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NURS 1950 Antibiotics and other Agents. Metropolitan Community College Nursing Program Nancy Pares, RN, MSN. In the beginning……. Before Antibiotics Infections treated topically with ‘poultice’ or surgically removed 1936…Sulfonamide discovered Beginning of understanding of microbes

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nurs 1950 antibiotics and other agents

NURS 1950Antibiotics and other Agents

Metropolitan Community College

Nursing Program

Nancy Pares, RN, MSN

in the beginning
In the beginning…….
  • Before Antibiotics
    • Infections treated topically with ‘poultice’ or surgically removed
  • 1936…Sulfonamide discovered
    • Beginning of understanding of microbes
  • 1941…Penicillin introduced
    • WWII had great results with high volume data
  • Present ….
    • Man vs. microbe= resistant pathogens
objective 1 identify the body s natural defenses against infections
Objective 1: Identify the body’s natural defenses against infections
  • Barriers/prevention
    • Intact skin, adequate nutrition, respiratory cilia, immune system
  • Seek and Destroy
    • WBC, adequate blood supply, intestinal flora, vaginal flora, stomach acids
objective 2 describe factors that increase the susceptibility of the body to infection
Objective 2: Describe factors that increase the susceptibility of the body to infection

Virulence of the pathogen

Number of pathogens

Chronic illness

Poor nutrition

Diseases/drugs that decrease the immune system

Entry point

Super infections

host factors
Host Factors
  • Status of immune system
    • May need prophylactic therapy
  • Location of the infection
    • Many drugs do not cross blood brain barrier
  • Extent of inflammation
    • Decrease circulation of drug
  • Age: metabolization of drug
  • Pregnancy: risks to fetus vs. benefit of drug
  • Genetics: enzyme deficiencies do not allow antibiotics to clear system
obj 3 name the lab tests done to identify the invading pathogen
Obj. 3: Name the lab tests done to identify the invading pathogen
  • Should be done before antibiotic initiated
  • Microscopic examination
    • Urine, stool, blood, spinal fluid, sputum, purulent drainage
    • Identify the organism and test with antibiotics
      • Culture and sensitivity testing
        • Preliminary results within 24 hours
        • Final results in 2-3 days
obj 5 explain what resistance means and the various types of resistance
Obj. 5 Explain what resistance means and the various types of resistance
  • Passive immunity
    • A person has been given vaccine
  • Active immunity
    • Has had the disease
  • Acquired resistance
    • Bacteria have randomly mutated and can transmit mutated bacteria to others
    • Healthcare practitioners role
      • Use antibiotics when indicated
      • Prophylaxis: deep tissue injury, prosthetic heart valves
obj 6 define narrow spectrum and broad spectrum
Obj. 6: Define narrow spectrum and broad spectrum
  • Narrow
    • Effective on limited number of organisms
  • Broad
    • Effective on many organisms; often used first
  • Bacteriocidal
    • Kills
  • Bacteriostatic
    • Prevents growth and reproduction
obj 7 describe adverse reactions to antibiotics
Obj. 7: Describe adverse reactions to antibiotics
  • Hypersensitivity
    • Can result in anaphylactic shock/death
      • 15% of penicillin users
      • Treat with Benedryl, corticosteroids, epinephrine
    • Cross sensitivity
      • When antibiotics are closely related chemically
  • Organ toxicity
    • Liver, kidneys, CNS, GI is most common
    • Vancomycin highly nephrotoxic
    • Gentamycin highly ototoxic
adverse reactions con t
Adverse reactions con’t
  • Hematotoxicity
    • Chloramphenicol
      • Causes aplastic anemia
        • Bone marrow cannot make red blood cells
obj 8 discuss the penicillins and identify specific penicillin preparations
Obj. 8 Discuss the penicillins and identify specific penicillin preparations
  • Action/use
    • Kill bacteria by disrupting cell wall; chemical make up responsible is beta lactam ring—
      • some bacteria secrete enzyme that splits the beta lactam ring allowing the bacteria to become resistant
    • Chemical modifications
      • Penicilinase resistant, broad spectrum, extended spectrum
    • Treatment of pneumonia, skin, bone and joint infections, blood infections, gangrene, meningitis
penicillins cont
Penicillins cont
  • Routes
    • PO, IM, IV
  • Adverse effects
    • Hypersensitivity most common
  • Nursing considerations
    • VS, assess previous reactions, lab (electrolytes, renal function, ECG, Observe for IV reaction within 30 min; client teaching
    • Prototype: Pen G Potassium
obj 9 discuss various cephalosporin preparations
Obj.9 Discuss various cephalosporin preparations
  • Action/Use
    • Bacteriocidal by attaching to penicillin binding proteins to inhibit cell wall synthesis
    • Gram negative infections and when less expensive penicillins are not tolerated; 5-10% of people allergic to penicillin are also allergic to cephalosporins
  • Adverse reactions
    • Hypersensitivity; kidney toxicity
  • Prototype—Cefotaxime (Claforan)
cephalosporin classifications
Cephalosporin classifications
  • First generation
    • Most effective against gram +; beta lactamase producing organisms usually resistant
  • Second generation
    • More potent, broader spectrum, moderately resistant to beta lactamase organisms
  • Third generation
    • Longer duration of action, resistant to b-lactamase
    • Drugs of choice for pseudomonas, klebsiella, neisseria, salmonella and H. influenza
