antiinfective medications copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by mosby, an imprint...

Antiinfective Medications

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Chapter 12

1

Learning Objectives

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.2

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

Learning Objectives (cont.)


Define "spectrum" and explain what this word means in antiinfective therapy

List some of the most common adverse reactions to medications used to treat infections

Overview


PathogenBacteriaFungiVirusesAntimicrobials

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

Penicillins


Main antibiotic for yearsBroad-spectrum drug of choiceOverusePenicillin-resistant strainsAction and UsesInterferes with creation of the mucopeptide

cell wallBacteriocidalUsed to treat multiple infectionsAllergies

Penicillin Medications


Natural PCNspenicillin G

Given IM; procaine /aqueous forms used to treat gonorrhea

penicillin Vpenicillin VK+

Penicillinase resistantcloxacillincicloxacillinnaficillinoxacillin

MORE Penicillins

• Aminopenicillins:Broad Spectrum

– amoxicillin• Amoxil / Trimox

– amoxicillin/ clavulanate• Augmentin

– ampicillin– ampicillin/ sulbactam

• Unasyn

• Extended Spectrum– pipercillin– pipercillin/ tazobactam

• Zosyn

– ticarcillin• Ticar

– ticarcillin/ clavulanate• Timentin

Penicillins (cont.)


Adverse Reactions Neuropathy

High parenteral dosesSkin eruptionsGI symptomsUrticariaLaryngeal edemaAnaphylaxis

Drug Interactions: PCN negates oral contraceptives!!!

Penicillins (cont.)


Nursing Implications and Patient TeachingAssessment

Signs of infection and allergiesDiagnosisPlanning

10-day regimenImplementation

Route of administrationEvaluationPatient Teaching

Sulfonamides


Broad-spectrum antiinfectiveBacteriostatic action: inhibits folic acid

synthesis in the cellAction and Uses Urinary tract infectionsEffectively treats multiple microorganismsPreoperative and postoperative therapy for

bowel surgery

Sulfonamides (cont.)


Adverse ReactionsDrug InteractionsPotentiateDecrease effectiveness

Nursing Implications and Patient TeachingContraindicationsTake on an empty stomach

Sulfonamides


Plainsulfadiazinesulfamethizolesulfasalazine

Azulfidine

Mixturestrimethoprim/

sulfamethoxazoleBactrimSeptraSulfatrim

Tetracyclines


Actions and usesBroad-spectrum antibioticsAdverse ReactionsGI upsetNursing ImplicationsNot for pregnant patients or children under 8

years of ageCan cause sensitivity to light (photosensitivity) so

counsel patient to be careful about sun exposureTake on empty stomach and avoid dairy within 2

hours of taking drug.

Tetracyclines


doxycyclineminocyclineoxytetracyclinetetracycline

Take on an empty stomach.Never give to pregnant woman or child under

8. Will turn teeth green/grey permanently.Binds with calcium products

Macrolides: Broad Spectrum


Zithromax; Z packazithromycin

Biaxinclarithromycin

E-Mycin / EESErythromycin

Bacteriostatic or bacteriocidal depending on dosage concentration.

Cephalosporin History


The first generation cephalosporins are mostly active against gram positive bacteria and vary with their delivery routes and uses.

Second generation cephalosporins are modified to increase spectrum against gram negative bacteria but have reduced effects against gram positive bacteria. These agents also have better membrane penetration and more B-lactamase resistance.

Third generation cephalosporins include effects against pseudomonas infections, they are also useful in multi-resistant hospital acquired infections.

Fourth generation cephalosporins are even more efficacious. They have an increased spectrum over third generation drugs and are excellent in multiple drug resistance patterns. The only currently available agent in this generation is cefepime.

http://sitemaker.umich.edu/medchem10/cephalosporins_2

Cephalosporin medications(all have kef-; cef-; or ceph in generic name


1st generationDuricef

cefadroxilKeflex

cephalexinAncef

Cefazolin

Bacteriocidal

2nd generationCeclor

cefaclorCefzil

cefprozilCeftin

Cefurozime

Bacteriocidal

More Cephalosporins


3rd generationOmnicef (cefdinir)Maxipime

(cefepime)Claforan

(cefotaxime)Fortaz

(ceftazidime)Cefizox

(cefizoxime)Rocephin

(ceftriaxone)

