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Action of Antimicrobials on Human Tissue: Before and After Treatment with Antiinfective Medications

This chapter explores the action of antimicrobial drugs on human tissue before and after treatment. It discusses the use of antibiotics such as penicillins, sulfonamides, aminoglycosides, and broad-spectrum antibiotics. It also covers antitubercular drugs and antiparasitic medications. The adverse reactions and nursing implications for each drug category are discussed.

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Action of Antimicrobials on Human Tissue: Before and After Treatment with Antiinfective Medications

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  1. Chapter 12 Antiinfective Medications

  2. Action of Antimicrobials Human tissue Before treatment with antimicrobial drugs Human tissue After treatment with antimicrobial drugs (tissue remains the same, microbes have been destroyed)

  3. Antibiotics • Broad-spectrum • Narrow-spectrum

  4. Penicillins commonly end in “cillin” • Largest most effective and least toxic • Penicillin-resistant strains • Broad-spectrum drug of choice SUPER Germ!

  5. Penicillins (cont.) Action and Uses • Inhibit Cell wall synthesis • Used to treat multiple infections (syphilis, wound infections,prophylaxis for endocarditis) • Overuse and allergies

  6. Penicillins (cont.) Adverse Reactions • Neuropathy • High parenteral doses • Skin eruptions • GI symptoms • Urticaria • Laryngeal edema • Anaphylaxis

  7. Probenecid prolongs blood levels by blocking PCN’s renal clearance Hold it right there Penicillin!! You ain’t goin no where!

  8. Penicillins (cont.) Nursing Implications and PatientTeaching • Assessment • Signs of infection and allergies • Planning • 10-day regimen • cultures should be drawn prior to starting antibiotic therapy • What happens if pcn is not given in effective doses or for the length of time required?

  9. Sulfonamides root has “sulf” in name • Broad-spectrum antiinfective • Bacteriostatic action

  10. Sulfonamides (cont.) Action and Uses • Urinary tract infections • Preoperative and postoperative therapy for bowel surgery • treats PCP, meningococcal meningitis, ulcerative colitis... • What is a superinfection??

  11. Sulfonamides (cont.) Adverse Reactions • Crystaluria • toxemia • fever Teaching • drink adequate fluids (promote urinary output to 1500ml/day) • take on empty stomach

  12. What is the normal BUN and CR levels? CR=0.5-1.5mg/dL BUN level = 5-25mg/dL It only takes 0.5-1.5 hours to CReate 5-25BUNs in the oven 

  13. Amnioglycosidesall end in “mycin” (not all that end in mycin are aminoglycosides.) • Strong antimicrobial Bactericidal drugs reserved for life threatining infections • Gentamycin (garamycin) • Amikacin (Amikin) • Tobramycin (Nebcin)

  14. Aminoglycosides cont.. Side effects • nephrotoxicity and ototoxicity Nursing Considerations • monitor Peak and Trough Levels • prior to therapy what should the nurse do? • Monitor … • Premedicate with anti-emetics, antihistamines and corticosteroids to decrease side effects

  15. Broad-Spectrum Antibiotics • Bactericidal or bacteriostatic

  16. Broad-Spectrum Antibiotics (cont.) Action and Uses • Large number of unrelated drugs used to treat infections caused by susceptible organisms • Gram-positive or gram-negative organisms

  17. Broad-Spectrum Antibiotics (cont.) Adverse Reactions • Superinfections • Drug interactions are individualized • Food interactions • Affected organs: auditory nerves, kidneys, and liver • Cross-sensitivity

  18. Learning Objectives • Identify the major antiinfective drug categories and the organisms against which they are effective • Outline the most important things to teach the patient who is taking antiinfective drugs • List some of the most common adverse reactions to medications used to treat infections

  19. Tuberculosis

  20. Antitubercular Drugs What does MDR refer to? Multiple Drug Resistant Organisms What role does the CDC have in relation to Tuberculosis treatment?

  21. Antitubercular Drugs • Isoniazid (INH,Nydrazid) • Rifampin (Rifadin, Rimactane) • Rifabutin (Mycobutin)

  22. Antitubercular Drugs (cont.) Action and Uses • Most antitubercular drugs are bacteriostatic, (some bacterialcidal) • INH (Isoniazid) only drug recommended for prophylactic therapy. • What is the current duration of prophylactic treatment?

