Antibiotics: Part 1 (Based off of PowerPoint only) Flashcards by Raven Demerath

Sulfonamides include

Sulfamethoxazole-trimethoprim

Others:
Sulfamethoxazole
Sulfisoxazole
Sulfadiazine
Sulfamethiozole

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Mechanism of Action: Sulfonamides

Bacteriostatic
Inhibits folic acid synthesis
Inhibit bacterial growth

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Indications for Sulfonamides

UTI’s
Respiratory Tract
Pneumocystis jerovecii (HIV associated pneumonia)
Infections: Skin Infections & Infections dt Staph or MRSA

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Contraindications for Sulfonamides

Allergy to sulfa

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Adverse Effects of Sulfonamides

Blood: agrunolocytosis, aplastic anemia, hemolytic anemia, thrombocytopenia
GI: N/V/D, pancreatitis, hepatotoxicity
Integumentary: Epidermal necrolysis, exfoliative dermatitis, Stevens-Johnson Syndrome, Photosensitivity
Other: Convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria, cough.

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Interactions of Sulfonamides

• Sulfonylureas, phenytoin, and warfarin can lead to hemorrhage.
(May require frequent monitoring)
• Increases likelihood of cyclosporine-induced nephrotoxicity
• May reduce efficacy of oral contraceptives.

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Nursing Process and Patient Centered Care for Sulfonamides

Assess for drug allergies to sulfa- type drugs or sulfites (sulfonylurea), oral antidiabetic drugs and thiazide diuretics.
Skin assessment d/t adverse effect of Stevens-Johnsons syndrome.
Assess complete blood count before therapy d/t possibility of drug-related anemias/blood dyscrasias
Assess renal function studies such as BUN, creatinine, urinalysis d/t potential drug-related crystalluria.
Check pt medication and med history for manifestations of G6PD and slow acetylation

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Penicillins are divided into 4 groups

Natural PCNs
Aminopenicillins
Penicillinase-resistant PCNS
Extended spectrum

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Natural PCNs include

Penicillin G

Penicillin V

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Aminopenicillins include

Amoxicillin

Ampicillin

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Penicillinase-resistant PCNs include

Nafcillin
Dicloxacillin
Oxacillin
Cloxacillin

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Extended Spectrum PCNs include

Amoxicillin/clavulanic acid
Ampicillin/sulbactam
Ticarcillin/clavulanic acid
Piperacillin/tazobactam

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Mechanism of Action: PCNs

Bactericidal

Inhibits cell wall synthesis. How?

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Adverse Effects of PCNs

Related to drug allergies/Type 1 hypersensitivity reaction
• Most common reactions are urticaria, pruritus and angioedema.
• Unpredictable reactions: maculopapular eruptions, eosinophilia, Stevens-Johnson syndrome and exfoliative dermatitis.

CNS: Lethargy, anxiety, depression, seizures.
Hematologic: N/V/D taste alterations, oral candidiasis.
Metabolic: hyperkalemia, hypernatremia, alkalosis
Skin: Pruritus, hives and rash

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Indications for PCNs

Infections - depends on pathogen and PCN class: Gram + Strep, Enterococcus, Staph infections;
Gram - and anaerobes moderate to severe infections
(i.e. Piperacillin/tazobactam);
PCN for prophylaxis (i.e. Amoxicillin)

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Contraindications for PCNs

Allergy (very common, incidence ~ 0.7% to 4%)

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Drug Interactions of PCNs

Aminoglycosides (IV) and clavulanic acid -> more effective killing of bacteria
Methotrexate -> decreases renal elimination of methotrexate -> increases methrotrexate levels
NSAIDs: compete for protein binding -> more free and active penicillin
Oral Contraceptives: uncertain -> may decrease efficacy of contraceptive
Probenecid: competes for elimination -> prolongs the effects of penicillins
Rifampin: inhibition -> may inhibit the killing activity of penicillins
Warfarin: reduced vitamin K from gut flora -> enhanced anticoagulant effect of warfarin.

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Nursing Process & Patient Centered Care: Patient Teaching (pp. 617-620) for PCNs

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Cephalosporins

First - Fifth Generations (Table 38-6, p. 610)

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First Generation Cephalosporins

Cefazolin
Has the most gram + coverage.
Treats infections caused by gram + bacteria, penicillinase-producing organism and some gram-negative organisms.
Used for preoperative and postoperative prophylaxis.

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Second Generation Cephalosporins

Cefoxitin and Cefuroxime
Treat infections. Less coverage of gram-positive organisms and greater coverage of gram-negative and anaerobic organisms.
Only generation with anaerobic coverage

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Third Generation Cephalosporins

Ceftriaxone and Ceftazidime
Ceftazidime: Infections; more extensive coverage of gram-negative organisms, including Psuedomonas spp.
Ceftriaxone: comparable to those for ceftazidime, except for psuedomonas spp.

