talk about drugs for bacterial infections it starts in chapter 35 page 504 in your text it's important to recognize that bacterial infection treatment is going to be large component of your nursing care delivery so it's very important to understand the very specific classifications and potential effects of these drugs there are a lot of slides in here so please pay attention and focus on the specifics on these slides again I will highlight underline and bold all the important factors within each drug let's go bacterial dangerous to the human body the human body can act as a host or a reservoir for the bacterial growth two terms to determine and discuss spectral infection process is pathogenicity and virulence pathogenicity is the ability of the organism to cause infection meaning the organism's ability to invade or overcome the body's normal defenses and cause disease virulence is the ability of the microbe to produce disease when present in small numbers so a bacteria that can produce a disease very quickly and very actively in the body can signify its virulence Gins can be a variety of things and again they must bypass the body's defenses could be things like viruses bacter bacteria fungus unicellular organisms called protozoans or protozoa and multicellular animals such as fleas mites worms Etc they cause disease in two ways via invasiveness and toxin formation to infect humans pathogens must again pass the body's defense mechanism usually through the skin or the mucous membranes and into the body the invasiveness is the pathogen to grow rapidly and cause damage to the surrounding tissues overwhelming the body toxin producing is bacterial toxins that disrupt the normal cellular activity and can cause even death three specific ways to identify bacteria in the laboratory Department this is by shape the ability to use oxygen and the size of the cell wall basic shapes include bacilli which is Rod shaped size spherical shaped and spirilla which are spiral shaped the ability to use oxygen is also important aerobic meaning using oxygen and anaerobic without oxygen the size of the cell wall of the bacteria also helps us identify a very specific antibiotic that may be most effective thick walls are gram-positive bacteria while thin walls are gram-negative bacteria the size of the cell wall helps determine again the classification of bacteria that is present this is determined by the gram staining or the color that resides in the bacteria after it is stained gram-positive cocci excuse me gram-positive bacteria contain a thick wall retaining that state as staining of color usually violet examples staphylococcus streptococcus and aerococcus gram-negative bacteria has thin walls that lose the stain and this example are bacterioids E coli klebsiella pseudomonas and salmonella now it's important to identify again the organisms you can treat with the least invasive antibiotic needed classification of the anti-infective drugs are very important they're very specific to affect and Target the organism's structure metabolism and life cycle to either kill it or slow its growth antibiotics are natural substances produced by bacteria that kill other bacteria some examples aminoglycosides for quinolone and sulfonamides bacteriostatic agents slow the growth of bacteria they allow the Natural Body defense to eliminate the bacteria after it is decreased in counts bactericidal agents conversely kill bacteria this is important focus is to know when you're treating patients and you're identifying how the drug works now there is a figure on page 506 figure 35.1 that outlines the basic action of each antibiotic class we will discuss this more in the next few slides resistance can be acquired pathogens can replicate rapidly during the cell division process genetic code replication Alters the alterations can occur these mutations can cause harmful changes including antibacterial resistance this can occur when an antibiotic kills sensitive pathogens and leaves behind resistant bacteria to mutate and multiply important to identify antibiotics do not create mutation this occurs during its cell division and is random it's important also also to know that ultimately resistant bacteria can allow humans to transfer these resistant organisms to others increasing the resistance level is to delay resistance to antibiotics one prevent it to use specific drugs to kill specific bugs an example narrow Spectrum treatment three resist antibiotic use Excuse me restrict antibiotic use to only those who need them and be sure to educate your patient to take the full course of their antibiotics next prevent transmission of the pathogen and identify that prophylactic treatment may be sometimes important now Healthcare Associated infections are often resistant to bacterias so it's very important to identify if you have a hospital quiet or Health Care acquired infection and prevent those whenever possible important to select the most effective antibiotic whenever possible careful selection of correct antibiotic is essential to decrease resistance and promote Effectiveness the use of culture and sensitivity testing is very important in a hospital or Health Care study this again determines the most effective pharmacotherapy and limits adverse effects as well as resistant possibilities there are two different ways to treat patients with antibiotics first giving a broad spectrum antibiotic prior to culture and sensitivity testing or second given a very narrow spectrum antibiotic based on the identification of the specific bacteria through culture and sensitivity testing more about culture and sensitivity sensitivity is the examination of specimen for microorganisms it's grown in a lab and identified it's then tested for sensitivity to different antibiotics bacteria may take several days to grow and identify while viruses may take several weeks to identify so you'll see viruses cultured much less often broad