Transcript CHAPTER 21 Cholinergic

Cholinergic-Blocking Drugs
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Antibiotics
For the GU system
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Antibiotics: Classes
 Sulfonamides
 Penicillins

Quinolones

Aminoglycosides

Tetracyclines

glycopepetides
 Cephalosporins
 Macrolides
Antibiotic Therapy:
Mechanism of Action
 Interference
with cell wall synthesis
 Interference with protein synthesis
 Interference with DNA replication
 Acting as a metabolite to disrupt critical
metabolic reactions inside the bacterial cell
Actions of Antibiotics
 Bactericidal:
kill bacteria
 Bacteriostatic: inhibit growth of susceptible
bacteria, rather than killing them immediately;
will eventually lead to bacterial death
Antibiotics: Sulfonamides

One of the first groups of antibiotics




Sulfadiazine
Sulfamethoxazole
Sulfisoxazole
Often combined with another antibiotic


Sulfamethoxazole combined with trimethoprim
(a nonsulfonamide antibiotic), known as
Bactrim, Septra, or co-trimoxazole (SMX-TMP)
This combination is used commonly
Sulfonamides:
Mechanism of Action
 Bacteriostatic
action
 Prevent synthesis of folic acid required for
synthesis of purines and nucleic acid
 Do not affect human cells or certain bacteria—
they can use preformed folic acid
 Only affect organisms that synthesize their own
folic acid
Sulfonamides: Indications

Effective against both gram-positive and
gram-negative bacteria
 Pneumocystis

jirovecii pneumonia (PJP)
Co-trimoxazole
 Upper
respiratory tract infections
 Treatment
of UTIs caused by susceptible
strains of:

Enterobacter spp., Escherichia coli, Klebsiella spp.,
Proteus mirabilis, Proteus vulgaris, Staphylococcus
aureus
Sulfonamides: Adverse Effects
Body System
Blood
Integumentary
Adverse Effects
Hemolytic and aplastic anemia,
agranulocytosis, thrombocytopenia
exfoliative dermatitis, Stevens- Johnson
syndrome, epidermal necrolysis
GI
Nausea, vomiting, diarrhea, pancreatitis
Other
Convulsions, crystalluria, toxic nephrosis,
headache, peripheral, neuritis, urticaria
Nursing Implications
 Assess:
 Before
beginning therapy, assess drug allergies;
renal, liver, and cardiac function; and other lab
studies
 Be sure to obtain thorough patient health history,
including immune status
 Assess for conditions that may be contraindications
to antibiotic use or that may indicate cautious use
 Assess for potential drug interactions
Nursing Implications
 Treat:
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

It is ESSENTIAL to obtain cultures from appropriate
sites BEFORE beginning antibiotic therapy
All oral antibiotics are absorbed better if taken
with at least 6 to 8 ounces of water
For safety reasons, check the name of the
medication carefully because there are many
drugs that sound alike or have similar spellings
Nursing Implications
 Teach:
 Patients
to take antibiotics exactly as prescribed
and for the length of time prescribed;

they should not stop taking the medication early
when they feel better
 Assess
for signs and symptoms of superinfection:
fever, perineal itching, cough, lethargy, or any
unusual discharge
Quinolones
 ciprofloxacin
(Cipro)
 norfloxacin (Noroxin)
 levofloxacin (Levaquin)
 moxifloxacin (Avelox)
Quinolones:
Mechanism of Action
 Bactericidal
 Alter
DNA of bacteria, causing death
 Do not affect human DNA
Quinolones: Indications
 Gram-negative
bacteria such as pseudomonas
 Respiratory infections
 Bone and joint infections
 GI, GU infections
 Skin infections
 Sexually transmitted diseases
 Anthrax
Fluoroquinolones: Adverse Effects
Body System
CNS
Adverse Effects
Headache, dizziness, fatigue, depression,
restlessness, insomnia
GI
Nausea, vomiting, diarrhea, constipation,
thrush, increased liver function studies,
Cardiac
Prolonged QT interval
Integumentary Rash, pruritus, urticaria, flushing,
photosensitivity (with lomefloxacin)
Other
Fever, chills, blurred vision, tinnitus
Black box warning: increased risk of tendonitis and tendon
rupture
Other Antibiotics
 nitrofurantoin
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
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
(Macrodantin)
Primarily used for UTIs (E. coli, S. aureus,
Klebsiella spp., Enterobacter spp.)
Use carefully if renal function is impaired
Drug concentrates in the urine
May cause fatal hepatotoxicity
Usually well-tolerated if patient is kept wellhydrated
Bladder analgesics
 Phenazopyridine


Reduces bladder pain and dysuria
3 x a day
Nursing Implications
 Monitor



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for therapeutic effects
Improvement of signs and symptoms of
infection
Return to normal vital signs
Negative culture and sensitivity tests
Disappearance of fever, lethargy,
drainage, and redness
 Monitor
for adverse reactions
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5-Alpha-Reductase Inhibitors
 Finasteride
(Proscar) and dutasteride
(Avodart)
 Block the effects of endogenous androgens
 Used to treat benign prostatic hyperplasia
(BPH)
 Results in alleviation of symptoms of BPH
 Easier
passage of urine
 May
also be used for treatment of malepattern baldness (minoxidil)
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Alpha1-Adrenergic Blockers
 Used
for symptomatic relief of obstruction
caused by BPH
 doxazosin (Cardura)
 tamsulosin (Flomax)
 terazosin (Hytrin)
 alfuzosin (Uroxatral)
 silodosin (Rapaflo)
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Nursing Implications
 Assessment
should include complete history,
including medication history, urinary
elimination problems, potential
contraindications
 Obtain baseline vital signs, weight, height,
serum electrolyte levels
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Nursing Implications (cont’d)
 Assess
renal and liver function
 Assess PSA level and perform digital rectal
examination (DRE) before beginning any
drugs for treatment of prostate disease
 Assess current medications for potential
interactions
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Elsevier Inc.