Penicillins

PCN

subclass  Natural PCN

Prototype: Penicillin G (Pfizerpen)

generic name/trade name: penicillin G (Pfizerpen)

Class/subclass: beta lactams/natural PCN           

Action: Inhibits Cell Wall Synthesis                   

Bactericidal

beta lactam 

Indidcations: infections                                    (respiratory,pneumonia,scarlet fever)

Side effects:anaphylaxis, proteinuria,coma,N/V/D

Nursing Implications: Give oral PCN on empty stomach, I&O ratio, toxicity, respiratory status, observe sputum, wounds, urine, stools.

Penicillins (PCN)

Inhibits cell wall synthesis

bactericidal

beta lactums

Indidcations: mostly Gram + Ext. Spec PCN only one to tx Gram -

Subclasses:                                                    Natural  PCN                                       ,                                   Penicillnase (resistant PCN), AminoPCN, Extended Spectrum PCN  

Pts On Beta Lactums= High risk for                   AAPMC        Antibacterial Associated Pseudomembranous Colitis) -especially if carrier of Clostridium difficile(toxin)

Monitor Patients: weight loss, diarrhea,            and  darkened tounge.  Can be fatal esp. older adults.

High doses/Long Term rxns:                         hepatotoxicity, seizures, coma,renal impairment

NSG: Oral PCN =empty stomach                        

MONITOR:hypersensitivity rxns,bleeding

EFFECTIVENESS DECREASED: taken with

caffeine

citrus fruit

cola

fruit juices

tomatoe juice

INTERFERES: w/ BCP (birth control pills)

generic name endsin "cillin"

Penicillins

subclass: Penicillnase resistant PCN        

prototype: nafcillin (Unipen)injectible only

INHIBITS CELL WALL SYNTHESIS

BACTERICIDAL

BETA LACTUM

Generic name/(trade name): nafcillin/(Unipen)

class/subclass: Penicillin/Penicillnase               

action: inhibits cell wall synthesis                    

indications: for gram + cocci infections caused by penicillinase producing Staphylococcus

Side Effects: lethargy, coma, seizures,               pseudomembranous colitis, proteinuria, glomerulonephritis, anaphylaxis

NSG: I&O ratio, hematuria, oliguria-nephrotoxic bowel patterns, respiratory status, allergies

PENICILLINS

subclass: Amino PCN

Prototype: ampicillin (Omnipen)

INHIBITS CELL WALL SYNTHESIS

BACTERICIDAL

BETA LACTUM

generic name/(tradename): ampicillin/Omnipen

class/subclass: penicillin/Amino PCN

Action:   Inhibits Cell Wall Synthesis

Indicaitons:  Bacterial meningitis, Gonorrhea, prevention of bacterial endocarditis, renal disease, biliary tract infection, shigellosis in AIDS patients, typhoid fever

side effects: coma, seizures, pseudomembranous colitis, glomerulonephritis, anaphylaxis

NSG: poor renal system functions = toxicity may occur, hepatic studies, blood studies, renal studies, bowel pattern before, during treatment, skin eruptions, after administering 1 week after discontinuing product, respiratory status: rate character, wheezing, tightness in chest, anaphylaxis, rash, itch, syspnea, facial swelling -stop product.                                    

Penicillin

subclass: Extended Spectrum PCN

prototype: tircarcillin (Ticar) IV only

INHIBITS CELL WALL SYNTHESIS

BACTERICIDAL

BETA LACTUM

generic name/(trade name): ticarcillin/(Ticar)

class/subclass: Penicillan/Extended Spectrum PCN

action: inhibits cell wall synthesis

indications: respiratory, soft tissue, uti, bacterial septicemia, effective for gram-positive cocci

side effects: coma,hepatotoxicity, glomerulonephritis, anaphylaxis

NSG: I&O, hematuria, oliguria, wheezing, rash, pruritus, blood work, bowel patterns, skin erruptions to 1 week after d/c product, allergies before treatment.

