NURS 133 Penicillin and Macolides

jasmine's version from 2016-04-26 03:42

Section 1

Question Answer
Bactericidal Kill bacteria directly
Bacteriostatic Stop bacteria from growing
Broad-spectrum antibiotic Acts against a wide range of disease-causing bacteria; Acts against both gram-positive and gram-negative bacteria, hence a wider number of bacterial types, and used to treat a variety of infectious diseases; For example: Meningitis: A person can get so ill that he/she could die within hours if broad-spectrum antibiotics are not initiated; For drug resistant bacteria; In super-infections where there are multiple types of bacteria causing illness, warranting either broad-spectrum or combination antibiotic therapy
Advantages of Broad-spectrum antibiotics Broader spectra of activity; Less of a need to identify the infecting pathogen with real certainty before commencing treatment
Disadvantages of Broad-spectrum antibiotics Children, who receive broad-spectrum antibiotics during their first year of life, are at increased risk of developing childhood asthma; May give rise to drug resistance
Risks of antibioticsCan change the body's normal microbial content by attacking indiscriminately both the pathological and naturally occurring, beneficial or harmless bacteria found in the intestines, lungs, and bladder; The destruction of the body's normal bacterial flora provides an opportunity for drug-resistant microorganisms to grow vigorously, and can lead to a secondary infection such as C. diff or Candidiasis (thrush) in females; This side-effect is more likely with the use of broad-spectrum antibiotics
Narrow-spectrum antibiotic Acts against a selected group of bacterial types that it affects
Advantages of Narrow-spectrum antibiotics Will not kill as many of the normal mircroorganisms in the body as broad-spectrum antibiotic, RESULTING in lesser ability to cause superinfection; Will cause less resistance of the bacteria, as it will deal with only specific bacteria
Disadvantages of Narrow-spectrum antibiotics Can be used only if the causative organism is identified; If don't choose drug carefully, may not actually kill the microorganism causing infection
Penicillin Antibiotic; Bactericidal; Disturbs the cell wall synthesis in bacteria; Initially derived from the mold Penicillin rubrum; Mainly active against gram-positive bacteria
Penicillin actionsBind to bacterial cell wall, resulting in cell death
Penicillin therapeutic usesBactericidal action against susceptible bacteria. Spectrum: Active against: Most gram-positive organisms, including many streptococci, staphylococci, and B. antibracis, some gram-negative organisms, such as N. meningitides and N. gonorrhoeae (only penicillin susceptible strains), some anaerobic bacteria and spirochetes including B. burgdorferi
Elimination/Excretion of Penicillin Minimally metabolized by the liver, excreted mainly unchanged by the kidneys
Adverse/Side Effects of Penicillin Seizures; Pseudomembranous Colitis, diarrhea, epigastric distress, nausea, vomiting; rash; pain, phlebitis; allergic reactions including anaphylaxis and serum sickness
Contraindications of Penicillin Previous hypersensitivity to penicillins (cross-sensitivity may exist with cephalosporins and other beta-lactams); Hypersensitivity to procaine or benzathine; Some products may contain tartrazine and should be avoided in patients with known hypersensitivity
Medication/Food interactions of Penicillin May decrease effectiveness of oral contraceptive agents; Probenecid decrease renal excretion and increase levels therapy may be combined for this purpose. Neomycin may decrease absorption of penicillin V. Decrease elimination of methotrexate and increase risk of serious toxicity
Medication administration of Penicillin PO; IM; IV
Nursing interventions of Penicillin Assess for infection at beginning of and during therapy. Obtain a history to determine previous use of and reactions to penicillins, cephalosporins, or other beta-lactam antibiotics; Obtain specimens for culture and sensitivity before initiating therapy-first dose may be given before receiving results; Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify health care professional immediately if symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction. Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy
Patient/Family teaching of PenicillinInstruct patient to take med around clock and to finish drug as directed. Advise patient to report signs of superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy. Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Patient with an allergy to penicillin should be instructed to always carry an identification card with this information. Advise patient taking oral contraceptives to use an additional non-hormonal method of contraception during therapy and until next menstrual period
Evaluation/Desired outcomes of Penicillin Resolution of signs and symptoms of infection; Length of time for complete resolution depends on the organism and site of infection
Potential nursing diagnoses of Penicillin Risk for infection (indications, side effects); Non-compliance (patient/family teaching)