spectrum antibiotics may be started before the lab culture is completed after culture and sensitivity testing is completed providers will narrow the antibiotic coverage to decrease the possibility for resistance and improve the possibility for Effectiveness with the antibiotics with less adverse effects factors that are included in selecting the best antibiotic it's important to identify the patient's immune system status the condition at the local tissues of the infection site so is it specific to skin infection the lungs is it infected in a specific area or how does it present itself it's important to identify if a patient has had previous allergic reactions to any type of antibiotic it's important to identify their age at pregnancy status and genetic factors to dive into host factors knowing the patient or the host risk factors is very important for antibiotic treatment defenses are especially affected when the patient's immune system is compromised by an invasive infectious disease such as HIV or Aids or the patient is taking immunosuppressant drugs broad spectrum coverage with antibiotics or aggressive antibiotic therapy may be needed even prophylactic antibiotics may be needed for prevention now it's important to identify the location of the infection and this again must be highly considered especially for those antibiotics that can be more invasive across the blood-brain barrier as some drugs only target certain cell bacterias it's certainly infective to identify those very specific areas to treat and identify now the age young or old are unable to metabolize drugs and excrete them effectively so doses may be adjusted and decreased to be more effective and less toxic regarding pregnancy some drugs cause the placenta so drugs must be carefully selected to ensure optimal safety and should only be given if needed risk versus benefit lastly genetics can also affect the metabolism of a drug so understanding the patient's history and clear uh previous antibiotic history is especially important actions can be caused as secondary infections that occur when too many whole floor are killed by an antibiotic it's important to recognize that the body has normal flora or normal bacterias in certain areas to help protect us antibiotics may go through and actually kill that hospora and allow the growth of pathogenic organisms these pathogenic microorganisms have a chance to multiply creating an opportunistic infection to take advantage of the suppressed immune system since signs and symptoms can include diarrhea bladder pain painful urination or abnormal excuse me abnormal vaginal discharge talk about classifications of antibiotic now penicillin or cillins are used for a variety of infections they were the first mass-produced antibiotic resistance is due to Extended or overuse over time and the ability for some penicillins to secrete an enzyme called beta-lactamarine this changes the chemical makeup of the bacteria over time now your prototype drug for penicillins is penicillin G otherwise it's known as pin G the mechanism of action allows for the weakening of the cell wall to allow water to enter the cell and kill the inside of the cell the action is only effective against pathogenic cells not human cells gram-positive cells are most often affected by penicillin for example streptococcus and staphylococcus however it's used in a variety of infections this is a very broad spectrum antibiotic so it can have more adverse effects it can unfortunately though have low oral absorption so parental Administration is preferred most common adverse effects include allergy to the antibiotic so it's very important to observe allergy for 30 minutes after IM injections and immediately after IV injections again adverse effects include allergy rash itching fever super infections and nausea vomiting and diarrhea pen G is also the drug of choice for gonorrhea or syphilis infections now a nurse work was specific to penicillins are educating the patient that penicillins can decrease the efficacy of birth control did not minute excuse me did not administer with aminoglycosides they antagonize the effects of the antibiotic important to monitor for drug allergies and identify that gut issues may be a complication of this antibiotic treatment so please advise the patient to take with food about cephalosporins cephalosporins are antibiotics that are started with a prefix c-e-p-h it's important to recognize the way these work as they bind to the cell wall inhibiting cell wall synthesis they act with broad spectrum activity against gram-negative organisms they are the largest class of antibiotics closely related to penicillins both containing a beta-lactin ring at times they are classified by Generations so it's important to recognize that different Generations are more specific on gram-positive versus gram-negative Effectiveness there are five total generations of cephalosporins safety from penicillin allergy depends on the class but is generally safe for the greater the generation an example generation 5 is safer than Generation 1 as chemical composition is less closely related prototype drug in this category otherwise known as cefazolin the mechanism of action is to attach to penicillin binding proteins to inhibit or stop bacterial cell wall synthesis it is bacterocidal primary use for serious infections a lower respiratory tract central nervous system genital urinary system bones blood and Joints it's also frequently given for prophylaxis treatment in cases specifically for things like surgery adverse effects include rash diarrhea allergy increased nephrotoxicity when given with other nephrotoxic drugs so it's very important to check kidney labs let's talk a little bit deeper about Nurse work with cephalosporins again they're close sister to the penicillin family so have increased risk for allergies it's important to monitor especially after the first dose for any type of allergy it