Download Antimicrobial Agents

Chapter 46
Antimicrobial Agents
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 46
Lesson 46.1
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Objectives
• Explain the major actions and effects of drugs
used to treat infectious diseases
• Identify criteria used to select an effective
antimicrobial agent
• Identify baseline data the nurse should collect
on a continual basis for comparison and
evaluation of antimicrobial drug effectiveness
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Slide 3
Objectives (cont’d)
• Describe the nursing assessments and
interventions for the common adverse effects
associated with antimicrobial agents:
 Allergic reaction
 Direct tissue damage (e.g., nephrotoxicity,
ototoxicity, hepatotoxicity)
 Secondary infection
 Other considerations, such as photosensitivity,
peripheral neuropathy, and neuromuscular
blockage
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Slide 4
Objectives (cont’d)
• Identify significant data in a patient history
that could alert the medical team that a
patient is more likely to experience an allergic
reaction
• Describe basic principles of patient care that
can be implemented to enhance an
individual’s therapeutic response during an
infection
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Slide 5
Antimicrobial Agents
• Antibiotics: classified according to type of
pathogen they are effective against
 Antibacterial – bacteria
 Antifungal – fungal
 Antiviral – viral
• Subdivided by chemical family
 Penicillins
 Tetracyclines
 Aminoglycosides
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Slide 6
Nursing Assessment
Before Antimicrobial Therapy
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•
•
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History of current infection
Past history
Allergies
Medication history
Physical examination
Laboratory and diagnostic testing
Identify patients who need prophylactic
antibiotic treatment
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Slide 7
Nursing Assessment
During Antimicrobial Therapy
• Nausea, vomiting, diarrhea; secondary
infection; allergies and anaphylaxis
• Nephrotoxicity; hepatotoxicity; ototoxicity
• Blood dyscrasias; photosensitivity
• Proper drug administration
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

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Timing: with meals or before or after meals
Use of a second drug to prevent excretion
Hydration
Drug-drug or drug-food interactions
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Slide 8
Chapter 46
Lesson 46.2
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Slide 9
Objectives
• Explain the major actions and effects of drugs
used to treat infectious diseases
• Review parenteral administration techniques
and the procedure for vaginal insertion of
drugs
• Differentiate between gram-negative and
gram-positive microorganisms and between
anaerobic and aerobic properties of
microorganisms
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Slide 10
Objectives (cont’d)
• Develop a plan for implementing patient
education for patients receiving
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Aminoglycosides
Carbapenems
Cephalosporins
Glycylcyclines, ketolides
Penicillins, quinolones
Streptogramins, sulfonamides
Tetracyclines
Antifungal and antiviral agents
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Slide 11
Drug Class:
Aminoglycosides
• Actions
 Inhibit protein synthesis
• Uses
 Effective against gram-negative organisms
that cause urinary infections, meningitis,
wound infections, septicemia
• Serious adverse effects
 Ototoxicity; nephrotoxicity
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Slide 12
Drug Class: Carbapenems
• Actions
 Inhibit bacterial cell wall synthesis; potent
broad-spectrum agents resistant to betalactamase enzymes secreted by bacteria
• Uses
 Treat severe infections by multiresistant
organisms
• Serious adverse effects
 Severe diarrhea; dizziness, confusion,
seizures
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Slide 13
Drug Class:
Cephalosporins
• Actions
 Related to penicillins; inhibit bacterial cell wall
synthesis; divided into groups
• Uses
 Treat urinary and respiratory tract infections,
abdominal infections, bacteremia, meningitis,
osteomyelitis
