Download PowerPoint Chapter 12

Chapter 12
Antiinfective Medications
1
Action of Antimicrobials
Human tissue Before
treatment with
antimicrobial drugs
Human tissue After
treatment with antimicrobial
drugs (tissue remains the
same, microbes have been destroyed)
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Antibiotics
• Broad-spectrum
• Narrow-spectrum
3
Penicillins
commonly end in “cillin”
• Largest most effective and least
toxic
• Penicillin-resistant strains
• Broad-spectrum drug of choice
SUPER Germ!
4
Penicillins (cont.)
Action and Uses
• Inhibit Cell wall synthesis
• Used to treat multiple infections (syphilis,
wound infections,prophylaxis for
endocarditis)
• Overuse and allergies
5
Penicillins (cont.)
Adverse Reactions
• Neuropathy
•
•
•
•
•
– High parenteral doses
Skin eruptions
GI symptoms
Urticaria
Laryngeal edema
Anaphylaxis
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Probenecid prolongs blood levels by blocking
it right there
PCN’s renal clearance Hold
Penicillin!! You
ain’t goin no
where!
7
Penicillins (cont.)
Nursing Implications and PatientTeaching
• Assessment
– Signs of infection and allergies
• Planning
– 10-day regimen
– cultures should be drawn prior to starting
antibiotic therapy
– What happens if pcn is not given in effective
doses or for the length of time required?
8
Sulfonamides
root has “sulf” in name
• Broad-spectrum antiinfective
• Bacteriostatic action
9
Sulfonamides (cont.)
Action and Uses
• Urinary tract infections
• Preoperative and postoperative therapy for
bowel surgery
• treats PCP, meningococcal meningitis,
ulcerative colitis...
• What is a superinfection??
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Sulfonamides (cont.)
Adverse Reactions
• Crystaluria
• toxemia
• fever
Teaching
• drink adequate fluids (promote urinary output
to 1500ml/day)
• take on empty stomach
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What is the normal BUN and CR
levels?
CR=0.5-1.5mg/dL
BUN level = 5-25mg/dL
It only takes 0.5-1.5 hours to CReate 5-25
BUNs in the oven 
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Amnioglycosides
all end in “mycin” (not all that end in mycin are
aminoglycosides.)
• Strong antimicrobial Bactericidal
drugs reserved for life threatining
infections
• Gentamycin (garamycin)
• Amikacin (Amikin)
• Tobramycin (Nebcin)
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Aminoglycosides cont..
Side effects
• nephrotoxicity and ototoxicity
Nursing Considerations
–
–
–
–
monitor Peak and Trough Levels
prior to therapy what should the nurse do?
Monitor …
Premedicate with anti-emetics,
antihistamines and corticosteroids to
decrease side effects
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Broad-Spectrum Antibiotics
• Bactericidal or bacteriostatic
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Broad-Spectrum Antibiotics
(cont.)
Action and Uses
• Large number of unrelated drugs used to
treat infections caused by susceptible
organisms
• Gram-positive or gram-negative organisms
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Broad-Spectrum Antibiotics
(cont.)
Adverse Reactions
•
•
•
•
Superinfections
Drug interactions are individualized
Food interactions
Affected organs: auditory nerves,
kidneys, and liver
• Cross-sensitivity
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Learning Objectives
• 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
• List some of the most common adverse
reactions to medications used to treat
infections
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Tuberculosis
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Antitubercular Drugs
What does MDR refer to?
Multiple Drug Resistant Organisms
What role does the CDC have in
relation to Tuberculosis treatment?
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Antitubercular Drugs
• Isoniazid (INH,Nydrazid)
• Rifampin (Rifadin, Rimactane)
• Rifabutin (Mycobutin)
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Antitubercular Drugs (cont.)
Action and Uses
• Most antitubercular drugs are
bacteriostatic, (some bacterialcidal)
• INH (Isoniazid) only drug recommended
for prophylactic therapy.
• What is the current duration of
prophylactic treatment?
22
Antitubercular Drugs (cont.)
Adverse Reactions
•
•
•
•
Common symptoms
Toxicity: body sights affected
Combination therapy
Drug-specific symptoms
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• Why are combination drugs used in
the treatment of tuberculosis?
• What are the most common side
effects of Antitubercular drugs?
• What are the typical s/s of active
TB?
24
Which statement by the patient
indicates that he has an accurate
understanding of the functioning of an
antiviral medication?
