1. NURS 1950 Antibiotics and other Agents
Metropolitan Community College
Nursing Program
Nancy Pares, RN, MSN

2. In the beginning……. Before Antibiotics 1936…Sulfonamide discovered
Infections treated topically with ‘poultice’ or surgically removed
1936…Sulfonamide discovered
Beginning of understanding of microbes
1941…Penicillin introduced
WWII had great results with high volume data
Present ….
Man vs. microbe= resistant pathogens

3. Peak effect Trough effect 15-30 min after infusion has begun
Lowest point of medication effect
Draw blood just before the next scheduled dose

5. Chain of infection….recall

7. Objective 1: Identify the body’s natural defenses against infections
Barriers/prevention
Intact skin, adequate nutrition, respiratory cilia, immune system
Seek and Destroy
WBC, adequate blood supply, intestinal flora, vaginal flora, stomach acids

8. Objective 2: Describe factors that increase the susceptibility of the body to infection
Virulence of the pathogen
Number of pathogens
Chronic illness
Poor nutrition
Diseases/drugs that decrease the immune system
Entry point
Super infections

9. Host Factors May need prophylactic therapy
Status of immune system
May need prophylactic therapy
Location of the infection
Many drugs do not cross blood brain barrier
Extent of inflammation
Decrease circulation of drug
Age: metabolization of drug
Pregnancy: risks to fetus vs. benefit of drug
Genetics: enzyme deficiencies do not allow antibiotics to clear system

11. Obj. 3: Name the lab tests done to identify the invading pathogen
Should be done before antibiotic initiated
Microscopic examination
Urine, stool, blood, spinal fluid, sputum, purulent drainage
Identify the organism and test with antibiotics
Culture and sensitivity testing
Preliminary results within 24 hours
Final results in 2-3 days

12. Obj. 4: Identify factors utilized to select an appropriate antibiotic
Covered in objective 2

13. Obj. 5 Explain what resistance means and the various types of resistance
Passive immunity
A person has been given vaccine
Active immunity
Has had the disease
Acquired resistance
Bacteria have randomly mutated and can transmit mutated bacteria to others
Healthcare practitioners role
Use antibiotics when indicated
Prophylaxis: deep tissue injury, prosthetic heart valves

14. Antibiotics do not create mutations
NOTE
Antibiotics do not create mutations

15. Obj. 6: Define narrow spectrum and broad spectrum
Effective on limited number of organisms
Broad
Effective on many organisms; often used first
Bacteriocidal
Kills
Bacteriostatic
Prevents growth and reproduction

16. Obj. 7: Describe adverse reactions to antibiotics
Hypersensitivity
Can result in anaphylactic shock/death
15% of penicillin users
Treat with Benedryl, corticosteroids, epinephrine
Cross sensitivity
When antibiotics are closely related chemically
Organ toxicity
Liver, kidneys, CNS, GI is most common
Vancomycin highly nephrotoxic
Gentamycin highly ototoxic

17. Adverse reactions con’t
Hematotoxicity
Chloramphenicol
Causes aplastic anemia
Bone marrow cannot make red blood cells

18. Obj. 8 Discuss the penicillins and identify specific penicillin preparations
Action/use
Kill bacteria by disrupting cell wall; chemical make up responsible is beta lactam ring—
some bacteria secrete enzyme that splits the beta lactam ring allowing the bacteria to become resistant
Chemical modifications
Penicilinase resistant, broad spectrum, extended spectrum
Treatment of pneumonia, skin, bone and joint infections, blood infections, gangrene, meningitis

19. Penicillins cont Routes Adverse effects Nursing considerations
PO, IM, IV
Adverse effects
Hypersensitivity most common
Nursing considerations
VS, assess previous reactions, lab (electrolytes, renal function, ECG, Observe for IV reaction within 30 min; client teaching; decrease effects of contraceptives; take on empty stomach
Pen G Procaine—not given IV= lethal
Prototype: Pen G Potassium

21. Obj.9 Discuss various cephalosporin preparations
Action/Use
Bacteriocidal by attaching to penicillin binding proteins to inhibit cell wall synthesis
Gram negative infections and when less expensive penicillins are not tolerated; 5-10% of people allergic to penicillin are also allergic to cephalosporins
Adverse reactions
Hypersensitivity; kidney toxicity
Prototype—Cefotaxime (Claforan)

