N303: Prototype Drugs for Anti-Infective Medications

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Includes Mechanism of Action, Pharmacokinetics, Adverse Effects, Medication Interactions, Contraindications, and Nursing Responsibilities

Describe the Mechanism of Action for Penicillin G

Penicillin G is a drug that inhibits the bacterial cell wall synthesis by binding PBP (Penicillin-binding Proteins). Penicillin G is bacteriocidal and destroyed by penicillinase.

Describe the Pharmacokinetics for Penicillin G

Can be administered IM or IV
Rapid Absorption (IM)
Widely distributed, but only a small amount crosses the BBB
Primarily excreted from the Kidneys

Describe Adverse Effects of Penicillin G

Urticaria and delayed skin reactions occasionally occur. The most serious adverse effect is severe hypersensitivity reaction. The anaphylactic response my include cardiovascular collapse, edema of the mouth, tongue, pharynx, and larynx.

What drug interactions may occur with Penicillin G?

Penicillin G may decrease the effectiveness of oral contraceptives. Potassium sparing diuretics such as spironolactone may cause hyperkalemia when administered with penicillin G potassium.

What contraindications/precautions should be taken when administering Penicillin G?

Patients who are allergic to any drug in the penicillin class. Cross hypersensitivity also occurs with drugs in the cephalosporin class. Patients with significant renal impairment must be carefully monitored.

Describe the Mechanism of Action for Ampicillin

Ampicillin is a drug that inhibits bacterial wall synthesis by binding PBPs. This drug is bacteriocidal and inactivated by penicillinase. Ampicillin is a Broad spectrum antibiotic.

Describe the Pharmacokinetics of Ampicillin

Ampicillin can be administered PO, IM, or IV
Only a small amount crosses the BBB
It is largely unmetabolized so renal function is very important

Describe Adverse Effects of Ampicillin

Rash and diarrhea are the most common adverse effects. Pain at the injection site is common.
Watch for anaphylaxis.
Pseudomembranous colitis is rare, though serious.

What contraindications/precautions should be taken when administering Ampicillin?

Ampicillin is contraindicated in patients who are allergic to any drug in the penicillin class and used cautiously in those with hypersensitivity to cephalosporins. Drug therapy must be monitored carefully in patients with renal disease.

What drug interactions may occur with Ampicillin?

Ampicillin may decrease the effectiveness of oral contraceptives. Food decreases its absorption, ampicillin should be taken on an empty stomach.

What are some Nursing Responsibilities when administering Ampicillin?

Immediately report severe or persistent diarrhea accompanied by fever. It is important to take Ampicillin around the clock to keep in a therapeutic range.

Describe the Mechanism of Action for Cefazolin (Ancef)

Cefazolin inhibits bacterial wall synthesis by binding to specific PBPs. The drug is bacteriocidal, exhibits a broad spectrum, and is sensitive to beta lactamase.

Describe the Pharmacokinetics of Cefazolin

Can be administered IM or IV
The drug is not metabolized so kidney function is CRUCIAL!!

Describe Adverse Effects of Cefazolin

Rash and diarrhea are the most common adverse effects, and superinfections are likely when the antibiotic is used for prolonged periods. Pain and phlebitis can occur at the IM injection site. Anaphylactic response is possible.

What contraindications/precautions should be taken when administering Cefazolin?

Contraindicated in patients who are allergic to any drug in the cephalosporin class. Patients with significant renal impairment must be carefully monitored.

What are some Nursing Responsibilities when administering Cefazolin?

Monitor for Fluid volume status, super infections, and hematologic functions.
Report any bleeding.
Dont drink Alcohol.
Immediately report severe or persistent diarrhea, bleeding or bruising, secondary infections.

Describe the Mechanism of Action for Vancomycin

Vancomycin is a drug given to treat severe infections that are resistant to safe antibiotics. Vancomycin kills bacteria mainly by inhibiting bacterial cell wall synthesis, it also affects the plasma membrane and interferes with ribonucleic acid synthesis.

