PHARMACOLOGY ANTIMICROBIALS ANTIBIOTICS ANTIINFLAMMATORY

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PHARMACOLOGYANTIMICROBIALSANTIBIOTICSANTIINF
LAMMATORY
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Definition of Terms

• Bacteremia - presence of viable bacteria in the
  circulation
• Septicemia - system infection caused by
  microorganism multiplication in the circulation
• Bacteremia can lead to septicemia
• Sepsis is a syndrome involving multiple system
  organ involvement

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• Antibiotics are chemicals produced by one kind of
  microorganism that inhibit the growth of or kills
  another.
• Antibacterial and antimicrobial drugs are
  substances that inhibit the growth of or kill
  bacteria or other microorganism.

Bacteriostatic - inhibits growth of
bacteria Bactericidal - kill bacteria
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• Narrow-spectrum
• primarily effective against one type of organism
• Penicillin erythromycin
• Broad-spectrum
• effective against both gram () and gram( -)
  organisms
• cephalosporins
• tetracycline

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Nursing Management

• fatigue
• anorexia
• weight loss
• cough
• sputum
• ? WBC
• pus or drainage

Assessment general health temperature chills sweat
s redness pain edema
Collect specimens blood, urine, sputum, wound
drainage discharge
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• Specimens before antibiotics unless otherwise
  ordered
• CHECK ALLERGIES
• Serious hypersensitivity and allergic reactions
  especially
• PENICILLIN!!!!
• Know about drug and check cross-sensitivity info
• Check effects of food on orals

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• Nursing Diagnoses
• Risk for infection
• Risk for allergic reaction
• Risk for infection transmission
• Monitor for signs drugs are working
• ?? SS

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Adverse Reactions

• Allergy or hypersensitivity effect
• Superinfections
• large doses
• gt 1 antibiotic used
• broad-spectrum drug use
• Organ toxicity
• liver kidney involved in drug metabolism
• Side effects
• N/V/D
• Check pregnancy safety category

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Penicillins and related antibiotics

• Bactericidal
• Gram () gt gram (-)
• Natural PCNs
• PCN G
• PCN v

• Penicillinase-resistant PCNs
• cloxacillin
• dicloxacillin
• methicillin
• nafcillin
• oxacillin

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• Aminopenicillins (broader-spectrum)
• amoxicillin
• amoxicillin clavulanate (Augmentin)
• ampicillin
• ampicillin sulbactam (Unasyn_

• Extended-spectrum PCNs
• carbenicillin
• mezlocillin
• piperacillin
• piperacillin tazobactam (Zosyn)
• ticarcillin
• ticarcillin clavulanate (Timentin)

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PCN Side/adverse effects

• Interaction with
• ACE inhibitors
• anticoagulants
• NSAIDs
• lipid lowering
• OC (estrogen)
• Methotrexate
• probenecid

• N/V/D
• HA
• sore mouth or tongue
• oral and vaginal candidiasis

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Cephalosporins

• Bactericidal
• Generations
• 1st - gram (_
• 2nd () (-)
• 3rd - (-) and beta-lactamase-producing microbial
  strains and less against gram () cocci

• Check hx of PCN sensitivity
• Caution in hx of bleeding disorders
• alcohol
• anticoagulants
• NSAIDs
• probenecid

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Generations

• First generation
• cefazolin (Ancef)
• cephalexin (Keflex)
• cechalothin (Keflin)
• cephapirin (Cefadyl)
• cephradine (Velosef)

Second generation cefaclor (Ceclor) cefotetan
(Cefotan) cefamandole (Mandol)

• Third generation
• cefixime (Suprax)
• cefotaxime (Claforan)
• ceftriaxone (Rocephin)

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Macrolide antibiotics

• Bacteriostatic-bactericidal in high
  concentrations
• gram () and selected gram (-)
• Side/adverse effects (listed with antibiotic)

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Interactions

• alffentanil (alfenta)
• carbamazepine (Tegretol)
• chloramphenicol (Chlormycetin)
• cyclosporine
• hepatotoxic meds
• terfenadine (Seldane)
• warfarin
• xanthines (aminophyllin)
• zidovudine (AZT)

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Most Common Macrolides

• Azithromyzin (Zithromax)
• stomach pain, NVD
• clarithromycin (Biaxin)
• anorexia, HA, NV, lethargy, severe anemia, fever,
  infection, rash
• Erythromycin
• abd cramps, NVD,

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Lincomycins

• Bacteriostatic (bactericidal in large doses with
  certain organisms)
• Clindamycin (Cleocin)
• interacts with anesthetics, antidiarrheals
  (adsorbent) chloramphenicol)
• Lincomycin (Lincocin)
• Vancomycin (ototoxic)
• interacts with aminogylcosides lipid lowering
  drugs

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Aminoglycosides

• Bactericidal (used for serious life-threatening
  infections)
• gram (-) and ()
• amikacin
• gentamicin
• kanamycin
• streptomycin
• tobramycin

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Interacts with..

• Other aminoglycosides - potential for
  ototoxicity, nephrotoxicity, and neuromuscular
  blockade is enhanced
• amphotericin B parenteral
• check list
• anesthetics
• methoxyflurane

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Tetraclycine

• Broad-spectrum
• bacteriostatic for many (-) and () organisms
• cross-sensitivity and cross-resistance
• demeclocyline (Declomycin)
• doxycycline (Vibramycin)
• minocycline (Minocin)
• tetracycline

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Interacts with...

• Antacids
• lipid lowering
• OC (estrogen)
• Caution with
• caine-type (Lidocaine)
• renal impairmentContraindicated in pregnant
  women and children lt8
• permanent mottling and discoloration of the teeth
• ? linear skeletal growth rate

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Chloramphenicol (chloromycetin)

• Broad spectrum bacteriostatic
• seriously toxic to bone marrow
• may be bacteriocidal in high doses with
  susceptible organisms
• CSF (meningitis)
• Infrequent side effects NVD.

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Interacts with..

• alfentanil
• anticonvulsants
• oral antidiabetic
• clindamycin, erythromycin, lincomycin
• warfarin

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Fluoroquinolones

• Broad spectrum bactericidal
• check for FDA approved use in various infections
• Side effects - dizziness, drowsiness,
  restlessness, stomach distress, NVD

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Interacts with..

• Interacts with
• antacids, ferrous sulfate
• xanthines
• warfarin
• Ciprofloxacin (Cipro), enoxacin (Penetrex),
  ofloxacin (Floxin)

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Other Antibiotics

• Azteonam (Azactam) synthetic bactericidal similar
  to PCN-NVD
• imipenem-cilastatin (Primaxin) broad spectrum
  beta-lactamase resistant

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More.

• metronidazole (Flagyl) - cytotoxic agent
  (microbicidal)-
• dizziness, HA, NVD, anorexia.
• Spectinomycin (Trobicin_)
• Neisseria gonorrhoeae (antibiotic resistant or
  cannot take ceftriaxone)-bacteriostatic