PathoPharm Module 1 - Infection + Inflammation Drug Chart Meds

What is an antipyretic?

fever reducing drug

Drug Classification of Aspirin

NSAID

Drug Classification of Ibuprofen

NSAID

Drug Classification of Acetaminophen

Analgesic + Antipyretic

Antibiotic Classification of Penicillins

Beta-Lactam

Antibiotic Classification of Cephalosporins

Beta-Lactam

T/F? Pts. should complete the prescribed course of treatment of antimicrobials even though symptoms may disappear before the course is over.

True

What should we look for when monitoring the pt. for indications of antimicrobial effects?

reduction in fever, pain, or inflammation; also improved appetite and sense of well being.

What is the action of Beta-Lactam?

Affects cell wall synthesis

Two examples of Beta-Lactam antibiotics?

Penicillins + Cephalosporins

Antibiotic Classification of Vancomycin

Glycopeptide NON-Beta-Lactam

Antibiotic Classification of Tetracycline

Tetracycline

Antibiotic Classification of Doxycycline

Tetracycline

Antibiotic Classification of

Minocycline

Tetracycline

Antibiotic Classification of Azithromycin (Zithromax)

Macrolides

Antibiotic Classification of Erythromycin

Macrolides

Antibiotic Classification of Clarithromycin (Biaxin)

Macrolides

Antibiotic Classification of Clindamycin

Macrolide antibiotics

Drug Classification of Gentamicin

Aminoglycosides

Drug Classification of Tobramycin

Aminoglycosides

Drug Classification of Amikacin

Aminoglycosides

Drug Classification of

Sulfamethoxazole-trimethoprim (Bactrim)

Sulfonamide antibiotics

Drug Classification of Ciprofloxacin (Cipro)

Fluoroquinolones

Drug Classification of Levofloxacin

Fluoroquinolones

Drug Classification of Oxofloxacin

Fluoroquinolones

Drug Classification of Metronidazole (Flagyl)

nitroimidazole antimicrobials

Drug Classification of Amphotericin B

Antifungal

Drug Classification of Fluconazole

class of antifungals called triazoles

Drug Classification of Ketoconazole

antifungal medications called imidazoles

Drug Classification of Itraconazole

class of antifungals called triazoles

Drug Classification of Acyclovir

In a class of antiviral medications called synthetic nucleoside analogues

What is Valacyclovir (Valtrex)

is a prodrug of acyclovir – but it is more bioavailable

Drug Classification of Ganciclovir

Antiviral

Drug Indication

an "indication" for a drug refers to the use of that drug for treating a particular disease

Aspirin Indications

Fever, anti-inflammation, analgesic for pain, reduction of platelet aggregation and reduction of cancer risk

Ibuprofen Indication

Fever, analgesic for pain and anti-inflammation

Acetaminophen Indication

Fever and Analgesic

Aspirin Actions

* Irreversible, non-selective inhibitor of COX 1 & 2
* Anti-inflammatory
* Anti-Pyretic

Ibuprofen Actions

* Non-selective inhibitor of COX 1 & 2
* Anti-Inflammatory
* Anti-Pyretic

Acetaminophen Actions

Decreases prostaglandin synthesis in the CNS

(NO anti-inflammatory effect peripherally)

Aspirin Side Effects

* GI- Gastritis, dyspepsia, ulcers, and possible bleeding
* Renal Impairment
* Allergy

Ibuprofen Side Effects

* GI- Gastritis, dyspepsia, ulcers, and possible bleeding
* Selective COX 2 inhibitors are known to cause an increased risk of thrombotic events; celecoxib (Celebrex)

Acetaminophen Side Effects

Possible liver toxicity in HIGH regular doses

Aspirin Dose for Antipyretic use

325-650mg po every 4 hrs

Aspirin Dose for Cardiac use

may use 325 mg po initially in acute event, then 81mg/day

Nursing Implications w/ Aspirin

* Administer WITH food
* Avoid alcohol ingestion with this med
* Check for Drug-drug interactions/contraindications.
* The enteric coating may not prevent GI bleeding.
* Do not administer to children or adolescents due to risk of Reyes Syndrome

Nursing Implications of Ibuprofen

* Check as there are MANY drug-drug interactions/contraindications
* Administer WITH food
* Avoid alcohol Ingestion with medication

Nursing Implications of Acetaminophen

* Inform patient of risk of liver injury if taken in high and frequent doses
* Advise patients to consume no more than 4000 mg (MAX) of acetaminophen a day, including the amount in combination prescription products (eg, Vicodin, Percocet) as well as OTC products.
* Advise patients not to drink alcohol while taking acetaminophen
* Advise patients who won't stop drinking alcohol (more than 3 drinks a day) to take no more than 2000 mg of acetaminophen a day.
* Advise patients with liver disease to ask the prescriber if acetaminophen is safe.

