antiinfective medications copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by mosby, an imprint...
TRANSCRIPT
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Antiinfective Medications
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
Chapter 12
1
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Learning Objectives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.2
Identify the major antiinfective drug categories and the organisms against which they are effective
Outline the most important things to teach the patient who is taking antiinfective drugs
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Learning Objectives (cont.)
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.3
Define "spectrum" and explain what this word means in antiinfective therapy
List some of the most common adverse reactions to medications used to treat infections
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Overview
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PathogenBacteriaFungiVirusesAntimicrobials
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Learning Objectives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.5
Identify the major antiinfective drug categories and the organisms against which they are effective
Outline the most important things to teach the patient who is taking antiinfective drugs
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Penicillins
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Main antibiotic for yearsBroad-spectrum drug of choiceOverusePenicillin-resistant strainsAction and UsesInterferes with creation of the mucopeptide
cell wallBacteriocidalUsed to treat multiple infectionsAllergies
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Penicillin Medications
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Natural PCNspenicillin G
Given IM; procaine /aqueous forms used to treat gonorrhea
penicillin Vpenicillin VK+
Penicillinase resistantcloxacillincicloxacillinnaficillinoxacillin
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MORE Penicillins
• Aminopenicillins:Broad Spectrum
– amoxicillin• Amoxil / Trimox
– amoxicillin/ clavulanate• Augmentin
– ampicillin– ampicillin/ sulbactam
• Unasyn
• Extended Spectrum– pipercillin– pipercillin/ tazobactam
• Zosyn
– ticarcillin• Ticar
– ticarcillin/ clavulanate• Timentin
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Penicillins (cont.)
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Adverse Reactions Neuropathy
High parenteral dosesSkin eruptionsGI symptomsUrticariaLaryngeal edemaAnaphylaxis
Drug Interactions: PCN negates oral contraceptives!!!
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Penicillins (cont.)
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Nursing Implications and Patient TeachingAssessment
Signs of infection and allergiesDiagnosisPlanning
10-day regimenImplementation
Route of administrationEvaluationPatient Teaching
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Sulfonamides
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Broad-spectrum antiinfectiveBacteriostatic action: inhibits folic acid
synthesis in the cellAction and Uses Urinary tract infectionsEffectively treats multiple microorganismsPreoperative and postoperative therapy for
bowel surgery
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Sulfonamides (cont.)
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Adverse ReactionsDrug InteractionsPotentiateDecrease effectiveness
Nursing Implications and Patient TeachingContraindicationsTake on an empty stomach
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Sulfonamides
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Plainsulfadiazinesulfamethizolesulfasalazine
Azulfidine
Mixturestrimethoprim/
sulfamethoxazoleBactrimSeptraSulfatrim
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Tetracyclines
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Actions and usesBroad-spectrum antibioticsAdverse ReactionsGI upsetNursing ImplicationsNot for pregnant patients or children under 8
years of ageCan cause sensitivity to light (photosensitivity) so
counsel patient to be careful about sun exposureTake on empty stomach and avoid dairy within 2
hours of taking drug.
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Tetracyclines
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doxycyclineminocyclineoxytetracyclinetetracycline
Take on an empty stomach.Never give to pregnant woman or child under
8. Will turn teeth green/grey permanently.Binds with calcium products
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Macrolides: Broad Spectrum
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Zithromax; Z packazithromycin
Biaxinclarithromycin
E-Mycin / EESErythromycin
Bacteriostatic or bacteriocidal depending on dosage concentration.
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Cephalosporin History
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The first generation cephalosporins are mostly active against gram positive bacteria and vary with their delivery routes and uses.
Second generation cephalosporins are modified to increase spectrum against gram negative bacteria but have reduced effects against gram positive bacteria. These agents also have better membrane penetration and more B-lactamase resistance.
Third generation cephalosporins include effects against pseudomonas infections, they are also useful in multi-resistant hospital acquired infections.
