IV/Pharm Integumentary Drugs part 1

Antibiotics

• Antimicrobial medications are classified as narrow spectrum or broad spectrum based on the range of organisms they target.
• Bactericidal medications kill bacteria, while bacteriostatic medications slow bacterial reproduction.
• Identifying the causative agent is crucial; methods include Gram staining and microorganism cultures.
• Cultures should be obtained before the first antibiotic dose for accurate results.
• Host factors like a weakened immune system, infection site, and pre-existing conditions impact treatment effectiveness.
• Combination therapy is often used for severe infections, using multiple antibiotics to enhance effectiveness and reduce resistance.

Sulfonamides

• Sulfonamides are effective against infections like UTIs, otitis media, chancroid, pertussis, shigellosis, and pneumocystis pneumonia.
• Common adverse reactions include anorexia, nausea, vomiting, diarrhea, abdominal pain, chills, fever, stomatitis, and orange-yellow urine.
• Sulfonamides can cause hyperkalemia, crystalluria, and photosensitivity, requiring monitoring and interventions like increased fluid intake and sunscreen.
• Hypersensitivity reactions range from mild itching and rashes to severe conditions like toxic epidermal necrolysis and Stevens-Johnson syndrome.
• Sulfonamides can cause blood dyscrasias (affecting platelet, red blood cell, and white blood cell counts), necessitating close monitoring of laboratory values.
• Contraindicated in lactation, late pregnancy, and children under two.
• Caution for patients with renal or hepatic impairment, and bronchial asthma.

Penicillins

• Work by weakening and disrupting bacterial cell walls, effective against many infections.
• Broad-spectrum antibiotic effective against a wide range of bacteria, including examples like penicillin, methicillin, and piperacillin.
• Adverse reactions include gastrointestinal upset, and hypersensitivity reactions, potentially leading to anaphylactic shock.
• Cross-sensitivity with cephalosporins exists; patients allergic to penicillin have a 10% chance of being allergic to cephalosporins.
• Superinfections can occur due to the elimination of beneficial bacteria.
• Hematopoietic changes can occur, requiring careful monitoring of blood cell counts.
• High doses of penicillin G may cause hypokalemia.
• Always have epinephrine and respiratory support readily available due to anaphylaxis risk.
• Anaphylactic reactions can occur 2–30 minutes after administration, or even later.
• Clients should wear an alert bracelet indicating penicillin allergy.
• Contraindicated in patients with hypersensitivity to penicillin, cephalosporins, or methicillin.
• Use cautiously in patients with renal disease, asthma, bleeding disorders, GI disease, pregnancy, or lactation.
• Monitor cardiac status and electrolyte levels, especially potassium.
• Decreases the effectiveness of birth control and when used with tetracycline.
• Increases bleeding risk when used with anticoagulants.
• Increases the risk of anaphylactic reaction when used with beta-adrenergic blockers.
• Penicillin, Amoxicillin, and Amoxicillin clavulanate should be taken with meals.
• All other penicillins should be given with eight ounces of water, one hour before meals or two hours after meals.
• Complete the entire course.
• Use additional contraception.

Cephalosporins

• Broad-spectrum bactericidal drugs, classified into four generations (first, second, third, and fourth).
• Later generations (third and fourth) better reach cerebrospinal fluid (CSF), less susceptible to breakdown, and more effective against gram-negative organisms.
• Used to treat various bacterial infections including respiratory, ear, bone, joint, genital, urinary tract, post-operative infections, and meningitis.
• Can be used prophylactically to prevent sexually transmitted infections.
• Side effects include nausea, vomiting, and diarrhea; diarrhea may indicate pseudomembranous colitis (often caused by Clostridium difficile).
• Intramuscular administration can cause pain, tenderness, and inflammation at the site.
• Rotate injection sites.
• Intravenous (IV) administration can result in phlebitis or thrombophlebitis.
• Other possible side effects: headache, dizziness, malaise, heartburn, fever, and nephrotoxicity.
• Monitor urine output, BUN, and creatinine if nephrotoxicity is suspected or suspected.
• Hypersensitivity reactions, aplastic anemia, and toxic epidermal necrolysis can occur.
• Approximately 10% of patients allergic to penicillin are also allergic to cephalosporins.
• Contraindicated in patients allergic to penicillin or cephalosporins.
• Avoid certain cephalosporins (Cefitin and Ceftriaxone) in patients with bleeding disorders or anticoagulants.
• Monitor bleeding times; have vitamin K readily available.
• Use cautiously with renal disease, hepatic impairment, bleeding disorders, pregnancy, or allergy history.
• Increases the risk of nephrotoxicity when used with aminoglycosides.
• Increases the risk of bleeding when given with oral anticoagulants.
• Cephalosporins can cause a disulfiram-like reaction with alcohol within 72 hours of a dose, causing symptoms like nausea, vomiting, palpitations, blurred vision, and dyspnea.
• Medications causing disulfiram-like effects include sulfonylureas, procarbazine, griseofulvin, and metronidazole.
• Shake oral suspensions well before use.
• Administer with food if gastrointestinal issues arise.
• Ceftriaxone (Rocephin) can be painful intramuscularly; mix with lidocaine to lessen pain.

Treatment Considerations

• Prophylactic treatment prevents infections in scenarios like surgery, infection exposure, and prosthetic heart valve patients.
• Preventative measures like hand hygiene, aseptic technique, and transmission precautions are crucial.
• Monitoring antibiotic effectiveness is essential through post-treatment cultures and surveillance for drug resistance.
• Drug resistance is a significant concern, influenced by over-prescription, incomplete courses, and close contacts.
• MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin-resistant Enterococcus) are common examples of resistant organisms.
• Antibiotic use should be minimized in viral infections (like colds) to avoid resistance.

This quiz covers the classification and mechanisms of antibiotics, focusing on narrow and broad spectrum medications. It includes information on sulfonamides, their uses, and adverse reactions, as well as the importance of identifying causative agents. Test your knowledge about antimicrobial treatments and their applications.