Examples of Drugs that combine a penicillin drug and a beta-lactamase inhibitor:

* Amoxicillin + clavulanic acid = Augmentin
* Ampicillin + sulbactam = Unasyn
* Ticarcillin + clavulanic acid = Timentin
* Piperacillin + tazobactam = Zosyn

Drug Indication for Penicillin

* __**Therapeutic**__: used for __gram-positive__ bacteria
* ex. *Strep* and *Staph &* a few gram-negatives such as *Neisseria,* and syphilis (*Treponema*)
* Some will cover anaerobes such as *Enterobacter* & also *Pseudomonas*, and *Klebsiella*
* __**Prophylactic**__: used to prevent bacteremia in selected populations at risk for endocarditis, such as people with artificial or damaged heart valves

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Penicillin Action

Beta-Lactam that affects Cell Wall Synthesis

Penicillin Side Effects

* Allergy
* GI: diarrhea or dyspepsia
* Renal Impairment can cause penicillins to accumulate to toxic levels
* Possibly Suprainfections

Penicillin Nursing Implications

* Advise patients with penicillin allergy to wear some form of identification (eg, Medic Alert bracelet) to alert emergency healthcare personnel
* Instruct outpatients to report any signs of an allergic response (eg, skin rash, itching, hives)
* Overdose can cause neurologic problems, including seizures
* Measure I & O’s

Administration of Penicillins

Instruct the patient to take oral penicillins with a full glass of water 1 hour before meals or 2 hours after. Penicillin V, amoxicillin, and amoxicillin/clavulanate may be taken with meals.

What is Penicillin __**synergistic**__ with?

aminoglycoside antibiotics, BUT can’t be administered in the same IV line.

What are the 5 generations of Cephalosporins?

* First generation (eg, cephalexin)
* Second generation (eg, cefoxitin)
* Third generation (eg, cefotaxime)
* Fourth generation (cefepime)
* Fifth generation (ceftaroline)

Cephalosporins Action

Beta Lactam than Affects Cell Wall Synthesis

Cephalosporins’ Indication

* Similar to that of penicillin in structure and activity
* To avoid the development of resistant populations of bacteria, __third and fourth generations should be reserved for serious infections__!

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Cephalosporin Side Effects

* Risk of increased bleeding with warfarin because of interference with Vitamin K metabolism
* Allergy
* GI upset: diarrhea and pseudomembranous colitis

What are Cephalosporins contraindicated for?

* Cephalosporins are contraindicated for patients with a history of allergic reactions to cephalosporins or of severe allergic reactions to penicillins.

Nursing Implications of Cephalosporins

 

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* Monitor prothrombin time, bleeding time, or both. Parenteral vitamin K can correct abnormal prothrombin time.
* Caution in pts. with a history of bleeding disorders and in patients receiving drugs that can interfere with hemostasis (anticoagulants; thrombolytics; antiplatelet drugs, including aspirin and other NSAIDs).
* Advise patients to take oral cephalosporins WITH food if a gastric upset occurs. Instruct patients to refrigerate oral suspensions.
* Intramuscular injections are frequently painful; forewarn the patient.
* Report any diarrhea

When should one discontinue Cephalosporin?

Observe patients for signs of bleeding and, if bleeding develops, discontinue the drug.

What can be triggered if Cephalosporins are used with alcohol?

Several can trigger a disulfiram-like reaction if used with alcohol. Advise patients about alcohol intolerance and warn them not to drink alcoholic beverages.

Vancomycin Indication

* A potentially toxic antibiotic __only used to treat serious infections__.
* Can be used in treating gram+ infections (in those with PCN allergy)
* Oral preparation can be used for bowel infections, particularly *Clostridium difficile* (a suprainfection) – topical to GI system, not absorbed by the bloodstream

Vancomycin Action

Non-Beta-Lactam that affects cell wall synthesis

Vancomycin Side Effects

* Ototoxicity and dose-related nephrotoxicity
* Multiple drug interactions with hyperlipidemic drugs, muscle relaxants, and ototoxic drugs
* Irritating to the vein → thrombophlebitis

Because vancomycin is irritating to the vein, what should be done/considered when administering it?

* Use a LARGE vein and change the site OFTEN
* Rapid infusion of VANCOMYCIN can cause “red man syndrome.”

What is “Red Man Syndrome"?

“red man syndrome,” characterized by flushing, rash, pruritus, urticaria, tachycardia, and hypotension.

How do you minimize the risk of the patient developing “red man syndrome” when administering Vancomycin?

To minimize risk, infuse vancomycin slowly, over 60 minutes or longer.

Indications for Tetracycline

* *Chlamydia* and rickettsial diseases (Rocky Mountain spotted fever)
* Also used in acne and periodontal disease

Tetracycline:(Tetracycline/Doxycycline/Minocycline) Actions

Bacteriostatic drug that binds to the 30S ribosomal sub unit

* This is a broad-spectrum class of drugs but resistance has developed

Side Effects of Tetracyclines

* Discoloration of Developing Teeth
* GI distress (epigastric burning, cramps, nausea, vomiting, diarrhea)


* Photosensitivity

Should a patient take Tetracycline on a empty stomach?

