NR 566 midterm .
NR 566 midterm.
566 Midterm Study Guide
WEEK 1
-Things to know about each of the major antibiotic drug classes
· Contraindications and high-risk patients
· Know examples of each of the major antibiotic drug classes
· Monitoring needs
· Which ones require renal dosing adjustments and how much (i.e., 25%, 50%, etc.)
· Patient education
· Lifespan considerations including pregnancy
· Indications for use
Penicillins
• caution with patients allergic reactions to penicillins, cephalosporins, or
carbapenems
• Treats infection cause by sensitive bacteria
check culture to identify infecting organism
• Can order skin test to assess allergy status
• adjusted doses for patients with impaired renal fnx
NARROW SPECTRUM PENICILLINS: PENICILLIN SENSITIVE(PEN G &PEN
V)
-Mechanism of Action: “Bactericidal”- Weakens the cell wall, causing bacteria to take up
excessive amounts of water and rupture.
Occurs by two actions simultaneously: inhibiting transpeptidases and activating autolysins
which disrupts synthesis of the cell wall and promotes the active destruction resulting in
cell lysis and death.
-Examples: Penicillin G (Prototype Drug), Penicillin V, Nafcillin, Oxacillin, Dicloxacillin,
, .
NR 566 midterm
Ampicillin, Amoxicillin, Piperacillin
Penicillin G-
-First Penicillin Available and often referred to plainly as Penicillin
-Bactericidal for gram negative and gram positive bacteria
-Should be taken with medications whereas Penicillin V is stable in stomach acids.
-Side Effects: Allergic reactions, pain at IM injection sites, prolonged (but reversible)
sensory and motor dysfunction if injected into peripheral nerves, and neurotoxicity
(seizures, confusion, hallucinations- if levels too high)
.
-Life Span Considerations:
*Infants- Used safely in infants with bacterial infections including syphilis, meningitis, &
group A streptococcus
*Children/Adolescents- Common drug used to treat bacterial infections in children.
*Pregnant- No well controlled studies but evidence suggests no 2nd or 3rd trimester fetal
risk.
*Breastfeeding- Amoxicillin is safe. Data is lacking about transmission of other PCNs from
mother to infant through breast milk.
*Older Adults- Doses should be adjusted in older adults with renal dysfunction.
, .
NR 566 midterm
Penicillin Allergy:
-Most common drug allergy to date with severity ranging from minor rash to anaphylaxis
-Can possibly display cross sensitivity to cephalosporins and should not be used if possible
-observed 30 minutes minimum post drug injection for adverse reactions
-For history of PCN allergy, a skin allergy test can be done to assess current risk by
injecting a tiny amount of allergen ID (only to be done where epinephrine and respiratory
support is available if needed)
Penicillin V-
• Stable in stomach acid (Pen G is not)
• Used for oral therapy, can be taken with meals
NARROW SPECTRUM PENICILLIN: PENICILLIN RESISTANT: (Nafcillin, Oxacillin,
Dicloxacillin)
-Treats S. aureus and S. epidermidis
Broad-Spectrum Penicillins (Ampicillin & Amoxicillin):
-Most common side effects are rash and diarrhea (rash usually 3-10 days post TX start).
-Therapy can be PO or IV and requires dosage adjustment for renal impairment
-Treats Haemophilus influenzae, E. Coli, proteus mirabilis, enterococci, and Neisseria
gonorrhoeae
EXTENDED SPECTRUM PENICILLIN: (Piperacillin)
-Treats same diseases as broad spectrum PLUS: *pseudomonas aeruginosa*, enterobacter
spp, proteus, bacteroides fragilis, klebsiella spp
-Can cause bleeding secondary to disrupting platelet function
-Usually administered IV
-Reduce dose in renal pt’s
Cephalosporins (Cephalexin)
-Bactericidal drug (similar to PCNs)
-Increases activity against gram-negative agents
-Increases ability to reach cerebral spinal fluid (CSF)-3rd,4th,5th generations
-no routine lab monitoring
-Administered IM or IV
-Take cultures to determine sensitivity and infecting organism
-Contraindicated in pt’s with severe allergic reaction to cephalosporins or penicillins
- CAN CAUSE C. DIFF INFECTION (tell pt. To monitor for frequent stools)
-Used to treat infants & neonates. Especially in otitis media and gonococcal and pneumococcal
infections
-Adverse Effects: Maculopapular rash, bronchospasm, anaphylaxis
-Education: Patients should not consume alcohol
First generation: tx’s staphylococci or streptococci
Cefadroxil, Cefazolin, Cephalexin
Second generation: TX’s H. Influenza, Klebsiella, pneumococci, staphylococci
Cefaclor, Cefotetan, Cefoxitin, Cefurozime
Third generation: tx’s pseudomonas aeruginosa, Neisseria gonorrhoeae, Klebsiella, Serratia
Cefdinir, Cefotaxime, Cefpodoxime, Ceftazidime, Ceftriaxone
Fourth generation: Pseudomonas aeruginosa
Cefepine, Ceftolozane/tazobactam
Fifth generation: Methicillin resistant Staphylococcus aureus
Ceftaroline
, .
