#2 Unit 4 NS10 Antibiotics (Part 1) LT 9.1.23 (2).pptx

Unit 4 Pharmacology: Antibiotics Lynnette Taylor MSN/Ed, RN Ventura College Nursing Objectives 1 Explain the mechanism of action of antibacterials, tuberculars, fungals, -virals, malarials, helminthics 2 Differentiate between the different drug classifications 3 Summarize the nurses’ role in detecti...

Unit 4 Pharmacology: Antibiotics Lynnette Taylor MSN/Ed, RN Ventura College Nursing Objectives 1 Explain the mechanism of action of antibacterials, tuberculars, fungals, -virals, malarials, helminthics 2 Differentiate between the different drug classifications 3 Summarize the nurses’ role in detecting otoand nephrotoxicity 4 Discuss reasons for peak and trough concentration levels 5 Apply the nursing process to patients receiving these drugs including patient teaching 2 Video: How Antibiotics Work (2:45) 3 Antibacteri als 4 Terms Broad spectrum Narrow spectrum Bacteriost atic Drug resistance Bactericida l 5 Antibiotics in Under 5 Minutes Picmonic Nursing Snippet (5:16) 6 KEY POINTS For ALL ABX Do c/s before administration Monitor closely during first dose Check for superinfection Diarrhea common to all No ETOH Decrease effectiveness of oral contraceptives Store safely 7 Penicillins 8 PCN Introduced to kill Staphylococcus Inhibit bacterial cell wall synthesis Penicillin G, Procaine Exampl Penicillin, Penicillin V es NarrowSpectrum Penicillins 9 Bacterici dal Examples E. coli, H. influenzae, Shigella, Salmonella Amoxicillin Ampicillin Broad-Spectrum Penicillins 10 Beta-Lactamase Inhibitors Combined with penicillina sesensitive penicillin Examples: Amoxicillinclavulanic acid (Augmentin) Ampicillinsulbactam (Unasyn) Piperacillintazobactam (Zosyn) Ticarcillin-clavulanic acid (Timentin) 11 Adverse Reactions to PCNs 1 2 Common GI disturbances (N, V, D, cramping) Adverse Hypersensitivity, neutropenia, thrombocytopenia, bleeding Nursing Interventions for PCNs Monitor for bleeding Increase fluids Take on empty stomach Crosssensitivity to cephalosporin s 13 Cephalosporins 14 15 Cephalosporins 1 Bactericidal Ceftriaxone, cephazolin cephalexin, cefuroxime 2 Treats respiratory, urinary, skin, bone, joint, and genital infections Adverse Reactions to Cephalosporins GI distress, pruritus, weakness High doses: Increased bleeding, seizure, nephrotoxi city 16 Nursing Interventions for Cephalosporins Assess for allergy (PCN) 17 Assess renal and liver function Macrolides 18 Broad spectrum Most gram(+), some gram (-) Bactericidal: high doses Bacteriostatic: low to moderate doses Erythromycin, clarithromycin, azithromycin (Zithromax) Macrolides 19 Moderate-tosevere infections Respiratory, GI tract STIs Skin, soft tissue Mycoplasma pneumonia and Legionnaire’s disease Macrolide’s Uses 20 Adverse Reactions for Macrolides Tinnitus Ototoxicity Hepatotoxicity Inhibit many drugs--statins 21 Nursing Interventions For Macrolides Monito r liver enzym es No calciu m (milk, antaci ds) Empty stomac h with full glass of water 22 Lincosami des 23 Lincosamides Bacteriostatic and bactericidal Dependent on Dose (larger vs small) Examples Clindamycin Lincomycin 24 Lincosamide Uses * Gram positive bacterial infections * Acne * Upper Respiratory Infections URI * Pneumonia * Bacterial Vaginosis 25 Adverse Reactions of Lincosamides Rash Stomatitis Anaphylac tic shock 26 Clindamyc in Is more likely to cause C. diff than all other abx 27 Vancomyc in 28 Vancomycin Bactericidal Gram (+) (S. aureus) For serious infections of bone, skin and lower respiratory tract 29 Adverse Reactions for Vancomycin Red neck or red man syndrome From too rapid IV Severe hypotension Red blotching of face, neck, chest, extremities Toxic reaction not allergic reaction Blood dyscrasias Stevens-Johnson syndrome 30 Vancomycin is also Ototoxic Nephroto xic 31 Nursing Interventions for Vancomycin Monitor peak, trough, random IV give over 1 to 2 hours Monitor BP Monitor IV site Monitor renal function, hearing 32 Tetracyclines 33 Broadspectrum Tetracycline, Doxycycline, Minocycline Treats acne, H. pylori, Mycoplasma Pneumoniae Tetracyclines 34 Tetracyclines Drug-food Interactions Milk products antacids Oral contraceptives Digoxin absorption increased, leading to dig toxicity 35 Adverse Reactions to Tetracyclines Photosensitivity reaction Discoloration of permanent teeth (8y) Stomatitis CNS toxicity, Hepatotoxicity Nephrotoxicity in high doses 36 Nursing Interventions for Tetracyclines Empty stomach Monitor kidney and liver function Use sunscreen Avoid milk, iron, antacids Use effective oral hygiene 37 Aminoglycosides Aminoglycosi des Bactericidal Narrow Spectrum: Gram (-), E. coli, P. aeruginosa IV to be effective Gentamicin, Neomycin, Streptomycin, Tobramycin 39 Adverse Reactions to Aminoglycosides Photosensitivity Ototoxicity Nephrotoxicity Drug interactions Penicillins decrease effectiveness 40 Nursing Interventions for Aminoglycosides Monitor Use Monitor Monitor renal function , hearing problem s or loss. Use sunscre en Monitor peak and trough levels 41 Fluoroquinolon es 42 Fluoroquinol ones Bactericidal Broad spectrum Drug interactions Antacids decrease absorption Dysglycemia Increases caffeine Tendon rupture Prolonged QT interval 43 UTIs; lower resp infections; skin, softCiprofloxa tissue, bone, cin and joint infections CA pna, chronic bronchitis, acute Levofloxac sinusitis, UTIs, uncomplicate in d skin infections Fluoroquino lones 44 Nursing intervention s for Fluoroquinol ones IV over 60 to 90 minutes Increase