1. Antiinfective Medications
Chapter 12
Antiinfective Medications 1

2. Action of Antimicrobials
Human tissue Before treatment with antimicrobial drugs
Human tissue After treatment with antimicrobial drugs (tissue remains the same, microbes have been destroyed)

3. Antibiotics Broad-spectrum Narrow-spectrum
Narrow Spectrum-only effective on a few organisms
Broad- act against a wide variety of microbes
Which two antibiotic classifications cause the most allergies?
How do bacteriostatic antibiotics differ from bactericidal antibiotics?
Bacteria
What body systems are often affected by drug toxicity associated with antibiotic use? 3

4. Penicillins commonly end in “cillin”
Largest most effective and least toxic
Penicillin-resistant strains
Broad-spectrum drug of choice
What issues can result from overuse of antibiotics?
SUPER Germ! 4

5. Penicillins (cont.) Action and Uses Inhibit Cell wall synthesis
Used to treat multiple infections (syphilis, wound infections,prophylaxis for endocarditis)
Overuse and allergies
Are penicillins bacteriostatic or bactericidal?
Bacterialcidal
Why are antibiotics prescribed prophylactically?
Some penicillins may be useful against organisms used in bioterrorism. 5

6. Penicillins (cont.) Adverse Reactions Neuropathy Skin eruptions
High parenteral doses
Skin eruptions
GI symptoms
Urticaria
Laryngeal edema
Anaphylaxis
If the health care provider wants the action of penicillin to be prolonged, which drug is used in combination with it?
Antacids may decrease absorption of penicillin.
Laboratory results may change when penicillin is used.
What drugs increase penicillin levels?
Ampicillin use may decrease the effectiveness of oral contraceptives, making the woman at increased risk for pregnancy. 6

7. Probenecid prolongs blood levels by blocking PCN’s renal clearance
Hold it right there Penicillin!! You ain’t goin no where!

8. Penicillins (cont.) Nursing Implications and PatientTeaching
Assessment
Signs of infection and allergies
Planning
10-day regimen
cultures should be drawn prior to starting antibiotic therapy
What happens if pcn is not given in effective doses or for the length of time required?
If the patient is treated for syphilis, to what other considerations should the nurse be alert?
Why do organisms become resistant to antibiotics?
Before administering IM penicillin injections, the nurse should obtain the patient’s blood pressure and pulse. Following administration, the patient should be advised to wait 30 minutes before leaving the clinic. Why?
What signs and symptoms would the patient experiencing an allergic reaction to penicillin exhibit? 8

9. Sulfonamides root has “sulf” in name
Broad-spectrum antiinfective
Bacteriostatic action
What type of symptoms would a patient exhibit if he or she developed a superinfection while on antibiotics? 9

10. Sulfonamides (cont.) Action and Uses Urinary tract infections
Preoperative and postoperative therapy for bowel surgery
treats PCP, meningococcal meningitis, ulcerative colitis...
What is a superinfection??
If a patient has a urinary tract infection due to Escherichia coli infection, what teaching should the nurse provide?
Sulfonamides may be used to treat ulcerative colitis. 10

11. Sulfonamides (cont.) Adverse Reactions Teaching Crystaluria toxemia
fever
Teaching
drink adequate fluids (promote urinary output to 1500ml/day)
take on empty stomach
What is the rationale for encouraging fluid intake for those patients prescribed sulfonamides?
If the patient develops toxemia while taking sulfonamides, what is the cause?
A patient complaining of tinnitus reports what type of symptoms? 11

12. What is the normal BUN and CR levels?
CR= mg/dL
BUN level = 5-25mg/dL
It only takes hours to CReate 5-25 BUNs in the oven 

13. Amnioglycosides all end in “mycin” (not all that end in mycin are aminoglycosides.)
Strong antimicrobial Bactericidal drugs reserved for life threatining infections
Gentamycin (garamycin)
Amikacin (Amikin)
Tobramycin (Nebcin)

14. Aminoglycosides cont.. Side effects nephrotoxicity and ototoxicity
Nursing Considerations
monitor Peak and Trough Levels
prior to therapy what should the nurse do?
Monitor …
Premedicate with anti-emetics, antihistamines and corticosteroids to decrease side effects
The nurse should weigh patient and obtain baseline renal function

