Antibacterial Drugs Study guide

Chronic care alert (Tetracyclines)

May reduce insulin requirements in patients with diabetes. Blood glucose levels should be monitored frequently during tetracycline therapy.

Cephalosporin therapy

May result in a bacterial or fungal superinfection. diarrhea may be an indication of pseudomembranous colitis which is one type of bacterial superinfection.

Penicillin beta lactamase inhibitor

Type of penicillin with a wider spectrum of antibacterial activity. examples are clavulanic acid, sulbactam, and tazobactam. They bind with penicillin and protect the penicillin from destruction

Sulfonamide uses

UTIs and acute otitis media, ulcerative colitis

Pseudomembranous colitis is usually seen how many days after treatment with a cephalosporin is started ?

4-10 days

Tetracyclines

A group anti-infectives composed of natural and semisynthetic compounds. Useful in select infections when the organism shows sensitivity such as cholera, Rocky Mountain spotted fever, and typhus. also used when a patient is allergic to the penicillins or cephalosporins. They exert their effect by inhibiting bacterial protein synthesis.

Azithromycin

A macrolide that is given 1 hr or more before a meal or 2 hrs or more after a meal.

Erythromycin

A macrolide that is given on an empty stomach (i hour before or 2 hrs after meals) and with 180-240 mL of water.

Adverse reactions of Lincosamides

Abdominal pain, esophagitis, nausea, vomiting, diarrhea. Other reactions; skin rash, blood dyscrasias (an abnormality of the blood cell structure or function) these drugs can also cause pseudomembranous colitis.

When can neuromuscular blockade occur or respiratory paralysis?

After administration of the aminoglycosides, therefore it is very important that any symptoms of respiratory difficulty be reported. if it occurs it may be reversed by the administration of calcium salts, but mechanical ventilation may be required.

Hematopoietic changes with Penicillin

Anemia, thrombocytopenia, leukopenia, bone marrow depression.

Adverse reactions of sulfonamides

Anorexia(mild adverse reaction), nausea, vomiting, diarrhea, abdominal pain, stomatitis, chills, fever, crystalluria, photosensitivity.

Oral penicillins

Are best to give on an empty stomach, 1 hr before or 2 hrs after a meal.

Sulfonamides

Antibacterial agents, primarily bacteriostatic because of their ability to inhibit the activity of folic acid in bacterial cell metabolism. Well absorbed by the GI System and excreted by kidneys. used to control infections caused by gram-positive or -negative such as E.Coli, staph, and klebsiella and enterobacter species.

Major hypersensitivity reactions to penicillin

bronchospasm, laryngospasm, hypotension, and angioedema require immediate treatment with drugs such as epinephrine, cortisone, or an IV antihistamine.

Kanamycin (Kantrex) and neomycin

aminoglycosides that are used before surgery to reduce intestinal bacteria. this reduces the possibility of abdominal infection that may occur after surgery on the bowel. this drug treatment protocol is called a bowel prep.

Penicillin V and Amoxicillin

Can be given without regards to meals.

Crystalluria

Can occur while taking a sulfonamide and can be prevented by increasing fluid intake . Encourage patients to increase fluid intake to 2000 mL or more per day.

Most cephalosporins may be taken with food except which of the following?

Ceftibuten (Cedax)

Contraindications of Lincosamides

Contraindicated in infants younger than 1 month of age and in patients hypersensitive to the lincosamides, taking cisapride (Propulsid) or the antipsychotic drug pimozide (Orap), or with minor bacterial or viral infections.

Contraindications with macrolides

Contraindicated in patients with hypersensitivity to the macrolides and in patients with preexisting liver disease. Telithromycin (ketek) should not be ordered if a patient is taking a cisapride (Propulsid) or pimozide (Orap)

Penicillinase-resistant penicillins

Developed to combat the problem of an enzyme called penicillinase to inactivate penicillin.

Contraindications of sulfonamides.

