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PHARMACOLOGY ANTIMICROBIALS ANTIBIOTICS ANTIINFLAMMATORY

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PHARMACOLOGY ANTIMICROBIALS ANTIBIOTICS ANTIINFLAMMATORY Powered By Docstoc
					 PHARMACOLOGY



 ANTIMICROBIALS
   ANTIBIOTICS
ANTIINFLAMMATORY
         Definition of Terms
• Bacteremia - presence of viable bacteria in
  the circulation
• Septicemia - system infection caused by
  microorganism multiplication in the
  circulation
• Bacteremia can lead to septicemia
• Sepsis is a syndrome involving multiple
  system organ involvement
• Antibiotics are
  chemicals produced by
  one kind of
  microorganism that
  inhibit the growth of or
  kills another.
• Antibacterial and
  antimicrobial drugs are    Bacteriostatic -
  substances that inhibit    inhibits growth of
  the growth of or kill      bacteria
  bacteria or other          Bactericidal - kill
  microorganism.             bacteria
• Narrow-spectrum
  – primarily effective against one type of organism
  – Penicillin & erythromycin
• Broad-spectrum
  – effective against both gram (+) and gram( -)
    organisms
     • cephalosporins
     • tetracycline
          Nursing Management

Assessment
                                          –   fatigue
   general health
   temperature                            –   anorexia
   chills                                 –   weight loss
   sweats                                 –   cough
   redness                                –   sputum
   pain
                                          –    WBC
   edema
                 Collect specimens:       –   pus or drainage
                  blood, urine, sputum,
                  wound drainage &
                 discharge
• Specimens before antibiotics unless
  otherwise ordered
• CHECK ALLERGIES
  – Serious hypersensitivity and allergic reactions
    especially
  – PENICILLIN!!!!
  – Know about drug and check cross-sensitivity
    info
• Check effects of food on orals
• Nursing Diagnoses
  – Risk for infection
  – Risk for allergic reaction
  – Risk for infection transmission
• Monitor for signs drugs are working
  –  S&S
         Adverse Reactions

• Allergy or hypersensitivity effect
• Superinfections
   – large doses
   – > 1 antibiotic used
   – broad-spectrum drug use
• Organ toxicity
   – liver & kidney involved in drug metabolism
• Side effects
   – N/V/D
• Check pregnancy safety category
Penicillins and related antibiotics
• Bactericidal          • Penicillinase-resistant
• Gram (+) > gram (-)     PCNs
• Natural PCNs             – cloxacillin
  – PCN G                  – dicloxacillin
  – PCN v                  – methicillin
                           – nafcillin
                           – oxacillin
• Aminopenicillins            • Extended-spectrum
  (broader-spectrum)            PCNs
   – amoxicillin                – carbenicillin
   – amoxicillin +              – mezlocillin
     clavulanate                – piperacillin
     (Augmentin)                – piperacillin +
   – ampicillin                   tazobactam (Zosyn)
   – ampicillin + sulbactam     – ticarcillin
     (Unasyn_                   – ticarcillin + clavulanate
                                  (Timentin)
        PCN Side/adverse effects

