antibiotics

bactericidal

• kills bacteria

• works well for immunocompromised pt’s

bacteriostatic

• suppress growth

• works well for someone that has decent immune system

spectrum of efficacy

range of microorangisms a drug is effective against

broad spectrum

• empiric

• going to be gven for an infection before knowing specific bacteria causing it

narrow-spectrum

• definitive

• given after finding out what bacteria it is

goal of antibiotics

• kill bacteria or suppress growth

• prevent reproduction while minimizing harm to pt

how do you know which antibiotic kills a specific bacteria?

• match the drug to the bug!

• an S means that the bug is sensitive to the drug, so it will work

indicators that antibiotic is effective

• culture shows that there isn’t as much of causative agent

• WBC count is decreased

• vitals should change (temp decreases, HR decreases, etc)

• wound starts to not have purulent drainage and starts to look pink (granulation formation) with no odor

general issues with antibiotics

• GI - diarrhea, nausea, cramping, bloating

• Yeast - vaginal walls, oral

why antibiotics cause GI and yeast problems

The antibiotics are killing all of the bacteria, which includes the good along with the bad. This allows overgrowth of fungus (candida).

how to prevent general GI and yeast problems

• take probiotics

• take kefir

• drink buttermilk

• eat fermented foods

serious problems with antibiotics

◦ Allergic reaction 

◦ Anaphylaxis 

◦ Pseudomembranous colitis - It is caused by C Diff. There is mucus, blood, characteristics of C Diff. 

◦ C Diff - Has a very distinct smell. 

pre-administration for antibiotics

◦ Assess for drug allergies

◦ Obtain specimens - Have to obtain this prior to starting an antibiotic; need to do it quickly. 

◦ Check WBCs

◦ Vitals (temperature)/ mental status

◦ IV patency/ rate of infusion

post-administration for antibiotics

◦ Bowel movements - Assessing for bloody stools, pus, frequent watery stool. 

◦ Allergy/anaphylaxis - Every 15 minutes for 1st dose

◦ Drug effectiveness 

◦ Yeast infection

◦ IV site regularly

pt education

◦ Complete entire course of therapy

◦ Take medication on recommended schedule - Keeps therapeutic amount of the drug in the blood at all times. 

◦ Stop and call provider if rash occurs

◦ Call 911 with breathing difficulties/lump in throat

◦ Prevention of yeast infections

prevention of oral yeast infection

• rinse mouth

• check mouth

• brush teeth

prevention of vaginal yeast infections

• perineal care twice a day

• consume yogurt and buttermilk

causes of antibacterial drug resistance

• overuse

• over-prescribed

• improper consumption (stopped taking before entire amount is finished)

multiple drug-resistant organisms

Superbugs lead to super infections. Bacteria where three or more drugs do not work on them. 

classes of antibiotics

◦ Sulfonamides

◦ Penicillin

◦ Cephalosporins

◦ Carbapenems

◦ Macrolides

◦ Tetracyclines

◦ Aminoglycosides

◦ Quinolones

◦ Miscellaneous Antibiotics

which classes have the same MOA of bacterial cell wall synthesis inhibitor?

• penicillin

• cephalosporins

• carbapenems

what classes have the same MOA of protein synthesis inhibitor?

• macrolides

• tetracyclines

• ahminoglycosides

sulfonamides

• metabolism inhibitor of bug

• used to treat UTIs and respiratory infections

• sulfamethoxazole/trimethoprim

sulfonamides adverse effects

◦ Hypersensitivity reactions - Rash, Steven Johnson’s Syndrome, Toxic Epidermal Necrolysis (Can range from mild to severe)

◦ Hematologic effects - Bone marrow suppression (anemia, leukopenia, thrombocytopenia)

◦ Renal toxicity - Causes crystalluria, which can lead to an acute kidney injury. 

sulfanomides nursing considerations

• Check to see if your PT has a sulfa allergy

• assess skin (blisters, slough, peeling)

• assess CBC levels and see if they are declining or within normal range

• assess BUN and creatinine. 

sulfonamides pt educations

• Drink 8-10 glasses of water per day

• notify provider if there are any skin changes

• notify the provider if you have any bleeding, bruising, or infection

• report dysuria, decreased output, or any other change in pattern. 

penicillin

◦ Penicillin, Amoxicillin, Ampicillin

◦ Clavulanic acid, Tazobactam, Sulbactam - Added to antibiotics to keep the bugs from breaking the beta-lactam ring, so that the drug will still work

o For strep, staph infections, ear infections - widely used. 

penicillin adverse effects

◦ Allergic reactions

◦ Gastrointestinal issues - N/V, diarrhea, C Diff (long-term use)

◦ Hematologic reactions - Anemia, leukopenia, thrombocytopenia

penicillin nursing considerations

• Ask PT if they are allergic or have had a reaction to penicillin

• assess if there is a cross-hypersensitivity to cephalosporins

• assess PT for about 20 minutes if giving an IM injection.

• For anaphylaxis reactions, have epinephrine, corticosteroids, oxygen therapy.

