pharma report anti infect ives

8/8/2019 Pharma Report Anti Infect Ives

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ANTIINFECTIVES

Group Report by G27


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I. Definition of Terms

Antibacterials/Antimicrobials

Substances that inhibit the growth of orkill bacteria and other microorganisms

(viruses, fungi, protozoa and ricketssiae)

Are either obtained from natural sources

or manufactured


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.

Antibiotics

Work with the bodys natural defenses

Chemicals that are produced by another

kind of antibiotic that inhibit the growth

of or kill another


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Bacteriostatic

Inhibit thegrowth of bacteria

Bactericidal

Killbacteria


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Narrow-Spectrum Antibiotics

Primarily effective against one type oforganism (e.g. Penicillin and

Erythromycin are used to treat infections

cause by gram-positive bacteria)

Broad-Spectrum Antibiotics

Can be effective against both gram-positive and gram-negative organisms


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III. Other factors that influence the

bodys ability to fight infection

Age

Ig (A, E, G)Nutrition

Organ function

WBC

Circulation


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V. General Adverse Reactions to

Antibacterials:1. Allergic reactions rash, pruritus,

hives; anaphylactic shock (vascular

shock, laryngeal edema, brochospasm,cardiac arrest, SOB)

Tx: mild allergic rxn: antihistamineanaphylaxis: epinephrine,

bronchodilators and antihistamines


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2. Superinfection secondary infection;

occurs when the normal flora is

distributed by the antibiotic therapy.

3. Organ Toxicity causes damage to

organs (kidneys, liver)


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V. What is Penicillin?

miracle drug

interferes with bacterial cell wall

synthesis by inhibiting the bacterial

enzyme that is necessary for cell division

and cellular synthesis. The bacteria die

of cell lysis (cell breakdown)


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Classes of Penicillin:

a. Broad-Spectrum Penicillins

(Aminopenicillins)

Used to treat both gram-positive and

gram-negative bacteria

Not penicillinase resistant


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Readily inactivated by beta-lactamases,thus becoming ineffective against S.

aureus (e.g. ampicillin (Omnipen),

amoxicillin (Amoxil), and bacampicillin(Spectrobid).

Amoxicillin is the most prescribedpenicillin derivative for adults and

children.


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b. Penicillinase-Resistant Penicillins(Antistaphylococcal Penicillins)

Treats penicillinase-producing S. aureus

Oral Forms: Cloxacilli (Cloxapen) and

dicloxacillin (Dynapen)


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IM and IV forms: nafcillin (Unipen) andoxacillin (Prostaphin)

Not effective against gram-negativeorganisms, and less effective than

penicillin G against gram-positive

organisms.


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c. Extended-Spectrum Penicillins

(Antipseudomonal Penicillins)

Group of broad-spectrum penicillins


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Effective against Pseudomonas

aeruginosa, a gram-negative bacillusthat is difficult to eradicate.

Not penicillinase-resistant

Pharmacologic action is similar to that

of aminoglycosides, but are less toxic.


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d.Beta-Lactamase Inhibitors

Inhibits the bacterial beta-lactamases,

making the antibiotic effective and

extending its antimicrobial effect

3 beta-lactamase inhibitors:1. clavulanic acid2. sulbactam

3. tazobactam


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Are not given alone but are combined

with a penicillinase-sensitive penicillin

such as amoxicillin, ampicillin,

piperacillin and ticarcillin

Oral use: amoxicillin-clavulanic acid

(Augmentin)

Parenteral use: ampicillin-sulbactam(Unasyn), piperacillin-tazobactam

(Zosyn), and ticarcillin-clavulanic acid

(Timentin)


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Drug Interactions

Broad-spectrum penicillins (amoxicillin

and ampicillin) may decrease the

effectiveness of oral contraceptives.

Potassium supplements can increase

the serum potassium levels when takingpotassium penicillin G orV.


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When penicillin is mixed with an

aminoglycoside in IV solution, theactions of both drugas are inactivated.


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NURSING PROCESS: Penicillins

Assessment:

Assess for allergy to penicillin.

Check for lab results especially liver enzymes.

Report elevated alkaline phosphatase,

alanine aminotransferase, aspartateaminotransferase.