cephalosporins

subclass: 1ST GEN

prototype: cefazolin(Ancef)-parental only

INHIBITS CELL WALL SYNTHESIS

BACTERIACIDAL

BETA LACTUM

generic/trade name: cefazolin/(Ancef)   

class/subclass: cephallosporins/1st Gen.

                       parental only

action: inhibits cell wall synthesis

indications:upper, lower respiratory taract, urinary tract, skin infections, otitis media, tonsilitis, and uti

side effects: siezures, speudomembranous colitis, nephrotoxicity, renal failure, leukopenia, anaphylaxis

NSG: assess sensitivity to penicillin, watch increased BUN, creatinine-neohrotoxicity, daily I&O blood work, electrolytes, bowel patterns, urine output, anaphylazis, bleeding

cephalosporins

subclass:2nd Generation

prototype: cepoxitin(Mefoxin)-surgical prophalaxis

INHIBITS CELL WALL SYNTHESIS

BACTERICIDIAL

BETA LACTUM

generic/trade name: cefoxitin/(Mefoxin)-surgical prophalaxis

class/subclass: cephalosporin/2nd gen.

action: inhibits cell wall synthesis

indications: respiratory tract, urinary tract, skin, bone, joint infections, otitis media

Side effects: dizziness, headache, N/V/D, pseudomembranous colitis, renal failure, leukopenia

NSG: Nephrotoxicity-increased BUN/creatinine, I&O, blood studies, electrolytes, bowel pattern, urine out put, anaphalaxis, change in cough sputum

cephalosporins

subclass: 3rd Gen

prototype: ceftriaxone(Rocephin)-will cross blood brain barrier.

INHIBITS CELL WALL SYNTHESIS

BACTERICIDAL

BETA LACTUM

generic/(trade name): ceftriaxone (Rocephin)-cross blood brain barrier.

class/subclass: cephalosporin/3rd gen.

action: inhibits cell wall synthesis

indications: serious lower restiratory tract, urinary tract, skin, gonococcal, intraabdominal infections, septicemis, meningitis, bone, joint infections, otitis media, pid

side effects: seizures, heart failure, bleeding, pseudomembranous colitis, proteinuria, nephrotoxicity, leukipenia, anaphylaxis

NSG: sensitivity to penicillin, check increased BUN.creatinine, electrolytes, blood work, bowel pattern, IV site should be checked for phlebitits.

cephalosporins

subclass: 4th gen

prototype: cefepime(Maxipime)

INHIBITS CELL WALL SYNTHESIS

BACTERICIDAL

BETA LACTUM

generic name/trade name: cefepime/(Maxipime)

class/subclass: cephalosporine/4th gen

action: inhibits cell wall synthesis

indications: will cross blood brain barrier

side effects: N/V/D, ABD PAIN

NSG: give orals with food, monitor for candidiasis,  no alcohol-increase amnt of acetaldehyde in blood causing a reactio:N/V, HA decreade BP, increased HR, SOB, flushing

monobactams

gram-

narrow spectrum

Prototype: aztreonam(Azactam)-for serious systemic infections

generic name/ (trade name): axtreonam/(Azactam)

class/subclass: monobactam/narrow spectrum

action: inhibits cell wall synthesis

indications:serious systemic infections

SE: may alter renal function, N/V/D, abd pain

NSG: Monitor renal function, I&O

Carbapenems

broad spectrum

very potent

last resort

prototype: imipenem-cilastatin(Primaxin)-resistant organism

INHIBITS CELL WALL SYNTHESIS, BACTERICIDAL, BETA LACTUM

generic name/(trade name): imipenem-cilastatin/(Primaxin)

class:carbapenems

action: inhibits cell wall synthesis

indidcations: serious  infections

SE: N/V/D ABD PAIN,

RXNS: may cause drug-induced seizure activity

NSG: monitor for seizures, renal function, liver function

Less drug interactions than PCN

Sulfonamide

Gram +and -

Prototype: sulfamethoxazole (Bactrim)

ANTIMETABOLITES

BACTERIOSTATIC

allergic rxn: uticaria, purities, edema

generic name/ (trade name): sulfamethoxazole/(Bactrim)

class: sulfonamides

action: antimetabolite, inhibits folic acid synthesis

indication: UTI's, bladder infection, otitis media, uper respiratory infection, malaria

Rxns: Anemia, photosensitivity, N/V/D. headache, rash, dermatitis, crystalluria, nephrotoxic,

SE:  seizures, allergic mycarditis, nausea, enterocolitis, anaphylaxis.

