Chapter 9: Antibiotics PDF

Chapter 9: Antibiotics Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Antibiotics  Antibiotics are defined as: o Chemicals that inhibit specific bacteria o Made in three ways  By living microorganisms  By synthetic man...

Chapter 9: Antibiotics Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Antibiotics  Antibiotics are defined as: o Chemicals that inhibit specific bacteria o Made in three ways  By living microorganisms  By synthetic manufacture  Through genetic engineering Copyright © 2017 Wolters Kluwer All Rights Reserved Signs of Infection  Fever  Lethargy  Slow-wave sleep induction  Classic signs of inflammation (redness, swelling, heat, and pain) Copyright © 2017 Wolters Kluwer All Rights Reserved Antibiotic Use Across the Life Span  Pediatric Population  Adult Population  Geriatric Population  ( See box 9.1) Copyright © 2017 Wolters Kluwer All Rights Reserved Types of Antibiotics  Bacteriostatic o Those substances that prevent the growth of bacteria  Bactericidal o Those that kill bacteria directly Copyright © 2017 Wolters Kluwer All Rights Reserved Bacteria and antibiotics  Gram positive/negative  Aerobic  Anaerobic Copyright © 2017 Wolters Kluwer All Rights Reserved Goal of Antibiotic Therapy  Decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invader Copyright © 2017 Wolters Kluwer All Rights Reserved Selecting Treatment  Identification of the causative organism  Based on the culture report, an antibiotic is chosen that has been known to be effective at treating the invading organism Copyright © 2017 Wolters Kluwer All Rights Reserved Bacteria Classification  Gram-positive o The cell wall retains a stain or resists decolorization with alcohol  Gram-negative o The cell wall loses a stain or is decolorized by alcohol  Aerobic o Depend on oxygen for survival  Anaerobic o Do not use oxygen Copyright © 2017 Wolters Kluwer All Rights Reserved Bacteria and Resistance to Antibiotics  Adapt to their environment  The longer an antibiotic has been in use, the greater the chance that the bacteria will develop into a resistant strain Copyright © 2017 Wolters Kluwer All Rights Reserved  Aminoglycosides #1  A group of powerful antibiotics used to treat serious infections caused by gram-negative aerobic bacilli  Common medications: o Amikacin (Amikin), Gentamicin (Garamycin) o Kanamycin (Kantrex) o Neomycin (Mycifradin) o Streptomycin o Tobramycin (Nebcin, Tobrex) Copyright © 2017 Wolters Kluwer All Rights Reserved Aminoglycosides #2 Bactericidal Indications: o Treatment of serious infections caused by susceptible bacteria Actions: o Inhibits protein synthesis in susceptible strains of gram-negative bacteria causing cell death Copyright © 2017 Wolters Kluwer All Rights Reserved Aminoglycosides #3 Pharmacokinetics- o Poorly absorbed from the GI tract, but rapidly absorbed after IM injection, reaching peak levels within 1 hour o Widely distributed throughout the body, crossing the placenta and entering breast milk o Excreted unchanged in the urine and have an average half-life of 2 to 3 hours o Depend on the kidney for excretion and are toxic to the kidney Copyright © 2017 Wolters Kluwer All Rights Reserved Aminoglycosides #4  Contraindications- o Known allergies, renal or hepatic disease, hearing loss  Adverse Effects- o Ototoxicity and nephrotoxicity are the most significant  Drug-to-Drug Interactions- o Diuretics, neuromuscular blockers, succinylcholine, or citrate anticoagulated blood Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for Patients Receiving Aminoglycosides Assess: o For possible contraindications or cautions: allergy to any aminoglycoside o Perform a physical assessment o Perform culture and sensitivity tests at the site of infection o Conduct orientation and reflex assessment o Assess vital signs o Perform renal and liver function tests Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Gentamicin Copyright © 2017 Wolters Kluwer All Rights Reserved Question #1 Tell whether the following statement is true or false. Because of the adverse effects of the aminoclycosides, it is important to teach the patient to restrict fluids and