Chapter 26: Penicillins, Other Beta Lactams And Cephalosporins Flashcards
All antibiotics treat what?
Bacterial infections
What is any side effect of any antibiotics ?? (3)
Yeast infection
Diarrhea
Thrust
Can you get CDIFF On any antibiotic?
Notes
- though in the presentation, we should focus on the specific medications !
Yes
Anytime a patient is on an antibiotic, what’s the super important thing to teach them?
FINISH THEM?!
Why is finishing antibiotics so important?
And if they don’t?
To properly get rid of the infection
If not, it can spread more
Nursing implications for all antibiotic use
Before beginning therapy
- assess drug allergies
- renal/liver/cardiac function
- lab studies
Be sure to obtain thorough patient health history, including immune status
Assess for conditions that may be contraindications to antibiotics use or that may indicate cautions use
Assess for potential drug interactions
Do you stop taking antibiotic after feeling better for some usage time?
NO!! Keep going!!
Every antibiotic you give what do you want know about the patient? (3)
Drug medications
Allergies
Blood work
What is assessing for signs and symptoms of superinfection?? (5)
Fever
Perineal itching
Cough
Lethargy
Unusual discharge
If a patient who is immune comprised, what is normally the process for antibiotics?
Stronger medication
Or medication for a longer period of time
Why do we need to know some contraindications before antibiotics?
Some antibiotics are nephro toxic
So we don’t give to them for kidney problems
What groups of people would we consider doing cultures before giving antibiotic administration? (3)
Immunocompromised
Elderly
Childern
What does a culture tells us?
What antibiotics work
What is the pathogen
What antibiotics don’t work
What are the 3 most common effects of antibiotics?
Vomitting
Nausea
Diarrhea
All oral antibiotics are absorbed better if taken with at least??
6-8 ounces of water
Test question
What are you gonna do first before administration of antibiotics?
Cultures !!
If the antibiotic causes photosensitivity what do we tell the patient?
Put sunscreen so don’t burn
Most antibiotics don’t mind what? When absorption’s?
But what helps break down and helps absorption 10x more?
Most of them don’t mind food or empty stomach
Water!! Helps easier breakdown
What is bacteriostatic drugs?
Inhibits growth of bacteria
( stops spreading )
What is bactericidal drugs?
Kills the bacteria
What are some body defenses? (6)
Age
Nutrition
Immunoglobulins
Circulation
WBCS
Organ function
Why does age affect body defenses?
Think about kids
They aren’t fully develop
We use their weight to determine dosage and which type of medication
Since their blood brain barrier isn’t fully develop, the war drugs will cross the blood brain barrier
And if you’re older, you may be on more medications and it can cause interactions
And organs slow down
How does nutrition play a part in helping antibiotics?
Some medications bind to medication
Like tetracycline binds to calcium
So it gets rid of you calcium!!
Think of protein bound
How does immunoglobulins work in antibiotics?
Some patients make not tolerate or simply work!
How does circulation work for antibiotics?
If the patient doesn’t have enough blood flow, the antibiotic may not reach the entire body
Example
Patient may have osteomyelitis ( infection of bone )
- because blood isn’t good enough flow
- which means we give IV
Why is antibiotic resistance the biggest thing to worry ?
Because people stop taking the medication and the bacteria start to gain resistance
Or the bacteria evaluation
What is inherent resistance?
Naturally resistant
What is acquired resistance?
Previous exposure
Antibiotics treat viral infections?
Nope
What are the 3 most common pathogens that are resistant ?
MRSA
VREF
VRSA
What are the 3 antibiotic misuse?
Taken for antiviral
When no infection
Skipping doses
Increase misuse resistance
What is cross resistance?
Give me an example?
Can occur between antibacterial drugs with similar drugs
Penicillin allergy increased chances of cephalosporins allergy too!
Or resistance !
What does additive mean?
Effect is doubled
What does potentiative mean?
One potentates effect of other
What does antagonistic mean?
When one bactericidal and one bacteriostatic are added together ; so it’s reduced
Should you give penicillin and tetracycline together?
Nope! They cancel each other out
What is allergic reaction? Anaphylaxis?(5)
Hypersensitivity
Rash
Pruritus
Hives
Anaphylactic shock
When a patient had a rash from their last medication, should you give it again?
What case scenario?
No change it because of allergy
Give them again and they have worse allergies
If the patient got diarrhea from medication, is that an allergy?
Nope!
Super infection is normally associated with yeast infection and thrush
( when normal flora killed )
Normally this will go away when?
The stopping of antibiotic
What are the main organ toxicity when giving antibiotics? (3)
Ear
Liver
Kidney
What does narrow spectrum mean?
Primary effective against one bacteria type
What are two examples of narrow spectrum?
Penicillin and erythromycin
What is broad spectrum?
