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Drugs: Magnesium Sulphate; Gentamicin; Amoxicillin & Cefuroxime. - Oriana, Lyndsay & Nicky. GENTAMICIN. Antibiotic – what are antibiotics? Molecules produced naturally by other organisms to combat the threat to themselves.

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drugs magnesium sulphate gentamicin amoxicillin cefuroxime

Drugs: Magnesium Sulphate; Gentamicin;Amoxicillin & Cefuroxime

- Oriana, Lyndsay & Nicky

gentamicin
GENTAMICIN
  • Antibiotic – what are antibiotics?

Molecules produced naturally by other organisms to combat the threat to themselves.

Mode of action is to inhibit some essential function of bacterial cell’s life cycle

gentamicin3
GENTAMICIN
  • Aminoglycoside – what are aminoglycosides?

Bactericidal, active against some Gram-positive and many Gram-negative organisms

Mode of action is to prevent part of cell that makes proteins (ribosome) from working

Known as protein synthesis inhibitors

Not absorbed from the gut, therefore given by injection

Excretion mainly from kidneys but filtered unchanged, therefore accumulation occurs in renal impairment

gentamicin4
GENTAMICIN
  • Aminoglycoside of choice in UK
  • Used for treatment of serious infections including:

- septicaemia, neonatal sepsis, meningitis,

biliary-tract inefections, endocarditis,

pneumonia in hospital patients

  • Can be used in form of drops for eye and ear infections
gentamicin5
GENTAMICIN
  • When given by injection it can have serious adverse effects on the ears and kidneys.
  • Courses limited to 7 days
  • In order to minimise toxicity:

- dose adjusted for weight (3-5mg/kg)

- dose no more frequent than once daily

- peak and trough levels to be measured

gentamicin6
GENTAMICIN
  • Side effects

Vestibular damage

Auditory damage

Nephrotoxicity

Aggravation of myasthenia by blocking neuromuscular transmission

  • Contra-indications

Myasthenia gravia

gentamicin7
GENTAMICIN
  • Monitoring

Blood sample should be taken approximately 1 hour after intramuscular or iv administration (peak serum concentration), and just before next dose (trough serum concentration)

gentamicin8
GENTAMICIN
  • Simon Hope

Administered for treatment of septic shock

When used for ‘blind’ therapy of undiagnosed serious infections, it is usually given in conjunction with penicillin or metronidazole, or both.

Could this be the reason why Simon was given Amoxycillin?

amoxicillin penicillin
AMOXICILLIN / PENICILLIN
  • Class: Penicillin :-

Amoxicillin, Ampicillin, Benzylpenicillin, Co-amoxiclav, Flucloxacillin, Phenoxymethylpenicillin.

  • Brand names: Amoxil
  • Combined preparations:

Amiclav, Augmentin,

Co-amoxiclav

cell lysis
Cell Lysis

Gould D (2004) Bacterial infections: antibiotics and decontamination. Nursing Standard, 18 (40),p. 38-42.

allergic reaction
Allergic Reaction
  • Stop immediately if:

- rash, wheezing, itching or oral swelling.

  • Avoid all drugs from the same class

- ie: penicillin's.

  • Basic penicillin structure.
  • Encephalopathy (brain dysfunction) - serious toxic effect of penicillin due to cerebral irritation: as a result from high doses, or renal failure.
anaphylaxis 1 2 300
Anaphylaxis: 1:2,300
  • systemic immediate hypersensitivity reaction
  • rash – collapse
  • Signs – Hypotention - Confusion
  • 6 recommendations for practice in case of a anaphylactic shock.
  • Treatment
  • documentation & Yellow Card system
  • reducing the risk of anaphylaxis.