fluid intake to more than 2 L per day Assess renal function/UOP Avoid caffeine (increases caff) 45 Sulfonamides Antibiotics 46 Sulfonam ides Bacteriostatic Narrow spectrum: gram (-) Proteus, Klebsiella, E. coli, Chlamydia Uses Otitis media, respiratory infections UTIs, prostatitis, Alternative for allergies to PCN 47 Sulfonami des: TMPSMZ Trimethoprimsulfamethoxazole urinary tract anti-infective Synergistic effect Urinary, intestinal, and lower respiratory tract infections; otitis media; prostatitis; 48 Adverse Reactions of Sulfonami des Stomatitis Photosensitivity reaction Crystalluria, renal failure Blood dyscrasias Stevens-Johnson syndrome 49 Nursing Interventions For Sulfonamides Increase fluid intake to 2L/day Monitor CBC and renal function Monitor for rash Avoid during third trimester Avoid calcium 50 51 Knowledg e Test! Question Which nursing intervention has the highest priority for the patient who is taking cefepime (Maxipime)? a) Wait until culture results are received before initiating antibiotic. b) Monitor the patient for signs and symptoms of a superinfection. c) Administer IV over 2 hours to prevent phlebitis. d) Instruct the patient to take the drug for 5 days only. 52 Answer: B Rationale: Superinfection is a common adverse effect of antibiotics. The nurse should culture the infected area before initiating antibiotics and may begin drug therapy before culture results are received. IV cephalosporins should be administered over 30 to 45 minutes, not 2 hours. Cephalosporins are usually given 10 days for a full regimen. 53 Question A patient is taking piperacillin-tazobactam (Zosyn). Which nursing interventions are most appropriate for this drug? (Select all that apply.) a) Give with an aminoglycoside. b) Send specimen to lab for C&S before antibiotic therapy is started. c) Instruct patient to take entire prescribed drug. d) Instruct patient to restrict fluid intake. e) Monitor for symptoms of superinfection, including stomatitis and vaginitis. 54 Answer: B, C, E Rationale: An extended-spectrum penicillin is not given with an aminoglycoside, as it may inactivate the aminoglycoside. Before any antibiotic, a C&S should be done. One should take the entire prescribed drug to avoid drug resistance. Patients should increase fluid intake, not restrict it. Symptoms of superinfection should always be monitored for all antibiotics. 55 Question A patient enters the emergency department with a draining wound. Once the patient is admitted and assessed, the priority nursing intervention is to a) administer the ordered antibiotics. b) teach the patient about the ordered antibiotics. c) culture the wound. d) enforce droplet isolation precautions. 56 Answer: C Rationale: The priority nursing intervention is to obtain a culture and antibiotic sensitivity testing of infective organism (C&S). 57 Question Which statement will the nurse include when teaching a patient about cephalosporin therapy? a) “Avoid ingesting buttermilk or yogurt when taking this medication.” b) “Stop taking the medication when you feel better.” c) “Immediately stop taking the medication if you develop nausea.” d) “Inform your health care provider if you develop mouth ulcers.” 58 Answer: D Rationale: The patient should be instructed to report signs of superinfection, such as mouth ulcers or discharge from the anal or genital area. Ingestion of buttermilk or yogurt may prevent superinfection of the intestinal flora; the entire course of the medication should be taken; and the medication should be taken with food if nausea develops. 59 Question A patient asks the nurse why she gets yeast infections after a course of antibiotics. The nurse explains, a) “The antibiotics lower your white blood cell count.” b) “People are poorly nourished and hydrated after an infection.” c) “Yeast infections happen if the antibiotic is not taken for the full course.” d) “Yeast infections are common when the normal body flora are disrupted.” 60 Answer: D Rationale: The patient should be advised to ingest buttermilk or yogurt to prevent this superinfection of the body's normal flora. 61 Question Which teaching by the nurse has highest priority for the patient taking azithromycin (Zithromax)? a) Instruct the patient to use sunblock and protective clothing during sun exposure. b) Instruct the patient to store the drug out of light and extreme heat. c) Inform parents that children younger than 8 should not take the drug, to avoid tooth discoloration. d) Instruct the patient to report any loose stools or diarrhea. 62 Answer: D Rationale: The patient should be instructed to report loose stools or diarrhea because of possible colitis. Photosensitivity during sun exposure is common with tetracyclines, which should not be given to children younger than 8 years; tetracyclines are also affected by light and extreme heat. 63 Question A patient has been prescribed trimethoprimsulfamethoxazole (TMP-SMZ). The nurse realizes that this drug is most likely used to treat which condition? a) b) c) d) Gonorrhea Rickettsial infection Chlamydial infection Urinary tract infection 64 Answer: D Rationale: TMP-SMZ is used to treat urinary tract infections, otitis media, bronchitis, pneumonia, rheumatic fever, and burns. It does not treat gonorrhea, rickettsial or chlamydial infections. 65 References McCuistion, L. E., Vuljoin-DiMaggio, K., Winton, M. B., & Yeager, J. J. (2023). Pharmacology: A patient-centered nursing process approach (11th ed.). St. Louis, MO: Elsevier. 66