محاضرة التعليمات الأساسية

Antibiotics

• Medications inhibit bacterial growth or kill bacteria and other microorganisms
• Also known as antimicrobials, anti-infective agents, and antibacterial agents

The basic principles of antimicrobial therapy

• Empiric therapy: immediate antimicrobial therapy given prior to culture and sensitivity testing to avoid delay in critically ill patients
• Prophylactic therapy: treatment with antibiotics to prevent infection, such as in intra-abdominal surgery

Classification according to effect on bacteria

• Bacteriostatic drugs arrest bacterial growth, limiting infection spread until the immune system eliminates the pathogen
• If the drug is removed too early, a second cycle of infection can occur
• Examples include tetracyclines, sulfonamides, and macrolides
• Bactericidal drugs kill bacteria
• Drugs of choice for seriously ill and immunocompromised patients
• Examples include aminoglycosides, cephalosporins, penicillins, and quinolones
• Some antibiotics can be both bacteriostatic and bactericidal, depending on dosage, duration, and invading bacteria's state

Mechanism of action of antibacterial drugs

• Inhibition of cell wall synthesis (bactericidal effect)
• Alteration of membrane permeability (bacteriostatic or bactericidal effect)
• Inhibition of protein synthesis (bacteriostatic or bactericidal effect)
• Inhibition of bacterial RNA and DNA synthesis
• Interference with cellular metabolism (bacteriostatic effect)

Nursing responsibilities for patients on penicillins & cephalosporins

• Assess patients for allergic reactions to penicillin or cephalosporins, especially after the first and second doses. Reactions may vary from mild (rash) to severe (respiratory distress or anaphylaxis)
• Have epinephrine readily available to counteract a severe allergic reaction
• Monitor for allergic reactions if a patient is allergic to penicillin and taking a cephalosporin, though the likelihood of a reaction is generally small
• Instruct patients to complete the entire course of medication, even if symptoms resolve
• Advise patients to take the medication with food to avoid gastric irritation
• Advise females of childbearing years to use additional contraception while taking penicillins

Aminoglycosides

• Side effects: ototoxicity (irreversible), nephrotoxicity, superinfection with prolonged use
• Drug interactions: decreased effectiveness of aminoglycosides when combined with certain drugs, such as penicillins, requiring administration several hours apart
• Risk of ototoxicity is increased when combined with other drugs

Fluoroquinolones

• MOA: inhibits the enzyme DNA gyrase, which is needed for bacterial DNA synthesis
• Indications: urinary tract infections, lower respiratory tract infections, skin/soft tissue/bone/joint infections.
• Side effects: dizziness, nausea, vomiting, diarrhea, flatulence, abdominal cramps

Macrolides

• MOA: bind to the 50S ribosomal subunits, and inhibit protein synthesis, acting bacteriostatic at lower doses and bactericidal at higher doses
• Indications: mild to moderate respiratory tract, sinus, GI tract, skin, and soft tissue infections, diphtheria

Tetracyclines

• MOA: inhibits bacterial protein synthesis
• Indications: treatment of Helicobacter pylori, severe acne
• Side effects: GI disturbances (nausea, vomiting, diarrhea), photosensitivity reaction (sunburns), teeth discoloration in children and pregnant women in later trimesters

Sulfonamides

• Side effects: allergic response (skin rashes, itching), blood disorders (hemolytic anemia, aplastic anemia, low WBC and platelet counts), GI disturbances (anorexia, nausea, vomiting), crystalluria and hematuria
• Contraindications: during pregnancy to prevent congenital malformations, neural tube defects, and kernicterus

What is Pain?

• Pain is an unpleasant sensory/emotional experience
• Associated with actual or potential tissue damage
• Nurses must have knowledge and skills to assess and measure pain to manage it appropriately.

Non-opioid analgesics

• NSAIDs (Non-steroidal anti-inflammatory drugs)
• Acetaminophen (analgesic - antipyretic)
• Relief of mild to moderate pain and acute/chronic arthritis, Gout, Migraines,

Opioids and opioid antagonists

• Morphine (the reference opioid) - Various routes of administration
• Codeine (methylmorphine) - Greater oral availability, less potent than morphine
• Fentanyl - Short acting synthetic opioid agonist 75-100 times more potent than morphine
• μ-receptor antagonists - Reverse life-threatening adverse effects (respiratory depression) of opioids
• Naloxone (parenteral)
• Naltrexone (oral) - Used in out-patient settings for detoxification
• Nursing process: Obtain medical history, assess vital signs (including respiratory rate and depth), monitor urinary output, administer morphine before pain reaches its peak, have Naloxone ready as an antidote for respiratory depression.