eat 6 small meals daily. Copyright © 2017 Wolters Kluwer All Rights Reserved Answer to Question #1 False Rationale: Provide the following patient teaching: Try to drink a lot of fluids and to maintain nutrition (very important) even though nausea, vomiting, and diarrhea may occur. Copyright © 2017 Wolters Kluwer All Rights Reserved Carbapenems #1  New class of broad-spectrum antibiotics effective against gram-positive and gram-negative bacteria  Common medications: - Doripenem (Doribax) - Ertapenem (Invanz) - Imipenem– Cilastatin (Primaxin) - Meropenem (Merrem IV). Copyright © 2017 Wolters Kluwer All Rights Reserved  Carbapenems #2 Bactericidal Indications- o Treatment of serious infections caused by susceptible bacteria o Actions: Inhibit cell membrane synthesis in susceptible bacteria, leading to cell death Copyright © 2017 Wolters Kluwer All Rights Reserved Carbapenems #3 Pharmacokinetics- o These drugs are rapidly absorbed if given IM and reach peak levels at the end of the infusion if given IV. o They are widely distributed throughout the body, although it is not known whether they cross the placenta or enter breastmilk o Excreted unchanged in the urine and have an average half-life of 1 to 4 hours Copyright © 2017 Wolters Kluwer All Rights Reserved Carbapenems #4 Contraindications- o Known allergy to any of the carbapenms or betalactams; seizure disorders, meningitis, pregnancy and lactation Adverse Effects- o Pseudomembranous colitis, Clostridium difficile diarrhea, and nausea and vomiting can lead to serious dehydration and electrolyte imbalances, as well as to new serious infections/Superinfections Drug-to-drug interactions- Valproic acid and Meropenem Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for Patients Receiving Carbapenems  Assess: o For possible contraindications or cautions: allergy to any Carbapenem or beta-lactam o Perform physical assessment o Perform culture and sensitivity tests o Conduct orientation and reflex assessment o VS and renal function tests Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Ertapenem Copyright © 2017 Wolters Kluwer All Rights Reserved Cephalosporin's #1 Similar to penicillin in structure and activity Common medications- o First generation: cefadroxil (generic) and cephalexin (Keflex) o Second : cefaclor (Ceclor), cefoxitin (generic), cefprozil (generic), and cefuroxime (Zinacef) o Third: cefdinir (Omnicef), cefotaxime (Claforan), cefpodoxime (generic), ceftazidime (Ceptaz,Tazicef), ceftibuten (Cedax), and ceftriaxone (Rocephin) o Fourth: cefditoren (Spectracef) and ceftaroline (Teflaro) Copyright © 2017 Wolters Kluwer All Rights Reserved Cephalosporins #2 Bactericidal and bacteriostatic Indications- o Treatment of infections caused by susceptible bacteria Action- o Interfere with the cell wall–building ability of bacteria when they divide Copyright © 2017 Wolters Kluwer All Rights Reserved Cephalosporins #3 Pharmacokinetics- o Well absorbed from the GI tract o Metabolized in the liver, excreted in the urine o Cross the placenta and enter breast milk (see Contraindications Copyright © 2017 Wolters Kluwer All Rights Reserved Cephalosporins #4 Contraindications o Allergies to cephalosporins or penicillin, hepatic or renal impairment Adverse Effects o Most significant -GI track Drug-to-Drug Interactions o Aminoglycosides, oral anticoagulants, ETOH Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for Patients Receiving Cephalosporins  Assess: o For possible contraindications or cautions: known allergy to any cephalosporin or penicillin o Perform physical assessment o Skin for any rash or lesions o Culture and sensitivity tests o Renal function tests Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Cefaclor Copyright © 2017 Wolters Kluwer All Rights Reserved Question #2 You are writing a plan of care for a patient receiving Cefaclor. What would be an appropriate nursing diagnosis for this patient? A. Deficient fluid volume and imbalanced nutrition: Less than body requirements, related to diarrhea B. Chronic pain related to GI, CNS effects of drug C. Monitor renal function test values D. Perform culture and sensitivity tests at