Exam 2: Antibiotics, Antivirals, and Antifungals

Tetracycline / doxycycline Nursing Considerations

1. Preventing interactions: a) Digoxin combined with tetracycline leads to increased digoxin absorption, resulting in digoxin toxicity. *** b) Administering oral anticoagulants with tetracycline enhances the effect of vitamin K. *** c)The combination of oral contraceptives and tetracycline results in diminished contraceptive effects. *** - Some women need to use an additional form of birth control. 2. is an Oral drug - most effective when taken on an empty stomach - do not take with dairy products (withhold tetracycline for 2 hours if dairy is consumed) ***

Azithromycin Adverse Effects

1. QT elongation *** 2. cardiac status changes *** - i.e. QT interval prolonged which can lead to Torsades de Pointes

Clindamycin Nursing Considerations

1. adminstier with full glass of water 2. monitor for fatal colitis *** 3. are ototoxic and nephrotoxic. [mycins are all ototoxic and nephrotoxic]

ciprofloxacin, levofloxacin, moxifloxacin (Nursing Considerations)

1. monitor for joint pain 2. measure QT interval (when available) - Quinolones can prolong the QT interval, and this increases the risk of a lethal rhythm called Torsades de pointe. 3. monitor for hypo and hyperglycemia 4. Take as prescribed 5. Contact provider for any complications 6. These medications can increase the skin's sensitivity to burns and blistering from the sun's rays. ***** Avoid Sun

Erythromycin Action and Use

1. Action - enters the microbial cells and reversibly binds to the 50S subunits of ribosomes, thereby inhibiting microbial protein synthesis and leading to cell death. - The medication has bacteriostatic or bactericidal activity against susceptible bacteria. 2. Use: - As a penicillin substitute in patients who are allergic to penicillin

Tetracycline / doxycycline Use and Action

1. Action: a) penetrates microbial cells by passive diffusion and an active transport system. - Intracellularly, it binds to the 30S ribosomes and possibly the 50S ribosomes and inhibits microbial protein synthesis. b) In patients with acne, it suppresses the growth of Propionibacterium acnes with sebaceous follicles, reducing the free fatty acid content in the sebum. 2. Use: a) used in patients with acne b) treats mycoplasma, chlamydia, rickettsia. c) Used when PCN (Penicillin) is contraindicated - i.e. pencilin allergy

Gentamicin Use and Action

1. Action: - Aminoglycosides penetrate the cell walls of susceptible bacteria and bind irreversibly to 30S and 50S ribosomal subunits, intracellular structures that synthesize proteins. -As a result, the bacteria cell membrane becomes defective and cannot synthesize the proteins necessary for their function and replication. 2. Use: - The major clinical use of gentamicin is empiric therapy for serious infections caused by aerobic gram-negative organisms. - Treatment of infections such as septicemia, respiratory tract infections, urinary tract infections, intra-abdominal infections, and osteomyelitis

Metronidazole Use and Action

1. Action: - Direct-acting trichomonacide and amebicide that works inside and outside the intestines. - It's thought to enter the cells of microorganisms that contain nitroreductase, forming unstable compounds that bind to DNA and inhibit synthesis, causing cell death. 2. Use: #1 drug to treat C. Difficile *** - is effective against anaerobic bacteria, including gram-negative bacilli, gram-positive bacilli, and some gram-positive cocci. AND ROSASCEA

ciprofloxacin, levofloxacin, moxifloxacin (Use and action)

1. Action: - Fluoroquinolones are bactericidal agents that cause cell death. - acts by interfering with enzymes required for synthesis of bacterial DNA and therefore necessary for bacterial growth and replication. 2. Use - gram negative bacteria

Nitrofurantoin Action and Use

1. Action: - May interfere with bacterial enzyme systems and bacterial cell-wall formation. 2. Use: - treatment and prophylaxis (prevention) of UTI's caused by e. Coli, S. Aureas, enterobacter, enterococcus and klesiella.

