NR293 Exam 1 Drugs GRADED A

NR293 Exam 1 Drugs




NR293 Exam 1 Drugs



DRUG CLASS: ANTIBIOTICS – sulfonamides

generic name / (Trade name)
 sulfamethoxazole-trimethoprim (Bactrim, Septra)
 co-trimoxazole (SMZ-TMP)




MOA: Indications:
Bacteriostatic – inhibits bacterial synthesis of folic acid  Effective against both gram (+/-) bacteria
required for synthesis of purines and nucleic acid for  UTIs caused by Enterobacter spp., E. Coli, Klebsiella
replication (does not affect human cells) spp., Proteus mirabilis, Proteus vulgarism and S.
aureus (sulfamethoxazole-trimethoprim often
combined for synergistic antibacterial effect)
 Pneumocystis jiroveci pneumonia, &
 Outpatient staph infections from high rate of
community acquired MRSA infections
 URIs 
Adverse Effects: Contraindications / Precautions:
 Blood – hemolytic and aplastic anemia,  G6PD deficiency (RBC breaks down faster than they
agranulocytosis, thrombocytopenia are made – anemia)
 Integumentary – photosensitivity, exfoliative  Impaired renal & hepatic functions
dermatitis, Steven-Johnson syndrome, epidermal  Bronchial asthma
necrolysis  Hyperkalemia
 GI – N/V/D, pancreatitis  Hypothyroidism
 Other – hepatotoxicity, convulsions, crystalluria,  Pregnancy (C)
toxic nephrosis, h/a, peripheral neuritis, urticaria,
cough
Drug Interactions: Nursing Implications:
 Warfarin – increases risk for bleeding  Obtain C&S before initiating therapy
 Monitor renal function as abx are highly concentrated
in kidneys, through which they are excreted (BUN,
creatinine, I/O’s,)
 Obtain urinalysis to assess for crystalluria
 Monitor for allergic reactions / CNS effects (rash,
bleeding, bruising, hallucinations, seizures, etc.)
Patient Teaching:
 Avoid sunlight / wear sunscreen
 Report any signs of rash, bleeding, or unusual bruising
 Report shortness of breath, diarrhea, blood in urine, fever, or severe/worsening rash immediately
 Increase fluid intake (2000-3000mL) to prevent crystalluria
 Take with food to avoid GI distress
 Use alt form of contraception
 Take as directed and avoid use of alcohol

, NR293 Exam 1 Drugs




DRUG CLASS: BETA-LACTAM ANTIBIOTICS – penicillin

generic name / (Trade name)
 ampicillin / sulbactam (Unasyn) [IV or IM injection]
 amoxicillin / clavulanic acid (Augmentin) [ PO]
MOA: Indications:
Bacteriostatic – Binds to specific proteins called penicillin-  Gram (+) bacterial infections caused: streptococcus
binding proteins and inhibit peptidoglycan, which interfere spp., enterococcus spp., and staphylococcus spp.
with cell wall synthesis – resulting in lysis  Health care-associated infections – pneumonia,
intrabdominal infections, and sepsis
 Otis media, sinusitis, various respiratory, skin, and
urinary tract infections, bacterial endocarditis, H.
pylori infections
Adverse Effects: Contraindications / Precautions:
 Seizures  Allergy/hypersensitivity to penicillin (should not
 Oral candidiasis, N/V/D, abdominal pain receive cephalosporins)
 Allergic reactions: urticaria, pruritis, hives,
angioedema
 Anemia, bone marrow depression, granulocytopenia
 Hyperkalemia, hypernatremia, alkalosis
Drug Interactions: Nursing Implications:
 Ethanol / alcohol (disulfiram-like reaction; severe  Obtain C&S before initiating therapy
nausea and vomiting, diaphoresis, headache)  Obtain accurate health history regarding allergies
 Antacids, Fe+ (decreases oral absorption, resulting in (types of reaction)
decreased effectiveness)  Assess for allergic reaction
 Probenecid (decreases renal excretion, resulting in  Obtain/assess CBC
increased cephalosporin levels)
 Oral contraceptives (increased risk for unintended
pregnancy)

Patient Teaching:
 Take as directed
 Use alternative form of contraceptives
 Avoid use of alcohol
 Report incidents of diarrhea, with blood, pus, to avoid dehydration
 Report mouth pain (indicative of superinfection: thrush)
 Encourage consumption of probiotics to avoid loss of normal intestinal flora (e.g., yogurt, buttermilk, and kefir)
 Do not take PO penicillin with juices (acidic fluids may nullify antibacterial action)
 Avoid taking w/ cola or caffeine-containing beverages, citrus or fruit juices, tomato juice (decreases effectiveness)
Drug Profile:
Natural penicillin G vs. penicillin V
 Penicillin G (IM)
 Penicillin V (PO)
Aminopenicillins (amoxicillin / ampicillin)  amino group + penicillin = enhancing activity against gram (-) bacteria

, NR293 Exam 1 Drugs




DRUG CLASS: BETA-LACTAM ANTIBIOTICS – cephalosporins

generic name / (Trade name)
 See drug profile

MOA: Indications:
Bactericidal – inhibits bacterial cell wall synthesis, resulting  See drug profile
in lysis



Adverse Effects: Contraindications / Precautions:
 Similar to penicillin allergy:  Allergy/hypersensitivity
o Oral candidiasis, N/V/D, abdominal pain  Infants < 1 month old
o Allergic reactions: urticaria, pruritis, hives,  Renal disease
redness, angioedema  Pregnancy (B) / breastfeeding

Drug Interactions: Nursing Implications:
 Warfarin (reduced vitamin K from gut flora)  Obtain C&S before initiating therapy
 Aminoglycosides (additive effect)  Obtain accurate health history regarding allergies
 NSAIDs (additive effect) (types of reaction)
 Rifampin (antagonistic effect)  Assess for allergic reaction
 Methotrexate (decreased elimination of methotrexate
– renal toxicity)
 Oral contraceptives (lowers efficacy of oral
contraceptives)

Patient Teaching:
 Take as directed
 Use alternative form of contraceptives
 Avoid use of alcohol
 Report incidents of diarrhea, with blood, pus, to avoid dehydration

Drug Profile:
1st generation: cefazolin (Ancef) & cephalexin (Keflex)
 Routes: IV or IM, but PO for cephalexin
 Good gram (+) coverage / poor gram (-) coverage
 Surgical prophylaxis for susceptible staphylococcal infections
nd
2 generation: cefoxitin (Mefoxin)
 Routes: IV or IM
 Less gram (+) positive coverage / better gram (-) and anaerobic coverage than 1st generation
 Surgical prophylaxis for abdominal/colorectal surgeries
rd
3 generation: ceftriaxone (Rocephin)
 Routes: IV or IM
 Most potent against gram (-) bacteria / less active against gram (+)
 Extremely long-acting drug that can be given only once a day for tx of most infections