1. Antibacterial Drugs Rachel R. Boersma MS, RN, CARN

2. Organs of the Immune System

3. Overview antibiotics: chemicals produced by living microorganisms or by laboratory synthesis bateriostatic: inhibit bacterial growth bactericidal: kill bacteria pathogen: disease-producing drugs or microorganisms

4. Immune System Refresher composed of –thymus gland –lymphatic tissue –circulating cells –chemical mediators –stem cells: primitive bone marrow cells –leukocytes: WBCs

5. Immune System Refresher –lymphocytes: immune system component capable of developing into variety of other cells including—mast, basophils, macrophages, T cells –phagocytosis: engulf and digest foreign matter

6. Immune System Refresher –antigen: on cell membrane and triggers formation of antibodies

7. Immune System Refresher –4 abnormal conditions can weaken the immune system and stimulate the immune response neoplasms viral invasion autoimmune disease transplant rejection

8. Bacteria Physiology/Pathophysiology multiple routes of entry gram-positive bacteria –accept positive stain often associated with respiratory and soft tissue infection – has an easily penetrated cytoplasmic membrane

9. Bacteria Physiology/Pathophysiology gram negative bacteria –accept negative stain and often associated with infections of GI and GU, has an additional and more complex outer membrane aerobic vs. anaerobic bacteria (gangrene) culture & sensitivity – for definitive identification of bacteria

10. Bacteria Physiology/Pathophysiology broad spectrum antibiotic – interferes with a biochemical reaction common to many organisms antibiotics often given in combination due to synergistic effect prophylaxis: prevention of potential infection

11. Bacteria Physiology/Pathophysiology resistance: bacteria adapt – control achieved by careful prescriptive practices and finishing full course of treatment superinfection: overgrowth of resistant bacteria, fungi, yeasts, etc.

12. Nursing Assessment-all antibiotics Before the administration of any antibiotic, it is important to ensuring the effectiveness and appropriateness of treatment to collect data regarding: –age; –a list of medications; –hypersensitivity to drugs; –hepatic, renal, and cardiac function;

13. Nursing Assessment – all antibiotics –Hepatic, renal, and cardiac function; –Culture and sensitivity results; –Vital signs and bowel sounds; –Bleeding assessment (ecchymosis, bleeding gums); –CBC, Hgb., and Hct. values.

14. Penicillin G – prototype of natural penicillins first antibiotic introduced in 1929 IM, IV via continuous infusion bactericidal

15. Penicillin G – prototype of natural penicillins pharmacotherapeutics: strep infection, GC, meningococcal (high dose) pharmacokinetics: rapid absorption and elimination, limited penetration of blood-brain barrier has significant drug interactions with tetracyclines and other antibiotics when used concurrently other PO drugs in this group include: penicillin V, ampicillin, amoxicillin, cloxacillin

16. Nursing Issues – Penicillin G assess for any prior reactions to antibiotics evaluate kidney function (BUN, creatinine) may counteract the effect of oral contraceptives take po drugs on employ stomach take exactly as directed around the clock

17. Nursing Issues – Penicillin G take missed dose ASAP but not at the same time as next dose alert patient to symptoms of allergic reaction most common adverse effects are GI

18. Cephalosporins cefazolin (Kefzol) introduced in 1960s (3 generations) pharmacotherapeutics: multiple forms of infection IM or IV does not cross blood brain barrier interferes with cell wall synthesis

19. Cephalosporins cefazolin (Kefzol) may be bacteriostatic or bactericidal most common adverse effects are GI drug interactions with: aminoglycosides (gentamicin) oral anticoagulants ______________

20. Cephalosporins cefazolin (Kefzol) may cause disulfiram-like reaction (flushing, SOB, N/V, dizzy, chest pains, confusion, seizures …) when used with ethyl alcohol which may continue for 72 hours after drug is discontinued use with caution in anyone with impaired renal function

21. Fluoroquinolones – prototype – ciprofloxacin (______) active against both gram negative and gram positive organisms has prolonged postantibiotic effect generally well tolerated however a significant adverse reaction is arthropathy and tendon ruptures have been reported additional side effects include: GI and CV oral forms as effective as IV therapy of other antibiotics

22. Fluoroquinolones – prototype – ciprofloxacin (______) PO, IV or topical opthalmic preparation IV requires infusion in large vein take on empty stomach possible photosensitivity may occur educate pt about superinfections

23. Aminoglycosides – prototype - gentamicin useful for UTIs, gyn infections, soft tissue, etc. IM or IV dosing, occasionally PO for specific local effect may be bacteriostatic or bactericidal may trigger severe adverse reactions

24. Aminoglycosides – prototype - gentamicin has many serious side effects including: nephrotoxicity, ototoxicity and neuromuscular blockade consistent (often daily) monitoring required monitored via peak and trough levels 30 min post dose and 30 min prior to next dose may cause CNS and GI symptoms multiple drug-drug interactions reported

25. Macrolide Antibiotics – prototype erythromycin (E-Mycin) same family as Z-pak (Zithromax) useful for those allergic to the penicillins good oral absorption but requires empty stomach

26. Macrolide Antibiotics – prototype erythromycin (E-Mycin) IV form is extremely irritating to veins infuse over 30-60 minutes GI history extremely important due to risk of antibiotic associated colitis related to clostridium overgrowth has significant ototoxic effects multiple drug-drug interactions including: benzodiazepines, carbamazepine, digoxin, oral anticoagulants…

27. Lincosamides – prototype clindamycin (Cleocin) very powerful drug effective over wide range of both aerobic and anerobic bacteria bactericidal in action used for serious to life-threatening infections caused by anaerobes, streptococci, staphylococci, etc. serious adverse effects: colitis may potentiate anesthetic effects