Penicillin, cephalosporin

1. Pharmacology
Chapter 29 & 30 Penicillinans Cephalosporin

2. What are some examples of Gram Positive bacteria?

3. Bacteria
 Bacteriostatic -Inhibits the growth of bacteria
 Bactericidal -Kills the bacteria
 Bacteriostatic drugs-Tetracycline and sulfa drugs
 Bactericidal drugs- Penicillin and cephalosporin

4. Antibacterial Drugs Mechanism of
action
 Inhibition of cell wall synthesis
 Alteration of membrane permeability
 Inhibition of protein synthesis
 Inhibition of the synthesis of bacterial ( RNA) &DNA
 Interference with metabolism within the cell

5. 3 main adverse reactions with
antibiotics:
 1) superinfections -secondary infection: normal flora killed, therefore other organisms can proliferate and
cause infection
 -ex: Candida and Clostridium difficile
 -sites: mouth, skin, respiratory tract, vagina, intestines
 -usually occurs when treated with longer courses of therapy
 2) allergic reactions or hypersensitivity
 3) Organ toxicity-ototoxicity (ear)
 -hepatotoxicity (liver)
 -nephrotoxicity (kidney
CAUTION
 When antibiotics are taken unnecessarily, incorrectly or stopped before the entire prescription is completed,
resistance to the antibiotic can and does occur.
 Viruses are not destroyed by antibiotics

6. General adverse reactions of Antibacterials
-Mild allergic reaction (Rash, pruritus, hives)
-Severe allergy: anaphylactic shock
Bronchospasm, laryngeal edema
Vascular collapse, cardiac arrest

7. Treatment of Severe allergy:
Antihistamines, Epinephrine, Bronchodilator

8. Body Defenses
 Age
 -Nutrition
 -Immunoglobulins
 -Circulation, WBCs
 -Organ function

9. MRSA
 First line treatment of MRSA infection -vancomycin (Vancocin)
 Effective treatment choices for MRSA
 vancomycin (Vancocin)
 linezolid (Zyvox)
 daptomycin (Cubicin)
 trimethoprim/sulfamethoxazole
 (Bactrim)
 doxycycline (Vibramycin)
 clindamycin (Cleocin)
 Telavancin (Vibativ)- a glycopeptides antiinfective, treats gram negative
bacteria (including MRSA)

10. Resistance to Antibacterials
 Natural or inherent resistance- naturally has resistance
 Acquired resistance- repeat exposure has caused resistance
 Nosocomial infections- Infections acquired while patients are hospitalized.
 Many are due to drug-resistant bacteria
 Cross-resistance-Can occur between antibacterial drugs that have similar
actions such as (penicillin and cephalosporin)
 MRSA

11. ANTIBIOTIC RESISTANCE
Narrow spectrum antibiotics are
Effective against a few bacteria types
Penicillin & Erythromycin
Broad spectrum antibiotics are
Effective against gram positive & gram negative
organisms Carbapenems & cephalosporin
Why would a nurse practitioner give a broad
spectrum rather than a narrow spectrum
antibacterial?

12. Cephalosporins
 structurally similar to penicillins
 -cef, -ceph
 inhibit cell wall
 respiratory, urinary, skin, bone, joint, genital infection
 allergy to penicillin

14. Cephalosporins
Cephalosporins drugs
 cefepime (psuedo)
 ceftazidime (psuedo)
 ceftaroline (MRSA)
Cephalosporins side effects
 pruritus, GI distress, increased
bleeding, seizures
 check renal and liver function
 cross sensitivity to penicillins

15. Cephalosporins Nursing Interventions
- Nursing Process
Cephalosporins Assessment
 -obtain allergy information prior to
administration of a cephalosporin
 -be aware of potential cross-
sensitivity in penicillin allergic patients
Cephalosporins Nursing Interventions
 -assess for allergy
 -assess renal and liver function
(dosage adjustment may be
necessary in patients with
renal/hepatic impairment)
 -monitor for superinfection (diarrhea
may indicate C difficile infection)
 -counsel patients on oral
contraceptives of the need to utilize
back-up contraception

16. What is Penicillin?
Penicillin is a natural antibacterial agent obtained from the mold genus
Penicillium, was introduced to the military during World War II and is
considered to save many soldiers' lives; used to treat various bacterial
infections

17. Alexander Fleming

18. Penicillin
 1928 Alexander Fleming a bacteriologist accidentally realized that mold was
contaminating his bacterial cultures by inhibiting bacterial growth.
 The mold was called penicillium notatum
 In 1939 Howard Florey expanded on Fleming’s findings
 After testing on rabbits and a soldier with an infected eye after World War II penicillin was finally
marketed in 1945

19. Penicillin action
 interferes with bacterial cell-wall synthesis (inhibits bacterial enzyme
necessary for cell division/synthesis)
 -bactericidal/bacteriostatic
 -penicillin G: bactericidal
Interaction
 may decrease effectiveness of oral contraceptives

