1. Copyright © 2008 Lippincott Williams & Wilkins. Introductory Clinical Pharmacology Chapter 8 Cephalosporins

2. Copyright © 2008 Lippincott Williams & Wilkins. Introduction Effective in the treatment of all strains of bacteria affected by penicillins and some strains resistant to penicillins Classification: Divided into first-, second-, third-, and fourth-generation drugs Uses: Treat urinary tract infections; skin infections; hospital-acquired pneumonias

3. Copyright © 2008 Lippincott Williams & Wilkins. Examples of Cephalosporins Keflex / cephalexin Ancef / cefazolin Ceclor / cefaclor Rocephin / ceftriaxone

4. Copyright © 2008 Lippincott Williams & Wilkins. Cephalosporins: Actions Exert bactericidal effect Targets the bacterial cell wall, making it defective and unstable

5. Copyright © 2008 Lippincott Williams & Wilkins. Cephalosporins: Uses Used to treat infections caused by bacteria –Respiratory –Ear –Bone/joint –Genitourinary tract infections Culture and sensitivity tests: Help determine best antibiotic to control an infection Used throughout perioperative period

6. Copyright © 2008 Lippincott Williams & Wilkins. Cephalosporins: Adverse Reactions Gastrointestinal reactions –Nausea; vomiting; diarrhea Administration route reactions –Intramuscularly; intravenously –Pain at site of injection/infusion

7. Copyright © 2008 Lippincott Williams & Wilkins. Other body system reactions –Headache; dizziness; malaise; heartburn; fever; nephrotoxicity; hypersensitivity; aplastic anemia; toxic epidermal necrolysis –Nursing alert Allergy: Approximately 10% of people allergic to penicillin are also allergic to cephalosporins Cephalosporins: Adverse Reactions (cont’d)

8. Copyright © 2008 Lippincott Williams & Wilkins. Cephalosporins: Contraindications and Precautions Contraindicated in patients allergic to cephalosporins or penicillins Used cautiously in patients with: –Renal disease; hepatic impairment; pregnancy (Category B); known penicillin allergy

9. Copyright © 2008 Lippincott Williams & Wilkins. Cephalosporins: Interactions DrugCommon useEffect of interaction AminoglycosidesAnti-infectiveIncreased risk for nephrotoxicity Oral anticoagulants Blood thinnerIncreased risk for bleeding

10. Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Assessment Preadministration assessment –Obtain general health history before first dose –Check for need of cultures and sensitivity tests

11. Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Assessment (cont’d) Ongoing assessment –Evaluate response to therapy –If infection worsens, notify primary health care provider –Check for signs and symptoms of infection

12. Copyright © 2008 Lippincott Williams & Wilkins. Educating the patient and family –Review dosage regimen with the patient and family –Advise to complete full therapy and adhere to timing –Explain to shake oral suspensions and keep refrigerated –Advise to avoid alcohol and take with food if GI upset Nursing Process: Implementation

13. Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Evaluation Therapeutic effect achieved Urine output at least 500 mL daily; diarrhea not experienced Patient and family demonstrate understanding of drug regimen Patient verbalizes importance of compliance with prescribed therapeutic regimen Skin is free of inflammation, irritation, or ulcerations

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