Anti-Infectives.pptx

ANTI-INFECTIVES Principles of Antimicrobial Therapy Treat infections Methods of action ◦ Destroying cell wall ◦ Inhibit conversion of enzyme unique for a particular bacteria's survival ◦ Impairing protein synthesis in bacteria’s ribosomes ◦ Disrupting bacterial synthesis/function of...

ANTI-INFECTIVES Principles of Antimicrobial Therapy Treat infections Methods of action ◦ Destroying cell wall ◦ Inhibit conversion of enzyme unique for a particular bacteria's survival ◦ Impairing protein synthesis in bacteria’s ribosomes ◦ Disrupting bacterial synthesis/function of RNA and DNA ◦ Inhibits viral replication Classification ◦ Narrow spectrum ◦ Broad spectrum Selection of Antimicrobials Identification ◦ Lab testing of body fluids (blood, urine, sputum, wound drainage) identifies the micro-organism causing infection Gram stain ◦ Identify micro-organisms directly by examining under a microscope Culture ◦ Colonies grow over several days ◦ Preferred when gram stain does not yield a positive identification ◦ Obtain culture specimen before treatment with medications ◦ Obtain culture specimen without contamination Penicillins Purpose ◦ Destroy bacteria by weakening the bacterial cell wall Uses ◦ Pneumonia ◦ Meningitis ◦ Endocarditis (can use as prophylaxis before dental procedures for at risk clients) ◦ UTIs ◦ Syphilis Adverse effects o Anaphylaxis o N/V/D, o Nephrotoxicity o Thrombocytopenia o Steven-johnson syndrome o Cdiff Penicillins ◦Prefix: -CILLIN ◦Examples ◦ Natural penicillins (narrow spectrum) ◦ Bicillin CR ◦ Aminopenicillins (broad spectrum) ◦ Amoxil (amoxicillin); Principin (ampicillin) ◦ Combinations ◦ Augmentin (amoxicillin/clavulanate); Zosyn (piperacillin/tazobactam); Unasyn (ampicillin/sulbactam) ◦ Extended spectrum ◦ Geocillin (carbenicillin indanyl) ◦ Ticar (ticarcillin) Penicillins  Nursing interventions ◦ Give IM deep IM in largest muscle mass ◦ Rotate sites ◦ Follow directions for reconstitution ◦ Give as directed (on time) ◦ Give on empty stomach ◦ Collect any culture and sensitivity prior to starting antibiotic ◦ Avoid admin with citrus  Client teaching ◦ Take as prescribed (full course of therapy) ◦ Take at the same time each day ◦ Take each dose with a full glass of water ◦ Keep suspensions refrigerated—shake well before pouring ◦ Use alternative birth control method ◦ Discard any unused portion Penicillins ◦ MRSA—methicillin-resistant Staphylococcus aureus ◦ More widespread in last few years ◦ Do not respond to conventional penicillin therapy—require high- potency antibiotics (such as Vancomycin) ◦ VRE—vancomycin resistant enterococci—fairly new development Cephalosporins  Prefix: CEF- and CEPH- Examples ◦ First generation  Duricef (cefadroxil); Ancef (cefazolin); Keflex (cephalexin) ◦ Second generation  Mefoxin (cefoxitin); Cefzil (cefprozil) ◦ Third generation  Omnicef (cefdinir); Cefobid (cefoperazone); Claforan (cefotaxime); Rocephin (ceftriaxone) Purpose ◦ beta-lactam antibiotic similar to PCN ◦ Destroy bacterial cell walls causing destruction of micro-organisms ◦ Most given IM or IV because decreased absorption in GI tract ◦ 5 generations each one works better and more effective against gram-negative organisms Cephalosporins Uses ◦ Respiratory infections ◦ Otitis media ◦ Bone/joint infections; ◦ UTIs ◦ Surgical site infection Adverse effects ◦ Anaphylaxis (cross-linked with PCN) ◦ C.diff ◦ N/V/D ◦ Nephrotoxicity ◦ Thrombocytopenia ◦ Stephen-Johnson syndrome Cephalosporins  Nursing Interventions ◦ Monitor urinary function ◦ Give with food ◦ Shake suspensions and keep refrigerated ◦ Monitor for s/s superinfection ◦ Do not administer with calcium- can lead to complications  Client teaching ◦ Take full course ◦ Avoid alcohol ◦ Don’t share Inhibitors of Cell Wall Synthesis Examples o Azactam- aztreonam o Primaxin- impenem cilastatin o Vancomycin Purpose o Destroys bacterial cell walls, causing disruption of micro-organisms Uses o methicillin-resistant staph and strep(MRSA) o cdiff Adverse effects o Ototoxicity o Nephrotoxicity o Red man syndrome (Vanc) o Thrombocytopenia o GI upset Inhibitors of Cell Wall Synthesis Nursing interventions oDrug levels--Vancomycin—peak and troughs oMonitor renal function oMonitor IV site oIncrease fluid intake oMonitor stool for blood (many of these may lead to pseudomembranous colitis) oAssess for difficulty hearing; ringing in the ears; dizziness oMonitor skin for red man syndrome Tetracyclines Prefix: -CYCLINE Examples ◦ Vibramycin (doxycycline) ◦ Sumycin (tetracycline) Action ◦ Inhibit RNA protein synthesis to allow boy’s immune system to kill bacteria (bacteriostatic) ◦ Targets gram + and - Uses o Rocky Mountain spotted fever o Acne o Helicobacter pylori o Lyme’s disease o STDs o Anthrax  Tetracyclines Adverse effects N/V/D Photosensitivity Tooth discoloration Nursing Considerations ◦ Contraindicated in kids