Anti-Infective and Anti-Inflammatory Part 1

bacteria

some gram positive (thick cell wall, capsule), gram negative (complex, harder to treat)

-culture to treat, some stop cell wall synthesis, proteins, DNA/RNA

bactericidal

kill bacteria

bacteriostatic

inhibit growth of susceptible bacteria rather than killing them immediately, eventually leads to bacterial death

prophylactic

treatment with antibiotics to prevent an infection

empiric

treatment before specific culture

definitive

antibiotic tailored to treat organism identified with cultures

superinfection

antibiotics reduce or eliminate normal bacteria flora

sulfonamides MOA

bacteriostatic-inhibit growth of susceptible bacteria by preventing bacterial synthesis of folic acid which is required for DNA/RNA synthesis

sulfonamides indications

-gram positive and gram negative bacteria

-UTIs (concentrates in kidneys)

-respiratory tract infections

sulfonamides contraindications

sulfa chemically related drugs allergy (sulfonylureas, thiazide, loop diuretics, carbonic anhydrase inhibitors, celebrex), pregnancy, less than 2 yo

sulfonamides adverse/side effects

-allergic reaction (fever, rash)

-blood disorders, N/V/D, hepatotoxicity, nephrotoxicity, crystalluria, dermatitis, photosensitivity, convulsions

sulfonamides interactions

-sulfonylureas, phenytoin, warfarin = additive

-oral contraceptives (reduce contraceptive effects)

sulfonamides drugs

sulfamethoxazole/trimethoprim (bactrim, septra): IV, PO

sulfonamides nursing implications

obtain culture prior to antibiotic therapy, take exactly as prescribed and full length of time (prevent antibiotic resistance), take with 2000-3000mL of fluid/24 hrs (concentrates in kidneys, lowers risk of nephrotoxicity and crystalluria), take with food for GI side effects, assess CBC before beginning therapy

beta-lactam antibiotics

inhibit cell wall synthesis

-penicillins

a. beta-lactam inhibitors: clavulanic acid, tasobactam, sulbactam, avibactam (more powerful-overcome antibiotic resistance)

-monobactams: azetreonam (azactram)-bactericidal, aerobic gram negative

-cephalosporings

-carbapenems

penicillins MOA

bactericidal - inhibit cell wall synthesis, bacteria dye from cell lysis

penicillins indications

-mainly gram positive bacteria: strep, entero, staphylo

-extended-spectrum: broad spectrum

penicillins contraindications

-drug allergy to other beta-lactam antibiotics

-HF, hyperkalemia, hypernatremia (high concentrations of K+ and Na+ in cillins)

penicillins adverse/side effects

-hives, pruritus, angioedema, rash, allergy

-N/V/D

penicillins interactions

-NSAIDs (competition for site, levels high), oral contraceptives (decrease effects)

-warfarin (enhances), rifampin (decrease effectiveness)

penicillins nursing drugs

-penicillin, G, amoxicillin*/clavulanic acid (augmentin), ampicillin: PO, IV, IM

-extended: pipercillin + tazobactam (zosyn): IV

penicillins nursing implications

culture prior to therapy, take exactly as prescribed and for full length of time, take oral doses with water (not juice: acidic), monitor for allergic reaction for 30 minutes after administration, labs: Na+, K+

cephalosporins MOA

bactericidal-interfere with cell wall synthesis

cephalosporins indications

broad spectrum: 1 generation-gram positive to 5 generation-gram negative

cephalosporins contraindications

drug allergy to other beta-lactams

cephalosporins adverse/side effects

-diarrhea, abdominal cramps

-rash, pruritus, edema

cephalosporins interactions

-antacids, iron = decreased absorption of PO meds

-alcohol, oral contraceptives: antibuse-sick

cephalosporins drugs

cef- some PO, IV

-cefazolin (ancef)

-cephalexin (keflex) *

-cefoxitin (mefoxin)

-cefuroxime (ceftin)

-cefdinir (omnicef)

-ceftriaxone (rocephin)

-ceftazidine (fortaz)

-cefepine (maxipine)

cephalosporins nursing implications

culture prior to therapy, exactly as prescribed and for full length of time, give orally administered forms with food

carbapenems MOA

bactericidal-inhibit cell wall synthesis

carbapenems indications

-broad spectrum

-reserved for complicated infections in acutely ill

carbapenems contraindications

drug allergy to penicillins

carbapenems adverse/side effects

-drug-induced seizures

-N/V/D (IV too fast)

carbapenems drugs

-penem

-imipenem/cilastatin (primaxin)*: IV, IM (not absorbed GI)

-meropenem (merrem)

-meropenem/varobactam (vabomere)

-ertapenem (invanz)

carbapenems nursing implications

infuse over 60 minutes, culture before therapy, exactly as prescribed and for full length of time

macrolides MOA

bacteriostatic - inhibit protein synthesis, bacteria eventually die

macrolides indications

-respiratory tract, skin, and soft tissue infections

-strep infections, skin infections

macrolides contraindications

heart disease (increase risk of heart problems)

macrolides adverse/side effects

-irritate GI: N/V/D, flatulence, anorexia

-dysrhythmias, chest pain, headache, dizziness, rash, phlebitis, hearing loss, hepatotoxicity (metabolized in liver)

macrolides interactions

highly protein bound and metabolized in liver

-carbamazepine, cyclosporine, theophylline, warfarin = additive effects, toxicity

-oral contraceptives, drugs with prolonged QT interval

macrolides drugs

-erythromycin: PO, IV, topical* (stimulates GI motility - after bowel surgery)

-azithromycin (zithromax): PO, IV

-clarithromycin (biaxin): PO

macrolides nursing implications

culture prior to therapy, take exactly as prescribed and for full length of time, many drugs are taken after a meal or snack (no juice), asses VS, ECG, LFTs

tetracyclines MOA

bacteriostatic-inhibit bacterial protein synthesis

tetracyclines indications

wide spectrum

tetracyclines contraindications

-pediatrics

-pregnant, nursing women

tetracyclines adverse/side effects

-teeth discoloration, photosensitivity (sunscreen)

-alteration of intestinal/vaginal flora- yeast infections (vaginal candidasis), diarrhea

-coagulation irregularities, rash

tetracyclines interactions

-dairy products, calcium, antacids, iron salts (decrease effectiveness)

-oral anticoagulants, oral contraceptives

tetracyclines drugs

-cycline

-tetracycline*

-doxycycline (doryx, vibramycin):PO

tetracycline nursing implications

culture prior to therapy, take exactly as prescribed and for full length of time, avoid milk products and iron preparations, take with 6-8oz of water (decrease GI SE), labs: CBC (coagulation effects), BUN (potential increase)