Penicillin

Cephalosporins

Aminoglycosides

Quinolones

Tetracycline

Macroslides

Sulfonamindes

Ampicillin

Amoxillin

Penicillin G

Which type of drug is Cephalexin?

(Keflex)

Majority kill gram (+),some gram(-)

Narrow: Pen G -> for Strep

Narrow: Penicillinase resistant, Methiciliin, Nafcillin, Didoxicillin

Broad: Amoxcillin and Ampicillin

* inhibit bacterial cell wall synthesis 

nausea, diarrhea, rash, itching,

difficulty breathing, thrush,

discharge, anemia, anaphylaxis

Toxicity: not too toxic, some allergic reactions, some fatal

-A thorough history

-Check for allergy prior to med chart and check wristband for allergies

-Nurses caution with skin contact of ATB

-Take ATB on time and finish prescription

What are the drug actions of Cephalosporins?

(Cephalexin)

Like Penicillin: inhibit bacterial cell wall synthesis

Action: Bind to “penicillin-binding” proteins (however, some resist binding to these due to prod. of bacterial enzymes (B-lactamase, Penicillinase) that destroy critical structures; therefore develop resistance to these ATBs

Kills most Staph, Strep, & some Gm (-): E.Coli, Klebsiella, Proteus)

Treats UTI, bone/ joint infection, septicemia, and otitis media

What are the side effects of Cephalopsorins?

(Cephalexin)

-Nausea & Vomiting

-Pseudomembranous colitis (diarrha)

-Abdominal cramps or distress

-Rash, Prurtis, redness and edema

What are the nurisng implications for Cephalosporins?

(Cephalexin-Keflex)

-Eliminated thru renal

-Must have OK kidney function; push fluids.

-Watch for cross allergies with Penicillins (rash, itching = urticaria; anaphylaxis)

-Culture sites before start on meds

-Phlebitis = vein inflammation (dc IV site & restart IV in another site if red streak up vein & warm)

-BUN and creatinine tests

-Administer around the clock

What are the Actions of Aminoglycosides?

(Gentamycin, Kanamycin & Tobramycin)

“BIG GUNS” à Bactericidal: Gm (+)&(-), but mostly Gm(-): Pseudomonas, E. Coli,

Inhibits protein synthesis of cell wall

Not given orally b/c poorly absorbed

Inactive against fungi, viruses and most anaerobic bacteria

Peak level drawn from blood 30 min p drug infused IV; trough before dose due (serum Gent levels done 1^st dose, then q 72 hrs)

What are the Side Effects of Aminoglycosides?

(Gentamycin, Kanamycin & Tobramycin)

Excreted unchanged by glomerular filtration; therefore, get Nephrotoxicity (the higher the trough levels of drug) and Ototoxicity (hearing loss)

Could have nephron damage/renal failure c rising BUN and creatinine levels; if nephron destroyed, pt on DIALYSIS QOD for rest of life!

HA, paresthesia, vertigo, skin rash, fever, and overgrowth

Toxicity: powerful but dangerous

What are the Nursing Implications of Aminoglycosides?

(Gentamycin, Kanamycin & Tobramycin)

Serum Gent level: √ BUN and creatinine levels for nephron damage; (Peak & Trough test: level of [drug] measured in blood); √ peak and trough concentrations

Push fluids; keep from dehydration

Calculate dosages carefully:

3-5 mg/kg/day

Usually need caution to infuse drug over 45 min - 1 hr

PO: given on empty stomach (better absorbed); Peak levels:1-4 hrs after taken. So, given 1 hr ac or 2 hrs pc.

Tx acne vulgaris, ricketsial infections: rat bit fever, Lyme disease, Chlamydia

Readily distribute to all tissues EXCEPT brain; drug binds to newly formed teeth and bone (child in womb might have stained teeth for life!)

Gm (+) and (-); inhibits protein synthesis

Rarely 1st line drug

Mostly GI

Oral stomatitis, black hairy tongue, Candida (thrush)

Allergic rxns

Hepato and nephrotoxic

Binds with teeth and bone

Photosensitivity

Avoid patients c liver and renal impairment

Diarrhea

Take @ time away from meals

Avoid dairy and antacids b/c delay absorption

Potentiate anticoagulants when taken c anticoagulants (blood thinner)

What are the actions of Macroslides?

(Erythromycin, Clarithromycin, & Azithromycin)

PO: inactivated by gastric acids (so, enteric coated or capsule)

Serum half life short; given 4x/day

Bacteriostatic: best for Gm (+), tx upper resp. infections

inhibit protein synthesis

What are the side effects of Macroslides?