Describe the Pharmacokinetics for Vancomycin

Infuse IV over 60 minutes with at least 200mL.
Not metabolized, so Kidney function is CRUCIAL!!

Describe Adverse Effects of Vancomycin.

Vancomycin may case a syndrome of flushing, hypotension, tachycardia, and a rash on the upper body, a condition called the RED MAN SYNDROME.

What contraindications/precautions should be taken when administering Cefazolin?

Contraindicated in patients who have experienced previous hypersensitivity to this drug. Monitor carefully in patient with impaired renal function.

What drug interactions may occur with Vancomycin?

Additive toxicity with aminoglycosides and other ototoxic and nephrotoxic drugs.

What are some Nursing Responsibilities when administering Vancomycin?

Monitor BP and HR
Monitor for Red Man Syndrome
May be asked to draw Peak and Trough levels
Assess patient for Hearing Abilities
Immediately report ringing in the ears or known or suspected pregnancy

Describe the Mechanism of Action for Tetracycline

Tetracycline inhibits bacterial protein synthesis by binding to the 30S ribosome subunit, interfering with the attachment of the tRNA to the mRNA. The growing amino acid chain is prematurely terminated and protein synthesis is inhibited. It is usually considered bacteriostatic, although it can be bacteriocidal at high concentrations.

Describe the Pharmacokinetics for Tetracycline

Can be administered PO or topically
Secreted in breast milk
60% renal excretion

Describe Adverse Effects of Tetracycline

Superinfection due to broad spectrum
Discoloration of Teeth
Fatty degeneration of the Liver (Liver Failure)
Exfoliative Dermatitis
Photosensitivity

What contraindication/precautions should be taken when administering Tetracycline?

Contraindicated in patients who are allergic to any drug in the tetracycline class. Should not be used during pregnancy.
Calcium/Magnesium/Iron

What drug interactions can occur when administering Tetracycline?

Dairy products affect absorption

What are some Nursing Responsibilities when administering Tetracycline?

Administer with a full glass of water on an empty stomach.
Dont take right before bed
Your skin may GLOW
Immediately report severe diarrhea
May be given for a skin infection so maintain skin care

Describe the Mechanism of Action for Erythromycin.

Erythromycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit. Erythromycin is considered bacteriostatic but may be bacteriocidal in high doses.

Describe the Pharmacokinetics of Erythromycin.

Can be administered PO, Topical, or IV
Primarily metabolized by CYP3A enzyme system
Primarily excreted in bile

Describe Adverse Effects of Erythromycin.

NVD is most common
Phlebitis and intense pain at the injection site
Hearing loss, vertigo, and dizziness
May be Cardiotoxic

What contraindication/precautions should be taken when administering Erythromycin?

Hypersensitivity to drugs in the Macrolide class.
Patients with impaired hepatic and biliary function.

What drug interactions may occur when administering Erythromycin?

Other drugs that use the CYP450 enzyme system.
Use with anticoagulants
Should not be taken with Grapefruit juice

What are some Nursing Responsibilities when administering Erythromycin?

Give enteric-coated tables without regard to meals
Can be applied to the eyes of newborn babies for gonerrhea. (.5 - 1 cm) into the lower conjunctival sac (Inner to outer canthus) Use a new tube for each neonate
If it's in a pediatric liquid form, SHAKE IT UP!

Describe the Mechanism of Action for Gentamicin.

Gentamicin inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. It is bacteriocidal in that it causes premature termination of the growing polypeptide chain.

Describe the Pharmacokinetics of Gentamicin.

Most are given IM and IV
Will have prolonged activity (even below therapeutic level)
Not metabolized so Renal function is Crucial!

Describe Adverse Effects of Gentamicin

Neuromuscular blockade and respiratory paralysis are possible and the drug may cause severe neuromuscular weakness.

What are some contraindications/precautions that should be taken when giving Gentamicin?

Hypersensitive to aminoglycosides
Patients with impaired renal function or preexisting hearing loss
Pregnant or breast feeding patients

What are some drug interactions that could occur when giving Gentamicin?

Penicillins can inactivate aminoglycosides if they are mixed together in the same solution.

