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Antiinfective Medications

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Presentation on theme: "Antiinfective Medications"— Presentation transcript:

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

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

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

4 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 new generations of that drug class. How do bactericidal drugs work to treat an infection? List a superinfection patients may acquire when using antibiotics. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

6 Penicillins 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 What issues can result from overuse of antibiotics? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

7 Penicillin Medications
Natural PCNs penicillin G Given IM; procaine /aqueous forms used to treat gonorrhea penicillin V penicillin VK+ Penicillinase resistant cloxacillin cicloxacillin naficillin oxacillin Are penicillins bacteriostatic or bactericidal? Why are antibiotics prescribed prophylactically? Some penicillins may be useful against organisms used in bioterrorism. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

8 MORE Penicillins Aminopenicillins: Broad Spectrum Extended 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.) Adverse Reactions
Neuropathy High parenteral doses Skin eruptions GI symptoms Urticaria Laryngeal edema Anaphylaxis Drug Interactions: PCN negates oral contraceptives!!! 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, putting a woman at increased risk for pregnancy. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

11 Sulfonamides 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 What type of symptoms would a patient exhibit if he or she developed a superinfection while on antibiotics? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

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

14 Tetracyclines Actions and uses Adverse Reactions Nursing Implications
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. - For which infections are tetracyclines first-line therapy? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

15 Tetracyclines 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 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

17 Cephalosporin History
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. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

18 Cephalosporin medications (all have kef-; cef-; or ceph in generic name
1st generation Duricef cefadroxil Keflex cephalexin Ancef Cefazolin Bacteriocidal 2nd generation Ceclor cefaclor Cefzil cefprozil Ceftin Cefurozime Bacteriocidal Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

19 More Cephalosporins 3rd generation Omnicef (cefdinir)
Maxipime (cefepime) Claforan (cefotaxime) Fortaz (ceftazidime) Cefizox (cefizoxime) Rocephin (ceftriaxone) 4th generation Maxipime cefepime Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

20 Cephalosporin Continued
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 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

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

23 Miscellaneous Medications
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 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

24 Aminoglycosides 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 1st. Encourage increased fluid intake to flush kidneys. Draw ‘Peak and Through’ levels to assess therapeutic levels. 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! Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

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

28 Antimalarials 4 aminoquinolones 8 aminoquinolones Aralen Plaquenil
chloroquine Plaquenil hydroxychloroquine 8 aminoquinolones All of these drugs have -quine in the generic primaquine phosphate Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

29 Antimalarials Folic acid agonist Miscellaneous agents 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. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

31 Antivirals 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 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

33 Protease inhibitors Crixivan Viracept Norvir Invirase
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’. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

34 Antifungal medications
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 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

35 Antifungal effects 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. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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


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