Antibiotics that affect bacterial cell wall

Question 1

What are the 4 antibiotic groups that work by disrupting the bacterial cell wall?

Answer 1

1. Penicillins
2. Cephalosporins
3. Carbapenems
4. Monobactams

Question 2

Penicillins

Prototype

Answer 2

Penicillin G potassium
(narrow-spectrum for IM or IV)

Question 3

Penicillin

What is a type of broad-spectrum?

Answer 3

Amoxicillin

Question 4

Penicillin

Pharmacologic action

Answer 4

Weaken bacterial cell wall
(beta-lactam antibiotic)

Question 5

Penicillins

Therapeutic uses

Answer 5

1. Treat infections due to gram-positive cocci (Strep)
2. Treat meningitis due to gram-negative cocci
3. Kill spirochetes (syphillis)
4. Prophylaxis against bacterial endocarditis before dental procedures
5. Extended-spectrum effective against Pseudomonas aeruginosa, Enterobacter, Proteus

Question 6

Penicillins

Nursing interventions for anaphylaxis

Answer 6

1. Review client allergies prior to med admin
2. Observe for allergic reaction for 30 min

Question 7

Complications of penicillin

Answer 7

1. allergy
2. renal impairment
3. hyperkalemia
4. hypernatremia
5. dysrhythmias

Question 8

Penicillins

Contraindications

Answer 8

• Previous allergic reaction

Question 9

Penicillins

Precautions

Answer 9

• have or at risk for kidney dysfunction

Question 10

Penicillins

Interactions

Answer 10

• Inactivates aminoglycoside
• Probenicid delays penicillin excretion

Question 11

Penicillins

Nursing admin

Answer 11

• Instruct client to report signs of allergic reaction
• Take penicillin V and amoxicillin with meals, and all others with water 1 hr before or 2 hrs after meals
• Complete entire abx course
• Use additional contraceptive

Question 12

Cephalosporins

Prototype

Answer 12

Cephalexin
(1st generation)

Question 13

Cephalosporins

Other 1st gen

Answer 13

Cefazolin (IM/IV)

Question 14

Cephalosporins

2nd gen

Answer 14

Cefaclor (PO)
Cefotetan (IM/IV)

Question 15

Cephalosporins

3rd gen

Answer 15

Ceftriaxone, cefotaxime (IM/IV)

Question 16

Cephalosporins

4th gen

Answer 16

Cefepime (IM/IV)

Question 17

Cephalsporins

5th gen

Answer 17

Ceftaroline (IV)
* Use for MRSA

Question 18

Cephalosporins

Pharmacologic action

Answer 18

• destroy bacterial cell wall

Question 19

Why are there serveral generations of cephalosporins?

Answer 19

each subsequent generation is:
* more likely to reach CSF
* less susceptible to destruction by beta-lactamase
* more effective against gram-negative and anaerobes.

Question 20

Cephalosporins

Therapeutic use

Answer 20

Broad-spectrum bactericidal with high therapeutic index

Question 21

Cephalosporins

Complications

Answer 21

• Allergy, and cross-sensitivity with penicillins
• Bleeding
• Thrombophlebitis
• Renal insufficiency
• Pain with IM injection
• C. diff

Question 22

Cephalosporins

Contraindications

Answer 22

History of allergic reactions to cephalosporins or penicillins

Question 23

Cephalosporins

Precautions

Answer 23

Renal impairment
Bleeding disorders or on anticoagulants

Question 24

cephalosporins

Interactions

Answer 24

• Disulfiram reaction (alcohol intolerance) with alcohol consumption
• Probenecid delays renal excretion of cephalosporins
• Calcium and ceftriazone interaction

Question 25

Should cephalosporins be taken with food or on an empty stomach?

Answer 25

with food

Question 26

# Carbapenems Prototype

Answer 26

Imipenem-cilastatin (IM or IV)

Question 27

# Carbapenems Pharmacologic action

Answer 27

Broad spectrum beta-lactam antibiotics that destroy bacterial cell walls

Question 28

# Carbapenems Therapeutic uses

Answer 28

* serious infections due to gram-positive and gram-negative cocci and anaerobic bacteria * reserved to clients who cannot be treated with a more narrow-spectrum antibiotic to avoid resistance

Question 29

# Carbapenems Complications

Answer 29

* allergic reaction and cross-sensitivity to penicillin or cephalosporins * GI upset * Suprainfection (yeast, colitis, black furry growth on tongue)

Question 30

# Carbapenems Contraindications

Answer 30

Pregnancy risk category C

Question 31

# Carbapenems Precautions

Answer 31

Renal impairment

Question 32

# Carbapenems Interactions

Answer 32

Reduce blood levels of valproic acid (monitor for seizures)

Question 33

Other meds that inhibit bacterial cell wall synthesis

Answer 33

Vancomycin (pneumonia) Monobactam (c diff) Fosfomycin (UTIs)

Question 34

# Vancomycin Complications

Answer 34

Ototoxicity VFS due to rapid infusion (rash, itching, flusing, hypotension, tachycardia) Thrombophlebitis Renal toxicity

Question 35

# Vancomycin Precautions

Answer 35

Renal impairment or healing loss Older patients

Question 36

# Vancomycin Nursing administration

Answer 36

Monitor trough levels routinely, even after reaching a steady state