Pharm Exam #1 Antibiotics

Anti-helminthic drugs

* Albendazole
* Diethylcarbamazine
* Thisbendazole
* Ivermectin
* Mebendazole
* Niclosamide

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route: oral

Anti-helminthic action

treatment for worms/helminth

mostly in countries with poor sanitation

where to find causative agent to determine anti-helminthic meds

stool specimen

Side effects of anti- helminthic drugs

diarrhea, abdominal pain, myelosupression

nursing implications for anti-helminthic drugs

\-Easily spread within families ⇒ **treat entire family** 

\-IMPT to find *causative agent* in **stool specimen**

Patient teaching needed: 

\-**Importance of sanitation** 

\-Handwashing after disposing feces, before/after eating

\-Change linens, night clothes, & towels DAILY

\-Keep fingernails short

\-Toilet disinfection 

Anti - malarial drugs

Chloroquine

Side effects of Anti- malarial drug (Chloroquine)

Big reason why ppl stop taking this drug

\-GI upset

\-Vision (retinopathy)

**-Psoriasis** exacerbation 

\-May **BLEACH** body/hair 

\-OD ⇒ pt death within 2 hours

__*Symptoms*__ of OD: 

\-Nausea/vomiting/drowsiness

\-Weak pulse   

Nursing implications for anti-malarial drugs

* -Do NOT give to kids; susceptible to OD  

\-**Begin treatment 1-2 weeks PRIOR going to endemic area** 

\-continue for 6-8 weeks after leaving area

  -must take weekly @ same    

    time with meals 

\-Rule out prior allergies 

\-Induce vomiting to get drug out of pt system

NSAIDS

Ibuprofen , Toradol, Cox 2 inhibitors

Ibuprofen

NSAID for arthritis
may take 2-4 weeks to anti-inflammatory effect

Toradol (ketorolac)

NSAIDS for post op with orthopedic surgeries

only 2 weeks because of bleeding

COX-2 inhibitors

inhibits prostaglandin synthesis by inhibiting COX2 enzymes

Cox 2 inhibitors for

pain, arthritis, dysmenorrhea

Cox2 inhibitor advantage

does not disrupt platelets → less GI bleeding

Side effects of NSAIDS

dizziness and drowsiness

NSAIDS nursing implications

-similar to ASA
- contra indicated in patients with hepatic disorders

Antimalarial drugs: chloroquine treats

Malaria
leg cramps

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routes: oral only

chloroquine actions

\-Stops DNA/RNA replication & protein synthesis of parasitic cells

Salicylates

aspirin (ASA), Tylenol (acetaminophen)

Salicylates (aspirin) produce

analgesia by blocking the generation of pain impulses and inhibition of prostaglandins

Antimalarial treats

malaria, leg cramps

antimalarial inhibits

DNA/RNA replications + protein synthesis of parasitic cells

Salicylates (aspirin/tylenol) reduce

fever by acting on the hypothalamus

Salicylates (aspirin/tylenol) prevent

clots by inhibiting platelet clumping

Salicylates (aspirin/tylenol) treat

Pain, inflammation for rheumatoid arthritis, osteoarthritis, fever

Salicylates (aspirin/tylenol) can be used

for post-op patient and adults at risk for stroke for its anticoagulant effects

Main side effect for Aspirin

GI bleeding

other side effects of Salicylates

Nausea, vomiting, diarrhea, dyspepsia (indigestion)
GI bleeding, heartburn, excess bleeding

Salicylism

→ tinnitus, hearing loss, headache, confusion

Aspirin increases

the effect of codeine, possibility of hypoglycemia, and bleeding with an anticoagulant

Aspirin Inspection

for bruising, blood in the stool, nosebleeds, etc.

nursing implications for Aspirin

-Stop 5-7 days before surgery

-Should not be taken with NSAIDs

-Avoid if there is a present viral infection

-Use child-proof containers

patient teaching for aspirin

-Take with food or milk

-Do not chew or crush enteric coated pills

Tylenol antidote

Acetylcysteine (Mucomyst) regimen

Tylenol side effects

GI problems
Overdose → hepatotoxicity

withhold Tylenol if

patient develops a rash or urticaria

if pain or fever after Tylenol lasts

see a doctor

Penicillins

Penicillin G, Ampicillin, Amoxicillin, Peracillin/Tazobactam

Penicillin mechanism of action

bactericidal, inhibits bacterial cell wall synthesis

Penicillin G

narrow spectrum penicillin

treats gram + some kill gram -

good for strep and penicillinase

Ampicillin

Amoxicillin

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\*Inhibits bacterial cell wall synthesis\*

\-Broad spectrum against G-treats both gram + and gram -

piperacillin/tazobactam

good for gram+ and gram -

Pneumonia, Sepsis, Intra- abdominal infections

side effects of penicillins

bad taste, nausea, vomiting, diarrhea -→ cephalosporin

\-Some have **high sodium** content; hypertension pt’s cannot take.