• A."If I take this medication correctly, my viral
infection will not reoccur.“
• B."If this medication is not effective, I can take an
antibiotic medication instead.“
• C."If I take the medication, my symptoms will
lessen and the infection will be cured.“
• D."I should not expect the medication to cure my
disease, but symptoms will decrease."
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Antiparasitic Drugs
• Amebicides
• Anthelmintics
• Antimalarials
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Amebicides
Chloroquine (Aralen)
Metronidazole (Flagyl, Metrogel)
• Caused by the parasite E”ntamoeba
histolytica”
• Relationship to traveling
• Infection sights in the body
– GI or extraintestinal
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Amebicides (cont.)
Action and Uses
• Destroy invading ameba
• Treatment of intestinal and extraintestinal
amebiasis.
• Drug choice depends on location
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Amebicides (cont.)
Adverse Reactions
• Common: nausea, vomiting, anorexia,
diarrhea, GI distress, hepatic abscess
• Drug-specific adverse reactions
– Flagyl:ECG changes, ataxia, confusion, blurry
vision, nasal congestion, dysuria
• Overdose
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Random questions...
• What are
superinfections?
• Pseudomembranos
colitis is caused by
which bacteria?
• How does it
manifest?
• How is it treated?
• What are the
expected
therapeutic
effects of
antibiotics?
• How long are PCNs
usually prescribed
for?
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HIV Infection
Acquired immunodeficiency syndrome (AIDS)
– Viral disease
– High mortality rate
High-risk populations include:
–
–
–
–
–
Homosexual and bisexual men
Intravenous drug users
People in prison
Female sexual partners of people in high-risk groups
Children born to mothers at risk
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Antivirals
Action and Uses
• Decrease symptoms of viral infection
• Lessen the symptoms of viral illness in
immunocompromised patients or adults and
children at risk
Adverse Reactions
– Hepatotoxicity, nephrotoxicity, blood
dyscrasias, peripheral neuropathies
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Antivirals (cont.)
Nursing Implications and Patient
Teaching
•
•
•
•
Medications do not cure
Follow specific storage instructions
Reporting adverse reactions
Administration
– Encourage immunocompromised clients in areas
with impure water supplies to drink bottled water
only
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Antiretrovirals
Action
• Interfere with the ability of a retrovirus
to reproduce or replicate
• Two types:
– Reverse transcriptase inhibitors
• Act early in viral life cycle
– Protease inhibitors
• Act later in viral life cycle
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Antiretrovirals (cont.)
Uses
– Slow advance of AIDS
– Maintain immunity
– Prevention of HIV in infants born to
HIV-infected mothers
– Prevention of HIV in healthcare workers
exposed to HIV
Drug Interactions
35
Antiretrovirals (cont.)
Nursing Implications and Patient
Teaching
• Adherence is essential
• Medications do not cure
• Report all drugs and supplements used,
including OTC and CAM
• Signs and symptoms of pancreatitis
• Signs and symptoms of peripheral neuropathy
36
Antiretrovirals (cont.)
Nursing Implications and Patient Teaching
(cont.)
• Routes of disease transmission
• Need for social and financial support
37
Antifungals
Action
– Fungistatic
– Fungicidal
Uses
– Treat mycotic infections
• Fungal-specific medications
• Systemic medications
38
Antifungals (cont.)
Common Antifungal Medications:
Ketoconazole (Nizoral)
• Broad-spectrum fungistatic and fungicidal
action
• Used to treat oral thrush, candidiasis,
histoplasmosis
Nystatin (Mycostatin)
• Antibiotic with fungistatic and fungicidal action
• Used to treat intestinal, vaginal, and oral fungal
infections caused by Candida strains
39
Antifungals (cont.)
Common Antifungal Medications (cont.)
Amphotericin B (Amphotec)
• Systemic drug
Griseofulvin
• Activity decreased with barbiturates
Metronidazole (Flagyl)
• Related drug for mixed fungal and bacterial
or protozoa infections; interacts with alcohol
40
Antifungals (cont.)
Nursing Implications and Patient Teaching
• Take all the medication as ordered; do not stop when
symptoms disappear
• Avoid alcohol
• Report nausea, vomiting, and diarrhea; watch for easy
bruising, sore throat, rash, or fever
• Nystatin must be shaken thoroughly before use
• Intolerance to the sun (photosensitivity) can occur
with griseofulvin therapy
• Cleanliness of hair, skin and nails will limit spread
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