During lactation, and in children younger than 2 years of age. not used during end of term pregnancy (pregnancy category D) because high blood levels of the drug can cause jaundice or hemolytic anemia in the neonate..

Extended-spectrum penicillins

Effective agains an even wider range of bacteria than the broad-spectrum penicillins. Used to destroy bacteria such as pseudomonas.

Macrolides

Effective against a variety of pathogenic organisms, particularly infections of the respiratory and genitourinary tact. Bacteriostatic or bactericidal in susceptible bacteria. The drugs act by causing changes in protein function and synthesis

Uses of Macrolides

Effective as prophylaxis before dental or other procedures in patients allergic to penicillin and in the treatment of a wide range of gram-negative and gram-positive infections, acne vulgaris and skin infections, upper respiratory infections caused by hemophilus influenzae (with sulfonamides)

Aminoglycosides

Exert their bactericidal effect by blocking a step in protein synthesis necessary for bacterial multiplication. They disrupt the functional ability of the bacterial cell wall, causing cell death.

SJS

Fever, cough, muscular aches and pains, and headache, lesions on the skin and mucous membranes, eyes,. Lesions appear as red wheals or blisters, often starting on the face, in the mouth, or on the lips, neck, and extremities

Natural penicillins

First large scale antibiotics used to combat infection. When the drug attaches to the cell, a portion of the drug molecule (the beta lactam ring) breaks the cell wall and the cell dies.

Lincosamides

Food impairs the absorption of lincomycin. the patient should take nothing by mouth. The nurse should give clindamycin with food or a full glass of water.

Adverse reactions to Penicillin

Glossitis, Stomatitis, gastritis, nausea, vomiting, diarrhea, abdominal pain, phlebitis, and pain at injection site when given IM.

Adverse reactions of Bactrim (trimethoprim)

Headache, GI disturbances, allergic skin reactions, hematologic changes, SJS Syndrome, anorexia, glossitis.

Dermatologic reactions with penicillin

Hives, rashes, and skin lesions. treatment of minor hypersensitivity reactions may include an antihistamine such as diphenhydramine (benadryl)

Administration route reactions to cephalosporins

Include pain, tenderness, and inflammation at the injection site when given IM and phlebitis or thrombophlebitis.

Chronic care alert (Tetracyclines)

May increase the risk of toxicity in patients who take digitalis drugs for heart disease. The effects of toxicity could last for months after tetracycline administration discontinues. Caution the patient and family to inform the primary care provider about the tetracycline drug therapy should digitalis toxicity symptoms appear.

Diarrhea

May be an indication of superinfection with penicillin of the GI tract or pseudomembranous colitis. nurse inspects all stools and notifies primary healthcare provider if diarrhea occurs.

Adverse reactions to sulfasalazine

May cause skin and urine to turn orange-yellow.

What should you monitor when an aminoglycoside is given?

Monitor the patients respiratory rate because neuromuscular blockade has been reported with the administration of these drugs.

Uses of penicillins: Infectious disease

Natural and semisynthetic penicillins are used in the treatment of moderate to mildly severe bacterial infections. UTIs, septicemia, meningitis, intra-abdominal infections, sexually transmitted infections(syphilis), pneumonia and other respiratory infections

Adverse reactions to Tetracyclines

Nausea or vomiting, diarrhea, epigastric distress, stomatitis, sore throat. other reactions; skin rashes, photosensitivity reaction (demeclocycline seems to cause the most serious photosensitivity reaction, whereas minocycline is least likely to cause this type of reaction.

Adverse reactions of aminoglycosides

Nausea, vomiting, anorexia, rash, urticaria.

Adverse reactions of Macrolides

Nausea, vomiting, diarrhea, abdominal pain or cramping, pseudomembranous colitis may occur. Visual disturbances (associated with telithromycin) may also occur.

