Pharm Unit 2 Chapter 7: Antibacterials that disrupt bacterial cell wall

Name other RXNs that can occur w/penicillin

Anemia Thrombocytopenia Luekopenia Bone marrow depression

Im all nerves when taking penicillin

CNS RXNs lethargy hallucinations anxiety, depression confusion seizures

How does adding a beta-lactamase inhibitor agent help achieve a therapeutic effect when prescribed for otitis media?

It extends the spectrum of antibacterial activity of penicillin. Explanation: 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.

What is the dangerous diarrhea that can be produced by extended release penicillins?

Psuedomembranous colitis, diarrhea caused by change in flora of colon or overgrowth of C. diff

What do Cephalosporins treat?

Respiratory infections Otitis Media Bone/joint infection Complicated Intraabdominal or UTI Used prophylactically for sexual assault victims

Name the penicillin beta-lactamase inhibitor combos

amoxicillin/clavulanate----Augmentin ampicillin/sulbactam-------Unasyn piperacillin/tazobactam----Zosyn

Penicillin would NOT be indicated for which clients?

A client with gram-negative bacteria allergic to penicillin

A client has been diagnosed with an infected postoperative wound, and cultures reveal methicillin-resistant Staphylococcus aureus (MRSA). The client is currently receiving intravenous cefarolin because in vitro testing indicates susceptibility. When considering the effectiveness of this client's treatment, what is the nurse's best action?

Administer the medication as prescribed and monitor for expected outcomes. Explanation: The nurse's responsibility in supporting prescribed medication therapy is to administer the medication as prescribed and to monitor for expected outcomes.

What do cephalosporins interact with?

Aminoglycosides (anti-infective)----increased r/o nephrotoxicity Oral anticoagulanyts---increased r/o bleeding Loop diuretic----increased cephalosporin blood level

Name the Broad Spectrum penicillinase-resistant penicillin

Amoxil amoxicillin ampicillin (infective endocarditis)

Discuss the pharmacodynamics of penicillins

Bactericidal in action. They bind reversibly to several enzymes outside of bacterial membrane; penicillin interferes w/cell wall synthesis this way. As a class they provide a wide spectrum of antimicrobial activity; covering Gram-pos, Gram-neg, and anearobic organisms, tho specific penicillins are more effective against specific organisms

Place the following cephalosporins in the proper sequence beginning with first generation cephalosporins up to fourth generation cephalosporins.

Cefazolin Cefuroxime Cefotaxime Cefepime

Name the 1st generation cephalosporins

Cefazolin----perioperative prophlx Cephalexin Cefadroxil Act primarily against Gram+ May be alt to those allergic to penicillin Used for streptococcal & staphylococcal infections, including pneumonia, cellulitis, and osteomylitis

Name the 4th generation cephalosporin

Cefepime----febrile neutropenia Act against wide range of Gram+ & Gram- bacteria

Name the 2nd generation cephalosporins

Cefotetan-----perioperative prophlx Cefoxitin------perioperative prophlx Cefaclor Cefprozil Cefuroxime----preop prophylx Act against Gram- Cefoxitin & cefotetan are the only cephalosporins effective against anaerobes

Name the 5th generation cephalosporin

Ceftaroline---pneumonia Ceftobiprole-----MRSA, penicillin resistant skin/soft tissue infections Ceftolozane/taxobactam-----complicated intraabdominal & UTI Aimed to treat resistant Gram+ & Gram- bacteria in acute bacterial skin infections and CAP (community acquired pneumonia)

Most cephalosporins may be taken with food except which one?

Ceftibuten (Cedax) Explanation: Most cephalosporins may be taken with food except ceftibuten which should not be administered with food.

Name the 3rd generation cephalosporins

Celfdinir Celfditoren Celfixime Cefotaxime-----periop prophylx Cefpodoxime-----STD treatment Ceftazidime Ceftibuten Ceftriaxone---gonorrhea, periop prophylx Act against Gram- Drug of choice for Enterobacter, P.aeruginosa & anaerobic MOs

A client with diabetes is ordered a cephalosporin to treat a recurring infection. The client is taking insulin and reports controlling the blood glucose level by monitoring it with urine stips and adjusting doses of insulin accordingly. What instructions should the nurse tell this client?

Cephalosporin may interfere with accurate test results. Explanation: Cliients with diabetes who use urine test strips for determining insulin dosing need to be aware that cephalosporin may interfere with accurate test results.

Who are cephalosporins contraindicated for? Who should use cautiously?

Contraindicated for pt w/allergy to cephalosporins Use cautiously in patients w/renal disease, hepatic impairment, bleeding disorder, pregnancy (Cat B), & known penicillin allergy

A client being treated for cellulitis with a cephalosporin asks what the essential difference is between generations of this medication. The nurse should respond to the client's question based on what fact?

Each successive generation is more effective against gram-negative microorganisms.

Which of the following classes of penicillins are used to treat Pseudomonas?

Extended spectrum penicillins are used to treat Pseudomonas.

GI didn't know this could happen w/penicillins

GI RXNs glossitis stomatitis nausea, vomiting penicillins

What are the adverse rxns for cephalosporins?