(Henderson N (1998) Anaphylaxis. Nursing Standard. 12, 47, 49-55)

speedshock
Speedshock:
  • associated hazard with peripheral IV therapy
  • a systemic reaction which occurs due to a rapid administration of a substance that is foreign to the body
  • commonly with rapid bolus injection
  • The Preparation and Administration of Parenteral Medicines policy (LUHD 2003b)

- ensures safe and consistent practice.

alternative to penicillin
Alternative to penicillin:

Erythromycin (class: Macrolides):

  • broad spectrum
  • alternative to Penicillin / Cephalosporin
  • main risk: impaired liver function
simon hope
SIMON HOPE:

Hospital-acquired pneumonia:

  • broad spectrum Cephalosporin (Cefotaxime / Ceftazidime)
  • penicillin
  • another beta-lactam: NOT IN PEN ALLERGY

Community-acquired: Septicaemia: (initial ‘blind’ therapy)

  • Aminoglycoside (Gentamicin) + broad spectrum penicillin (Penicillin)
  • Broad spectrum Cephalosporin alone (Cefotaxime)

Hospital-acquired: Septicaemia: (initial ‘blind’ therapy)

  • Aminoglycoside (Gentamicin, Streptomycin) + broad spectrum antipseudomonial beta-lactam (Cefazidime)
  • Meropenem (Beta Lactam:ultra-broad spectrum injectable used for meningisits / pneumonia) aloneNOT IN PEN ALLERGY
  • Imipenem (IV Beta Lactam: broad spectrum ) alone

NOT IN PEN ALLERGY

magnesium sulphate
Magnesium Sulphate
  • Magnesium (Mg2+) is predominantly an intracellular cation (+ charged ion)
  • Has an important role in enzyme activity, contributing to the metabolism of CHO and proteins
  • Also important in neuromuscular activity, impulse transmission and myocardial functioning
magnesium sulphate21
Magnesium Sulphate
  • Has an effect on smooth muscle cells:

- Hypomagnesemia – causes contraction

- Hypermagnesemia – causes relaxation

  • Used IV as a bronchodilator in acute severe asthma attacks
magnesium sulphate22
Magnesium Sulphate
  • Reduces the proliferation of neutrophils associated with the inflammatory response in asthma
  • A magnesium imbalance is common in critically ill patients – electrolyte imbalance?
  • Available on the resuscitation trolley Magnesium Sulphate 50% solution 2g (4ml)
  • Contraindicated in renal failure because it is excreted by the kidneys
cefuroxime
Cefuroxime
  • Categorised as a Cephalosporin – semisynthetic derivative of the mould cephalosporium C
  • Bactericidal
  • Broad-spectrum and similar to Penicillin but have greater activity against Gram –ve bacteria and a longer half-life
cefuroxime24
Cefuroxime
  • Adverse reactions: GI disturbances, haematological abnormalities and a rise in serum hepatic enzyme levels
  • Hypersensitivity to ß-lactam structure also found in penicillin
  • By intravenous injection or infusion, 750 mg every 6–8 hours; 1.5 g every 6–8 hours in severe infections; single doses over 750 mg intravenous route only (BNF)
references
References:
  • British Medical Association (2004) New guide to Medicines and Drugs. Dorling Kindersley: London
  • British Medical Association and Royal Pharmaceutical Society of Great Britain (2004) British National Formulary. London: British Medical Association and Royal Pharmaceutical Society of Great Britain.
  • British National Formulary. Available from: http://www.bnf.org
slide26
Galbraith A, Bullock S, Manias E, Hunt B, Richards A (1999) Fundamentals of pharmacology. Pearson Prentice Hall
  • Hand H, Banks A (2004) The contents of the resuscitation trolley. Nursing Standard 18:44 p43-52
  • Hand H (2001) The use of intravenous therapy. Nursing Standard 15:43 p47-52
  • Henry, J. eds (2004) The British Association:The New Guide to Medicines and Drugs. London: Dorking Kindersley.
  • Henderson N (1998) Anaphylaxis. Nursing Standard. 12, 47, 49-55.
slide27
Ingram P, Lavery I (2005) Peripheral intravenous therapy: key risks and implications for practice. Nursing Standard. 19, 46, 55-64.
  • Rowe B, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA (2000) Intravenous Magnesium Sulfate treatment for acute asthma in the emergency department: a systematic review of the literature. Annals of Emergency Medicine. 36:3 p181-190
  • Tortora G, Grabowski SR (1996) Principles of Anatomy and Physiology. 8th ed. Harper Collins
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