Chapter 12

Antiinfective Medications

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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Learning Objectives

  Identify the major antiinfective drug categories and the organisms against which they are effective Outline the most important things to teach the patient who is taking antiinfective drugs 2 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Learning Objectives (cont.)

  Define "spectrum" and explain what this word means in antiinfective therapy List some of the most common adverse reactions to medications used to treat infections 3 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Overview

     Pathogen Bacteria Fungi Viruses Antimicrobials 4 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Learning Objectives

  Identify the major antiinfective drug categories and the organisms against which they are effective Outline the most important things to teach the patient who is taking antiinfective drugs 5 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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Penicillins

    Main antibiotic for years Broad-spectrum drug of choice Overuse Penicillin-resistant strains Action and Uses  Interferes with creation of the mucopeptide cell wall    Bacteriocidal Used to treat multiple infections Allergies Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Penicillin Medications

 Natural PCNs    penicillin G  Given IM; procaine /aqueous forms used to treat gonorrhea penicillin V penicillin VK+  Penicillinase resistant     cloxacillin cicloxacillin naficillin oxacillin 7 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

MORE Penicillins

•

Aminopenicillins: Broad Spectrum

– amoxicillin • Amoxil / Trimox – amoxicillin/ clavulanate • Augmentin – – ampicillin ampicillin/ sulbactam • Unasyn •

Extended Spectrum

– – pipercillin pipercillin/ tazobactam • Zosyn – ticarcillin • Ticar – ticarcillin/ clavulanate • Timentin

Penicillins (cont.)

Adverse Reactions   Neuropathy  High parenteral doses Skin eruptions     GI symptoms Urticaria Laryngeal edema Anaphylaxis Drug Interactions: PCN negates oral contraceptives!!!

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Penicillins (cont.)

10 Nursing Implications and Patient Teaching  Assessment  Signs of infection and allergies   Diagnosis Planning  10-day regimen    Implementation  Route of administration Evaluation Patient Teaching Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Sulfonamides

  Broad-spectrum antiinfective Bacteriostatic action: inhibits folic acid synthesis in the cell Action and Uses  Urinary tract infections   Effectively treats multiple microorganisms Preoperative and postoperative therapy for bowel surgery 11 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Sulfonamides (cont.)

Adverse Reactions Drug Interactions  Potentiate  Decrease effectiveness Nursing Implications and Patient Teaching   Contraindications Take on an empty stomach 12 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Sulfonamides

 Plain    sulfadiazine sulfamethizole sulfasalazine  Azulfidine  Mixtures  trimethoprim/ sulfamethoxazole    Bactrim Septra Sulfatrim 13 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Tetracyclines

Actions and uses  Broad-spectrum antibiotics Adverse Reactions  GI upset Nursing Implications   Not for pregnant patients or children under 8 years of age Can cause sensitivity to light (photosensitivity) so counsel patient to be careful about sun exposure  Take on empty stomach and avoid dairy within 2 hours of taking drug.

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Tetracyclines

    doxycycline minocycline oxytetracycline tetracycline   Take on an empty stomach.

Never give to pregnant woman or child under 8. Will turn teeth green/grey permanently.

 Binds with calcium products 15 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Macrolides: Broad Spectrum

   Zithromax; Z pack  azithromycin Biaxin  clarithromycin E-Mycin / EES  Erythromycin Bacteriostatic or bacteriocidal depending on dosage concentration.

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Cephalosporin History

    The first generation cephalosporins are mostly active against gram positive bacteria and vary with their delivery routes and uses.

Second generation cephalosporins are modified to increase spectrum against gram negative bacteria but have reduced effects against gram positive bacteria. These agents also have better membrane penetration and more B-lactamase resistance.

Third generation cephalosporins include effects against pseudomonas infections, they are also useful in multi-resistant hospital acquired infections.

Fourth generation cephalosporins are even more efficacious. They have an increased spectrum over third generation drugs and are excellent in multiple drug resistance patterns. The only currently available agent in this generation is cefepime.

 http://sitemaker.umich.edu/medchem10/cephalosporins_2 17 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Cephalosporin medications (all have kef-; cef-; or ceph in generic name

    1 st generation Duricef  cefadroxil Keflex  cephalexin Ancef  Cefazolin     2 nd generation Ceclor  cefaclor Cefzil  cefprozil Ceftin  Cefurozime  Bacteriocidal  Bacteriocidal 18 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

More Cephalosporins

       3 rd generation Omnicef (cefdinir) Maxipime (cefepime) Claforan (cefotaxime) Fortaz (ceftazidime) Cefizox (cefizoxime) Rocephin (ceftriaxone)   4 th generation Maxipime  cefepime 19 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Cephalosporin Continued

    Made from molds like PCN.