(Erythromycin, Clarithromycin, & Azithromycin)

mostly gastric upset and irritating

palpitations, chest pain, HA, dizziness, vertigo, N & V, hepatotoxicity, diarrhea, rash, uticaria, thrombophlebitis

1 of the least toxic ATB; safer

What are the nursing implications of Macroslides?

(Erythromycin, Clarithromycin, & Azithromycin)

True allergies RARE, but may not tolerate because of GI problems taking this drug

Gastric upset, GI irritation

What are the actions of Sulfonamindes?

(Sulfisoxazole'Gastrin', & Bactrim)

Drug choice for UTI; caused by E.Coli, Klebsiella, Proteus, Staph A, Enterobacter

Tx ear and upper resp. infections

inhibit growth of susceptible bacteria by preventing the synthesis of folic acid

choice for Pneumocystis carinii

What are the side effects of Sulfonamindes?

(Sulfisoxazole'Gastrin', & Bactrim)

Allergic rxns common

Cross sensitivities to thiazide diuretics & oral diabetic meds

Poorly soluble in urine and CRYSTALLIZE in the renal tubule (Bad b/c kidney stones); orange urine

Taken on empty stomach, 1 hr before or 2 hrs after

What are the nursing implications of Sulfonamindes?

(Sulfisoxazole'Gastrin', & Bactrim)

Teach pts not to miss a dose & take entire Rx

drink 1.5 L/day for adults

Watch for toxic effects by lab tests that reflect bone marrow (WBC counts and bleeding)

Risk of photosensitivity; use sunscreen and protective clothing

What are the actions of Quinolones?

(Ciprofloxin)

Alter the DNA of bacteria and are bactericidal

Newer ATB, c wider range to kill bacteria, esp Gm (-)

PO or IV diluted in @ least 100 ml of IV soln. (if not diluted, get inflammation of vein: phlebitis); tx systemic or UTI

Tx for UTI, bone and joint infections, skin & lower resp. infections, Pseudomonas, diarrhea

destroy bacteria by altering DNA 

What are the side effects of Quinolones?

(Ciprofloxin)

Few side effects: nausea

HA, dizziness, fatigue, nausea, constipation, rash, photosensitivity, chills and fevers

Very potent

Crystalluria- crystals in urine

Can cause photophobia

Keep patient well hydrated

May have interactions with other drugs (antacids, iron, multi-vits, oral anticoagulants, asthma drugs)

Monitor client for anorexia, vomiting and nausea, impaired renal or hepatic dysfunction especially in elderly

Advise client to wear sunglasses

Limit 

What are the actions of Clindamycin?

(Cleocin)

What are the side effects of Clindamycin?

(Cleocin)

Genitourinary tract infections,

anaerobic pneumonia

What are the nursing implications of Clindamycin?

(Cleocin)

Tx for Staph infections, esp. if PEN

Allergy; IV diluted in 100 ml IV soln; give @ least over 1 hr.

Bind to cell wall, inhibits cell wall synthesis and cell death. Unlike PEN and cephalo; gram (+), NOT (-)

Ototoxicity, Nephrotoxicity; draw

serum peak and trough levels (for toxicity); Never give IM!

Push fluids 2000-3000 cc/day;

If hypotension b/c given too fast à give over 2-3 hrs

Watch for allergy (Med Alert bracelet)

What are the actions of Antifungals?

(Amphotericin B & Ampho B and Flucyosine)

either fungicidal or fungistatic (works by binding sterols in the fungal cell membrane, which alters cell wall permeability)

Do IV-test-dose for allergic rxn; dilute c D5W(NOT SALINE!)

infused slowly over 4-6 hrs; careful c dosing; may have to give QOD; can involve tx over 4-8 weeks; light sensitive, protect with foil

for severe systemic fungal infections (Crytococcsis: valley fever, Histoplasmosis, Coccidiomycosis, Aspergillosis, Candida)

What are the side effects of Antifungals?

(Amphotericin B & Ampho B and Flucyosine)

HA, chills, fever, malaise, muscle and joint pain (flu like sxs)

Pre-medicate to avoid allergic rxn 30 min before: aspirin, benadryl, steroids, Demerol

Severe Thrombophlebitis, give in subclavian (IV)

Nephrotoxicity; more obvious the longer pt stays on drug (do QOD)

sometimes pt become anemic:

VERY TOXIC

What are the nursing implications of Antifungals?