What are some Nursing Responsibilities for administering Gentamicin?

Don't use topical preparations on large denuded body surfaces!
Avoid direct sunlight
Check hearing

Describe the Mechanism of Action for Isoniazid (INH)

Isoniazid acts by inhibiting the synthesis of mycolic acid, and essential cell-wall component of mycobacteria. It is bacteriocidal for rapidly dividing organisms, but bacteriostatic for dormant mycobacteria.

Describe the Pharmacokinetics for Isoniazid (INH)

Can be given PO or IM (IM is preferred)
75% renal excretion
Crosses the BBB

Describe Adverse Effects of Isoniazid (INH)

Common adverse effects of isoniazid are rash and fever.
Alcohol consumption increases risk for developing hepatotoxicity
Blood dyscrasias

What are some contraindication/precautions for Isoniazid (INH)

Previous allergy to drug
Significant renal/hepatic impairment
Seizure disorder

What are some drug interactions that can occur with Isoniazid (INH)?

Food decreases absorption
Ethanol increases the risk of hepatotoxicity

What are some Nursing Responsibilities for Isoniazid (INH)?

Assess for positive TB tests
Adhere to long term therapy
Monitor Serum drug levels
Vitamin B6 supplement
Orthostatic Hypotension
FINISH ALL DOSES

What are the indications for Amphotericin B (Fungizone)?

Severe systemic mycoses
Prophylactic therapy for immunocompromised

Describe the Mechanism of Action for Amphotericin B (Fungizone)

Amphotericin B acts by binding to ergosterol in fungal cell membrane, causing the to become permeable.

Describe the Pharmacokinetics for Amphotericin B (Fungizone)

Administer IV

Describe Adverse Effects of Amphotericin B (Fungizone)

Acute fever and Chills
Cardiac Arrest
Anaphylaxis
Blood abnormalities

What are some contraindications/precautions when administering Amphotericin B (Fungizone)

If BUN exceeds 40mg/dL
If Serum creatinine above 3mg/dL
Rapid IV infusion can cause hypotension, hypokalemia and shock

What are some drug interactions that can occur when giving Amphotericin B (Fungizone)

MANY

What are some Nursing Responsibilities for administering Amphotericin B (Fungizone)

Premedicate with antipyretics, antihistamines, antimetics, and corticosteriods to decrease the adverse effects.
Check vitals every 30 minutes
Notify if no improvement in 1 to 2 weeks
Wash any towels and wear gloves

What are the indications for Fluconazole (Diflucan)?

Infections by Candida Albicans
Mycoses resistant to other antifungals

Describe the Mechanism of Action for Fluconazole (Diflucan)

Like other azoles, fluconazole acts by interfering with the synthesis or ergosterol. Inhibitor of fungal cell membrane synthesis.

Describe the Pharmacokinetics for Fluconazole (Diflucan)

Readily absorbed when given PO

Describe Adverse Effects for Fluconazole (Diflucan)

GI distrubances
STEVENS-JOHNSON syndrome in immunosuppressed patients
Inflammatory repsonse

What are some contraindications/precautions to consider when giving Fluconazole (Diflucan)?

Don't give to hypokalemia patients
Preexisting renal impairment

What are some Nursing Responsibilities to consider when giving Fluconazole (Diflucan)?

Report signs of liver toxicity
Monitor BUN, and liver function

What are the indications for Nystatin (Mycostatin)?

Candida infections of the vagina, skin, mouth, and intestine.

Describe the Mechanism of Action for Nystatin

Binds to sterols in the fungal cell membrane and allows leakage of intracellular contents across the weakened membrane.

Describe the Pharmacokinetics of Nystatin

Usually given PO or topically
Poorly absorbed and not distributed

Describe Adverse Effects of Nystatin

Minor Skin irritation and burning
Contact dermatitis
When given PO, NVD

What are some contraindications/precautions to consider when giving Nystatin

Hypersensitivity to the drug

What are some Nursing Responsibilities when giving Nystatin?

