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8/8/2019 Pharma Report Anti Infect Ives
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ANTIINFECTIVES
Group Report by G27
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I. Definition of Terms
Antibacterials/Antimicrobials
Substances that inhibit the growth of orkill bacteria and other microorganisms
(viruses, fungi, protozoa and ricketssiae)
Are either obtained from natural sources
or manufactured
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.
Antibiotics
Work with the bodys natural defenses
Chemicals that are produced by another
kind of antibiotic that inhibit the growth
of or kill another
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Bacteriostatic
Inhibit thegrowth of bacteria
Bactericidal
Killbacteria
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Narrow-Spectrum Antibiotics
Primarily effective against one type oforganism (e.g. Penicillin and
Erythromycin are used to treat infections
cause by gram-positive bacteria)
Broad-Spectrum Antibiotics
Can be effective against both gram-positive and gram-negative organisms
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III. Other factors that influence the
bodys ability to fight infection
Age
Ig (A, E, G)Nutrition
Organ function
WBC
Circulation
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V. General Adverse Reactions to
Antibacterials:1. Allergic reactions rash, pruritus,
hives; anaphylactic shock (vascular
shock, laryngeal edema, brochospasm,cardiac arrest, SOB)
Tx: mild allergic rxn: antihistamineanaphylaxis: epinephrine,
bronchodilators and antihistamines
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2. Superinfection secondary infection;
occurs when the normal flora is
distributed by the antibiotic therapy.
3. Organ Toxicity causes damage to
organs (kidneys, liver)
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V. What is Penicillin?
miracle drug
interferes with bacterial cell wall
synthesis by inhibiting the bacterial
enzyme that is necessary for cell division
and cellular synthesis. The bacteria die
of cell lysis (cell breakdown)
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Classes of Penicillin:
a. Broad-Spectrum Penicillins
(Aminopenicillins)
Used to treat both gram-positive and
gram-negative bacteria
Not penicillinase resistant
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Readily inactivated by beta-lactamases,thus becoming ineffective against S.
aureus (e.g. ampicillin (Omnipen),
amoxicillin (Amoxil), and bacampicillin(Spectrobid).
Amoxicillin is the most prescribedpenicillin derivative for adults and
children.
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b. Penicillinase-Resistant Penicillins(Antistaphylococcal Penicillins)
Treats penicillinase-producing S. aureus
Oral Forms: Cloxacilli (Cloxapen) and
dicloxacillin (Dynapen)
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IM and IV forms: nafcillin (Unipen) andoxacillin (Prostaphin)
Not effective against gram-negativeorganisms, and less effective than
penicillin G against gram-positive
organisms.
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c. Extended-Spectrum Penicillins
(Antipseudomonal Penicillins)
Group of broad-spectrum penicillins
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Effective against Pseudomonas
aeruginosa, a gram-negative bacillusthat is difficult to eradicate.
Not penicillinase-resistant
Pharmacologic action is similar to that
of aminoglycosides, but are less toxic.
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d.Beta-Lactamase Inhibitors
Inhibits the bacterial beta-lactamases,
making the antibiotic effective and
extending its antimicrobial effect
3 beta-lactamase inhibitors:1. clavulanic acid2. sulbactam
3. tazobactam
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Are not given alone but are combined
with a penicillinase-sensitive penicillin
such as amoxicillin, ampicillin,
piperacillin and ticarcillin
Oral use: amoxicillin-clavulanic acid
(Augmentin)
Parenteral use: ampicillin-sulbactam(Unasyn), piperacillin-tazobactam
(Zosyn), and ticarcillin-clavulanic acid
(Timentin)
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Drug Interactions
Broad-spectrum penicillins (amoxicillin
and ampicillin) may decrease the
effectiveness of oral contraceptives.
Potassium supplements can increase
the serum potassium levels when takingpotassium penicillin G orV.
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When penicillin is mixed with an
aminoglycoside in IV solution, theactions of both drugas are inactivated.
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NURSING PROCESS: Penicillins
Assessment:
Assess for allergy to penicillin.
Check for lab results especially liver enzymes.
Report elevated alkaline phosphatase,
alanine aminotransferase, aspartateaminotransferase.
