Binds to bacterial cell wall resulting in cell death
Spectrum is broader than penicillin
What are some adverse reactions to Ampicillin?
Diarrhea (because it kills of native flora)
Rash: Nonallergic (response to Rx itself), dull red, macular or maculopapular, mildly pruritic. Always ask what the allergic reaction is because it may not actually be a histamine reaction and simply the normal response to the drug.
Decreased effectiveness of BC (birth control) pills; one of the WORST offenders.
History of Penicillin sensitivity. Ampicillin is a Penicillin derivative, so pt will likely be sensitive to both and all related anibiotics. If pt has never been subjected to antibiotic treatments, stay in the room with the pt to monitor possible rxn.
What do you need to tell your pt about Ampicillins?
Take all medication on schedule
Monitor for superinfections
Notify health care provider if symptoms do not improve. Should see improvement 24-48 hrs.
Those on BC Pills should use additional birth control measures
Best absorbed if taken on an empty stomach, so take 1hr before or 2hrs after eating. However, may cause upset stomach so may have to administer with food.
What is Probenecid?
Medication used in conjunction with Penicillin and other related antibiotics to prolong and increase serum levels because it delays renal excretion. Keeps Ampicillin active even though it binds to the molecule.
Rarely seen with Penicillin … but might see with more expensive newer meds.
What are some Nursing Implications for administering Ampicillin and related drugs?
Monitor for signs of hypersensitivity, ie hives, rash, wheezing, etc.
D/C therapy at first sign of hypersensitivity
Monitor clients for 30 minutes after receiving PCN (Penicillin) in ER or MD’s office
Some forms may cause bleeding abnormalities
High IV doses of NA or K salts of PCN my produce E+lyte imbalance
Oral on empty stomach
Drugs that weaken the bacterial cell wall Cephalosporins/Vancomycin
Beta-lactam antibiotics, very close realtives to PCNs, which means PCN sensitive pts may or may not be sensitive to Cephalosporins.
Similar to penicillin structure
Usually given parenterally, a few can be given orally.
What are the actions of Cephalosporins?
Binds to bacterial cell wall, causing cell death
How are antibiotics used profilactically?
One dose given immediately before surgery, another immediately afterward.
Can drammatically reduce postop nfxn.
What are some adverse reactions to Cephalosporins?
Pain at injection site
Phlebitis: Results in inflamed vein, burning, almost immobile. Remove IV and restart infusing at different site. Continued infusion will resutl in scarring and prevent subsequent IV infusion at that site.
Interference with VitK metabolism-->Global bleeding/bruising.
Pseudomembraneous Colitis: Overgrowth with Clostridium Difficile-->Amazing diarrhea (green, mucous, continuous, heroically unforgettable stench. If smelled, treat immediately. Treated with donar feces containing normal flora. Wash hands with soap and water after treating pt with C. diff.
Use caution in those with PCN allergies; 5-16% will have cross sensitivity
Vancomycin (not to be confused with Cephalosporines)
Used only for serious infections where other antibiotics are not effective
Pseudomembraneous colitis (C. Difficile)
Those with allergies to PCN
What are the actions of Vancomycin?
Binds to precursors for cell wall biosynthesis, thereby promoting cell lysis and death. Binds to precursors to ALL rapidly dividing cell wall, ie wbc, mucous membranes, hair, skin, etc.
Only effective against Gram+ organisms (narrow spectrum)
Use should be reserved for the most severe infections
What are some adverse effects to Vancomycin?
Monitor I and O (Intake should = output) If I>O then indicative of nephrotoxicity.
Pink or cloudy urine, need to be able to monitor urine.
Creatinine clearance. Need test 1/day.
Monitor 8th cranial nerve function by...
Hypotension; Administer SLOWLY over 60 minutes
Safety measures; ie call bell, bed rails, etc.
Phlebitis; should always be admin'd with pick or central line.
Red Man Syndrome: Related to rapid infusion.
Sudden, severe hypotension
Flushing and/or maculopapular rash of face, neck, chest and upper extremities
What are some nursing implication for administering Vancomycin?
Monitor lab values
Peak and trough; Peak 25 mcg/ml, Trough 5-10 mcg/ml
Monitor 8th cranial nerve function for ototoxicity.
Assess for superinfections; candida, c. diff. (nausea, vomitting)
Monitor IV insertion site closely; everytime you hang meds before you start Rx.
Monitor BP closely
Assess bowel status/sounds, frequency and character of stools, presence of blood in stool. Must be able to tell if normal diarrhea (from death of normal flora) or c. diff. diarrhea.
Beta lactam antibiotics (again, similar to PCNs)
Bind to bacteria cell wall
Parenteral dosing required, no oral administrations.
Effective against both gram + and gram –
Effective against anaerobic organisms. Getting an effective therapeutic dose to site of nfxn is difficult.
Crosses blood-brain barrier and placental barrier.
May be given with cilastatin which prevents inactivation in the renal system
Pancytopenia: Decrease in ALL blood cells (all of the above)
Synergistic combination of two drugs (Wouldn't normally see them used individually)
Dalfopristin (70%) and Quinupristin (30%)
Each is bacteriostatic by self but in combination is bactericidal
Similar efficacy to Vancomycin, might be used in leui of
Streptogramins Side Effects
Infusion site reactions… thrombophlebitis (redness and clotting along vein. Should have pck or central line)
Inhibition of other drugs metabolized by Cytochrome P450
Arthralgia (joint pain) and myalgia (muscle pain)
Mupirocin (aminoglycocides) Bactroban
Action: Inhibits bacterial protein synthesis
Nurses tend to colonate MRSA in nares. Apply 1/2 of each single use tube in each nostril. After application-close and release nostril several times.
Use 2 x daily for 5 days
C&S of nares after treatment
Would be used in conjunction with systemic antibiotic.
Bacteriocydal inhibitors of protein synthesis
Narrow spectrum antibiotic
Aerobic Gram neg Bacilli (ie, anthrax, menengitis, encephilitis,) can also be anaerobic
Disrupts protein synthesis
Serious Nephrotoxicty and Ototoxicity
Not absorbed from GI tract: Given orally for local effect only, ie colon surgery because it will wipe out all flora in digestive track to prevent bacteria from spilling into abdomen. Typically given parenterally.
Maintain Appropriate Serum Drug Levels –Concentration Dependent Killing
Examples of Aminoglycocides
All end in suffix "cin."
Nursing Implications of Administering Aminoglycocides
Ototoxy. Evaluate 8th cranial nerve function by audiometry:
Subjective hearing loss
Monitor I&O and Daily weights
Monitor drug serum levels
Monitor Kidney function
Monitor for suprainfections
(Unique to aminoglycocides) May cause a decrease in Serum:
Magnesium (useful in conjunction with calcium, also vasodialator)
Potassium (heart function/contractions)
Sodium (maintains fluids)
Sulfonamides and Trimethoprim
Broad spectrumAntimicrobials via making environment less hospitable for microbes.
Disrupt the synthesis of tetrahydrofolic acid. Required by all proteins to synthesis DNA, RNA and other proteins.