1. Copyright © 2008 Lippincott Williams & Wilkins. Introductory Clinical Pharmacology Chapter 7 Penicillins

2. Copyright © 2008 Lippincott Williams & Wilkins. Group of antibiotics for treatment of susceptible pathogens Actions: Cell wall synthesis; DNA or RNA synthesis; protein synthesis Introduction

3. Copyright © 2008 Lippincott Williams & Wilkins. 4 Groups of Penicillin Natural penicillins – penicillin G and penicillin V Penicillinase-Resistant Penicillins –cloxacillin, dicloxacillin Aminopenicillins (broad sprectrum) – amoxicillin, ampicillin Extended-spectrum penicillins – mezlocillin, ticarcillin

4. Copyright © 2008 Lippincott Williams & Wilkins. Receive culture and sensitivity report Select antibiotic to which the micro-organism is sensitive Identifying the Appropriate Penicillin: Sensitivity and Resistance

5. Copyright © 2008 Lippincott Williams & Wilkins. Culture/Sensitivity Test 1.Obtain culture (cx) from patient 2.Swab cx and incubate to allow bacteria to grow (24-48 hours) Disks with different antibiotics (-) Bacteria growth around abx; bacteria is sensitive to abx; GOOD abx choice (+) bacteria growth around abx; bacteria is NOT sensitive to abx

6. Copyright © 2008 Lippincott Williams & Wilkins. Used against infectious diseases Used as initial therapy for any suspected staphylococcal (bacterial) infection Prescribed as a prophylaxis –Potential infection in high-risk patients –On a continuing basis for those with rheumatic fever or chronic ear infections Uses

7. Copyright © 2008 Lippincott Williams & Wilkins. Drug resistance becomes an issue when –Antibiotics are regularly used by a patient –A group of people live in close proximity Bacteria: –Can have a natural resistant or acquired resistance to drug, such as MRSA Resistance to Drugs

8. Copyright © 2008 Lippincott Williams & Wilkins. Gastrointestinal reactions –N/V/D Hypersensitivity reactions –Anaphylactic shock –Cross-sensitivity/cross-allergenicity (cephalosporins) Adverse Reactions

9. Copyright © 2008 Lippincott Williams & Wilkins. Contraindicated in patients with history of hypersensitivity to penicillin or the cephalosporins Use cautiously in patients with renal disease, gastrointestinal disease, pregnancy or lactation (Pregnancy Catergory C), history of allergies Contraindications and Precautions

10. Copyright © 2008 Lippincott Williams & Wilkins. Interactions Interactant DrugEffect of Interaction with Penicillin Birth control pillsDecreased effectiveness TetracyclinesDecreased effectiveness AnticoagulantsIncrease bleeding risks Beta-adrenergic blocking drugs May increase the risk for an anaphylactic reaction FoodAffects the absorption of most penicillins

11. Copyright © 2008 Lippincott Williams & Wilkins. Obtain general health history Record vital signs Obtain description of signs and symptoms Assess infected area Note patient’s general appearance Obtain culture and sensitivity test results Preadministration Assessment

12. Copyright © 2008 Lippincott Williams & Wilkins. Evaluate patient daily Notify primary health care provider if signs and symptoms worsen Ensure that additional culture and sensitivity tests are performed Conduct urinalysis, complete blood count, renal and hepatic function tests at intervals Observe patient closely for hypersensitivity Ongoing Assessment

13. Copyright © 2008 Lippincott Williams & Wilkins. Ensure patient has thorough understanding of drug, treatment, and adverse reactions Describe drug regimen; stress importance of continued and uninterrupted therapy Provide patients with appropriate teaching plan Educating the Patient and Family

14. Copyright © 2008 Lippincott Williams & Wilkins. End of Presentation