Section 2

Question Answer
Macrolides Antibiotics; Primarily bacteriostatic; Some have antibiotic or antifungal activity; A class of natural products that consist of a large macrocyclic lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, may be attached; Used to treat infections caused by Gram-positive (e.g., Streptococcus pneumoniae) and limited Gram-negative (e.g., Bordetella pertussis, Haemophilus influenzae) bacteria, and some respiratory tract and soft-tissue infections.[2] The antimicrobial spectrum of macrolides is slightly wider than that of penicillin, and, therefore, macrolides are a common substitute for patients with a penicillin allergy.
Macrolides actions Inhibition of bacterial protein biosynthesis to varying extents; Macrolides bind to the 50S ribosomal subunit with a specific target in the 23S ribosomal RNA molecule and various ribosomal proteins (blocks addition of new amino acids to the growing peptide chain. The drug is usually bacteriostatic, yet can be bactericidal against highly susceptible organisms, or when present in high concentration
Macrolides therapeutic uses Erythromycin is a common use antibiotic. It is used for several infections and may be used as an alternative to penicillin G in patients with penicillin allergy. Macrolides have immunomodulatory and anti-inflammatory effects without affecting homeostatic immunity. These properties have led to their long-term use in treating neutrophil-dominated inflammation in diffuse panbronchiolitis, bronshiectasis, rhinosinusitis, and cystic fibrosis
Elimination/Excretion of Macrolides Varies by drug; For example: Erythromycin: metabolized by liver, and 2-5 percent excreted in urine, and also excreted in bile; Clarithromycin: 20-40 percent excreted unchanged in urine; Azithromycin: some hepatic metabolism to inactive metabolite, excreted by bile and 12 percent by urine
Adverse/Side effects of Macrolides Epigastric pain, nausea, vomiting, diarrhea; cardiotoxicity, especially when erythromycin is combined with drugs that can raise its plasma level; high concentrations of erythromycin can prolong the QT interval, posing risk of torsades de pointes; combined with a CYP3A4 inhibitor may create 5-fold increase in risk of sudden cardiac death; Should be avoid in patients taking CYP3A4 inhibitors and certain calcium channel blockers (verapamil and diltiazem), azole antifungal drugs, HIV protease inhibitors and nefazodone, to include patients with congenital QT prolongation and by those class IA or class III anidysrhythmic drugs; Supra-infection of the bowel; Thrombophlebitis (IV infusion); Evidence erythromycin may cause hypertrophic pyloric stenosis in infants, especially those under 2 weeks of age
Contraindications of Macrolides Hypersensitivity; should be avoided in severe liver disease due to increased risk of hepatotoxicity and altered handling
Medication/Food interactions of Macrolides Erythromycin can increase the plasma levels and half-lives of several drugs, posing risk of toxicity; It also prevents binding of chloramphenicol and clindamycin to bacterial ribosomes, thereby antagonizing their antibacterial effects; Verapamil, diltiazem, HIV protease inhibitors, and azole antifungal drugs can inhibit erythromycin metabolism. Erythromycin and clarithromycin are strong inhibitors of cytochrome P450 3A4 and may result in elevated concentrations of many drugs (e.g., Benzodiazepines, Calcium channel antagonists, HMG CoA reductase inhibitors, Immuno-suppressants, Psychiatric drugs, and other
Medication administration of Macrolides PO; IV
Nursing interventions of Macrolides Erythromycin: Advise patient to take as prescribe, and complete med prescription; Assess for infection before and during therapy; Check culture and sensitivity before therapy; monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to heath care professional promptly. monitor liver enzymes; If antacids, instruct patient to take antacids 2 hours before or 2 hours after; If azithromycin, instruct patient to take 1 hour before or 2 hours after meals with full glass of water; Lab test considerations: monitor liver function tests periodically on patients receiving high-dose, long term therapy
Patient/Family teaching of MacrolidesErythromycin: Instruct patient to take med around clock and finish drug completely as directed; Inform patient may cause nausea, vomiting, diarrhea, or stomach cramps, and if persist or if severe abdominal pain, yellow discoloration of skin or eyes, darkened urine, pale stools, or unusual tiredness develops to notify health care professional; May cause infantile hypertrophic pyloric stenosis in infants; Notify health care professional if vomiting and irritability occur; Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication; Advise patient to report signs of superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul smelling stools)-Instruct if symptoms do not improve to notify health care professional
Evaluation/Desired outcomes of Macrolides Erythromycin: Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection; Improvement of acne lesions
Potential nursing diagnoses of Macrolides Risk for infection (indications, side effects); Non-compliance (patient/family teaching)

Section 2