Vancomycin Action and Use

1. Action: - acts by inhibiting cell wall synthesis. 2. Use: - is active only against gram-positive microorganisms. - IV vancomycin used to treat MRSA, SSNA

Clindamycin Use and Action

1. Action: - enters microbial cells and attaches to 50S subunits of ribosomes, thereby inhibiting microbial protein synthesis. 2. Use: - used with other medications to treat mixed infections

Meropenem Use and Action

1. Action: - inhibit synthesis of bacterial cell walls by binding with penicillin-binding proteins. (Like other beta-lactam drugs) 2. Use: - effective in infections caused by a wide range of bacteria - Its main use is in the treatment of infections caused by organisms resistant to other drugs. - Used in polymicrobial (caused by multiple microorganisms), bacterial septicemia, endocarditis

Cephalexin / Cefuroxime Action and Use

1. Action: - inhibits bacterial cell wall synthesis by binding to one or more penicillin-binding proteins. - usually bactericidal 2. Clinical indications for the use of the cephalosporins include: - surgical prophylaxis - treatment of infections of the respiratory tract, skin and soft tissues, bones and joints, urinary tract, brain and spinal cord, and bloodstream (septicemia). ** Also know what each gen is generally effective for (in the need to knows for cephalosporin gen flashcard) **

Amoxicillin Action and Use

1. Action: - inhibits bacterial cell wall synthesis by binding to one or multiple penicillin-binding proteins. 2. use: - Treat bacterial infections caused by susceptible microorganisms. *** - used in the treatment of infective endocarditis. - The drug's broad spectrum is often useful in skin, soft tissue, respiratory, gastrointestinal (GI), and genitourinary infections. 3. Note: The broad-spectrum coverage of ampicillin extends its activity against gram-negative bacilli.

Metronidazole Adverse Effects

1. CNS effects *** -seizures, peripheral paresthesias, ataxia, confusion, dizziness, and headache. 2. GI effects: - nausea, vomiting, diarrhea 3. When comsumed with alcohol: *** - flushing - headache - nausea and vomiting - chest and abdominal pain

Linezolid Adverse Effects

1. CNS effects: - mental status changes - muscle twitching - shivering - lack of coordination. 2. myelosuppression - bone marrow depression (when there are fewer red and white blood cells and platelets due to reduced bone marrow activity)

Meropenem Adverse Effects

1. CNS toxicity (rare): - Seizures are more likely in patients with a preexisting seizure disorder or when recommended doses are exceeded. ** ---> This may have to do with the decrease serum concentrations of divalproex.

Intro

1. Health care practitioners have used the aminoglycosides to treat serious aerobic gram-negative infections extensively for many years. 2. The quinolones are also older drugs originally used only for the treatment of urinary tract infections a) Synthesis of the quinolones involves adding a fluorine molecule to the quinolone structure. - This addition increases drug activity against gram-negative microorganisms, broadens the antimicrobial spectrum to include several other microorganisms, and allows the use of the drugs in treating systemic infections

Tetracycline / doxycycline Adverse Effects

1. Hypersensitivity - such as rash, urticaria, serum sickness, or anaphylaxis 2. increased risk of sunburn *** 3. GI upset 4. Superinfections: a) Candidal: -sore throat - white patches on the oral mucosa - black, furry tongue b) GI: - pseudomembranous colitis 5. renal and hepatic toxicity 6. discoloration of teeth and enamel

Amoxicillin Adverse Effects

1. Hypersensitivity reactions *** - including rash and/or anaphylactoid reactions. 2. GI adverse effects - abdominal pain, diarrhea, gastritis, and nausea and vomiting. 3. Nephropathy. 4. FDA has issued a Black Box Warning to alert health care providers that inadvertent IV administration of penicillin G benzathine may result in cardiopulmonary arrest and death. **

Cephalosporins Generations Need to Knows ****

5 gens 1. From 2nd and 5th gen, Cephalosporins increase in bacterial coverage - The earlier the generation the more narrow the reach of the antibiotic. - While newer generations have a broader reach and can take on some serious bacterial infections. 2. Gram negative coverage for 2nd and 3rd gen 3. Gram Positive and Negative Coverage for 4th and 5th gen. 4. 5th generation effective against Vancomycin Resistant Staphylococcus Aureus

Gram Positive Bacteria

Bacteria that have a thick peptido glycan cell wall, and no outer membrane. - They stain very darkly (purple) in Gram stain. 1. Ex: - staphylococci (Staphylococcus aureus, S. epidermidis,) - streptococci (Streptococcus pyogenes, S. pneumoniae, etc.) - enterococci