Adverse reactions to Cephalosporins

Nausea, vomiting, diarrhea. other reactions; headaches, dizziness, malaise, heartburn, fever, nephrotoxicity, hypersensitivity- mild reactions include pruritis, urticaria, and skin rashes; more serious reactions include SJS syndrome and hepatic and renal dysfunction, aplastic anemia, Toxic epidermal necrolysis.

More serious adverse reactions with aminoglycosides

Nephrotoxicity (damage to the kidneys by a toxic substance), ototoxicity (damage to the hearing organs by a toxic substance), neurotoxicity (damage to the nervous system by a toxic substance)

S/S of neurotoxicity

Numbness, skin tingling, circumoral paresthesia, peripheral paresthesia, tremors, muscle twitchings, convulsions, muscle weakness, and neuromuscular blockade (acute muscular paralysis and apnea).

Anaphylactic shock

Occurs more frequently when penicillin is given as a parenteral administration but can occur with oral use. signs include hypotension, loss of consciousness, and acute respiratory distress. Those allergic to penicillin also have incidence of being allergic to cephalosporins.

Penicillin IM

Patient who receives this in the outpatient setting is asked to wait in waiting area for at least 30 minutes because anaphylactic reaction is most likely to occur.

Contraindications with penicillin

Patients with history of hypersensitivity or the cephalosporins. should be used cautiously in patients with renal disease, asthma, bleeding disorders, GI disease, pregnancy category C, or lactation and history of allergies.

Clients with what condition should not be administered cefprozil (Cefzil) because it contains phenylananine?

Phenylketonuria. this drug may also interfere with accurate test results.

Infectious microorganisms that respond to penicillin therapy

Pneumococci and group A beta-hemolytic streptococci.

S/S of nephrotoxicity

Proteinuria, hematuria, increase in the BUN level, decrease in urine output, and an increase in the serum creatinine concentration. usually reversible once drug is discontinued.

Uses of cephalosporins

Respiratory infections, otitis media (ear infection), bone/joint infections, genitourinary tract and other infections caused by bacteria. also used during perioperative period to prevent infections in patients having surgery on a contaminated or potentially contaminated area, such as GI tract or vagina.

Aminopenicillins

Result of chemical treatment of a biological precursor to penicillin. More slowly excreted by kidneys and thus have a somewhat wider spectrum of antibacterial activity because of their chemical modification.

Superinfection with penicillins

Seen with administration of the oral penicillins and occur in the bowel. symptoms include diarrhea or bloody diarrhea, rectal bleeding, fever, and abdominal cramping. Pseudomembranous colitis is a commonly occurring superinfection

Precautions with macrolides

Should be used cautiously in patients who have liver dysfunction or myasthenia gravis, or who are pregnant or lactating

Signs and symptoms of hypersensitivity to Penicillin

Skin rash, urticaria, sneezing, wheezing, pruritis, bronchospasm, laryngospasm, angioedema, hypotension, serum sickness (chills, fever, edema, joint and muscle pain, and malaise.

Pseudomembranous colitis

Superinfection with penicillin that may occur after 4-9 days of treatment or as long as 6 weeks after the drug is discontinued.

MRSA

Type of bacteria that is resistant to methicillin, oxacillin, penicillin, and amoxicillin.

Impaired oral mucous membranes

The administration of oral penicillin can result in a fungal superinfection in the oral cavity. characterized by varying degress of oral mucous membrane inflammation, swollen and red tongue, swollen gums and pain in the mouth and throat. symptoms are glossitis, sore tongue, ulceration, or a black furry tongue. Yogurt, butter, or Acidophilus capsules can be taken to reduce risk of fungal superinfection. nonirritating soft diet may be required

Impaired comfort; increased fever (penicillin)

The nurse takes vital signs every 4 hr. increase in body temp may indicate a secondary bacterial infection or failure of the drug to control original infection. fever can be managed with antipyretic.