the site of infection Copyright © 2017 Wolters Kluwer All Rights Reserved Answer to Question #2 A. Deficient fluid volume and imbalanced nutrition: Less than body requirements, related to diarrhea Rationale: Nursing diagnoses related to drug therapy might include: Acute Pain related to GI, CNS effects of drug; Risk for infection related to repeated injections; Deficient fluid volume and imbalanced nutrition: Less than body requirements, related to diarrhea; Deficient knowledge regarding drug therapy Copyright © 2017 Wolters Kluwer All Rights Reserved Fluoroquinolones #1 Relatively new class of antibiotics with a broad spectrum of activity Common medications- o ciprofloxacin (Cipro), which is the most widely used o fluoroquinolone, gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox),norfloxacin (Noroxin), ofloxacin (Floxin, Ocuflox), and finafloxacin (Xtoro) Copyright © 2017 Wolters Kluwer All Rights Reserved Fluroquinolones #2  Bactericidal  Indications: Treating infections caused by susceptible strains of gram-negative bacteria. Includes: urinary track, respiratory track, and skin infections  Actions: Interferes with DNA replication in susceptible gram- negative bacteria, preventing cell reproduction  Pharmacokinetics: Absorbed in GI tract, metabolized in the liver, excreted in urine and feces and cross the placenta and enter breast milk Copyright © 2017 Wolters Kluwer All Rights Reserved Fluoroquinolones #3  Contraindications o Known allergy, pregnancy, or lactating women and renal disfuntion  Adverse Effects o Most common: Headache, dizziness, insomnia and depression  Drug-to-Drug Interactions o Antacids, quinidine, theophylline Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for Patients Receiving Fluoroquinolones  Assess: o Known allergy to any fluoroquinolone o Perform physical assessment o Examine the skin for any rash or lesions o Perform culture and sensitivity tests o Orientation, affect, and reflexes o VS, and renal function tests Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Ciprofloxacin Copyright © 2017 Wolters Kluwer All Rights Reserved Question #3 What is a contraindication to receiving a fluoroquinolones? A. Over 65 years B. Weight under 100 pounds C. Fluoroquinolones are contraindicated in patients with known allergy to any fluoroquinolone. D. History of cancer Copyright © 2017 Wolters Kluwer All Rights Reserved Answer to Question #3 c. Fluoroquinolones are contraindicated in patients with known allergy to any fluoroquinolone. Rationale: Fluoroquinolones are contraindicated in patients with known allergy to any fluoroquinolone and in pregnant or lactating patients because potential effects on the fetus and infant are not known. Copyright © 2017 Wolters Kluwer All Rights Reserved Penicillins and Penicillinase - Resistant Antibiotics #1  First antibiotic introduced for clinical use  Common medications- o G benzathine (Bicillin, Permapen), penicillin G potassium (Pfizerpen), penicillin G procaine (Wycillin), penicillin V (generic), amoxicillin (Amoxil, Trimox), and ampicillin (Principen) Copyright © 2017 Wolters Kluwer All Rights Reserved Penicillins and Penicillinase - Resistant Antibiotics #2 Bactericidal Indications- Severe infections caused by sensitive organisms and broad spectrum use Actions- Interfere with the ability of susceptible bacteria to build their cell walls Pharmacokinetics- rapidly absorbed from the GI tract, reaching peak levels in 1 hour. excreted unchanged in the urine and enter breast milk Copyright © 2017 Wolters Kluwer All Rights Reserved Penicillins and Penicillinase-Resistant Antibiotics #3 Contraindications - Allergies to penicillin or cephalosporins, renal disease, use cautiously in patients who are pregnant or lactating Adverse Effects- o Most significant GI tract Drug–Drug Interactions- o Tetracyclines, parenteral aminoglycosides Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for Patients Receiving Penicillins and Penicillinase- Resistant Antibiotics Assess: o Known allergy to any cephalosporins and penicillins o Physical o Skin and mucous membranes for any rashes or lesions o Culture and sensitivity tests o Respiratory