Cephs

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jean
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17221
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Cephs
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2010-05-03 10:47:24
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cephs
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  1. Cephalosporins
    • First Generation
    • Second Generation
    • Third Generation
    • Fourth Generation
  2. Drug Interactions
    • PCN + Tetracycline= lowers effectiveness of PCN
    • PCN+ Aminoglycoside= inactivates the Aminoglycosides
  3. NURSING PROCESS of Cephalosporins
    • Assess, assess, assess, assess, assess
    • Drug effectiveness
  4. Adverse Effects of Cephalosporins
    • Skin and mucous membranes
    • Respiratory Status
    • Abdomen/ GI effects
    • BUN and Creatinine
    • Phlebitis
  5. Nursing Interventions of cephalosporins
    • GET THE CULTURE
    • Observe for reactions
    • Have epinephrine on hand
    • Give with water
    • Monitor urine output
    • Monitor for bleeding if dosage large
    • MONITOR WBC!!!
  6. What will you teach the patient taking cephalosporins?
    • Full course
    • side effects
    • storage
    • s/s infection
    • empty stomach
    • 8 oz water
    • no fruit juices
    • milk
    • sodas
  7. Assess what?
    • Infection
    • Superinfection
    • Teaching effectiveness “teach back”
  8. OETTEL’S OPALS
    • The penicillins are one of the oldest classes of Abx.
    • Many resistant strains have evolved producing the enzyme “penicillinase.”
    • “Penicillinase” destroys the effect PCN
    • Drug companies developed drugs resistant to “PCNase” thus PCN remains effective against “resistant” bacterial strains
  9. OETTEL’S OPALS
    • PCN’s are used to treat a broad spectrum of infections
    • -Urinary Tract Infections
    • -Respiratory Infections
    • Monitor client for N/V/D, superinfections,
    • - Possible hypersensitive rxn’s
  10. Cephalosporins inhibit ______ _______ snythesis
    cell wall
  11. CEPHALOSPORINS First Generation
    • Cefazolin (Ancef & Kefzol) given IV & PO
    • IV and PO
  12. Cephalexin (Keflex & Keftab) PO
  13. What are cefazolin (Andef & kefzol) & Cephalexin (Keflex & Keftab) used for
    • surgical prophylaxis
    • URIs
    • otitis media
    • (strep and staph)
  14. Mechanism of Action of 1st generation cephalosporins
    • Both bacteriostatic and bactericidal
    • Depends on dose and drug
    • Interferes with cell wall synthesis
  15. Pharmacokinetics
    • Well absorbed from GI tract
    • Metabolized in the liver
    • Excreted in the urine
    • Cross placenta and enter breast milk
    • Use caution in renal and liver impaired
    • Alters drug metabolism
    • Use with caution in pregnancy and lactation
  16. Adverse Effects of 1st Generation Cephalosporins
    • Similar to PCN
    • Allergic rxn’s most common
    • Headache, anal /genital itching
    • Skin rash common
    • GI Distress..pseudomembranous colitis
    • C-diff often reported with ceph’s
    • Nephrotoxicity in early ceph generations
    • Not so much in the newer drugs
  17. Major Distinctions of “Generations”
    • First- generation:
    • Most effective against gram + organisms
    • Destroyed by beta-lactam “ase”
  18. Difference of Second-generation:
    • More potent, more resistant to “beta-lactamase”
    • Broader spectrum against gram negative organisms than 1st generation ceph’s
  19. Difference of Third Generation
    • Longer duration of action than 2nd
    • Even broader spectrum against gram –
    • Resistant to beta-lactamase
    • 3rd generation ceph’s DOC:
    • Pseudomonas, Salmonella,
    • Less effective against gram +
  20. Difference of 4th Generation Ceph’s
    • Effective in treating septicemia
    • Effective against many strains of gram –
    • E-coli
    • Klebsiella
    • Streptococci
    • Staphyloccus….certain strains
  21. Cephalosporins
    • 1st G -cefazolin
    • 2nd G -cefoxitin, cefotetan, cefuroxime
    • 3rd G -cefotaxime, ceftazidine
    • 4th G - Cefepime
  22. What do you notice about these drugs?
    Start with “Cef”
  23. Contraindications and Cautions
    • Not given to clients with known allergy
    • Caution with clients allergic to PCN
    • -Due to cross-sensitivity
    • Caution with renal impaired
    • -These drugs are nephrotoxic
    • Caution in pregnancy
    • -Effects to fetus unknown
  24. If giving cephalosporins with aminoglycosides
    increases risk of Nephrotoxicity
  25. If giving cephalosporins with anti-coagulants
    may experience increased bleeding
  26. If Cephalosporins consumed with alcohol
    • can cause an “antabuse” like reaction
    • -- severe vomiting, HA, chest pain, dyspnea, blurred vision,
    • --Palpitations, cardiovascular collapse, even death.
  27. Prototype: Cephalexin (Keflex)
    • Broad spectrum
    • First generation
    • Respiratory, soft tissue, bones, urinary tract, and bloodstream infections
    • Contraindicated with prior severe anaphylactic reaction to PCN
  28. CLINICAL INDICATIONS of Keflex
    • Treatment of infection
    • Depends on drug/bacteria sensitivity
    • Most for gram negative infections
    • Clients who cannot tolerate PCN
  29. NURSING PROCESS
    • ASSESSMENT
    • NURSING DX
    • IMPLEMENTATION
    • --Teach
  30. Nursing Interventions
    • CULTURE BEFORE FIRST DOSE
    • Observe for superinfections or reaction
    • Monitor BUN, Creatinine, UOP
    • Monitor IV site for thrombophlebitis
    • Monitor WBC count
    • Buttermilk or yogurt to prevent diarrhea

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