15. Broad-Spectrum Antibiotics
Bactericidal or bacteriostatic
Is culture and sensitivity testing necessary before drug therapy with a broad-spectrum antibiotic?
Which antibiotic is particularly effective for the elderly and for patients with decreased renal function? 15

16. Broad-Spectrum Antibiotics (cont.)
Action and Uses
Large number of unrelated drugs used to treat infections caused by susceptible organisms
Gram-positive or gram-negative organisms
Antibiotics are not effective in treating infections caused by viruses, parasites, or fungi.
What is a secondary infection?
How is an organism determined to be gram-positive or gram-negative?
Why is Cipro important in bioterrorism? 16

17. Broad-Spectrum Antibiotics (cont.)
Adverse Reactions
Superinfections
Drug interactions are individualized
Food interactions
Affected organs: auditory nerves, kidneys, and liver
Cross-sensitivity
What types of symptoms would the patient with a yeast infection exhibit?
Patients receiving aminoglycosides should be monitored for what types of reactions?
The nurse should read the manufacturer’s product insert information about specific drug interactions for each drug before administration.
Use of tetracyclines during pregnancy and in children under the age of 8 can cause tooth discoloration or inadequate bone or tooth development in the child.
Monitoring blood levels for “peak” and “trough” determines therapeutic range levels for those patients receiving aminoglycosides. 17

18. Learning Objectives
Identify the major antiinfective drug categories and the organisms against which they are effective
Outline the most important things to teach the patient who is taking antiinfective drugs
List some of the most common adverse reactions to medications used to treat infections

19. Tuberculosis

20. Antitubercular Drugs What does MDR refer to?
Multiple Drug Resistant Organisms
What role does the CDC have in relation to Tuberculosis treatment?
What does the term multiple-drug-resistant (MDR) refer to?
What role does the Centers for Disease Control and Prevention (CDC) have in relationship to tuberculosis treatment?
Why have states enacted laws related to the treatment of tuberculosis? 20

21. Antitubercular Drugs Isoniazid (INH,Nydrazid)
Rifampin (Rifadin, Rimactane)
Rifabutin (Mycobutin)

22. Antitubercular Drugs (cont.)
Action and Uses
Most antitubercular drugs are bacteriostatic, (some bacterialcidal)
INH (Isoniazid) only drug recommended for prophylactic therapy.
What is the current duration of prophylactic treatment?
Chemotherapy refers to taking a drug to treat a disease.
Chemoprophylaxis: taking a drug to prevent disease when the patient is at high risk for developing the disease.
How are antitubercular drugs classified?
What differentiates primary from secondary drugs used in the treatment of tuberculosis? 22

23. Antitubercular Drugs (cont.)
Adverse Reactions
Common symptoms
Toxicity: body sights affected
Combination therapy
Drug-specific symptoms
Why are combination drugs used in the treatment of tuberculosis?
What type of side-effect symptoms are common while on antitubercular drugs?
What does the term photosensitivity refer to? 23

24. Why are combination drugs used in the treatment of tuberculosis?
What are the most common side effects of Antitubercular drugs?
What are the typical s/s of active TB?
1. B/c drug resistance is likely to develop if only one is used for active TB

25. Which statement by the patient indicates that he has an accurate understanding of the functioning of an antiviral medication?
A."If I take this medication correctly, my viral infection will not reoccur.“
B."If this medication is not effective, I can take an antibiotic medication instead.“
C."If I take the medication, my symptoms will lessen and the infection will be cured.“
D."I should not expect the medication to cure my disease, but symptoms will decrease."

26. Antiparasitic Drugs Amebicides Anthelmintics Antimalarials
Parasites affecting humans are a worldwide problem.
Patient assessment should include history of recent travel outside the U.S. or Canada. 26

27. Amebicides Chloroquine (Aralen) Metronidazole (Flagyl, Metrogel)
Caused by the parasite E”ntamoeba histolytica”
Relationship to traveling
Infection sights in the body
GI or extraintestinal
Where in the body do ameba invade?
Hepatic infection is more difficult to treat than intestinal infection. 27

28. Amebicides (cont.) Action and Uses Destroy invading ameba
Treatment of intestinal and extraintestinal amebiasis.
Drug choice depends on location
Which drugs are used to treat Trichomonas vaginalis?
Chloroquine is also used to treat rheumatoid arthritis. 28

