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Drugs: Magnesium Sulphate; Gentamicin; Amoxicillin & Cefuroxime

Drugs: Magnesium Sulphate; Gentamicin; Amoxicillin & Cefuroxime. - Oriana, Lyndsay & Nicky. GENTAMICIN. Antibiotic – what are antibiotics? Molecules produced naturally by other organisms to combat the threat to themselves.

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Drugs: Magnesium Sulphate; Gentamicin; Amoxicillin & Cefuroxime

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  1. Drugs: Magnesium Sulphate; Gentamicin;Amoxicillin & Cefuroxime - Oriana, Lyndsay & Nicky

  2. GENTAMICIN • Antibiotic – what are antibiotics? Molecules produced naturally by other organisms to combat the threat to themselves. Mode of action is to inhibit some essential function of bacterial cell’s life cycle

  3. GENTAMICIN • Aminoglycoside – what are aminoglycosides? Bactericidal, active against some Gram-positive and many Gram-negative organisms Mode of action is to prevent part of cell that makes proteins (ribosome) from working Known as protein synthesis inhibitors Not absorbed from the gut, therefore given by injection Excretion mainly from kidneys but filtered unchanged, therefore accumulation occurs in renal impairment

  4. GENTAMICIN • Aminoglycoside of choice in UK • Used for treatment of serious infections including: - septicaemia, neonatal sepsis, meningitis, biliary-tract inefections, endocarditis, pneumonia in hospital patients • Can be used in form of drops for eye and ear infections

  5. GENTAMICIN • When given by injection it can have serious adverse effects on the ears and kidneys. • Courses limited to 7 days • In order to minimise toxicity: - dose adjusted for weight (3-5mg/kg) - dose no more frequent than once daily - peak and trough levels to be measured

  6. GENTAMICIN • Side effects Vestibular damage Auditory damage Nephrotoxicity Aggravation of myasthenia by blocking neuromuscular transmission • Contra-indications Myasthenia gravia

  7. GENTAMICIN • Monitoring Blood sample should be taken approximately 1 hour after intramuscular or iv administration (peak serum concentration), and just before next dose (trough serum concentration)

  8. GENTAMICIN • Simon Hope Administered for treatment of septic shock When used for ‘blind’ therapy of undiagnosed serious infections, it is usually given in conjunction with penicillin or metronidazole, or both. Could this be the reason why Simon was given Amoxycillin?

  9. AMOXICILLIN / PENICILLIN • Class: Penicillin :- Amoxicillin, Ampicillin, Benzylpenicillin, Co-amoxiclav, Flucloxacillin, Phenoxymethylpenicillin. • Brand names: Amoxil • Combined preparations: Amiclav, Augmentin, Co-amoxiclav

  10. Cell Lysis Gould D (2004) Bacterial infections: antibiotics and decontamination. Nursing Standard, 18 (40),p. 38-42.

  11. REMEMBER:

  12. Allergic Reaction • Stop immediately if: - rash, wheezing, itching or oral swelling. • Avoid all drugs from the same class - ie: penicillin's. • Basic penicillin structure. • Encephalopathy (brain dysfunction) - serious toxic effect of penicillin due to cerebral irritation: as a result from high doses, or renal failure.

  13. Anaphylaxis: 1:2,300 • systemic immediate hypersensitivity reaction • rash – collapse • Signs – Hypotention - Confusion • 6 recommendations for practice in case of a anaphylactic shock. • Treatment • documentation & Yellow Card system • reducing the risk of anaphylaxis. (Henderson N (1998) Anaphylaxis. Nursing Standard. 12, 47, 49-55)

  14. Speedshock: • associated hazard with peripheral IV therapy • a systemic reaction which occurs due to a rapid administration of a substance that is foreign to the body • commonly with rapid bolus injection • The Preparation and Administration of Parenteral Medicines policy (LUHD 2003b) - ensures safe and consistent practice.

  15. Alternative to penicillin: Erythromycin (class: Macrolides): • broad spectrum • alternative to Penicillin / Cephalosporin • main risk: impaired liver function

  16. SIMON HOPE: Hospital-acquired pneumonia: • broad spectrum Cephalosporin (Cefotaxime / Ceftazidime) • penicillin • another beta-lactam: NOT IN PEN ALLERGY Community-acquired: Septicaemia: (initial ‘blind’ therapy) • Aminoglycoside (Gentamicin) + broad spectrum penicillin (Penicillin) • Broad spectrum Cephalosporin alone (Cefotaxime) Hospital-acquired: Septicaemia: (initial ‘blind’ therapy) • Aminoglycoside (Gentamicin, Streptomycin) + broad spectrum antipseudomonial beta-lactam (Cefazidime) • Meropenem (Beta Lactam:ultra-broad spectrum injectable used for meningisits / pneumonia) aloneNOT IN PEN ALLERGY • Imipenem (IV Beta Lactam: broad spectrum ) alone NOT IN PEN ALLERGY

  17. Magnesium Sulphate • Magnesium (Mg2+) is predominantly an intracellular cation (+ charged ion) • Has an important role in enzyme activity, contributing to the metabolism of CHO and proteins • Also important in neuromuscular activity, impulse transmission and myocardial functioning

  18. Magnesium Sulphate • Has an effect on smooth muscle cells: - Hypomagnesemia – causes contraction - Hypermagnesemia – causes relaxation • Used IV as a bronchodilator in acute severe asthma attacks

  19. Magnesium Sulphate • Reduces the proliferation of neutrophils associated with the inflammatory response in asthma • A magnesium imbalance is common in critically ill patients – electrolyte imbalance? • Available on the resuscitation trolley Magnesium Sulphate 50% solution 2g (4ml) • Contraindicated in renal failure because it is excreted by the kidneys

  20. Cefuroxime • Categorised as a Cephalosporin – semisynthetic derivative of the mould cephalosporium C • Bactericidal • Broad-spectrum and similar to Penicillin but have greater activity against Gram –ve bacteria and a longer half-life

  21. Cefuroxime • Adverse reactions: GI disturbances, haematological abnormalities and a rise in serum hepatic enzyme levels • Hypersensitivity to ß-lactam structure also found in penicillin • By intravenous injection or infusion, 750 mg every 6–8 hours; 1.5 g every 6–8 hours in severe infections; single doses over 750 mg intravenous route only (BNF)

  22. References: • British Medical Association (2004) New guide to Medicines and Drugs. Dorling Kindersley: London • British Medical Association and Royal Pharmaceutical Society of Great Britain (2004) British National Formulary. London: British Medical Association and Royal Pharmaceutical Society of Great Britain. • British National Formulary. Available from: http://www.bnf.org

  23. Galbraith A, Bullock S, Manias E, Hunt B, Richards A (1999) Fundamentals of pharmacology. Pearson Prentice Hall • Hand H, Banks A (2004) The contents of the resuscitation trolley. Nursing Standard 18:44 p43-52 • Hand H (2001) The use of intravenous therapy. Nursing Standard 15:43 p47-52 • Henry, J. eds (2004) The British Association:The New Guide to Medicines and Drugs. London: Dorking Kindersley. • Henderson N (1998) Anaphylaxis. Nursing Standard. 12, 47, 49-55.

  24. Ingram P, Lavery I (2005) Peripheral intravenous therapy: key risks and implications for practice. Nursing Standard. 19, 46, 55-64. • Rowe B, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA (2000) Intravenous Magnesium Sulfate treatment for acute asthma in the emergency department: a systematic review of the literature. Annals of Emergency Medicine. 36:3 p181-190 • Tortora G, Grabowski SR (1996) Principles of Anatomy and Physiology. 8th ed. Harper Collins

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