(Amphotericin B & Ampho B and Flucyosine)

Watch closely for side and toxic effects

Initially take temp. q 1-2 hrs

Watch serum blood levels for anemia (RBC) and kidney tests

May need K+ supplements; check serum K+ levels

What are the actions of Antivirals

(Acyclovir/Zovirax)

(Topical, parenteral, oral)

against Herpes simplex 1 & 2, & Herpes Zoster (Shingles)

taken up by Herpes virus cells & inhibits DNA/RNA replication; Not a cure, just a tx

IV form used for immunocompromised pts(AIDS pts)

What are the side effects of Antivirals

(Acyclovir/Zovirax)

(Topical, parenteral, oral)

Contraindicated if pt shows hyper-

sensitivity or allergy to drug: N & V, diarrhea, HA, burning

What are the nursing implications of Antivirals

(Acyclovir/Zovirax)

(Topical, parenteral, oral)

May help treat genital herpes, but NOT a cure, may reoccur

Use topical (cold sores sparingly) and gloves to apply, so won't spread

for resp. sncytial virus (RSV) in new babies

Most antivirals very expensive

* Avoid nebulized exposure if 

   pregnant

* IM inj -> change sites daily

   to avoid abscesses

disrupts cell wall synthesis

      and cellular functions

Rx choice; well absorbed in GI tract; bacteriostatic.

Usually give in combo with other anti-TB drugs b/c develop drug resistance (go for  all TB tx)à (9mo-3yrs)

-protein synthesis

-good for Methicillin resistant Staph Aureus

HA, drowsiness, dizziness, visual

disturbances, fever/flu-like syndrome;  red-orange tears, urine, sweat, contacts; liver toxicity; GI upset

-inhibits lipid and nucleic acid

    synthesis

-treat peripheral neuropathies associated with INH therapy; used with other TB drugs

liver toxicity, hyperuricemia = GOUT, lead to joint swelling, pain; GI irritation

(Counteracts side effects of INH: peripheral neuritis)

-not used much

-IM 2-3x/wk; give if SEVERE CASE

-ototoxicity lead to hearing loss,

-dizziness (aminoglycoside);

kidney toxicity

Albendazole

Diethylcarbamazine & Thiabendazole

Ivermectin

Mebendazole

Niclosamide

OxaminQuine

Piperazine & Pyrantel

Praziquantel

tx for worms

important to find causative agent in stool specimen

(1/3 of world’s pop. infected; common in 3^rd world countries c poor sanitation)

diarrhea

myelosuppression

abd pain

- pinworms spread easily through entire family, so all may need tx

- meticulous hand washing esp. after disposal of feces and urine

- wash ac and pc

- change bed linens, night clothes and towels daily

- keep nails short, toilet disinfection

GI upset, vision (retinopathy) & hearing problems; may bleach scalp and body hair after several months of tx; Psoriasis may be exacerbated; (people stop Rx b/c of side effects)

Rule out prior allergies

Children susceptible to OD; Sx cause quickly and may be dead within 2 hrs; induce vomiting to get drug out of system

Start tx 1-2 weeks prior to going to endemic area; continue 6-8 weeks after leave country

Drug taken weekly at same time, with meals

Release moderate to severe pain; provides pre-op sedation

Alters pain perception, induces mental changes, promotes deep sleep, depresses respirations, constricts pupils, DEPRESSES GI MOTILITY

Bind with opiate receptors at many sites within CNS, altering both perception and emotional responses to pain

* Resp depression à give NARCAN (narcotic antagonist) if respirationtoo slow

* Adverse CNS changes à sedation, light-headedness, dizziness

* constriction of pupils

* GIà N&V, constipation

* Some cause hypotension and anti-cholingergic effects (dry mouth, bladder retention)

* Euphoria

* Allergic reactions- pruritis (itch), uticartia, laryngospasm

ONSET: IV à rapid within 10 min

ONSET: IM à 5-20 min

ONSET: ORAL à 12-24 hr time released: Morphine Contin; OxyContin

ONSET: Patchà slow release

Pts work up tolerance for Narcotics; DURATION: 4-6 hrs for most w/ PO & IM; Fentanyl = shorter 1-2 hr duration

Codeine (cough suppressant)

     Dilaudid

     Morphineà Schedule II b/c high

     Demerol  à potential for abuse

     Darvon, Vicodin

     Hydrocodone àMixture of

     Oxycodone    àCodeine &

     Tylenol #3     àNon-narctoics

     Duragesics (Fentanyl – patch)

     Talwin

Stadal

     Nubain

     Forms of Morphine Sulfate:

    * IV: very concentrated = IV     

      Fentanyl   

     * IM

     * Transdermal patch – Duragesic

       or Fentanyl: for cancer pain

     * Epidural 

     * PCA = Pt controlled analgesia;   pre-measured syringe infusion pump

Come in oral forms; syrup/tablets, suppositories and IV and IM

Usual adult dose: subQ or IMà 4-15 mg; PO or suppà 30-60 mg;

MSO4 Contin (PO): long-acting; 12 hr DURATION

“Preservative-free”: longer-acting (Duramorph); 12-24 hrs pain relief; may not use other pain med. for 24 hours

Safety factor allows med to be delivered every X minutes; charted every 4 hours

Resp depression withhold RR ß 12

Drowsiness, nausea, urine retention, constipation

Pruritis (lots of itching), nausea

Pt. TEACHING: assess EVERY HOUR to report pain, pain relief; respiratory rate, level of numbness, if catheter in right place, if leaking; encourage coughing/deep breathing to avoid atelectasis

Continue to assess pain relief and sedation

-          MSO4 Contra-indicated: pts w/head injury b/c need to stay alert; alters pupil resonse (constricts)

-          Monitor & take RR prior to giving – hold drug if RR < 12/min àNarcan (Naloxon) = antidote

-          Safety precautions, siderails up

-          May need laxative or á fiber b/c constipation; may mask other pains; may cause bladder retention

-          Post op ptsà encourage pts to cough and deep breaths q 1-2 hrs and turn (need to keep lungs clear of secretions)

-          Use round the clock, don’t wait until pain severe

-          Can become addictive, no problem with acute surgical pain; problem w/ chronic pain

-          Interacts with alcohol and sedatives; Don’t drive!

Can combine w/ Non-narcotics for Adjuvant therapy (i.e. codeine)

·       Resp depression < 12/min

·       Drowsiness, urine retention, constipation, MORE NAUSEA than Morphine

Inj. – often mixed in syringe with Vistaril or Phenergen(relieve nausea &potentiates narcotics, lasts longer)

Salicilates

    Aspirin à PO or suppository;

    ONSET: PO (30-60 min.); Peak

    levels: 2-3 hrs; Duration: 4-6 hrs;

    DOSE: 325-650 mg, q 3-4 hrs

Urinary Tract

   Phenazopyridine HCL (Pyridium)

Non-Salicylates

   Acetaminophen (Tylenol)

ASA – relief of mild to moderate pain, alleviate inflammation of RA, reduce fever, inhibits platelet aggregation to prevent clots

Action: produces analgesia (pain relief) à CNS will some way ill-defined on hypothalamus and peripherally à blocks generation of pain impulses and inhibits prostaglandin synthesis(fools brain to think no pain)

Relieves fever by acting on hypothalamus which is heat regulating center

ASA – GI (heart burn, N&V, dyspepsia, bleeding); affects bleeding times

* Chronic salicylate intoxication: Salicylism (prolonged high doses)

    – tinnitus, hearing loss, HA,  

    confusion, hyperventilation,

    coagulation (bleeding problems)

Tylenol – GI problems, relatively few problems with lose dose; Overdose causes Hepatic Toxicity

-          Take ASA with meals/milk/food (or switch to brand that’s enteric coated/buffered

-          ASA therapeutic levels may be large 2.6-5.4 grams/day (10pills if 600 mg pill)

-          Insect for bruising, check stools for occult (old blood), nosebleeds

-          √ c Dr. about stopping ASA (5-7 days) prior to any surgery

-          Don’t chew or crush enteric-coated ASA. Don’ttake with non-steroidal anti-inflammatry drugs (like Advil or Ibuprofen) b/c both cause GI upset and GI bleeding

-          Don’t use on children b/c can cause Reyes syndrome

-          Tylenol – hold if pt develops rash or uticartia

If pain or fever for several days à see Dr.

-          Tylenol – hold if pt develops rash or uticartia

If pain or fever for several days à see Dr.

For arthritis pts, may take 2-4 weeks to get the anti-inflammatory effect of doses 200-800 mg/day

For post-op pts, w/ orthopedic surgeries; only 2 weeks b/c bleeding

Inhibits prostaglandin synthesis by inhibiting Cox2 enzymes; for pain, arthritis & dysmennorrhea

ADVANTAGE over other NSAIDS: don’t disrupt platelets and have less GI bleeding problems

-          similar to ASA; may get dizziness and drowsiness

Contra-indicated: pts w/ hepatic disorders

Advil, Motrin, Midol, Pamprin,   

         Nuprin

 ~200-800 mg/day