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Penicillin Nursing Implications

Terms in this set (45)

Therapeutic goal
treat infections caused by sensitive bacteria
Baseline data
- prescriber may order tests to identify the infecting organism and drug sensitivity

- Take sample of microbiologic culture before starting treatment

- perform skin test to determine allergy status in patients w history of penicillin allergy
High risk patients
- patients w severe allergy to penicillin, cephalosporins, or carbapenems
Routes of administration
orally
IM
IV
- make sure preparation is appropriate for the intended route
Dosage for penicillin G? Other penicillins?
prescribed in units. All others prescribed in mg or g
Administration via IM
- aspirate to avoid injection into an artery
- avoid injection into a nerve
which 3 types of penicillin can be administered w food?
Penicillin V
amoxicillin
amoxicillin/clavulanate
Oral administraion
Patients should take drug w full glass of water 1 hr before or 2 hrs after meal (3 exceptions)
Monitor patient for....
- indications of antimicrobial effects
- reduction in fever, pain or inflammation
- improved appetite and sense of well being
Why should the nurse monitor kidney function?
renal impairment can cause penicillin to accumulate to toxic levels. Monitoring kidney function can help avoid injury.
How to assess kidney function
- measure urine intake and outake
Who should be assessed for kidney function
- those with kidney disease
- acutely ill patients
- very old and very young
Adverse effects of penicillin
- allergic reaction
- sodium loading
- hyperkalemia
- incorrect injection injury
Adverse interactions w penicillin
aminoglycosides
Allergic reaction to penicillin
- very rare but life threatening
- interview patient for history of penicillin allergy
Skin test
- given to patients w prior allergic reactions
- assesses current allergy status
- can cause a sever reaction
- when skin test is performed, make sure epinephrine and respiratory support is immediately available
Patient w penicillin allergy should....
- wear some type of identification to alert emergency personel
- outpatients should report any signs of allergic response immediately (ie rash, itching, hives)
How to prevent adverse effects of sodium loading?
- exercise caution w patients under sodium restriction ie cardiac and hypertension patients
- monitor electrolytes and cardiac status
How is hyperkalemia caused? How to prevent it
- caused by high doses IV potassium penicillin G. Leads to dysrhythmia
- prevent it by monitoring electrolyte and cardiac status
What drug should penicillin not be administered with?
aminoglycosides
Types of Penicillins
amoxicillin, ampicillin, piperacillin, nafcillin
Mechanism of action
Weaken the cell wall, causing bacteria to take up excessive water and rupture
penicillin works against what types of bacteria
mostly gram positive and some gram negative
How is penicillin excreted?
renal excretion
Penicillin effect on pregnant women?
Pregnancy category B (considered safe to use during pregnancy)
Adverse effects of penicillin
Allergy, rare but serious
CNS toxicity
Nephritis
neurotixicity (if blood levels are too high)
Penicillin is only effective against ______________ bacteria
growing and dividing
signs/symptoms of neurotoxicity
seizures
confusion
hallucination
Penicillin Binding Proteins (PBPs)
- molecular targets of penicillin
- penicillin binds to PBP's to produce antibacterial effects
-
PBP's are only produced in _____________ bacteria
growing and dividing
Gram-negative cell envelope
Three layers
Thin cell wall and an additional outer membrane that is hard to penetrate
penicillin is LESS likely to work
Gram-positive cell envelope
Only two layers
Relatively thick cell wall that is easily penetrated
Peniciliin works BETTER against gram-positive
How does penicillin work?
- It binds to transpeptidase which weakens the cell wall causing the cell to rupture and die
- Disruption of peptidoglycan synthesis
Penicillinases (beta lactamases)
- Enzymes that cleave the beta lactam ring and render penicillin inactive
- created by bacteria
Do gram positive or gram negative produce more beta lactamase?
gram positive
Methicillin Resistance Staphylococcus Aureus (MRSA)
is caused by.....
-Altered PBPs produce mechanism of resistance
- Produce PBP with a low affinity for PCN
How did MRSA develop?
-Developed by acquiring genes that code for low affinity PBP from other bacteria
- caused by alteration of target molecules; randomly happens in DNA
What is the treatment of choice for MRSA patients?
Vancomycin
Purpose of combining Penicillin and beta lactamase inhibitor?
Synergy— Extends antimicrobial spectrum when combined with penicillinase-sensitive antibiotics
Beta-lactamase inhibitor examples
clavulanic acid, sulbactam, tazobactam
Combinations you may see: beta lactam/beta lactamase inhibitor
Ampicillin/sulbactam (Unasyn)
Amoxicillin/clavulanic acid (Augmentin)
Ticarcillin/clavulanic acid (Timentin)
Piperacillin/tazobactam (Zosyn)
3 types of allergic reactions
Immediate (reaction in 2-30 minutes)
Accelerated (reaction in 1-72 hours)
Late (reaction takes days or weeks to develop)
symptoms of anaphylaxis
Laryngeal edema
Bronchoconstriction
Severe hypotension
treatment for anaphylaxis
epinephrine
respiratory support
Prevention of Anaphylaxis
skin testing
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