Cephalosporin

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Cephalosporin

  1. 1. Introductory Clinical Pharmacology Chapter 8 Cephalosporins Copyright © 2008 Lippincott Williams & Wilkins.
  2. 2. Introduction• Effective in the treatment of all strains of bacteria affected by penicillins and some strains resistant to penicillins• Classification: Divided into first-, second-, third-, and fourth-generation drugs (refer to next slides please)• Uses: Treat urinary tract infections; skin infections; hospital-acquired pneumonias Copyright © 2008 Lippincott Williams & Wilkins.
  3. 3. Cephalosporins• First generation Cephalosporins – Cefazolin (Ancef) – MSSA, Surgical Prophylaxis – Cephalexin – Pharyngitis, impetigo, cellulitis, mild diabetic foot ulcers• Second generation Cephalosporins – Cefoxitin – Cefotetan Copyright © 2008 Lippincott Williams & Wilkins.
  4. 4. Cephalosporins• Third generation Cephalosporins – Ceftriaxone – meningitis, pneumonnia, gonorrhae – Ceftazidime – Pseudomonas, Pyelonephritis• Fourth generation Cephalosporins – Cefepime – febrile neutropenia Copyright © 2008 Lippincott Williams & Wilkins.
  5. 5. Cephalosporins: Actions• Exert bactericidal effect – Have a beta-lactam ring •Targets the bacterial cell wall, making it defective and unstable Copyright © 2008 Lippincott Williams & Wilkins.
  6. 6. Cephalosporins: Uses• Used to treat infections caused by bacteria – Respiratory – Ear – Bone/joint) – Genitourinary tract infections• Culture and sensitivity tests: Help determine best antibiotic to control an infection• Used throughout peri-operative period Copyright © 2008 Lippincott Williams & Wilkins.
  7. 7. Cephalosporins: Adverse Reactions• Gastrointestinal reactions – Nausea; vomiting; diarrhea• Administration route reactions – Intramuscularly; intravenously Copyright © 2008 Lippincott Williams & Wilkins.
  8. 8. Cephalosporins: Adverse Reactions(cont’d)• Other body system reactions – Headache; dizziness; malaise; heartburn; fever; nephrotoxicity; hypersensitivity; aplastic anemia; toxic epidermal necrolysis – Nursing alert •Allergy: Approximately 10% of people allergic to penicillin are also allergic to cephalosporins Copyright © 2008 Lippincott Williams & Wilkins.
  9. 9. Cephalosporins: Contraindications andPrecautions• Contraindicated in patients allergic to cephalosporins or penicillins• Used cautiously in patients with: – Renal disease; hepatic impairment; bleeding disorder; pregnancy; known penicillin allergy Copyright © 2008 Lippincott Williams & Wilkins.
  10. 10. Cephalosporins: Interactions Drug Common use Effect of interactionAminoglycosides Anti-infective Increased risk for(Gentamicin) nephrotoxicityOral Blood thinner Increasedanticoagulants risk for bleeding(Coumadin) Copyright © 2008 Lippincott Williams & Wilkins.
  11. 11. Cephalosporins: Interactions (cont’d)• Nursing alert – Disulfiram-like reaction: If alcohol consumed within 72 hours (nausea, vomiting) – Symptoms: Flushing; throbbing; respiratory problems; vomiting; sweating; chest pain; hypotension – Severe reaction: Arrhythmias and unconsciousness Copyright © 2008 Lippincott Williams & Wilkins.
  12. 12. Nursing Process: Assessment• Preadministration assessment – Obtain general health history before first dose – Check for need of cultures and sensitivity tests Copyright © 2008 Lippincott Williams & Wilkins.
  13. 13. Nursing Process: Assessment (cont’d)• Ongoing assessment – Evaluate response to therapy – If infection worsens, notify primary health care provider – Check for signs and symptoms of infection Copyright © 2008 Lippincott Williams & Wilkins.
  14. 14. Nursing Process: Nursing Diagnoses• Risk for impaired skin integrity• Risk for impaired comfort• Impaired urinary elimination• Diarrhea Copyright © 2008 Lippincott Williams & Wilkins.
  15. 15. Nursing Process: Planning• The expected outcome includes an optimal response to therapy – Management of adverse drug reactions – Understanding of and compliance with the prescribed treatment regimen Copyright © 2008 Lippincott Williams & Wilkins.
