NR 566 MIDTERM STUDY GUIDE/NR 566 MIDTERM STUDY GUIDE

NR 566 MIDTERM STUDY GUIDE 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 • Should be used in caution with patients with hx of allergic reactions to penicillins, cephalosporins, or carbapenems • Treats infection cause by sensitive bacteria • Get culture to identify infecting organism • Can order skin test to assess allergy status • Dosing should be adjusted 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, 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. 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 -Patients should be 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)