3Learning ObjectivesIdentify the major antiinfective drug categories and the organisms against which they are effectiveOutline the most important things to teach the patient who is taking antiinfective drugs
4Learning Objectives (cont.) Define "spectrum" and explain what this word means in antiinfective therapyList some of the most common adverse reactions to medications used to treat infections
5Overview 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.
6Antibiotics 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?
7Penicillins Main antibiotic for years Overuse Penicillin-resistant strainsBroad-spectrum drug of choiceWhat issues can result from overuse of antibiotics?
8Penicillins (cont.) Action and Uses Interferes with creation of the mucopeptide cell wallUsed to treat multiple infectionsOveruse and allergiesAre penicillins bacteriostatic or bactericidal?Why are antibiotics prescribed prophylactically?Some penicillins may be useful against organisms used in bioterrorism.
9Penicillins (cont.) Adverse Reactions Drug Interactions Neuropathy High parenteral dosesSkin eruptionsGI symptomsUrticariaLaryngeal edemaAnaphylaxisDrug InteractionsIf 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.
10Penicillins (cont.) Nursing Implications and Patient Teaching AssessmentSigns of infection and allergiesDiagnosisPlanning10-day regimenImplementationRoute of administrationEvaluationPatient TeachingIf 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?
11Sulfonamides Broad-spectrum antiinfective Bacteriostatic action: inhibits folic acid synthesis in the cellWhat type of symptoms would a patient exhibit if he or she developed a superinfection while on antibiotics?
12Sulfonamides (cont.) Action and Uses Urinary tract infections Effectively treats multiple microorganismsPreoperative and postoperative therapy for bowel surgeryIf 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.
13Sulfonamides (cont.) Adverse Reactions Drug Interactions PotentiateDecrease effectivenessNursing Implications and Patient TeachingContraindicationsWhat 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?
14Broad-Spectrum Antibiotics Bactericidal or bacteriostaticIs 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?
15Broad-Spectrum Antibiotics (cont.) Action and UsesLarge number of unrelated drugs used to treat infections caused by susceptible organismsGram-positive or gram-negative organismsAntibiotics 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?
16Broad-Spectrum Antibiotics (cont.) Adverse ReactionsSuperinfectionsDrug interactions are individualizedFood interactionsAffected organs: auditory nerves, kidneys, and liverCross-sensitivityNursing Implications and Patient TeachingWhat 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.
18Learning ObjectivesIdentify the major antiinfective drug categories and the organisms against which they are effectiveOutline the most important things to teach the patient who is taking antiinfective drugsList some of the most common adverse reactions to medications used to treat infections
19Antitubercular Drugs Overview Underdeveloped nations Risks Etiology: Mycobacterium tuberculosisWhat 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?
20Antitubercular Drugs (cont.) Action and UsesMost antitubercular drugs are bacteriostatic: have intracellular or extracellular effects that prevent the organism from building new cell walls, thus limiting growth and spreadSome antitubercular drugs are bactericidalLength of treatmentChemoprophylaxisBox 12-1 High-Priority Candidates for Tuberculosis-Preventive TherapyChemotherapy 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?
21Antitubercular Drugs (cont.) Adverse ReactionsCommon symptomsToxicity: body sights affectedCombination therapyDrug-specific symptomsWhy 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?
22Antitubercular Drugs (cont.) Drug InteractionsUse of other drugs during therapyNursing Implications and Patient TeachingAssessmentDiagnosisHistory, chest x-ray, labsAdditional patient needsPlanningLength of treatmentImplementationDoseEvaluationPatient and Family TeachingWhat 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.
23Antiparasitic 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.
24Amebicides Entamoeba histolytica Relationship to traveling Infection sights in the bodyWhere in the body do ameba invade?Hepatic infection is more difficult to treat than intestinal infection.
25Amebicides (cont.) Action and Uses Destroy invading ameba Treatment of intestinal and extraintestinal amebiasis.Drug choice depends on locationWhich drugs are used to treat Trichomonas vaginalis?Chloroquine is also used to treat rheumatoid arthritis.
26Amebicides (cont.) Adverse Reactions Common: nausea, vomiting, anorexia, diarrhea, GI distress, hepatic abscessDrug-specific adverse reactionsOverdoseSymptoms of overdose are seen with all of the antimalarial drugs.To what do the symptoms ataxia and polyuria refer?
27Amebicides (cont.) Drug Interactions Nursing Implications Patient TeachingWhat 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?
28Anthelmintics Helminthiasis: infestation by worms Common infestations: PinwormsRoundwormsHookwormsTapewormsWhipwormsHow is the diagnosis made?
29Anthelmintics (cont.) Action and Uses Action is drug specific Drugs used:ThiabendazoleNiclosamide and paromomycinPiperazine and pyrantel pamoateDiethylcarbamazine citrateMebendazoleWhat 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?
30Anthelmintics (cont.) Adverse Reactions Drug specific Allergic reaction due to dead microfilariaWhat is the relationship among side effect, drug dosage, and treatment length?If the patient complains of myalgia, what symptoms would the patient have?
31Anthelmintics (cont.) Drug Interactions Nursing Implications and Patient TeachingAssessmentDiagnosisPlanningImplementationPreventing transmissionEvaluationWhen 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?
32Antimalarials Action Uses Adverse Reactions Drug Interactions Interfere with the life cycle of PlasmodiumUsesPrevention and treatmentAdverse ReactionsDrug specific: blood dyscrasias, visual and neurologic changesDrug InteractionsDrug specific: dermatologic, ototoxic, or neurologic symptomsHow is malaria transmitted?In what regions of the United States is malaria seen?What are the symptoms associated with quinine poisoning?
33Antimalarials (cont.) Nursing Implications and Patient Teaching AssessmentSymptomsDiagnosisPlanningTreatment is strain relatedImplementationLoading dosePreventionEvaluationLaboratory and diagnostic monitoring; eye examinationWhat are the common symptoms of malaria?Caution should be used for patients being treated with quinine who have a history of cardiac dysrhythmiasIf 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?