Mary Claire M.

Gunabe Pharmacology
BSN – 2B 10/10/2022
MIDTERM: RESEARCH
1. Compare and contrast the terms pathogenicity and virulence
Pathogens are bacteria that can cause illness. Viruses, bacteria, fungus, protozoans, unicellular
creatures, and multicellular animals are examples of human pathogens (fleas, mites, and worms).
Pathogens must overcome a variety of complicated bodily defenses before they may infect
people. Pathogens can enter the body by eating, inhalation, or contact with mucous membranes
such as the vaginal, urinary, or nasal mucosa. While some infections are deadly and extremely
infectious, others simply cause modest symptoms or none at all. Pathogenicity, or an organism's
ability to dodge or overcome the body's defenses, is determined by its ability to induce infection.
Fortunately, only a small proportion of the millions of microbial species are harmful to humans.
Virulence is a term that is frequently used to describe a pathogen. When present in small
amounts, a highly virulent microbe can cause disease.
2. Explain how bacteria are described and classified
Drugs that are effective against one member of a class of organisms are likely to be effective
against other infections in the same class. One of the simplest methods to categorize bacteria
after applying a crystal violet Gram stain is to examine them under a microscope. Because
certain bacteria have strong cell walls, their staining color remains purple. Gram-positive
bacteria are bacteria such as staphylococci, streptococci, and enterococci. Gram-negative
bacteria have thinner cell walls and lack the violet stain. Gram-negative bacteria include
Salmonella, Klebsiella, pseudomonas, bacteroides, and Escherichia coli. Gram-positive and
gram-negative bacteria are markedly different from one another, reflecting substantial metabolic
and physiological differences between the two categories.
Some antibacterial medications are exclusively effective against gram-positive bacteria, whereas
others are only effective against gram-negative bacteria. Some are used to treat gram-positive
bacteria, while others are used to treat gram-negative bacteria. A second descriptive technique is
based on cellular shape. Bacterial fundamental forms may be easily spotted under a microscope.
Bacilli are rod-shaped, cocci are sphere-shaped, and spirilla are spiral-shaped. Bacteria are
classified based on how effectively they use oxygen, which is a third criteria. Anaerobic species
thrive in the absence of oxygen, whereas aerobic organisms thrive in oxygen-rich situations.
Some organisms may change their metabolic rate and live in either aerobic or anaerobic settings
depending on their external environment. The effectiveness of antibacterial medications in
treating aerobic versus anaerobic bacteria varies.
 3. Compare and contrast the terms bacteriostatic and bacteriocidal
The primary goal of antimicrobial treatment is to assist the body's defenses in eliminating a
pathogen. Bacteriocidal medications are those that destroy germs in order to accomplish this
purpose. Some drugs, rather of killing germs, limit their development, enabling the body's
natural defenses to eliminate the organisms. Bacteriostatic medications are those that impede the
development of bacteria. When bacterial cells are compared to human cells, major morphological
and physiological differences are revealed. Bacteria have cell walls, various metabolic processes,
and certain enzymes that human cells do not.
4. Describe the nurse’s role in the pharmacological management of bacterial infections
In order to progress science and provide direct treatment to patients, acute and critical care
nurses must stay current on bacterial infections. When an infectious process is present, the
practicing nurse must be competent in both treatment and preventative approaches. The
integument serves as the body's initial line of defense against invading germs. Inflammation and
adaptive immunity, the second and third lines of protection against pathogenic germs, follow this
barrier to bacterial invasion. However, when it comes to preventing the transmission of
infectious illnesses, nurses who specialize in acute and critical care should be the first line of
defense. Modern medicine and critical thinking treatments used by nurses are the patient's best
line of defense against poor health and wellbeing.
5. Explain the importance of culture and sensitivity testing to anti-infective
Culture and sensitivity tests are used to help in the diagnosis of an infection. Furthermore, it may
help your doctor choose the best drugs to treat your illness. A medical practitioner will check a
sample of your tissue or body fluid in a lab to discover if germs can grow there (culture). Any
bacteria that arise from the culture will be tested against a variety of treatments to discover which
medication is most successful (sensitivity testing). For example, multiple antibiotic drugs may be
tried for a bacterial infection during this procedure of cultivating the pathogen and determining
the best effective antibiotic. Other laboratory procedures include testing the blood for particular
antibodies and direct antigen detection.
