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Antiinfective Medications
Chapter 12 Antiinfective Medications
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Chapter 12 Lesson 12.1
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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
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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
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Overview Pathogen Bacteria Fungi Viruses Antimicrobials
How do synthetic and natural antibiotics differ? When new groups of drugs are refined, purified, and sensitive as a result of long-term testing, they are referred to as generations. How do bactericidal drugs work to treat an infection? List a superinfection patients may acquire when using antibiotics.
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Antibiotics Broad-spectrum Narrow-spectrum Adverse reactions
Which two antibiotic classifications cause the most allergies? How do bacteriostatic antibiotics differ from bactericidal antibiotics? What body systems are often affected by drug toxicity associated with antibiotic use?
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Penicillins Main antibiotic for years Overuse
Penicillin-resistant strains Broad-spectrum drug of choice What issues can result from overuse of antibiotics?
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Penicillins (cont.) Action and Uses
Interferes with creation of the mucopeptide cell wall Used to treat multiple infections Overuse and allergies Are penicillins bacteriostatic or bactericidal? Why are antibiotics prescribed prophylactically? Some penicillins may be useful against organisms used in bioterrorism.
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Penicillins (cont.) Adverse Reactions Drug Interactions Neuropathy
High parenteral doses Skin eruptions GI symptoms Urticaria Laryngeal edema Anaphylaxis Drug Interactions 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.
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Penicillins (cont.) Nursing Implications and Patient Teaching
Assessment Signs of infection and allergies Diagnosis Planning 10-day regimen Implementation Route of administration Evaluation Patient Teaching 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?
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Sulfonamides Broad-spectrum antiinfective
Bacteriostatic action: inhibits folic acid synthesis in the cell What type of symptoms would a patient exhibit if he or she developed a superinfection while on antibiotics?
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Sulfonamides (cont.) Action and Uses Urinary tract infections
Effectively treats multiple microorganisms Preoperative and postoperative therapy for bowel surgery 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.
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Sulfonamides (cont.) Adverse Reactions Drug Interactions
Potentiate Decrease effectiveness Nursing Implications and Patient Teaching Contraindications 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?
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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?
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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?
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Broad-Spectrum Antibiotics (cont.)
Adverse Reactions Superinfections Drug interactions are individualized Food interactions Affected organs: auditory nerves, kidneys, and liver Cross-sensitivity Nursing Implications and Patient Teaching 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.
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Chapter 12 Lesson 12.2
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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
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Antitubercular Drugs Overview Underdeveloped nations Risks
Etiology: Mycobacterium tuberculosis 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?
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Antitubercular Drugs (cont.)
Action and Uses Most antitubercular drugs are bacteriostatic: have intracellular or extracellular effects that prevent the organism from building new cell walls, thus limiting growth and spread Some antitubercular drugs are bactericidal Length of treatment Chemoprophylaxis Box 12-1 High-Priority Candidates for Tuberculosis-Preventive Therapy 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?
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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?
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Antitubercular Drugs (cont.)
Drug Interactions Use of other drugs during therapy Nursing Implications and Patient Teaching Assessment Diagnosis History, chest x-ray, labs Additional patient needs Planning Length of treatment Implementation Dose Evaluation Patient and Family Teaching What administration considerations are recommended for the patient on antitubercular therapy? What governmental agency publishes treatment guidelines for tuberculosis? What laboratory test is used to evaluate treatment effectiveness? What treatment is available to the patient with an MDR strain? Family members and close contacts to the patient should be screened for tuberculosis.
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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.
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Amebicides Entamoeba histolytica Relationship to traveling
Infection sights in the body Where in the body do ameba invade? Hepatic infection is more difficult to treat than intestinal infection.
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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.
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Amebicides (cont.) Adverse Reactions
Common: nausea, vomiting, anorexia, diarrhea, GI distress, hepatic abscess Drug-specific adverse reactions Overdose Symptoms of overdose are seen with all of the antimalarial drugs. To what do the symptoms ataxia and polyuria refer?
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Amebicides (cont.) Drug Interactions Nursing Implications
Patient Teaching What should patients taking metronidazole be instructed to avoid? What factor does the drug ordered to treat amebiasis depend on? How would dehydration complicate amebicide therapy? What important patient education should the nurse include to prevent reinfection?
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Anthelmintics Helminthiasis: infestation by worms Common infestations:
Pinworms Roundworms Hookworms Tapeworms Whipworms How is the diagnosis made?
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Anthelmintics (cont.) Action and Uses Action is drug specific
Drugs used: Thiabendazole Niclosamide and paromomycin Piperazine and pyrantel pamoate Diethylcarbamazine citrate Mebendazole What is the exact action of diethylcarbamazine citrate? Where would a filarial worm be found within the body? Which drug is used to treat patients who have visited a tropical area and become infected with worms?
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Anthelmintics (cont.) Adverse Reactions Drug specific
Allergic reaction due to dead microfilaria What is the relationship among side effect, drug dosage, and treatment length? If the patient complains of myalgia, what symptoms would the patient have?
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Anthelmintics (cont.) Drug Interactions
Nursing Implications and Patient Teaching Assessment Diagnosis Planning Implementation Preventing transmission Evaluation When would the use of anthelmintic drugs be contraindicated? How can the patient prevent transmission to others in the home? The patients receiving drug therapy to treat hookworms may require what type of supplement? What are some foods that are high in iron?
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Antimalarials Action Uses Adverse Reactions Drug Interactions
Interfere with the life cycle of Plasmodium Uses Prevention and treatment Adverse Reactions Drug specific: blood dyscrasias, visual and neurologic changes Drug Interactions Drug specific: dermatologic, ototoxic, or neurologic symptoms How is malaria transmitted? In what regions of the United States is malaria seen? What are the symptoms associated with quinine poisoning?
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Antimalarials (cont.) Nursing Implications and Patient Teaching
Assessment Symptoms Diagnosis Planning Treatment is strain related Implementation Loading dose Prevention Evaluation Laboratory and diagnostic monitoring; eye examination What are the common symptoms of malaria? Caution should be used for patients being treated with quinine who have a history of cardiac dysrhythmias If a patient develops bruising while on quinine, what should the nurse suspect? Which ethnic backgrounds have an increased risk for blood dyscrasias with antimalarial drug therapy?
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