29. Amebicides (cont.) Adverse Reactions
Common: nausea, vomiting, anorexia, diarrhea, GI distress, hepatic abscess
Drug-specific adverse reactions
Flagyl:ECG changes, ataxia, confusion, blurry vision, nasal congestion, dysuria
Overdose
Symptoms of overdose are seen with all of the antimalarial drugs.
To what do the symptoms ataxia and polyuria refer? 29

30. Random questions... What are superinfections?
Pseudomembranos colitis is caused by which bacteria?
How does it manifest?
How is it treated?
What are the expected therapeutic effects of antibiotics?
How long are PCNs usually prescribed for?
Yeast, infections
C-diff, 4-6 watery stools with blood and or mucus, abd pain and fever.
Vanco and flagyl treat it
therapeutic effects…decreased wbc, temperature, and decreased local signs of infection

31. HIV Infection Acquired immunodeficiency syndrome (AIDS)
Viral disease
High mortality rate
High-risk populations include:
Homosexual and bisexual men
Intravenous drug users
People in prison
Female sexual partners of people in high-risk groups
Children born to mothers at risk
AIDS is caused by a retrovirus (currently named human immunodeficiency virus, or HIV). Retroviruses are viruses that contain ribonucleic acid (RNA) rather than deoxyribonucleic acid (RNA) as their genetic material.
More than 98% of patients with the severest form of AIDS die within 5 years of diagnosis. However, advances in treatment have significantly prolonged patient lifespan.
AIDS probably arose in central Africa in the 1950s. Today, AIDS is a disease that affects the world in epidemic proportions. 31

32. Antivirals Action and Uses Adverse Reactions
Decrease symptoms of viral infection
Lessen the symptoms of viral illness in immunocompromised patients or adults and children at risk
Adverse Reactions
Hepatotoxicity, nephrotoxicity, blood dyscrasias, peripheral neuropathies
Viral infections are not suppressed by antibiotics. Studies of viruses such as HIV, herpes, and cytomegalovirus have led to the development of a variety of antiviral drugs.
All these medications are associated with risk, and the benefit-to-risk ratio must be evaluated before their use.
These medications interact with many different products, including some not typically involved in drug reactions. 32

33. Antivirals (cont.) Nursing Implications and Patient Teaching
Medications do not cure
Follow specific storage instructions
Reporting adverse reactions
Administration
Encourage immunocompromised clients in areas with impure water supplies to drink bottled water only
Review the Nursing Process (ADPIE) as it applies to patients receiving antiviral medications.
Patient teaching is always an essential component of any medication regimen.
Patients and significant family members must be taught not only the action and uses of specific medication but also how to store and administer the product.
Why is bottled water recommended for immunocompromised patients? (Because they are at greater risk for further infections. Using bottled water, if it is available, avoids potential pathogens in untreated or poorly treated water supplies.) 33

34. Antiretrovirals Action
Interfere with the ability of a retrovirus to reproduce or replicate
Two types:
Reverse transcriptase inhibitors
Act early in viral life cycle
Protease inhibitors
Act later in viral life cycle
Antiretrovirals are an important group of drugs that slow the growth or prevent the duplication of retroviruses. They are used to limit the advance of HIV and AIDS.
Reverse transcriptase inhibitors prevent the HIV enzyme reverse transcriptase from creating HIV proviral DNA from the viral RNA. This in turn prevents more viruses from being produced. There are two categories of reverse transcriptase inhibitors: nucleoside analogue reverse transcriptase inhibitors and nonnucleoside analogue reverse transcriptase inhibitors.
Protease inhibitors result in noninfectious HIV virions being produced. 34

35. Antiretrovirals (cont.)
Uses
Slow advance of AIDS
Maintain immunity
Prevention of HIV in infants born to HIV-infected mothers
Prevention of HIV in healthcare workers exposed to HIV
Drug Interactions
Antiretrovirals are relatively new drugs and can cause severe toxic reactions: pancreatitis, peripheral neuropathy, myopathy, and less serious conditions such as mouth ulcers, rash, headaches, diarrhea, and nausea.
Why should antiretrovirals not be taken with other drugs? (They inhibit the cytochrome P-450 enzyme system in the liver, which enables the liver to metabolize medications.)
Most of the drugs used in the treatment of AIDS are toxic to the liver. Past or present history of hepatitis or hepatomegaly (enlarged liver), pancreatitis, and alcohol use or abuse could be contraindications to anteretroviral therapy.
What laboratory tests would be done to assess liver and pancreatic function? 35