Gram-negative bacteria

Bacteria that have a thin peptidoglycan cell wall covered by an outer plasma membrane. -They stain very lightly (pink) in Gram stain. -Gram-negative bacteria are typically more resistant to antibiotics than Gram-positive bacteria. 1. Ex: - Klebsiella, - Acinetobacter - Pseudomonas aeruginosa - E.coli

Carbapenem

Carbapenems are broad-spectrum, bactericidal beta-lactam antimicrobials. - we need to know Meropenem

Important discharge instructions for antibiotics

During discharge: Patient education NUMBER 1: -Take all of their antibiotics regardless if you feel better. --> Or else superbugs can occur NUMBER 2: -in general, take ur drugs one hour before or 2 hours after meals --> Some medications don't do well with diary --> Some are better absorbed with empty stomach NUMBER 3: -Make sure antibiotics on regular intervals (scheduled) ---> Take within 30 minutes of scheduled time regularly. --------> Bc this will maintain therapeutic serum drug levels that will kill/inhibit the microorganisms NUMBER 4: -report any adverse side effects to provider

Beta-lactam antibacterial drugs: What is it and What are its Actions?

bactericidal agents that interrupt bacterial cell-wall formation as a result of covalent binding to essential penicillin-binding proteins (PBPs) 1. Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins (penicillin- binding proteins) in bacterial cell membranes. --> The beta-lactam ring from the drug is binding to the PBPs. a) This binding produces a defective cell wall (defective peptidoglycan) that allows leakage of the intracellular contents, destroying the microorganisms. - Thus beta-lactams are considered bactericidal

Cephalosporins: Fourth Generations

Fourth-Generation Cephalosporins 1. Fourth-generation cephalosporins have a greater spectrum of antimicrobial activity and greater stability against breakdown by beta-lactamase enzymes compared with third-generation drugs. - Cefepime, the first fourth-generation cephalosporin to be developed, is active against both gram-positive and gram-negative organisms.

Beta-lactam antibacterial drugs Weaknesses

Several gram-positive and gram-negative bacteria produce beta-lactamases , which are enzymes that disrupt the beta-lactam ring and inactivate the beta-lactam antibacterial drugs. ** - This is the major mechanism by which microorganisms acquire resistance to these drugs. 1. Penicillinase and cephalosporinase are beta-lactamase enzymes that act on penicillins and cephalosporins to render them resistant and ineffective. - Patients receive beta-lactamase inhibitors concurrently with the beta-lactam antibacterial drugs to overcome this resistance.

Cephalexin / Cefuroxime

Therapeutic class: Antibiotics Pharmacologic class: "# Generation" cephalosporins

Gentamicin

Therapeutic class: Antibiotics Pharmacologic class: Aminoglycosides

Amoxicillin

Therapeutic class: Antibiotics Pharmacologic class: Aminopenicillins

Meropenem

Therapeutic class: Antibiotics Pharmacologic class: Carbapenems

ciprofloxacin, levofloxacin, moxifloxacin

Therapeutic class: Antibiotics Pharmacologic class: Fluoroquinolones

Other: Vancomycin

Therapeutic class: Antibiotics Pharmacologic class: Glycopeptides

Other: Clindamycin

Therapeutic class: Antibiotics Pharmacologic class: Lincomycin derivatives

Azithromycin (ZPak)

Therapeutic class: Antibiotics Pharmacologic class: Macrolides

Erythromycin

Therapeutic class: Antibiotics Pharmacologic class: Macrolides

Aztreonam

Therapeutic class: Antibiotics Pharmacologic class: Monobactams

Nitrofurantoin

Therapeutic class: Antibiotics Pharmacologic class: Nitrofurans

Other: Linezolid

Therapeutic class: Antibiotics Pharmacologic class: Oxazolidinones

Trimethoprim-sulfamethoxazole

Therapeutic class: Antibiotics Pharmacologic class: Sulfonamides-folate antagonists

Tetracycline/doxycycline

Therapeutic class: Antibiotics Pharmacologic class: Tetracyclines

Other: Metronidazole

Therapeutic class: Antiprotozoals Pharmacologic class: Nitroimidazoles

Cephalosporins: Third Generations

Third-Generation Cephalosporins 1. Third-generation cephalosporins further extend the spectrum of activity against gram-negative organisms. - they are also active against several strains resistant to other antibiotics and to first- and second-generation cephalosporins. 2. Another difference is the ability of third-generation cephalosporins to penetrate inflamed meninges to reach therapeutic concentrations in CSF.

