Pharm 4 antibacterials

C&S

consider selective toxicity & classification of the drug

IV

drugs kill microbe without harming host cells

• 1. susceptible organism
• 2. mechanism of action
• 3. bactericidal or bacteriostatic

w/in first 30 minutes of admin

bactericidal - kills microbe

• bacteriostatic - inhibit growth
• depends on body's defense mechanism more than bactericidal

• 1. pathogen causing infection
• 2. drug susceptibility
• 3. broad or narrow spectrum
• 4. time takes drug to fight pathogen
• 5. infection site
• 6. pt health/assessment

give broad spectrum ABX until C&S is done then give correct ABX

must draw culture sample before giving ABX or ABX will mess up the samples

• 1. limits potential for AE like superinfection
• 2. more specific

combination therapy

more likely to kill normal flora

superinfection- infection that occurs during Tx of primary infection

suprainfection- secondary infection usually caused by an oppurtunistic infection

ABX can kill normal flora & may cause:

• 1. superinfection with secondary microbe
• 2. resistant microbe

• 1. gram staining
• 2. C&S

• 1. gram + or -
• 2. aerobic or anaerobic

gram +

broad spectrum ABX

• 1. microbe produces drug inactivating enzymes
• 2. improper drug conc., dose strength, or length b/t doses
• 3. not taking all the drug
• 4. prophylactic use of ABX

ancef

• 1. MRSA - methicillin-resistant staphylococcus aureus
• 2. MDR - TB - multiple drug resistant mycobacterium tuberculosis
• 3. Penicillin-resistant streptococcus pneumoniae
• 4. VRE - vancomycin resistant enterococcus

do assessment and be sure it is not allergic response

in the urine

Treated with multiple drugs & long-term

take ASAP but never double up

• 1. how long it takes ABX to work
• 2. keep away from CH
• 3. S/S of AE and allergic reaction
• 4. women of CH-bearing age need back-up BC b/c interferes with oral contraceptives

• 1. throat discomfort of any kind
• 2. sunburn-like rash
• 3. itching

penicillin and cephalosporins

vancomycin

• 1. penicillin
• 2. cephalosporins
• 3. monobactams
• 4. carbapenems
• 5. vancomycin

• similar
• cross allergies

monobactams

can be taken with penicillin allergy

beta lactam

special ring chemical structure of penicillins and their family that is essential for their ABX activity

• 1. narrow-spectrum penicillinase sensitive
• 2. narrow spectrum penicillinase resistant
• 3. broad-spectrum
• 4. extended spectrum

Pen VK

give on empty stomach

penicillin aqueous

NVD

allergic reaction/anaphylaxis

contraindicated with allergies to penicillin, cephalosporins, and imipenem

allergic responses

1st

within the first 30 minutes of admin

EPI & resusitation equipment

• 1. check for allergies to penicillin, any other "cillins", or cephalosporins
• 2. check C&S

• 1. Evaluated effectiveness of drug/improvement
• 2. monitor for suprainfections:  candida
• 3. monitor I&O & s/s of allergic response

make sure kidneys not affected

drugs that may be given with penicillins or other beta-lactam drugs

binds to beta-lactamase produced by bacteria that stops the action of penicillin

allows penicillin to reach target site so it can act

pneumonia, pharyngitis, tonsillitis, endocarditis, scarlet fever, tetanus, anthrax, meningitis, syphilis, diptheria,

• 1. monobactams
• 2. carbapenems
• 3. cephalosporins

gram negative aerobic bacteria

gram + or anaerobe

have very diff chem structure from others

aztreonam/Azactam

penem

broad

• 1. ertapenem/Invanz
• 2. meropenem/Merrem

• 1. abdominal infections like peritonitis
• 2. nosocomial infections

renal insufficiency

gram positive & anaerobes

GI or GU surgery

they are very similar in structure

macrolides/erythromycin

they are effective and cheap

resistance is developing

• 4 generations & with each generation:
• 1. increased activity against gram-neg bacteria
• 2. increased resistance to beta-lactamase
• 3. increased ability to reach CSF

cefazolin/Ancef

prophylaxis for surgery & artificial parts like pacemakers

NVD & decreased appetite

hypersensitivity/anaphylaxis

can have acute alcohol intolerance if used with alcohol

• 1. check for allergy to cephalosporins/"ceph"/"kef" drugs
• 2. check for allergy to penicillin/"cillins"
• 3. check C&S

