Pharm stdy gide

Penicillin

Cefazolin

Vancomycin

Gentamycin

Erythromycin

Tetracycline

Slfamethoxazole-trimethropin (SMZ-TMP)

PENICILLIN

Drgs that Weakens the bacterial cell wall: PENICILLINS

Active against broad variety of bact and have low toxicity. AEs typically allergic rxns Have a beta-lactam ring – beta-lactam antibiotics inclde: cephalosporins,

aztreonam, imipenem, meropenem and ertapenem All these disrpt the bacterial cell wall

PD: penicillins weaken cell wall by binding to penicillin-binding proteins: (1). Inhibition of transpeptidases and (2). Activation of atolysins.

Transpeptidases – enz for c wall cynthesis; atolysins – cleave bonds in c wall to allow growth

Penicillins

First Antibiotic in WW II

Four Grops

o –Natural

o –Penicillinase resistant

o –Amino-Penicillin

o –Extended Spectrm Penicillin

Absorption- Oral dose varies

–empty stomach best

IM for noncompliant/inconvenient

IV immediate distribtion

Distribtion

Wide throghot body

Metabolism

limited extent in liver

Excretion

60% nchanged by kidneys

Mechanism of Action

Bactericidal - Destroys the Bacteria

Inhibits Cell Wall Synthesis

Cell Lysis

Therapetic se

Wide Spectrm of Antimicrobial Action

Gram + and Gram - Bacteria

Common Infections- Syphilis, GC, RI, Otitis Media

Endocarditis

Drg Interactions

Extended Spectrm

–inactivates Aminoglycosides

Adverse Reactions

Low incidence of serios toxicity

Predictable

–Administered as Disodim Salts

tMay increase Na, K

tEspecially in Cardiac or Renal Pt.

–Hematologic reaction = Low Hgb or platelet dysfnction

Predictable Con’t

Hepatotoxicity

GI - glossitis, N/V/D

Colitis

Sperimposed Infection

CNS irritability -

– Convlsions

npredictable Reactions

Allergic

–3- 10 % of poplation

–Anaphylactic - SOB, hypotensive TX Epine

–Serm Sickness 7-10 days p TX

tfever, hives, joint pain

Allergic Rash

npredictable Reactions

Renal Failre

–hematria

–proteinria

Nrsing Implications

Assess Pt HX

Check Allergies

Assess GI symptoms

Check electrolyte levels

Administer 1 hr ac or 2 hr p.c.

