Pharm 1

ANTIMICROBI

AL DRUGS

Presented by: Kayla Jackson Carrie Davis Adiodun Kassim Christabel Amoah

Rasmussen University

Pharmacology Winter 2023

Professor Latania Hargrave

Due 02/05/2023

SUMMARY OF THE UNIT

Antimicrobials are drugs used to treat

infection caused by disease- producing microorganisms such as gram-positive or

gram-negative bacteria, viruses, protozoans, or fungi. The degree to which

they are pathogenic depends on the microorganism and its virulence (Yeager,

2021). Antimicrobials include antibiotics, antivirals, antifungals and antiparasitics.

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THREE TYPES OF DRUGS AND THE ROUTES OF ADMINISTRATION

Penicillins: anti-infectives

Classifications:

1) Broad-Spectrum Penicillins (Aminopenicillins)- used to treat both gram-positive and gram-negative bacteria (i.e. ampicillin [PO, IV, IM] and amoxicillin [PO])

2) Penicillinase-Resistant Penicillins (Antistaphylococcal Penicillins)- used to treat penicillinase-producing S. aureus; not effective against gram-negative organisms (i.e. dicloxacillin [PO], nafcillin and oxacillin [IV])

3) Extended-Spectrum Penicillins (Antipseudomonal Penicillins)- effective against P. aeruginosa, a gram-negative bacillus that is difficult to eradicate; useful against many gram- negative organisms (i.e. piperacillin [IV])

4) Beta-Lactamase Inhibitors- combined with a penicillinase- sensitive penicillin to achieve additive antibiotic effects (i.e. clavulanic acid [PO, IV], sulbactam [IM, IV] , and tazobactam [IV])

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Routes of Administration:

Penicillin V- PO (after meals)

Penicillin G- IM and IV

Benzathine Penicillin- IM

Procaine Penicillin- IM

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THREE TYPES OF DRUGS AND THE ROUTES OF ADMINISTRATION

Vancomycin: glycopeptide anti-infectives

Indications: can be used against drug-resistant S. aureus and prophylactically in cardiac surgery for persons allergic to penicillin. It is given orally for Tx of staphylococcal enterocolitis and antibiotic- associated pseudomembranous colitis due to C. difficile. Vancomycin can also be given intravenously for septicemia; MRSA; and for bone, skin, and lower respiratory tract infections that do not respond or are resistant to other antibiotics (Yeager, 2021).

Routes of Administration: PO and IV

Gentamicin: aminoglycosides

Indications: to treat serious gram-negative bacteria and infections caused by staphylococci when penicillins or less toxic drugs are contraindicated.

Routes of Administration: Topical, IM and IV

COMMON SIDE EFFECTS AND ADVERSE REACTIONS

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Penicillins side effects

 Nausea

 Vomiting

 Diarrhea

 Rash, Urticaria

 Abdominal pain

 Pain at injection site

 Phlebitis at IV site

Penicilins adverse side effects

 Stevens-Johnson Syndrome Toxic Epidermal Necrolysis

 Flu like symptoms, such as a fever, feeling ill, or joint pain

 Hemolytic anemia  C.Difficile associated diarrhea  Seizures  Anaphylaxis  Superinfection

COMMON SIDE EFFECTS AND ADVERSE REACTIONS Vancomycin side effects

 Black, tarry stools  Blood in the urine or stools  Continuing ringing or buzzing or other unexplained noise in the ears

(ototoxicity)  Nephrotoxicity (monitor kidney function)  Cough or hoarseness  Dizziness or lightheadedness  General feeling of tiredness or weakness  Hypotention (rapid infusion)

Vancomycin adverse effects

 Bladder pain  Decreased urine  Increased thirst  Irregular heartbeat  Mood changes  Muscle pain or cramps  Numbness or tingling in the hands, feet, or lips  Unusual tiredness or weakness  Stevens-Johnson syndrome  Fever with or without chills

COMMON SIDE EFFECTS AND ADVERSE REACTIONS

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Gentamicin side effects

 Rash  Hearing loss, vertigo  Bradycardia  Muscle tightness, twitching, contractions  Kidney dysfunction (decreased urination, edema)  Photosensitivity

Gentamicin adverse side effects

 Seizures  Hypotension  Angioedema  Syncope  Conjunctivitis  Ototoxicity  Nephrotoxicity

This Photo by Unknown Author is licensed under CC BY-SA

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SPECIAL CONSIDERATIONS

Penicillin Special Considerations

 Is safe to take when breastfeeding or pregnant

 Additional contraceptives are suggested, as this

medication makes oral contraceptives ineffective

 It is essential to educate the patient to take this

antibiotic with food to lower GI upset

 Penicillin allergies are common. Cross sensitivity

to Cephalosporins (i.e. cephalexin or Keflex).

 Monitor urine output; report urine output less

than 30mL/hr or 600mL/day.

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SPECIAL CONSIDERATIONS

Gentamicin Special Considerations (Chaves, 2022)

 This can be taken by expecting mothers. Risk to benefit ratio.