• Common adverse effects
 Diarrhea; electrolyte imbalance
• Serious adverse effects
 Secondary infections; hepatotoxicity;
nephrotoxicity; hypoprothrombinemia
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Slide 14
Drug Class:
Glycylcyclines
• Drug: tigecycline (Tygacil)
• Actions
 Bind to 30S ribosome, preventing protein
synthesis; bacteriostatic
• Uses
 Treat broad-spectrum gram-positive, gramnegative, and anaerobic infections
• Common adverse effects
 Gastric irritation
• Serious adverse effects
 Severe diarrhea; photosensitivity
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Slide 15
Drug Class: Ketolides
• Drug: telithromycin (Ketek)
• Actions
 Bactericidal, prevent bacterial ribosomes from
translating its mRNA into new protein
• Uses
 Treat acute bacterial sinusitis, bronchitis, and
lung infections; gram-positive infections
• Common adverse effects
 Gastric irritation
• Serious adverse effects
 Fainting, visual disturbances; hepatotoxicity
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Slide 16
Drug Class: Macrolides
• Actions
 Inhibit protein synthesis, bacteriostatic and
bactericidal
• Uses
 Treat respiratory, GI tract, skin, and soft tissue
infections
• Common adverse effects
 Gastric irritation
• Serious adverse effects
 Severe diarrhea, thrombophlebitis
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Slide 17
Drug Class:
Oxazolidinones
• Drug: linezolid (Zyvox)
• Actions
 Inhibit protein synthesis in bacterial cells,
bactericidal and bacteriostatic
• Uses
 Treat serious or life-threatening infections caused
by gram-positive organisms
• Common adverse effects
 Gastric irritation, headaches
• Serious adverse effects
 Severe diarrhea, bone marrow suppression,
secondary infections, lactic acidosis, seizures,
visual neuropathy
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Slide 18
Drug Class: Penicillins
• Actions
 Inhibit cell wall synthesis, penicillinaseresistant penicillins
• Uses
 Treat middle ear infections, pneumonia,
meningitis, urinary tract infections, syphilis,
gonorrhea
• Common adverse effects
 Diarrhea, electrolyte imbalance
• Serious adverse effects
 Hepatotoxicity, nephrotoxicity
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Slide 19
Drug Class: Quinolones
• Actions
 Subclass known as fluoroquinolones; inhibit
activity of DNA gyrase, an enzyme needed for
replication of bacteria
• Uses
 Effective against gram-positive and gram-negative
bacteria
• Common adverse effects
 Nausea, vomiting, diarrhea, discomfort, dizziness,
lightheadedness
• Serious adverse effects
 Photosensitivity, rash, nephrotoxicity, neurologic
effects
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Slide 20
Drug Class:
Streptogramins
• Drug: quinupristin-dalfopristin (Synercid)
• Actions
 Inhibit protein synthesis in bacterial cells
• Uses
 Treat vancomycin-resistant E. faecium (VRE),
MRSA
• Common adverse effects
 Pain, infusion site inflammation, nausea,
vomiting, anorexia, abdominal cramps, diarrhea
• Serious adverse effects
 Hepatotoxicity, arthralgia, myalgia
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Slide 21
Drug Class: Sulfonamides
• Actions
 Inhibit bacterial biosynthesis of folic acid
resulting in cell death
• Uses
 Treat UTIs and otitis media
• Common adverse effects
 Nausea, vomiting, anorexia, diarrhea
• Serious adverse effects
 Rash, pruritus, photosensitivity, hematologic
reactions, neurologic CNS effects
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Slide 22
Drug Class: Tetracyclines
• Actions
 Inhibit protein synthesis by bacterial cells
• Uses
 Treat venereal diseases, UTIs, upper
respiratory tract infections, pneumonia, and
meningitis when penicillin is contraindicated
• Common adverse effects
 Nausea, vomiting, anorexia, abdominal
cramps, diarrhea
• Serious adverse effects
 Photosensitivity
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Slide 23
Drug Class: Antitubercular Agents
• Drug: ethambutol (Myambutol)
• Actions
 Alter cellular RNA synthesis and phosphate
metabolism
• Uses
 Treat tuberculosis
• Common adverse effects
 Nausea, vomiting, anorexia, abdominal
cramps
• Serious adverse effects
 Confusion, hallucination, blurred vision, redgreen vision changes
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Slide 24
Drug Class: Antitubercular Agents
(cont’d)
