Ppt chapter 09

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

AntibioticsAntibiotics

Chapter 09


AntibioticsAntibiotics

• Antibiotics are defined as:

– Chemicals that inhibit specific bacteria

– Made in three ways

• By living microorganisms

• By synthetic manufacture

• Through genetic engineering


Types of AntibioticsTypes of Antibiotics

• Bacteriostatic

– Those substances that prevent the growth of bacteria

• Bactericidal

– Those that kill bacteria directly


Signs of InfectionSigns of Infection

• Fever

• Lethargy

• Slow-wave sleep induction

• Classic signs of inflammation (redness, swelling, heat, and pain)


Goal of Antibiotic TherapyGoal of Antibiotic Therapy

• Decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invader


Selecting TreatmentSelecting Treatment

• Identification of the causative organism

• Based on the culture report, an antibiotic is chosen that has been known to be effective at treating the invading organism


Bacteria ClassificationBacteria Classification

• Gram-positive

– The cell wall retains a stain or resists decolorization with alcohol

• Gram-negative

– The cell wall loses a stain or is decolorized by alcohol

• Aerobic

– Depend on oxygen for survival

• Anaerobic

– Do not use oxygen


Bacteria and Resistance to AntibioticsBacteria and Resistance to Antibiotics

• Adapt to their environment

• The longer an antibiotic has been in use, the greater the chance that the bacteria will develop into a resistant strain


AminoglycosidesAminoglycosides

• A group of powerful antibiotics used to treat serious infections caused by gram-negative aerobic bacilli

• Common medications:

– Amikacin (Amikin)

– Gentamicin (Garamycin)

– Kanamycin (Kantrex)

– Neomycin (Mycifradin)

– Streptomycin

– Tobramycin (Nebcin, Tobrex)


Aminoglycosides (cont.)Aminoglycosides (cont.)

• Bactericidal

• Indications: Treatment of serious infections caused by susceptible bacteria

• Actions: Inhibits protein synthesis in susceptible strains of gram-negative bacteria causing cell death



• Pharmacokinetics

– Poorly absorbed from the GI tract, but rapidly absorbed after IM injection, reaching peak levels within 1 hour

– Widely distributed throughout the body, crossing the placenta and entering breast milk

– Excreted unchanged in the urine and have an average half-life of 2 to 3 hours

– Depend on the kidney for excretion and are toxic to the kidney



• Contraindications

– Known allergies, renal or hepatic disease, hearing loss

• Adverse Effects

– Ototoxicity and nephrotoxicity are the most significant

• Drug-to-Drug Interactions

– Diuretics, neuromuscular blockers


QuestionQuestion

Tell whether the following statement is true or false.

Because of the adverse effects of the aminoclycosides, it is important to teach the patient to restrict fluids and eat 6

small meals daily.


AnswerAnswer

False

Rationale: Provide the following patient teaching: Try to drink a lot of fluids and to maintain nutrition (very

important) even though nausea, vomiting, and diarrhea may occur.


Nursing Considerations for Patients Receiving Aminoglycosides

Nursing Considerations for Patients Receiving Aminoglycosides

• Assessment: History and Examination

• Nursing Diagnoses

• Implementation With Rationale

• Evaluation


Prototype Summary: GentamicinPrototype Summary: Gentamicin


CarbapenemsCarbapenems

• Therapeutic Actions and Indications


• Contraindications and Cautions

• Adverse Effects

• Clinically Important Drug–Drug Interactions


Nursing Considerations for Patients Receiving Carbapenems

Nursing Considerations for Patients Receiving Carbapenems




• Evaluation


Prototype Summary: ErtapenemPrototype Summary: Ertapenem


CephalosporinsCephalosporins

• Similar to penicillin in structure and activity

• Action

– Interfere with the cell wall–building ability of bacteria when they divide

• Indications

– Treatment of infections caused by susceptible bacteria


– Well absorbed from the GI tract

– Metabolized in the liver, excreted in the urine


Cephalosporins (cont.)Cephalosporins (cont.)


– Allergies to cephalosporins or penicillin

• Adverse Effects

– GI track


– Aminoglycosides, oral anticoagulants, ETOH


Nursing Considerations for Patients Receiving Cephalosporins

Nursing Considerations for Patients Receiving Cephalosporins




• Evaluation


Prototype Summary: CefaclorPrototype Summary: Cefaclor


QuestionQuestion

You are writing a plan of care for a patient receiving Cefaclor. What would be an appropriate nursing diagnosis for this patient?

A. Deficient fluid volume and imbalanced nutrition: Less than body requirements, related to diarrhea

B. Chronic pain related to GI, CNS effects of drug

C. Monitor renal function test values

D. Perform culture and sensitivity tests at the site of infection


AnswerAnswer

a. Deficient fluid volume and imbalanced nutrition: Less than body requirements, related to diarrhea

Rationale: Nursing diagnoses related to drug therapy might include: Acute Pain related to GI, CNS effects of drug; Risk for infection related to repeated injections; Deficient fluid volume and imbalanced nutrition: Less than body requirements, related to diarrhea; Deficient knowledge regarding drug therapy


FluoroquinolonesFluoroquinolones• Relatively new class of antibiotics with a broad spectrum of activity

• Indications: Treating infections caused by susceptible strains of gram-negative bacteria. Includes: urinary track, respiratory track, and skin infections

• Actions: Interferes with DNA replication in susceptible gram-negative bacteria, preventing cell reproduction

• Pharmacokinetics:

– Absorbed in GI tract

– Metabolized in the liver

– Excreted in urine and feces


Fluoroquinolones (cont.)Fluoroquinolones (cont.)