  23. Antitubercular Drugs (cont.) Adverse Reactions • Common symptoms • Toxicity: body sights affected • Combination therapy • Drug-specific symptoms

  24. Why are combination drugs used in the treatment of tuberculosis? • What are the most common side effects of Antitubercular drugs? • What are the typical s/s of active TB?

  25. Which statement by the patient indicates that he has an accurate understanding of the functioning of an antiviral medication? • A."If I take this medication correctly, my viral infection will not reoccur.“ • B."If this medication is not effective, I can take an antibiotic medication instead.“ • C."If I take the medication, my symptoms will lessen and the infection will be cured.“ • D."I should not expect the medication to cure my disease, but symptoms will decrease."

  26. Antiparasitic Drugs • Amebicides • Anthelmintics • Antimalarials

  27. Amebicides Chloroquine (Aralen)Metronidazole (Flagyl, Metrogel) • Caused by the parasite E”ntamoeba histolytica” • Relationship to traveling • Infection sights in the body • GI or extraintestinal

  28. Amebicides (cont.) Action and Uses • Destroy invading ameba • Treatment of intestinal and extraintestinal amebiasis. • Drug choice depends on location

  29. Amebicides (cont.) Adverse Reactions • Common: nausea, vomiting, anorexia, diarrhea, GI distress, hepatic abscess • Drug-specific adverse reactions • Flagyl:ECG changes, ataxia, confusion, blurry vision, nasal congestion, dysuria • Overdose

  30. What are superinfections? Pseudomembranos colitis is caused by which bacteria? How does it manifest? How is it treated? What are the expected therapeutic effects of antibiotics? How long are PCNs usually prescribed for? Random questions...

  31. HIV Infection Acquired immunodeficiency syndrome (AIDS) • Viral disease • High mortality rate High-risk populations include: • Homosexual and bisexual men • Intravenous drug users • People in prison • Female sexual partners of people in high-risk groups • Children born to mothers at risk

  32. Antivirals Action and Uses • Decrease symptoms of viral infection • Lessen the symptoms of viral illness in immunocompromised patients or adults and children at risk Adverse Reactions • Hepatotoxicity, nephrotoxicity, blood dyscrasias, peripheral neuropathies

  33. Antivirals (cont.) Nursing Implications and Patient Teaching • Medications do not cure • Follow specific storage instructions • Reporting adverse reactions • Administration • Encourage immunocompromised clients in areas with impure water supplies to drink bottled water only

  34. Antiretrovirals Action • Interfere with the ability of a retrovirus to reproduce or replicate • Two types: • Reverse transcriptase inhibitors • Act early in viral life cycle • Protease inhibitors • Act later in viral life cycle

  35. Antiretrovirals (cont.) Uses • Slow advance of AIDS • Maintain immunity • Prevention of HIV in infants born to HIV-infected mothers • Prevention of HIV in healthcare workers exposed to HIV Drug Interactions

  36. Antiretrovirals (cont.) Nursing Implications and Patient Teaching • Adherence is essential • Medications do not cure • Report all drugs and supplements used, including OTC and CAM • Signs and symptoms of pancreatitis • Signs and symptoms of peripheral neuropathy

  37. Antiretrovirals (cont.) Nursing Implications and Patient Teaching (cont.) • Routes of disease transmission • Need for social and financial support

  38. Antifungals Action • Fungistatic • Fungicidal Uses • Treat mycotic infections • Fungal-specific medications • Systemic medications

  39. Antifungals (cont.) Common Antifungal Medications: Ketoconazole (Nizoral) • Broad-spectrum fungistatic and fungicidal action • Used to treat oral thrush, candidiasis, histoplasmosis Nystatin (Mycostatin) • Antibiotic with fungistatic and fungicidal action • Used to treat intestinal, vaginal, and oral fungal infections caused by Candida strains

  40. Antifungals (cont.) Common Antifungal Medications (cont.) Amphotericin B (Amphotec) • Systemic drug Griseofulvin • Activity decreased with barbiturates Metronidazole (Flagyl) • Related drug for mixed fungal and bacterial or protozoa infections; interacts with alcohol

  41. Antifungals (cont.) Nursing Implications and Patient Teaching • Take all the medication as ordered; do not stop when symptoms disappear • Avoid alcohol • Report nausea, vomiting, and diarrhea; watch for easy bruising, sore throat, rash, or fever • Nystatin must be shaken thoroughly before use • Intolerance to the sun (photosensitivity) can occur with griseofulvin therapy • Cleanliness of hair, skin and nails will limit spread

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