Add to your bookmark Subscribe to Philippine Nurses feed Add to Del.icio.us StumbleUpon Add to Digg Add to Yahoo Bookmark on Google Add to furl Add to Reddit Add to Blinklist Add to Meneame Add to Fark Add to Ma.golia

Join our Nursing Review Community! Subscribe below. Its Free!

Join NurseReview.Org Community!

Get Connected With Other Nurses All Over The World! Its Free!! Enter your email to receive the Nursing Board Exam NLE Quick Result!

Email:

         Nursing Board Exam Result Subscribers PRC December NLE Quick Results Subscription


NurseReview.Org helps nurses all over the world keep in touch with each other. We provide an interactive environment where nurses can share their experience, ask questions regarding issues, provide assistance, etc.

If you want to be informed through email regarding NLE RESULTS, Nursing News, Retrogression Updates, New Nursing Board Exam Question & Answer, Latest Updates Regarding Nclex, please subscribe to us by filling in your email address above.

NOTE: You email address will be kept private and will not be distributed to spammers.

Sunday, September 28, 2008

Antibiotics Updates (advanced nclex pharmacology for nurse practitioners)

If you're new here, you may want to subscribe to our RSS feed. One advantage of subscribing to RSS feeds is that you don't have to constantly re-visit this site to check for updates within specific sections you might be interested in because your browser or Feed reader will do this for you automatically on a regular basis plus you can even get email notification. Thank you so much. Enjoy!




