ANTIBIOTICS.

PREPARED BY L.MBISE OCTOBER 2012.

Definition
.

Classification .
The antimicrobial drugs fall into seven major groups based on mechanisms of action , inhibitors of cell wall synthesis. Penicillin's. Cephalosporin's. Vacomycine .

Cont
drugs that disrupt the cell membrane. Ketoconazole. Bactericidal inhibitors of protein synthesis. amino glycosides. Bacteriostatic inhibitors of protein synthesis. clindamycine. Erthyromyciline Tetracycline's .

Cont
drugs that interfere with synthesis of bacterial DNA or RNA. Fluoroquinolones. Rifampin. Antimetabolites . Sulfonamides . Trimethoprin

cont..
Drugs that inhibit viral enzymes. acyclovir. Zidovudine. Inhibitors of mycolic acid synthesis. isoniaziad .

 Penicillins. Mechanism of action. They are bactericidal, inhibiting the synthesis of cell wall of sensitive organisms, causing bacteria cell death . Indications . Infection of streptococci,pneumonia,staphalococci,N.gono rrhoeae,meningoccocci, salmonella,shigella

Drugs that weaken the bacterial cell wall

Cont.
Treatment of syphilis. Contraindication . Use with cautiously with renal disease, pregnancy ,lactation. Adverse effects. CNS: lethargy ,hallucination, and seizures. GI: stomatitis, gastritis, mouth sore ,nausea and vomiting ,diarrhea & abdominal pain.

Cont..
Hematologic: Anemia,thrombocytopenia, leukopenia ,neutropenia & prolonged bleeding. GU: nephritisoliguria, proteinuria, hematuria ,casts, azotemia & pyuria. Others : superinfections ,sodium overload. Hypersensitivity: rash,fever,wheezing, anaphylaxis.

Clinically important interactions. Drug-drug. Decreased effectivess with tetracycline. inactivation of parental aminoglycoside.

Cont.
Nursing consideration . History :any allergy to penicillin ,cephalosporin. Lab: CBC,LFT,RFT, serum electrolytes & urinalysis. Use small dose for IM injection to avoid pain & other discomfort. Monitor S.Electrolytes and cardiac status while patient is on IV infusion.

Cont
Check IV site carefully for signs of thrombosis or local drug reaction. Do not give IM repeatedly in the same site. Explain the reason for parenteral route of administration. Provide a small and frequent meals if GI upset occurs. If GI effects occur provide frequently mouth care.

Cont--- maintain epinephrine,IV fluids, vasopresors, bronchodilators ,oxygen's and other emergency equipment on standby . Arrange for the use of corticosteroids, antihistamine for skin reactions. Teaching points. This drug must be given by injection. GI-Up set small & frequent meal can help.

Cephalosporin's
Indications: They are bactericidal ,inhibiting synthesis of bacterial cell wall, causing cell death in susceptible bacteria. Indications: treatment of pharyngitis, tonsillitis caused by streptococcus pyogenes ,otitis media caused by streptococcus pneumonia, haemophilus infuenzae.

Cont.
contraindication: Renal failure & lactation. Adverse effects . CNS :Headache ,dizziness ,lethargy GI:Nausea,vomiting and diarrhea. Heamatologic: bone marrow depression ,decreased WBC & platelets.

Cont.
GU: nephrotoxicity. Hypersensitivity. Anaphylaxis. Local .Pain, abscess at the site of injection. phlebitis ,inflammation at the site. Clinically important interactions. Drug-drug , increased nephrotoxicity with amino glycoside. Bleeding effects with oral anticoagulants.

Nursing consideration
Assessment. History :to any allergy to cephalosporin's or penicillin ,liver and kidney dysfunction. Physical : LFT & RFT Administer oral drug with food to decrease GI upset and enhance absorption. Administer liquid drugs to children who cant swallow tablets , crushing the drugs results in a bitter ,unpleasant taste.

Cont.
Have vit K available in case of thrombonemia occurs. Discontinue drugs if hypersentivity occurs. Arrange for treatment of superinfections. teaching points. Oral drugs ,take full course of therapy. this drugs is specific to an infection and should not be used self-treat other problem.

Cont.
Swallow tablets whole ,do not crush Avoid drinking alcoholic while taking and for 3days after stopping. Report the following , severe diarrhea with blood , pus or mucus ,rash ,difficult breathing ,unusual tiredness , itching and pain at injection site.

Aminoglycosides.
Inhibit protein synthesis in susceptible strains of gram ve bacterial ,appear to disrupt the functional integrity of bacterial cell membrane ,causing cell death. Other drugs, Tetracycline ,microlides ,clindamycin chlophenicol and spectinomycine.

