Post on 26-Dec-2015
Overview
• antibiotics: chemicals produced by living microorganisms or by laboratory synthesis
• bateriostatic: inhibit bacterial growth
• bactericidal: kill bacteria
• pathogen: disease-producing drugs or microorganisms
Immune System Refresher
• composed of
– thymus gland
– lymphatic tissue
– circulating cells
– chemical mediators
– stem cells: primitive bone marrow cells
– leukocytes: WBCs
Immune System Refresher
– lymphocytes: immune system component capable of developing into variety of other cells including—mast, basophils, macrophages, T cells
– phagocytosis: engulf and digest foreign matter
Immune System Refresher
– 4 abnormal conditions can weaken the immune system and stimulate the immune response• neoplasms• viral invasion• autoimmune disease• transplant rejection
Bacteria Physiology/Pathophysiology
• multiple routes of entry
• gram-positive bacteria
– accept positive stain often associated with respiratory and soft tissue infection
– has an easily penetrated cytoplasmic membrane
Bacteria Physiology/Pathophysiology
• gram negative bacteria– accept negative stain and often associated
with infections of GI and GU, has an additional and more complex outer membrane
• aerobic vs. anaerobic bacteria (gangrene)• culture & sensitivity – for definitive
identification of bacteria
Bacteria Physiology/Pathophysiology
• broad spectrum antibiotic – interferes with a biochemical reaction common to many organisms
• antibiotics often given in combination due to synergistic effect
• prophylaxis: prevention of potential infection
Bacteria Physiology/Pathophysiology
• resistance: bacteria adapt – control achieved by careful prescriptive practices and finishing full course of treatment
• superinfection: overgrowth of resistant bacteria, fungi, yeasts, etc.
Nursing Assessment-all antibiotics
• Before the administration of any antibiotic, it is important to ensuring the effectiveness and appropriateness of treatment to collect data regarding: – age;– a list of medications; – hypersensitivity to drugs; – hepatic, renal, and cardiac function;
Nursing Assessment – all antibiotics
– Hepatic, renal, and cardiac function; – Culture and sensitivity results; – Vital signs and bowel sounds; – Bleeding assessment (ecchymosis, bleeding
gums); – CBC, Hgb., and Hct. values.
Penicillin G – prototype of natural penicillins
• first antibiotic introduced in 1929
• IM, IV via continuous infusion
• bactericidal
Penicillin G – prototype of natural penicillins
• pharmacotherapeutics: strep infection, GC, meningococcal (high dose)
• pharmacokinetics: rapid absorption and elimination, limited penetration of blood-brain barrier
• has significant drug interactions with tetracyclines and other antibiotics when used concurrently
• other PO drugs in this group include: penicillin V, ampicillin, amoxicillin, cloxacillin
Nursing Issues – Penicillin G
• assess for any prior reactions to antibiotics
• evaluate kidney function (BUN, creatinine)
• may counteract the effect of oral contraceptives
• take po drugs on employ stomach
• take exactly as directed around the clock
Nursing Issues – Penicillin G
• take missed dose ASAP but not at the same time as next dose
• alert patient to symptoms of allergic reaction
• most common adverse effects are GI
Cephalosporins cefazolin (Kefzol)
• introduced in 1960s (3 generations)
• pharmacotherapeutics: multiple forms of infection
• IM or IV
• does not cross blood brain barrier
• interferes with cell wall synthesis
Cephalosporins cefazolin (Kefzol)
• may be bacteriostatic or bactericidal
• most common adverse effects are GI
• drug interactions with: aminoglycosides (gentamicin)
• oral anticoagulants ______________
Cephalosporins cefazolin (Kefzol)
• may cause disulfiram-like reaction (flushing, SOB, N/V, dizzy, chest pains, confusion, seizures …) when used with ethyl alcohol which may continue for 72 hours after drug is discontinued
• use with caution in anyone with impaired renal function
Fluoroquinolones – prototype – ciprofloxacin (______)
• active against both gram negative and gram positive organisms
• has prolonged postantibiotic effect• generally well tolerated however a significant
adverse reaction is arthropathy and tendon ruptures have been reported
• additional side effects include: GI and CV• oral forms as effective as IV therapy of other
antibiotics
Fluoroquinolones – prototype – ciprofloxacin (______)
• PO, IV or topical opthalmic preparation
• IV requires infusion in large vein
• take on empty stomach
• possible photosensitivity may occur
• educate pt about superinfections
Aminoglycosides – prototype - gentamicin
• useful for UTIs, gyn infections, soft tissue, etc.
• IM or IV dosing, occasionally PO for specific local effect
• may be bacteriostatic or bactericidal
• may trigger severe adverse reactions
Aminoglycosides – prototype - gentamicin
• has many serious side effects including: nephrotoxicity, ototoxicity and neuromuscular blockade consistent (often daily) monitoring required
• monitored via peak and trough levels 30 min post dose and 30 min prior to next dose
• may cause CNS and GI symptoms• multiple drug-drug interactions reported
Macrolide Antibiotics – prototype erythromycin (E-Mycin)
• same family as Z-pak (Zithromax)
• useful for those allergic to the penicillins
• good oral absorption but requires empty stomach
Macrolide Antibiotics – prototype erythromycin (E-Mycin)
• IV form is extremely irritating to veins infuse over 30-60 minutes
• GI history extremely important due to risk of antibiotic associated colitis related to clostridium overgrowth
• has significant ototoxic effects• multiple drug-drug interactions including:
benzodiazepines, carbamazepine, digoxin, oral anticoagulants…
Lincosamides – prototype clindamycin (Cleocin)
• very powerful drug effective over wide range of both aerobic and anerobic bacteria
• bactericidal in action• used for serious to life-threatening
infections caused by anaerobes, streptococci, staphylococci, etc.
• serious adverse effects: colitis• may potentiate anesthetic effects