S/S of ototoxicity

Tinnitus (ringing in the ears), dizziness, roaring in the ears, vertigo, and a mild to severe loss of hearing. if hearing loss occurs, it is usually permanent. this may occur during drug therapy or even after therapy is discontinued. Kanamycin and neomycin rarely cause these two adverse reactions.

Mafenyde and silver sulfadiazine

Topical sulfonamides used in the treatment and prevention of infections in second- and third-degree burns.

Penicillins

Treatment of susceptible pathogens, inhibit cell wall synthesis, DNA or RNA synthesis, protein synthesis.

Precautions with aminoglycosides

Used cautiously in elderly patients and patients with renal failure and neuromuscular disorders.

Precautions of Lincosamides

Used cautiously in patients with a history of GI disorders, renal disease, liver impairment, or myasthenia gravis.

Prophylaxis

Used for prevention against a potential secondary bacterial infection that can occur in a patent with a viral infection; the viral infection has weakened the bodys defenses and person is susceptible to other infections particularly a bacterial infection. Penicillin also may be prescribed as prophylaxis for a potential infection in high risk patients with a history of rheumatic fever or chronic ear infections.

Kanamycin, neomycin, and paromomycin

Used orally in the management of hepatic coma, in this disorder liver failure results in an elevation of blood ammonia levels.

Uses of aminoglycosides

Used primarily in treatment of infections caused by gram-negative microorganisms. may be used to reduce bacteria (normal flora) in the bowel when patients are having abdominal surgery or when a patient is in hepatic coma. oral aminoglycosides are poorly absorbed they are useful in suppressing GI bacteria.

Cephalosporins

Valuable group of drugs that are effective in the treatment of infection with almost all of the strains of bacteria affected by the penicillins as well as some strains of bacteria that have become resistant to penicillin.

When should the nurse evaluate the patients level of consciousness and ability to swallow?

When kanamycin or neomycin (aminoglycoside) is given for hepatic coma

Dirithromycin

a macrolide that can be given with food or within 1 hour of eating.

Contraindications to Tetracyclines

contraindicated in patients that are hypersensitive to any tetracyclines; during pregnancy because of the possibility of toxic effects to the developing fetus (pregnancy category D) and during lactation and in children younger than 9 yrs of age.

Contraindications of aminoglycosides

contraindicated in patients with hypersensitivity to aminoglycosides, preexisiting hearing loss, myasthenia gravis, and parkinsonism. also contraindicated during lactation or pregnancy (pregnancy category C, except for neomycin, amikacin, gentamicin, kanamycin, netilmicin, and tobramycin, which are in pregnancy category D)

Uses of Lincosamides

effective in the treatment of infection caused by a range of gram-negative and gram-positive microorganisms. used for more serious infections and may be used in conjunction with other antibiotics.

Uses of Tetracyclines

effective in the treatment of infections caused by a wide range of gram negative and gram positive microorganisms. Used as a broad spectrum antibiotic when penicillin is contraindicated and to treat rickettsial diseases, intestinal amebiasis, skin and soft tissue infections, uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis, severe acne as an adjunctive treatment, infection with helicobacter pylori in combination with metronidazole and bismuth subsalicylate.

How often during ongoing assesment of clients taking cephalosporins the nurse inspects the skin for redness, rash, or lesions that appear as red wheals or blisters?

every 4 hours.

What should you avoid when taking a tetracycline?

exposure to the sun or any type of tanning lamp or bed. when exposure to direct sunlight is unavoidable completely cover the arms and legs and wear a wide-brimmed hat to protect the face and neck

Lincosamides

group of anti-infectives with a high-potential for toxicity, are usually used only for treating serious infections in which penicillin or erythromycin (a macrolide) is not effective. act by inhibiting protein synthesis in susceptible bacteria causing cell death.

Clarithromycin and telithromycin

group of macrolides that can be given without regards to meals, and clarithromycin can be taken with milk.