NSG: Take with at least 2 L of fluid ea. day

avoid sunlight and tanning beds, reduces the effects of  Birth control pills, take with food or milk to reduce GI upset.

Macrolides

prototype: erythromycin(E-mycin)

1950's

Inhibits protein synthesis

Bacteriostatic

generic name/(trade name): 

erythromycin/(E-mycin)

class: Macrolides

action:binds to 50S ribosome to inhibit protein  synthesis-

indications: Upper respiratory infection, Lymes, Neisseria gonorrhoeae(good to use if allergic to penicillin

SE: seizures, dysrythmias, hepatotoxicity, pseudomembranous colitis, anaphylaxis,

Allergic Rxn: uticaria, purities, edema

Rxns:  N/V/D, hepatotoxicity, ototoxicity

NSG:  take on an empty stomach, course may be shorter than other antibiotics,   May still have s/s after they finish course.  report S/S after 5 days post course.

Aminoglycosides

mostly gram -

Potent

Prototype: gentamycin(Garamycin)

INHIBITS PROTEIN SYNTHESIS-(30S RIBOSOME)

class name/(trade name): gentamycin/(Garamycin)

Class: Aminoglycosides

action: inhibits protein synthesis

indications: severe systemic infections of CNS, respiratory, GI, urinary tract, bone, skin

SE: Ototoxicity-permanent(monitor peaks and troughs) nephrotoxicity, HA, Paresthesia

NSG: Monitor blood levels to prevent nephrotoxicity and ototoxicity:  no po form

Tetracycline

gram +and -

prototype: doxycycline(Vibramycin)

Inhibits protein synthesis

bacteriostatic

generic name/(trade name):

doxycycline/(Vibramycin)

action: inhibits protein synthesis (30S Ribosome)

indications: syphilis, chronic periodontitis, acne, anthrax, lymes disease and

Allergic rxns: uticaria, purities, edema

RXNs: N/V/D, abd pain, tooth discoloration-don't give to 8years and younger, AAPMC-colitis, photosensitivity, hepatotoxicity, and nephrotoxicity

NSG:  don't give to children less than 8years,

avoid sunlight and tanning beds, interferes with BCP,  don't take with dairy or antacids,  monitor liver and kidney function, monitor for candidiasis, discard outdated drugs-become toxic as they decompose

generic names end in "cycline"

Oxazolidnones

MRSA & VRE

Prototype: linezolid (Zyvox)

INHIBITS PROTEIN SYNTHESIS

BACTERIOSTATIC

generic name/(trade name): linezolid/*(Zyvox)

class: Lycomycins

Action: inhibits protein synthesis (30S ribosome)

indications: septic and bone infections

SE: N/V/D, ABD pain, AAPMC, bone marrow supression.

NSG: use appropriate precautions  monitor platelets

(Fluoro)Quinolones

gram + and -

prototype: ciprofloxacin(Cipro)

INTERFERES WITH DNA REPLICATION

BACTERICIDAL

generic name/(trade name):ciprofloxacin(Cipro)

class/subclass: flouroquinolones

action: interferes with DNA replication

indications: chronic bacterial prostatitis, anthrax, infectious diarrhea, nosocomial pnemonia, UTI

SE: N/V/D, abd pain, dizziness, insomnia, photosensitivity, seizures, crystalluria-can interfere with cardiac medications

NSG:

- do not take with calcium or antacids or fortified oj-decreases absorption.