General Steps for Taking Antibiotics

1) Before giving patient first dose of antibiotics, send off cultures for a culture+sensitivity exam 2. Check for allergies, renal function, liver function. ***** a) Renal and liver function/lab values will affect their dosage of antibiotics ----> Renal lab value: CrCl 3. While waiting for C+S results (48 to 72 hours), we use broad spectrum antibiotics. - The patient is first treated with a general antibiotic and then a more specific antibiotic to target the bacteria --> this prevents SUPERBUGS (bacteria that are resistant to antibiotics) --> 48 hr for preliminary results --> 72 hrs for final results a) Monitor for rxn of broad spectrum antibiotic - Initial hypersensitibity s+s to report to doctor: fever, rash, hives ( are histamine response) 4. While monitoring for rxns - Ask is patient getting better? 5. Administer the most effective Antibiotic Drug based on C+S Test Results.

Aztreonam Use and Action

1. Action: a) Like other beta-lactam drugs, aztreonam inhibits synthesis of bacterial cell walls by binding with penicillin-binding proteins. - However, aztreonam, because of its monobactam structure, has limited cross-allergenicity between itself and other beta-lactam antibiotics. - It is generally considered safe to administer aztreonam to patients with a penicillin allergy. 2. Use: a) lacks gram-positive coverage b) Indications for use include infections of the urinary tract, skin and skin structures, and lower respiratory tract caused by N. gonorrhoeae, H. Influenzae, Enterobacter-klebsiella, serratia, p aeruginosa. c) This medication is typically prescribed for illnesses that are considered critical *** --> use typically is reserved for those patients with a severe penicillin allergy.

Linezolid Action and Use

1. Action: a) acts by inhibiting protein synthesis - The drug binds to the bacterial 23S ribosomal RNA of the 50S subunit, thus preventing an essential component of the bacterial translation process. 2. Use: - It is active against aerobic gram-positive bacteria. - indicated for pneumonia (both CAP [community-acquired pna] and nosocomial)

Azithromycin Use and Actions

1. Action: a) enters the microbial cell and binds to the 50S subunit of bacterial ribosomes which blocks the involved transpeptide. - this inhibits RNA dependent protein synthesis at the chain elongation step. - bacteriostatic or bactericidal, depending on concentration. 2. Use: - useful in the treatment of respiratory infections, pharyngitis, and tonsillitis - effective for treatment with S. Pneumoniae and Community acquired Pneumonia (CAP)

Trimethoprim-sulfamethoxazole Use and Actions

1. Actions: TMP-SMZ acts by inhibiting bacterial synthesis of essential nucleic acids and proteins. a) TMP-SMZ and other sulfonamides act as antimetabolites of para-aminobenzoic acid (PABA), which microorganisms require to produce folic acid. - In turn, folic acid is necessary for the production of bacterial intracellular proteins. b) Sulfonamides enter into the reaction instead of PABA, compete for the enzyme involved, and cause formation of nonfunctional derivatives of folic acid. - Thus, sulfonamides halt multiplication of new bacteria but do not kill mature, fully formed bacteria. 2. Use: - Useful in UTI's ----> appropriate antibiotic for E. Coli

Nitrofurantoin Nursing Considerations

1. Administer with foods *** -Administration of nitrofurantoin with food aids in absorption and decreases the onset of adverse effects. 2. Report side effects 3. take all antibiotics

Nitrofurantoin Adverse Effects and Contraindications

1. Adverse Effects: a. ST / T wave changes *** - nonspecific ST- and T-wave changes b. In addition, the nurse should inform patients that the drug may cause the urine to turn brown. 2. Contraindications: - renal insufficency *** - pregnancy

Penicillins (cillin)

1. Ampicillin (Principen) is the prototype penicillin. - Ampicillin extends its activity against gram-negative bacilli ** 2. There are MANY kinds of penicilins - they end in "cillin" **** 3. We will focus on: - Amoxicillin - Amoxicillin/clavulanate

ciprofloxacin, levofloxacin, moxifloxacin (Adverse Effects)

