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Beta- lactam
Pharamocolgy chapter 30
35
Nursing
Undergraduate 1
10/11/2009

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Term

 

Beta-lactam Antibacterials
Definition

 

Derive name from beta-lactam ring, which is part of their chemical structure
 
Ring is essential for antibacterial activity
Specific enzymes can disrupt ring
Inactivate mechanism of action
Major mechanism of action in acquiring resistance
Characteristics widely differ
Term

 

Beta-lactam Antibacterials
Definition

 

Penicillins
Cephalosporins
Carbapenems
Monobactams
Term

 

Penicillins
Definition

 

Safe, effective, widely used ATB
First ATB developed
Had to be given parenterally
Destroyed by gastric acid
Injections were painful
Extensive use produced drug-resistant strains of staphylococci
Term

 

Penicillins
Definition

 

Post-absorption
Widely distributed
Achieve therapeutic concentrations in most body fluids
Not usually obtained in intraocular and CSF unless inflammation present
Rapidly excreted by kidneys
Term

 

Penicillins 
Indications for use
Definition

 

Bacterial infections caused by susceptible organisms
More effective in gram(+) than gram(–) infections
Skin/soft tissue, respiratory, GI and GU infections
Incidents of resistance continue to increase
Term

 

Penicillins 
Contraindications for use
Definition

 

Hypersensitivity/allergic reaction to any penicillin preparation
Potential exists for cross-allergenicity with cephalosporins and carbapenems
In life-threatening allergic reactions to PCN, cephalosporin and carbapenem use is to be avoided
Term

 

Extended-spectrum Penicillins
Definition

 

Broad-spectrum ATB
Especially against gram(-) organisms
Available orally for UTIs, prostatitis
Intermittent IV dosing
Most can be given IM
Term

 

Penicillin/Beta-lactamase Inhibitor Combinations
Definition

 

Beta-lactamase inhibitors
Very little antibacterial activity
Bind with and inactivate beta-lactamase
Protects PCN from destruction
Extends PCN’s spectrum of efficacy
Term

 

Cephalosporins
Definition

 

Widely used group of medications
Derived from a fungus
Broad-spectrum ATB with activity against gram(+) and gram(-) bacteria
More active against gram(-) compared with PCNs
Widely distributed into most body fluids and tissues
Maximum concentration in liver and kidneys
Term

 

Cephalosporins 
Clinical indications for use
Definition

 

Surgical prophylaxis
Treatment of infections
Respiratory tract, urinary tract
Skin, soft tissues
Bones, joints
Brain, spinal cord; septicemia
Term

 

Cephalosporins 
Contraindications for use
Definition

 

Previous anaphylactic reaction to PCN
Cross-sensitivity low in those with delayed reactions to PCN
Skin rash
Cephalosporin allergy
Term

 

Carbapenems
Definition

 

Broad-spectrum, bactericidal beta-lactam antimicrobials
Inhibit synthesis of bacterial cells walls by binding with penicillin-binding proteins
Three medications
Term

 

Monobactam
Definition

 

Active against gram(-) bacteria
Active against many strains that are ATB resistant
Does not cause kidney damage or hearing loss (as can aminoglycosides)
Indications for use
Urinary tract, skin/skin structures, lower respiratory tract, intra-abdominal and gynecologic infections, septicemia
Term

 

Is the following statement True or False?
The classification of beta-lactam antibiotics refers to cephalosporins, carbapenems, and monobactams.
Definition

 

False.
The classification of beta-lactam antibiotics refers to penicillins, cephalosporins, carbapenems, and monobactams.
Term

 

Beta-lactam Antibacterials 
Mechanism of action
Definition

 

Inhibits synthesis of bacterial cell wall
Binding with proteins
Produces defective cell wall, which destroys microorganism
Term

 

Is the following statement True or False?
The mechanism of action for beta-lactam antibiotics is to prevent the duplication of bacterial cells.
Definition

 

False.
The mechanism of action for beta-lactam antibiotics is to produce a defective cell wall, which results in the destruction of the microorganism.
Term

 

Principles of Antimicrobial Therapy 
Goal of therapy
Definition

 

Prevent/treat infections caused by pathogenic organisms
Drug selection
Depends on organism causing infection
Severity of infection
Other factors
Term

 

Use in Special Populations
Definition

 

Perioperative use
Children
Older adults
Renal impairment
Hepatic impairment
Clients with critical illness
Home care
Term

 

Perioperative use of cephalosporins:
Definition

Are used insurgical prophylaxis

1st generation is use for gram + is cefazolin

2nd cefotetan & cefoxitin are used abdominal, gynecologic & colorectal sirgery against gram -

Term
Cephalosporins should be use
Definition
Within 2 hours before 1st skin incision is made so the drug has time to reach therapeutic serum.
Term

 

Use in Children
Definition
Penicillins and cephalosporins are widley use to treat infection in children and generally safe
Term
Use in Children of penicillins & cephalosporin
Definition
Dosage shoul be based on age, weight severity of the infection beging treated, & renal function
Term

 

Use In Older adults
Definition
Beta-lactam antibacterials are relativelt safe, although decrease renal function, other disease process, and concurrent drug therapies increase the risks of adverse effectes in older adults.
Term
Risk in Older Adults
Definition
With penicillins, hyperkalemia may occur with large IV dose of penicillin G potassium and hypernatremia may occur with ticarcillin.
Term
Risk In Used Older Adults
Definition
Cephalosporins may aggravate renal impairment, especially when other nephrotoxic drugs are used concurrently
Term
Other Risk in Older Adults
Definition
Dosage of most cephalosporins must be reduced in the presence of renal impairment, depending on creatinie clearance
Term

 

Use in Renal impairment
Definition
Beta-lactam antimicrobials are excreted mainly by the kidneys and may accumulate in the presence of renal impairment
Term
Use in Renal impairment Penicillin
Definition
  • Dosage is reduce of Penicillin
  • Patients on hemodialysis usually require an additional dose after treatment because hemodialysis removes
  • Carbenicillin dose not reach therapeutic
  • Nephropathy High dosage can contribute to  hypersensitiy reaction
  • Electrolyte imbalances
Term

 

 USE in Renal impairment Cephalosporins
Definition

Reduce dosage because usual dosage may produce high and prolonged serum drug levels.In renal failure dosage of all cephalosporins should be reduce

Cefotaxime can cause toxicity in patients with renal impairment

Term
 USE in Renal impairment Carbapenems
Definition
  • Drug is contraindicated in  renal impairment & should be reduce
  • Dosage of meropenem should be reduced with renal impairment
  • Dosage of ertapenem should be reduced to 500 miligrams daily
Term
USE in Renal impairment Monobactum
Definition
  • Aztreonam should be reduced by 50% or more in patients with CrCl of 30 ml
  • Life threating infection in clients give 12.5%
Term

 

Use in Patients with Hepatic impairment
Definition
  • A few beta-lactam antibiotics may cause or aggravate hepatic impairment
  • Amoxicillin-clavulante should be used with caution in patients with hepatic impairmen
  • Aztreonam,imipenem, meropenem, and ertapenem may cause abnormalities in liver function
Term

 

Clients with critical illness
Definition
The beta-lactam grugs are frequently given concomitantly with other antimicrobialdrugs because critically ill patients often have multiorganism or nosocomial infections
Term

 

Home care
Definition
The antibiotics are given oral in home setting. Liquid suspensions for childern should be measure with a spoon or medication device
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