Antibiotics Updates (advanced pharmacology for nurse practitioners) Slideshow Transcript
Slide 1: Anti-Infective Agents Antibiotics: Sulfonamides Penicillins Cephalosporins Tetracyclines Aminoglycosides Quinolones Macrolides Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 2: Antibiotics • Medications used to treat bacterial infections • Ideally, before beginning antibiotic therapy, the suspected areas of infection should be cultured to identify the causative organism and potential antibiotic susceptibilities. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 3: Antibiotics • Empiric therapy: treatment of an infection before specific culture information has been reported or obtained • Prophylactic therapy: treatment with antibiotics to prevent an infection, as in intra- abdominal surgery Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 4: Antibiotics • Bactericidal: kill bacteria • Bacteriostatic: inhibit growth of susceptible bacteria, rather than killing them immediately; will eventually lead to bacterial death Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 5: Antibiotics: Sulfonamides One of the first groups of antibiotics • sulfadiazine • sulfamethizole • sulfamethoxazole • sulfisoxazole Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 6: Sulfonamides: Mechanism of Action • Bacteriostatic action • Prevent synthesis of folic acid required for synthesis of purines and nucleic acid • Does not affect human cells or certain bacteria—they can use preformed folic acid Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 7: Sulfonamides: sulfamethoxazole Therapeutic Uses Azo-Gantanol • Combined with phenazopyridine (an analgesic-anesthetic that affects the mucosa of the urinary tract). • Used to treat urinary tract infections (UTIs) and to reduce the pain associated with UTIs. Bactrim • Combined with trimethoprim. • Used to treat UTIs, Pneumocystis carinii pneumonia, ear infections, bronchitis, gonorrhea, etc. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 8: Sulfonamides: sulfisoxazole Therapeutic Uses Azo-Gantrisin • Combined with phenazopyridine • Used for UTIs Pediazole • Combined with erythromycin • Used to treat otitis media Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 9: Sulfonamides: Side Effects Body System Effect Blood Hemolytic and aplastic anemia, thrombocytopenia Integumentary Photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrolysis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 10: Sulfonamides: Side Effects Body System Effect GI Nausea, vomiting, diarrhea, pancreatitis Other Convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 11: Antibiotics: Penicillins • Natural penicillins • Penicillinase-resistant penicillins • Aminopenicillins • Extended-spectrum penicillins Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 12: Antibiotics: Penicillins Natural penicillins • penicillin G, penicillin V potassium Penicillinase-resistant penicillins • cloxacillin, dicloxacillin, methicillin, nafcillin, oxacillin Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 13: Antibiotics: Penicillins Aminopenicillins • amoxicillin, ampicillin, bacampicillin Extended-spectrum penicillins • piperacillin, ticarcillin, carbenicillin, mezlocillin Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 14: Antibiotics: Penicillins • First introduced in the 1940s • Bactericidal: inhibit cell wall synthesis • Kill a wide variety of bacteria • Also called “beta-lactams” Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 15: Antibiotics: Penicillins • Bacteria produce enzymes capable of destroying penicillins. • These enzymes are known as beta-lactamases. • As a result, the medication is not effective. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 16: Antibiotics: Penicillins • Chemicals have been developed to inhibit these enzymes: – clavulanic acid – tazobactam – sulbactam • These chemicals bind with beta-lactamase and prevent the enzyme from breaking down the penicillin Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 17: Antibiotics: Penicillins • Penicillin-beta-lactamase inhibitor combination drugs: – ampicillin + sulbactam = Unasyn – amoxicillin + clavulanic acid = Augmentin – ticarcillin + clavulanic acid = Timentin – piperacillin + tazobactam = Zosyn Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 18: Penicillins: Mechanism of Action • Penicillins enter the bacteria via the cell wall. • Inside the cell, they bind to penicillin-binding protein. • Once bound, normal cell wall synthesis is disrupted. • Result: bacteria cells die from cell lysis. • Penicillins do not kill other cells in the body. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 19: Penicillins: Therapeutic Uses • Prevention and treatment of infections caused by susceptible bacteria, such as: – gram-positive bacteria – Streptococcus, Enterococcus, Staphylococcus species Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 20: Penicillins: Adverse Effects • Allergic reactions occur in 0.7% – 8% of treatments – urticaria, pruritus, angioedema • 10% of allergic reactions are life-threatening and • 10% of these are fatal Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 21: Penicillins: Side Effects • Common side effects: – nausea, vomiting, diarrhea, abdominal pain • Other side effects are less common Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 22: Antibiotics: Cephalosporins • First Generation • Second Generation • Third Generation • Fourth Generation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 23: Antibiotics: Cephalosporins • Semisynthetic derivatives from a fungus • Structurally and pharmacologically related to penicillins • Bactericidal action • Broad spectrum • Divided into groups according to their antimicrobial activity Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 24: Cephalosporins: First Generation • cefadroxil • cephalexin • cephradine • cefazolin • cephalothin • cephapirin – Good gram-positive coverage – Poor gram-negative coverage Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 25: Cephalosporins: First Generation cefazolin cephalexin (Ancef and Kefzol) (Keflex and Keftab) IV and PO PO used for surgical prophylaxis, URIs, otitis media Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 26: Cephalosporins: Second Generation • cefaclor • cefonicid • cefprozil • ceforanide • cefamandole • cefmetazole • cefoxitin • cefotetan • cefuroxime – Good gram-positive coverage – Better gram-negative coverage than first generation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 27: Cephalosporins: Second Generation Cefoxitin cefuroxime (Mefoxin) (Kefurox and Ceftin) IV and IM PO Used prophylactically for Surgical prophylaxis abdominal or colorectal surgeries Does not kill Also kills anaerobes anaerobes Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 28: Cephalosporins: Third Generation • cefixime • ceftizoxime • cefpodoxime proxetil • ceftriaxone • cefoperazone • ceftazidime • cefotaxime • moxalactam – Most potent group against gram-negative – Less active against gram-positive Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 29: Cephalosporins: Third Generation cefixime (Suprax) • Only oral third-generation agent • Best of available oral cephalosporins against gram-negative • Tablet and suspension ceftriaxone (Rocephin) • IV and IM, long half-life, once-a-day dosing • Easily passes meninges and diffused into CSF to treat CNS infections Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 30: Cephalosporins: Third Generation ceftazidime (Ceptaz, Fortaz, Tazidime, Tazicef) • IV and IM • Excellent gram-negative coverage • Used for difficult-to-treat organisms such as Pseudomonas spp. • Eliminated renally instead of biliary route • Excellent spectrum of coverage Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 31: Cephalosporins: Fourth Generation cefepime (Maxipime) • Newest cephalosporin agents. • Broader spectrum of antibacterial activity than third generation, especially against gram-positive bacteria. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 32: Cephalosporins: Side Effects • similar to penicillins Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 33: Antibiotics: Tetracyclines • demeclocycline (Declomycin) • oxytetracycline • tetracycline • doxycycline (Doryx, Doxy-Caps, Vibramycin) • minocycline Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 34: Antibiotics: Tetracyclines • Natural and semi-synthetic • Obtained from cultures of Streptomyces • Bacteriostatic—inhibit bacterial growth • Inhibit protein synthesis • Stop many essential functions of the bacteria Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 35: Antibiotics: Tetracyclines • Bind to Ca2+ and Mg2+ and Al3+ ions to form insoluble complexes • Thus, dairy products, antacids, and iron salts reduce absorption of tetracyclines Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 36: Tetracyclines: Therapeutic Uses • Wide spectrum: – gram-negative, gram-positive, protozoa, Mycoplasma, Rickettsia, Chlamydia, syphilis, Lyme disease • Demeclocycline is also used to treat SIADH, and pleural and pericardial effusions Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 37: Tetracyclines: Side Effects Strong affinity for calcium • Discoloration of permanent teeth and tooth enamel in fetuses and children • May retard fetal skeletal development if taken during pregnancy Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 38: Tetracyclines: Side Effects Alteration in intestinal flora may result in: • Superinfection (overgrowth of nonsusceptible organisms such as Candida) • Diarrhea • Pseudomembranous colitis Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 39: Tetracyclines: Side Effects May also cause: • Vaginal moniliasis • Gastric upset • Enterocolitis • Maculopapular rash Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 40: Antibiotics: Aminoglycosides • gentamicin (Garamycin) • kanamycin • neomycin • streptomycin • tobramycin • amikacin (Amikin) • netilmicin Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 41: Aminoglycosides • Natural and semi-synthetic • Produced from Streptomyces • Poor oral absorption; no PO forms • Very potent antibiotics with serious toxicities • Bactericidal • Kill mostly gram-negative; some gram-positive also Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 42: Aminoglycosides • Used to kill gram-negative bacteria such as Pseudomonas spp., E. coli, Proteus spp., Klebsiella spp., Serratia spp. • Often used in combination with other antibiotics for synergistic effect. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 43: Aminoglycosides • Three most common (systemic): gentamicin, tobramycin, amikacin • Cause serious toxicities: – Nephrotoxicity (renal failure) – Ototoxicity (auditory impairment and vestibular [eighth cranial nerve]) • Must monitor drug levels to prevent toxicities Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 44: Aminoglycosides: Side Effects Ototoxicity and nephrotoxicity are the most significant • Headache • Paresthesia • Neuromuscular blockade • Dizziness • Vertigo • Skin rash • Fever • Superinfections Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 45: Antibiotics: Quinolones • ciprofloxacin (Cipro) • enoxacin (Penetrex) • lomefloxacin (Maxaquin) • norfloxacin (Noroxin) • ofloxacin (Floxin) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 46: Quinolones • Excellent oral absorption • Absorption reduced by antacids • First oral antibiotics effective against gram-negative bacteria Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 47: Quinolones: Mechanism of Action • Bactericidal • Effective against gram-negative organisms and some gram-positive organisms • Alter DNA of bacteria, causing death • Do not affect human DNA Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 48: Quinolones: Therapeutic Uses • Lower respiratory tract infections • Bone and joint infections • Infectious diarrhea • Urinary tract infections • Skin infections • Sexually transmitted diseases Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 49: Quinolones: Side Effects Body System Effects CNS headache, dizziness, fatigue, depression, restlessness GI nausea, vomiting, diarrhea, constipation, thrush, increased liver function studies Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 50: Quinolones: Side Effects Body System Effects Integumentary rash, pruritus, urticaria, flushing, photosensitivity (with lomefloxacin) Other fever, chills, blurred vision, tinnitus Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 51: Antibiotics: Macrolides • erythromycin • azithromycin (Zithromax) • clarithromycin (Biaxin) • dirithromycin • troleandomycin – bactericidal action Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 52: Instructors may wish to insert EIC Image #102: Erythromycin Formulations Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 53: Macrolides: Therapeutic Uses Strep infections • Streptococcus pyogenes (group A beta-hemolytic streptococci) Mild to moderate URI • Haemophilus influenzae Spirochetal infections • Syphilis and Lyme disease Gonorrhea, Chlamydia, Mycoplasma Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 54: Macrolides: Side Effects GI effects, primarily with erythromycin: • nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia • Newer agents, azithromycin and clarithromycin: fewer side effects, longer duration of action, better efficacy, better tissue penetration Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 55: Antibiotics: Nursing Implications • Before beginning therapy, assess drug allergies; hepatic, liver, and cardiac function; and other lab studies. • Be sure to obtain thorough patient health history, including immune status. • Assess for conditions that may be contraindications to antibiotic use, or that may indicate cautious use. • Assess for potential drug interactions. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 56: Antibiotics: Nursing Implications • It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 57: Antibiotics: Nursing Implications • Patients should be instructed to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better. • Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 58: Antibiotics: Nursing Implications • For safety reasons, check the name of the medication carefully since there are many agents that sound alike or have similar spellings. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 59: Antibiotics: Nursing Implications • Each class of antibiotics has specific side effects and drug interactions that must be carefully assessed and monitored. • The most common side effects of antibiotics are nausea, vomiting, and diarrhea. • All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 60: Antibiotics: Nursing Implications Sulfonamides • Should be taken with at least 2400 mL of fluid per day, unless contraindicated. • Due to photosensitivity, avoid sunlight and tanning beds. • These agents reduce the effectiveness of oral contraceptives. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 61: Antibiotics: Nursing Implications Penicillins • Any patient taking a penicillin should be carefully monitored for an allergic reaction for at least 30 minutes after its administration. • The effectiveness of oral penicillins is decreased when taken with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 62: Antibiotics: Nursing Implications Cephalosporins • Orally administered forms should be given with food to decrease GI upset, even though this will delay absorption. • Some of these agents may cause an Antabuse-like reaction when taken with alcohol. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 63: Antibiotics: Nursing Implications Tetracyclines • Milk products, iron preparations, antacids, and other dairy products should be avoided because of the chelation and drug-binding that occurs. • All medications should be taken with 6 to 8 ounces of fluid, preferably water. • Due to photosensitivity, avoid sunlight and tanning beds. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 64: Antibiotics: Nursing Implications Aminoglycosides • Monitor peak and trough blood levels of these agents to prevent nephrotoxicity and ototoxicity. • Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss. • Symptoms of nephrotoxicity include urinary casts, proteinuria, and increased BUN and serum creatinine levels. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 65: Antibiotics: Nursing Implications Quinolones • Should be taken with at least 3 L of fluid per day, unless otherwise specified Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 66: Antibiotics: Nursing Implications Macrolides • These agents are highly protein-bound and will cause severe interactions with other protein-bound drugs. • The absorption of oral erythromycin is enhanced when taken on an empty stomach, but because of the high incidence of GI upset, many agents are taken after a meal or snack. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Slide 67: Antibiotics: Nursing Implications Monitor for therapeutic effects: • Disappearance of fever, lethargy, drainage, and redness Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.




Article copyright NurseReview.org - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.




0 comments:


Philippine Nurses in Action

Search for Nursing Jobs Abroad!

Quick Nursing Facts:

NLE Results December 2011 Results

December 2011 Nursing Board Exam Successful Examinees for the December NLE 2011

Nursing Board Exam July 2010 NLE PRC

July 2011 Nursing Board Exam Successful Examinee PRC

List of Successful Examinees for Nursing Licensure Examination July 2011 Conducted by the PRC

We are one of the few websites to post results right after the Philippine Regulatory Board have release the list of successful examinees

Results for July 2011 NLE Board Exam

July 2011 NLE Nursing Licensure Examination Results List Of Passers

Recommended Books

Filipino Nurse del.icio.us Tag Rolls

NursingReview.Org Disclaimer

© 2008-2009 NurseReview.Org This site contains links to other Web sites. The owner of this blog has no control over the content or privacy practices of those sites. The information provided here is for general information purpose only. Comments are moderated. If in any case the owner approves a comment, it should not be taken as an endorsement of that comment. The owner doesn't claim full ownership of all photos or articles posted on this site. If the respective copyright owners wish for their photos or articles to be taken down, feel free to e-mail me and it will be taken down immediately.