Introduction to Antibiotics, Antibiotics, & More Antimicrobials

What is an antimicrobial?

What is an antibiotic?

What is selective toxicity?

Ways antibiotics achieve selective toxicity

Drug used to treat infections caused by microorganisms

Antimicrobial targeting bacteria

Destroying microbes without harming host cells

• Dis srupt bacterial cell wall (water comes in)

• Inhibit bacterial enzymes (stop it from growing)

• Disrupt bacterial protein synthesis (slows the growth)

• Inhibit DNA/RNA synthesis (stop replication)

Antimicrobial Classification

1. What is broad-spectrum?

• Main risk of broad-spectrum?

1. What is narrow spectrum?

2. What is bactericidal

3. What is bacteriostatic?

1. Treat various bacteria

• Resistance and superinfection

1. Treat a certain amount of bacteria

2. kill bacteria

3. slow growth of bacteria and let body do the rest (immune system)

1. What is microbial resistance?

2. What promotes antibiotic resistance?

3. Why do antibiotics increase resistance?

4. Which antibiotics promote resistance the most and why?

5. What are Nosocomial infections or HAIs

6. What is a superinfection?

• caused by?

1. Bacteria developing resistance to antibiotics

2. Overuse and misuse of antibiotics

3. They alter normal homeostasis and could overgrow bacteria

4. Broad spectrum becaus they are used more often for more bacterias

5. Healthcare associated infection (happen during caring)

6. New infection developing during treatment (meds) of a primary infection

• Drug-resistant bacteria making them hard to treat (C.diff and candasis)

What should be collected before antibiotics when possible?

Culture and sensitivy

Thought on how to treat infection

1. Emperic Therapy:

2. Prophylactic Therapy:

1. Antibiotics started before cultures return then we can change it

2. Antibiotics used to prevent infection (they have risk for infection so AB first; recurring UTI or Neutropenia)

Combining Antibiotics

1. What is Additive?

2. What is Potentiating?

3. What is Antagonistic?

4. Why are antibiotic combinations used?

1. When combining two antibiotics is the same as using the two drugs alone

2. When combining the two antibiotics enhances the effect of each

3. When the drugs work against each other and reduce their effects

4. Severe infections, mixed infections, prevent resistance, decrease toxicity, enhanced action

1. Most important antibiotic teaching

2. What indicates antibiotics are working?

3. Signs antibiotics are working

1. finsih ALL medication

2. Decreased fever and symptom improvement

3. Improved lab/cultures. drug levels

Pencillins and Cephalosporins

1. Chemical structure?

2. MOA:

3. Major nursing considerations?

1. Beta-lactams

2. Bactericidal—> weaken cell wall and kill it

3. assess for allergies, moniotr C.diff, GI effects, renal function

Penicillins (PCNs)

1. Pre-fix:

2. Prototype?

3. MOA?

4. Penicillins work best against?

5. Main problem with penicillins?

6. Major Adverse effect?

7. Are penicillins broad or narrow spectrum?

8. What is beta-lactamase?

9. How do bacteria resist penicillins?

10. What medication protects amoxicillin from beta-lactamase?

11. Range of allergic reactions with penicillins

12. Cross-sensitivity means?

13. Important pt teaching?

14. Important to monitor what function?

15. Monitor for what infection with penicillins?

16. Common side effects of penicillins

1. -cillins

2. amoxicillin (Amoxil)

3. Bactericidal —> weakends bacterial cell wall killing it

4. Gram positive bacteria

5. Resistance to AB

6. Allergy (Most common type)

7. Depends on the type

8. break the beta-lactam ring of the abx, making it ineffective

9. Beta-lactamase production or altered receptors

10. Augmentin; the PCN combines with secondary chemical to prevent ring from breaking down (extended spectrum

11. Rash → anaphylaxis

12. Allergy to PCN may increase risk for cephalosporins

13. Evenly space doses and finish

14. Renal

15. C. diff

16. Nausea & diarrhea

MRSA

1. What does it stand for?

2. What does it do?

3. What is it resistant to?

1. Methicillin-resistant Staphylococcus aureus

2. A gram positive colonizer of skin and nostrils

3. PCNs and cephalosporins

Cephalosporins

1. Prefix:

2. Prototype:

3. MOA?

4. Narrow or Broad Spectrum?

5. What improves with newer cephalosporin generations?

6. Main concern with cephalosporins?

7. What GI complication is important with cephalosporins?

8. Major superinfection concern with cephalosporins

1. cef- or ceph-

2. cephalexin (Keflex)

3. Bactericidal - weken cell wall and kill

4. Broad

5. Better gram-negative coverage and CSF penetration and resistance to beta lactamase

6. Cross-sensitivity with penicillin allergies

7. c. diff

8. candasis and c.diff

Superinfections

1. Candidiasis:

2. C. DIFF

• Transmission?

