Pharmacokinetics:

Route: oral; peak: 60 mins.; duration: 8-10 hours Metabolism: T 1/2: 50-80 mins Distribution: crosses the placenta; enters the breast milk Excretion: urine Cephalexin belongs to a class of antibiotic called cephalosporins. They are similar to penicillin in action and side effects. They stop or slow the growth of bacterial cells by preventing bacteria from forming the cell wall that surrounds each cell. The cell wall protects the bacteria from

Pharmacodynamics:

the external environment and keeps the contents of the cell together. Without a cell wall , bacteria are not able to survive. Bacteria that are susceptible to cephalexin includes staphylococcus aureus, streptococcus pnuemoneae, haemophilus influenza, E. Coli, and several others. Cephalexin is approved by the FDA in January 1971
Indications:

Respiratory tract infections, skin and skin structure infection caused by staphylococcus/streptococcus Otitis media, bone infection, GU infections

Contraindication

Allergy to cephalosporins or penicillin Use cautiously with renal failure, pregnancy or lactation

 Nursing

Responsibilities:

History: cephalosporins or penicillin allergy, pregnancy, lactation Physical: Renal function tests, respiratory status, skin status, culture and sensitivity test on infected area. Give drug with meals; arrange for small frequent meals if GU complication occur complete drug in full course. Teach that drug prescribed for this type of infection; do not self-medicate Report severe diarrhea with blood; pus, mucus, rash or hives; difficulty in breathing, unusual tiredness, fatigue, unusual bleeding or bruising. Teach to avoid alcohol while taking this drug.

Pharmacokinetics:
Route: oral; Onset: varies; Peak: 2 hours; Duration: 18-24 hours Metabolism: T 1/2: 1-2 hours Distribution: crosses the placenta, enters breast milk; widely to body tissues and fluid; crosse blood-brain barrier; therapeutic concentrations achieved in CSF even with meninges are not inflammed. Excretion: urine

Pharmacodynamics

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in return inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls,

thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins & murein hydrolases) while cell wall assembly is arrested. Cefuroxime is a semisynthetic cephalosporin antibiotic, chemically similar to penicillin. It is effective against a wide variety of bacteria organisms, such as staphylococcus aureus, streptococcus pneumoniae, haemophilus influenzae, E.coli, N.gonorrhoeae, and many others.

Indications
Pharyngitis, tonsilitis, otitis media, lower respiratory infections; UTIs Uncomplicated gonorrhoea, skin & skin structure infection for early Lyme disease Septicimia, meningitis, bone & joint infections Perioperative prophylaxis, treatment for acute bacterial maxillary sinusitis in patients 3 months to 12 years

 Contraindications

Allergy to cephalosporins or penicillin Use cautiously w/ renal failure, lactation & pregnancy

Nursing

Responsibilities

History: Hepatic & renal impairment, lactation & pregnancy Physical: Skin status, LFTs, renal function test, culture of affected area, sensitivity test Give oral drug w/ food to decrease GI upset & enhance absorption Have Vit. K available in case hypoprothrombinemia occurs Teach to avoid alcohol while taking this drug Ask to report severe diarrhea, difficulty breathing, unusual tiredness or fatigue, pain in injection site if parenteral

 Pharmacokinetics

Route: Oral; Onset: 30 mins; Peak: 2hrs; Duration: 6-8 hrs Route: IM; Onset: 15 mins; Peak: 1 hr; Duration: 6-8 hrs Route: IV; Onset: stat; Peak: 5mins; Duration: 6-8 hrs Metabolism: T 1/2 : 1-2 hrs Distribution: Crosses placenta & enters breastmilk Excretion: Urine; unchanged

Pharmacodynamics

Ampicillin is able to penetrate Gram-positive & some Gram-negative bacteria. It differs from penicillin only by the presence of an amino acid group. That amino acid group helps the drug penetrate the outer membrane of the Gram-negative bacteria Ampicillin acts as a competitive inhibitor of the enzyme transpeptidase, which is needed by bacteria to make their cell walls. It inhibits the third & final stage of bacterial cell wall synthesis in binary fission, which lead to cell lysis

Indication
Treatment of infections caused by susceptible strains of shigella, salmonella, E. Coli, etc. Meningitis Unlabeled use: Prophylaxis in CS in certain high-risk patients

 Contraindications

Allergy to penicillin, cephalosporins or other allergens Use cautiously with renal disorders

Nursing

Responsibilities

History: Allergy to this drug, renal disorder, lactation Physical: Culture infected area, skin color/lesions, respiration adventitious sounds, bowel sounds, CBC, LFTs, renal function test, serum electrolytes, HCT, UA Culture infected are before treatment Check IV site carefully for signs of thrombosis or drug reaction Do not give IM injections in the same site, atrophy can occur, monitor site

Administer oral drug on an empty stomach, 1 hr before or 2 hrs after meals w/ a full glass of water; no fruit juice or soft drinks The oral drug is stable for 7 days at room temperature. And 14 days if refrigerated Teach to take drug around the clock; take full course of treatment This drug is specific to your problem; do not self medicate If a woman using this is using hormonal contraceptive, ask to use a second form of birth control for 1-2 weeks while taking this drug Report pain or discomfort at site usually bleeding or bruising, mouth sores, rash,, hives, fever, itching, severe diarrhea, difficulty breathing.

