Antibiotics (2).pptx

Antibioti cs Jenny Gordon, MSN, FNP  Mechanism of Action Stop bacterial cell wall...

Antibioti cs Jenny Gordon, MSN, FNP  Mechanism of Action Stop bacterial cell wall synthesis (holds the cell together). Diff from mammalian in lipid composition and cholesterol Inhibit enzyme conversion (metabolism/think of as starving the bacteria) Impair protein synthesis in the ribosomes (basic building blocks of all body processes such as hormones/enzymes/tissues – wear out and new are constantly needed - all cellular actions are protein dependent – i.e. This Photo by Unknown Author is licensed under CC BY leaves cellular components unable to do their job) Disrupt bacterial RNA or DNA synthesis (can’t reproduce) Kill or Stop? Bactericidal = Lethal/Kill the bacteria Bacteriostatic = Stop bacterial growth but the immune system kills them – “Freeze tag” How do we know what antibiotic to choose? Identify the organism/bacteria By visualization via Gram stain- get the infected fluid and look at it – identified by staining/color uptake and by cell wall properties. Gram+ or Gram- different colors. By culture – grow the organism out on a culture medium – feed it and let it multiply to identify it. Through a Sensitivity test – shows which antibiotics the bacteria are susceptible or resistant to. Culture and Sensitivity = C&S Special Populations Infants – immature kidneys and liver (kidneys reach adult concentration capacity at 18mos; full liver maturity also around the same time) Elderly – worn out kidneys and liver Pregnant women – antibiotics can cross the placenta causing fetal effects.  Who needs prophylaxi s Pre-Op for some surgeries – appendectomy/ gastrointestinal, orthopedic, gynecologic Exposed to an STD (HIV PrEP pre-exposure prophylaxis) Prosthetic Heart Valves prior to dental and other procedures Reoccurring UTI’s – may take a postcoital preventative, MS This Photo by Unknown Author is licensed under CC BY patient/neurogenic bladder, self catheterizing patient’s Penicillin/ PCN Cidial = lethal PCN – TX Gram+ Strep and Gram- Neisseria Meningitis, prophylaxis dental procedures Allergic Reactions: Observe 30 min post-injection CanNOT give in the same solution as Aminoglycosides: PCN Inactivates the aminoglycoside. Decrease oral contraceptive effectiveness no pillin on the cillin. Also Safe for pregnant women. Increase bleeding time by interfering with platelet aggregation  Cephalosporin s Ceph/Cef Multiple generations (5) each subsequent generation more likely to penetrate the CSF, less susceptible to resistance, more effective against gram (-) organisms. Bactericidal = lethal Are Broad spectrum – Ceftriaxone (Rocephin), Cephalexin (Keflex), Cefazolin (Ancef), Cefepime (Maxipime) This Photo by Unknown Author is licensed under CC BY-NC-ND Contraindicated with Major PCN allergy – cross-sensitivity. Risk for diarrhea, Clostridium Difficile (C. Diff) “C” PG safe Carbapenems Bactericidal = lethal Meropenem (Merrem), Ertapenem (Invanz) Broad spectrum Reserve for high risk, resistant to other more narrow ABX Suprainfection secondary to protective bacterial death Colitis – diarrhea Oral thrush – abx kills the bacteria allowing for yeast overgrowth Black Hairy (appearing) tongue Vaginal yeast infection This Photo by Unknown Author is licensed under CC BY Tetracyclines Doxycycline Used to TX: Acne, Rocky Mountain Spotted Fever, Chlamydia, Mycoplasma Pneumonia, Lyme disease, Anthrax, H.Pylori. Side effects: Tooth staining under age 8 years, GI discomfort – n/v/d. Esophageal ulcers (sit up lots water). Photosensitivity – sunburn. Teratogenic – No PG! Interactions with milk products, calcium, iron, magnesium, and antacids. Decrease effectiveness of birth control. This Photo by Unknown Author is licensed under CC BY Macrolides Erythromycin Azithromycin “ thro mycin” Bacteriostatic – Stops growth; High dose bactericidal – kills. Good alternative for patients with PCN allergy TX: Pertussis (whooping cough), Legionnaires’ disease, Diphtheria, Chlamydia, Mycoplasma pneumonia, and strep. Contraindicated with liver disease or prolonged QT. Thro the QT, Thro the liver (AST/ALT) This Photo by Unknown Author is licensed under CC BY-ND Aminoglycosides Vancomycin Gentamicin Tobramycin Neomycin Streptomycin “mycin” Bactericidal = lethal Gram (-) organisms – E. Coli, Pseudomonas aeruginosa (nosocomial/ hot tubes/trach tubing) Known for Ototoxicity!! – tinnitus, hearing loss, vertigo/dizzy Known for Nephrotoxicity (kidney)!! Can cause acute kidney injury, watch BUN and Creatinine Symptoms of AKI – proteinuria, casts, elevated BUN & Creatinine Inactivated by PCN This Photo by Unknown Author is licensed under CC BY-SA-NC  Toxicity Aminoglycoside s Peak and Trough levels When do you draw a trough? 15-30min before next dose. Check the Peak 30min post infusion (IV) 60min post IM injection, 2hrs post oral admin If trough is too high – then HOLD the dose and notify MD. Narrow therapeutic window – too high kidney will die, too low bacteria will grow Kidney labs – BUN>20 CR>1.3 Poor urine output – all signs of damage. This Photo by Unknown Author is licensed under CC BY-SA Vancomycin Given for Serious Infections Very hard/irritating to veins = thrombophlebitis – assess your site! Preferred central line RED MANS SYNDROME – what is the cause? Too rapid of infusion – give SLOW over at least 60minutes Signs of Red Man = This Photo by Unknown Author is licensed under CC BY hypotension, Flushing/itching, Big Red Rash. Sulfonamides Trimethoprim- Sulfamethoxazole / Bactrim TX: UTI (E.Coli), Otitis media (ear infection), chancroid (STD), pertussis, shigellosis, and Pneumocystis jirovecii pneumonia (HIV). Contraindicated with Sulfa or Thiazide diuretic allergy (hydrochlorothiazide) or Sulfonylurea (Glyburide) allergy Side effects: Bone Marrow Suppression – hemolytic anemia, leukopenia, thrombocytopenia, aplastic anemia. Can cause crystalluria – insoluble crystal deposits in kidney/ureters/bladder – solution? More fluids, monitor urine output. Kernicterus – jaundice, increased bilirubin, neurotoxic for newborns (Never when Pregnant – Category D) Photosensitivity – Sun Burn Steven Johnson’s Syndrome – flu like illness Urinary tract antiseptic Nitrofurantoin/Macrobi d Commonly used first line tx of uncomplicated UTI Turns the urine orange/brown color, can stain teeth if you open the capsule Contraindicated in Pregnancy = birth defects This Photo by Unknown Author is licensed under CC BY  Fluoroquinolones Ciprofloxacin Levofloxacin Bactericidal, reserved for severe infections, also used to tx anthrax. Side effects: GI n/v/d, C.Diff, Achilles tendon rupture – This Photo by Unknown Author is licensed under CC BY-SA popping/swelling/redness, increased risk in adolescents