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NURS 1950 Antibiotics and other Agents

NURS 1950 Antibiotics and other Agents. Metropolitan Community College Nursing Program Nancy Pares, RN, MSN. In the beginning……. Before Antibiotics Infections treated topically with ‘poultice’ or surgically removed 1936…Sulfonamide discovered Beginning of understanding of microbes

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NURS 1950 Antibiotics and other Agents

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  1. NURS 1950Antibiotics and other Agents Metropolitan Community College Nursing Program Nancy Pares, RN, MSN

  2. In the beginning……. • Before Antibiotics • Infections treated topically with ‘poultice’ or surgically removed • 1936…Sulfonamide discovered • Beginning of understanding of microbes • 1941…Penicillin introduced • WWII had great results with high volume data • Present …. • Man vs. microbe= resistant pathogens

  3. Peak effect • 15-30 min after infusion has begun • Trough effect • Lowest point of medication effect • Draw blood just before the next scheduled dose

  4. Chain of infection….recall

  5. Objective 1: Identify the body’s natural defenses against infections • Barriers/prevention • Intact skin, adequate nutrition, respiratory cilia, immune system • Seek and Destroy • WBC, adequate blood supply, intestinal flora, vaginal flora, stomach acids

  6. Objective 2: Describe factors that increase the susceptibility of the body to infection Virulence of the pathogen Number of pathogens Chronic illness Poor nutrition Diseases/drugs that decrease the immune system Entry point Super infections

  7. Host Factors • Status of immune system • May need prophylactic therapy • Location of the infection • Many drugs do not cross blood brain barrier • Extent of inflammation • Decrease circulation of drug • Age: metabolization of drug • Pregnancy: risks to fetus vs. benefit of drug • Genetics: enzyme deficiencies do not allow antibiotics to clear system

  8. Obj. 3: Name the lab tests done to identify the invading pathogen • Should be done before antibiotic initiated • Microscopic examination • Urine, stool, blood, spinal fluid, sputum, purulent drainage • Identify the organism and test with antibiotics • Culture and sensitivity testing • Preliminary results within 24 hours • Final results in 2-3 days

  9. Obj. 4: Identify factors utilized to select an appropriate antibiotic Covered in objective 2

  10. Obj. 5 Explain what resistance means and the various types of resistance • Passive immunity • A person has been given vaccine • Active immunity • Has had the disease • Acquired resistance • Bacteria have randomly mutated and can transmit mutated bacteria to others • Healthcare practitioners role • Use antibiotics when indicated • Prophylaxis: deep tissue injury, prosthetic heart valves

  11. NOTE • Antibiotics do not create mutations

  12. Obj. 6: Define narrow spectrum and broad spectrum • Narrow • Effective on limited number of organisms • Broad • Effective on many organisms; often used first • Bacteriocidal • Kills • Bacteriostatic • Prevents growth and reproduction

  13. Obj. 7: Describe adverse reactions to antibiotics • Hypersensitivity • Can result in anaphylactic shock/death • 15% of penicillin users • Treat with Benedryl, corticosteroids, epinephrine • Cross sensitivity • When antibiotics are closely related chemically • Organ toxicity • Liver, kidneys, CNS, GI is most common • Vancomycin highly nephrotoxic • Gentamycin highly ototoxic

  14. Adverse reactions con’t • Hematotoxicity • Chloramphenicol • Causes aplastic anemia • Bone marrow cannot make red blood cells

  15. Obj. 8 Discuss the penicillins and identify specific penicillin preparations • Action/use • Kill bacteria by disrupting cell wall; chemical make up responsible is beta lactam ring— • some bacteria secrete enzyme that splits the beta lactam ring allowing the bacteria to become resistant • Chemical modifications • Penicilinase resistant, broad spectrum, extended spectrum • Treatment of pneumonia, skin, bone and joint infections, blood infections, gangrene, meningitis

  16. Penicillins cont • Routes • PO, IM, IV • Adverse effects • Hypersensitivity most common • Nursing considerations • VS, assess previous reactions, lab (electrolytes, renal function, ECG, Observe for IV reaction within 30 min; client teaching; decrease effects of contraceptives; take on empty stomach • Pen G Procaine—not given IV= lethal • Prototype: Pen G Potassium

