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Cephalosporins
- First Generation
- Second Generation
- Third Generation
- Fourth Generation
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Drug Interactions
- PCN + Tetracycline= lowers effectiveness of PCN
- PCN+ Aminoglycoside= inactivates the Aminoglycosides
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NURSING PROCESS of Cephalosporins
- Assess, assess, assess, assess, assess
- Drug effectiveness
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Adverse Effects of Cephalosporins
- Skin and mucous membranes
- Respiratory Status
- Abdomen/ GI effects
- BUN and Creatinine
- Phlebitis
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Nursing Interventions of cephalosporins
- GET THE CULTURE
- Observe for reactions
- Have epinephrine on hand
- Give with water
- Monitor urine output
- Monitor for bleeding if dosage large
- MONITOR WBC!!!
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What will you teach the patient taking cephalosporins?
- Full course
- side effects
- storage
- s/s infection
- empty stomach
- 8 oz water
- no fruit juices
- milk
- sodas
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Assess what?
- Infection
- Superinfection
- Teaching effectiveness “teach back”
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OETTEL’S OPALS
- The penicillins are one of the oldest classes of Abx.
- Many resistant strains have evolved producing the enzyme “penicillinase.”
- “Penicillinase” destroys the effect PCN
- Drug companies developed drugs resistant to “PCNase” thus PCN remains effective against “resistant” bacterial strains
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OETTEL’S OPALS
- PCN’s are used to treat a broad spectrum of infections
- -Urinary Tract Infections
- -Respiratory Infections
- Monitor client for N/V/D, superinfections,
- - Possible hypersensitive rxn’s
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Cephalosporins inhibit ______ _______ snythesis
cell wall
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CEPHALOSPORINS First Generation
- Cefazolin (Ancef & Kefzol) given IV & PO
- IV and PO
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Cephalexin (Keflex & Keftab) PO
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What are cefazolin (Andef & kefzol) & Cephalexin (Keflex & Keftab) used for
- surgical prophylaxis
- URIs
- otitis media
- (strep and staph)
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Mechanism of Action of 1st generation cephalosporins
- Both bacteriostatic and bactericidal
- Depends on dose and drug
- Interferes with cell wall synthesis
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Pharmacokinetics
- Well absorbed from GI tract
- Metabolized in the liver
- Excreted in the urine
- Cross placenta and enter breast milk
- Use caution in renal and liver impaired
- Alters drug metabolism
- Use with caution in pregnancy and lactation
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Adverse Effects of 1st Generation Cephalosporins
- Similar to PCN
- Allergic rxn’s most common
- Headache, anal /genital itching
- Skin rash common
- GI Distress..pseudomembranous colitis
- C-diff often reported with ceph’s
- Nephrotoxicity in early ceph generations
- Not so much in the newer drugs
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Major Distinctions of “Generations”
- First- generation:
- Most effective against gram + organisms
- Destroyed by beta-lactam “ase”
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Difference of Second-generation:
- More potent, more resistant to “beta-lactamase”
- Broader spectrum against gram negative organisms than 1st generation ceph’s
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Difference of Third Generation
- Longer duration of action than 2nd
- Even broader spectrum against gram –
- Resistant to beta-lactamase
- 3rd generation ceph’s DOC:
- Pseudomonas, Salmonella,
- Less effective against gram +
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Difference of 4th Generation Ceph’s
- Effective in treating septicemia
- Effective against many strains of gram –
- E-coli
- Klebsiella
- Streptococci
- Staphyloccus….certain strains
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Cephalosporins
- 1st G -cefazolin
- 2nd G -cefoxitin, cefotetan, cefuroxime
- 3rd G -cefotaxime, ceftazidine
- 4th G - Cefepime
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What do you notice about these drugs?
Start with “Cef”
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Contraindications and Cautions
- Not given to clients with known allergy
- Caution with clients allergic to PCN
- -Due to cross-sensitivity
- Caution with renal impaired
- -These drugs are nephrotoxic
- Caution in pregnancy
- -Effects to fetus unknown
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If giving cephalosporins with aminoglycosides
increases risk of Nephrotoxicity
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If giving cephalosporins with anti-coagulants
may experience increased bleeding
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If Cephalosporins consumed with alcohol
- can cause an “antabuse” like reaction
- -- severe vomiting, HA, chest pain, dyspnea, blurred vision,
- --Palpitations, cardiovascular collapse, even death.
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Prototype: Cephalexin (Keflex)
- Broad spectrum
- First generation
- Respiratory, soft tissue, bones, urinary tract, and bloodstream infections
- Contraindicated with prior severe anaphylactic reaction to PCN
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CLINICAL INDICATIONS of Keflex
- Treatment of infection
- Depends on drug/bacteria sensitivity
- Most for gram negative infections
- Clients who cannot tolerate PCN
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NURSING PROCESS
- ASSESSMENT
- NURSING DX
- IMPLEMENTATION
- --Teach
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Nursing Interventions
- CULTURE BEFORE FIRST DOSE
- Observe for superinfections or reaction
- Monitor BUN, Creatinine, UOP
- Monitor IV site for thrombophlebitis
- Monitor WBC count
- Buttermilk or yogurt to prevent diarrhea
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