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Pharm stdy gide

Penicillin
Cefazolin
Vancomycin
Gentamycin
Erythromycin
Tetracycline
Slfamethoxazole-trimethropin (SMZ-TMP)

PENICILLIN
Drgs that Weakens the bacterial cell wall: PENICILLINS
 Active against broad variety of bact and have low toxicity.
 AEs typically allergic rxns
 Have a beta-lactam ring – beta-lactam antibiotics inclde: cephalosporins,
aztreonam, imipenem, meropenem and ertapenem
 All these disrpt the bacterial cell wall
PD: penicillins weaken cell wall by binding to penicillin-binding proteins:
(1). Inhibition of transpeptidases and (2). Activation of atolysins.
 Transpeptidases – enz for c wall cynthesis; atolysins – cleave bonds in c
wall to allow growth

Penicillins
 First Antibiotic in WW II
 Four Grops
o –Natural
o –Penicillinase resistant
o –Amino-Penicillin
o –Extended Spectrm Penicillin

 Absorption- Oral dose varies


 –empty stomach best
 IM for noncompliant/inconvenient
 IV immediate distribtion
 Distribtion
 Wide throghot body
 Metabolism
 limited extent in liver
 Excretion
 60% nchanged by kidneys
 Mechanism of Action
 Bactericidal - Destroys the Bacteria
 Inhibits Cell Wall Synthesis
 Cell Lysis
 Therapetic se
 Wide Spectrm of Antimicrobial Action
 Gram + and Gram - Bacteria
 Common Infections- Syphilis, GC, RI, Otitis Media
 Endocarditis
 Drg Interactions
 Extended Spectrm
 –inactivates Aminoglycosides
 Adverse Reactions
 Low incidence of serios toxicity
 Predictable
 –Administered as Disodim Salts
 tMay increase Na, K
 tEspecially in Cardiac or Renal Pt.
 –Hematologic reaction = Low Hgb or platelet dysfnction
 Predictable Con’t
 Hepatotoxicity
 GI - glossitis, N/V/D
 Colitis
 Sperimposed Infection
 CNS irritability -
 – Convlsions
 npredictable Reactions
 Allergic
 –3- 10 % of poplation
 –Anaphylactic - SOB, hypotensive TX Epine
 –Serm Sickness 7-10 days p TX
 tfever, hives, joint pain
 Allergic Rash
 npredictable Reactions
 Renal Failre
 –hematria
 –proteinria
 Nrsing Implications
 Assess Pt HX
 Check Allergies
 Assess GI symptoms
 Check electrolyte levels
 Administer 1 hr ac or 2 hr p.c.
 Advise pt. to complete fll corse
Cephalosporins