**-Benadryl + Epinephrine** (Treats side effects)

allergic reaction of penicillin

seizures, rash, itching

anaphylaxis reactions to penicillin

difficulty breathing, laryngeal edema, cardiovascular collapse, shock, hypotension,

penicillin superinfections

trush in mouth, vaginal candida, pseudomembranous colitis (constant diarrhea), c dificile

nursing implications for penicillin

\-Thorough assess patient's medical history for potential allergy
\-Check for allergy bracelet prior to med administration

\-label chart w allergy sticker

\-Take FULL amount evenly spaced intervals

* Affected by meals; Take ONE HOUR before meals
* Caution with skin contact-

patient teaching for penicillin

* Do not drink with grapefruit juice because it can inactivate the drug

\-Can inactivate birth control pills → need other form of birth control

Cephalosporins 1st gen

Cephalothin (Keflin)
Cefazolin (Kefzol)

Cephalothin(keflin)

CHEAPEST, G+ and G-

doesnt cross blood brain barrier

Cephalosporins 2nd gen

Cefamandol (Mandol)
Cefuroxime (Ceftin, Zinacef)

bind to penicillin bind proteins -→ resistance

do not cross blood brain barrier

cephalosporins 3rd gen

Cephotaxime (Clarofin) Ceftriaxone (Rocephin) Cefatazidime (Fortaz) Good for Gram - & some anaerobes

EXPENSIVE LIKE TAXES

**Gets into CSF**

\-Problems with developing resistance

Cephalosporins 4th gen

Cephapime (Maxipime)
Broad spectrum, but better for Gram -

cephalosporins 5th gen

Ceftaroline (Treflaro) For MRSA, acute skin, & community acquired pneumonia

only injection

cephalosporins treat

Staph, strep

Some Gram - bacteria: E. coli, Klebsiella, Proteus

UTI, bone/joint infections, septicemia, otitis media

Side effects of cephalosporins

Nausea, vomiting Phlebitis, rash, redness, edema, abdominal cramps, poor GI absorption

decrease renal function , P colitis

Route for cephalosporins

Given via IV/IM due to poor absorption

nursing implications for cephalosporins

\-Take culture before administration- culture sites

\-Obtain a thorough history of previous use of penicillins or cephalosporins

\- Must have OK kidney function

* Push fluids 
* BUN & creatinine lab tests + Urine output
* **BUN** - protein breakdown

**Creatinine** - levels indicate proper kidney function

\-Cross-check allergies with penicillin

\-Can cause decreased renal function

\-Observe for symptoms of anaphylaxis reactions

Aminglycosides

Gentamycin
Kanamycin
Tobramycin

Actions of Aminoglycosides

Big Guns

G+ , mostly G-

Inhibits protein synthesis

\-Inactive against fungi, viruses, most anaerobic bacteria

Aminoglycosides treat

Gram - bacteria:
E. coli, pseudomonas

Side effects of aminoglycosides

Headache, fever
Paresthesia (tingling), vertigo, skin rash
Nephron damage/renal failure due to rising BUN and creatinine → put patient on dialysis if happens

Ototoxicity→ hearing loss

nursing implications for aminoglycosides

\-Nephrotoxicity → critical to assess kidney function

* Serum Gent. levels, BUN & Creatinine tests 
* Push FLUIDS

\-Ototoxicity → assess hearing function-→ Pre-tests for hearing (ESP in children) 

Calculate dosages carefully **3-5mg/day**

-Compare peak (30 mins after IV) and trough levels (before next dose) -Push fluids

Tetracycline

Tetracycline & doxycycline

Route → oral (empty stomach)

Tetracycline action

Rarely 1st line drug

Inhibits protein synthesis

tetracycline treats

Broad spectrum:
Treats both Gram + and Gram -


Acne, lyme disease, chlamydia, and rickettsial infections

Side effects of tetracyclines

Black, hairy tongue caused by the tetracycline binding with teeth and bone

black teeth in fetuses

candida

Stomatitis/thrush, gi upset, allergic reactions

Hepatotoxicity, nephrotoxicity,

photosensitivity

dairy delays absorption

nursing implications for tetracycline

* Readily distributes to all tissue except brain 
* **DO NOT give to females childbearing age/teens**
* Binds to newly formed teeth/bones ⇒ stain child’s teeth black
* **Avoid with dairy/antacids** ⇒ delay absorption
* Potentiates anticoagulants effects

patient teaching for tetracycline

-Avoid dairy and antacids → leads to delayed absorption

-Wear sunblock

Macrolides

erythromycin, azithromycin, clarithromycin(newer)

routes → mostly oral (enteric coated) IV/IM

oral enteric coated macrolides

inactivated by gastric acid

macrolides treat

Upper respiratory infections

macrolides action

Bacteriostatic for Gram +
Inhibits protein synthesis

side effects of macrolides

Mostly gastric upsets

Nausea, vomiting, diarrhea, headache, dizziness

Chest pain, palpitations, vertigo, rash, thrombophlebitis

Hepatotoxicity

one of the least toxic atb, safer than others

nursing implications for macrolide

\-Hard to tolerate drugs due to GI irritability
\-One of the least toxic ATB

half life short, given 4 times a day (QID)

