Antibiotics: Cell Wall, Protein Synthesis, and Metabolism Inhibitors

ceftriaxone sodium

A cell wall inhibitor and a type of cephalosporin

gentamycin

Inhibits protein synthesis. A type of aminoglycoside

levofloxin

DNA synthesis inhibitor. A type of fluroquinolone

penicillin

cell wall synthesis inhibitor

sulfonamide

metabolism inhibitor

tetracycline

Protein synthesis inhibitor

vancomycin

Cell wall synthesis inhibitor. A type of glycopeptide

meropenem

Cell wall synthesis inhibitor. A type of carbapenem

azithromycin

Protein synthesis inhibitor. A type of macrolide

Beta-lactam drugs

Penicillins

Cephalosporins

Carbapenems

Monobactams

Glycopeptide drugs

Vancomycin

Types of cell wall synthesis inhibitors

Beta-lactams, glycopeptides

Cell wall synthesis inhibitor: intended response

These antibiotics are bactericidal. They prevent bacteria from forming cell walls.

Cell wall synthesis inhibitors: common side effects

These antibiotics are more likely to cause allergic reactions. More powerful drugs can cause nausea/vomiting, fever, chills, "red man syndrome," reduced hearing, and reduced kidney function

Cell wall synthesis inhibitors: adverse effects

CNS changes (such as seizures or confusion), kidney damage

Cell wall synthesis inhibitors: administering

Check before: if the patient has an allergy to penicillin, they have an increased risk of also having an allergy to cephalosporins. Give vancomycin slowly to prevent red man syndrome

Check after: monitor for an allergic reaction

Teaching priorities: take cephalosporins at least an hour before or 4 hours after iron or antacid because they are poorly absorbed together

Cell wall synthesis inhibitors: pregnancy or lactation considerations

-Penicillins and most cephalosporins pose a low risk for fetal harm

-Carbapenems, monobactams, and vancomycin pose a low to moderate risk for fetal harm

-All drugs can be passed into breast milk, increasing the risk of the infant developing an allergy

Cell wall synthesis inhibitors: older adults consideration

Carbapenems and glycopeptide antibiotics can cause ototoxicity and nephrotoxicity. Make sure the patient doesn't begin experiencing tinnitus

Types of protein synthesis inhibitors

Aminoglycosides

Macrolides

Tetracyclines

What do protein synthesis inhibitors do?

Slows bacteria from making proteins important to their life cycles, thus the bacterium cannot make the protein essential to survive or reproduce. This antibiotic can either be bacteriostatic or bactericidal.

Protein synthesis inhibitors: common side effects with Aminoglycosides

Nausea, vomiting, rash, fever, lethargy

Protein synthesis inhibitors: common side effects with Macrolides

Nausea, vomiting, diarrhea, loss of appetite, photosensitivity

Protein synthesis inhibitors: common side effects with Tetracyclines

Nausea, vomiting, diarrhea, glossitis (sore tongue), rash, photosensitivity, yeast infections

Protein synthesis inhibitors: adverse effects with Aminoglycosides

ototoxicity, nephrotoxicity, neuromuscular blockade

Protein synthesis inhibitors: adverse effects with Macrolides

many serious drug interactions, irritation at administration site (with parenteral forms)

Protein synthesis inhibitors: adverse effects with Tetracyclines

increased intracranial pressure which can cause dizziness, blurred vision, confusion, and tinnitus

Protein synthesis inhibitors: adverse effects with Lincosamides

reduce liver function and decrease WBC count. Shock and cardiac arrest could occur if it is given too rapidly via IV infusion

Protein synthesis inhibitors: adverse effects with Oxazolidionones

Reduce blood cell counts and damage to the optic nerve

Protein synthesis inhibitors: adverse effects with Streptogramin

Increases the blood levels of many drugs, which can lead to normal doses of drugs causing adverse effects

Protein synthesis inhibitors: check before with Aminoglycosides

Assess breathing baseline, lab tests to view kidney function, and hearing ability

Protein synthesis inhibitors: check before with Macrolides

Check what other medications the patient is receiving. Infuse this medication intravenously slowly over 8 hours

Protein synthesis inhibitors: check before with Tetracyclines

Food, antacids, and dairy products can prevent this drug from absorbing. Give the drugs 1 hour before or 2 hours after a meal.