Migraines

• Throbbing head pain, nausea, vomiting, photophobia, symptoms may last 4-24 hours or several days
• Possible causes: imbalance in neurotransmitters, serotonin causes vasoconstriction and suppresses headaches
• Treatment options include triptans, NSAIDs, opioids, caffeine, antiemetics
• Prophylaxis: beta-blockers, valproic acid, Calcium Channel blockers

Immune system

• Innate defenses (1st line barriers): mechanical barriers (skin, mucous membranes), chemical barriers (tears), reflexes (sneezing, coughing)
• Passive immunity (transfer of antibodies) > Natural (from mother) & Induced (administration of antibodies)
• Active immunity: naturally acquired (after exposure to a disease), artificially acquired (vaccination)

Immunosuppressants

• Drugs for suppressing immune responses.
• Classes: Selective cytokine inhibitors, Immunosuppressive antimetabolites, Antibodies, Corticosteroids

Selective inhibitors of lymphocyte and cytokine signaling

• Cyclosporine/Sirolimus/tacrolimus: suppress cell-mediated immune reactions
• Adverse effects: nephrotoxicity, hepatotoxicity, infections, other (lymphoma, hypertension, hyperlipidemia, hyperkalemia, tremor, glucose intolerance, gum hyperplasia)

Immunosuppressive antimetabolite (Azathioprine)

Glucocorticoids

• Side effects: impaired wound healing, increased risk of infection, growth arrest in children, musculoskeletal effects, adrenocortical excess (Cushing's disease), CNS effects (psychological/behavioral changes), increased appetite, central obesity, cardiovascular effects (CVS), thin fragile skin

Nursing process for glucocorticoids: monitor vital signs, advise patient to take drug as prescribed and not to stop abruptly, assess for side effects when therapy lasts for a long time

Cardiac glycosides (Digoxin)

• Positive inotropic effect: increases heart muscle contraction
• Used to treat supraventricular arrhythmias
• Adverse reactions: K+ loss (hypokalemia), liver disease, kidney disease
• Antidote: Digoxin-binding fragment (Fab) IV administration

Treatment strategies for Angina

• Reduce cardiac work or increase oxygen supply: Organic nitrates, Beta-blockers, Calcium channel blockers, Potassium channel openers

I-Nitrates

• Used to relieve acute angina
• Mechanism of action: Relax blood vessels (smooth muscle)
• Result: Decrease workload on the heart
• Side effects: Headache (common), flushing, postural hypotension/dizziness

II- Beta Blockers

• Reduce cardiac oxygen demand
• Side effects: may inhibit normal heart function

IV- K Channel Openers

• Vasodilators
• Side Effects: headache, palpitation, dizziness

What is Arrhythmia?

• Any deviation from normal heart rate or pattern (too slow/fast/irregular)

Classification of Antiarrhythmic Drugs

• Class I: Sodium channel blockers
• Class II: Beta-blockers
• Class III: Potassium channel blockers
• Class IV: Calcium channel blockers

2-2 Hyperlipidemia Treatment (Statins)

• For lowering cholesterol
• Simvastatin & Atorvastatin
• Adverse effects: muscle & liver injury, contraindicated in pregnancy; Use cautiously with warfarin; Monitor liver function

2-2 Hyperlipidemia Treatment (Fibrates)

• Fenofibrate
• Adverse effects: muscle injury, contraindicated for combined therapy with statins

2-2 Hyperlipidemia Treatment (Bile Acid Sequestrants)

• Cholestyramine
• Adverse effects: GIT disturbances (constipation, dyspepsia, flatulence), decreased absorption of fat-soluble vitamins

3.1 Thrombosis (overview)

Anticoagulants (Heparin)

• Mechanism: activates antithrombin III, enhancing body's anticoagulant system
• Used for clot formation risk (post-surgery, past history of clots)
• Administration: IV or SC
• Monitoring: CBC and aPTT

Anticoagulants (Warfarin)

• Mechanism: inhibits vitamin K-dependent clotting factors
• Used for long-term anticoagulation
• Monitoring: INR (international normalized ratio)
• Antidote: vitamin K IV, fresh frozen plasma

Anticoagulants (Antiplatelets)

• e.g., Aspirin, Clopidogrel
• Mechanism: interferes with platelet aggregation
• Side effects: GI bleeding, co-administer with antacids for chronic conditions
• Important note: Prolonged use of aspirin in chronic conditions must be co-administered with antacids to decrease the possibility of peptic ulcer development.

Antitussives

• Act on cough center in the medulla to suppress cough reflex
• Types: Opioid (codeine), non-opioid (dextromethorphan), combination (guaifenesin & dextromethorphan)

Expectorants

• Loosen bronchial secretions for easier elimination by coughing
• Commonly used is guaifenesin
• Increase fluid intake for better mucus loosening

Gastrointestinal Drugs

• Treatment for PUD and GERD (proton pump inhibitors, histamine-2 receptor antagonists, antacids)

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