Works against cell wall synthesis like PCN does.

Can be allergic to cephalosporins if also allergic to PCN. Use with caution. Give PO with food to decrease nausea and diarrhea side effects 20 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Lincosamides

 Cleocin  clindamycin   Empty stomach with full glass of water May be give as a deep IM injection 21 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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Fluoroquinolones (all generics end in floxacin)

    Cipro  ciprofloxacin Levaquin  levofloxacin Avelox  moxifloxacin Maxaquin  lomefloxacin   All are excreted through the kidneys so check your patient’s renal function Potent newer medication. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Miscellaneous Medications

  Bacitracin Vancocin  Vancomycin – slows cell wall synthesis; damages plasma membrane making it susceptible to osmotic pressure; interferes with RNA synthesis Very irritating to the vein; dilute and give over 1 hour IV 23 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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Aminoglycosides

      Used to treat gram negative bacteria when PCN is not an option Amikin  amikacin Garamycin  gentamicin Neo-fradin  neomycin streptomycin sulfate TOBI (tobramycin sulfate) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

    Very ototoxic and nephrotoxic!!!

Assess renal function 1 st .

Encourage increased fluid intake to flush kidneys.

Draw ‘Peak and Through’ levels to assess therapeutic levels.

WARNING

Allergic reactions can appear at any time whether you have safely taken the drug before or not. Be aware!

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Antituberucal drugs

 Primary treatment agents    INH/ Isoniazid  isoniazid Rifadin  rifampin Priftin  rifapentine  Retreatment agents   Seromycin Pulvules  cycloserine Kantrex  kanamycin Prevention in HIV patients Mycobutin (rifabutin) 26 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Antiparasitic Drugs

 Amebicides   Aralen   Chloroquine Ototoxic Flagyl/ Metrogel   Metronidazole No alcohol intake  Antihelminths      Treat pinworms & roundworms Can taste bitter Vermox  mebendazole Pin-X  pyrantel Mintezol  thiabendazole 27 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Antimalarials

 4 aminoquinolones   Aralen  chloroquine Plaquenil  hydroxychloroquine  8 aminoquinolones  All of these drugs have -quine in the generic  primaquine phosphate 28 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Antimalarials

 Folic acid agonist  Daraprim  pyrimethamine  Miscellaneous agents   doxycycline mefloquine  quinine sulfate Quinine is very bitter. Put in the back of the mouth and swallow quickly. Give fruit drink/ sweet drink to rinse mouth. 29 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Chapter 13 – Antivirals (have –vir)

    Zovirax  acyclovir Symmetrel  amantadine Famvir  famciclovir Tamiflu  oseltamivir phosphate     Virazole  ribavirin Valtrex  valacyclovir HCL Valcyte  valganciclovir Relenza  zanamivir 30 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Antivirals

    Most have –vir in generic or brand name.

Medications decrease the viral load but do not cure.

Viristatic.

Goal is to prevent opportunistic infections while the body heals itself from the virus using the immune system 31 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Reverse transcriptase inhibitors

 Nucleoside Analogues   Epivir – HBV  lamivudine (3TC) Retrovir  zidovudine (AZT)  Nonnucleoside Analogues    Ziagen  abacavir sulfate Rescriptor  delavirdine Viramune  nevirapine 32 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Protease inhibitors

    Crixivan   Indinavir Nephrolithiasis Viracept  nelfinavir Norvir  ritonavir Invirase  saquinavir     Take prescribed dose at ordered times.

Skipping doses can lead to a resistant strain of the virus.

Standard precautions continue to be needed.

Look for ‘Crix belly’.

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Antifungal medications

      Mycostatin - nystatin Fungizone - amphotericin B *** Diflucan - fluconazole GrifulvinV - griseofulvin Nizoral - ketoconazole Lamisil – terbinafine HCL  Flagyl (metronidazole) can also be used *** protect IV fluid from light. very potent; used only with serious fungal infections Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Antifungal effects

    Mycotic infections take a while to cure. Phototoxicity – use sun screen; avoid summer sun hours Hepatotoxicity – watch the liver function studies Avoid alcohol with any of these drugs. The liver is busy clearing out the med.

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 Questions?

36 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.