  • Fourth generation-treat CNS infections
cephalosporins
Cephalosporins
  • Nursing considerations
    • Assess for bleeding disorders-check PT levels
    • Assess kidney and liver function labs
    • Assess concurrent meds: (NSAIDS)
    • Monitor I&O
    • Assess GI symptoms
    • Client teaching
      • Cultured dairy (superinfection prevention); avoid alcohol use, complete full RX; IM inj. painful
obj 10 discuss tetracycline including nursing implications
Obj. 10 Discuss tetracycline , including nursing implications
  • Action/Use
    • Bacteriostatic; inhibits protein synthesis to slow microbial growth
    • Rocky Mtn Spotted fever, typhus, cholera, Lyme disease, peptic ulcers (caused by H. pylori), chlamydial infections
  • S/E
    • n/v, diarrhea, photosensitivity, permanent discoloration of teeth <8 yo
tetracycline con t
Tetracycline con’t
  • Nursing considerations
    • Avoid use <8 yo, avoid sunlight/UV exposure; monitor labs (CBC, liver function, kidney function)
    • Teach importance of oral and perineal hygiene due to super infections
    • Do not take with milk products, iron supplements, or antacids; wait 1-3 hrs before taking antacids; wait 2 hrs before and after taking lipid lowering drugs (Ca+ and iron bind with tetracycline)
obj 11 describe the uses s e nursing implications of the various aminoglycosides
Obj. 11 Describe the uses, s/e, nursing implications of the various aminoglycosides
  • Action/use
    • Bacteriocidal; inhibits protein synthesis
    • Aerobic gram neg bacteria (e. coli, seratia, proteus, klebsiella, pseudomanas); administered with other antibiotic for entercocci infections.
  • S/E
    • Irreversible ototoxicity, nephrotoxicity, respiratory paralysis
  • Prototype: Gentamycin (Garamycin)
aminoglycosides cont
Aminoglycosides cont
  • Nursing considerations
    • Monitor for ototoxicity (How?)
    • Monitor for nephrotoxicity (How?)
    • Provide optimal oral hygiene
    • IV administration should be done slowly
    • Poorly absorbed via GI—only route is IV
    • Monitor peak and trough levels for toxicity
obj 12 discuss uses of quinolones and macrolides
Obj. 12 Discuss uses of quinolones and macrolides
  • Quinolones/fluoroquinolones
    • First introduced in 1962
    • Currently four generations
  • Macrolides
    • Low doses-bacteriostatic
    • High doses-bacteriocidal
quinolones
Quinolones
  • Action/Use
    • Bacteriocidal;inhibit enzymes (DNA gyrase and topoisomerase) to affect DNA synthesis;gram neg microbes
    • Respiratory, GI, GU tracts; skin and soft tissue; newer agents very effective against anerobes
  • S/E/route
    • n/v; ADVERSE: dysrhythmias,liver failure and CNS changes; not used in pregnancy; caution in children; oral BID
  • Prototype:Ciprofloxicin (Cipro)
quinolones1
Quinolones
  • Nursing considerations:
    • Assess hypersensititivity; report neurologic effects
    • Phototoxicitity
    • Don’t take with vitamins/mineral supplements (or wait 2 hrs before and after
    • Monitor labs
    • I & O
    • Take all the prescription
macrolides
Macrolides
  • Action/Use
    • Binds to bacterial ribosome to inhibit synthesis (act inside cell); bacteriostatic; effective against gram + and -;treats whooping cough,
    • Legionaire’s disease, H. influenza and Mycoplasma pneumoniae
    • Newer drugs synthesized from erythromycin—less GI disturbance
  • S/E—very few
  • Prototype: erythromycin (E-Mycin)
macrolides1
Macrolides
  • Nursing considerations
    • Do not use in pregnancy
    • Assess history of hypersensititivity
    • Monitor labs (liver and kidney, INR)
    • Macrolides decrease warfarin metablism and excretion
13 describe misc drugs
# 13 Describe Misc. drugs
  • Clindamycin (Cleocin)
    • Grm + and – effectiveness
    • Use: oral infections
    • Contraindication: hypersensitivity
      • Limited use due to association w pseudomenbranous colitis
misc agents cont
Misc. agents cont
  • Sulfonamides
    • Action:bacteriostatic, broad spectrum, used for UTI
    • Classified by route of administration
      • Systemic and topical
    • Systemic
      • Sulfisoxazole (Gantrisin)
    • topical
      • Sulfadoxine (Fansidar)- not 1st choice drug
    • Contraindicated in pregnancy and infants < 2 years (promotes jaundice);low soluability causes crystals in urine
misc agents
Misc. agents
  • Vancomycin ( Vancocin)
  • Imipenim (primaxin)
misc agents1
Misc agents
  • Ketolides
  • glycylcyclines
15 antitubucular drugs
15: Antitubucular drugs
  • Tuberculosis:
    • Cause:
    • Incidence:
    • Treatment: prolonged due to cell wall resistance to penetration by anti infective drugs
      • Multiple drug concurrently
tuberculosis cont
Tuberculosis cont
  • Isoniazid (INH) (table 34.10)
    • Action:
    • Use:
    • S/E
16 antifungal agents
16: antifungal agents
  • General Action:
  • Amphoericin B (Fungizone)
    • Systemic
  • New class: echinocandins
    • Used for systemic mycoses
    • Caspofungin: treats aspergilosis
antifungals
Antifungals
  • Azoles
    • Fluconazole (Diflucan)
      • Action/use
    • Nystatin (Mycostatin)
17 antivirals
17: Antivirals
  • Nonnucleoside reverse transcriptase inhibitors (NRTI)
  • Nucleoside and nucleotide reverse transcriptase inhibitors (NNRTI)
antivirals cont
Antivirals cont
  • Protease inhibitors
  • Fusion inhibitor:
nursing process diagnosis
Nursing Process: Diagnosis
  • Infection RT
  • Risk of transmission of infection RT
  • Risk for infection RT
  • Risk for injury RT
  • Deficient knowledge RT
nursing process goals
Nursing Process:Goals
  • To prevent…
  • To alleviate..
  • To improve…
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