Sulfonamides

sulfisoxazole (Gastrisin), Azo gantanol, Bactrim

Route → oral (empty stomach)

axo gantanol

Combined with phenazopyridine (analgesics-anesthetic)

Sulfonamides (Gastrisin) action

\-Antimetabolite:

***prevents synthesis of folic acid and inhibits growth of susceptible bacteria***

\-Analgesic-anesthetic

Sulfisoxazole(gastrisin) treats

**Drug of choice for UTI**

 -Ear infections  

 -Pneumonia in HIV pt (Pneumocystis carinii) 

 -Bronchitis

 -Gonorrhea

Sulfonamides side effects

Blood → hemolytic and aplastic anemia, thrombocytopenia

Integumentary → photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrolysis

GI → nausea, vomiting, pancreatitis

Renal → poorly soluble in urine and may crystallize in renal tubule

__Allergies →__ ”**sulfa/sulfur allergy**”  

 -**COX-2 inhibitor (Celebrex):** 

   DO NOT use with pt.’s    

   w/ sulfonamide allergy

nursing implications for Sulfonamides

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* **Cross sensitivities** w/ oral diabetic meds and thiazide diuretics
* Sunblock/Long sleeves
* **PUSH FLUIDS** to prevent crystallization in renal tubes
* 1.5-2 L/day
* Watch for toxic effects in bone marrow (lab tests/WBCs) 

patient teaching for sulfonamides

-Take on an empty stomach
-Must take the whole prescription

Fluoroquinolone

Ciprofloxacin

Route -→ oral , iv (dilute with 100mL)

action of ciprofloxacin

Newer ATB
\-VERY POTENT!!

* Wider range to kill bacteria
* G+ & mostly G-
*Alters DNA of bacteria*

Ciprofloxacin treats

Broad spectrum:
Mostly Gram -, but also Gram+

UTI, bone/joint infections, skin and lower respiratory infections, pseudomonas, diarrhea, anthrax

**Med of choice for ANTHRAX**

side effects of ciprofloxacin

Nausea, headache, fatigue, constipation, rash, fever, chills
Photosensitivity, photophobia, yeast infection, crystalluria

nursing implications for ciprofolaxacin

-PO or IV (dilute to at least 100mL to decrease risk of phlebitis)

-Keep patient well hydrated

-May have interactions with OTC meds (antacids, iron, multivitamins, asthma drugs, etc.)

-Monitor patient for anorexia and impaired renal function

Teaching for Ciprofloxacin

wear sunglasses

Clindamycin

semi-synthetic ATB

Route: IV(divided doses)

clindamycin action

**-Semi-synthetic ATB** 

\-**Bactericidal OR static** 

\-Inhibits protein synthesis

Clindamycin treats

Gram + and Gram -

UTI and anaerobic pneumonia

nursing implications for clindamycin

* Give in 2-4 divided doses IV. 600mg-4.8 Gm/day 

Vancomycin

Often used if patient is allergic to penicillin

Route: IV (diluted at least 100mL)

ACTION of vancomycin

Bactericidal
Binds to cell wall, inhibits cell wall synthesis

\-used in PEN allergy pt.’s 

Vancomycin treats

Gram + only

Staph infections

side effects of vancomycin

Ototoxicity

Nephrotoxicity 

Red man syndrome (Rapid infusion, hypotension, flushing & pruritus, red rash)

nursing implications of vancomycin

\-Never give IM→ bc necrosis/death of muscle tissue 
\-Draw serum peak and trough levels for toxicity
\-Watch for hypotension → slow to 2 to 3 hours if occurs

* IV diluted w/ at least 100 ml over 1 hour
* Watch IV to avoid amputation

amphotericin B

Can be fungistatic or fungicidal

Binds to sterol in fungal cell membrane and alters cell wall permeability

very toxic

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Route:

IV (dilute with D5W 

\-infuse slowly over 4-6 hours)

\-give over 4-8 weeks) 

Oral (swish in mouth/swallow for oral thrush)

Amphotericin B treats

Severe systemic mycoses

Cryptococcosis/valley fever Histoplasmosis Aspergillosis Candida

side effects of amphotericin B

Nausea, vomiting, diarrhea, headache, chills, fever, malaise, muscle and joint pain, flu-like symptoms
Thrombophlebitis → give in subclavian IV
Nephrotoxicity if used for extended period
Neurotoxicity → seizures, paresthesia

dilute amphotericin B IV with

D5W and infuse slowly over 4 to 6 hours