• 1. effectiveness of med/improvement
• 2. monitor for suprainfections
• 3. monitor for s/s of allergic response

can interfere with some tests

• 1. alters cell wall permeability -> inhibits cell wall synth
• 2. inhibits RNA synth

strong and toxic

serious infections when other ABX have failed

vancomycin resistance is increasing

its ability to produce toxic effects

• 1. ototoxicity
• 2. nephrotoxicity
• 3. red-man syndrome

tinnitus, decreased hearing

monitor I&O & creatinine

anaphylactoid reaction caused by histamine release when the med is given too fast

diffuse redness & blisters

• 1. admin slowly over at least 60 minutes (more if possible)
• 2. use the largest access/vein possible
• 3. Avoid extravasation

it is very caustic

• 1. monitor peak and trough levels
• 2. monitor I&O & creatinine for renal failure
• 3. assess for s/s of ototoxicity

• 1. aminoglycosides
• 2. lincosamides
• 3. oxazolidinones
• 4. streptogramins
• 5. tetracyclines
• 6. macrolides
• 7. miscellaneous

bactericidal or bacteriostatic

reserved for more serious infections

superinfections

• enter bacterial cell wall -> bind to ribosomes -> prod. wrong amino acids ->
• 1. prevents bacterial reproduction
• 2. weakens the cell wall
• 3. cell wall rupture & death

gentamicin

many bacteria are resistant to aminoglycosides entering their cell walls

increase effectiveness or allow it to enter cell walls

lowest conc. in pt blood

should be drawn 30 minutes before the next dose

drug is at its highest conc.

draw 45 min (IV) to 1h (IM) after admin of a med

• 1. ototoxicity
• 2. nephrotoxicity
• 3. neurotoxicity

• 1. hearing
• 2. I&O, creatinine, and BUN
• 3. neurovascular assessments
• 4. draw peak & trough levels

has a narrow therapeutic index

very toxic

clindamycin

enters cell -> binds to ribosomes -> suppresses protein synth -> cell death

serious to life-threatening infections

clindamycin

sulfa ABX

life-threatening/serious

Clinda loves Zelda.  She is Link from Zelda (lincosamide).  All she does is play vid games and eat.  She eats so much she gets GI upset that causes pseudomembranous colitis, and is so sedentary that her blood has pooled (blood abnormalities).

GI disturbances

• pseudomembranous colitis
• blood abnormalities

serious/life-threatening infections

• diarrhea
• abd cramps/tenderness

macrolide - macro means big and ends with E

big E - erythromycin

inhibits RNA-dependent protein synth at chain elongation step -> prevent reproduction

absorption is diminished by food, dairy, & antacids

decrease effects of drug

tetracycline

hypersensitivity

GI distress even when admin IV

small frequent meals, but remember to time them so they are not close to med admin b/c decrease med effects

• 1. hepatotoxicity
• 2. pseudomembranous colitis
• 3. QT prolongation
• 4. ventricular tachycardia

• 1. monitor liver enzymes
• 2. have on telemetry if poss. or monitor frequently & educate pt what to look for
• 3. monitor for s/s of pseudomembranous colitis
• 4. HR for tachycardia

admin very slowly to decrease irritation to the veins - at least 60 minutes

oxazolididones - zyvox

• MRSA
• VRE

blocks early stages of protein synth - may prevent the dev of resistance & cross resistance

• 1. inhibits protein synth in bacteria
• 2. nonselective MAOI actions

has serious drug & food interactions r/t MAOI actions:

Avoid:  tyramine, alcohol, & caffeine

GI disturbances

• 1. thrombocytopenia
• 2. pseudomembranous colitis

Zyvox - Ox guts someone (pseudomembranous colitis) & they bleed so much they don't have platelets

will need to call MD to see what to do r/t concern for W/D if don't take alcohol

can't take alcohol with zyvox

superbugs

Synercid

assess platelets - if low don't give

irreversibly blocks ribosome functioning -> inhibits protein synth

Tx superbugs:  VRE & MRSA

may need approval from infectious disease department before using

have more AE & get more expensive

potent inhibitor of P450

• 1. injection site reaction/pain
• 2. thrombophlebitis
• 3. NVD

hepatotoxicity - very hepatotoxic

synercid - sinner drink too much and damage their liver

• 1. check C&S
• 2. assess liver LFT & bilirubin

need bilirubin and LFT twice in first week then weekly

• 1. flush IV before & after admin with D5W - interacts with saline & heparin
• 2. prefer central line for admin
• 3. if no central line dilute in 250mL D5W & infuse over 1 h in largest vein possible