• N/V/D                  • Interaction
                           with
• HA
                            – ACE
• sore mouth or               inhibitors
  tongue                    – anticoagulants
• oral and vaginal          – NSAIDs
  candidiasis               – lipid lowering
                            – OC (estrogen)
                            – Methotrexate
                            – probenecid
                 Cephalosporins
• Bactericidal               • Check hx of PCN
• Generations                  sensitivity
   – 1st - gram (+_          • Caution in hx of
   – 2nd (+) & (-)             bleeding disorders
   – 3rd - (-) and beta-        –   alcohol
     lactamase-producing        –   anticoagulants
     microbial strains and      –   NSAIDs
     less against gram (+)
                                –   probenecid
     cocci
                   Generations
• First
                     Second
  generation
                     generation
   – cefazolin          cefaclor      • Third
     (Ancef)            (Ceclor)        generation
   – cephalexin         cefotetan        – cefixime
     (Keflex)           (Cefotan)          (Suprax)
   – cechalothin        cefamandole
                                         – cefotaxime
     (Keflin)           (Mandol)           (Claforan)
   – cephapirin                          – ceftriaxone
     (Cefadyl)                             (Rocephin)
   – cephradine
     (Velosef)
       Macrolide antibiotics
• Bacteriostatic-bactericidal in high
  concentrations
• gram (+) and selected gram (-)
• Side/adverse effects (listed with
  antibiotic)
               Interactions
–   alffentanil (alfenta)
–   carbamazepine (Tegretol)
–   chloramphenicol (Chlormycetin)
–   cyclosporine
–   hepatotoxic meds
–   terfenadine (Seldane)
–   warfarin
–   xanthines (aminophyllin)
–   zidovudine (AZT)
    Most Common Macrolides
• Azithromyzin (Zithromax)
  – stomach pain, NVD;
• clarithromycin (Biaxin)
  – anorexia, HA, NV, lethargy, severe anemia,
    fever, infection, rash
• Erythromycin
  – abd cramps, NVD,
               Lincomycins
• Bacteriostatic (bactericidal in large doses
  with certain organisms)
• Clindamycin (Cleocin)
  – interacts with anesthetics, antidiarrheals
    (adsorbent) & chloramphenicol)
• Lincomycin (Lincocin)
• Vancomycin (ototoxic)
  – interacts with aminogylcosides & lipid
    lowering drugs
           Aminoglycosides
• Bactericidal (used for serious life-
  threatening infections)
• gram (-)* and (+)
• amikacin
• gentamicin
• kanamycin
• streptomycin
• tobramycin
             Interacts with…..
• Other aminoglycosides - potential for
  ototoxicity, nephrotoxicity, and
  neuromuscular blockade is enhanced
  –   amphotericin B parenteral
  –   check list
  –   anesthetics
  –   methoxyflurane
              Tetraclycine

• Broad-spectrum
• bacteriostatic for many (-) and (+)
  organisms
• cross-sensitivity and cross-resistance
• demeclocyline (Declomycin)
• doxycycline (Vibramycin)
• minocycline (Minocin)
• tetracycline
             Interacts with…...
• Antacids
  – lipid lowering
  – OC (estrogen)
• Caution with
  – “caine-type” (Lidocaine)
  – renal impairment
    Contraindicated in pregnant women and children <8
  – permanent mottling and discoloration of the teeth
  –  linear skeletal growth rate
  Chloramphenicol (chloromycetin)
• Broad spectrum bacteriostatic
• seriously toxic to bone marrow
• may be bacteriocidal in high doses with
  susceptible organisms
• CSF (meningitis)
• Infrequent side effects NVD.
    Interacts with…..
– alfentanil
– anticonvulsants
– oral antidiabetic
– clindamycin, erythromycin, lincomycin
– warfarin
        Fluoroquinolones

• Broad spectrum bactericidal
• check for FDA approved use in various
  infections
• Side effects - dizziness, drowsiness,
  restlessness, stomach distress, NVD
           Interacts with…..
• Interacts with
   – antacids, ferrous sulfate
   – xanthines
   – warfarin
• Ciprofloxacin (Cipro), enoxacin (Penetrex),
  ofloxacin (Floxin)
      Other Antibiotics


• Azteonam (Azactam) synthetic
  bactericidal similar to PCN-NVD
• imipenem-cilastatin (Primaxin)
  broad spectrum; beta-lactamase
  resistant;
                 More…….
• metronidazole (Flagyl) - cytotoxic agent
  (microbicidal)-
  – dizziness, HA, NVD, anorexia.
• Spectinomycin (Trobicin_)
  – Neisseria gonorrhoeae (antibiotic resistant or
    cannot take ceftriaxone)-bacteriostatic