NR 566 midterm
Carbapenems (Imipenem)
-Patients on valproate for seizures not to give
-Avoid in renal impairment pts
-Adverse effects: N/V/D, seizures (rare), rashes, pruritus
Vancomycin
-Used for C. Diff infection
-Treats S. Aureus and S. epidermidis, and MRSA
-Monitor Vanco drug levels
-Use caution in pt’s with renal impairment
Telavancin
-Black Box Warning: when used to tx hospital acquire or ventilator-associated bacterial
pneumonia with creatinine clearance of less thn 50 ml/min, increased chance of mortality.
Not safe in pregnancy
Aztreonam
-Adverse effects: pain & thrombophlebitis at injection site
USES: -treats gram negative bacteria: E. Coli, salmonella, Shigella, Serratia, Klebsiellam
Proteus, H. influenza, P. aeruginosa
Fosfomycin
-Single dose therapy in women with uncomplicated UTI
-Adverse effects: diarrhea, headache, vaginitis, nausea, abdominal pain, rhinitis,
drowsiness, dizziness, rash
Tetracyclines (Tetracycline)
-Broad spectrum bacteriostatic
-Contraindication/Precautions:
- After the 4th month of pregnancy can stain deciduous teeth and stain permanent teeth of
children ages of 4 month and 8 years
- If given to treat an STD, abstain from intercourse until med is finished.
o Food decreases absorption
· Complications
o GI discomfort (cramping, nausea, diarrhea, and esophageal ulceration)
§ Taking Doxycycline and Minocycline with meals will with GI discomfort BUT
food will reduce absorption.
§ Avoid taking at bedtime to reduce the risk of esophageal ulceration.
NR 566 midterm.
566 Midterm Study Guide
WEEK 1
-Things to know about each of the major antibiotic drug classes
· Contraindications and high-risk patients
· Know examples of each of the major antibiotic drug classes
· Monitoring needs
· Which ones require renal dosing adjustments and how much (i.e., 25%, 50%, etc.)
· Patient education
· Lifespan considerations including pregnancy
· Indications for use
Penicillins
• caution with patients allergic reactions to penicillins, cephalosporins, or
carbapenems
• Treats infection cause by sensitive bacteria
check culture to identify infecting organism
• Can order skin test to assess allergy status
• adjusted doses for patients with impaired renal fnx
NARROW SPECTRUM PENICILLINS: PENICILLIN SENSITIVE(PEN G &PEN
V)
-Mechanism of Action: “Bactericidal”- Weakens the cell wall, causing bacteria to take up
excessive amounts of water and rupture.
Occurs by two actions simultaneously: inhibiting transpeptidases and activating autolysins
which disrupts synthesis of the cell wall and promotes the active destruction resulting in
cell lysis and death.
-Examples: Penicillin G (Prototype Drug), Penicillin V, Nafcillin, Oxacillin, Dicloxacillin,
, .
NR 566 midterm
Ampicillin, Amoxicillin, Piperacillin
Penicillin G-
-First Penicillin Available and often referred to plainly as Penicillin
-Bactericidal for gram negative and gram positive bacteria
-Should be taken with medications whereas Penicillin V is stable in stomach acids.
-Side Effects: Allergic reactions, pain at IM injection sites, prolonged (but reversible)
sensory and motor dysfunction if injected into peripheral nerves, and neurotoxicity
(seizures, confusion, hallucinations- if levels too high)
.
-Life Span Considerations:
*Infants- Used safely in infants with bacterial infections including syphilis, meningitis, &
group A streptococcus
*Children/Adolescents- Common drug used to treat bacterial infections in children.
*Pregnant- No well controlled studies but evidence suggests no 2nd or 3rd trimester fetal
risk.
*Breastfeeding- Amoxicillin is safe. Data is lacking about transmission of other PCNs from
mother to infant through breast milk.
*Older Adults- Doses should be adjusted in older adults with renal dysfunction.
, .