1. BLACK BOX WARNING: **** - increased risk of tendonitis or tendon rupture - increased risk of peripheral neuropathy - increased risk of CNS and cardiac side effects. 2. BLACK BOX WARNING: **** - may exacerbate muscle weakness in persons with myasthenia gravis. 3. QT prolongation may occur **** - MEASURE THIS! 4. Hypoglycemia and hyperglycemia 5. Hypersensitivity reactions

Beta-lactam Origin and Characteristics

1. Beta-lactam antibacterials derive their name from the beta-lactam ring that is part of their chemical structure. a) An intact beta-lactam ring is essential for the antibacterial activity of these drugs. 2. Although a beta-lactam ring is common to all beta-lactam antibiotics, the characteristics of these drugs vary widely because of differences in their chemical structures. - Because of these differences, the range of activity to particular bacteria is also different. - The drugs may also differ in the routes of administration, susceptibility to beta-lactamase enzymes, and adverse effects.

Penicillin with Beta Lactamase Inhibitor: Amoxicillin Clavulanate

1. Beta-lactamase inhibitors are drugs with a beta-lactam structure but minimal antibacterial activity. - They bind with and inactivate the beta-lactamase enzymes produced by many bacteria. A) When combined with a penicillin, the beta-lactamase inhibitor protects the penicillin from destruction by the enzymes and extends the penicillin's spectrum of antimicrobial activity. B) Thus, the combination drug may be effective in infections caused by bacteria that are resistant to a beta-lactam antibiotic alone. 2. Ex: Amoxicillin Clavulanate NOTE: SOLE PURPOSE of the second med / med combination is to INHIBIT the beta lactamase enzyme to keep the beta lactam ring intact. **

Trimethoprim-sulfamethoxazole Nursing Responsibilities

1. Culture and Sensitivity testing should be completed prior to administering the drug *** 2. Monitor K+ levels as hyperkalemia may result in the older adult. *** 3. Hypersensitivity reaction *** - discontinue at first sign of a rash 4. Increase sensitivity to sun *** - more at risk for sunburn - When in the sun, wear sunscreen and protective clothing 5. Monitor for hypoglycemia *** - esp if you are diabetic 6. take with lots of water, drink 2-3 L of fluid a day (unless contraindicated) 7. Monitor renal function

Linezolid Nursing Considerations

1. Do not administer to patients who are taking SSRI's, SNRI's, tricyclic antidepressants or MOA's *** a) It is thought that linezolid inhibits the action of those drug *** - It is thought that linezolid inhibits the action of monoamine oxidase A, an enzyme responsible for breaking down serotonin in the brain. - high levels of serotonin build up in the brain, causing serotonin syndrome (serotonin toxicity) c) The combination of drugs results in severe CNS reactions. 2. Monitor for CNS reactions***

Aminoglycosides and Fluoroquinolones Drugs to KNOW

1. Fluoroquinolones (xacin) -Ciprofloxacin -Levofloxacin -Moxifloxacin 2. Aminoglycosides - Gentamicin --> Ends in mycin/micin

Fluoroquinolones (xacin)

1. Fluoroquinolones, also called Quinolones, are a group of antibiotics helpful for treating gram-negative and gram-positive bacterial infections. 2. Their action: - They inhibit the bacteria's DNA replication process (hence inhibit bacterial DNA synthesis). --> To do this, they target two main enzymes that play a role in this DNA replication process called DNA gyrase and Topoisomerase IV. 1. We need to know: - ciprofloxacin - levofloxacin - moxifloxacin

Trimethoprim-sulfamethoxazole Adverse Effects

1. GI - abdominal pain - N & V - diarrhea 2. Renal - increased BUN and serum creatinine - renal failure 3. hypoglycemia 4. increased risk of sunburn

Cephalexin / Cefuroxime Adverse Effects

1. GI disturbance 2. hypersensitivity **

Erythromycin Adverse Effects

1. GI effects: - n/v 2. if fever / jaundice occur discontinue drug 3. CNS effcts: - reversible hearing loss - confusion 4. Administration of IV form may cause cardiac arrhythmias

Vancomycin Nursing Considerations

1. LIMIT use of vancomycin to reduce the incidence of VRE (Vancomycin Resistant Enterococcus). 2. Check vancomycin for therapeutic levels. *** 3. ADMINISTER slowly to reduce "Red Man Syndrome". *** (SLOW infusion over 60 minutes) - characterized by hypotension, flushing and skin rash 4. Toxic to kidneys and eyes