4th generationMaxipime

cefepime

Cephalosporin Continued


Made from molds like PCN.Works against cell wall synthesis like PCN

does.Can be allergic to cephalosporins if also

allergic to PCN. Use with caution. Give PO with food to decrease nausea and

diarrhea side effects

Lincosamides


Cleocin clindamycin

Empty stomach with full glass of waterMay be give as a deep IM injection

Fluoroquinolones(all generics end in floxacin)


Ciprociprofloxacin

Levaquinlevofloxacin

Aveloxmoxifloxacin

Maxaquinlomefloxacin

All are excreted through the kidneys so check your patient’s renal function

Potent newer medication.

Miscellaneous Medications


BacitracinVancocin

Vancomycin – slows cell wall synthesis; damages plasma membrane making it susceptible to osmotic pressure; interferes with RNA synthesis

Very irritating to the vein; dilute and give over 1 hour IV

Aminoglycosides


Used to treat gram negative bacteria when PCN is not an option

Amikinamikacin

Garamycingentamicin

Neo-fradinneomycin

streptomycin sulfateTOBI (tobramycin

sulfate)

Very ototoxic and nephrotoxic!!!

Assess renal function 1st.

Encourage increased fluid intake to flush kidneys.

Draw ‘Peak and Through’ levels to assess therapeutic levels.


WARNING

Allergic reactions can appear at any time whether you have safely taken the drug before or not. Be aware!

Antituberucal drugs


Primary treatment agentsINH/ Isoniazid

isoniazidRifadin

rifampinPriftin

rifapentine

Retreatment agentsSeromycin

Pulvulescycloserine

Kantrexkanamycin

Prevention in HIV patientsMycobutin (rifabutin)

Antiparasitic Drugs


AmebicidesAralen

ChloroquineOtotoxic

Flagyl/ MetrogelMetronidazoleNo alcohol intake

AntihelminthsTreat pinworms &

roundwormsCan taste bitterVermox

mebendazolePin-X

pyrantelMintezol

thiabendazole

Antimalarials


4 aminoquinolonesAralen

chloroquinePlaquenil

hydroxychloroquine

8 aminoquinolonesAll of these drugs

have -quine in the genericprimaquine

phosphate

Antimalarials


Folic acid agonistDaraprim

pyrimethamine

Miscellaneous agentsdoxycyclinemefloquinequinine sulfateQuinine is very bitter. Put in the back of the mouth and swallow quickly. Give fruit drink/ sweet drink to rinse mouth.

Chapter 13 – Antivirals (have –vir)


Zoviraxacyclovir

Symmetrelamantadine

Famvirfamciclovir

Tamifluoseltamivir

phosphate

Virazoleribavirin

Valtrexvalacyclovir HCL

Valcytevalganciclovir

Relenzazanamivir

Antivirals


Most have –vir in generic or brand name.Medications decrease the viral load but do

not cure.Viristatic.Goal is to prevent opportunistic infections

while the body heals itself from the virus using the immune system

Reverse transcriptase inhibitors


Nucleoside AnaloguesEpivir – HBV

lamivudine (3TC)Retrovir

zidovudine (AZT)

Nonnucleoside AnaloguesZiagen

abacavir sulfateRescriptor

delavirdineViramune

nevirapine

Protease inhibitors


CrixivanIndinavirNephrolithiasis

Viraceptnelfinavir

Norvirritonavir

Invirasesaquinavir

Take prescribed dose at ordered times.

Skipping doses can lead to a resistant strain of the virus.

Standard precautions continue to be needed.

Look for ‘Crix belly’.

Antifungal medications


Mycostatin - nystatinFungizone - amphotericin B ***Diflucan - fluconazoleGrifulvinV - griseofulvinNizoral - ketoconazole Lamisil – terbinafine HCL

Flagyl (metronidazole) can also be used*** protect IV fluid from light. very potent; used only with serious fungal infections

Antifungal effects


Mycotic infections take a while to cure. Phototoxicity – use sun screen; avoid

summer sun hoursHepatotoxicity – watch the liver function

studiesAvoid alcohol with any of these drugs. The

liver is busy clearing out the med.


Questions?

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