Record urine output. If the amount isinadequate (


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Nursing Diagnosis:

Risk for infection

Risk for impaired tissue integrity

N

oncompliance with drug regimen

Planning:

Clients infection will be controlled and

later eliminated.


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Nursing Interventions:

Check for signs and symptoms of

superinfection, especially for clients

taking high doses of the antibiotic for aprolonged time. S/sx include stomatitis

(mouth ulcers), genital discharge

(vaginitis), and anal or genital itching.


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Examine client for allergic reaction to

the penicillin product, especially afterthe first and second doses. This may be

a mild reaction, such as a rash, or a

severe reaction, such as respiratorydistress or anaphylaxis.

Have EPINEPHRINE available tocounteract a severe allergic reaction.


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Client Teaching:

Instruct client to take all of the

prescribed penicillin product such asamoxicillin until the bottle is empty. If

only a portion of the penicillin is taken,

drug resistance to that antibacterialagent may develop in the future.


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Advise client who is allergic to penicillin

to wear a medical alert bracelet ornecklace and carry a card that indicates

the allergy.

Keep drugs out of the reach of smallchildren. Request childproofcontainers.

Inform client to report any side effects

or adverse reaction that may occur whiletaking the drug.


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Encourage client to increase fluid

intake; fluid aid in decreasing body

temperature and in excreting the drug.

Instruct client or childs parent that

chewable tablets must be chewed orcrushed before swallowing.

Advise client to take medication with

food if gastric irritation occurs and totake oral penicillin 1 hour before or 2

hours after meals to avoid delay in drug

absorption.


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Evaluation:

Clients infection wascontrolled/eliminated.


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CEPHALOSPORINS

Active against gram-positive and gram-

negative bacteria and resistant to beta-

lactamase (an enzyme that acts against beta-

lactam structure of penicillin)

Have a beta-lactam structure and act by

inhibiting the bacterial enzyme that isnecessary for cell wall synthesis. Lysis to the

cell occurs, and the bacterial cell dies.


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Generations ofCephalosporins

First generation:

Effective against gram-positive bacteria such

as Streptococci and most Staphylococci.

Effective against most gram-negativebacteria such as E. Coli and species of

Klebsiella, Proteus, Salmonella and Shigella.Destroyed by beta lactamases


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Second generation:

Same effectiveness as the first

generation.

Possesses a broader spectrum againstother gram-negative bacteria such as H.Influenza,N. Gonorrhea,N.

Meningitidis etc.Not all is affected by beta-lactamases.


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Third generation:

Same effectiveness as the first and

second generations.

Less effective against gram-positive

bacteria.

Effective in treating sepsis and many

strains of gram-negative bacilli.


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Fourth generation:

Similar to the third generation.

Resistant to most beta-lactamase

bacteria.Has a broader gram-positive coverage

than the third generations.

Also effective in treating sepsis andmany strains of gram-negative bacilli.


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NURSING PROCESS:Cephalosporins

Assessment:

Assess for allergy to cephalosporins.

RecordVS andUrine Output.

Nursing Diagnosis:

Risk for infection

Noncompliance with drug regimen


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Planning:

Clients infection will be controlled and

later eliminated.

Nursing Interventions:

Check for s/sx ofsuperinfection.


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Refrigerate oral suspensions. For IV

cephalosporins, dilute in an appropriateamount ofIV fluids (5-100 ml).

Administer

IVcephalosporins over 30-45minutes 2 to 4 times a day.

MonitorVS, urine output. Reportabnormal findings.


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Client Teaching:

Instruct client to report signs and

symptoms ofsuperinfection, such as

mouth ulcers or discharge from the analor genital area.

Advise client to ingest buttermilk oryogurt to prevent superinfection of the

intestinal flora with long term use of

cephalosporin.


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Instruct client to take complete course ofmedication even when symptoms of infection

have ceased.

Instruct client to report any side effects from

use of oral cephalosporin drugs; they mayinclude anorexia, nausea, vomiting,headache, dizziness, itching and rash.

Advise client to take medication with food ifgastric irritation occurs.


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Infuse all IV cephalosporins over 30

minutes or as ordered to prevent painand irritation.

Observe for hypersensitivity reactions.

Evaluation:

Client infection wascontrolled/eliminated.

pharma report anti infect ives

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