 First throgh Third


 Have beta lactm strctre similar to PCN
 Cross sensitivity occrs
 Pharmacokinetics
 Absorption poor po, IM painfl, better IV
 Distribtion wide except CNS
 Metabolized different by each generation
 Excreted- nchanged in kidneys
 Mechanism Of Action
 Bacterialcidial
 Inhibits Cell Wall Synthesis
 Cell lysis
 Therapetic se
 Gm + and Gm -, some anaerobic
 Srgical prophylaxis
 Resp infection, Skin, Soft tisse
 Bones, joints TI
 Drg Interactions
 Alcohol -Antibse effect
 –HA dizziness, N/V, cramps
 Imipenem, Cilastatin
 Adverse Reactions
 Predictable
 –IM painfl
 –Colitis
 –Thrombophelibitis
 –Renal insfficiency
 –Bleeding disorders
 –GI = NVD, sper infection
 npredictable
 Hypersensitivity
 mild to severe
 5-10% cross-reactivity with PCN
 Nrsing Implications
 Check for allergies to PCN
 Give IM with lidocaine
 Monitor for Sperinfection
 Avoid ETOH
 Tetracycline
 Rarely Rx of choice
 Classified
 –short, Intermediate and long-acting
 Pharmacokinetics
 Absorption - po several food & Rx interfere
 –Poor IM
 Distribted -widely
 Excreted primarily by kidneys
 Mechanism of Action
 Bacteriostatic
 Inhibits growth and mltiplication
 Interferes with protein synthesis
 Therapetic ses
 Broad spectrm Gm + and GM -
 Rocky Montain Fever
 Lyme disease
 Acne in low doses
 Food and Drg Interactions
 Antacids
 Iron
 ETOH
 Milk prodcts
 Adverse Reactions
 Predictable
 –Poor tooth enamel development nder 8 years old
 Adverse Reactions
 –GI distress
 –Photosensitivity skin and eyes
 –Altered Bone growth
 –Hepatotoxic - fatty infiltrates
 –Nephrotoxic - renal failre
 –CNS Toxic - dizzy
 npredictable Adverse Reactions
 Hypersensitivity
 Anaphylaxis
 Nrsing Implications
 Not in children nder 8 years old
 Assess hypersensitivity
 Check renal fnctions
 check if pregnant or lactating
 Nrsing Implications Con’t
 Take po with 8 oz flids
 Not with milk, Ca, Mg, Fe
 Take on empty stomach
 Avoid direct snlight
 Contains tartrazine (dye)
 Chloramphenicol
 Absorbed- po or IV
 Distribted -widely
 Metabolized in liver by special enzyme
 –(may not be present)
 Excreted as metabolite by kidneys
 Mechanism of Action
 Bacteriostatic
 –inhibits mltiplication
 –cell wall synthesis
 Maybe Bactericidal
 Therapetic se
 Gm + and Gm -
 Very active against Anaerobic bacteria
 Typhoid Fever, Salmonella
 Hemopils inflenza meningitis
 Drg Interactions
 Inhibits metabolism of hypoglycemia agents = low Blood Glcose
 Inhibits anticonvlsant = dilantin toxicity
 Alters potential of anticoaglants = bleeding
 Adverse Reactions
 Limited se de to potential toxicity
 Predictable
 –GI - N/V, glossitis Diarrhea
 –Gray syndrome - neonates maybe fatal
 tashen color, circlatory collapse, death
 –Bone Marrow Sppression (reversible)
 tlekocytes, erythrocytes, platelets
 npredictable Adverse Reactions
 Aplastic Anemia
 –irreversible
 –pancytopenia
 Hypersensitivity
 Nrsing Implications
 Screen for sensitivity
 Assess liver fnction
 Monitor for bone marrow sppression (labs)
 Tell MD if fever, sore throat, fatige, brising
 –(signs of liver disease)
 Clindamycin & Lincomycin
 Inhibit protein synthesis
 se limited to serios infections
 –intrabdominal, pleroplmonary
 Drg interactions with Erythromycin
 – and Neromscle Blocking Agents
 Adverse Reactions
 Predictable- 80% diarrhea
 –Psedomembranos Colitis - maybe fatal
 npredictable - Hypersensitivity
 Nrsing Implications
 sed for Nosocomial infections
 Screen pt. for intestinal diseases esp colitis
 Monitor liver fnction tests
 Erythromycin
 TX common infections
 Highly effective
 Safe
 Mechanism of Action
 Bacteriostatic
 Inhibits protein synthesis
 Therapetic ses
 Broad spectrm gm+ & gm-
 Legionaries
 GC/ syphilis if PCN sensitive
 Drg interactions
 Decreased theophylline excretion
 –increased toxicity
 Adverse Reactions
 Few
 Only with High doses
 more likely if renal failre
 Allergic reactions
 Hepatitis
 Nrsing Implications
 Assess allergies (cross sensitivity to ASA)
 Assess liver fnction
 Check incompatibilities in IV soltion - many
 Slfonamides (Slfa)
 First effective systemic antibiotic
 Many resistant bacteria
 Mechanism of Action - Bacteriostatic
 –inhibits prodction of folic acid
 se in TI, colitis, Pnemocyctis Pnemonia (AIDS)
 –prevents reoccrrence of rhematic fever- grop A beta hemolytic strep
 Drg Interactions
 PABA (para-aminobenzoic acid) sn screens
 Digoxin - redces dig Bioavailability
 Adverse Reactions
 High dose- crystalria
 N/V/D common
 Hypersensitive
 Photosensitivity
 Nrsing Implications
 Pt HX - skin rash, low rine otpt
 Pregnancy, lactation, recent se of PABA
 po with ample flids
 Avoid direct snlight

 Call MD for sx hematologic reaction
 –sore throat, pallor, jandice, weakness

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