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Fourth Generation Cephalosporins

Cefepime
Infections
Provides more extensive coverage of gram-negative organisms and better gram-positive coverage than third-generation, including organisms causing intraabdominal infections.

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Fifth Generation Cephalosporins

Study These Flashcards

Ceftaroline
Is broad spectrum (including MRSA) and covers gram - and gram + organisms (except for psuedomonas and acinetobacter).
Has the most gram - coverage.

Mechanism of Action: Cephalosporins

- Bactericidal - Disrupt bacterial cell wall -> lysis and death - Depends on generation, level of gram negative coverage increases as generation increases

Indications for Cephalosporins

moderate to severe infections and choice of drug depends on pathogens and generation

Contraindications for Cephalosporins

Allergy to cephalosporins and PCNs | Renal disease

Adverse Effects of Cephalosporins

Similar to PCNs. | Most commonly reported are mild diarrhea, abdominal cramps, rash, pruritus, redness and edema.

Interactions of Cephalosporins

* Ethanol (alcohol): Accumulation of acetaldehyde metabolite of ethanol -> acute alcohol intolerance after drinking alcoholic beverages with 72 hrs of taking cefotetan. Symptoms include stomach cramps, N/V, diaphoresis, pruritus, headache and hypotension. * Antacids, iron: decreases absorption of certain oral cephalorsporins -> decreased effectiveness of the drug. * Probenecid: decreased renal excretion -> increased cephalosporin levels * Oral Contraceptives: unknown -> increased risk for unintended pregnancy.

Nursing Process & Patient Centered Care: Patient Teaching (pp. 617-620) for Cephalosporins

Carbapenems include

Imipenem/cilastatin

Adverse Effects of Carbapenems

CNS (most serious: seizure esp. in elderly)

Nursing Process & Patient Centered Care: Patient Teaching (pp. 617-620) for Carbapenems

Mechanism of Action: Carbapenems

Binds to penicillin binding proteins inside bacteria, inhibits bacterial cell wall synthesis

Indications for Carbapenems

Severe infections of the skin and soft tissues, bones, joints, endocarditis, intraabdominal, respiratory UTIs Septicemia

Contraindications for Carbapenems

Allergy to carbapenems and local anesthetics such as lidocaine Renal Disease

Monobactam includes

aztreonam

Mechanism of Action: Monobactam

Inhibits bacterial cell wall synthesis causing lysis

Indications for Monobactam

moderate to severe infections

Contraindications for Monobactam

Allergy

Adverse Effects for Aztreonam

Skin and GI effects (more common)

Interactions for Aztreonam

Nursing Process & Patient Centered Care: Patient Teaching (pp. 617-620) for Aztreonam

Macrolides include

azithromycin (Zithromax, Z-Pak) clarithromycin (Biaxin) dirithromycin (Dynabac) erythromycin (E-Mycin, Erythrocin)

Mechanism of Action: Macrolides

- Bacteriostatic - Bactericidal in high dosage - Binds to 50s bacterial ribosomes, inhibit protein synthesis, suppress bacterial growth

Indications for Macrolides

- Infections of the skin and soft tissues, respiratory tract, sexually transmitted disease - Alternative drug for patients allergic to PCNs - For prophylaxis

Contraindications for Macrolides

Allergies

Adverse Effects of Macrolides

Refer to Table 38-8, p. 614

Interactions of Microlides

Nursing Process & Patient Centered Care: Patient Teaching (pp. 617-620) for Macrolides

Tetracyclines include

``` demeclocycline (Declomycin) doxycycline (Vibramycin, others) minocycline (Minocin, others) tetracycline (sumycin, others) tigecycline (Tygacil) ```

Mechanism of Action: Tetracyclines

Bacteriostatic | Binds to 30s bacterial ribosomes, inhibit protein synthesis, suppress bacterial growth

Indications for Tetracyclines

Infections of the skin and soft tissues (acne, gum disease), sexually transmitted disease; respiratory tract, intraabdominal

Contraindications for Tetracyclines

Allergy and pregnancy

Adverse Effects of Tetracyclines

GI Bones & teeth Superinfection (e.g. vaginal candidiasis) Hepatotoxicity Photosensitivity Vestibular toxicity (dizziness, unsteadiness)

Interactions of Tetracyclines

Nursing Process & Patient Centered Care: Patient Teaching (pp. 617-620) for Tetracyclines

Patient Teaching for Sulfonamides

* Encourage increased in fluids, preferably water to prevent drug-related crystalluria) * Encourage patients to immediately report the following to the HCP: worsening ab cramps, stomach pain, diarrhea, blood in the urine, severe or worsening rash, SOB, and fever – May indicate adverse reactions to these drugs.

Antibiotics: Part 1 (Based off of PowerPoint only) Flashcards

(58 cards)