Avoid in dark, moist areas of the body
Stop if contact dermatitis occurs
Dissolve troches in the mouth for about 30 minutes (dont chew or swallow)
Use cream instead of ointment in body folds
Use vaginal tablets up to 6 weeks before the end of the pregnancy

What are the indications for Acycolvir (Zovirax)

Herpes Viruses (1 and 2)
High Doses - Cytomegalovirus and Varicella-Zoster

Describe the Mechanism of Action for Acycolvir (Zovirax)

Inhibits Viral replication by terminating DNA synthesis

Describe the Pharmacokinetics of Acycolvir

Monitor renal function because it is excreted unmetabolized in the kidneys
Crosses the BBB

Describe Adverse Effects of Acycolvir

When given IV
Nephrotoxicity
Neurotoxicity at high doses

What are some contraindications/precautions to take when administering Acycolvir?

Do not use with patient with renal impairment

What are some Nursing Responsibilities for administering Acycolvir?

Use surgical glove
Infuse over 1 hour
Monitor I&O
Start therapy as soon as possible
It's a treatment, not a cure
Refrain from sexual intercourse

What are the indications for Amantadine (Symmetrel)

Active influenze infection
Influenze prevention

Describe the Mechanism of Action for Amantadine (Symmetrel)

Inhibit viral replication by preventing uncoating
It is also antiparkinsonism because it releases dopamine and norephinephrine from neuronal storage sites.

Describe the Pharmacokinetics for Amantadine (Symmetrel)

Administered Po
Completely Absorbed
Cross the BBB
Not metabolized

Describe Adverse Effects for Amantadine (Symmetrel)

CNS effects (insomnia)
Visual or Auditory hallucinations
Can worsen mental problems in patients with history of psychiatric disorders

What are some contraindications/precautions for patients taking Amantadine (Symmetrel)?

Psychiatric disorders
Patients with preexisting renal disease
Preexisting Cardiac disease

What are some Nursing Responsibilities for Amantadine (Symmetrel)?

Take history for suicide attempts
Start therapy within 24 hours but no later than 48 hours after onset of symptoms
DO NOT abruptly withdraw in patients with parkinson's disease (Will increase symptoms)

What are the indications for Zidovudine (AZT)

Post-exposure prophylaxis in HIV-exposed health care workers
To reduce transmission rate from mother to fetus

Describe the Mechanism of Action for Zidovudine (AZT)

Resembles thymidine
Uses AZT to synthesize viral DNA instead of thymidine
Terminates growing chain and creates defective DNA strand
DOES NOT CURE

Describe Pharmacokinetics of Zidovudine (ACT)

Given IV or PO
Cross BBB

Describe Adverse Effects of Zidovudine (AZT)

Anemia and Neutropenia
Myalgia (muscle pain)
Toxicity to bone marrow
Acidosis

What are some contraindications/precautions to consider when giving Zidovudine (ACT)

Preexisting anemia or neutropenia
Significant renal or hepatic impairment

What are some drug interactions that can occur with Zidovudine (ACT)

Depress bone marrow function
Lactic acidoses with other antiretroviral agents
caution use with St. John's wort

What are some Nursing Responsibilities to consider when giving Zidovudine (ACT)

Not a cure for HIV and does not prevent spread
Do not discontinue taking med w/o approval
Observe signs and symptoms of myelosuppression (CBC)
Watch for opportunistic infections

Describe the Mechanism of Action for Metronidazole (Flagyl)

Enters pathogens and binds to DNA, RNA, and intracellular proteins. Cell death is likely the result of an absence of DNA repair and abnormalities in RNA synthesis.

Describe Pharmacokinetics in Metronidazole (Flagyl)

PO, IV, Topical
Widely Distributed BBB
77% renal excretion

Describe Adverse Effects in Metronidazole (Flagyl)

Unpleasant metallic taste
Can cause seizures and peripheral neuropathy

What are some Nursing Responsibilities when giving Metronidazole (Flagyl)

Maintain infection control interventions
Assess for sodium retention (bloating/edema)
Avoid alcohol in any form!!
It is normal for urine to appear dark or reddish brown

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