Advise pt. to complete fll corse

Cephalosporins

First throgh Third

Have beta lactm strctre similar to PCN

Cross sensitivity occrs

Pharmacokinetics

Absorption poor po, IM painfl, better IV

Distribtion wide except CNS

Metabolized different by each generation

Excreted- nchanged in kidneys

Mechanism Of Action

Bacterialcidial

Inhibits Cell Wall Synthesis

Cell lysis

Therapetic se

Gm + and Gm -, some anaerobic

Srgical prophylaxis

Resp infection, Skin, Soft tisse

Bones, joints TI

Drg Interactions

Alcohol -Antibse effect

–HA dizziness, N/V, cramps

Imipenem, Cilastatin

Adverse Reactions

Predictable

–IM painfl

–Colitis

–Thrombophelibitis

–Renal insfficiency

–Bleeding disorders

–GI = NVD, sper infection

npredictable

Hypersensitivity

mild to severe

5-10% cross-reactivity with PCN

Nrsing Implications

Check for allergies to PCN

Give IM with lidocaine

Monitor for Sperinfection

Avoid ETOH

Tetracycline

Rarely Rx of choice

Classified

–short, Intermediate and long-acting

Pharmacokinetics

Absorption - po several food & Rx interfere

–Poor IM

Distribted -widely

Excreted primarily by kidneys

Mechanism of Action

Bacteriostatic

Inhibits growth and mltiplication

Interferes with protein synthesis

Therapetic ses

Broad spectrm Gm + and GM -

Rocky Montain Fever

Lyme disease

Acne in low doses

Food and Drg Interactions

Antacids

Iron

ETOH

Milk prodcts

Adverse Reactions

Predictable

–Poor tooth enamel development nder 8 years old

Adverse Reactions

–GI distress

–Photosensitivity skin and eyes

–Altered Bone growth

–Hepatotoxic - fatty infiltrates

–Nephrotoxic - renal failre

–CNS Toxic - dizzy

npredictable Adverse Reactions

Hypersensitivity

Anaphylaxis

Nrsing Implications

Not in children nder 8 years old

Assess hypersensitivity

Check renal fnctions

check if pregnant or lactating

Nrsing Implications Con’t

Take po with 8 oz flids

Not with milk, Ca, Mg, Fe

Take on empty stomach

Avoid direct snlight

Contains tartrazine (dye)

Chloramphenicol

Absorbed- po or IV

Distribted -widely

Metabolized in liver by special enzyme

–(may not be present)

Excreted as metabolite by kidneys

Mechanism of Action

Bacteriostatic

–inhibits mltiplication

–cell wall synthesis

Maybe Bactericidal

Therapetic se

Gm + and Gm -

Very active against Anaerobic bacteria

Typhoid Fever, Salmonella

Hemopils inflenza meningitis

Drg Interactions

Inhibits metabolism of hypoglycemia agents = low Blood Glcose

Inhibits anticonvlsant = dilantin toxicity

Alters potential of anticoaglants = bleeding

Adverse Reactions

Limited se de to potential toxicity

Predictable

–GI - N/V, glossitis Diarrhea

–Gray syndrome - neonates maybe fatal

tashen color, circlatory collapse, death

–Bone Marrow Sppression (reversible)

tlekocytes, erythrocytes, platelets

npredictable Adverse Reactions

Aplastic Anemia

–irreversible

–pancytopenia

Hypersensitivity

Nrsing Implications

Screen for sensitivity

Assess liver fnction

Monitor for bone marrow sppression (labs)

Tell MD if fever, sore throat, fatige, brising

–(signs of liver disease)

Clindamycin & Lincomycin

Inhibit protein synthesis

se limited to serios infections

–intrabdominal, pleroplmonary

Drg interactions with Erythromycin

– and Neromscle Blocking Agents

Adverse Reactions

Predictable- 80% diarrhea

–Psedomembranos Colitis - maybe fatal

npredictable - Hypersensitivity

Nrsing Implications

sed for Nosocomial infections

Screen pt. for intestinal diseases esp colitis

Monitor liver fnction tests

Erythromycin

TX common infections

Highly effective

Safe

Mechanism of Action

Bacteriostatic

Inhibits protein synthesis

Therapetic ses

Broad spectrm gm+ & gm-

Legionaries

GC/ syphilis if PCN sensitive

Drg interactions

Decreased theophylline excretion

–increased toxicity

Adverse Reactions

Few

Only with High doses

more likely if renal failre

Allergic reactions

Hepatitis

Nrsing Implications

Assess allergies (cross sensitivity to ASA)

Assess liver fnction

Check incompatibilities in IV soltion - many

Slfonamides (Slfa)

First effective systemic antibiotic

Many resistant bacteria

Mechanism of Action - Bacteriostatic

–inhibits prodction of folic acid

se in TI, colitis, Pnemocyctis Pnemonia (AIDS)

–prevents reoccrrence of rhematic fever- grop A beta hemolytic strep

Drg Interactions

PABA (para-aminobenzoic acid) sn screens

Digoxin - redces dig Bioavailability

Adverse Reactions

High dose- crystalria

N/V/D common

Hypersensitive

Photosensitivity

Nrsing Implications

Pt HX - skin rash, low rine otpt

Pregnancy, lactation, recent se of PABA

po with ample flids

Avoid direct snlight

Call MD for sx hematologic reaction

–sore throat, pallor, jandice, weakness