ANTI-INFECTIVES- CHAPTERS 37-41

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ANTI-INFECTIVES- CHAPTERS 37-41

• Antibiotics
• Anti-TB
• Antivirals

• Antifungals
• Antimalarials
• Antiprotozoals
• Antihelminthics

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ANTIBIOTICS

• Treat bacterial infections
• Bacteriostatic or bactericidal
• Prescribed specifically to type or area of
  infection
• Culture and Sensitivity testing

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• Expected outcome
• Decreased signs of infection as measured by
• normal temperature
• decreasing / normal WBC count
• patient saying generally, I feel better

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• Antibiotic resistance
• Over prescribed
• Immunocompromised and other critically ill
  patients
• Not completing prescribed treatment

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• Nursing considerations
• Nausea, vomiting, diarrhea most common SE
• Many make birth control pills less effective
• Check for allergies
• history of hives, rash, wheezing, anaphylaxis
• Take for length of time prescribed.
• Assess for signs/symptoms of superinfection,
  relapse, re-infection

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Classes of antibiotics

• Sulfonamides
• Penicillins
• Cephalosporins
• First generation
• Second generation
• Third generation
• Fourth generation

• Tetracyclines
• Aminoglycosides
• Fluoroquinolones
• Macrolides
• Miscellaneous

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SULFONAMIDES

• Inhibit bacterial growth
• Indications
• Urinary Tract, Ear, Pneumocystis carinii
  pneumonia
• Side effects
• Nausea, diarrhea, hypersensitivity, hematologic
  reactions, photosensitivity

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SULFONAMIDES
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PENICILLINS

• Bactericidal
• interfere with cell wall synthesis
• Indications
• Respiratory, skin, and ear
• Wide range of Gram and Gram - bacteria
• Beta-lactamase inhibitors

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PENICILLINS- 4 classes

• Natural penicillins
• (Penicillin G potassium)
• Aminopenicillins
• Amoxillin ( Amoxil)
• Penicillinase-resistant
• Nafcillin ( Nafcil, Unipen)
• Extended spectrum
• Ticarcillin (Timentin)

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• Most given IM or IV
• If po, give on empty stomach
• Penicillin G procaine and benzathine (Bicillin)
  deep IM
• Cross-sensitivity to cephalosporins

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CEPHALOSPORINS

• Bactericidal- interfere with bacterial cell wall
  synthesis
• First generation
• Cefazolin (Ancef, Kefzol)
• Second generation
• Cefuroxime ( Ceftin, Zinacef)
• Third generation
• Ceftriaxone (Rocephin)
• Fourth generation
• Cefemipime (Maxipime)

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TETRACYCLINES

• Bacteriostatic, inhibit protein synthesis
• Indications
• STDs, acne, Lyme disease
• Do not give with calcium/meals.
• Can cause teeth discoloration in children

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TETRACYCLINES
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AMINOGLYCOSIDES

• Bactericidal- prevent protein synthesis
• First defense against serious G infections of
  the skin, biliary tract, bones, and joints
• Side effects
• Ototoxicity, nephrotoxicity
• Peak and trough levels

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AMINOGLYCOSIDES
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FLUOROQUINOLONES

• Bactericidal
• Interfere with DNA synthesis
• Indications
• Bronchitis, bacterial gastroenteritis, gonorrhea
• Examples
• Ciprofloxacin (Cipro)
• Ofloxacin (Floxin)
• Levofloxacin (Levaquin)

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• Effective against many G- and G organisms
• Methicillin-resistant staph aureus (MRSA)
• Take with plenty of fluids but not within 3 hours
  of products containing aluminum/magnesium
• Do not take Cipro with dairy products.

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MACROLIDES

• Bacteriostatic or bactericidal
• depending on concentration and offending bacteria
• Examples
• Erythromycin (E-mycin many trade names)
• Azithromycin (Zithromax)
• Clarithromycin (Biaxin)
• Dirithromycin (Dynabac)

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MISCELLANEOUS
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Miscellaneous- Vancomycin

• binds to cell wall
• reserved for most serious infections (MRSA)
• Poorly absorbed from GI tract
• PO only to treat Clostridium difficile
• IV over an hour
• Side effects
• hearing loss, renal failure, Red Mans syndrome
• Peak and trough levels

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ANTI-TB

• TB caused by Mycobacterium tuberculosis
• Non-compliance leads to drug resistance
• Why take multiple medications?

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ANTI-TB
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• Patient teaching
• Take all medications as prescribed.
• Do not consume _________.
• Notify MD of signs of
• liver problems (nausea, vomiting, anorexia,
  yellow tint on skin or eyes, unusual bleeding)
• optic nerve damage
• auditory nerve damage

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ANTIVIRALS

• Kill viruses by inhibiting ability to replicate
• Examples
• Acyclovir (Zovirax)
• Herpes simplex and varicella-zoster
• Rivabirin (Virazole)
• Influenza A and B, RSV
• Amantadine (Symmetrel)
• Influenza A

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• Used to treat HIV (antiretroviral therapy)
• Classes
• Nucleoside reverse transcriptase inhibitors
  (NRTI)
• Non-Nucleoside reverse transcriptase inhibitors
  (NNRTIs)
• Protease inhibitors (PIs)

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NRTIS- interferes with virus ability to make DNA
copy
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NNRTI- cause direct inhibition of reverse
transcriptase
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PROTEASE INHIBITORS-interfere with multiplication
of virus by inhibiting protease
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• Patient teaching
• Take as prescribed.
• The drugs do not cure but manage related
  symptoms.
• Many drug interactions.

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ANTIFUNGALS

• Fungi consists of yeasts and molds
• Infections caused by fungi are called mycotic
  infections
• Oral candidiasis-Vaginal candidiasis
• Tinea pedis-Histoplasmosis
• Topical and systemic drugs

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POLYENES-bind to ergosterol in the fungal cell
membrane causing a channel to form.

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IMIDAZOLES- inhibit the enzyme cytochrome P-450
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ANTIMALARIALS

• Act when parasite is in the human host
• Classes
• 4-aminoquionolone derivatives
• Chloroquine(Aralen)
• Diaminopyrimidines
• Pyrimethamine (Daraprim)
• Primaquine- 8-aminoquinolone
• Sulfonamides, tetracyclines, and clindamycin in
  combination with antimalarial agents
• Take with food.

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ANTIPROTOZOALS

• Disease conditions
• Amebiasis-Giardiasis-Pneumocystosis
• Toxoplasmosis-Trichomoniasis
• Who are at risk for the above?

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• Metronidazole (Flagyl)
• Prevents DNA synthesis
• Used against giardiasis, amebiasis,
  trichomoniasis
• Turns urine to dark color.
• Do not take with alcohol.
• causes a disulfiram-like reaction
• Not used in first trimester (category B)

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• Pentamidine (Pentam)
• Inhibits protein and nucleic acid synthesis
• Used for P. carinii pneumonia

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ANTIHELMINTHICS

• Kill worms and trematodes (flukes)
• Drugs very specific in the worms they can kill
• Examples
• mebendazole (Vermox) tapeworms and roundworms
• Oxamniquinine (Vansil)- flukes
• Kill directly or cause it to be expelled