Frequently used when offending microorganism that has not been identified by a culture or swab
What is an example of broad spectrum?(2)
Tetracycline & cephalosporins
Broad spectrum is effective against what?
Gram positive
Gram negative
If our patient is waiting for the culture to come back, what spectrum will we give until we know the bacteria?
Broad spectrum
What’s the biggest downside of being on a broad spectrum antibiotics?
They have a higher risk of superinfection
( thrush )
What are the 4 penicillins?
Basic penicillins
Broad spectrum
Penicillinase
Extended spectrum
What does penicillins treat??(6)
ENT ( ear, nose throat )
Skin
Bone
Joint
GI
Cardiac
It’s important to note that some patients may have bacteria that produce a beta lactamase or Penicilase
And why is this important?
It’s because it makes the usage of a penicillin not work
Or it’s pretty much resistant to penicillins
So when we have bacteria that produce that lactamase, how do we help treat it?
And how does it help?
Adding a beta lactamase inhibitor
Which will reduce the resistance ( augmentin )
How does beta lactamse inhibitors work?
Inhibits bacteria enzyme which stops this resistance
Making the penicillin work better
What are the 3 things we can add to a penicillin to stop that beta lactamse production?
Clavulanic acid
Sulbactam
Tazobactam
Her best way to explain
Beta lactamse is the boss!!
( use all power to fight it )
Your power up to fight the boss
( clavulanic acid, sulbactam and tazobactam )
What is the only oral medication, antibiotics that’s a penicillin that treats beta lactamse bacteria?
Augmentin
( amoxicillin and clavulanic acid )
Can augmentin treat beta lactamse bacteria? And why?
Yes because it has that Clavulanic acid in its built up
What are the 2 normally beta lactamase inhibitors for penicillins of IV?
Unasyn & Zosyn
Does the injection of penicillin hurt ? And what do we help to aid with it?
Yes super!!
Litacane
What are main side effects of penicillin? (3)
Tongue discoloration
Glossitis ( red, lose of taste)
Arthralgia ( joint pain )
( it isn’t common with CDIFF but can happen )
Clinical judgment penicillins
Concept
- infection
Recognize cues
- assess for allergy to penicillins or cephalosporins
- evaluate lab results, especially hepatic enzymes
Analyze cues & prioritize hypothesis
- tissue injury, nausea, vomitting
Generate solutions
- the patients WBC will be within normal limits
Take action
- obtain a sample for lab culture and antibiotics sensitivity testing to discern the infective organism before antibiotic therapy is started
- monitor for evidence of superinfection, especially in patients taking high doses of an antibiotic for a prolonged time
- examine the patient for an allergic reaction, especially after the first and second doses
- teach patient to take entire prescribed antibiotic
Evaluate outcomes
Test question
White blood count
- 18 or 20 !!
We need to know that that 18-20 is not normal!
When it’s elevated, it means infection going on!
Cephalosporins and penicillin are what?
Cousins!!
Cephalosporins pretty much treat the same things as penicillins, so what are they?
Pharyngitis
Tonsillitis
Otitis media
Respiratory
Skin
Intrabdominal
Bone and joint
Urinary
Gynecological infections
STIS
bacteremia
Sepsis
How much generations of cephalosporins are there?
5
First and second generations cephalosproins, what are the main things to do about them ? (4)
Not effective against beta lactamase
Narrow spectrum
Short half life
Take them 4x a day !!
Third and fourth generation cephalosproins generations ; things to really remember ? (2)
Don’t treat beta lactamse
Long duration
Take 2x a day
4th generation and 5th generation cephalosporins are the only ones to what?
Enters CSF to treat CNS infections
What is the only important thing about 5th generation cephalosporin?
Only one to treat MRSA
Cephalosporins have a 10% cross reaction if patient is allergic to what?
Penicillin
What is the main side effects of cephalosporins? (4)
Increased bleed
Elevated liver enzymes
Nephrotoxicity
Headaches/dizzines
Cephalosporins interact with what and it increases what?
Anti coagulant medications
Bleeding
Does cephalosporins hurt when you give IM?
Yes
Are cephalosporins nephrot toxic when a patient has healthy kidneys?
What about they have reneal disease, diabetics, etc ?
Super
Nope
Are penicillins nephrotoxic?
Nope
What are the 3 medications that a patient may be on that we don’t give cephalosporins because of high nephro toxic?
Aminioglycosides
Loop diuretics
Vancomycin
What is the medication of cephalosporins we need to know ??
Cefoteatan?
What is cefoteatan or how does it work?
Interacts with alcohol
Causes like disulfiram action
Vomiting after consuming
Test question
Your patient is taking cefotetan , what the most important thing to include teaching the patient?
- finish medication
- take food
- don’t drink alcohol on medication
- call doctor when have rash
Don’t drink alcohol on this medication
Cephalosporin use can increase bleeding time so we need caution with which medication?
Anticoagulants