Fourth generation cephalosporins are even more efficacious. They have an increased spectrum over third generation drugs and are excellent in multiple drug resistance patterns. The only currently available agent in this generation is cefepime.
http://sitemaker.umich.edu/medchem10/cephalosporins_2
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Cephalosporin medications(all have kef-; cef-; or ceph in generic name
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1st generationDuricef
cefadroxilKeflex
cephalexinAncef
Cefazolin
Bacteriocidal
2nd generationCeclor
cefaclorCefzil
cefprozilCeftin
Cefurozime
Bacteriocidal
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More Cephalosporins
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3rd generationOmnicef (cefdinir)Maxipime
(cefepime)Claforan
(cefotaxime)Fortaz
(ceftazidime)Cefizox
(cefizoxime)Rocephin
(ceftriaxone)
4th generationMaxipime
cefepime
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Cephalosporin Continued
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Made from molds like PCN.Works against cell wall synthesis like PCN
does.Can be allergic to cephalosporins if also
allergic to PCN. Use with caution. Give PO with food to decrease nausea and
diarrhea side effects
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Lincosamides
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Cleocin clindamycin
Empty stomach with full glass of waterMay be give as a deep IM injection
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Fluoroquinolones(all generics end in floxacin)
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Ciprociprofloxacin
Levaquinlevofloxacin
Aveloxmoxifloxacin
Maxaquinlomefloxacin
All are excreted through the kidneys so check your patient’s renal function
Potent newer medication.
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Miscellaneous Medications
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BacitracinVancocin
Vancomycin – slows cell wall synthesis; damages plasma membrane making it susceptible to osmotic pressure; interferes with RNA synthesis
Very irritating to the vein; dilute and give over 1 hour IV
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Aminoglycosides
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Used to treat gram negative bacteria when PCN is not an option
Amikinamikacin
Garamycingentamicin
Neo-fradinneomycin
streptomycin sulfateTOBI (tobramycin
sulfate)
Very ototoxic and nephrotoxic!!!
Assess renal function 1st.
Encourage increased fluid intake to flush kidneys.
Draw ‘Peak and Through’ levels to assess therapeutic levels.
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WARNING
Allergic reactions can appear at any time whether you have safely taken the drug before or not. Be aware!
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Antituberucal drugs
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Primary treatment agentsINH/ Isoniazid
isoniazidRifadin
rifampinPriftin
rifapentine
Retreatment agentsSeromycin
Pulvulescycloserine
Kantrexkanamycin
Prevention in HIV patientsMycobutin (rifabutin)
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Antiparasitic Drugs
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AmebicidesAralen
ChloroquineOtotoxic
Flagyl/ MetrogelMetronidazoleNo alcohol intake
AntihelminthsTreat pinworms &
roundwormsCan taste bitterVermox
mebendazolePin-X
pyrantelMintezol
thiabendazole
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Antimalarials
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4 aminoquinolonesAralen
chloroquinePlaquenil
hydroxychloroquine
8 aminoquinolonesAll of these drugs
have -quine in the genericprimaquine
phosphate
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Antimalarials
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Folic acid agonistDaraprim
pyrimethamine
Miscellaneous agentsdoxycyclinemefloquinequinine sulfateQuinine is very bitter. Put in the back of the mouth and swallow quickly. Give fruit drink/ sweet drink to rinse mouth.
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Chapter 13 – Antivirals (have –vir)
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Zoviraxacyclovir
Symmetrelamantadine
Famvirfamciclovir
Tamifluoseltamivir
phosphate
Virazoleribavirin
Valtrexvalacyclovir HCL
Valcytevalganciclovir
Relenzazanamivir
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Antivirals
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Most have –vir in generic or brand name.Medications decrease the viral load but do
not cure.Viristatic.Goal is to prevent opportunistic infections
while the body heals itself from the virus using the immune system
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Reverse transcriptase inhibitors
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Nucleoside AnaloguesEpivir – HBV
lamivudine (3TC)Retrovir
zidovudine (AZT)
Nonnucleoside AnaloguesZiagen
abacavir sulfateRescriptor
delavirdineViramune
nevirapine
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Protease inhibitors
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CrixivanIndinavirNephrolithiasis
Viraceptnelfinavir
Norvirritonavir
Invirasesaquinavir
Take prescribed dose at ordered times.
Skipping doses can lead to a resistant strain of the virus.
Standard precautions continue to be needed.
Look for ‘Crix belly’.
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Antifungal medications
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Mycostatin - nystatinFungizone - amphotericin B ***Diflucan - fluconazoleGrifulvinV - griseofulvinNizoral - ketoconazole Lamisil – terbinafine HCL
Flagyl (metronidazole) can also be used*** protect IV fluid from light. very potent; used only with serious fungal infections
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Antifungal effects
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Mycotic infections take a while to cure. Phototoxicity – use sun screen; avoid
summer sun hoursHepatotoxicity – watch the liver function
studiesAvoid alcohol with any of these drugs. The
liver is busy clearing out the med.
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Questions?