Antibiotics Affecting the Bacterial Cell Wall (Pharmacology Ch 44) Flashcards Preview

ATI-Review Modules > Antibiotics Affecting the Bacterial Cell Wall (Pharmacology Ch 44) > Flashcards

Flashcards in Antibiotics Affecting the Bacterial Cell Wall (Pharmacology Ch 44) Deck (26):
1

Bactericidal antibiotics

-antibiotics that affect the cell wall
1) penicillins
2) cephalosporins
3) carbapenems
4) monobactams

2

Penicillins

-destroy bacteria by weakening the bacterial cell wall
-select prototype = penicillin G potassium (Pfizerpen)--narrow-spectrum med for IM or IV use

3

Other penicillin medications

-narrow-spectrum
1) penicillin G benzathine (Bicillin)--IM use
2) penicillin V (Veetids)--oral use
-broad-spectrum
1) amoxicillin-clavulanate (Augmentin)--oral use
2) ampicillin (Principen)--oral or IV use
-antistaphylococcal
1) nafcillin (Unipen)--IM or IV use
-antipseudomonas
1) ticarcillin-clavulanate (Timentin)--IV use
2) piperacillin tazobactam (Zosyn)--IV use

4

Penicillins: therapeutic uses

1) med of choice for gram-positive cocci such as Streptococcus pneumoniae (pneumonia and meningitis), Streptococcus viridans (infectious endocarditis), and Streptococcus pyogenes (pharyngitis)
2) med of 1st choice for meningitis caused by gram-negative cocci Neisseria meningitides
3) med of choice for treatment of syphilis caused y Spirochete treponema pallidum
4) extended-spectrum penicillin (piperacillin, ticarcillin) is effective against Pseudomonas aeruginosa, Enterobacter species, Proteus, Bacteroides fragilis, and Klebsiella
5) used as prophylaxis against bacterial endocarditis in at-risk clients prior to dental and other procedures

5

Penicillins:
adverse effects and nursing interventions/client education

1) allergies/anaphylaxis -- interview clients for prior allergy; advise clients to wear allergy ID bracelet; observe client for 30 min following administration of parenteral penicillin
2) renal impairment -- monitor kidney function; monitor I&O
3) hyperkalemia/dysrhythmias (high doses of penicillin G potassium) and hypernatremia (IV ticarcillin) -- monitor cardiac status and electrolyte levels

6

Penicillins: contraindications/precautions

1) contraindicated in clients w/ severe hx of allergies to penicillin, cephalosporin, and/or imipenem
2) use cautiously in clients who have or are @ risk for kidney dysfunction (acutely ill clients, older adults, young children)
3) clients allergic to one penicillin should be considered cross-allergic to other penicillins and at risk for cross allergy to cephalosporin

7

Penicillins: interactions

1) penicillin inactivates aminoglycosides when mixed in the same IV solution
2) probenecid (Probalan) delays excretion of penicillin

8

Penicillins: nursing administration

1) instruct clients that penicillin V, amoxicillin, and amoxicillin-clavulanate may be taken w/ meals. All others should be taken w/ full glass of water 1 hr before meals or 2 hr after
2) instruct clients to report signs of allergic response (skin rash, itching, and/or hives)
3) IM injection should be performed cautiously to avoid injection into a nerve or artery
4) advise clients to complete entire course of therapy regardless of presence of symptoms

9

Cephalosporins

-beta-lactam antibiotics, similar to penicillins, that destroy bacterial cell walls causing destruction of micro-organisms
-select prototype = cephalexin (Keflex)--1st generation

10

Cephalosporins: other medications

-1st generation: cefazolin (Ancef)
-2nd generation: cefaclor (Ceclor), cefotetan (Cefotan)
-3rd generation: ceftriaxone (Rocephin), cefotaxime (Claforan)
-4th generation: cefepime (Maxipime)

11

Cephalosporins are grouped into 4 generations. Each subsequent generation is:

-more likely to reach cerbrospinal fluid
-less likely to be destroyed by beta-lactamase
-more effective against gram-negative organisms and anaerobes

12

Cephalosporins: therapeutic uses

-broad-spectrum bactericidal medications with a high therapeutic index that treat UTIs, postoperative infections, pelvic infections, and meningitis.