Protein synthesis inhibitors: check before with other protein synthesis inhibitors

Check the patient's lab work carefully and give drugs slowly

Protein synthesis inhibitors: check after with Macrolides

check heart rate and rhythm every 4 hours.

Protein synthesis inhibitors: check after with Tetracyclines

Keep on the lookout for bleeding if the patient is also on warfarin

Protein synthesis inhibitors: patient teaching with Macrolides

take with food to decrease GI side effects. Avoid sun exposure to prevent sunburns

Protein synthesis inhibitors: patient teaching with Tetracyclines

Avoid sun exposure. Take 1 hour before or 2 hours after meals, do NOT take with milk

Protein synthesis inhibitors: life span considerations regarding children

Aminoglycosides can cause severe respiratory depression and kidney damage. Tetracyclines should be avoided in children younger than 8 y/o

Protein synthesis inhibitors: life span considerations regarding pregnancy/lactation

Avoid aminoglycosides and tetracyclines with pregnancy and breastfeeding, as it could cause fetal harm or birth defects. Most macrolides are generally safe, but they could cause colic and diarrhea in the infant

Protein synthesis inhibitors: life span considerations regarding older adults

Ototoxicity and nephrotoxicity more likely

Types of metabolism inhibitors

Sulfonamides and trimethoprim

How do metabolism inhibitors work?

They stop cells from using folic acid to make DNA and reproduce. This antibiotic is bacteriostatic. It can also be used to treat some nonbacterial infections

Metabolism inhibitors: common side effects

Headache, fever, rash, and photosensitivity

Metabolism inhibitors: adverse effects

Suppression of bone marrow cell division, Stevens-Johnson syndrome (severe blistering), hyperkalemia (high blood potassium) with trimethoprim, and kidney stones with sulfonamides

Metabolism inhibitors: check before

Check for sulfa allergies or blood disorders. Review lab tests as well

Metabolism inhibitors: check after

Check if the patient is jaundice, has bruising, petechiae, or blisters. Offer water every 4 hours

Metabolism inhibitors: patient teaching

-Avoid direct sunlight

-Wear protective clothes and use sunscreen

-Avoid tanning beds and salons

-Drink a full glass of water with the drug and more fluids throughout the day

-Report the development of jaundice, sore throat, fever, rash, blisters, or multiple bruises

Metabolism inhibitors: life span considerations with children

Infants younger than 2 months are more likely to become jaundiced

Metabolism inhibitors: life span considerations with pregnancy/lactation

Avoid during the last 2 months of pregnancy, and avoid during breastfeeding

Metabolism inhibitors: life span considerations with older adults

Increased risk of bleeding or anemia

Types of DNA synthesis inhibitors

Fluoroquinolones

How do DNA synthesis inhibitors work?

These antibiotics are bacteriostatic. They suppress the action of two enzymes important in making bacterial DNA.

DNA synthesis inhibitors: common side effects

Rash, nausea/vomiting, headache, abdominal pain, muscle and joint pain, photosensitivity, concentrated urine that may irritate tissues

DNA synthesis inhibitors: adverse effects

Acute confusion in older adults, serious heart dysrhythmias especially while taking other drugs, peripheral neuropathy (damage to nerves), changes in blood glucose level, tendon rupture

DNA synthesis inhibitors: check before

Check if the patient is taking iron, vitamins, or antacids as they can affect how well this antibiotic is absorbed. Also determine whether the patient is taking certain medications because together, they can lead to serious dysrhythmias. Give with a full glass of water

DNA synthesis inhibitors: check after

Check heart rate and rhythm every 4 hours. Check blood glucose in diabetic patients and monitor for acute confusion in older adults

DNA synthesis inhibitors: patient teaching

-Take with full glass of water; increase fluids throughout day

-Check pulse twice daily

-If diabetic, check blood glucose levels more often

-Avoid direct sunlight

-Report tingling, burning, numbness, and pain in the hands or feet

DNA synthesis inhibitors: life span considerations regarding children

Not recommended for kids under 18

DNA synthesis inhibitors: life span considerations regarding pregnancy and lactation

Avoid use in pregnant and breastfeeding women. Increased risk for bone, joint, and tendon defects

DNA synthesis inhibitors: life span considerations regarding older adults

Increased risk of tendon rupture

How is antibacterial drug resistance caused?

Overused, over-prescribed, or improperly taken antibacterials

Multi-drug resistant organisms

Also known as super-bugs, they can cause super-infections.

Examples include: MRSA or drug-resistant streptococcus pneumoniae