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Antiinfective Medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. Chapter 12 1.

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Presentation on theme: "Antiinfective Medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. Chapter 12 1."— Presentation transcript:

1 Antiinfective Medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. Chapter 12 1

2 Learning Objectives Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 2 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

3 Learning Objectives (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 3 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

4 Overview Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 4 Pathogen Bacteria Fungi Viruses Antimicrobials

5 Learning Objectives Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 5 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

6 Penicillins Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 6 Main antibiotic for years Broad-spectrum drug of choice Overuse Penicillin-resistant strains Action and Uses Interferes with creation of the mucopeptide cell wall Bacteriocidal Used to treat multiple infections Allergies

7 Penicillin Medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 7 Natural PCNs penicillin G Given IM; procaine /aqueous forms used to treat gonorrhea penicillin V penicillin VK+ Penicillinase resistant cloxacillin cicloxacillin naficillin oxacillin

8 MORE Penicillins Aminopenicillins: Broad Spectrum – amoxicillin Amoxil / Trimox – amoxicillin/ clavulanate Augmentin – ampicillin – ampicillin/ sulbactam Unasyn Extended Spectrum – pipercillin – pipercillin/ tazobactam Zosyn – ticarcillin Ticar – ticarcillin/ clavulanate Timentin

9 Penicillins (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 9 Adverse Reactions Neuropathy High parenteral doses Skin eruptions GI symptoms Urticaria Laryngeal edema Anaphylaxis Drug Interactions: PCN negates oral contraceptives!!!

10 Penicillins (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 10 Nursing Implications and Patient Teaching Assessment Signs of infection and allergies Diagnosis Planning 10-day regimen Implementation Route of administration Evaluation Patient Teaching

11 Sulfonamides Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 11 Broad-spectrum antiinfective Bacteriostatic action: inhibits folic acid synthesis in the cell Action and Uses Urinary tract infections Effectively treats multiple microorganisms Preoperative and postoperative therapy for bowel surgery

12 Sulfonamides (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 12 Adverse Reactions Drug Interactions Potentiate Decrease effectiveness Nursing Implications and Patient Teaching Contraindications Take on an empty stomach

13 Sulfonamides Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 13 Plain sulfadiazine sulfamethizole sulfasalazine Azulfidine Mixtures trimethoprim/ sulfamethoxazole Bactrim Septra Sulfatrim

14 Tetracyclines Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 14 Actions and uses Broad-spectrum antibiotics Adverse Reactions GI upset Nursing Implications Not for pregnant patients or children under 8 years of age Can cause sensitivity to light (photosensitivity) so counsel patient to be careful about sun exposure Take on empty stomach and avoid dairy within 2 hours of taking drug.

15 Tetracyclines Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 15 doxycycline minocycline oxytetracycline tetracycline Take on an empty stomach. Never give to pregnant woman or child under 8. Will turn teeth green/grey permanently. Binds with calcium products

16 Macrolides: Broad Spectrum Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 16 Zithromax; Z pack azithromycin Biaxin clarithromycin E-Mycin / EES Erythromycin Bacteriostatic or bacteriocidal depending on dosage concentration.

17 Cephalosporin History Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 17 The first generation cephalosporins are mostly active against gram positive bacteria and vary with their delivery routes and uses. Second generation cephalosporins are modified to increase spectrum against gram negative bacteria but have reduced effects against gram positive bacteria. These agents also have better membrane penetration and more B-lactamase resistance. Third generation cephalosporins include effects against pseudomonas infections, they are also useful in multi-resistant hospital acquired infections. Fourth generation cephalosporins are even more efficacious. They have an increased spectrum over third generation drugs and are excellent in multiple drug resistance patterns. The only currently available agent in this generation is cefepime.