– Known allergy, pregnancy, or lactating women

• Adverse Effects

– Headache, dizziness, GI upset


– Antacids, quinidine, theophylline


Nursing Considerations for Patients Receiving Fluoroquinolones

Nursing Considerations for Patients Receiving Fluoroquinolones




• Evaluation


Prototype Summary: CiprofloxacinPrototype Summary: Ciprofloxacin


QuestionQuestion

What is a contraindication to receiving a fluoroquinolones?

A. Over 65 years

B. Weight under 100 pounds

C. Fluoroquinolones are contraindicated in patients with known allergy to any fluoroquinolone.

D. History of cancer


AnswerAnswer

c. Fluoroquinolones are contraindicated in patients with known allergy to any fluoroquinolone.

Rationale: Fluoroquinolones are contraindicated in patients with known allergy to any fluoroquinolone and in pregnant or lactating patients because potential effects on the fetus and infant are not known.


Penicillins and Penicillinase - Resistant Antibiotics

Penicillins and Penicillinase - Resistant Antibiotics

• Therapeutic Actions and Indications


• Contraindications and Cautions

• Adverse Effects

• Clinically Important Drug–Drug Interactions


Nursing Considerations for Patients Receiving Penicillins and Penicillinase-

Resistant Antibiotics

Nursing Considerations for Patients Receiving Penicillins and Penicillinase-

Resistant Antibiotics




• Evaluation


Prototype Summary: AmoxicillinPrototype Summary: Amoxicillin


SulfonamidesSulfonamides• Drugs that inhibit folic acid synthesis

• Action

– Interfere with the cell wall–building ability of bacteria when they divide

• Indications

– Treatment of infections caused by gram-negative and gram-positive bacteria





Sulfonamides (cont.)Sulfonamides (cont.)


– Allergy, pregnancy

• Adverse Effects

– GI symptoms; Renal effects related to the filtration of the drug


– Cross sensitivity with thiazide diuretics

– Sulfonylureas


Nursing Considerations for Patients Receiving Sulfonamides

Nursing Considerations for Patients Receiving Sulfonamides




• Evaluation


Prototype Summary: CotrimoxazolePrototype Summary: Cotrimoxazole


TetracyclinesTetracyclines

• Developed as semisynthetic antibiotics based on the structure of a common soil mold

• Action

– Inhibits protein synthesis in susceptible bacteria, preventing cell replication

• Indications

– Treatment of various infections caused by susceptible strains of bacteria; acne when penicillin is contraindicated for eradication of susceptible organisms


– Adequately absorbed from the GI tract

– Concentrated in the liver, excreted unchanged in the urine


Tetracyclines (cont.)Tetracyclines (cont.)


– Allergy, pregnancy, and lactation

• Adverse Effects

– GI, Skeletal – damage to bones and teeth


– Penicillin G, oral contraceptive therapy, methoxyflurane, digoxin


Nursing Considerations for Patients Receiving Tetracyclines

Nursing Considerations for Patients Receiving Tetracyclines




• Evaluation


Prototype Summary: TetracyclinePrototype Summary: Tetracycline


QuestionQuestion

Tell whether the following statement is true or false.

Sulfonamides should not be given with thiazide diuretics because of a cross sensitivity of the drugs.


AnswerAnswer

True

Rationale: Drug-to-Drug Interactions: Cross sensitivity with thiazide diuretics; Sulfonareas


AntimycobacterialAntimycobacterial

• Contain pathogens causing TB and leprosy

• Action

– Act on the DNA of the bacteria leading to lack of growth and eventual bacterial death

• Indications

– Treatment of acid fast bacteria





AntimycobacterialAntimycobacterial


– Allergy, renal or hepatic failure

• Adverse Effects

– CNS effects and GI irritation


– Rifampin and INH can cause liver toxicity


Nursing Considerations for Patients Receiving Antimycobacterials

Nursing Considerations for Patients Receiving Antimycobacterials




• Evaluation


Prototype Summary: IsoniazidPrototype Summary: Isoniazid


Other AntibioticsOther Antibiotics

• Ketolides

– Therapeutic Actions and Indications

– Pharmacokinetics

– Contraindications and Cautions

– Adverse Effects

– Clinically Important Drug-Drug Interactions


Prototype Summary: TelithromycinPrototype Summary: Telithromycin


Other Antibiotics (cont.)Other Antibiotics (cont.)

• Lincosamides




– Adverse Effects


Prototype Summary: ClindamycinPrototype Summary: Clindamycin



• Macrolides




– Adverse Effects

– Clinically Important Drug–Drug Interactions

– Clinically Important Drug–Food Interactions


Prototype Summary: ErythromycinPrototype Summary: Erythromycin



• Monobactam Antibiotic




– Adverse Effects


Prototype Summary: AztreonamPrototype Summary: Aztreonam


Nursing Considerations for Patients Receiving Other Antibiotics

Nursing Considerations for Patients Receiving Other Antibiotics




• Evaluation


QuestionQuestion

The macrolide antibiotics have known food-drug interactions. What would you teach your patient taking a macrolide antibiotic?

A. Take with meals

B. Take daily just before going to bed

C. Take daily upon arising in the morning

D. Take 1 hour before or at least 2 to 3 hours after meals


AnswerAnswer

D. Take 1 hour before or at least 2 to 3 hours after meals

Rationale: Food in the stomach decreases absorption of oral macrolides. Therefore, administer the antibiotic on an empty stomach with a full, 8-oz glass of water, 1 hour before or at least 2 to 3 hours after meals.


New Classes of Antibiotics and Adjuncts New Classes of Antibiotics and Adjuncts

• Daptomycin

• Linezolid (Zyvox)

• Tigecycline

• Streptogramins


Antibiotic Use Across the Life SpanAntibiotic Use Across the Life Span

• Pediatric Population

• Adult Population

• Geriatric Population

Ppt chapter 09

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