Cephalosporins and Carbapenems Overview

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Questions and Answers

What is the primary therapeutic action of tetracyclines?

Inhibiting protein synthesis leading to bacterial multiplication inability (correct)

Inhibiting bacterial cell wall formation

Enhancing protein synthesis in bacteria

Increasing the effectiveness of the immune response

Which of the following conditions are tetracyclines indicated for?

Chronic obstructive pulmonary disease (COPD)

Infections caused by Rickettsiae and H.influenzae (correct)

Bacterial infections resistant to antibiotics

Viral infections and fungal diseases

What is a contraindication for the use of tetracyclines?

Use in patients with asthma

Known allergies to tetracyclines or tartrazine (correct)

Age over 18 years

Mild renal dysfunction

How are tetracyclines primarily excreted from the body?

Through urine via the kidneys Signup and view all the answers

What is the half-life range of tetracyclines?

6-12 hours Signup and view all the answers

What is the primary therapeutic action of carbapenems?

Interfere with the cell-wall building ability during cell division. Signup and view all the answers

Which generation of cephalosporins is primarily effective against gram-positive bacteria and P.mirabilis?

First-generation cephalosporins. Signup and view all the answers

Which cephalosporin generation is more potent against gram-negative bacilli?

Third-generation. Signup and view all the answers

What is the primary route of excretion for cephalosporins?

Kidney (urine). Signup and view all the answers

Which of the following conditions is a contraindication for cephalosporins?

Known allergy to cephalosporins. Signup and view all the answers

What is the approximate duration of action for oral cephalosporins?

8-10 hours. Signup and view all the answers

Which factor is NOT a caution for using cephalosporins?

Mild allergic reactions to other antibiotics. Signup and view all the answers

Which bacteria are first-generation cephalosporins primarily effective against?

Gram-positive cocci and some gram-negative bacteria. Signup and view all the answers

What gastrointestinal adverse effects may result from the use of tetracyclines?

Nausea and vomiting Signup and view all the answers

Which adverse effect is associated with the use of tetracyclines regarding the skeletal system?

Staining and pitting of teeth Signup and view all the answers

What effect do tetracyclines have on oral contraceptives?

Decreased effectiveness Signup and view all the answers

What is the primary therapeutic action of antimycobacterials?

Act on DNA and/or RNA of bacteria Signup and view all the answers

What is a common contraindication for the use of antimycobacterials?

Known allergies to antimycobacterials Signup and view all the answers

How do calcium salts affect the absorption of tetracyclines?

Decrease absorption of tetracyclines Signup and view all the answers

What is the half-life (T1/2) of antimycobacterials in the body?

1-4 hours Signup and view all the answers

What hematologic adverse effect can occur with the use of tetracyclines?

Hemolytic anemia Signup and view all the answers

What is the primary purpose of checking culture and sensitivity reports for a patient taking antibiotics?

To ensure the drug is the best option for the specific infection Signup and view all the answers

Which nursing intervention is essential to minimize the risk of developing resistant bacteria?

Ensuring the patient completes the full course of aminoglycosides Signup and view all the answers

What should a nurse educate a patient about regarding side effects of antibiotic therapy?

To report symptoms like severe headache or difficulty breathing Signup and view all the answers

Which evaluation aspect indicates effective drug therapy in a patient undergoing antibiotic treatment?

Decreased signs and symptoms of infection Signup and view all the answers

How should a nurse respond if a patient exhibits CNS effects while on antibiotic therapy?

Monitor the patient and provide safety measures Signup and view all the answers

What adverse effect is associated with the use of antibiotics?

Pseudomembranous colitis Signup and view all the answers

Which drug when combined with ketolides can lead to a loss of therapeutic effects?

Rifampin Signup and view all the answers

What should be monitored when administering antibiotics that have the potential for prolonged QT interval?

Heart rhythm and medications causing prolonged QT Signup and view all the answers

What nursing assessment is crucial before initiating antibiotic therapy?

Assessing for allergies and CNS disorders Signup and view all the answers

What is a nursing diagnosis related to the effects of antibiotics on gastrointestinal function?

Deficient fluid volume related to diarrhea Signup and view all the answers

What should be done to ensure appropriate antibiotic therapy?

Conduct culture and sensitivity tests at the site of infection Signup and view all the answers

Which side effect is associated with aminoglycosides due to their impact on the central nervous system?

Hearing loss Signup and view all the answers

Which statement about macrolides is accurate regarding their administration?

Must be taken on an empty stomach Signup and view all the answers

Study Notes

Carbapenems

Similar in structure and activity to penicillins
Exert bactericidal and bacteriostatic effects by interfering with bacterial cell wall synthesis during cell division

Cephalosporins

First-generation: effective against gram-positive bacteria like penicillin G, as well as gram-negative bacteria like P.mirabilis, K.pneumoniae, and E.coli
Second-generation: effective against first-generation strains, as well as H.influenzae, E.aerogenes, and Neisseria spp., less effective against gram-positive bacteria.
Third-generation: effective against all previously mentioned strains, relatively weak against gram-positive bacteria, more potent against gram-negative bacilli and S.marcescens
Fourth-generation: active against gram-negative and gram-positive organisms including cephalosporin-resistant staphylococci and P.aeruginosa

Cephalosporins Pharmacokinetics

Oral: onset N/A, peak 30-60 minutes, duration 8-10 hours
Half-life: 30-60 minutes
Metabolism: N/A
Excretion: kidney (urine); unchanged