status o Abdomen and renal function Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Amoxicillin Copyright © 2017 Wolters Kluwer All Rights Reserved Sulfonamides #1 Drugs that inhibit folic acid synthesis Most common medications- o sulfadiazine (generic) o sulfasalazine (Azulfidine) o cotrimoxazole (Septra, Bactrim) Copyright © 2017 Wolters Kluwer All Rights Reserved Sulfonamides #2 Bacteriostatic Action- o block para-aminobenzoic acid to prevent the synthesis of folic acid in susceptible bacteria Indications- o Treatment of infections caused by gram-negative and gram-positive bacteria Copyright © 2017 Wolters Kluwer All Rights Reserved Sulfonamides #3 Pharmacokinetics o Well absorbed from the GI tract o Metabolized in the liver, excreted in the urine and are teratogenic Copyright © 2017 Wolters Kluwer All Rights Reserved Sulfonamides #4 Contraindications- o Known allergy to any sulfonamide, thiazide diuretics and pregnancy Adverse Effects- o GI symptoms; Renal effects related to the filtration of the drug Drug-to-Drug Interactions- o tolbutamide, tolazamide, glyburide, glipizide, or chlorpropamide and cyclosporine Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for Patients Receiving Sulfonamides #1 Assessment: o Known allergy to any sulfonamide, sulfonylureas, or thiazide diuretics o Physical status o Skin and mucous membranes for any rash or lesions o Specimens for culture and sensitivity tests o Respiratory status o Orientation, affect, and reflexes Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for Patients Receiving Sulfonamides #2 o Abdomen o Renal function tests o Complete blood count Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Cotrimoxazole Copyright © 2017 Wolters Kluwer All Rights Reserved Tetracyclines #1 Developed as semisynthetic antibiotics based on the structure of a common soil mold Most common medications- o Tetracycline (generic) o demeclocycline (generic) o doxycycline (Doryx, Vibromycin) o minocycline (Arestin, Minocin) Copyright © 2017 Wolters Kluwer All Rights Reserved Tetracyclines #2 Bacteriostatic Action- o Inhibits protein synthesis in susceptible bacteria, preventing cell replication Indications- o Treatment of various infections caused by susceptible strains of bacteria; acne when penicillin is contraindicated for eradication of susceptible organisms and when penicillin is contraindicated Copyright © 2017 Wolters Kluwer All Rights Reserved Tetracyclines #3 Pharmacokinetics o Adequately absorbed from the GI tract o Concentrated in the liver, excreted unchanged in the urine o Cross the placenta and pass into breast milk Contraindications- o Known allergy to tetracyclines or to tartrazine, pregnancy, lactation and renal and hepatic dysfunction, Penicillin G, oral contraceptive therapy, methoxyflurane, digoxin Copyright © 2017 Wolters Kluwer All Rights Reserved Tetracyclines #4 Adverse Effects- o Most GI, but possible damage to the teeth and bones.  Drug-to-Drug Interactions – o penicillin G, oral contraceptives, Digoxin Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for Patients Receiving Tetracyclines Assess: o Known allergy to any tetracycline or to tartrazine o Physical examination o Skin for any rash or lesions o Culture and sensitivity tests o Respiratory status o Renal and liver function test reports Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Tetracycline Copyright © 2017 Wolters Kluwer All Rights Reserved Question #4 Tell whether the following statement is true or false. Sulfonamides should not be given with thiazide diuretics because of a cross sensitivity of the drugs. Copyright © 2017 Wolters Kluwer All Rights Reserved Answer to Question #4 True Rationale: Drug-to-Drug Interactions: Cross sensitivity with thiazide diuretics; Sulfonareas Copyright © 2017 Wolters Kluwer All Rights Reserved Antimycobacterial #1 Contain pathogens causing TB and leprosy Most common medications- o Rifabutin (Mycobutin), isoniazid (generic), rifampin (Rifadin), pyrazinamide (generic), ethambutol, (Myambutol), streptomycin (generic), and rifapentine, (Priftin) Copyright © 2017 Wolters Kluwer All Rights Reserved Antimycobacterial #2 Action- o