retards bacterial growth by inhibiting protein synth

• 1. serious infections when penicillin cannot be used:  lyme disease, rocky mnt. spotted fever
• 2. acne vulgaris
• 3. chlamydia & other STD's

resistance is occurring

dairy products, vitamins/supplements, & antacids interfere with the absorption

• 1. pregnant/breast feeding
• 2. CH < 8

causes skel retardation

• 1. GI distress:  NVD & heartburn
• 2. photosensitivity
• 3. tooth discoloration

• 1. skel. retardation in infants
• 2. azotemia

• high levels of nitrogenous wastes build up (urea, creatinine)
• decreased UO & LOC, increased HR, dry mouth, edema, ortho BP, uremic frost

monitor I&O & creatinine

chloramphenical & fluoroquinolones

true broad spectrum ABX

gram positive & gram negative

serious infections:  meningitis, brain abscesses, rickettsial infections, and acute typhoid fever

blood dyscrasias

infections caused by bacteria from ticks:  rocky mnt spotted fever, lyme disease, ricketsia ricketsii, etc

hypersensitivity & breastfeeding

• 1. HA
• 2. NVD

• 1. blood dyscrasias
• 2. grey-baby syndrome

chloramphenicol - bleaches babies & blood

breastfeeding

preemies and/or underdeveloped liver

grey/blue skin, feeding probs

give on empty stomach

• 1. monitor peak, trough, and levels
• 2. teach pt s/s of bone marrow suppression/blood dyscrasias & importance of telling MD immediately
• 3. monitor clotting & CBC

floxacin

• ciprofloxacin/Cipro
• levafloxacin/levaquin
• moxafloxacin/Avelox

inhibits DNA gyrase (enzyme needed for bacterial DNA replication)

human DNA is not affected b/c uses diff enzyme

gram negative aerobes

some has developed

• 1. a lot of GI probs
• 2. secondary infection by candida

b/c normal flora in the body are mostly gram neg. & ciprofloxacin is effective against them

• UTI
• resp. infection

• 1. arthropathy (joint disease)
• 2. achilles tendon rupture

cipro - pro athletes are hard on their joints and may rupture their achilles tendon

b/c arthropathy AE is more common in ppl under 18 years old

do not give - increased risk for arthropathy

• 1. admin slowly over at least 60 minutes
• 2. use large vein

reduces venous irritation

eat small frequent meals

daptomycin/Cubicin

complicated skin infections like staph infections

antibiotic-resistant gram positive

resistant to penicillins which also work on gram positive

GI distress

myopathy - muscle pain/damage

obtain C&S

admin over at least 30 minutes to mnimize AE

monitor weekly CK

CK - creatinine kinase - will increase with muscle damage

CQT's = No OB's

chloramphenicol, tetracycline, quinolones

notify MD if have diarrhea, muscle pain, or tingling

• 1. cephalosporins
• 2. fluoroquinolones
• 3. penicillins
• 4. tetracycline
• 5. bactrim

SMZ-TMP or TMP-SMZ

interferes with the synthesis of FA needed for synth of RNA/DNA & proteins -> prevents formation of new bacteria

folate deficiency disorders

• 1. UTI
• 2. resp infections - pneumocystis carinii pneumonia in AIDS pt
• 3. GI infection
• 4. STI's

NVD

immunocompromised pt such as AIDS pt

• 1. renal damage caused by crystalluria
• 2. allergic reactions
• 3. Stevens Johnson Syndrome
• 4. blood dyscrasias
• 5. photosensitivity

• 1. monitor immunocompromised closely r/t increased risk for AE
• 2. give with food
• 3. increase fluid intake to at least 1.5L/day unless CI to decrease crystalluria
• 4. avoid ETOH

• 1. I&O & creatinine
• 2. CBC
• 3. s/s of stevens johnson/hypersensitivity

wear sunscreen

• 1. methanamine
• 2. nitrofurantoin/Macrodantin/Macrobid

work locally in the urinary tract

do not achieve high serum levels b/c work in urinary tract -> have few systemic effects

phenazopyridine/Pyridium

no antibacterial activity

relieves pain, burning, frequency, & urgency r/t irritation of the urinary tract due to infection

discolors urine orange/red