Macrolides and Miscellaneous Anti-infective Agents DRUGS TO KNOW

1. Macrolides -Azithromycin -Erythromycin 2. Other -Clindamycin -Linezolid -Metronidazole -Vancomycin

Macrolides

1. Macrolides are a class of antibiotics most helpful against gram-positive bacteria - However, it is not effective against the gram-positive group of bacteria called Enterococcus. - Macrolides can also target some gram-negative bacteria like Salmonella, Chlamydia, H. pylori, Legionella, Gonorrhea, and H. influenza (causes epiglottis). 2. Macrolides are known to be overall bacteriostatic, which means they inhibit the growth/reproduction of the bacteria. - They are able to do this by inhibiting protein synthesis. ---> Macrolides target 50S ribosomes which prevents proper translocation of messenger RNA and transfer RNA within the ribosome. ---> Therefore, mRNA and tRNA can't move properly through the ribosome to help create proteins. ----> This will help prevent the bacteria from thriving and growing ---> therefore, macrolides are bacteriostatic. 3. We need to know: -Azithromycin -Erythromycin

Meropenem Nursing Consideration

1. Monitor for side effects (allergies) 2. Monitor for patient response 3. Take medication as prescribed and report adverse reactions

Gentamicin Adverse Effects

1. Otoxicity *** - changes in hearing, dizziness, vertigo, tinnitus, and hearing loss may be signs of ototoxicity. 2. nephrotoxicity*** - occurs more frequently in patients with a history of renal impairment. 3. Muscle weakness *** - use in caution with patients with neuromuscular disorders

Azithromycin Nursing Considerations

1. Patients should take the oral medication on an empty stomach, 2 hours before or after the administration of antacids. *** - generally you do not take with antacids 2. Close monitoring of the international normalized ratio (INR) when azithromycin is administered with warfarin. *** 3. Take all medication 4. report any cardiac changes

Aztreonam Nursing Considerations

1. monitor for hypersensitivity and resolution of symptoms 2. take all medication as prescribed

Cephalosporins (Cef/Ceph)

1. Structurally and functionally similar to penicillins 2. are broad-spectrum antibiotics that can be used by most patients that are allergic to penicillin 3. Cephalosporins are classified into five subgroups, or "generations," based on their pharmacology and spectrum of activity. 4. They start with "Cef" or "Ceph" 5. General action: (Basically like all Antibiotics Beta Lactams) a) Inhibit cell wall synthesis by having an overall bactericidal affect meaning it kills the bacteria - Cephalosporins target a specific part of the cell wall known as peptidoglycan. ---> beta-lactam from drug binds to Penicillin-Binding Proteins which inhibits successful cross-linking leading to a faulty peptidoglycan layer and inhibits cell wall synthesis. ---> In turn, the bacterium's cell ruptures and dies! 6. We just need to know: -Cephalexin (1st gen) -Cefuroxime (2nd gen)

Cephalexin / Cefuroxime Nursing Considerations

1. Take all drugs as prescribed, take all doses, report side effects 2. If used prophylactically (preventatively) for surgery the medication must be administered within 60 minutes of the first skin incision. ** 3. May impact coagulation ** - monitor closely in patients with anticoagulation therapy 4. Monitor for C. Diff - at risk for c.diff if u use cephalosporins

GENERAL TIPS for Antibiotics ******

1. Take all of your medication until you are finished even if you are feeling better. - to prevent superbug 2. Accidental pregnancy - cillins / cycline will makes oral contraceptive ineffective. - Thus we need to use an additional contraceptive when we are on cillin/cycline medications such as IUDs. 3. No alcohol while taking antibiotics as they impact the liver. - both alcohol and antibotics are hard on the liver 4. Give one hour before or take two hours after eating - Take most antibiotics on an empty stomach with a full glass of h20. (exception: Nitrofurantoin is taken with food) 5. Avoid sun (Fluoroquinolones, Sulfa drugs, tetracycline) - Some antibiotics can make you more sensitive to sun exposure. ---> This can cause sun burn and rashes more easily than you normally expect. 6. Super toxic to Kidney/Ears (are the ones ending in MYCIN's) - VancoMYCIN, GentaMICIN, NEOmycin ---> measure drug levels when using these drugs.

