WJM 2NUR-6
The Cell
- Basic structural unit of the body
- Make up living organisms which are arranged into
tissues & organs, all have same basic structure
*safe enough to protect the body but lethal to
kill the bacteria
Cell Membrane
- Is a lipoprotein structure that separates the interior
of a cell from the external environment; regulates
what can enter & leave a cell
- Lipoprotein
Allows cytoplasm to remain intact
Polar regions = mix well with water
Non-polar regions = repel water
Receptor Sites
- Reacts with specific chemicals outside the cell
- Identifying markers
- Histocompatibility antigens or Human Leukocyte
Antigen
Identifies a cell as self cell
Can be classified through several ways;
cell injury; viral invasion; age, etc.
Channels
- Pores within the cell membrane made by the protein
in the cell wall for passage of small substances
Cell Cycle
G0 Resting Phase
G1 Stimulation of DNA Formation
S Phase Energy Consuming Activities, Synthesis
of DNA
G2 DNA has doubled
M Phase Mitosis, Splits to 2 daughter cells
ANTI- INFECTIVE AGENTS
Drug that are designed to act selectively on foreign
organisms that have invaded and infected the body
of a human host
With selective toxicity
*Some anti-infectives are compatible with gram (+)
or gram (-)
*Antibiotic that affects only aerobic; anaerobic
Agents found on mold samples are the first sources
of anti-infective agents
Mechanism of action:
Interfere with bacterial wall synthesis
Penicillins, Cephalosporins, Carbapenams,
Vancomycin (pp 402)
Prevention of utilizing substances essential for
growth & development
- Sulfonamides, Antimycobacterials (TB meds)
& trimethoprim
*Amoxicillin comes from the group of penicillin
(not wide selective toxicity)
* Vancomycin - broad spectrum
Interfere with protein synthesis
- Macrolides, chloramphenicol, tetracyclines,
aminoglycosides
Interfere with DNA synthesis
- Fluoroquinolones, antimycobacterium
Alter cell membrane permeability
- Antifungal and antiprotozoal
TERMS
Treatment to prevent an infection
before it occurs, as in the use of
Prophylaxis antibiotics to prevent a disease
(given 30-45 min before a procedure
or days before a procedure)
Range of bacteria against which an
antibiotic is effective (e.g. broad-
Spectrum
spectrum antibiotics are effective
against a wide range of bacteria)
Ability of bacteria over time to adapt
to an antibiotic produce cells that are
no longer affected by the drug
Resistance Example: If you are given Amoxicillin
whenever you have fever, they will
give you Co-amoxiclav (amoxicillin +
clavulanic acid)
HOW ORGANISMS DEVELOP RESISTANCE
Producing an enzyme that deactivates an
antimicrobial agents
Changing cellular permeability to prevent the drug
from entering the cell or altering transport systems
Altering binding sites on the membranes or
ribosomes which then no longer accept the drugs
Producing chemicals that act as antagonist to the
drug
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TREATMENT OF SYSTEMIC INFECTIVES DEFINITIONS

Identification of the pathogen Chemical that is able to inhibit

- Culture
Sample of the bacteria to grow in a
laboratory to determine the species of
bacteria that is causing an infection
Sensitivity of the pathogen
- Sensitivity testing
Evaluation of bacteria obtained in a culture
to determine to which antibiotic the
organisms are sensitive and which agent
would be appropriate for treatment of a
particular infection
Beta Lactam Ring
the growth of specific bacteria or
cause the death of susceptible
bacteria
Antibiotic
Agents derived from other living
microorganisms
*some antibiotic may kill the
infection or only stop or prevent
Substance that causes the death
of bacteria, usually by interfering
with cell membrane stability or
Bactericidal
proteins or enzyme necessary to
maintain the cellular integrity of
the bacteria
Substance that prevents the
replication of bacteria, usually by
Bacteriostatic interfering with proteins or
enzyme systems necessary for
reproduction