• Signs?

• How many watery stools suggest C. difficile?

1. an overgrowth of fungus (oral & vaginal) THURSH

2. a gram positive spore forming bacteria in the COLOn

• fecal → oral

• 3+ watery stools/day, abdominal pain, fever, perforation

• 3+ watery diarrhea stools in 24 hours

Carbapenems

1. Protype:

2. Drug example?

3. MOA?

4. Spectrum?

5. Chemical Structure?

6. Administration route?

7. How is it excreted?

8. Main teaching point for carbapenems

9. What should nurses monitor with carbapenems?

10. MAJOR adverse effect

11. Mnemonic for carbapenems

1. imipenem (Primaxin)

2. Meropenem (Merrem-IV)

3. Bactericidal —> weaken cell wall and killd

4. BROAD; gram pos and gram neg and anaerobic bacteria

5. beta lactams but resist beta lactamase because of structure

6. IV or IM (dont absorb through GI tract)

7. Renally

8. Reserved for serious infections and stewardship importance

9. IV site complications, GI upset, renal function, cross-sensitivity with PCNS and cephalosporins

10. seizures

11. super PEN icclin

Vancomycins

1. Used to treat?

2. MOA?

3. Adminstration route?

4. How is it excreted?

5. Does vancomycin contain beta-lactam ring?

6. Therapeuatic range?

7. Why are peak and trough levels monitored with vancomycin?

8. Main adverse effects?

9. What labs should be monitored with vancomycin?

10. why do we infuse slowly?

11. Mnemonic for vancomycin

1. MRSA and C.diff

2. Bactericidal —> weakens cell wall

3. PO or IV

4. renally

5. NO

6. Narrow

7. Prevent toxicity while maintaining effectiveness

8. Renal failure, ototoxicity, Red Man Syndrome (IV), Thrombophlebitis (IV)

9. Renal labs (SrCr)

10. to prevent red man syndrome

11. "VAN crash damaged kidneys and ears"

What is Red Man Syndrome?

Histamine reaction causing flushing from rapid IV infusion

Tetracyclines

1. Prefix:

2. Prototype:

3. MOA?

4. spectrum?

5. Who sister is this?

6. Main adverse effects?

7. Why avoid dairy?

8. What should we avoid during this drug?

9. Mnemonic for tetracyclines

1. -cline

2. tetracycline, doxycycline (vibramycin)

3. Bacteriostatic → inhibit protein synthesis

4. BROAD

5. alternative to PCN

6. Photosensitivty, Binds to calcium (tooth), risk for superinfections, GI upset, hepatic/renal

7. Calcium decreases absorption

8. Pregnancy (tooth/bone damage) and Sun

9. "TETRA stains TEETH at the BEACH"

Macrolides

1. prefix:

2. Prototype:

3. MOA?

4. spectrum?

5. who sister is this?

6. Major adverse effects?

7. Important nursing assessment for macrolides

8. Mnemonic for macrolides

1. -mycin

2. erythromycin

3. Bacteriostatic→ inhibit protein synthesis

4. BROAD

5. alternate if allergic to PCN

6. Gi upset, risk for superinfection, QT prolongation, CYP Inhibitor

7. Assess cardiac history, ototoxicity

8. "THROW MY RHYTHM off"

Aminoglycosides

1. Prototype

2. Prefix?

3. Spectrum?

4. Therapeatic range

5. what bacteria does it go against?

6. Are aminoglycosides absorbed orally?

7. Major adverse effcts?

8. Beneficial interaction with?

9. What is the post-antibiotic effect?

10. What labs are monitored with aminoglycosides?

1. gentamicin

2. -mycin

3. Narrow

4. Narrow

5. gram-neg

6. NO

7. Nephrotoxicty, Ototoxicity (iirreservable), and their drugs

8. abx that weaken cell wall (PCNS, cephalosporins, vancomycin)