Yes!

* Advise patients to take most oral tetracyclines on an empty stomach (1 hour before meals or 2 hours after) and w/ a full glass of water.
* Minocycline may be taken with food.

Ex: of chelators in relation to Tetracyclines

milk products, calcium supplements, iron supplements, magnesium-containing laxatives, and most antacids.

How long should be between taking a tetracycline and ingesting any chelators

At least 2 Hours.

Why should Tetracycline not be given to pregnant women or children below 8?

It binds to calcium in developing teeth and forms a discolored area→ don’t give to pregnant women (will only affect baby teeth) or children below 8 years.

Other Nursing Implications for Tetracycline

* Candidiasis -Inform patients about symptoms of fungal infection (vaginal or anal itching; inflammatory lesions of the anogenital region; black, the furry appearance of the tongue), and advise them to notify the prescriber if these occur.

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* Advise patients to avoid prolonged exposure to sunlight, wear protective clothing, and apply sunscreen to exposed skin.

Macrolides ie. Azithromycin (Zithromax), Erythromycin, & Clarithromycin (Biaxin) act by…?

By being bacteriostatic and inhibiting 50 S ribosomal subunit

Macrolides ie. Azithromycin (Zithromax), Erythromycin, & Clarithromycin (Biaxin) are indicated for…?

Gram-positive and some gram-negative bacteria.

* *Legionella* and *Chlamydia*

IV erythromycins, clarithromycin, and azithromycin are known to be what to veins?

corrosive

t/f? Some forms of erythromycin are corrosive to the GI tract and can cause erosive esophagitis

True

Macrolides are an alternative to…

* Be aware of Drug-drug interactions.


* Alternative to penicillin in those with PCN allergy

What are Erythromycin and clarithromycin are __strong inhibitors__ of?

cytochrome P450; therefore administer with caution in patients taking drugs metabolized by these enzymes (statins and warfarin, among others).

How are Macrolides such as Azithromycin (Zithromax), Erythromycin, & Clarithromycin (Biaxin) administered?

They are DILUTED in large quantities of fluid and infused SLOWLY into a large vein.

T/F? Azithromycin is a weaker inhibitor of P450 enzymes

True; and caution is still advised

Clindamycin Indication

* Anaerobes and gram-positive aerobes
* Reserve for serious infections
* Poor penetration of the brain.

Clindamycin Action

A bacteriostatic drug that inhibits the 50S ribosomal unit.

Clindamycin Side Effects

Suprainfection with *Clostridium difficile*

Nursing Implication when administering clindamycin

IV infusion must be __SLOW__ (fatalities have occurred from too rapid infusion).

What are the drug implications for aminoglycosides like: Gentamicin, Tobramycin, and Amakacin?

* Good coverage of gram-negative bacteria: *Pseudomonas, Klebsiella, and Serratia*.
* No activity against anaerobes.

What is the __**ACTION**__ of Aminoglycosides ex: Gentamicin, Tobramycin, and Amikacin?

Bacteriocidal drugs that bind to the 30S ribosomal unit

Side Effects of of Aminoglycosides ex: Gentamicin, Tobramycin, and Amikacin?

* Ototoxic and nephrotoxic— adjust for renal impairment
* Aminoglycosides can inhibit neuromuscular transmission, causing potentially fatal respiratory depression

Nursing Implications for Aminoglycosides

* For many patients, once the daily infusion is as good as divided doses because it produces very high levels that kill bacteria even after the blood level declines.
* Low levels in between the daily dose allow washout from body cells in between doses and lower the risk of toxicity. (measure peak and trough levels)
* Can be used topically to sterilize the gut or on the skin (neomycin) or eye.

Sulfa-methoxazole-trimethoprim (Bactrim)’s Drug Indication

* Broad spectrum, including many gram negative and gram positive
* Used extensively for UTI,  *Pneumocystis jerovici* pneumonia

SupraInfection

the appearance of both microbiological and clinical evidence of a new infection developing during the course of antibiotic therapy of a previous one

Action of Sulfamethoxazole-trimethoprim (Bactrim)

* Bactericidal drug which blocks bacterial enzymes that are important for the synthesis of the building blocks of DNA, RNA and proteins.

t/f? The combination of a sulfa drug (sulfamethoxazole) and an inhibitor of a bacterial enzyme called dihydrofolate reductase (trimethoprim) - are **SYNERGYSTIC** in their activity. 

True

What are the most concerning reactions to Sulfamethoxazole-trimethoprim (Bactrim)?

Hypersensitivity reactions are most concerning: 

Rash, including rare Stevens-Johnson syndrome.

Heme related side effects to taking Bactrtim

hemolytic anemia and other blood dyscrasias (agranulocytosis, leukopenia, thrombocytopenia, aplastic anemia).

Side effects of Bactrim on the CNS

headache, psychosis