6. Identify the mechanism of development and symptoms of superinfections cause by
anti-infective therapy
A typical adverse effect of anti-infective medication is the formation of superinfections, or
secondary infections, which occur when bacteria ordinarily present in the body are killed. These
common bacteria, also known as host flora, may be found in the intestine, upper respiratory tract,
genitourinary tract, and skin. Some of these species serve a valuable purpose by producing
antimicrobial chemicals and competing for nutrition and available space with harmful microbes.
The elimination of the host flora by an antibiotic permits the remaining bacteria to flourish,
promoting the expansion of pathogenic germs. Host flora can spread illness if their development
is unregulated or if they form colonies in unusual areas.
For example, E. coli is an important part of the host flora, but it can cause significant sickness if
it enters the urinary system. If the patient's immune system is inhibited, the host flora may
become pathogenic as well. When the immune system is impaired, opportunistic pathogens
develop a pathogenic capability. Viruses and fungus are examples of opportunistic organisms
that live on the human body but can turn into harmful ones if the natural flora is repressed.
Superinfection should be detected if a new infection develops while the patient is undergoing
anti-infective medication. Diarrhea, difficult urination, bladder discomfort, and strange vaginal
secretions are common signs of superinfections.
7. For each of the drug classes listed,
A. Penicillin - is a medication used to manage and treat a wide range of infections. It is in the
beta-lactam antibiotic class of drugs. This activity describes penicillin's indications, action, and
contraindications as a valuable agent in treating infection. example drug is Amoxicillin,
Ampicillin, Carbenicillin. Mechanism of action is kills bacteria through binding of the beta-
lactam ring to DD-transpeptidase, inhibiting its cross-linking activity and preventing new cell
wall formation. Depending on the type of penicillin, common side effects may include mild
nausea or diarrhea, headache, or vaginal itching and the serious adverse effect is cardiovascular
collapse.
Nursing Responsibilities is:
administering antibiotics, monitoring its effectiveness and educating the patient.
B. Cephalosporins - are beta-lactam antimicrobials used to manage a wide range of infections
from gram-positive and gram-negative bacteria. Example Drug is Ancef and Kefazol (cefazolin),
Ceclor and Cefaclor (cefaclor) Cefdinir, Ceftin and Zinacef (cefuroxime), Duricef (cefadroxil),
Keflex and Keftabs (cephalexin), Maxipime (cefepime), Rocephin (ceftriaxone). Mechanisim of
Action is inhibition of bacterial cell wall peptidoglycan synthesis by inhibition of penicillin-
sensitive enzymes (transpeptidases, carboxypeptidases) that are responsible for the final three-
dimensional structure of the rigid bacterial cell wall. The most common adverse reactions from
cephalosporins are nausea, vomiting, lack of appetite, and abdominal pain, blistering, peeling, or
loosening of the skin, clay-colored stools, general tiredness and weakness, itching or rash.
Nursing Responsibilities is:
Ensure adequate hydration.
Patient IV.
Indwelling urinary catheter.
Confirm ordered dose.
Monitor. Insertion site for extravasation. Hypersensitivity reaction. Vital signs. ...
Evaluate therapeutic response: absence of postoperative surgical site; approximated
wound edges, infection, stable vital signs.
C. tetracyclines - sold under various brand names, is an oral antibiotic in the tetracyclines
family of medications, used to treat a number of infections, including acne, cholera, brucellosis,
plague, malaria, and syphilis. Example drug is lymecycline, Metacycline, minocycline,
rolitetracycline, and doxycycline. Mechanism of action bind reversibly to the 30S ribosomal
subunit at a position that blocks the binding of the aminoacyl-tRNA to the acceptor site on the
mRNA-ribosome complex. Importance Adverse effect is Nausea, vomiting, diarrhea, loss of
appetite, mouth sores, black hairy tongue, sore throat, dizziness, headache, or rectal discomfort
may occur. Serious adverse effect is nail discoloration, muscle pain, difficult or painful
swallowing, signs of kidney problems (such as change in the amount of urine), brown/gray tooth
discoloration.
