◦ May need prophylactic therapy
Location of the infection
◦ Many drugs do not cross blood brain barrier
Extent of inflammation
◦ Decrease circulation of drug
Age: metabolization of drug
Pregnancy: risks to fetus vs. benefit of drug
Genetics: enzyme deficiencies do not allow antibiotics to
clear system
Should be done before antibiotic initiated
Microscopic examination
◦ Urine, stool, blood, spinal fluid, sputum, purulent
drainage
◦ Identify the organism and test with antibiotics
Culture and sensitivity testing
Preliminary results within 24 hours
Final results in 2-3 days
Covered in objective 2
Passive immunity
◦ A person has been given vaccine
Active immunity
◦ Has had the disease
Acquired resistance
◦ Bacteria have randomly mutated and can transmit
mutated bacteria to others
◦ Healthcare practitioners role
Use antibiotics when indicated
Prophylaxis: deep tissue injury, prosthetic heart
valves
Antibiotics
do not
create mutations
Narrow
◦ Effective on limited number of organisms
Broad
◦ Effective on many organisms; often used first
Bacteriocidal
◦ Kills
Bacteriostatic
◦ Prevents growth and reproduction
Hypersensitivity
◦ Can result in anaphylactic shock/death
15% of penicillin users
Treat with Benedryl, corticosteroids, epinephrine
◦ Cross sensitivity
When antibiotics are closely related chemically
Organ toxicity
◦ Liver, kidneys, CNS, GI is most common
◦ Vancomycin highly nephrotoxic
◦ Gentamycin highly ototoxic
Hematotoxicity
◦ Chloramphenicol
Causes aplastic anemia
Bone marrow cannot make red blood cells
Action/use
◦ Kill bacteria by disrupting cell wall; chemical make
up responsible is beta lactam ring—
some bacteria secrete enzyme that splits the beta
lactam ring allowing the bacteria to become resistant
◦ Chemical modifications
Penicilinase resistant, broad spectrum, extended
spectrum
◦ Treatment of pneumonia, skin, bone and joint
infections, blood infections, gangrene, meningitis
Routes
◦ PO, IM, IV
Adverse effects
◦ Hypersensitivity most common
Nursing considerations
◦ VS, assess previous reactions, lab (electrolytes,
renal function, ECG, Observe for IV reaction within
30 min; client teaching; decrease effects of
contraceptives; take on empty stomach
◦ Pen G Procaine—not given IV= lethal
◦ Prototype: Pen G Potassium
Action/Use
◦ Bacteriocidal by attaching to penicillin binding
proteins to inhibit cell wall synthesis
◦ Gram negative infections and when less expensive
penicillins are not tolerated; 5-10% of people
allergic to penicillin are also allergic to
cephalosporins
Adverse reactions
◦ Hypersensitivity; kidney toxicity
Prototype—Cefotaxime (Claforan)
First generation
◦ Most effective against gram neg; beta lactamase
producing organisms usually resistant
Second generation
◦ More potent, broader spectrum, moderately
resistant to beta lactamase organisms
Third generation
◦ Longer duration of action, resistant to b-lactamase
◦ Drugs of choice for pseudomonas, klebsiella,
neisseria, salmonella and H. influenza
Fourth generation-treat CNS infections
◦ Use: gram + cocci; gram - bacilli
Nursing considerations
◦ Assess for bleeding disorders-check PT levels
Interferes with Vit K metabolism
◦ Assess kidney and liver function labs
Important in Vit K production
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Assess concurrent meds: (NSAIDS)
Monitor I&O
Assess GI symptoms
Client teaching
Cultured dairy (superinfection prevention); avoid
alcohol use, complete full RX; IM inj. painful
Action/Use
◦ Bacteriostatic; inhibits protein synthesis to slow
microbial growth
◦ Rocky Mtn Spotted fever, typhus, cholera, Lyme
disease, peptic ulcers (caused by H. pylori),
chlamydial infections
S/E
◦ n/v, diarrhea, photosensitivity, permanent
discoloration of teeth <8 yo
Nursing considerations
◦ Avoid use <8 yo, avoid sunlight/UV exposure;
monitor labs (CBC, liver function, kidney function)
◦ Teach importance of oral and perineal hygiene
due to super infections
◦ Do not take with milk products, iron supplements,
or antacids; wait 1-3 hrs before taking antacids;
wait 2 hrs before and after taking lipid lowering
drugs (Ca+ and iron bind with tetracycline)
◦ Decreases effectiveness of oral contraception
◦ Prototype: tetracycline
Action/use
◦ Bacteriocidal; inhibits protein synthesis
◦ Aerobic gram neg bacteria (e. coli, seratia,
proteus, klebsiella, pseudomanas); administered
with other antibiotic for entercocci infections.
S/E
◦ Irreversible ototoxicity, nephrotoxicity, respiratory
paralysis
Prototype: Gentamycin (Garamycin)
Nursing considerations
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Monitor for ototoxicity (How?)
Monitor for nephrotoxicity (How?)