is excreted by the kidneys so it's important to check for kidney function if you're going to give it parentally I am it's important to give into deep IM tissues if this route is ordered it can work synergistically with other antibiotics so it's important to identify if it's being given with other antibiotics it also can cause more resistance if given synergistically with other antibiotics now it can cause nausea vomiting and diarrhea an example of gut issues so it's important to give with food if possible so let's talk about a different classification otherwise known as tetracyclines or cyclins this one is one of the most broadest Spectrum antibiotics that are available today it was discovered in 1948 and it acts by inhibiting protein synthesis within bacteria it is bacterostatic meaning it slows bacterial growth however it does not kill it allows the body's immune system to take over and kill the rest of the bacteria many bacteria are resistant to tetracyclines for this reason all have similar spectrum and adverse effects your prototype drug protections is tetracycline the primary use is that being the drug of choice for only a few diseases because of resistant bacterial strains one specifically is Rocky Mountain Spotted Fever are rmsf typhus cholera Lyme disease peptic ulcers and chlamydia also treatment for acne adverse effect may be super infections nausea vomiting diarrhea discoloration of teeth and photosensitivity it is pregnancy category D so should be avoided in pregnancy and other unless otherwise needed to treat a life-threatening disease nurse with tit with tetracycline you should avoid some light for risk of sunburn give with full glass of water to decrease GI irritation do not mix with antacids or bile sequestrians it's important to recognize that these bind and reduce the absorption of tetracycline to reduce its effectiveness it is a drug of choice for h pylori and again it should be avoided in pregnancy and in young children whenever possible because it does inhibit fetal bone growth it's decreased efficacy with birth control so a patients should use another method of birth control while taking this antibiotic it can increase serum levels if taken with milk iron magnesium and antacids higher incidence of super infections have occurred and it's important to recognize it can cause renal severe renal and hepatic disease or potentiate them so check your lapse also it can cause that issue so whenever possible take with food and take plenty of water during this Administration to decrease GI irritation it's important to recognize it does have a very short half-life so Administration may be multiple times per day to stay in the therapeutic index level macrolides these antibiotics end in mycin they were created in 1952 they are a safe alternative to penicillin and they are used most frequently because of patient allergy to penicillin low doses are bacterostatic versus high doses are considered cidal versus uh slowing the bacterial growth versus killing they are both gram-positive and gram-negative susceptible the Prototype drug for mycins is erythromycin mechanism of action it inhibits or stops protein synthesis of binding to the bacterial ribosome it's effective against most gram-positive and many gram-negative bacteria primary uses are very specific for instance whooping cough Legionnaires disease or infections caused by streptococcus each influenza or Mica excuse me Micro plasma pneumoniae adverse effects nausea abdominal cramping or vomiting also diarrhea super infections and resistant bacterial strains work in teaching with macrolides this antibiotic can be inactivated in the stomach acid so it's important to give it whole and not crush it also identify that many of the antibiotics will be coded to help resist acid in the stomach and also that full glass of water will help Advance the antibiotic into the small intestine so encourage the patient to take with plenty of water it can cause GI issues meaning upset stomach and nausea vomiting and potentially diarrhea so giving food will help it's important to monitor hearing imbalance as it may be odotoxic also high doses may be cardio toxic so observe your patient for any changes in cardiac system identification it can increase serum levels with anesthetics anti-fungal drugs otherwise known as easels and anticonvulsants this also occurs when taking with grapefruit juice so please ask the patient to avoid those if possible avoid mixing with statin drugs as it may also cause muscle toxicity these drugs are often used patients with Penicillin allergies so it's important to identify what patient allergies are and previous reactions to any antibiotic treatment that Amino glycocides mycensor mycins created in 1942 the air bactericidal especially against gram-negative bacteria reserved for most serious infections because they can have some adverse effects specifically to the kidney and the ears they can become toxic concurrent use is common but must be spaced out it is poorly absorbed internally so that's often giving para entirely and now many resistant strains of bacteria occur so it's important to identify these antibiotics are often only given after the culture and sensitivity is completed prototype drugs for mycins is Gentamicin mechanism of action is it inhibits bacterial protein synthesis primary uses is a treatment of serious infections caused by aerobic gram-negative bacteria myobacteria and some protozoas adverse effects they are most more toxic than most other antibiotic classes with serious systemic adverse effects box warning again IV use may be causing ototoxicity nephrotoxicity or neurotoxicity so it's important to check your serum labs for a therapeutic index nurse work with aminoglycosides is again check renal function bun creatinine also monitor for signs and symptoms of ototoxicity example tinnitus are ringing in the ears hearing loss and balance concerns again it's important to