 Birth control should be used to prevent unwanted pregnancy during treatment.

 Breastfeeding is not recommended when taking this medication.

 Avoid long-term use as it will increase the risk of toxicity and superinfection.

 Avoid administering gentamicin with potent diuretics, as diuretics may cause ototoxicity.

 Diuretics administered intravenously increase gentamicin toxicity by increasing the drug strength in serum and tissue.

SPECIAL CONSIDERATIONS Vancomycin Special Considerations (Patel, Preuss, Bernice, 2022)

 Elderly patients are more susceptible to vancomycin toxicity with IV administration due to age-related changes in renal function. These patients must be monitored closely and require a more conventional dosage regimen.

 Oral vancomycin capsules can be used for pregnant women. However, per doctor’s orders, intravenous vancomycin injections should not be used during pregnancy unless treatment is necessary.

 Close monitoring is required to lower the chances of ototoxicity and nephrotoxicity in the fetus.

 Vancomycin is expelled in breast milk following intravenous administration.

 Oral vancomycin has minimal systemic absorption and limited excretion through breastmilk. Mothers who receive intravenous vancomycin should consult their provider before resuming breastfeeding, as it could affect the baby’s health.

COMMON NURSING INTERVENTIONS

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Penicillin Common Nursing Interventions

 Observe patients for side effects and anaphylactic reactions such as rash, prurit is, laryngeal edema, hypotension, and wheezing.

 Monitor bowel function, diarrhea, abdominal cramping, fever, and bloody stools (monitor clott ing factors).

 Assess the patient for bleeding if high doses of penicillin are being given; a decrease in platelet aggregation (clott ing) may result.

 Inform patients penicil lin V may be taken orally without food and encourage to take entirety of antibiotic regimen even if they are feeling better.

 Inform patient to report signs of superinfection (i .e. black, furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools).

 Monitor for allergies to cephalosporins and penicil lins.

COMMON NURSING INTERVENTIONS

Gentamicin Common Nursing Interventions

 Report t innitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating.

 Encourage plenty of liquids (nephrotoxic), unless contraindicated.  Topical application if applicable. Assess skin and inform HCP if skin

irri tation develops or infection worsens.  Monitor for hearing loss (ototoxicity) and ataxia, intake and output, and

daily weights.  Monitor CBC with differential and peak and trough serum blood levels.

Blood should be drawn 45-60 mins after drug has been administered for peak levels and minutes before next drug dosing for trough levels (peak: 5–8 mcg/mL; trough: <1–2 mcg/mL).

 Monitor for fungal infections (superinfection: stomatitis or mouth ulcers and genital discharge).

 Neonates should be assessed by audiometric studies prior to discharge.

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COMMON NURSING INTERVENTIONS

Vancomycin Common Nursing Interventions

 Report tinnitus, rash, vertigo, hearing loss, flushing of the skin or dizziness.

 If taken orally take as directed, complete entire antibiotic regimen even if symptoms subside.

 Monitor IV sites to avoid extravasation.

 Monitor BP and presence of skin flushing throughout IV infusion, intake and output, and daily weights.

 Make note that cloudy or pink urine may be a sign or nephrotoxicity.

 Assess bowel status.

 Administer IV over at least 60-90 minutes to prevent “tired man syndrome” also known as a massive histamine release.

REFERENCES 1) VALLERAND, A. H. , & SANOSKI, C . A. (2022) . DAVIS 'S DRUG GUIDE FOR NURSES (18TH ED.) . F. A. DAVIS

COMPANY. PAGES 1276 , 133 , 1029 . HTTPS: / /AMBASSADORED.VITALSOURCE.COM/BOOKS/9781719648127

2) YEAGER, J . , ET ALL (2021) . UNIT VIII . ANTIMICROBIAL DRUGS. PHARMACOLOGY (10TH ED.) . ELSEVIER

HEALTH SCIENCES (US). HTTPS: / /AMBASSADORED.VITALSOURCE.COM/BOOKS/9780323642477

3) PATEL, S . , ET ALL. (2022) . VANCOMYCIN - STATPEARLS – NCBI BOOKSHELF. NATIONAL LIBRARY OF

MEDICINE . RETRIEVED FROM: HTTPS: / /WWW.NCBI.NLM.NIH.GOV/BOOKS/NBK459263/

4) CHAVEZ, B. , ET ALL.(2022) . GENTAMICIN - STATPEARLS - NCBI BOOKSHELF. NATIONAL LIBRARY

OF MEDICINE . RETRIEVED FROM: HTTPS: / /WWW.NCBI.NLM.NIH.GOV/BOOKS/NBK557550/#ARTICLE-

22211 .S6

5) GERRIETS, V. (2022) . PENICILLIN - STATPEARLS - NCBI BOOKSHELF. NATIONAL LIBRARY

OF MEDICINE . RETRIEVED FROM: HTTPS: / /WWW.NCBI.NLM.NIH.GOV/BOOKS/NBK554560/

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