Pharmacokinetics
Route: IV; Onset: stat; Peak: 30 mins Route: IM; Onset: varies; Peak: 45-120 mins Metabolism: T 1/2 : 2-3 hrs Distribution: Crosses placenta; enters breastmilk Excretion: urine, unchanged

Pharmcodynamics
Gram-negative: Amikacin if active in vitro against Pseudomonas sp, E. coli, Proteus sp (indole-positive-&negative), Providencia sp, Klebsiella-Enterobacter-Serratia sp, Acinobacter (formerly Mima-Herellea) sp, & Citrobacter freundii When strains of the previously mentioned organism are found to be resistant to other aminoglycosides, including gentamicin, tobramycin, & kanamycin, many are susceptible to amikacin in vitro

Gram-positive: Amikacin is active in vitro against penicillinase & nonpenicillinase produce streptococcus including methicillin-resistant strains. However, aminoglycosides in general have a low order of activity against other grampositive organisms eg. Streptococcus pygenes, Entecocci & Streptococcus pneumoniae(formerly Diplococcus pneumoniae). Amikacin resists degrafation by most aminoglycoside inactivating enzymes known to affect gentamicin, tobramycin, & kanamycin In vitro studies have shown that amikacin combined w/ a -lactam antibiotic acts synergistically against many clinically significant gram-negative organism

Indications
Short term treatment for serious infection caused by susceptible strains of Pseudomonas sp, E. Coli, Proteus sp, etc Suspected gram-negative infections before results of susceptibility studies are known Initial treatment of Streptococcal infections when penicillin is contraindicated or infection may be caused by mixed organisms Neonatal sepsis when other antibiotics cannot be used Unlabeled uses: Intrathecal or intraventricular administration at 8 mg/24 hrs part of a multidrug regimen for treatment of Mycobacterium avium complex, a common infection of AIDS patients

Contraindications
Allergy to any aminoglycosides, renal or hepatic disease, pre-existing hearing loss, myathenia gravis, parkinsonism, infant botulism, lactation Use cautiously w/ elderly patients, any patient w/ diminished hearing, decrease renal function, dehydration, neuromuscular disorders, pregnancy

Nursing Responsibilities

History: Allergy to any aminoglycosides, renal or hepatic disease, pre-existing hearing loss, myasthenia gravis, parkinsonism, infant botulism, lactation, diminished hearing, decreased renal function, dehydration, neuromuscular disorders Physical: Arranged culture & sensitivity test on infection prior to therapy; 8th cranial nerve function, & state of hydration prior to, during, & after therapy; LFTs; renal function test; CBC, skin color & lesions, orientation & affect, reflexes, bilateral grip strength, weight & bowel sounds Monitor patient for nephrotoxicity, ototoxicity w/ baseline & periodic renal function & neurologic examination; risk for serious toxicity Arranged for culture & sensitivity testing of infected area before treatment Monitor duration & treatment: usually 7-10 days. If there is no clinical response w/in 3-5 days, stop therapy because prolonged use increases risk for toxicity. If drug is used longer than 10 days, monitor auditory & renal function daily Ensure patient is well-hydrated before & during therapy

 Pharmacokinetics

Absorption: the 2 components of co-amoxiclav, amoxicillin & clavulanic acid, are fully dissociated in aqueous solution at physiological pH. Both components are rapidly & well absorb by the oral route of administration. Absorption of co-amoxiclav is optomized when taken at the start of a meal

 Pharmacodynamics

It inhibits transpeptydase, preventing crosslinking of bacterial cell wall & leading to cell death. Addition of clavulanic( a beta-lactam) increases drug resistance to beta-lactanase (an enzyme produced by bacteria that may inactivate amoxicillin) Amoxicillin is a semisynthetic antibiotic w/ a broad spectrum of antibacterial activity against many gram-positive & gram-negative microorganisms. Amoxicillin is, however, susceptible by degradation by -lactamases & therefore the spectrum of activity of amoxicillin alone does not include organism w/c produce this enzymes

Indications

Lower respiratory tract infections, otitis media, sinusitis, skin & skin-structure infections, & UTIs caused by susceptible strains of gram-negative & gram-positive organism Serious infections & community-acquired pneumonia Recurrent or persistent acute otitis media caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis in children ages 2 & younger & in children who have receive antibiotic therapy w/in last 3 months Use cautiously: severe renal insufficiency, infectious mononucleosis; pregnant patient

Contraindications
Hypersensitivity to drug or any penicillin Phenylketonuria (some products) History of cholestatic jaundice or hepatic dysfunction associated w/ this drug

Nursing Resposibilities
Monitor patient carefully for signs & symptoms of hypersensitivity reaction Monitor for seizure when giving high doses Check patients temperature & watch for other s/s of superinfections, specially oral or rectal candidiasis Instruct patient to immediately report s/s of hypersensitivity reaction such as rash, fever & chills Tell patient he may take drug w/ or w/o food Inform patient that drug lowers resistance to some types of infections Instruct him to report s/s of infection (specially of mouth & rectum) Advice patient to minimize GI upset by eating small, frequent servings of food & drinking plenty of fluids Tell patients taking hormonal contraceptives that drug may reduce contraceptive efficacy. Suggest she use alternative birth control method Inform parents that they may give liquid form of drug directly to child or may mix it w/ foods or beverages

 Karch,

Amy M. 2010 Lippincotts Nursing Drug Guide.(2010). 323 Norristown Road, Suite 200: Lippincott Williams & Wilkins.

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