Cont
Indications. Pseudomonas species, E.Coli. Staphylococcal infection when penicillin is contraindicated or when infection caused by mixed organism. Neonatal sepsis , when other drugs cant be used.

Cont---Contraindication Allergy to amino glycosides, renal disease, hepatic disease , Parkinsonism ,lactation. Use caution with elderly patients, decreased renal function , dehydration & neuromuscular disorder.

Cont---Adverse effects. Ototoxicityconfusion,disorientation,depression ,visual disturbances headache, fever ,numbness. GI:Nausea,vomiting,anorexia,dirrohoea. CV: palpitation ,hypotension, hypertension. Hematologic : granulocytosis ,leukopenia ,anemia.

Cont--GU: Nephrotoxicity. Hypersensitivity:Purpura,rash,dermatitis,itching Others, super infections, pain, irritation at the site of IM. Clinically important interaction. Drug-drug : increased ototoxic and nephrotoxic effects if taken with diuretic and similaly toxic drugs.

Cont--Nursing consideration. History :to any allergy to any amino glycosides, Renal disease, hepatic disease, hearing loss. Lab test : B/C prior to therapy. RFT before, during & after. 8th cranial nerves function. LFT & CBC.

CONT-- Monitor duration of treatment. Give IM dosage by deep injection. Ensure pt is well hydrates before and after therapy. Establish safety measures if CNS & vestibular nerve effect occurs. Provide small , frequent meals if nausea ,anorexia occur.

Cont---Teaching point Take a full course of oral drugs.drink plently of fluids. Possible side effects ringing in the ears, headache ,dizziness, reversible safety measures need to be taken. Report pain at the site of IM injection.

Fluroquinolones.
Actions . Fluroquinolones are antibacterial .they are bactericidal ,interfering with DNA replication in susceptible gram- ve bacterial. Indications. Gram ve bacteria , E.coli, S.aureus, s.epidermidis, group D sterptococci. Cystic fibrosis.

Cont--Contraindication. Allergy to fluroquinolone,pregnancy or lactation. Adverse effects. CNS: headache, dizziness , insomnia, fatique,depression and blurred vision. GI: Nausea, vomiting, dry mouth , diarrhoea & abd pain.

Cont--Hematologic: elevated BUN, S. Creatinine & decreased WBC. Others, fever, rash and photosensitivity. Clinically important interaction. Drug-drug , decrease therapeutic effects with iron salts sucralfate ,decreased absorption with antacids, increased serum levels and toxic effects with theophylines.

Cont..
Nursing consideration. History : allergy to fluroquiolones, renal dysfunctions ,seizures and lactation. Lab test, RFT & LFT. B/C test prior to surgery. Cont therapy for 2 days after signs and symptoms of infection have disappeared. .

Cont-- Administer oral drugs 1 hrs before or 2hrs after meals with glass of water. Ensure that patients is well hydrated during course of drug therapy. Administer antacids ,if needed ,at least 2hrs after dosing. Monitor clinical response . Encourage patient to complete full course of therapy.

Cont--- establish safety precaution s if CNS ,Visual changes occurs. If constipation occurs arrange training of bowel habit. Monitoring for env ,avoid noise, high temperature room in case of headache.

Cont----Teaching point. Take oral drugs on an empty stomach ,1hr before or 2hr after meals. if antacids is needed do not take it within 2hrs of use ciprofloxacin dose. Drink plenty of fluids. Reports rashes ,visual changes ,severe GI problem, weakness ,tremors.

ketoconazole
action : disrupt the cell membrane ,allowing increased permeability and leakage of cellular components and causing cell death. Indications. fungal infections , candidiasis ,oral thrush. Dermatophytosis.

Cont--Contraindication Allergy to ketoconazole , fungal meningitis ,pregnancy & lactation. Use cautiously with hepatocellular failure. Adverse effects. CNS:headache,dizziness,photobia. GI: Hepatoxicity, nausea, vomiting & abdominal pain.

Cont--GU: importance & oligospermia. Hematologic . thrombocytopenia,leukopenia and hemolytic anemia. Hypersensitivity: anaphylaxis. General : fever, chills & gynecomastia. Local : severe irritation.

Cont---Drug drug interaction: Decreased blood levels of ketokonazole with rifampin, increased duration of adrenal suppression with methlyprednisoline. Decreased absorption if taken with antacid, space 2hrs.

Other groups,
ant metabolites sulfonamide. Trimethopin. Viral enzymes Acyclovir. zidovudine Drugs treat Tuberculosis isoniazid .

Reference .
Richard .A.Lehne , pharmacology for nursing care,4th edition ,2001. Amy M.Karch ,nursing drug guide,Lippincotts 2002.