36. Antiretrovirals (cont.)
Nursing Implications and Patient Teaching
Adherence is essential
Medications do not cure
Report all drugs and supplements used, including OTC and CAM
Signs and symptoms of pancreatitis
Signs and symptoms of peripheral neuropathy
Patients must be closely supervised and assessed when taking these medications. What lab tests should be done before starting these medications? During?
Encourage the client to inform his or her health care provider about ALL other medications and supplements being taken.
Signs and symptoms of pancreatitis include sudden and severe abdominal pain, nausea, fever, and leukocytosis.
If signs and symptoms of peripheral neuropathy are noted in a patient taking antiretrovirals, what is the most appropriate nursing intervention? (Alert the prescribing physician. Peripheral neuropathy is usually reversible when the medication is discontinued early.) 36

37. Antiretrovirals (cont.)
Nursing Implications and Patient Teaching
(cont.)
Routes of disease transmission
Need for social and financial support
HIV-positive patients and their families must be counseled regarding disease-transmission routes. All HIV women should be warned of the high risk of HIV transmission in breast milk. The CDC advises HIV-infected women not to breastfeed.
Psychosocial and financial factors have a significant impact on a client’s ability to adhere to the prescribed medication regime. 37

38. Antifungals Action Uses Fungistatic Fungicidal
Treat mycotic infections
Fungal-specific medications
Systemic medications
Fungi are plants that produce yeastlike or moldlike diseases called mycotic infections in humans. These can be either superficial infections or systemic infections.
Because fungi are found almost everywhere, they pose a risk for immunocompromised patients, including those taking corticosteroids.
Many opportunistic infections in AIDS patients are fungal in nature. 38

39. Antifungals (cont.) Common Antifungal Medications:
Ketoconazole (Nizoral)
Broad-spectrum fungistatic and fungicidal action
Used to treat oral thrush, candidiasis, histoplasmosis
Nystatin (Mycostatin)
Antibiotic with fungistatic and fungicidal action
Used to treat intestinal, vaginal, and oral fungal infections caused by Candida strains
These are two of the most common antifungal medications used.
Patients taking ketoconazole should be monitored closely for hepatic toxicity.
Nystatin topical cream is available OTC and is used in the treatment of vaginal Candida infections. 39

40. Antifungals (cont.) Common Antifungal Medications (cont.)
Amphotericin B (Amphotec)
Systemic drug
Griseofulvin
Activity decreased with barbiturates
Metronidazole (Flagyl)
Related drug for mixed fungal and bacterial or protozoa infections; interacts with alcohol
Amphotericin is a highly toxic drug given IV or PO to aggressively treat fungal infections. This drug is given in increasingly high dosages and is used in patients with progressive and potentially fatal fungal infections.
Griseofulvin is a common antifungal agent that is absorbed over a long period of time. Commonly, a daily dose is all that is required. It should be taken with meals high in fat to enhance absorption of the drug. Griseofulvin activity is decreased when used at the same time as barbiturates, requiring dosage adjustments of griseofulvin.
Patients taking metronidazole (Flagyl) should be counseled not to drink alcohol or ingest alcohol-containing products, because severe GI and cardiovascular responses may develop. 40

41. Antifungals (cont.) Nursing Implications and Patient Teaching
Take all the medication as ordered; do not stop when symptoms disappear
Avoid alcohol
Report nausea, vomiting, and diarrhea; watch for easy bruising, sore throat, rash, or fever
Nystatin must be shaken thoroughly before use
Intolerance to the sun (photosensitivity) can occur with griseofulvin therapy
Cleanliness of hair, skin and nails will limit spread
It may take several weeks before lab tests show that the infection is gone.
Use of alcohol while taking antifungals potentiates, or increases, the effect of the alcohol.
These medications are extremely toxic to the liver and renal system. Nausea, vomiting and diarrhea are common symptoms of toxicity. In addition, symptoms such as bruising, sore throat or fever should be reported to the physician.
Patient teaching is essential to assist with the effectiveness of the medication. Patients who stop taking these medications prematurely are at risk for superinfection.
Why do you think patients allergic to penicillin may exhibit cross-sensitivity to antifungal agents? 41