Nursing Responsibilities is:
Do not breast-feed while you are taking tetracycline. Children younger than 8 years old
should not take tetracycline. Tetracycline can cause permanent tooth discoloration and
can also affect a child's growth.
D. Macrolides - Macrolides are complex antibacterial broad-spectrum medications that are
effective against both gram-positive and gram-negative bacteria. Example of Drug is
erythromycin, clarithromycin, azithromycin, fidaxomicin and telithromycin. Mechanism of
Actioni Macrolides inhibit RNA protein synthesis and suppress reproduction of the bacteria.
Macrolides are bacteriostatic as they do not actually kill bacteria, but inhibit additional growth
and allow the body’s immune system to kill the offending bacteria. Importance Adverse effect
nausea, vomiting, abdominal pain, and diarrhea. Abdominal symptoms are largely the result of
macrolides being motilin agonists causing an increased risk of gastrointestinal upset and side
effects.
Nursing Responsibilities is:
Macrolides are safe for use across the lifespan, including in pregnancy and with pediatric
clients.
E. Aminoglycosides - are poorly absorbed orally but are well absorbed from the peritoneum,
pleural cavity, joints and from denuded skin. Representative drug Example is gentamicin,
amikacin, tobramycin, neomycin, and streptomycin. Mechanism of Action, primarily act by
binding to the aminoacyl site of 16S ribosomal RNA within the 30S ribosomal subunit, leading
to misreading of the genetic code and inhibition of translocation. Importance adverse effect
Symptoms and signs of vestibular damage are vertigo and ataxia. High doses given over a long
period of time typically cause more concern about renal toxicity, but even low doses given for a
short time can worsen renal function. Serious Adverse effect is Nephrotoxicity (deterioration of
kidney function due to poisonous effect of the drug), Ototoxicity: may cause hearing loss,
Neurotoxicity: may cause paralysis, Allergic reactions, Anemia (low hemoglobin in blood),
Thrombocytopenia (low platelet count) kidney injury, hearing impairment and vestibular
toxicity.
Nursing Responsibilities is:
Nurses should monitor the patient receiving aminoglycosides for signs of decreased renal
function such as declining urine output and increasing blood urea nitrogen (BUN),
creatinine, and declining glomerular filtration rate (GFR).
F. Fluoroquinolones - are a class of antibiotics approved to treat or prevent certain bacterial
infections. Representative drug Example levofloxacin (Levaquin), ciprofloxacin (Cipro),
ciprofloxacin extended-release tablets, moxifloxacin (Avelox), ofloxacin, gemifloxacin (Factive)
and delafloxacin (Baxdela). Mechanism of Action: Fluoroquinolones are a synthetic antibacterial
medication that work by inhibiting the bacterial DNA replication. They are bacteriocidal due to
the action they take against the DNA of the bacterial cell wall. Many fluoroquinolones are broad
spectrum and effective against a wide variety of both gram-positive and gram-negative bacteria.
side effect gastrointestinal reactions (nausea, dyspepsia, vomiting) and CNS reactions such as
dizziness, insomnia and headache. Serious adverse effect tendinopathy, aortopathy, neuropathy,
arrhythmia, hypoglycaemia and hyperglycaemia.
Nursing Responsibilities is:
The patient should take measures to ensure that dosages are spaced evenly throughout the
day and that fluid balance is maintained. It is important to maintain an intake of
1500mL-2000mL per day while taking the medication. The patient should be advised
that medications containing calcium, aluminum, iron, or zinc may impair absorption and
should be avoided. Other side effects of fluoroquinolones increase drowsiness
Additionally, the patient should be cautioned to monitor for episodes of fainting or
decreased heart rate and report any history of prolonged QT syndrome. If a patient
notices peripheral neuropathy occurring, this should be reported to the healthcare
provider.