20. Penicillin
Broad spectrum penicillins
 Aminopenicillins
 -Amoxicillin
 -Ampocillin
Broad Spectrum Penicillins Treat:
 Most gram positive
 Influenza
 E.coli
 Salmonella
Extended-spectrum penicillins
 Gram negative
 piperacillin (Pipracil)
 ticarcillin (Ticar)
 carbenicillin (Geopen)
Extended Spectrum Penicillin Treat:
 Bone infection
 skin infection
 respiratory tract infection,
 UTI

21. Penicillin
Interventions for Penicillins
 -Check for allergies
 -Use a back up birth control method
 -Monitor for bleeding
 -Culture and sensitivity
 -Increase fluids
 -Check for superinfection (looking in
their mouth)
 -Take 1 hour before or 2 hours after
meals (foods can mess with the
effects)
Side effects of penicillin
 hypersensitivity is common
 N/V/D
 superinfection
 stomatitis
 pseudo colitis
 Life threatening: blood dycrasias and
SJS

22. Macrolides ( Broad spectrum )
 Azithromycin (Zithromax
 clarithromycin (Biaxin)
 erythromycin (E-Mycin)

23. Macrolide action
 Binds to 50S ribosomal subunits and inhibits protein synthesis

24. Macrolides use to treat ?
 Respiratory Community acquired pneumonia
 COPD exacerbation
 Sinusitus
 Mycoplasmal pneumonia

25. Side affect for macrolides
 QT segment prolongation
 Nurse Must monitor which type of
patient is taking Macrolides
 Cardiac --> they should wear EKG
 Interaction for Azithromycin
Macrolides
 NO ANTACIDS ( Blocks absorption of
antibiotics )

26. Lincosamides Drug ( Gram Positive
drug )
 Clindamycin ( Cleocin)
Lincosamides Action:
 Inhibits bacterial Protein Synthesis
 Lincosamides is highly associated with C difficle Infection

27. Glycopeptides ( Gram Postive )
 Vancomycin (Vancocin) --> MRSA
Glycopeptides Action:
 Inhibits cell wall synthesis
 #1 Drug choice for MRSA

28. Vancomycin ( Vancocin) ( Side affect )
 Red Man syndrome
 Occurs When IV infused at too rapid a rate of
administration
 red blotching of face , neck , check , and
extremities
 Hypotension
 Tachycardia

29. Tetracycline ( Long Acting Drugs )
Broad Spectrum (+,-)
 Doxycycline (Vibramycin)
 Minocycline HCl (Minocin)
Side effects of Tetracycline:
 Discoloration of permanent teeth in pediatric patient
 Caution in children younger than 8 years
 Avoid milk, contraceptives, and antacids when taking tetracycline's
 Store out of light and extreme heat.

30. Aminoglycosides Drugs
 Amikacin sulfate (Amikin)
 Gentamicin sulfate (Garamycin)
 Tobramycin sulfate (Nebcin)
Action:
 Inhibit bacterial protein Synthesis Gram Negative (E coli ,Proteus
pseudomonas)

31. Aminoglycosides
 Adequate Hydration
 Ototoxicity and nephrotoxicity at supratherapeutic levels
 Requires close monitoring of drug levels and renal function
When should you take Aminoglycosides?
 Through --> Half a hour before Administration
 Peak --> Should be obtained 1 hours following completion of infusion

32. Fluoroquinolones ( Quinolones ) Drugs
 Ciprofloxacin (Cipro)
 Levofloxacin (Levaquin )
 Moxifloxacin ( Avelox)
Action:
 Interfere with enzyme DNA gyrase
 Fight gram positive and gram negative bacteria
 broad spectrum

33. Fluoroquinolones Drugs
Ciprofloxacin ( Cipro)
 Gram negative
 UTI , and Lower respiratory Tract infection and skin , soft tissue , bone , joint infection
Levofloxacin (Levaquin)
 Community acquired pneumonia , chronic bronchitis , acute sinusitis , UTI &
UNCOMPLICATED SKIN INFECTION
Moxiflocacin ( Avelox )
 road spectrum , including activity against anaerobic organism
 once a day oral and parental dosing
 use to treat the same infection other Fluoroquinolones are effective against

34. Side effect for Fluoroquinolones
(Quinolones)
 High Associated with C diff infection
 TENDONITIS /TENDON RUPTURE
 PHOTOSENSITIVE
 QT PROLONGATION
Interaction:
 Antacids decrease absorption
 No Milk or diary

35. Lipopeptides Drugs
 Daptomycin ( Cubicin
 Daptomycin is the alternative to Vancomycin for MRSA
Lipopeptides Treat:
 Complicated skin infectious due to gram positive microorganism ,
septicemia --> S aureus
 and ineffective endocarditis due to MRSA

36. Side Effect of Lipopeptides
 Elevation in Creatinine Phosphokinase (CPK ) , and Myopathy

37. The End