Chapter 26: Penicillins, Other Beta Lactams And Cephalosporins Flashcards by Brina Quintanilla Reyes

All antibiotics treat what?

Bacterial infections

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What is any side effect of any antibiotics ?? (3)

Yeast infection
Diarrhea
Thrust

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Can you get CDIFF On any antibiotic?

Notes
- though in the presentation, we should focus on the specific medications !

Yes

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Anytime a patient is on an antibiotic, what’s the super important thing to teach them?

FINISH THEM?!

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Why is finishing antibiotics so important?

And if they don’t?

To properly get rid of the infection

If not, it can spread more

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Nursing implications for all antibiotic use

Before beginning therapy
- assess drug allergies
- renal/liver/cardiac function
- lab studies

Be sure to obtain thorough patient health history, including immune status

Assess for conditions that may be contraindications to antibiotics use or that may indicate cautions use

Assess for potential drug interactions

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Do you stop taking antibiotic after feeling better for some usage time?

NO!! Keep going!!

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Every antibiotic you give what do you want know about the patient? (3)

Drug medications
Allergies
Blood work

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What is assessing for signs and symptoms of superinfection?? (5)

Fever
Perineal itching
Cough
Lethargy
Unusual discharge

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If a patient who is immune comprised, what is normally the process for antibiotics?

Stronger medication
Or medication for a longer period of time

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Why do we need to know some contraindications before antibiotics?

Some antibiotics are nephro toxic
So we don’t give to them for kidney problems

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What groups of people would we consider doing cultures before giving antibiotic administration? (3)

Immunocompromised
Elderly
Childern

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What does a culture tells us?

What antibiotics work
What is the pathogen
What antibiotics don’t work

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What are the 3 most common effects of antibiotics?

Vomitting
Nausea
Diarrhea

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All oral antibiotics are absorbed better if taken with at least??

6-8 ounces of water

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Test question
What are you gonna do first before administration of antibiotics?

Cultures !!

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If the antibiotic causes photosensitivity what do we tell the patient?

Put sunscreen so don’t burn

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Most antibiotics don’t mind what? When absorption’s?

But what helps break down and helps absorption 10x more?

Most of them don’t mind food or empty stomach

Water!! Helps easier breakdown

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What is bacteriostatic drugs?

Inhibits growth of bacteria

( stops spreading )

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What is bactericidal drugs?

Kills the bacteria

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What are some body defenses? (6)

Age
Nutrition
Immunoglobulins
Circulation
WBCS
Organ function

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Why does age affect body defenses?

Think about kids
They aren’t fully develop
We use their weight to determine dosage and which type of medication

Since their blood brain barrier isn’t fully develop, the war drugs will cross the blood brain barrier

And if you’re older, you may be on more medications and it can cause interactions

And organs slow down

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How does nutrition play a part in helping antibiotics?

Some medications bind to medication

Like tetracycline binds to calcium
So it gets rid of you calcium!!

Think of protein bound

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How does immunoglobulins work in antibiotics?

Some patients make not tolerate or simply work!

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How does circulation work for antibiotics?

If the patient doesn’t have enough blood flow, the antibiotic may not reach the entire body Example Patient may have osteomyelitis ( infection of bone ) - because blood isn’t good enough flow - which means we give IV

Why is antibiotic resistance the biggest thing to worry ?

Because people stop taking the medication and the bacteria start to gain resistance Or the bacteria evaluation

What is inherent resistance?

Naturally resistant

What is acquired resistance?

Previous exposure

Antibiotics treat viral infections?

Nope

What are the 3 most common pathogens that are resistant ?

MRSA VREF VRSA

What are the 3 antibiotic misuse?

Taken for antiviral When no infection Skipping doses Increase misuse resistance

What is cross resistance? Give me an example?

Can occur between antibacterial drugs with similar drugs Penicillin allergy increased chances of cephalosporins allergy too! Or resistance !

What does additive mean?

Effect is doubled

What does potentiative mean?

One potentates effect of other

What does antagonistic mean?

When one bactericidal and one bacteriostatic are added together ; so it’s reduced

Should you give penicillin and tetracycline together?

Nope! They cancel each other out

What is allergic reaction? Anaphylaxis?(5)

Hypersensitivity Rash Pruritus Hives Anaphylactic shock

When a patient had a rash from their last medication, should you give it again? What case scenario?

No change it because of allergy Give them again and they have worse allergies

If the patient got diarrhea from medication, is that an allergy?

Nope!

Super infection is normally associated with yeast infection and thrush ( when normal flora killed ) Normally this will go away when?

The stopping of antibiotic

What are the main organ toxicity when giving antibiotics? (3)

Ear Liver Kidney

What does narrow spectrum mean?

Primary effective against one bacteria type

What are two examples of narrow spectrum?

Penicillin and erythromycin

What is broad spectrum?