observe the peak and trucks levels and recognize the other neurotoxicity may occur in the example of seizures paralysis and muscle weakness overall there's an increased risk when giving with other nephrotoxic meds so it's important to recognize the toxicity component and also very very important to again monitor your renal function through your Laboratory Testing well let's talk about fluoroquinolones these end in oxycin they arrived in the 1960s they're very narrow Spectrum at first that have now become more broad spectrum there are four generations of therapy at first there were only effective against ground negative bacterias but again now they're both effective against gram-negative and gram-positive their preferred drug for UTIs they allow good oral absorption and they also may be used as a drug of choice for Anthrax exposure as well as other biological warfare exposure as prophylaxis they also may be considered a drug of choice for post-exposure Expo excuse me post exposure treatment of Yesenia pestis or the plague tularemia brucellosis and also impetigo for this classification is ciprofloxacin otherwise known as Cipro the mechanism of action of this drug is it inhibits bacterial DNA synthesis primary use respiratory infections GI and gu infections some skin and soft tissue infections and UTIs it is indicated again for the prophylaxis of Anthrax infection adverse effects nausea vomiting diarrhea sleep disturbances headache dizziness and the most important serious adverse effects for dysrhythmias and hepatotoxicity meaning liver toxicity talk about Nurse work in education for fluoroquinolones it's important the Space Administration from Iron and antacids by four hours to prevent binding and decreasing the effectiveness it can cause gut issues so most importantly take with food if possible also drink plenty of fluids during this Administration avoid sun and exercise as it may cause a potentiation for Sunburn and also risk for cartilage toxicity and tendon rupture with exercise it may cause headaches seizures increased risk of bleeding with Warfarin and increased circulation of caffeine it also may be hepatotoxic again so please check your liver labs it's not approved in pregnancy or patients less than 18 years of age sonamites they showed up in the 1930s and changed the treatment of infectious disease they are very wide spectrum bacteriostatic and they work by inhibiting folic acid production necessary for Rapid cell growth they are substantial resistant strains now occur however they are used in many combo drugs it's important to identify their a very effective against PCP and shigella due to folic acid inhibition it's important to identify if the patient is pregnant or not as folic acid is very very effective in preventing neuronal tube malformations talk about your prototype drug in this section sulfamexazole mechanism of action of this drug suppresses bacterial growth by inhibiting bacterial synthesis of folic acid the primary used for urinary tract infections also pneumocystic carnite pneumonia otherwise known as PCP as well as shigella infections of the small bowel adverse effects formulation of crystals in the urine hypersensitivity reactions nausea and vomiting as well serious adverse effects can include a granulocytosis acute hemolytic anemia and aplastic anemia let's talk about Nurse work and education with sulfonomides it's again important to have the patient increase their fluids to prevent Crystal formation and promote excretion of the drug this drug can cause increased toxicity when used with Methotrexate in anticoagulant so it's important to assess the other medications the patient's taking in advise The Physician if the patients are taking these drugs they may increase potassium levels so check your labs gut issues may occur so you may need to give this antibiotic with food and it's important to avoid in pregnancy and lactation as it causes to deplete excuse me the depletion of folic acid and it also crosses the placenta and enters breast milk it can be causing a photosensitivity so it's important to advise a patient to use sunscreen when taking this antibiotic and again monitor the complete blood count let's talk about uh miscellaneous antibiotics these are otherwise outside of all the other drug classifications carbopenum it is only given parenteral and is very Broad and bacterial cytal let's talk about clindamycin as well it's effective excuse me it's effective against positive gram-positive and gram-negative bacteria it is the drug of choice for many abdominal infections however it may cause gut issues specifically pseudomembranous colitis causing c-diff infection the China day is all is unique as its bacterocidal and against multicellular parasites it is good with anaerobes as well when you pristine or Delphi pristin is effective against the ref and is very hepatotoxic so it's important to identify if a patient has any other liver disorders and assess the liver lapse was venezolid or zyvox is very effective on MRSA infections methicillin-resistant staph aureus it also increased with risk of hypertension and thrombocytopenia it's important to also avoid with ssris as it may cause serotonin syndrome lastly Vancomycin is effective against gram-positive infections specifically MRSA as well it can cause symptoms of odotoxicity so it's important to check the hearing as well as nephrotoxicity so it's important to encourage in increased po intake specifically a fluid intake of water and assess your kidney function labs a pecan trough may be done after three doses are given so it's important to identify what the peak levels are and the trough levels are in order to stay in the therapeutic window without getting toxic it also can cause red Mound syndrome after rapid IV dosing and this is due to histamine release it's important to identify this quickly as you may need to give drugs to inhibit this histamine release and even stop the infusion