• Assess bowel status (C Diff). 

penicillin pt educations

• Call provider if there are watery, frequent stools with blood or pus or abnormal odor

• call provider if there are any abnormal bleeding, bruising, etc. 

cephalosporins

• cephalexin

• cefuroxime

• ceftazidime

• cefepime

• ceftaroline

cephalosporins adverse effects

◦ Hypersensitivity reactions 

◦ Gastrointestinal disturbances

◦ Hematologic abnormalities

cephalosporins nursing considerations

• be aware of cross-sensitivity between penicillin and cephalosporins

carbapenems

◦ Imipenem (this drug breaks down very fast without Celestin)/Celestin (additive), Meropenem

◦ Seen more often in the hospital for acutely ill patients, infections in the joints/bones, endocarditis, meningitis. 

carbapenems adverse effects

◦ CNS toxicity - An issue with seizures, especially if you have a hx of seizures. 

◦ Hypersensitivity reactions

◦ Gastrointestinal issues

carbapenems nursing considerations

• Assess patients because it lowers the seizure threshold and can decrease the effectiveness of a seizure medication

• allergic responses could happen days later after getting the medication. 

carbapenems pt education

Educate about C Diff and that they need to stop the antibiotics and call provider if they notice symptoms. 

macrolides

◦ Azithromycin, Clarithromycin, Erythromycin

◦ See this used for skin infections, respiratory infections, STI, and when allergic to penicillin. .

macrolides adverse effects

◦ Gastrointestinal disturbances

◦ QT prolongation and cardiac arrhythmias - Ventricular tachycardia

◦ Hepatotoxicity - Liver dysfunction. 

macrolides nursing considerations

• Place PT on a cardiac monitor and assess an ECG

• monitor baseline liver function (AST and ALT)

• assess for pale stool or dark urine (liver dysfunction)

• assess for jaundice.

macrolides pt teaching

• Teach PT to report any cardiac changes (palpitations, feel as heart is skipping a beat)

• teach S/S of liver problems. 

tetracyclines

◦ Doxycycline, Minocycline

◦ Used for acne (most common), unusual types of infections (syphilis, STIs, lyme disease)

tetracyclines adverse effects

◦ Gastrointestinal upset

◦ Photosensitivity - Places PT at risk of getting sunburned. 

◦ Tooth discoloration

tetracyclines nursing considerations

If a pregnant mom takes these, then their baby is going to have it, or if a child younger than 8 taking these will have discoloration on their permanent teeth. 

tetracyclines pt educations

• Teach PT to wear sunscreen and wear protective clothing

• avoid going out between 10 am - 2 pm

• teach PT to not take these drugs with an antacid (tums, mylanta, aluminum, calcium, iron in them)  iron, or milk because it will decrease the absorption of the drug

• take antibiotics one hour before or 4 hours after taking the antacid

• teach PT to consume a small snack if they are having GI upset (not a huge meal).

ahminoglycosides

• tobramycin

• amikacin

• gentamicin

aminoglycosides adverse effects

◦ Nephrotoxicity (Black Box Warning) - Harmful to the kidneys. 

◦ Ototoxicity (Black Box Warning) - Harmful to the ears. 

◦ Neuromuscular blockade - Affect the nerve transmissions, causing weakness or paralysis (especially if taking an additional drug that causes it)

aminoglycosides nursing considerations

• Assess for changes in the urinary pattern

• assess for tinnitus, roaring, and hearing loss

• obtain and assess peak and trough levels (based on what the values show, the pharmacy can adjust the dosing and frequency)

• assess other possible ototoxic medications the PT might be on (aspirin, vancomycin, furosemide, contrast dye)

• assess baseline hearing

• assess for protein in the urine, increased BUN and creatinine, oliguria, hematuria. 

aminoglycosides pt educations

• Teach PT to call provider if they experience tinnitus, ringing, or hearing loss.

• Report any urinary problems to the provider. 

quinolones

◦ Ciprofloxacin, Levofloxacin

◦ MOA: DNA synthesis inhibitor - prevent bug from making DNA

◦ Given for serious infections (bones, joints, UTI), respiratory illnesses, etc.

quinolones adverse effects

◦ Tendon rupture- black box warning (Typically occurs in the older adult)

◦ Central nervous system effects - DIzziness, confusion, hallucinations, seizures (Typically occurs in the older adult)

◦ Heart dysrhythmias - Prolongs QT interval

quinolones nursing considerations

• Assess for pre existing heart conditions

• If a PT is on an antidysrhythmic, get ahold of the provider.

• If PT is on this medication, then assess for dysrhythmias.

• Monitor for the tendon rupture (can happen in shoulder, wrist, hand, heel, etc.).  

quinolones pt educations

Teach PT to report any tendon pain, if there heart is palpating, if there is any pain, and if there is any differences or changes in their CNS functioning

miscellanous drugs

◦ Vancomycin

◦ MOA: bacterial cell wall synthesis inhibitor (different from beta lactams) 

miscellaneous adverse effects

◦ Nephrotoxicity

◦ Ototoxicity

◦ Red Man Syndrome

miscellaneous nursing considerations

• Assess I&O’s, any changes in urinary output, and BUN and Creatinine.

• Assess for ringing or roaring in PT’s ears (have PT tell you immediately, so you can stop the drug and prevent permanent hearing loss).

• Monitor for extravasation or necrosis because this medication is very hard on the veins.

• Monitor for Red Man Syndrome (drop in BP, flushing of skin); typically occurs when you give the medication too fast (causes body to release histamine).
  

how do you treat red man syndrome?

• give antihistamine

• slow IV administration rate (typically an hour or longer would help this problem)

pregnancy considerations

risks vs benefits

tetracyclines considerations

◦ Pregnancy - There can be congenital malformations on the infant’s teeth. 

◦ Children < 8 years

quinolones considerations

◦ Tender rupture - Older adult