• Drug: isoniazid (INH, Nydrazid)
• Actions
 Disrupt the cell wall and inhibit replication of
tuberculosis bacteria
• Uses
 Treat and prevent tuberculosis
• Common adverse effects
 Nausea, vomiting
• Serious adverse effects
 Hepatotoxicity, tingling, numbness of hands
and feet, dizziness, ataxia
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Slide 25
Drug Class: Antitubercular Agents
(cont’d)
• Drug: rifampin (Rifadin)
• Actions
 Prevent RNA synthesis by inhibiting DNAdependent RNA polymerase
• Uses
 Eliminate meningococci and H. influenzae
type b, (Hib) from asymptomatic carriers
• Common adverse effects
 Reddish orange secretions
• Serious adverse effects
 Nausea, vomiting, anorexia, abdominal
cramps
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Slide 26
Miscellaneous Antibiotics
• Aztreonam (Azactam)
 Inhibits cell wall synthesis, monobactams
• Chloramphenicol
 Inhibits bacterial protein synthesis
• Clindamycin (Cleocin, Dalacin C)
 Inhibits protein synthesis
• Daptomycin (Cubicin)
 Cyclic lipopeptide, binds to bacterial
membranes and causes rapid depolarization
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Slide 27
Miscellaneous Antibiotics
(cont’d)
• Metronidazole (Flagyl)
 Bactericidal, trichomonacidal, and protozoacidal
• Spectinomycin (Trobicin)
 Inhibits protein synthesis
• Tinidazole (Tindamax)
 Similar to metronidazole
• Vancomycin (Vancocin)
 Prevents synthesis of bacterial cell walls
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Slide 28
Drug Class:
Topical Antifungal Agents
• Actions
 Alter permeability of cell membranes causing
amino acids and electrolytes to leak out
• Uses
 Treat tinea pedis, tinea cruris, tinea corporis,
tinea versicolor, Candida infections
• Common and serious adverse effects
 Irritation, redness, swelling, blistering, oozing
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Slide 29
Drug Class:
Systemic Antifungal Agents
• Drug: amphotericin B dosage forms
• Actions
 Fungistatic agent; disrupt cell membrane of
fungal cells
• Uses
 Treat systemic life-threatening fungal infection
• Drug: amphotericin B
• Common adverse effects
 Malaise, fever, chills, headache, nausea,
vomiting, thrombophlebitis
• Serious adverse effects
 Nephrotoxicity, electrolyte imbalance
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Slide 30
Drug Class:
Systemic Antifungal Agents (cont’d)
• Drug: fluconazole (Diflucan)
• Actions
 Chemically related to ketoconazole and
itraconazole; inhibit certain metabolic pathways in
fungi
• Uses
 Treat meningitis, candidiasis systemic candidiasis
• Common adverse effects
 Nausea, vomiting, diarrhea
• Serious adverse effects
 Rash, hepatotoxicity
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Slide 31
Drug Class:
Systemic Antifungal Agents (cont’d)
• Drug: flucytosine (Ancobon)
• Actions
 Antifungal; thought to inhibit RNA and protein
synthesis
• Uses
 Treat candidal septicemia, endocarditis, UTIs,
meningitis, pulmonary infections
• Common adverse effects
 Nausea, vomiting, diarrhea
• Serious adverse effects
 Hematologic, rash; hepatotoxicity; nephrotoxicity
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Slide 32
Drug Class:
Systemic Antifungal Agents (cont’d)
• Drug: griseofulvin microsize (Griseofulvin
Microsize, Grifulvin V)
• Actions
 Stop cell division and new cell growth
• Uses
 Treat ringworm
• Common adverse effects
 Nausea, vomiting, abdominal cramps
• Serious adverse effects
 Urticaria, rash, pruritus; photosensitivity;
confusion, dizziness, secondary infections,
nephrotoxicity, hepatotoxicity
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Slide 33
Drug Class:
Systemic Antifungal Agents (cont’d)
• Drug: itraconazole (Sporanox)
• Actions
 Chemically related to fluconazole and
ketoconazole; interfere with cell wall synthesis
• Use
 Treat variety of infections such as candidiasis,
histoplasmosis, blastomycosis
• Common adverse effects
 Nausea, vomiting
• Serious adverse effects
 Hepatotoxicity; heart failure; pruritus, rash
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Slide 34
Drug Class:
Systemic Antifungal Agents (cont’d)
• Drug: ketoconazole
• Actions
 Chemically related to fluconazole and
itraconazole; interfere with cell wall synthesis
• Uses
 Treat candidiasis, histoplasmosis; topically
treat seborrheic dermatitis, etc.