-do not use for under 18years old-cartiledge

-avoid sunlight and tanning beds

-take with full glass of water and increase fluid intake-drugs=insoluble when pH>6.8 causes crystalluria

generic names end in "oxacin" or "floxacin"

Nitromidazole 

prototype: metronidazole(Flagyl)-metalic taste

anti protozoal

Interferes with DNA replication

bactericidal

generic name/(trade name): metronidazole/(Flagyl)

class:Nitromidazole-anriprotozoal

action: interferes with DNA replication

indications:septicemia, amebic abscess, lower respiratory tract infections, rosacea

allergic rxns: uticaria, purities, edema

SE: N/V/D, abd pain, dizziness, metalic taste, toxic with alcohol, superinfection, peripheral neuropathy, CNS toxicity, seizures, pancraeatitis

NSG: NO ALCOHOL, monitor for candidiasis, monitor neurovascular status

Tricyclic gylcopeptitides

gram +

MRSA

prototype: vancomycin(Vancocin)-drug of choice

INHIBITS CELL WALL SYNTHESIS

BACTERICIDAL

generic name/(trade name): vancomycin(Vancocin)

class: tricyclic glycopeptide

action: inhibits cell wall synthesis-bactericidal

indications:resistant staphylococcal infections, pseudomembranous colitis, endocardititis prophylaxis for dental

allergic rxn: uticaria, purities, edema

SE: permanemt ototoxicity, nephrotoxicity, decreased bp, flushing of neck and face, crosses blood brain barrier

NSG: infuse over 60 minutes, monitor IV site, monitor blood levels to prevent toxicity, ensure adequate hydration (2L in 24hrs)-prefent-nephrotoxicity

REDMAN SYNDROME=RED FACE, LOWER BP-FLUSH-PEAKS AND TROUGHS GIVE FLUIDS

LYCOMYCINS

gram+and-

Potent

prototype: clindamycin (Cleocin)

septic & bone infections

BACTERIOSTATIC

INHIBITS CELL WALL SYNTHESIS

generic name/(trade name):

clindamycin (Cleocin)

class: Lycomycin

action: inhibits cell wall synthesis-bacteriostatic

indications: septic and bone infections

allergic reactions: uticaria, purities, edema

SE: N/V/D, abd pain, stomatitis, AAPMC, tissue damage with IV use if leaks around IV site

NSG: inspect IV site regularly, IM injections of drug may be painful

antiviral Agent

prototype: oseltamivir(Tamiflu)

PREVENTION/TREATMENT OF INFLUENZA A OR B

generic name/(trade name):

oseltamivir(Tamiflu)

class:Antiviral

action:inhibis influenza virus

indications: prevention/treatment of influenza AorB

SE: lethargy, seizures, coma, N/V/D, psedomembranous colitis, hepatotoxicity,

NSG: I&O ratio, report hematuria, oliguria

Antiretroviral Agent

subclass:Reverse Transriptase inhibitor

prototype: Zidovudine (AZT)

INHIBITS REPLICATION OF HIV-1-terminates DNA chain

generic name/(trade name): zidovudine/(AZT)

class/subclass: Antiretroviral Agent/reverse transcritase inhibitor

action: inhibits replication of HIV-1-terminates DNA chain

indications:HIV-1 infection

SE: fever, headache, malaaise, diaphoresis, insomnia, taste chane, hearing loss, photophobia, N/V/D, anorexia,

NSG: blood counts-watch for decrease granulocytes,

Antiretroviral Agent

subclass:Protease Inhibitor

prototype: indinavir (Crixavan)

INHIBITS hiv-1 PROTEASE-PREVENTS MATURATION OF VIRUS

generic name/(trade name):

indinavir/(Crixivan)

class/subclass: antiretroviral agent/protease inhibitor

action: Inhibits HIV-1-prevents maturation of virus

indications: HIV-1 in combo with other antiretrovirals

SE: headache, insomnia, N/V/D, abd pain, anorexia, dry mouth, nephrolithiasis, rash, pain, heperglycemia

NSG: complaints of lower back pain= kidney stones, anemia, bowel patterns, allergies before treatment.