  17. Obj.9 Discuss various cephalosporin preparations • Action/Use • Bacteriocidal by attaching to penicillin binding proteins to inhibit cell wall synthesis • Gram negative infections and when less expensive penicillins are not tolerated; 5-10% of people allergic to penicillin are also allergic to cephalosporins • Adverse reactions • Hypersensitivity; kidney toxicity • Prototype—Cefotaxime (Claforan)

  18. Cephalosporin classifications • First generation • Most effective against gram neg; beta lactamase producing organisms usually resistant • Second generation • More potent, broader spectrum, moderately resistant to beta lactamase organisms • Third generation • Longer duration of action, resistant to b-lactamase • Drugs of choice for pseudomonas, klebsiella, neisseria, salmonella and H. influenza • Fourth generation-treat CNS infections • Use: gram + cocci; gram - bacilli

  19. Cephalosporins • Nursing considerations • Assess for bleeding disorders-check PT levels • Interferes with Vit K metabolism • Assess kidney and liver function labs • Important in Vit K production • Assess concurrent meds: (NSAIDS) • Monitor I&O • Assess GI symptoms • Client teaching • Cultured dairy (superinfection prevention); avoid alcohol use, complete full RX; IM inj. painful

  20. Obj. 10 Discuss tetracycline , including nursing implications • Action/Use • Bacteriostatic; inhibits protein synthesis to slow microbial growth • Rocky Mtn Spotted fever, typhus, cholera, Lyme disease, peptic ulcers (caused by H. pylori), chlamydial infections • S/E • n/v, diarrhea, photosensitivity, permanent discoloration of teeth <8 yo

  21. Tetracycline con’t • Nursing considerations • Avoid use <8 yo, avoid sunlight/UV exposure; monitor labs (CBC, liver function, kidney function) • Teach importance of oral and perineal hygiene due to super infections • Do not take with milk products, iron supplements, or antacids; wait 1-3 hrs before taking antacids; wait 2 hrs before and after taking lipid lowering drugs (Ca+ and iron bind with tetracycline) • Decreases effectiveness of oral contraception • Prototype: tetracycline

  22. Obj. 11 Describe the uses, s/e, nursing implications of the various aminoglycosides • Action/use • Bacteriocidal; inhibits protein synthesis • Aerobic gram neg bacteria (e. coli, seratia, proteus, klebsiella, pseudomanas); administered with other antibiotic for entercocci infections. • S/E • Irreversible ototoxicity, nephrotoxicity, respiratory paralysis • Prototype: Gentamycin (Garamycin)

  23. Aminoglycosides cont • Nursing considerations • Monitor for ototoxicity (How?) • Monitor for nephrotoxicity (How?) • Provide optimal oral hygiene • IV administration should be done slowly • Poorly absorbed via GI—only route is IV • Monitor peak and trough levels for toxicity

  24. Obj. 12 Discuss uses of quinolones and macrolides • Quinolones/fluoroquinolones • First introduced in 1962 • Currently four generations • Macrolides • Low doses-bacteriostatic • High doses-bacteriocidal • Prototype: e mycin

  25. Quinolones • Action/Use • Bacteriocidal;inhibit enzymes (DNA gyrase and topoisomerase) to affect DNA synthesis;gram neg microbes • Respiratory, GI, GU tracts; skin and soft tissue; newer agents very effective against anerobes • S/E/route • n/v; ADVERSE: dysrhythmias,liver failure and CNS changes; not used in pregnancy; caution in children; oral BID • Prototype:Ciprofloxicin (Cipro) • Most common= levaquin

  26. Quinolones • Nursing considerations: • Assess hypersensititivity; report neurologic effects • Phototoxicitity • Don’t take with vitamins/mineral supplements (or wait 2 hrs before and after • Monitor labs • I & O • Take all the prescription

  27. Macrolides • Action/Use • Binds to bacterial ribosome to inhibit synthesis (act inside cell); bacteriostatic; effective against gram + and -;treats whooping cough, • Legionaire’s disease, H. influenza and Mycoplasma pneumoniae • Newer drugs synthesized from erythromycin—less GI disturbance • S/E—very few • Prototype: erythromycin (E-Mycin)