Cephalosporins Contraindications and Cautions

Known allergy to cephalosporins or beta-lactams (cross-reactions are common)
Hepatic or renal impairment (toxic to the kidneys)
Pregnancy and lactation (potential effects on fetus and infant are not known)
Reserve cephalosporins for appropriate situations due to increasing cephalosporin-resistant bacteria
Perform culture and sensitivity tests before starting therapy

Tetracyclines

Inhibit protein synthesis leading to an inability of bacteria to multiply
Can be toxic to humans at high concentrations due to similar protein structure to human cells

Tetracyclines Indications

Treatment of infections caused by susceptible strains: Ricketssiae, M.pneumoniae, B.recurrentis, H.influenzae, H.ducreyi, Bacteroides spp., V.comma, Shigella spp., D.pneumoniae, and S.aureus
Adjunct in treatment of protozoal infections

Tetracyclines Pharmacokinetics

Oral: onset varies, peak 2-4 hours, duration N/A
Topical: minimal absorption occurs, peak N/A, duration N/A
Half-life: 6-12 hours
Metabolism: N/A
Excretion: kidney (urine)

Tetracyclines Contraindications and Cautions

Known allergies to tetracyclines or tartrazine
Pregnancy and lactation (effects on developing bones and teeth)
Fungal, mycobacterial, or viral ocular infections
Use with caution in children below 8 (can damage developing bones and teeth)
Hepatic or renal dysfunction (drugs are concentrated in the bile and excreted in urine)

Tetracyclines Adverse Effects

GI: nausea, vomiting, diarrhea, abdominal pain, glossitis, dysphagia, fatal hepatotoxicity
Skeletal and bones: weakening structure, staining, and pitting of teeth and bones
Dermatological: photosensitivity and rash
Superinfection
Local: pain and stinging with topical or ocular applications
Hematologic: hemolytic anemia, bone marrow depression
Hypersensitivity reactions: urticaria, anaphylaxis
Intracranial hypertension

Tetracyclines Interactions

Penicillin G: decreased effectiveness of penicillin G
Oral contraceptives: decreased effectiveness of oral contraceptives
Digoxin: increased digoxin toxicity
Calcium salts, magnesium slats, zinc salts, aluminum salts, bismuth salts, iron, urinary alkalinizers, and charcoal: decreased absorption of tetracyclines

Antimycobacterials

Used to treat infections caused by pathogens responsible for tuberculosis and leprosy
Mycobacterium tuberculosis causes tuberculosis, the leading cause of death from infectious disease in the world
Mycobacterium leprae causes leprosy or Hansen's disease, characterized by skin lesions and respiratory tract damage

Antimycobacterials Therapeutic Action

Act on bacteria DNA and/or RNA, leading to a lack of growth and eventually bacterial death

Antimycobacterials Indications

Treatment of tuberculosis and leprosy

Antimycobacterials Pharmacokinetics

Oral: onset varies, Peak 1-2 hours, duration 24 hours
Half-life: 1-4 hours
Metabolism: liver
Excretion: kidney (urine)

Antimycobacterials Contraindications and Cautions

Known allergies to antimycobacterials
Pregnancy (adverse effects on the fetus)

Antimycobacterials Adverse Effects

GI: nausea, vomiting, potential for pseudomembranous colitis, superinfections, taste alterations, risk for C.difficile diarrhea

Antimycobacterials Interactions

Ketolides: loss of therapeutic effects if combined with rifampin, phenytoin, carbamazepine, phenobarbital; increased serum levels of digoxin and metoprolol, increased GI toxicity with theophylline
Lipoglycopeptides: increased risk for prolonged QT interval if combined with drugs that cause prolonged QT interval
Macrolides: food in the stomach decreases absorption of oral macrolifes, take on an empty stomach 1 hour before or 2-3 hours after meals

Monobactams

Incompatible in solution with nafcillin, cephradine, and metronidazole

Nursing Considerations for Antibiotics

Assess for cautions and contraindications to prevent complications
Perform a thorough physical assessment to establish baseline data, determine effectiveness, and evaluate adverse effects
Perform culture and sensitivity tests to ensure appropriate drug use
Conduct orientation and reflex assessment, as well as auditory testing for CNS effects (aminoglycosides)

Nursing Diagnoses for Antibiotics

Acute pain related to GI or CNS drug effects
Deficient fluid volume and imbalanced nutrition: less than body requirements due to diarrhea
Disturbed sensory perception (auditory) due to CNS effects
Risk for infection due to bone marrow suppression (aminoglycosides) and repeated injections (cephalosporins)

Nursing Interventions for Antibiotics

Ensure the patient receives a full course of aminoglycosides as prescribed, divided around the clock
Monitor infection site and presenting signs and symptoms throughout drug therapy
Provide safety measures to protect the patient if CNS effects occur
Educate the patient on drug therapy to promote understanding and compliance

Nursing Interventions for Antibiotics - Patient Teaching

Safety precautions (e.g., changing positions, avoiding hazardous tasks)
Drinking lots of fluids and maintain nutrition
Report difficulty breathing, severe headache, fever, diarrhea, and signs of infection

Evaluation of Nursing Interventions

Monitor patient response to therapy (decrease in signs and symptoms of infection)
Monitor for adverse effects
Evaluate patient understanding of drug therapy (name, indication, adverse effects)
Monitor patient compliance to drug therapy

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Description

This quiz covers the structure, activity, and classification of carbapenems and cephalosporins. It explains their bactericidal and bacteriostatic effects, as well as their pharmacokinetics across the different generations of cephalosporins. Test your knowledge on these important antibiotics and their mechanisms of action.