Antiretroviral Agents

subclass: Fusion Inhibitors

prototype: enfuvirtide (Fuzeon)

INHIBITS OF THE FUSION OF HIV-1 W/ CD4+CELLS

generic name/(trade name):

enfurvirtide/(Fuzeon)

class/subclass: antiretroviral/fusion inhibitor

action:inhibits fusion of HIV-1 w/ CD4+ cells

indications: Treatment of HIV-1in combo w/ other antiretrovirals

SE: anxiety, taste disturbance, insomnia, abd pain, anorexia, constipation, pancreatitis, glomerulnephritis, thrombocytopenia, cough, fatigue, conjunctivitis

NSG: watch inj site for signs of infection, renal studies, bowel pattern, skin eruptions, allergies, blood chemistry.

Antitubercular Agents

Prototype: isoniazid (INH)

BACTERICIDAL

INTERFERES WITH LIPID, NUCLEIC ACID BIOSYNTHESIS

generic name/(trade name): isoniazid/(INH)

class: antitubercular agent

action:bactericidal-interferes with lipid, nucleic acid biosynthesis

indication: treatment/prevention of TB

SE:  toxic endocepholopathy, seizures, dizziness, memory impairment, plurred vision, jaundice, fatal hepatitis, N/V/D.

NSG: liver tests, mental status-often, decreased appetitie, jaundice, dark urine, fatigue, paresthesia in hands and feet

ANTITUBURCULAR AGENTS

prototype: rifampin (Rifadin)

INHIBITS DNA DEPENDENT POLYMERASE

DECREASES TUBERCLE BACILLI REPLICATION

generic name/(trade name): rifampin/(Rifadin)

class: antitubercular agent

action: inhibits DNA dependent polymerase and decrease tubercle bacilli replication

indications: pulmonary TB, meningococcal carriers(prevention)

SE:fatigue, drowsiness, confusion, visual disturbances, N/V/D, psudomembranous colitis, heartburn, acute renal failure, rash, pruritus, urticaria,

NSG: sputum culture, lung sounds, signs of anemia, liver studies, renal status, hepatic status

ANTIFUNGALS

prototype: amphotericin B (Fungizone)

Increases cell membrane permeability in susceptible fungi by binding sterols

Alters cell membrane=leakage of cell components=death

generic name/(trade name):

amphotericin B/(Fungizone)

class: antifungal

action: alter cell membrane causing death

indidcations: histoplasmosis, cryptococcal meningitis

SE:headaches, fever, chills, tinnitus, N/V anorexia, liver failure,

NSG: VS q15-30 min during 1st infusion-note changes in pulse, Bp, I&O ratio, blood studies, weight

Antifungal

Prototype: fluconazole (Diflucan)

INHIBITS ERGOSTEROL BIOSYNTHESIS

CAUSES DIRECT DAMAGE TO FUNGAL MEMBRANE PHOSPHOLIPIDS

generic name/(trade name):

 fluconazole/(Diflucan)

class: antifungal

action: inhibits ergosterol biosynthesis-causing direct damage to fungal membrane phospholipids

indication:oropharyngeal candidiasis, systemic, vaginal, urinary candidiasis,

SE: headache, N/V/D, hepatotoxicity

NSG: obtain baseline for infection

watch blood work for hepatotoxcity

Antifungal

prototype: nystatin(Nystat)

Interferes with fungal DNA replication

generic name/(trade name): nystatin/(Nystat)

class: antifungal

action: interferes with fungal DNA replication

indications: oral infections-swish & swallow, GI infections-

SE: N/V/D anorexia, cramps, rash, urticaria(rare)

NSG: allergic reactions, predisposing factors

Antimalarial

Prototype: chloroquine (Aralen)

INHIBITS PARASITE REPLICATIONS, TRANSCRIPTION OF DNA TO RNA BY FORMING COMPLEXES WITH DNA OF PARASITE.

generic name/ (trade name):

chloroquine/(Aralen)

class: antimalarial

action: inhibits parasite replications, transcription of DNA to RNA by forming complexes with DNA of parasite.

indications: malaria, extraintestinal amebiasis,

SE psychosis, ECG changes, N/V/D, dermatitis

NSG:  eye test, liver tests-weekly, ECG during therapy, allergies, fever, tinnitus