Record urine output. If the amount isinadequate (
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Nursing Diagnosis:
Risk for infection
Risk for impaired tissue integrity
N
oncompliance with drug regimen
Planning:
Clients infection will be controlled and
later eliminated.
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Nursing Interventions:
Check for signs and symptoms of
superinfection, especially for clients
taking high doses of the antibiotic for aprolonged time. S/sx include stomatitis
(mouth ulcers), genital discharge
(vaginitis), and anal or genital itching.
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Examine client for allergic reaction to
the penicillin product, especially afterthe first and second doses. This may be
a mild reaction, such as a rash, or a
severe reaction, such as respiratorydistress or anaphylaxis.
Have EPINEPHRINE available tocounteract a severe allergic reaction.
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Client Teaching:
Instruct client to take all of the
prescribed penicillin product such asamoxicillin until the bottle is empty. If
only a portion of the penicillin is taken,
drug resistance to that antibacterialagent may develop in the future.
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Advise client who is allergic to penicillin
to wear a medical alert bracelet ornecklace and carry a card that indicates
the allergy.
Keep drugs out of the reach of smallchildren. Request childproofcontainers.
Inform client to report any side effects
or adverse reaction that may occur whiletaking the drug.
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Encourage client to increase fluid
intake; fluid aid in decreasing body
temperature and in excreting the drug.
Instruct client or childs parent that
chewable tablets must be chewed orcrushed before swallowing.
Advise client to take medication with
food if gastric irritation occurs and totake oral penicillin 1 hour before or 2
hours after meals to avoid delay in drug
absorption.
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Evaluation:
Clients infection wascontrolled/eliminated.
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CEPHALOSPORINS
Active against gram-positive and gram-
negative bacteria and resistant to beta-
lactamase (an enzyme that acts against beta-
lactam structure of penicillin)
Have a beta-lactam structure and act by
inhibiting the bacterial enzyme that isnecessary for cell wall synthesis. Lysis to the
cell occurs, and the bacterial cell dies.
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Generations ofCephalosporins
First generation:
Effective against gram-positive bacteria such
as Streptococci and most Staphylococci.
Effective against most gram-negativebacteria such as E. Coli and species of
Klebsiella, Proteus, Salmonella and Shigella.Destroyed by beta lactamases
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Second generation:
Same effectiveness as the first
generation.
Possesses a broader spectrum againstother gram-negative bacteria such as H.Influenza,N. Gonorrhea,N.
Meningitidis etc.Not all is affected by beta-lactamases.
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Third generation:
Same effectiveness as the first and
second generations.
Less effective against gram-positive
bacteria.
Effective in treating sepsis and many
strains of gram-negative bacilli.
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Fourth generation:
Similar to the third generation.
Resistant to most beta-lactamase
bacteria.Has a broader gram-positive coverage
than the third generations.
Also effective in treating sepsis andmany strains of gram-negative bacilli.
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NURSING PROCESS:Cephalosporins
Assessment:
Assess for allergy to cephalosporins.
RecordVS andUrine Output.
Nursing Diagnosis:
Risk for infection
Noncompliance with drug regimen
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Planning:
Clients infection will be controlled and
later eliminated.
Nursing Interventions:
Check for s/sx ofsuperinfection.
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Refrigerate oral suspensions. For IV
cephalosporins, dilute in an appropriateamount ofIV fluids (5-100 ml).
Administer
IVcephalosporins over 30-45minutes 2 to 4 times a day.
MonitorVS, urine output. Reportabnormal findings.
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Client Teaching:
Instruct client to report signs and
symptoms ofsuperinfection, such as
mouth ulcers or discharge from the analor genital area.
Advise client to ingest buttermilk oryogurt to prevent superinfection of the
intestinal flora with long term use of
cephalosporin.
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Instruct client to take complete course ofmedication even when symptoms of infection
have ceased.
Instruct client to report any side effects from
use of oral cephalosporin drugs; they mayinclude anorexia, nausea, vomiting,headache, dizziness, itching and rash.
Advise client to take medication with food ifgastric irritation occurs.
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Infuse all IV cephalosporins over 30
minutes or as ordered to prevent painand irritation.
Observe for hypersensitivity reactions.
Evaluation:
Client infection wascontrolled/eliminated.