13

Cephalosporins:
adverse effects and nursing interventions/client education

1) allergic/hypersensitivity/anaphylaxis--if indications of allergy appear (urticaria, rash, hypotension, and/or dyspnea) stop cephalosporin immediately and notify provider.
2) possible cross-sensitivity to penicillin--question client carefully regarding past hx of allergy to penicillin or other cephalosporin, and notify provider if present
3) bleeding tendencies w/ use of cefotetan and ceftriaxone--avoid use in clients who have bleeding disorders and those taking anticoagulants; observe clients for signs of bleeding; monitor prothrombin time and bleeding time. Abnormal levels can require discontinuation of medication; administer parenteral vitamin K
4) thrombophlebitis w/ IV infusion--rotate injection sites; administer as a diluted intermittent infusion or, if a bolus dose is prescribed, administer slowly over 3-5 min and in a dilute solution
5) pain w/ IM injection--administer IM injection deep in large muscle mass
6) antibiotic-associated pseudomembranous colitis--observe clients for diarrhea and notify provider; medication should be discontinued

14

Cephalosporins: contraindications/precautions

1) should not be given to clients w/ a hx of severe allergic reaction to penicillins
2) use cautiously in clients who have renal impairment or bleeding tendencies

15

Cephalosporins: interactions

1) disulfiram reaction (intolerance to alcohol) occurs w/ combined use of cefotetan, cefazolin, cefoperazone, and alcohol--instruct clients not to consume alcohol while taking these cephalosporins
2) probenecid delays renal excretion--monitor I&O

16

Carbapenems

-beta-lactam antibiotics that destroy bacterial cell walls, causing destruction of micro-organisms
-select prototype = imipenem-cilastatin (Primaxin)

17

Carbapenems: other medications

-meropenem (Merrem IV)

18

Carbapenems: therapeutic uses

1) broad antimicrobial spectrum is effective for serious infections such as pneumonia, peritonitis, and UTIs caused by gram-positive cocci, gram-negative cocci, and anaerobic bacteria
2) resistance develops when imipenem is used alone to treat Pseudomonas aeruginosa. A combination of antipseudomonal medications should be used to treat this micro-organism

19

Carbapenems:
adverse effects and nursing interventions/client education

1) allergy/hypersensitivity--monitor clients for indications of allergic reactions, such as rashes or pruritus
2) possible cross-sensitivity to penicillin or cephalosporins--question clients carefully regarding past hx of allergy to a penicillin or other cephalosporin and notify provider if present
3) GI symptoms (nausea, vomiting, diarrhea)--observe clients for manifestations and notify the provider if they occur; monitor I&O
4) suprainfection--monitor for indications of colitis (diarrhea, oral thrush, and/or vaginal yeast infection)

20

Carbapenems: interactions

-imipenem-cilastatin can reduce blood levels of valproic acid (Depakote). Breakthrough seizures are possible.--avoid using together. If concurrent use is unavoidable, monitor for increased seizure activity.

21

Carbapenems: contraindications/precautions

1) imipenem-cilastatin is a pregnancy risk category C medication
2) use cautiously in clients who have renal impairment

22

Other inhibitors

-this group of antibiotics destroys bacterial cell walls, causing destruction of micro-organisms
-select prototype medications:
1) vancomycin (Vancocin)
2) aztreonam (Azactam)--[classified as a monobactam]
3) fosfomycin (Monurol)

23

Other inhibitors: therapeutic uses

They are antimicrobials of choice for:
1) serious infections caused by methicillin-resistant Staphylococcus aureus, E. coli, or Staphylococcus epidermidis AND
2) antibiotic-associated pseudomembranous colitis caused by Clostridium difficile.

24

Other inhibitors:
adverse effects and nursing interventions/client education

1) ototoxicity--assess for indications of hearing loss; instruct clients to notify the provider if changes in hearing acuity develop; monitor vancomycin levels
2) infusion reactions (rashes, flushing, tachycardia, and hypotension, sometimes called "red man syndrome")--administer vancomycin slowly over 60 min
3) IV injection site thrombophlebitis--rotate injection sites; monitor the infusion site for redness, swelling, and inflammation
4) renal toxicity--monitor I&O and kidney function tests; monitor vancomycin trough levels

25

Other inhibitors: interactions

1) increased risk for ototoxicity when vancomycin is used concurrently w/ another medication that also produces ototoxicity (loop diuretics and aminoglycoside antibiotics)--assess for hearing loss

26

Other inhibitors: contraindications/precautions

1) contraindicated for clients who have allergy to corn/corn products or previous allergy to vancomycin
2) use cautiously in clients who have renal impairment, hearing impairment, or older adults