DRUGS TO KNOW

1. Tetracyclines -Tetracycline -doxycycline 2. Sulfonamides -Trimethoprim-sulfamethoxazole -Silver sulfadiazine Silvadene (See skin) 3. Urinary Antiseptics - Nitrofurantoin

Clindamycin Adverse Effects

1. The FDA has issued a Black Box Warning for clindamycin regarding the potential of severe and possible fatal colitis. *** - a sign of fatal colitis is Loose and bloody stools.

Urinary Antiseptics

1. The adjuvant medications used to treat UTIs urinary antiseptic agents a) Urinary antiseptics may be bactericidal for sensitive organisms in the urinary tract because these drugs are concentrated in renal tubules and reach high levels in urine. - They are not used in systemic infections because they do not attain therapeutic plasma levels. 2. We need to know: - Nitrofurantoin

Aztreonam Adverse Effects

1. The nurse carefully assesses any rash. ** - may indicate hypersensitivity ** ** It is important to distinguish a hypersensitivity reaction from a nonallergic aztreonam rash, if possible.

Metronidazole Nursing Considerations

1. The nurse tells the patient that consumption of alcohol when taking metronidazole will produce a disulfiram reaction. - This reaction results in symptoms of flushing, headache, nausea, vomiting, and chest and abdominal pain.

Aminoglycosides (mycin/micin)

1. This is a particular class of antibiotic medications that are great at targeting mainly gram-negative microorganisms. - They're not very helpful with most gram-positive microorganisms, but can help target a few like Staphylococcus aureus or Enterococcus. 2. Aminoglycosides inhibit the bacteria's protein synthesis. - they bind to the 30S ribosomal subunit (particularly the A-site). --> When it does this it causes the genetic information to not be read correctly which hinders the subunit's ability to make healthy proteins. ---> This results in the death of the bacteria. 3. It's important to remember Aminoglycosides actually kill bacteria (they are bactericidal) rather than bacteriostatic (inhibit the bacteria's growth). *** We need to know Gentamicin

Amoxicillin Nursing Indications

1. When administering ampicillin, it is recommended that serum creatinine and blood urea nitrogen (BUN) be monitored. - Monitor these labs for renal function ; Because ampicillin is excreted primarily by the kidneys, it is important to use caution with renal impairment. 2. Use 2 contraceptives 3. Take full course of antibiotics and report side effects

Erythromycin Nursing Considerations

1. drink lots of fluids when taking E-Mycin - Take each dose with 8 oz of water. 2. Be aware that the effectiveness of oral contraceptives is decreased when combined with erythromycin. *** 3. grapefruit juice and St. John's wort decrease absorption of erthromycin *** 4. Do not administer with antacids. 5. Assess for therapeutic effects (pt infection resolving).

Gentamicin Nursing Considerations

1. is ototoxic *** - Monitor for changes in hearing such as ringing in ear (tinnitus), hearing loss, dizzy, fullness in ears 2. is nephrotoxic *** - With impaired renal function, a reduction in dosage of aminoglycosides is essential. - Monitor renal function (Creatinine/ BUN) ** 3. Monitor serum drug concentrations (peak and trough) - A peak is the highest level of a medication in the blood, while a trough level indicates the lowest concentration. - Prescribers adjust dosages according to serum drug levels and creatinine clearance (CrCl). 4. Take as prescribed

CrCl

Creatinine clearance (CrCl) is the volume of blood plasma cleared of creatinine per unit time. - This test allows your healthcare provider to look at samples of your urine and blood to see how much of the waste product (creatinine) is filtered out by your kidneys. [Gentamicin dosage is dependent on CrCl levels] - Abnormal levels of creatinine in your urine and blood could point to an issue like kidney disease.

Monobactam

Currently, the only monobactam available for use is Aztreonam (Azactam), which serves as the prototype of this class. 1. Aztreonam is active against aerobic gram-negative bacteria and many strains that are resistant to multiple antibiotics. 2. The coverage is similar to that of the aminoglycosides, but the drug does not cause kidney damage or hearing loss. 3. Because gram-positive and anaerobic bacteria are resistant to aztreonam, the drug's ability to preserve normal gram-positive and anaerobic flora may be an advantage compared with other antimicrobial agents.