Beta Lactamase BACTERIA

e.g. Clavulanic
Beta Lactamase Inhibitor
acid Aerobic
Combination Therapy - Bacteria that depend on oxygen for survival
- Use smaller doses of the drugs (because these drugs Anaerobic
have side effects & adverse effects; to prevent - Survive without oxygen
severe side effects and adverse effects from - Seen when blood flow is cut off to an area of the
occurring) body
- Synergism (if given at the same time, increases Gram negative (-)
mechanism of action) - GI & GU
- Many microbial infection usually caused by more - Negative stain
than one microorganism Gram positive (+)
- Delay the emergence of resistant strain - Positive stain
- Respiratory and soft tissues
ADVERSE REACTIONS TO ANTI-INFECTIVE THERAPY
PREVENTING THE DEVELOPMENT OF RESISTANCE
Kidney Disease
GI Toxicity Identify bacteria
Neurotoxicity Correct drug use
Hypersensitivity reactions Full course of therapy
Superinfections Avoid inappropriate use
Resistant to almost all drugs
 WJM 2NUR-6

PENICILLINS Adverse Rxns:

Bactericidal GI upset
Gram (+) - Glossitis, stomatitis, sore mouth, N/V
Inhibit cell wall synthesis - Diarrhea
Also called Beta lactams Allergy (most common)
Thrombophlebitis
Common Drugs
Anaphylaxis
Penicillins
Thrombocytopenia & Leukopenia
pen G
pen V If patients have allergic rxns to
Azithromycin penicillin; Allergic reaction to
Extended Spectrum Penicillin
Erythromycin penicillin = allergic rxn to
carbenicillin (Geocillin)
cephalosporin
amoxicillin (Amoxil, Himox)
ticarcillin (Ticar) DRUG INTERACTIONS OF PENICILLIN
ampicillin (Pensyn) Increased plasma concentration
Penicillinase Resistant Antibiotics - Whe n combined with Probenecid
dicloxacillin Decreased secretion of Methotrexate
oxacillin (Prostaphillin) Tetracycline & Chloramphenicol
natcillin - Decreases penicillin action
Bacteria produce enzymes capable of destroying Decreases effectiveness of hormonal contraceptives
penicillins called penicillinase or beta-lactamase Aminoglycosides
As a result, the medication is not effective Dont give oral medications with fruit juices
Chemicals have been developed to inhibit these
enzymes AMINOGLYCOSIDES
- Clavulanic acid Bactericidal inhibits protein synthesis
- Tazobactam Used to kill gram (-) bacteria such as
- Sulbactam Pseudomonas spp, E.coli, Proteus spp, Klebsiella
These chemicals bind with beta-lactamase and spp, Serratia spp
prevent the enzyme from breaking down the Effective with gram (-)
penicillin Nosocomial infections, UTI, CNS & eye
Amoxicillin infections
No effect with food
Bacapicillin Often used in combination with other antibiotics
- Given 1hour before or 2hours after or vise versa for synergistic effect
PENICILLIN-BETA-LACTAMASE INHIBITOR COMBINATION Absorbed poorly in the GI tract
DRUGS - Usually given IV
- Serious side effects and adverse effects
Ampicillin + sulbactam = Unasyn GANTS (Common Drugs)
Amoxicillin + clavulanic acid = Augmentin Gentamycin (Servigenta, Garamycin)
Ticarcillin + clavulanic acid = Timentin Amikacin (Amikin)
Neomycin (Maxitrol, Terramycin)
Piperacillin + tazobactam = Zosyn
Tobramycin (Tobrex)
Streptomycin
Kanamycin
 WJM 2NUR-6

DRUG INTERACTIONS
FLUOROQUINOLONES
Anesthetics, Muscle Relaxants
Diuretics Bactericidal & Bacteriostatic
Other antibiotics Effective against gram (-)
UTI, Respiratory, Dermatological, eye, ear, bone
Adverse Effects
& joint infection, after anthrax, typhoid fever
Neurotoxicity
Ototoxicity Adverse effects
Risk for Nephropathy
Headache, dizziness
Cardiac effects
Bone marrow depression GI upset
- blood levels Photosensitivity
GI irritation Common Drugs (CLONG)
Ciprofloxaxin (Ciprobay)
CEPHALOSPORINS
Levofloxacin (Levox, Floxel)
Semisynthetic derivations from a fungus
Ofloxacin
Structurally and pharmacologically related to
penicillins Drug Interactions
Bactericidal & bacteriostatic theophylline level
- Inhibits cell wall synthesis Cardiac dysrhythmias (procainamide, quindine,
Broad spectrum amiodarone, tricyclic)
Divided into groups according to their NSAIDs increased risk of CNS stimulation
antimicrobial activity
Numerous sensitive bacteria MACROLIDES
- Respiratory, dermatological, middle ear infection Bactericidal or Bacteriostatic
(page 409 highlight table 29-4) - Binds to cell membrane to change protein function
*Cephalosporins are better than penicillins because in RNA synthesis
it is divided into 4 generations Effective against many sensitive organisms &
intestinal amoebiasis
ADVERSE REACTIONS Usually enteric coated
GI N/V, Diarrhea (pronounced)
CNS headache, dizziness Common Drugs (DACE)
Hypoprothrombinemia dirithromycin (Dynabac)
Phlebitis azithromycin (Zithromax)
DRUG INTERACTIONS clarithromycin (Klaricid)
Aminoglycosides erythromycin (Ilosone, Erythrocin, Erycin)
Alcohol *duodenum = site of absorption; GI upset (p445)