• Common adverse effects
 Nausea, vomiting
• Serious adverse effects
 Hepatotoxicity; pruritus, rash
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Slide 35
Drug Class:
Systemic Antifungal Agents (cont’d)
• Drug: terbinafine (Lamisil)
• Actions
 Inhibit squalene epoxidase, a key enzyme
required for biosynthesis in fungi
• Uses
 Treat onychomycosis of the toenail or
fingernail
• Serious adverse effects
 Pruritus, rash, fever, chills; nephrotoxicity,
hepatotoxicity; neutropenia, lymphopenia
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Slide 36
Drug Class: NRTI Antiviral Agents
• Drug: abacavir (ABC) (Ziagen)
• Actions
 Nucleoside analogue transcriptase inhibitor
(NRTI); prevent viral DNA growth
• Uses
 In combination with zidovudine and lamivudine
to treat HIV-1 infection
• Common adverse effects
 Diarrhea, nausea, vomiting
• Serious adverse effects
 Abdominal pain, numbness, tingling
 Hypersensitivity; lactic acidosis; hepatotoxicity
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Slide 37
Drug Class: Antiviral Agents
• Drug: acyclovir (Zovirax)
• Actions
 Inhibit viral cell replication
• Uses
 Topically used to treat herpes genitalis; orally
used to treat recurrent genital herpes; IV to
treat herpes simplex type 1 and 2 in
immunosuppressed patients
• Serious adverse effects
 Pruritus, rash, burning, hives, diaphoresis,
nephrotoxicity, hypotension, confusion
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Slide 38
Drug Class: Antiviral
Agents (cont’d)
• Drug: atazanavir (Reyataz)
• Actions
 HIV protease inhibitor, prevent maturation of viral
particles by inhibiting HIV-1 protease
• Uses
 In combination with other antiretroviral agents to
treat HIV-1 infections
• Common adverse effects
 Nausea, vomiting, diarrhea, fat distribution,
hyperbilirubinemia
• Serious adverse effects
 Hepatotoxicity, rash, hyperglycemia
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Slide 39
Drug Class: Antiviral
Agents (cont’d)
• Drug: enfuvirtide (Fuzeon)
• Actions
 New class of antiviral agents interferes with
entry of viruses into host cells, inhibits fusion
of viral and cellular membranes
• Uses
 Treat HIV-1 infections
• Common adverse effects
 Nausea, vomiting, diarrhea
• Serious adverse effects
 Injection site reactions, pneumonia
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Slide 40
Drug Class: Antiviral
Agents (cont’d)
• Drug: etravirine (Intelence)
• Actions
 Nonnucleoside reverse transcriptase inhibitor
(NNRTI) antiviral agent; inhibit replication of
HIV-1
• Uses
 In combination with other agents that act
differently to treat HIV-1 infection
• Serious adverse effects
 Rash
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Slide 41
Drug Class: Antiviral
Agents (cont’d)
• Drug: famciclovir (Famvir)
• Actions
 Prodrug of penciclovir; inhibit viral cell
replication
• Uses
 Treat recurrent infections of genital herpes,
acute herpes zoster
• Common adverse effects
 Nausea, vomiting, headache
• Serious adverse effects
 Confusion
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Slide 42
Drug Class: Antiviral
Agents (cont’d)
• Drug: fosamprenavir (Lexiva)
• Actions
 Prodrug of amprenavir; prevent maturation of
viral particles by inhibiting HIV-1 protease
• Uses
 In combination with other antiretroviral agents
to treat HIV-1 infections
• Common adverse effects
 Nausea, vomiting, diarrhea, fat distribution
• Serious adverse effects
 Hepatotoxicity, rash, hyperglycemia
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Slide 43
Drug Class: Antiviral
Agents (cont’d)
• Drug: lamivudine (Epivir)
• Actions
 NRTI that inhibits replication of viruses
• Uses
 In combination with zidovudine to treat HIV-1
infection; chronic hepatitis B associated with
active liver inflammation
• Serious adverse effects
 Anemia, granulocytopenia, lactic acidosis,
hepatotoxicity
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Slide 44
Drug Class: Antiviral
Agents (cont’d)
• Drug: maraviroc (Selzentry)
• Actions
 Fusion inhibitor antiretroviral agents known as
chemokine receptor 5 coreceptor antagonists, block
entry of HIV-1 into cells
• Uses
 In combination with other antiviral agents to treat
HIV-1
• Common adverse effects
 GI effects
• Serious adverse effects
 Hepatotoxicity, orthostatic hypotension, infection
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Slide 45
Drug Class: Antiviral
Agents (cont’d)
• Drug: raltegravir (Isentress)
• Actions
 HIV integrase strand transfer inhibitor, enzyme
needed to integrate DNA into the host cell
• Uses
 In combination with other antiviral agents to treat
HIV-1
• Common adverse effects
 Headache, nausea, diarrhea
• Serious adverse effects
 Creatine kinase elevations, myopathy,
rhabdomyolysis, hepatotoxicity
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Slide 46
Drug Class: Antiviral
Agents (cont’d)
• Drug: ribavirin (Virazole, Rebetol, Ribasphere)
• Actions: Unknown
• Uses
 In combination with interferon alpha-2b to treat
chronic hepatitis C, effective against DNA type
viral families, inhibitory activity against RSV,
influenza, parainfluenza
• Common adverse effects
 Rash, conjunctivitis
• Serious adverse effects
 Diminishing pulmonary function, anemia
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Slide 47
Drug Class: Antiviral
Agents (cont’d)
• Drug: zanamivir (Relenza)
• Actions
 Inhibit neuraminidase, an enzyme on the viral
cell coat necessary for replication
• Uses
 Uncomplicated acute illness from influenza
• Serious adverse effects
 Asthma, bronchospasm, diminishing pulmonary
function, cough, sore throat, fever continuing
symptoms
• Oseltamivir (Tamiflu) also an agent of this type
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Slide 48