9. Continued bacterial suppression after drug removal

10. BUN, creatinine, GFR (watch for proteinuria)

Fluoroquinolones

1. Suffix?

2. Prototype?

3. MOA?

4. Spectrum?

5. Treatment for what kinds of infections?

6. Major Adverse effects?

7. Important teaching considerations?

8. What symptoms should pts report immediately?

9. Nursing considerations/monitors?

10. Mnemonic for fluoroquinolones

1. -floxacins

2. ciprofloxacin (cipro)

3. Bactericidal —> prevents DNA replication and kill it

4. BROAD

5. treats most bacteria that causes UTIs and GI infections

6. CNS symptoms, Tendonitits/Achilles rupture (pain), CYP enxyme inhibtor, Photosensitivity, Risk of Superinfections, GI effects

7. Photosentivity precautions, avoid hard excersise, take with food, interventions for dry mouth

8. Tendon pain or popping

9. Report CNS, watch for superinfections, monitor drug levels for other NTI drugs

10. "FLOX your tendons"

Sulfonamides

1. Prototype?

2. What kinds of infections doe sit usually treat?

3. Spectrum?

4. MOA?

5. Major adverse effects?

6. Main teaching points?

7. Main monitoring considerations?

8. Mnemonic for sulfonamides

9. why increase fluids?

1. sulfamethoxazole/trimethoprim (bactrim and septra)

2. UTIs and Topical infections (eyes, burns)

3. BROAD but reistance is common

4. Bacteriostatic- inhibit/slow down folic acid synthesis

5. Hypersensitivity reactions (stevens-johnson syndrome), CYP enzyme inhibtor, renal damage, teratogenic, Allergy to sulfa'

6. Photosensitivity precauations and no alcohol, educate to push oral fluids

7. Drug levels with other NTI drugs and hypersensitivity reactions

8. "SULFA makes skin SUFFER"

9. Drug can crystallize in urine

Nitrofurantoin

1. Prototype?

2. Suffixx?

3. MOA?

4. Antimicrobial classffication?

5. spectrum?

6. Uses?

7. Where are therapeutic levels achieved

8. Main adverse effects

9. Teaching

10. What harmless effect can occur

11. Nursing monitoring considerations?

12. Mnemonic for nitrofurantoin

1. Macrobid, Macrodantin

2. Macro-

3. Interferes with RNA and DNA producing enzymes

4. Both

5. BROAD

6. UTI

7. In URINE

8. hepatotoxicity, pulmonary reactions, peripheral neuropathy

9. Take with food, avoid in last trimester (hemolytic anemia), urine may turn brown

10. BRown urine

11. Liver enzymes and bilirubin, pulmonary symptoms, and impaired kidney function

12. MACRO-BROWN pee

TB BASICS

1. Trasmission

2. Latent vs active

3. Treatment for Latent TB

4. Treatment for active TB “first line drugs”

1. Airborne: coughing, signing, sneezing

2. Latent (no symp, positive) Active (symp, infectious)

3. daily isoniazid for 6-9 months

4. isoniazid, rifampin, ethambutol, pyrazinamide (months to years)

Isoniazid (NIH)

1. Uses

2. MOA?

3. Adverse effects?

4. Mnemonic for INH

1. Latent and Active TB

2. Bactericidal —> inhibit cell wall and kill (Tb can develop resistance to this

3. Peripheral neuropathy, hepatotoxicity

4. I so NEED Hands and feet feeling

Rifampin

1. Uses:

2. MOA?

3. Adverse effects?

4. Mnemonic for INH

1. Active Tb and leprosy

2. Bactericidal —> disrupts RNA synthesis and kill

3. Harmless red-orange color of body fluids, CYP enzyme inducer, hepatotoxicity

4. RIF turn red

Purine Analog Antivirals

1. Classification?

2. Suffix?

3. prototype?

4. MOA?

5. Effective against?

6. Adminstration route?

7. Major IV concern with acyclovir

8. Important IV nursing action

9. What should nurses monitor in renal impairment

1. Viral DNA inhibitor

2. -ovir

3. Acyclovir (Zovirax)

4. Bacteriostatic —> inhibit of viral DNA replication

5. herpes simplex and zoster

6. PO, IV, topical

7. Renal toxicity

8. Hydrate patient and infuse slowly and dilute , watch for tissue necrosis

9. CNS effects

What is some patient teaching for TB drugs?

what is nursing monitoring considerations?

1. Educate treatment is prolonged and DOT, body fluids can change colors

2. Monitor liver funcion, peripheral neuropathy, CNS effects, DRESS (drug reaction with eosinophilia and systenuc symp), Expect dose increase for other drugs if same CYP pathway