Provide optimal oral hygiene
IV administration should be done slowly
Poorly absorbed via GI—only route is IV
Monitor peak and trough levels for toxicity
Quinolones/fluoroquinolones
◦ First introduced in 1962
◦ Currently four generations
Macrolides
◦ Low doses-bacteriostatic
◦ High doses-bacteriocidal
◦ Prototype: e mycin
Action/Use
◦ Bacteriocidal;inhibit enzymes (DNA gyrase and
topoisomerase) to affect DNA synthesis;gram
neg microbes
◦ Respiratory, GI, GU tracts; skin and soft tissue;
newer agents very effective against anerobes
S/E/route
◦ n/v; ADVERSE: dysrhythmias,liver failure and
CNS changes; not used in pregnancy; caution in
children; oral BID
Prototype:Ciprofloxicin (Cipro)
Most common= levaquin
Nursing considerations:
◦ Assess hypersensititivity; report neurologic
effects
◦ Phototoxicitity
◦ Don’t take with vitamins/mineral supplements (or
wait 2 hrs before and after
◦ Monitor labs
◦I&O
◦ Take all the prescription
Action/Use
◦ Binds to bacterial ribosome to inhibit synthesis
(act inside cell); bacteriostatic; effective against
gram + and -;treats whooping cough,
◦ Legionaire’s disease, H. influenza and
Mycoplasma pneumoniae
◦ Newer drugs synthesized from erythromycin—
less GI disturbance
S/E—very few
Prototype: erythromycin (E-Mycin)
Nursing considerations
Do not use in pregnancy
Assess history of hypersensititivity
Monitor labs (liver and kidney, INR)
Macrolides decrease warfarin metablism and
excretion
◦ Photosensitivity
◦ Complete the course of treatment
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Clindamycin (Cleocin)
◦ Grm + and – effectiveness
◦ Use: oral infections
◦ Contraindication: hypersensitivity
Limited use due to association w pseudomenbranous
colitis
Sulfonamides
◦ Action:bacteriostatic, broad spectrum, used for
UTI
◦ Classified by route of administration
Systemic and topical
◦ Systemic
Sulfisoxazole (Gantrisin)
◦ topical
Sulfadoxine (Fansidar)- not 1st choice drug
◦ Contraindicated in pregnancy and infants < 2
years (promotes jaundice);low soluability causes
crystals in urine
Vancomycin ( Vancocin)
◦ Reserved for severe infections; most effective with
MSRA; need peak and trough labs
◦ Sensititivity reaction: hypotension and rash with
rapid IV infusion (Red Man Syndrome)
Imipenim (primaxin)—carbapenem category
◦ Bacteriocidal; preparation specific for IV vs IM
◦ Stable for 4 hrs; synergistic effects with
aminoglycosides
◦ Use; septicemia/bacterial meningitis
Ketolides
◦ Use: respiratory infections
◦ Low incidence of adverse effects
Glycylcyclines
◦ Use: complicated skin infections; MSRA
Nursing Dx
Pain related to infection
Infection
Hyperthermia
Risk for injury related to adverse drug effects
Deficient knowledge related to drug therapy
Risk for deficient fluid volume r/t fever, diarrhea
from adverse drug effect
◦ Risk for non compliance r/t deficient knowledge,
cost of drug, drug effects
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Client will
◦ Report diminished signs and symptoms of infection;
decreased fever and fatigue; increased appetite
◦ Be free from or experience minimal adverse effects
◦ Verbalize understanding of the drugs use, adverse
effects and required precautions
◦ Demonstrate proper self administration
Monitor vs and symptoms of infections
Monitor hypersensitivity reaction
Monitor for severe diarrhea
Admin drug as ordered
Monitor for superinfection
Precaution regarding OTC
Monitor for photosensitivity
Determine food and drug interactions
Monitor IV site
Patient
◦ reports diminished signs and symptoms of
infection, decreased fever
◦ Is free from or experiences minimal adverse effects
◦ Verbalizes and understanding of the drugs use,
effects and precautions
◦ Demonstrates proper self admin.
Tuberculosis:
◦ Cause:
Mycobacterium tuberculosis
◦ Incidence:
◦ Treatment: prolonged due to cell wall resistance
to penetration by anti infective drugs
Multiple drug concurrently
Rifampin: used for H influenza
Isoniazid (INH)
◦ Action:
Inhibits synthesis of cell wall
◦ Use:
tuberculosis
◦ S/E
Numbness of hands, feet; rash; fever
Contraindicated: hepatic disease; do not take with
antacids
General Action:
◦ Inhibit ergosteral synthesis
Amphoericin B (Fungizone)
◦ Systemic
New class: echinocandins
◦ Used for systemic mycoses
◦ Caspofungin: treats aspergilosis
Azoles
◦ Fluconazole (Diflucan)
Action/use
Penetrates most body membranes; interferes with
synthesis of ergosterol
◦ Nystatin (Mycostatin)
Superficial antifungal
Swish and swallow
Glycemic control changes occur
Do not use intravaginally with pregnancy or lactating
moms
Nonnucleoside reverse transcriptase
inhibitors (NRTI)
◦ Action: binds to viral transcript and dis allows the
DNA action
◦ Prototype: efavirenz (Sustiva)
Nucleoside and nucleotide reverse
transcriptase inhibitors (NNRTI)
◦ Action: creates a defective DNA by replacing one
of the nucleotides
◦ Prototype: Zidovudine (AZT)
Protease inhibitors
◦ Lopinavir (Kalentra)
Combination drug of lopinavir and ritonavir
Action: inhibits hepatic breakdown of lopinavir
Fusion inhibitor:
◦ Action: blocks fusion of HIV viron to DC4
receptor
Assessment
Infection RT
Risk of transmission of infection RT
Risk for infection RT
Risk for injury RT
Deficient knowledge RT
To prevent…
To alleviate..
To improve…
Client teaching