Antibiotics Affecting Bacterial Cell wall minus Penicillin Flashcards
Monobactams
axetreonam (Azactam) Given if allergic to PCN Given IV or IM, check IV site frequently for thrombophlebitis Eliminated by kidneys Half-life is prolonged in renal failure
Monobactams/axetreanam (Azactam) MOA
Inhibits cell wall synthesis
Works on gram negative bacteria
Cautions with Monobactams/axetreanam (Azactam)
Renal infufficiency
Adverse effects with Monobactams/axetreanam (Azactam)
Thrombophlebitis - check IV site
Nuring implications/Education for Monobactams/axetreanam (Azactam)
If patient is not eating well - find out if taste has changed
Encourage patient to eat
Monitor BUN and creatinine - get baseline before treatment
If patient complains about burning, slow rate by 5 mL/hr or place ice pack over IV site
Carbapenems - drugs ending in “penem”
imipenem + cilastatin (Primaxin)
ertapenem (Invanz)
meropenem (Merrem)
imipenem + cilastatin (Primaxin)
deactivated by enzyme in kidneys quickly
the cilastatin inhibits the enzyme
ertapenem (Invanz)
Highly protein bound
No liver metabolism
Excreted by kidneys
meropenem (Merrem)
Little protein binding
No metabolism
Renally excreted
Broad spectrum
Gram positive
Gram negative
Anaerobic
Resistant to beta-lactamase
MOA of broad specrtum
Inhibits wall synthesis
Adverse effects of broad spectrum
Seizures Cross reactivity with PCNs - space out when give each Rash Seizures Diarrhea N/V Edema
Drug interactions with broad spectrum
Cross reactivity with PCN
Works synergistically with aminoglycosides but need to be separated when giving
Cephalosporins - drugs beginning with “Cef”
First generation
cefazolin, cefadroxil, cephalexin Gram positive Some gram negative Some anaerobic Little resistance to beta lactamase
Second generation Cephalosporins
cefaclor, cefuroxime, cefoxitin
Increased gram negative
More beta resistance
Third generation Cephalosporins
ceftriaxone, ceflazidime
Extended gram negative
even more beta resistance
Fourth generation Cephalosporins
cefepime
Most gram negative coverage
Most resistant to beta lactamase
Fifth generation Cephalosporins
ceftaroline (Teflano), ceftobipole (Zeftera)
Mainly targets resistant bacteria
Mainly MRSA
If allergic to PCN, most likely allergic to cephalosporins
True “kissing cousins”
Kinetics of Cephalosporins
Widely distributed in body water 3rd, 4th, 5th generations have good CSF penetration (good for meningitis) Most excreted unchanged by kidney ceftriaxone excreted hepatically Half-lives are short
MOA of Cephalosporins
Similar to PCNs in structure
Inhibition of cell wall synthesis, causing weakened wall that will swell and burst
Also beta lactam antibiotics
bactericidal
Adverse effects of Cephalosporins
Hypersensitivity - cross reactivity with PCN
Thrombocytopenia
Rash
GI upset
Superinfection due to normal flora destroyed
Can alter blood clotting times = increase risk of bleeding especially in high doses
Cautions of Cephalosporins
Kidney patients (hard on kidneys) Look at BUN and Creatinine levels
Drug interactions
Aminoglycosides - risk for nephrotoxicity
Oral Anticoagulants - increased risk for bleeding
Probenicid - like PCN, may prolong effects
Alcohol - especially in earlier generations
- flushing, SOB, N/V, chest pains confusion, dizziness, seizures, headache
- Read OTC labels
Tricyclic Glycopeptides
Pretty toxic, usually given as last resort tx vancomycin (P) telavancin (very expensive) Gram positive Good for MRSA
Kinetics of Tricyclic Glycopeptides/Vancomycin
Not absorbed orally well
Renally excreted, but PO excreted in feces
Usually given in central line - hard on veins
Always give on pump
If infiltrated = tissue sloughing
Some protein binding
Half-life 4-6 hours
Elderly/renal impairement - half life can be as long as 146 hours.
MOA for Tricyclic Glycopeptides/Vancomycin
Inhibits cells wall synthesis
Bactericidal
Adverse effects of Tricyclic Glycopeptides/Vancomycin
Rash, Nephrotoxicity, BBW: ototoxicity (tinnitus, hearing loss, ataxia, vertigo, n/v)
Red man syndrome (histamine release)
Tissue sloughing with IV infiltration
Cautions with Tricyclic Glycopeptides/Vancomycin
Renal patients
Patients receiving aminoglycosides in conjunction with vanco - used to treat methicillin resistant organisms
- Due to nephrotoxicity
Inflammatory Bowel disease
- PO only
- increases absorption of vanco and increasing risk of toxicity
- Can cause c-diff
Elderly - decreased renal function may put them at risk for toxicity
Metformin - increase risk for lactic acidosis.
