This document summarizes various classes of antibacterial drugs including penicillins, cephalosporins, macrolides, lincosamides, glycopeptides, tetracyclines, aminoglycosides, fluoroquinolones, and lipopeptides. It describes the mechanisms of action, common uses, and side effects for each drug class. It also discusses antibiotic resistance, MRSA treatment options, and nursing considerations when administering antibiotics like assessing for allergies, monitoring for side effects, and ensuring proper dosing.

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

20. 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

21. 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

22. 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

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

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

27. 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 )

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

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

30. 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

31. 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.

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

33. 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

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

35. 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

36. 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

37. 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

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

39. The End