  16. 16. Nursing Process: Implementation• Promoting an optimal response to therapy – Oral administration: Question patient regarding allergy to cephalosporins or penicillins; shake oral suspensions – Administer around the clock – Administer orally at least 1 hour before or 2 hours after meals – If patient experiences GI upset: Administer with food Copyright © 2008 Lippincott Williams & Wilkins.
  17. 17. Nursing Process: Implementation (cont’d)• Promoting an optimal response to therapy (cont’d) – Parenteral administration •Read the manufacturer’s instructions – injection; storage; life; methods; precautions – Methods of infusing cephalosporin: Direct, intermittent, or continuous IV infusion Copyright © 2008 Lippincott Williams & Wilkins.
  18. 18. Nursing Process: Implementation (cont’d)• Promoting an optimal response to therapy (cont’d) – Nursing alert •Inspect the needle insertion site for signs of extravasation or infiltration •Inspect several times a day for signs of redness – phlebitis or thrombophlebitis Copyright © 2008 Lippincott Williams & Wilkins.
  19. 19. Nursing Process: Implementation (cont’d)• Promoting an optimal response to therapy (cont’d) – Gerontologic alert • When given IM – inject the drug into a large muscle mass • Assess muscle for atrophy in nonambulatory patient or if paralysis is present • Warn patient about stinging or burning sensation at site Copyright © 2008 Lippincott Williams & Wilkins.
  20. 20. Nursing Process: Implementation (cont’d)• Promoting an optimal response to therapy (cont’d) – Chronic care alert •People with phenylketonuria need to be aware that the oral suspension cefprozil contains phenylalanine •Interferes with urine test results – diabetic patients Copyright © 2008 Lippincott Williams & Wilkins.
  21. 21. Nursing Process: Implementation (cont’d) • Monitoring and managing patient needs – Impaired skin integrity • Inspect skin every 4 hours for redness, rash, or lesions and report when found • Emollients or antipyretic creams may be prescribed; avoid harsh soaps and perfumed lotions; avoid rubbing the area • Warn about wearing rough or irritating clothing Copyright © 2008 Lippincott Williams & Wilkins.
  22. 22. Nursing Process: Implementation (cont’d) • Monitoring and managing patient needs (cont’d) – Impaired comfort •Increased fever; take vital signs every 4 hours; administer an antipyretic drug or change drug or dosage as prescribed Copyright © 2008 Lippincott Williams & Wilkins.
  23. 23. Nursing Process: Implementation (cont’d)• Monitoring and managing patient needs (cont’d) – Impaired urinary elimination •Nephrotoxicity may occur; measure and record the fluid intake and output; report changes Copyright © 2008 Lippincott Williams & Wilkins.
  24. 24. Nursing Process: Implementation (cont’d)• Monitoring and managing patient needs (cont’d) – Impaired urinary elimination: Gerontologic alert •Nephrotoxic effects / renal impairment: Monitor blood creatinine levels •Diarrhea: Check the patient’s stools and reports any presence of blood and mucus immediately Copyright © 2008 Lippincott Williams & Wilkins.
  25. 25. Nursing Process: Implementation (cont’d)• Educating the patient and family – Review dosage regimen with the patient and family – Advise to complete full therapy and adhere to timing – Explain to shake oral suspensions and keep refrigerated – Advise to avoid alcohol and take with food if GI upset Copyright © 2008 Lippincott Williams & Wilkins.
  26. 26. Nursing Process: Evaluation• Therapeutic effect achieved• Urine output at least 500 mL daily; diarrhea not experienced• Patient and family demonstrate understanding of drug regimen• Patient verbalizes importance of compliance with prescribed therapeutic regimen• Skin is free of inflammation, irritation, or ulcerations Copyright © 2008 Lippincott Williams & Wilkins.
  27. 27. End of Presentation Copyright © 2008 Lippincott Williams & Wilkins.

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