Fourth generation Cephalosporin

has a broader spectrum and longer duration of resistance to beta-lactamase. These drugs are used to treat urinary tract and skin infections and hospital-acquired pneumonias.

Action of cephalosporins

have a beta lactam ring and target the bacterial cell wall, making it defective and unstable. usually bactericidal.

Lab results while taking cephalosporins

if renal impairment is present, a lower dosage and monitoring of blood creatinine levels are indicated. Blood creatinine levels greater than 4 mg/dL indicate serious renal impairment.

The patient taking aminoglycosides

is at risk for ototoxicity. auditory changes are irreversible, usually bilateral, and may be partial or total. The risk is greater in patients with renal impairment or those with preexisting hearing loss.

What is a danger while taking Telithromycin (ketek)?

it is a drug related to macrolides. it can cause the patients eyes to have difficulty focusing and accomodating to light. the nurse should be alert for symptoms such as numbness or tingling of the skin, circumoral paresthesia, peripheral paresthesia, tremors, and muscle twitching or weakness.

Dilsufiram-like reaction

may occur if alcohol is consumed within 72 hrs after administration of certain cephalosporins (cefamandole, cefoperazone, and cefotetan). Symptoms include flushing, throbbing in the head and neck, respiratory difficulty, vomiting, sweating, chest pain, and hypotension. Severe reactions may cause arrythmias and unconsciousness.

Nephrotoxicity

may occur with the administration of cephalosporins . an early sign of this adverse reaction may be a decrease in urine output. The nurse should measure and record the fluid output and notify the primary healthcare provider if output is less than 500 mL daily.

First generation Cephalosporin

more useful against gram positive microorganisms than would a third generation cephalosporin.

What is the patient taking an aminoglycoside at risk for?

nephrotoxicity. The nurse measures and records the intake and output and notifies the primary healthcare provider if the output is less than 750 mL/day. It is important to keep a record of the fluid intake and output as well as patients daily weight to assess hydration and renal function.

How should tetracyclines be given?

on an empty stomach. should be given with a full glass of water (8 oz). The exceptions are minocycline (minocin), and tigecycline (Tygacil) which may be taken with food.

Precautions of sulfonamides.

patients with renal impairment, hepatic impairment, or bronchial asthma

Risk of hypogylcemia

seen in diabetic patients that are prescribed sulfonamides. they may inhibit the hepatic metabolism of the oral hypoglycemic drugs tolbutamide (Orinase) and chlorpropamide (Diabinese).

Precautions with Tetracyclines

should be used cautiously in patients with impaired renal function and those with liver impairment (doses greater than 2 g/day can be extremely damaging to the liver)

Contraindications and precautions with cephalosporins

should not be administered if has a history of allergies to cephalosporins or penicillins. should be used cautiously in patients with renal disease, hepatic impairment, bleeding disorder, pregnancy category B.

Nursing alert for tetracyclines

should not be given with dairy products (milk or cheese), antacids, laxatives, or products containing iron. when those drugs are prescribed they are given 2 hrs before or after the administration. food or drugs containing calcium, magnesium, aluminum, or iron prevent absorption of this drug.

When to contact physician while taking cephalosporin

signs of infection appear to worsen, rash or loose stools or diarrhea occur, allergy of penicillin or cephalosporin, previously injected areas appear red or if pt reports continued pain, report rash or hives, if superinfection occurs, increase in temperature.

drug to drug interaction with cephalosporins and aminoglycosides

the effect is that it can increase risk for nephrotoxicity

Preadministration assessment with Lincosamides

the nurse should identify and record signs and symptoms of the infection (pain, drainage, redness, changes in appearance of sputum, general malaise, chills and fever, cough, and swelling), obtain allergy history, order C&S test, renal & hepatic function tests, CBC, and urinalysis.

S/S of a bacterial or fungal superinfection

vaginal or anal itching, sores in the mouth, diarrhea, fever, chills, and sore throat.