22. Cephalosporin classifications
First generation
Most effective against gram neg; beta lactamase producing organisms usually resistant
Second generation
More potent, broader spectrum, moderately resistant to beta lactamase organisms
Third generation
Longer duration of action, resistant to b-lactamase
Drugs of choice for pseudomonas, klebsiella, neisseria, salmonella and H. influenza
Fourth generation-treat CNS infections
Use: gram + cocci; gram - bacilli

23. Cephalosporins Nursing considerations
Assess for bleeding disorders-check PT levels
Interferes with Vit K metabolism
Assess kidney and liver function labs
Important in Vit K production
Assess concurrent meds: (NSAIDS)
Monitor I&O
Assess GI symptoms
Client teaching
Cultured dairy (superinfection prevention); avoid alcohol use, complete full RX; IM inj. painful

24. Obj. 10 Discuss tetracycline , including nursing implications
Action/Use
Bacteriostatic; inhibits protein synthesis to slow microbial growth
Rocky Mtn Spotted fever, typhus, cholera, Lyme disease, peptic ulcers (caused by H. pylori), chlamydial infections
S/E
n/v, diarrhea, photosensitivity, permanent discoloration of teeth <8 yo

26. Tetracycline con’t Nursing considerations
Avoid use <8 yo, avoid sunlight/UV exposure; monitor labs (CBC, liver function, kidney function)
Teach importance of oral and perineal hygiene due to super infections
Do not take with milk products, iron supplements, or antacids; wait 1-3 hrs before taking antacids; wait 2 hrs before and after taking lipid lowering drugs (Ca+ and iron bind with tetracycline)
Decreases effectiveness of oral contraception
Prototype: tetracycline

27. Obj. 11 Describe the uses, s/e, nursing implications of the various aminoglycosides
Action/use
Bacteriocidal; inhibits protein synthesis
Aerobic gram neg bacteria (e. coli, seratia, proteus, klebsiella, pseudomanas); administered with other antibiotic for entercocci infections.
S/E
Irreversible ototoxicity, nephrotoxicity, respiratory paralysis
Prototype: Gentamycin (Garamycin)

28. Aminoglycosides cont Nursing considerations
Monitor for ototoxicity (How?)
Monitor for nephrotoxicity (How?)
Provide optimal oral hygiene
IV administration should be done slowly
Poorly absorbed via GI—only route is IV
Monitor peak and trough levels for toxicity

30. Obj. 12 Discuss uses of quinolones and macrolides
Quinolones/fluoroquinolones
First introduced in 1962
Currently four generations
Macrolides
Low doses-bacteriostatic
High doses-bacteriocidal
Prototype: e mycin

31. Quinolones S/E/route Prototype:Ciprofloxicin (Cipro)
Action/Use
Bacteriocidal;inhibit enzymes (DNA gyrase and topoisomerase) to affect DNA synthesis;gram neg microbes
Respiratory, GI, GU tracts; skin and soft tissue; newer agents very effective against anerobes
S/E/route
n/v; ADVERSE: dysrhythmias,liver failure and CNS changes; not used in pregnancy; caution in children; oral BID
Prototype:Ciprofloxicin (Cipro)
Most common= levaquin

32. Quinolones Nursing considerations:
Assess hypersensititivity; report neurologic effects
Phototoxicitity
Don’t take with vitamins/mineral supplements (or wait 2 hrs before and after
Monitor labs
I & O
Take all the prescription

33. Macrolides S/E—very few Prototype: erythromycin (E-Mycin) Action/Use
Binds to bacterial ribosome to inhibit synthesis (act inside cell); bacteriostatic; effective against gram + and -;treats whooping cough,
Legionaire’s disease, H. influenza and Mycoplasma pneumoniae
Newer drugs synthesized from erythromycin— less GI disturbance
S/E—very few
Prototype: erythromycin (E-Mycin)

34. Macrolides Nursing considerations Do not use in pregnancy
Assess history of hypersensititivity
Monitor labs (liver and kidney, INR)
Macrolides decrease warfarin metablism and excretion
Photosensitivity
Complete the course of treatment

35. # 13 Describe Misc. drugs Clindamycin (Cleocin)
Grm + and – effectiveness
Use: oral infections
Contraindication: hypersensitivity
Limited use due to association w pseudomenbranous colitis