Act on the DNA of the bacteria leading to lack of growth and eventual bacterial death for TB and Leprosy Indications- Treatment of TB and Leprosy Pharmacokinetics- o Well absorbed from the GI tract o Metabolized in the liver, excreted in the urine, cross the placenta and enter breast Copyright © 2017 Wolters Kluwer All Rights Reserved Antimycobacterial #3  Contraindications o Allergy, renal or hepatic failure, CNS dysfunction and pregnancy  Adverse Effects o CNS effects and GI irritation  Drug-to-Drug Interactions o Rifampin and INH can cause liver toxicity Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for Patients Receiving Antimycobacterials Assess: o Known allergy to any antimycobacterial drug o History of renal or hepatic disease and CNS dysfunction o Physical examination o Skin for any rash or lesions o Culture and sensitivity testing o Respiratory status and evaluate renal and hepatic function tests Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Isoniazid Copyright © 2017 Wolters Kluwer All Rights Reserved Other Antibiotics #1 Ketolides, Lincosamides, Lipoglycopeptides, Macrolides, Oxazolidinones, Monobactam, o Antibiotics that do not fit into the large antibiotic classes o Most common medications-  telithromycin (Ketek), telithromycin, Clindamycin (Cleocin) televancin (Vibativ), dalbavancin (Dalvance), and oritavancin (Orbactiv), azithromycin (Zithromax), clarithromycin (Biaxin), Tedizolid (Sivextra) and linezolid (Zyvox), and aztreonam (Azactam) Copyright © 2017 Wolters Kluwer All Rights Reserved Other Antibiotics #2 o Bactericidal and bacteriostatic o Actions and Indications- Treatment of severe infections Pharmacokinetics- o All rapidly absorbed, metabolized by the liver and excreted in urine or feces and may cross the placenta, and does pass into breast milk Copyright © 2017 Wolters Kluwer All Rights Reserved Other Antibiotics #3 o Contraindications and Cautions-  Known allergy, hepatic or renal impairment, Myasthenia Gravis, pregnant and lactating patients, phenylketonuria, MAO inhibitors, o Adverse Effects-  Most significant CNS and GI, hepatic enzyme elevation and superinfections Copyright © 2017 Wolters Kluwer All Rights Reserved Other Antibiotics #4 o Drug to -Drug Interactions-  Pimozide, simvastatin, lovastatin, or atorvastatin, NSAIDs, nafcillin, cephradine, and metronidazole, foods containing tyramine with Oxazolidinones and MAO inhibitors Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for patients receiving Other Antibiotics #1 Assess- o Known allergy to ketolides, lincosamides, lipoglycopeptides, macrolides, oxazolidinones, and monobactams o History of renal and hepatic disease o Physical assessment o Skin for any rash or lesions o Culture and sensitivity testing Copyright © 2017 Wolters Kluwer All Rights Reserved Nursing Considerations for patient receiving Other Antibiotics #2 Assess- o Temperature to detect infection o Liver and renal function test values o Baseline electrocardiogram Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Telithromycin Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Clindamycin Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Erythromycin Copyright © 2017 Wolters Kluwer All Rights Reserved Prototype Summary: Aztreonam Copyright © 2017 Wolters Kluwer All Rights Reserved Question #5 The macrolide antibiotics have known food-drug interactions. What would you teach your patient taking a macrolide antibiotic? A. Take with meals B. Take daily just before going to bed C. Take daily upon arising in the morning D. Take 1 hour before or at least 2 to 3 hours after meals Copyright © 2017 Wolters Kluwer All Rights Reserved Answer to Question #5 D. Take 1 hour before or at least 2 to 3 hours after meals Rationale: Food in the stomach decreases absorption of oral macrolides. Therefore, administer the antibiotic on an empty stomach with a full, 8-oz glass of water, 1 hour before or at least 2 to 3 hours after meals. Copyright © 2017 Wolters Kluwer All Rights Reserved New Classes of Antibiotics and Adjuncts  Daptomycin  Linezolid (Zyvox)  Fidaxomicin (Dificid)  Tigecycline Copyright © 2017 Wolters Kluwer All Rights Reserved