Headache dizziness malaise heartburn fever nephrotoxicity Hypersensitivity aplastic anemia toxic epidermal necrosis

How is penicillin administered

IM injection when pt can;t swallow Long acting penicillin G are relatively insoluble and must be given IM

What are the carbapenems?

Imipenem---broadest spectrum of activity Meropenem Ertapenem Doripenem Beta-lactam antibacterials

What are the key nursing diagnosis for pt taking Penicillin, Cephalosporin, Carbapenems, or miscellanious cell wall inhibitors?

Impaired skin integrity Risk for Impaired gas exchange Impaired Urinary Elimination Diarrhea Impaired Oral Mucous Membrane Impaired Comfort: Increased Fever

The nurse understands that bacterial resistance can result when certain bacteria produce penicillinase. What does penicillinase do?

Inactivates penicillin Explanation: One example of bacterial resistance is the ability of certain bacteria to produce penicillinase, an enzyme that inactivates penicillin. The penicillinase-resistant penicillins were developed to combat this problem.

Some combination antibacterial drugs consist of a penicillin and a beta-lactamase inhibitor. What is the primary purpose of a beta-lactamase inhibitor in one of these drugs?

It protects the penicillin.

What things affect absorbtion of penicillins?

Kind of penicillin used pH of stomach and intestine presence of food in the GI tract ***Most penicillins should be taken on an empty stomach (1h before meal or 2h after) to enhance absorbtion, EXCEPT penicillin V, amoxicillin, and amoxicillin-clavulanatepotassium

What are carbapenems used for?

Multi-drug resistant organisms, gram (+), gram (-), aerobic and anaerobic gram (-) bacilli Drug of choice for Enterobacter They are resistant to beta-lactamases

What are common adverse RXNs for carbapenems and other miscallaneous drugs that inhibit cell wall synthesis?

Nausea Vomiting Diarrhea Rash psuedomembranous colitis---always assess stools for blood

Which drugs do penicillins interact with?

Oral contraceptives Anticoagulants Tetracycline--antiinfective Beta-blockers for BP/heart problems

The nurse is caring for a 44-year-old client who takes furosemide (Lasix) on a daily basis. The physician has ordered ceftrixone (Rocephin) now for an infection. The nurse expects that the healthcare provider will do what with the dosage of ceftrixone (Rocephin) for this client?

Order a decreased dosage. Explanation: The healthcare provider will most likely order a decreased dose because cephalosporins interact with loop diuretics, causing an increased cephalosporin blood level.

An instructor is describing an antibiotic that is resistant to the enzyme penicillinase. What would the nurse identify as an example?

Oxacillin Explanation: Oxacillin and nafcillin are examples of penicillinase-resistant antibiotics

Your client has been diagnosed with streptococcal pharyngitis. Which of the following would you anticipate being ordered?

Penicillin G Explanation: Some strains of streptococci have acquired resistance to penicillin G, although the drug is still effective in many streptococcal infections. It remains the drug of choice for the treatment of streptococcal pharyngitis; for prevention of recurrent attacks in clients who have had previous acute rheumatic fever due to group A streptococcus; and for the treatment of neurosyphilis.

Clients with which of the following conditions should not be administered cefprozil (Cefzil) oral suspension because it contains phenylalanine? (Choose one)

Phenylketonuria Explanation: Clients with phenylketonuria (PKU) should not be administered cefprozil (Cefzil) oral suspension because if contains phenylalanine, a substance that people with PKU cannot process. Reference:

What are appropriate assessments for patients treated w/cephalosporins?

Review allergy history Assess continuously for hypersensitivity Obtain C&S

An older adult client responded well to inclient treatment with a third-generation cephalosporin. After being largely symptom free for 48 hours, the client has developed a fever of 38.6°C and an elevated white cell count. What phenomenon may account for this client's current clinical presentation?

The client may be infected with microorganisms that were resistant to the cephalosporin. Explanation: Clients treated with cephalosporins may be vulnerable to superinfections (infection after a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier).

A client is taking penicillin for an upper respiratory infection. The client calls the office after 2 days of therapy reporting nausea and abdominal pain. Which would be the best instruction for the nurse to give the client?

These are normal side effects, but if they increase in severity or frequency, you need to contact the office again. Explanation The client is having an adverse effect from the medication, which is not life threatening. The best advice to the client would be to continue to take the medication as prescribed and report any worsening of the symptoms. The most serious adverse effect of penicillin G is allergic reaction: rash, fever, and wheezing, and possibly anaphylaxis and death. More common adverse effects of penicillin therapy involve the GI tract: nausea, vomiting, diarrhea, abdominal pain, glossitis, stomatitis, gastritis, sore mouth, and furry tongue. These effects are primarily related to the loss of normal flora (naturally occurring bacteria in the body) and subsequent opportunistic infections. Reference:

A client diagnosed with infective endocarditis would be most effectively treated with which medication?

ampicillin Explanation: Health care providers use ampicillin in the treatment or prophylaxis of infective endocarditis. Ampicillin is effective against bacterial infections. Dicloxacillin, nafcillin, and oxacillin are typically used to treat methicillin-resistant Staphylococcus aureus.