  28. Macrolides • Nursing considerations • Do not use in pregnancy • Assess history of hypersensititivity • Monitor labs (liver and kidney, INR) • Macrolides decrease warfarin metablism and excretion • Photosensitivity • Complete the course of treatment

  29. # 13 Describe Misc. drugs • Clindamycin (Cleocin) • Grm + and – effectiveness • Use: oral infections • Contraindication: hypersensitivity • Limited use due to association w pseudomenbranous colitis

  30. Misc. agents cont • Sulfonamides • Action:bacteriostatic, broad spectrum, used for UTI • Classified by route of administration • Systemic and topical • Systemic • Sulfisoxazole (Gantrisin) • topical • Sulfadoxine (Fansidar)- not 1st choice drug • Contraindicated in pregnancy and infants < 2 years (promotes jaundice);low soluability causes crystals in urine

  31. Misc. agents • Vancomycin ( Vancocin) • Reserved for severe infections; most effective with MSRA; need peak and trough labs • Sensititivity reaction: hypotension and rash with rapid IV infusion (Red Man Syndrome) • Imipenim (primaxin)—carbapenem category • Bacteriocidal; preparation specific for IV vs IM • Stable for 4 hrs; synergistic effects with aminoglycosides • Use; septicemia/bacterial meningitis

  32. Misc agents • Ketolides • Use: respiratory infections • Low incidence of adverse effects • Glycylcyclines • Use: complicated skin infections; MSRA

  33. 14: patient education for anbx • Nursing Dx • Pain related to infection • Infection • Hyperthermia • Risk for injury related to adverse drug effects • Deficient knowledge related to drug therapy • Risk for deficient fluid volume r/t fever, diarrhea from adverse drug effect • Risk for non compliance r/t deficient knowledge, cost of drug, drug effects

  34. Planning • Client will • Report diminished signs and symptoms of infection; decreased fever and fatigue; increased appetite • Be free from or experience minimal adverse effects • Verbalize understanding of the drugs use, adverse effects and required precautions • Demonstrate proper self administration

  35. Implementation • Monitor vs and symptoms of infections • Monitor hypersensitivity reaction • Monitor for severe diarrhea • Admin drug as ordered • Monitor for superinfection • Precaution regarding OTC • Monitor for photosensitivity • Determine food and drug interactions • Monitor IV site

  36. Evaluation • Patient • reports diminished signs and symptoms of infection, decreased fever • Is free from or experiences minimal adverse effects • Verbalizes and understanding of the drugs use, effects and precautions • Demonstrates proper self admin.

  37. 15: Antitubucular drugs • Tuberculosis: • Cause: • Mycobacterium tuberculosis • Incidence: • Treatment: prolonged due to cell wall resistance to penetration by anti infective drugs • Multiple drug concurrently • Rifampin: used for H influenza

  38. Tuberculosis cont • Isoniazid (INH) • Action: • Inhibits synthesis of cell wall • Use: • tuberculosis • S/E • Numbness of hands, feet; rash; fever • Contraindicated: hepatic disease; do not take with antacids

  39. 16: antifungal agents • General Action: • Inhibit ergosteral synthesis • Amphoericin B (Fungizone) • Systemic • New class: echinocandins • Used for systemic mycoses • Caspofungin: treats aspergilosis

  40. Antifungals • Azoles • Fluconazole (Diflucan) • Action/use • Penetrates most body membranes; interferes with synthesis of ergosterol • Nystatin (Mycostatin) • Superficial antifungal • Swish and swallow • Glycemic control changes occur • Do not use intravaginally with pregnancy or lactating moms

  41. 17: Antivirals • Nonnucleoside reverse transcriptase inhibitors (NRTI) • Action: binds to viral transcript and dis allows the DNA action • Prototype: efavirenz (Sustiva) • Nucleoside and nucleotide reverse transcriptase inhibitors (NNRTI) • Action: creates a defective DNA by replacing one of the nucleotides • Prototype: Zidovudine (AZT)

  42. Antivirals cont • Protease inhibitors • Lopinavir (Kalentra) • Combination drug of lopinavir and ritonavir • Action: inhibits hepatic breakdown of lopinavir • Fusion inhibitor: • Action: blocks fusion of HIV viron to DC4 receptor

  43. 18: Nursing process for antivirals • Assessment

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