Cephalosporins: Fifth Generations

Fifth-Generation Cephalosporins 1. Ceftaroline (Teflaro) is an IV cephalosporin used for the treatment of community-acquired pneumonia and skin infections. - It is the first cephalosporin to be considered active against resistant gram-positive organisms, such as MRSA, vancomycin-resistant S. aureus (VRSA), vancomycin-insensitive S. aureus (VISA), and heteroresistant VISA.

Cephalosporins: First Generations

First-Generation Cephalosporins - Ex: Cephalexin a) The first cephalosporin, cephalothin, is no longer available for clinical use. b) In general, first-generation cephalosporins have strong activity against gram-positive bacteria and poor activity against gram-negative bacteria. - Often, health care providers use first-generation cephalosporins for surgical prophylaxis, especially with prosthetic implants, because gram-positive organisms such as staphylococci cause most infections of surgical sites.

fatal colitis

In this rare condition, your colon is unable to get rid of gas and stool, causing it to become greatly distended. - Left untreated, your colon may rupture, causing bacteria from the colon to enter your abdominal cavity.

ANTIOBIOTICS

PLACEHOLDER

Aminoglycosides and Fluoroquinolones

PLACEHOLDER

Drug Therapy With Beta-Lactam Antibacterial Agents

PLACEHOLDER

Drug Therapy With Macrolides and Miscellaneous Anti-infective Agents

PLACEHOLDER

Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics

PLACEHOLDER

Cephalosporins: Second Generations

Second-Generation Cephalosporins - Ex: Cefuroxime 1. Second-generation cephalosporins are more active against some gram-negative organisms and somewhat less active against gram-positive cocci than the first-generation agents. 2. Often, other uses for second-generation cephalosporins also include surgical prophylaxis, especially for gynecologic and colorectal surgery.

Sulfonamides

Sulfonamides are bacteriostatic drugs that were once effective against a wide range of gram-positive and gram-negative bacteria. - However, increasing resistance is making them less useful. 1. We need to know - Trimethoprim-sulfamethoxazole (below) [oral] - Silver sulfadiazine Silvadene (See skin) [topical] ** They have different actions and uses. - TMP-SMZ is more for UTIs while silvedene is more for burn wounds.

Beta Lactams antibiotics Categories

a) Penicillins (cilin) - Amoxicilin - Amoxicillin/clavulanate b) Cephalosporins (cef/cep) - Cephalexin - Cefuroxime c) Carbapenems (nem) -Meropenem d) Monobactam (nam) - Aztreonam 1. Actions of Beta Lactams - Inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes ----> Binding produces an defective cell wall which causes leakage of intracellular contents, thus destroying microorganisms - Beta Lactams are Considered BACTERICIDAL

suberbugs

are antibiotic-resistant bacteria/microorganisms

Tetracyclines

are antibiotics, derived from chlortetracycline, that have been used to treat serious, life-threatening infections. 1. Tetracyclines are effective against both gram-negative and gram-positive microorganisms, but the older drugs are usually not drugs of choice. 2. We need to know -Tetracycline -doxycycline

Anaphylactoid reactions

are immediate systemic reactions that mimic anaphylaxis but are not caused by IgE-mediated immune responses.

antibiotics DRUGS TO KNOW

drugs with the ability to kill bacteria or interfere with the ability of bacteria to grow and replicate. - Can be Separated into Categories 1) Beta Lactams a) Penicillins (cilin) - Amoxicillin - Amoxicillin/clavulanate b) Cephalosporins (cep/cef) - Cephalexin - Cefuroxime c) Carbapenems (nem) -Meropenem d) Monobactam (nam) - Aztreonam 2)Fluoroquinolones (xacins) -Ciprofloxacin -Levofloxacin -Moxifloxacin 3) Aminoglycosides - Gentamicin -->Ends in mycin/micin 4) Tetracyclines (cycline) -Tetracycline -doxycycline 5) Sulfonamides - Trimethoprim-sulfamethoxazole - Silver sulfadiazine Silvadene (See skin) 6) Urinary Antiseptics - Nitrofurantoin 7)Macrolides (mycin) - Azithromycin - Erythromycin 8) Other -Clindamycin -Linezolid -Metronidazole -Vancomycin

penicillin-binding proteins (PBPs)

enzymes that are involved in the terminal steps of peptidoglycan cross-linking in both Gram-negative and Gram-positive bacteria. - Penicillin-Binding Proteins (PBPs) help with the cross-linking process necessary for the peptidoglycan layer to function.