18 Cephalosporin medications (all have kef-; cef-; or ceph in generic name Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc st generation Duricef cefadroxil Keflex cephalexin Ancef Cefazolin Bacteriocidal 2 nd generation Ceclor cefaclor Cefzil cefprozil Ceftin Cefurozime Bacteriocidal

19 More Cephalosporins Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc rd generation Omnicef (cefdinir) Maxipime (cefepime) Claforan (cefotaxime) Fortaz (ceftazidime) Cefizox (cefizoxime) Rocephin (ceftriaxone) 4 th generation Maxipime cefepime

20 Cephalosporin Continued Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 20 Made from molds like PCN. Works against cell wall synthesis like PCN does. Can be allergic to cephalosporins if also allergic to PCN. Use with caution. Give PO with food to decrease nausea and diarrhea side effects

21 Lincosamides Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 21 Cleocin clindamycin Empty stomach with full glass of water May be give as a deep IM injection

22 Fluoroquinolones (all generics end in floxacin) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 22 Cipro ciprofloxacin Levaquin levofloxacin Avelox moxifloxacin Maxaquin lomefloxacin All are excreted through the kidneys so check your patient’s renal function Potent newer medication.

23 Miscellaneous Medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 23 Bacitracin Vancocin Vancomycin – slows cell wall synthesis; damages plasma membrane making it susceptible to osmotic pressure; interferes with RNA synthesis Very irritating to the vein; dilute and give over 1 hour IV

24 Aminoglycosides Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 24 Used to treat gram negative bacteria when PCN is not an option Amikin amikacin Garamycin gentamicin Neo-fradin neomycin streptomycin sulfate TOBI (tobramycin sulfate) Very ototoxic and nephrotoxic!!! Assess renal function 1 st. Encourage increased fluid intake to flush kidneys. Draw ‘Peak and Through’ levels to assess therapeutic levels.

25 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 25 WARNING Allergic reactions can appear at any time whether you have safely taken the drug before or not. Be aware!

26 Antituberucal drugs Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 26 Primary treatment agents INH/ Isoniazid isoniazid Rifadin rifampin Priftin rifapentine Retreatment agents Seromycin Pulvules cycloserine Kantrex kanamycin Prevention in HIV patients Mycobutin (rifabutin)

27 Antiparasitic Drugs Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 27 Amebicides Aralen Chloroquine Ototoxic Flagyl/ Metrogel Metronidazole No alcohol intake Antihelminths Treat pinworms & roundworms Can taste bitter Vermox mebendazole Pin-X pyrantel Mintezol thiabendazole

28 Antimalarials Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc aminoquinolones Aralen chloroquine Plaquenil hydroxychloroquine 8 aminoquinolones All of these drugs have -quine in the generic primaquine phosphate

29 Antimalarials Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 29 Folic acid agonist Daraprim pyrimethamine Miscellaneous agents doxycycline mefloquine quinine sulfate Quinine is very bitter. Put in the back of the mouth and swallow quickly. Give fruit drink/ sweet drink to rinse mouth.

30 Chapter 13 – Antivirals (have –vir) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 30 Zovirax acyclovir Symmetrel amantadine Famvir famciclovir Tamiflu oseltamivir phosphate Virazole ribavirin Valtrex valacyclovir HCL Valcyte valganciclovir Relenza zanamivir

31 Antivirals Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 31 Most have –vir in generic or brand name. Medications decrease the viral load but do not cure. Viristatic. Goal is to prevent opportunistic infections while the body heals itself from the virus using the immune system

32 Reverse transcriptase inhibitors Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 32 Nucleoside Analogues Epivir – HBV lamivudine (3TC) Retrovir zidovudine (AZT) Nonnucleoside Analogues Ziagen abacavir sulfate Rescriptor delavirdine Viramune nevirapine

33 Protease inhibitors Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 33 Crixivan Indinavir Nephrolithiasis Viracept nelfinavir Norvir ritonavir Invirase saquinavir Take prescribed dose at ordered times. Skipping doses can lead to a resistant strain of the virus. Standard precautions continue to be needed. Look for ‘Crix belly’.

34 Antifungal medications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 34 Mycostatin - nystatin Fungizone - amphotericin B *** Diflucan - fluconazole GrifulvinV - griseofulvin Nizoral - ketoconazole Lamisil – terbinafine HCL Flagyl (metronidazole) can also be used *** protect IV fluid from light. very potent; used only with serious fungal infections

35 Antifungal effects Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 35 Mycotic infections take a while to cure. Phototoxicity – use sun screen; avoid summer sun hours Hepatotoxicity – watch the liver function studies Avoid alcohol with any of these drugs. The liver is busy clearing out the med.

36 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 36 Questions?


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