NR 566 midterm
Penicillin Allergy:
-Most common drug allergy to date with severity ranging from minor rash to anaphylaxis
-Can possibly display cross sensitivity to cephalosporins and should not be used if possible
-observed 30 minutes minimum post drug injection for adverse reactions
-For history of PCN allergy, a skin allergy test can be done to assess current risk by
injecting a tiny amount of allergen ID (only to be done where epinephrine and respiratory
support is available if needed)
Penicillin V-
• Stable in stomach acid (Pen G is not)
• Used for oral therapy, can be taken with meals
NARROW SPECTRUM PENICILLIN: PENICILLIN RESISTANT: (Nafcillin, Oxacillin,
Dicloxacillin)
-Treats S. aureus and S. epidermidis
Broad-Spectrum Penicillins (Ampicillin & Amoxicillin):
-Most common side effects are rash and diarrhea (rash usually 3-10 days post TX start).
-Therapy can be PO or IV and requires dosage adjustment for renal impairment
-Treats Haemophilus influenzae, E. Coli, proteus mirabilis, enterococci, and Neisseria
gonorrhoeae
EXTENDED SPECTRUM PENICILLIN: (Piperacillin)
-Treats same diseases as broad spectrum PLUS: *pseudomonas aeruginosa*, enterobacter
spp, proteus, bacteroides fragilis, klebsiella spp
-Can cause bleeding secondary to disrupting platelet function
-Usually administered IV
-Reduce dose in renal pt’s
Cephalosporins (Cephalexin)
-Bactericidal drug (similar to PCNs)
-Increases activity against gram-negative agents
-Increases ability to reach cerebral spinal fluid (CSF)-3rd,4th,5th generations
-no routine lab monitoring
-Administered IM or IV
-Take cultures to determine sensitivity and infecting organism
-Contraindicated in pt’s with severe allergic reaction to cephalosporins or penicillins
- CAN CAUSE C. DIFF INFECTION (tell pt. To monitor for frequent stools)
-Used to treat infants & neonates. Especially in otitis media and gonococcal and pneumococcal
infections
-Adverse Effects: Maculopapular rash, bronchospasm, anaphylaxis
-Education: Patients should not consume alcohol
First generation: tx’s staphylococci or streptococci
Cefadroxil, Cefazolin, Cephalexin
Second generation: TX’s H. Influenza, Klebsiella, pneumococci, staphylococci
Cefaclor, Cefotetan, Cefoxitin, Cefurozime
Third generation: tx’s pseudomonas aeruginosa, Neisseria gonorrhoeae, Klebsiella, Serratia
Cefdinir, Cefotaxime, Cefpodoxime, Ceftazidime, Ceftriaxone
Fourth generation: Pseudomonas aeruginosa
Cefepine, Ceftolozane/tazobactam
Fifth generation: Methicillin resistant Staphylococcus aureus
Ceftaroline
, .
NR 566 midterm
Carbapenems (Imipenem)
-Patients on valproate for seizures not to give
-Avoid in renal impairment pts
-Adverse effects: N/V/D, seizures (rare), rashes, pruritus
Vancomycin
-Used for C. Diff infection
-Treats S. Aureus and S. epidermidis, and MRSA
-Monitor Vanco drug levels
-Use caution in pt’s with renal impairment
Telavancin
-Black Box Warning: when used to tx hospital acquire or ventilator-associated bacterial
pneumonia with creatinine clearance of less thn 50 ml/min, increased chance of mortality.
Not safe in pregnancy
Aztreonam
-Adverse effects: pain & thrombophlebitis at injection site
USES: -treats gram negative bacteria: E. Coli, salmonella, Shigella, Serratia, Klebsiellam
Proteus, H. influenza, P. aeruginosa
Fosfomycin
-Single dose therapy in women with uncomplicated UTI
-Adverse effects: diarrhea, headache, vaginitis, nausea, abdominal pain, rhinitis,
drowsiness, dizziness, rash
Tetracyclines (Tetracycline)
-Broad spectrum bacteriostatic
-Contraindication/Precautions:
- After the 4th month of pregnancy can stain deciduous teeth and stain permanent teeth of
children ages of 4 month and 8 years
- If given to treat an STD, abstain from intercourse until med is finished.
o Food decreases absorption
· Complications
o GI discomfort (cramping, nausea, diarrhea, and esophageal ulceration)
§ Taking Doxycycline and Minocycline with meals will with GI discomfort BUT
food will reduce absorption.
§ Avoid taking at bedtime to reduce the risk of esophageal ulceration.