COMMON DRUGS Adverse effect

1st Gen Cephalosporin (Ceporex, Keflex), cefazolin (severe) GI upset N/V, GI irritation, abnormal taste
(Ancef) Thrombophlebitis
These Drugs Can Interact
2nd Gen cefaclor (Ceclor), cefoxitin (mefoxin) Fever, anaphylaxis
- Theophylline
3rd Gen cefotaxime (Rocephin) Various resistant salt
- Digoxin
4th Gen cefeprime (Cepimax) *pp416 = eryhthromycin ethylsuccinate - Coumadin
= erythrocin sterase

LINCOSAMIDES
Inhibits bacterial protein synthesis
Similar to macrolides in terms of coverage
Associated with severe toxicity
Drugs
o clindamycin (Dalacine) - seen in association
with severe GI upset; seen in Derma clinics
o lincomycin (Lincocin)
Careful monitoring
Stop once bloody diarrhea occurs
Monobactam Antibiotic
- Bactericidal
- Effective against gram (-) enterobacteria
- Caution use for patients allergic to
penicillins/Cephalosporins
- aztreonam (Azactam)
Adverse Reactions:
Local GI effects
Elevated liver enzymes
Inflammation
Vancomycin
- Used to treat methicillin-resistant S. Aureus
(MRSA)
- With high incidence of vancomycin resistant
therefore should be used when C&S confirms
need for it
Adverse Reactions
Renal failure, ototoxicity, supeinfections
Red man syndrome
sudden & severe hypotension, fever, chills,
paresthesia & erythema of the neck & back
Nursing Consideration: infuse slowly
Chloramphenicol
- Prevents bacterial cell wall division
- Common treatment for typhoid fever
- Gray Syndrome - abdominal distention, cyanosis,
vasomotor collapse, irregular respiration and
even death
- Bone marrow depression - aplastic anemia
WJM 2NUR-6
Peptides (Polymyxin B)
- Uses a surfactant like reaction to penetrate
bacterial cell wall
- Can be toxic to human host
- Neurotoxicity
facial flushing, dizziness, ataxia, paresthesia
Paresthesia is the tingling of extremities
- Nephrotoxicity
Watch out for creatinine & kidney
function
SULFONAMIDES
Bactericidal
o Blocks para amino benzoic acid to inhibit
folic acid synthesis
Effective against gram (-) & gram (+) bacteria
and many resistant strains
Common drugs
o cotrimoxazole (Bactrim, Septra)
For UTI
o sulfadiozine (Flammazine)
Sulfonylurea (glyboride, glypizide) OHA
Cyclosporine - increased risk of nephrotoxicity
Nephrotoxicity lowers kidney function,
creatinine, BUN
Nursing Consideration: increase fluid intake
Watch out for photosensitivity
Crystalluria
Caution on its use during
Pregnancy - cause birth defects, kernicterus
Lactation - kernicterus & diarrhea
Kidney disorders
Adverse Effects
GI disturbance increases hepatic injury
Renal - crystalluria, hematuria, proteinuria
Prevent proteinuria by increasing fluid
intake not less than 2L/day
CNS
Dermatologic
Bone marrow suppression
 WJM 2NUR-6