G. Sulfonamides - (sulphonamides) are a group of man-made (synthetic) medicines that contain
the sulfonamide chemical group. Representative drug example is sulfadiazine, sulfadoxine,
sulfalene, sulfamerazine, sulfamethizole and sulfamethoxazole. Mechanism of action
competitively inhibit the incorporation of PABA into folic acid, thereby preventing the synthesis
of folic acid. Trimethoprim binds reversibly to and inhibits dihyrofolate reductase, an enzyme
that reduces dihydrofolic acid to tetrahydrofolic acid,decreasing folic acid synthesis. Primary
Action competitively inhibiting bacterial metabolic enzymes needed for bacterial function.
Importance Adverse effect may cause blood problems, especially if they're taken for a long
period of time. Serious Adverse effect severe allergic skin rashes, Stevens-Johnson syndrome,
drug fever, serum sickness, agranulocytosis, aplastic anemia, nephritis, pancreatitis, confusion,
ataxia and seizures. side effect Abdominal or stomach cramps and pain (severe), abdominal
tenderness, blood in urine, diarrhea (watery and severe), which may also be bloody, greatly
increased or decreased frequency of urination or amount of urine, increased thirst, lower back
pain, pain or burning while urinating.

Nursing Responsibilities is:

Weigh the child daily, monitor child's temperature, give milk with medication,
Administer the drug at prescribed times. The medication can cause increased photo
sensitivity, and clients should be educated to use sunscreen and protective clothing with
sun exposure. The client should also report any rash, sore throat, fever, or mouth sores
that might occur. Unusual bleeding or bruising should also be reported to the provider.
H. Antitubercular agents - represent a diverse group of compounds, which are used either alone
or in combination to treat Mycobacterium infections, including tuberculosis and leprosy.
Representative drug Example Rifampin, isoniazid, pyrazinamide, and ethambutol. Side Effect
Diarrhea, Nausea, Vomiting, Abdominal pain, Anorexia (lack or loss of appetite), Headache,
Malaise (a general feeling of discomfort, illness, or unease), Muscle/joint pain, Upset stomach,
Heartburn, Metallic taste in the mouth. Mechanism of Action They work impacting the synthesis
or transcription of mycobacteria RNA or inhibiting the synthesis of mycolic acids in the cellular
wall. Mycobacteria can develop resistance to antitubercular medications; therefore, strict
compliance to drug regimen must be emphasized. Serious Adverse Effect hepatitis, cutaneous
reactions, gastrointestinal intolerance, hematological reactions and renal failure.
Nursing Responsibilities is:
Advise patients that medications must be taken as directed. It is important that patients
understand the significance of continuing drug therapy even after symptoms have
resolved to prevent the spread of disease. Drug therapy may be continued for six months
to two years. If a patient notices any change in visual acuity or eye discomfort, it should
be reported immediately to the healthcare provider.
8. Categorize antibacterial drugs based on their classification and mechanism of action
NURSING RESPONSIBILITIES IN ALL EACH DRUGS CLASSES:
REFERENCES:
Pharmacology for Nurses, A Pathophysiological Approach, 4th Edition- Michael Adams
(Crit Care Nurs Clin North Am, 2007) “Bacterial infections: management by acute and
critical care nurses” https://pubmed.ncbi.nlm.nih.gov/17338946/
(Elsevier, 2022) “CULTURE AND SENSITIVITY TESTING”
https://elsevier.health/en-US/preview/culture-sensitivity-testing
https://wtcs.pressbooks.pub/pharmacology/chapter/3-19-antituberculars/
https://pressbooks.bccampus.ca/nursingpharmacology/chapter/3-9-sulfonamides/
#:~:text=The%20medication%20can%20cause%20increased,be%20reported%20to%20the
%20provider.
https://www.ncbi.nlm.nih.gov/books/NBK557666/#:~:text=Antitubercular%20medications
%3A%20rifampin%2C%20isoniazid%2C,drugs%20used%20to%20treat%20tuberculosis.