NR 566 midterm

-Things to know about each of the major antibiotic drug classes · Contraindications and high-risk patients · Know examples of each of the major antibiotic drug classes · Monitoring needs · Which ones require renal do ...

-Things to know about each of the major antibiotic drug classes · Contraindications and high-risk patients · Know examples of each of the major antibiotic drug classes · Monitoring needs · Which ones require renal dosing adjustments and how much (i.e., 25%, 50%, etc.) · Patient education · Lifespan considerations including pregnancy · Indications for use Penicillins • caution with patients allergic reactions to penicillins, cephalosporins, or carbapenems • Treats infection cause by sensitive bacteria check culture to identify infecting organism • Can order skin test to assess allergy status • adjusted doses for patients with impaired renal fnx NARROW SPECTRUM PENICILLINS: PENICILLIN SENSITIVE(PEN G &PEN V) -Mechanism of Action: “Bactericidal”- Weakens the cell wall, causing bacteria to take up excessive amounts of water and rupture. Occurs by two actions simultaneously: inhibiting transpeptidases and activating autolysins which disrupts synthesis of the cell wall and promotes the active destruction resulting in cell lysis and death. -Examples: Penicillin G (Prototype Drug), Penicillin V, Nafcillin, Oxacillin, Dicloxacillin, Ampicillin, Amoxicillin, Piperacillin Penicillin G- -First Penicillin Available and often referred to plainly as Penicillin -Bactericidal for gram negative and gram positive bacteria -Should be taken with medications whereas Penicillin V is stable in stomach acids. -Side Effects: Allergic reactions, pain at IM injection sites, prolonged (but reversible) sensory and motor dysfunction if injected into peripheral nerves, and neurotoxicity (seizures, confusion, hallucinations- if levels too high) . -Life Span Considerations: *Infants- Used safely in infants with bacterial infections including syphilis, meningitis, & group A streptococcus *Children/Adolescents- Common drug used to treat bacterial infections in children. *Pregnant- No well controlled studies but evidence suggests no 2nd or 3rd trimester fetal risk. *Breastfeeding- Amoxicillin is safe. Data is lacking about transmission of other PCNs from mother to infant through breast milk. *Older Adults- Doses should be adjusted in older adults with renal dysfunction. Penicillin Allergy: -Most common drug allergy to date with severity ranging from minor rash to anaphylaxis -Can possibly display cross sensitivity to cephalosporins and should not be used if possible -observed 30 minutes minimum post drug injection for adverse reactions -For history of PCN allergy, a skin allergy test can be done to assess current risk by injecting a tiny amount of allergen ID (only to be done where epinephrine and respiratory support is available if needed) Penicillin V- • Stable in stomach acid (Pen G is not) • Used for oral therapy, can be taken with meals NARROW SPECTRUM PENICILLIN: PENICILLIN RESISTANT: (Nafcillin, Oxacillin, Dicloxacillin) -Treats S. aureus and S. epidermidis Broad-Spectrum Penicillins (Ampicillin & Amoxicillin): -Most common side effects are rash and diarrhea (rash usually 3-10 days post TX start). -Therapy can be PO or IV and requires dosage adjustment for renal impairment -Treats Haemophilus influenzae, E. Coli, proteus mirabilis, enterococci, and Neisseria gonorrhoeae EXTENDED SPECTRUM PENICILLIN: (Piperacillin) -Treats same diseases as broad spectrum PLUS: *pseudomonas aeruginosa*, enterobacter spp, proteus, bacteroides fragilis, klebsiella spp -Can cause bleeding secondary to disrupting platelet function -Usually administered IV -Reduce dose in renal pt’s Cephalosporins (Cephalexin) -Bactericidal drug (similar to PCNs) -Increases activity against gram-negative agents -Increases ability to reach cerebral spinal fluid (CSF)-3rd,4th,5th generations -no routine lab monitoring -Administered IM or IV -Take cultures to determine sensitivity and infecting organism -Contraindicated in pt’s with severe allergic reaction to cephalosporins or penicillins - CAN CAUSE C. DIFF INFECTION (tell pt. To monitor for frequent stools) -Used to treat infants & neonates. Especially in otitis media and gonococcal and pneumococcal infections ...........................................................CONTINUED.....................................................