Name the other miscallaneous drugs that inhibit cell wall synthesis.

aztreonam-----E. coli, UTI, respiratory infections, GI dalbavancin oritavancin telavancin vancomycin----serious Gram+ infections not responding to anything else

After teaching a group of nursing students about the action of penicillins, the instructor determines that the teaching was effective when the students identify natural penicillins as exerting which type of effect on microorganisms?

bactericidal Explanation: Natural penicillins exert a bactericidal effect on bacteria. Because penicillin targets bacterial cells, it is of no value to treat fungal infections as it is neither fungicidal nor fungistatic. Since it targets the bacterial cell wall to destroy the bacteria, it does not inhibit growth as in bacteriostatic

How are cephalosporins classified?

by generations; 5 generations Progression from 1st to 4th generation drugs shows an increase in their sensitivity of Gram-neg MOs and a decrease in the sensitivity of Gram-pos MOs/

A client is scheduled for a bowel resection. During the perioperative period, which type of medication should the nurse anticipate the client will be given?

cephalosporins Explanation: Cephalosporins may be used throughout the perioperative period to prevent infection in clients having surgery on a contaminated or potentially contaminated area, such as the gastrointestinal tract or vagina. The other drug groups are not normally given during the perioperative period for bowel surgery. Antivirals are not part of the perioperative protocol for any type of surgery. Reference:

A new graduate nurse is confused about how someone gets MRSA. An experienced nurse explains how it develops and informs her of the following groups in whom MRSA generally occurs. (Select all that apply.)

clients in hospitals clients in dialysis centers clients in nursing homes clients with weakened immune systems Explanation: According to the Centers for Disease Control and Prevention in 2008, staphylococcal infections, including MRSA, occur most frequently among persons in hospitals and health care facilities (such as skilled nursing facilities and dialysis centers) and who have weakened immune systems.

Name the Narrow Spectrum penicillinase-resistant penicillins

dicloxacillin nafcillin oxacillin

A client is administered a third-generation cephalosporin. The broad-spectrum agents like cephalosporins are most effective in treating which type of microorganism?

gram negative Explanation: Cephalosporins are broad-spectrum agents with activity against both gram-positive and gram-negative bacteria. But they are, in general, less active against gram-positive organisms and more active against gram-negative ones.

What is vancomycin used for?

gram positive one- MRSA, enterococci and Clostridium difficile (oral form) IV form for pt w/serious staphylococcal infections

What will the nurse assess in the pt being treated with penicillin?

h/o patients infection before therapy Adverse RXNs allergy history culture and sensitivity Vital signs, electrolyte & renal function studies LOC (level of consciousness), neuro status when giving high doses PT, INR, PTT Pt/family knowledge of the drug

Who are penicillins contraindicated for?

hypersensitivity to penicillins or cephalosporins Pt w/renal disease, asthma, bleeding disorders, GI disease Pregnant (Cat C) or lactating (may cause diarrhea or candidiasis in infant) h/o allergies

The nurse is justified in suspecting that a client who recently completed a course of ceftaroline may have been treated for what health problem?

methicillin-resistant Staphylococcus aureus (MRSA) infection Explanation: Ceftaroline is an IV cephalosporin 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. This drug is not indicated in the treatment of chlamydial infections, endocarditis, or encephalitis.

A nurse is conducting an in-service education program for a group of nurses. When describing the action of the various classes of penicillins, which class would the nurse identify as having the narrowest spectrum of activity?

natural penicillins

The nurse has encouraged a client prescribed oral amoxicillin to take this medication with fluids but with the exception of what beverage?

orange juice Explanation: Clients should not take penicillins with orange juice or any acidic beverages because these may destroy the drug.

Which medication should be administered as prophylaxis for rheumatic fever?

penicillin G Explanation: Rheumatic fever is an autoimmune inflammatory disorder. Penicillin G benzathine is administered as prophylaxis for rheumatic fever for its anti-inflammatory properties.

Name the narrow spectrum penicillins (natural)

penicillin G, aqueous, Pfizerpen penicillin G, benzathine, Bicillin, Permapen penicillin G, procain penicillin V

Ampicillin-sulbactam is administered to a client with Staphylococcus aureus. What type of antiinfective is ampicillin-sulbactam?

penicillin-beta-lactamase inhibitor combination

Name extended spectrum penicillins

piperacillin

What event triggers the development of a superinfection?

proliferation of antibiotic-resistant microorganisms Explanation: Superinfection is an infection after the occurrence of a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier. None of the other options accurately describe this condition as it is associated with antibiotic-resistant microorganisms.

The major adverse rxn to penicillins is hypersensitivity; what are the s/s of this?

skin rash, urtacaria, pruritis sneezing, wheezing bronchospasm, laryngospasm angioedema Hypotension---can progress to shock Serum sickness--occurs 1-2 weeks after injection of foreign serum) S/S are fever, chills, edema, joint & muscle pain, malaise