Frequently used when offending microorganism that has not been identified by a culture or swab

What is an example of broad spectrum?(2)

Tetracycline & cephalosporins

Broad spectrum is effective against what?

Gram positive Gram negative

If our patient is waiting for the culture to come back, what spectrum will we give until we know the bacteria?

Broad spectrum

What’s the biggest downside of being on a broad spectrum antibiotics?

They have a higher risk of superinfection ( thrush )

What are the 4 penicillins?

Basic penicillins Broad spectrum Penicillinase Extended spectrum

What does penicillins treat??(6)

ENT ( ear, nose throat ) Skin Bone Joint GI Cardiac

It’s important to note that some patients may have bacteria that produce a beta lactamase or Penicilase And why is this important?

It’s because it makes the usage of a penicillin not work Or it’s pretty much resistant to penicillins

So when we have bacteria that produce that lactamase, how do we help treat it? And how does it help?

Adding a beta lactamase inhibitor Which will reduce the resistance ( augmentin )

How does beta lactamse inhibitors work?

Inhibits bacteria enzyme which stops this resistance Making the penicillin work better

What are the 3 things we can add to a penicillin to stop that beta lactamse production?

Clavulanic acid Sulbactam Tazobactam

Her best way to explain Beta lactamse is the boss!! ( use all power to fight it ) Your power up to fight the boss ( clavulanic acid, sulbactam and tazobactam )

What is the only oral medication, antibiotics that’s a penicillin that treats beta lactamse bacteria?

Augmentin ( amoxicillin and clavulanic acid )

Can augmentin treat beta lactamse bacteria? And why?

Yes because it has that Clavulanic acid in its built up

What are the 2 normally beta lactamase inhibitors for penicillins of IV?

Unasyn & Zosyn

Does the injection of penicillin hurt ? And what do we help to aid with it?

Yes super!! Litacane

What are main side effects of penicillin? (3)

Tongue discoloration Glossitis ( red, lose of taste) Arthralgia ( joint pain ) ( it isn’t common with CDIFF but can happen )

Clinical judgment penicillins Concept - infection Recognize cues - assess for allergy to penicillins or cephalosporins - evaluate lab results, especially hepatic enzymes Analyze cues & prioritize hypothesis - tissue injury, nausea, vomitting Generate solutions - the patients WBC will be within normal limits Take action - obtain a sample for lab culture and antibiotics sensitivity testing to discern the infective organism before antibiotic therapy is started - monitor for evidence of superinfection, especially in patients taking high doses of an antibiotic for a prolonged time - examine the patient for an allergic reaction, especially after the first and second doses - teach patient to take entire prescribed antibiotic Evaluate outcomes

Test question White blood count - 18 or 20 !! We need to know that that 18-20 is not normal! When it’s elevated, it means infection going on!

Cephalosporins and penicillin are what?

Cousins!!

Cephalosporins pretty much treat the same things as penicillins, so what are they?

Pharyngitis Tonsillitis Otitis media Respiratory Skin Intrabdominal Bone and joint Urinary Gynecological infections STIS bacteremia Sepsis

How much generations of cephalosporins are there?

First and second generations cephalosproins, what are the main things to do about them ? (4)

Not effective against beta lactamase Narrow spectrum Short half life Take them 4x a day !!

Third and fourth generation cephalosproins generations ; things to really remember ? (2)

Don’t treat beta lactamse Long duration Take 2x a day

4th generation and 5th generation cephalosporins are the only ones to what?

Enters CSF to treat CNS infections

What is the only important thing about 5th generation cephalosporin?

Only one to treat MRSA

Cephalosporins have a 10% cross reaction if patient is allergic to what?

Penicillin

What is the main side effects of cephalosporins? (4)

Increased bleed Elevated liver enzymes Nephrotoxicity Headaches/dizzines

Cephalosporins interact with what and it increases what?

Anti coagulant medications Bleeding

Does cephalosporins hurt when you give IM?

Yes

Are cephalosporins nephrot toxic when a patient has healthy kidneys? What about they have reneal disease, diabetics, etc ? Super

Nope

Are penicillins nephrotoxic?

Nope

What are the 3 medications that a patient may be on that we don’t give cephalosporins because of high nephro toxic?

Aminioglycosides Loop diuretics Vancomycin

What is the medication of cephalosporins we need to know ??

Cefoteatan?

What is cefoteatan or how does it work?

Interacts with alcohol Causes like disulfiram action Vomiting after consuming

Test question Your patient is taking cefotetan , what the most important thing to include teaching the patient? - finish medication - take food - don’t drink alcohol on medication - call doctor when have rash

Don’t drink alcohol on this medication

Cephalosporin use can increase bleeding time so we need caution with which medication?

Anticoagulants

Chapter 26: Penicillins, Other Beta Lactams And Cephalosporins Flashcards

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