36. Misc. agents cont Sulfonamides
Action:bacteriostatic, broad spectrum, used for UTI
Classified by route of administration
Systemic and topical
Systemic
Sulfisoxazole (Gantrisin)
topical
Sulfadoxine (Fansidar)- not 1st choice drug
Contraindicated in pregnancy and infants < 2 years (promotes jaundice);low soluability causes crystals in urine

37. Misc. agents Vancomycin ( Vancocin)
Reserved for severe infections; most effective with MSRA; need peak and trough labs
Sensititivity reaction: hypotension and rash with rapid IV infusion (Red Man Syndrome)
Imipenim (primaxin)—carbapenem category
Bacteriocidal; preparation specific for IV vs IM
Stable for 4 hrs; synergistic effects with aminoglycosides
Use; septicemia/bacterial meningitis

38. Misc agents Ketolides Glycylcyclines Use: respiratory infections
Low incidence of adverse effects
Glycylcyclines
Use: complicated skin infections; MSRA

39. 14: patient education for anbx
Nursing Dx
Pain related to infection
Infection
Hyperthermia
Risk for injury related to adverse drug effects
Deficient knowledge related to drug therapy
Risk for deficient fluid volume r/t fever, diarrhea from adverse drug effect
Risk for non compliance r/t deficient knowledge, cost of drug, drug effects

40. Planning
Client will
Report diminished signs and symptoms of infection; decreased fever and fatigue; increased appetite
Be free from or experience minimal adverse effects
Verbalize understanding of the drugs use, adverse effects and required precautions
Demonstrate proper self administration

41. Implementation Monitor vs and symptoms of infections
Monitor hypersensitivity reaction
Monitor for severe diarrhea
Admin drug as ordered
Monitor for superinfection
Precaution regarding OTC
Monitor for photosensitivity
Determine food and drug interactions
Monitor IV site

42. Evaluation
Patient
reports diminished signs and symptoms of infection, decreased fever
Is free from or experiences minimal adverse effects
Verbalizes and understanding of the drugs use, effects and precautions
Demonstrates proper self admin.

43. 15: Antitubucular drugs Tuberculosis: Cause: Incidence:
Mycobacterium tuberculosis
Incidence:
Treatment: prolonged due to cell wall resistance to penetration by anti infective drugs
Multiple drug concurrently
Rifampin: used for H influenza

44. Tuberculosis cont Isoniazid (INH) Action: Use: S/E
Inhibits synthesis of cell wall
Use:
tuberculosis
S/E
Numbness of hands, feet; rash; fever
Contraindicated: hepatic disease; do not take with antacids

45. 16: antifungal agents General Action: Amphoericin B (Fungizone)
Inhibit ergosteral synthesis
Amphoericin B (Fungizone)
Systemic
New class: echinocandins
Used for systemic mycoses
Caspofungin: treats aspergilosis

46. Antifungals Azoles Fluconazole (Diflucan) Nystatin (Mycostatin)
Action/use
Penetrates most body membranes; interferes with synthesis of ergosterol
Nystatin (Mycostatin)
Superficial antifungal
Swish and swallow
Glycemic control changes occur
Do not use intravaginally with pregnancy or lactating moms

47. 17: Antivirals Nonnucleoside reverse transcriptase inhibitors (NRTI)
Action: binds to viral transcript and dis allows the DNA action
Prototype: efavirenz (Sustiva)
Nucleoside and nucleotide reverse transcriptase inhibitors (NNRTI)
Action: creates a defective DNA by replacing one of the nucleotides
Prototype: Zidovudine (AZT)

48. Antivirals cont Protease inhibitors Fusion inhibitor:
Lopinavir (Kalentra)
Combination drug of lopinavir and ritonavir
Action: inhibits hepatic breakdown of lopinavir
Fusion inhibitor:
Action: blocks fusion of HIV viron to DC4 receptor

50. 18: Nursing process for antivirals
Assessment

51. Nursing Process: Diagnosis
Infection RT
Risk of transmission of infection RT
Risk for infection RT
Risk for injury RT
Deficient knowledge RT

52. Nursing Process: Goals
To prevent…
To alleviate..
To improve…

53. Nursing Process: Implementation
Client teaching