TETRACYCLINES Adverse Reactions

Natural & semi-synthetic N/V, diarrhea, fatal pseudomembranous colitis
Obtained from cultures of streptomycin Hypersensitivity reactions
Bacteriostatic Confusion & seizure
o Inhibit protein synthesis Common drugs
Effective against wide range of bacteria
imipinem - cilastatin (Tienam)
Acne treatment
meropenem (Meronem)
Absorption affected by food; calcium & iron
ertapenem (Invanz)
Caution use on:
o Pregnant women
ANTIMYCOBACTERIALS
o Children under 8 yrs old ( cause retarded
Mycobacteria - group of microorganisms that
skeletal development & teratogenic effect)
has the ability to hold a stain (acid fast bacilli) in
Discoloration of permanent teeth (green &
yellow patches on teeth)
the presence of
Fetal-skeletal development & retardation Destaining - termed as acid fast bacilli
Drug to food interaction a. M.tuberculosis
High affinity to Calcium, Aluminum, b. M.leprae
Magnesium & Irons c. M.avium-intracellulare
Don't use on food with high Calcium, Bactericidal
aluminum, magnesium, and iron Long term therapy (6 months - 2 years)
Short term use only RIPES
Adverse Effects Antituberculosis Drugs & Common Side Effects
GI disturbances o affects mycoloic acid coating
Give yakult Ioniazid (INH) - Peripheral Neuropathies,
Alteration in intestinal flora may result in Gynecomastia
o Superinfection (Overgrowth of nonsusceptible o alters DNA & RNA activity
organisms such as Candida) Don't use contact lenses
o Diarrhea Rifampicin
because it produces orange-
o Pseudomembranous colitis colored output
Fetal hepatotoxicity o inhibits cellular metabolism
Skeletal effects Ethambutol
- Optic neuritis
Photosensitivity & rash Pyrazinamide o Bactericidal & Bacteriostatic
Steven Johnson Syndrome o Nephrotoxicity
o Scaling of skin (all over the body) Antituberculosis drugs -
Drug Interactions causes patients to always
Penicillin G Streptomycin
feel sleepy; usually during
Oral contraceptives afternoon they are already
Digoxin tired
Ca, Mg, Al, Bi, Fe salts - ototoxicity
Anti-Leprosy
Common Drugs: DOM-T
o Inhibits folate synthesis
doxycycline (Doxin) Dapsone
o Used to treat P.carinii pneumonia
oxytetracycline (Terramycin)
on AIDS client
minocycline (Minocin)
Clofazimone o Binds to bacterial DNA sites &
tetracycline
(Lamprene) causes cell death
o Treatment of erythema nodosum
CARBAPENEMS
leprosum
Bactericidal - inhibit cell wall synthesis
o Caution use for pregnant women
Broad spectrum and used for serious life Thalidomide
Babies with no hands or feet
threatening gram (+) & gram (-) infections No leprosy cases now
because there's treatment
 WJM 2NUR-6

Interactions
Drug - Drug
o Rifampicin & INH - liver toxicity
o Increased metabolism of drugs when given with
quinidine, metoprolol, oral contraceptives, oral
antidiabetic agents, ketoconazole
Drug - Food
o Take combination of anti-TB early am with an
empty stomach
Nursing Considerations on Antibiotic Therapy
Check for allergies, HX
Assessment
Upset on GI
o Take with full glass of water if not tolerated,
small frequent feedings & mouth care
Small/light meals/snack
All antibiotics cause GI upset but it should be
given on an empty stomach because food limited
the absorptive effect of GI mucosa
Site of absorption = duodenum
Variant resistant salts are added to vancomycin
(macrolides). They protect erythromycin from
being broken down or metabolizer and protects
patient from severe GI upset
Variant salts - page 416
Teachings
o Take full course of medication
If you forgot, adjust the dose and take meds
ASAP then back to the original time where you
should take the meds
o Use full course
o Use Barrier contraceptives
Increase fluid intake specific for sulfonamides
because it causes crystalluria and hematuria
Interactions
Digoxin, Theophylline, Coumarin, Synergism
Food, milk (Tetracycline)
Macrolides, penicillin, sulfonamides & Tetracyclines
should be given 1h before meals
Others
Prepare for any allergic reactions
Note: Labs, Normal results, Pregnancy & Lactation
Rifampicin - orange output
Special Consideration
o Refrigerate IV solutions after reconstitution
o Administe Co-amoxiclav immediately (within 30
mins)