抗生素与其他抗菌药（英文ppt）nurs 1950 antibiotics and other agents课件

NURS 1950 Antibiotics and other Agents,Metropolitan Community College Nursing Program Nancy Pares, RN, MSN,In the beginning.,Before Antibiotics Infections treated topically with poultice or surgically removed 1936Sulfonamide discovered Beginning of understanding of microbes 1941Penicillin introduced WWII had great results with high volume data Present . Man vs. microbe= resistant pathogens,Chain of infection.recall,Objective 1: Identify the bodys natural defenses against infections,Barriers/prevention Intact skin, adequate nutrition, respiratory cilia, immune system Seek and Destroy WBC, adequate blood supply, intestinal flora, vaginal flora, stomach acids,Objective 2: Describe factors that increase the susceptibility of the body to infection,Virulence of the pathogen Number of pathogens Chronic illness Poor nutrition Diseases/drugs that decrease the immune system Entry point Super infections,Host Factors,Status of immune system May need prophylactic therapy Location of the infection Many drugs do not cross blood brain barrier Extent of inflammation Decrease circulation of drug Age: metabolization of drug Pregnancy: risks to fetus vs. benefit of drug Genetics: enzyme deficiencies do not allow antibiotics to clear system,Obj. 3: Name the lab tests done to identify the invading pathogen,Should be done before antibiotic initiated Microscopic examination Urine, stool, blood, spinal fluid, sputum, purulent drainage Identify the organism and test with antibiotics Culture and sensitivity testing Preliminary results within 24 hours Final results in 2-3 days,Obj. 4: Identify factors utilized to select an appropriate antibiotic,Covered in objective 2,Obj. 5 Explain what resistance means and the various types of resistance,Passive immunity A person has been given vaccine Active immunity Has had the disease Acquired resistance Bacteria have randomly mutated and can transmit mutated bacteria to others Healthcare practitioners role Use antibiotics when indicated Prophylaxis: deep tissue injury, prosthetic heart valves,Narrow Effective on limited number of organisms Broad Effective on many organisms; often used first Bacteriocidal Kills Bacteriostatic Prevents growth and reproduction,Obj. 7: Describe adverse reactions to antibiotics,Hypersensitivity Can result in anaphylactic shock/death 15% of penicillin users Treat with Benedryl, corticosteroids, epinephrine Cross sensitivity When antibiotics are closely related chemically Organ toxicity Liver, kidneys, CNS, GI is most common Vancomycin highly nephrotoxic Gentamycin highly ototoxic,Adverse reactions cont,Hematotoxicity Chloramphenicol Causes aplastic anemia Bone marrow cannot make red blood cells,Obj. 8 Discuss the penicillins and identify specific penicillin preparations,Action/use Kill bacteria by disrupting cell wall; chemical make up responsible is beta lactam ring some bacteria secrete enzyme that splits the beta lactam ring allowing the bacteria to become resistant Chemical modifications Penicilinase resistant, broad spectrum, extended spectrum Treatment of pneumonia, skin, bone and joint infections, blood infections, gangrene, meningitis,Penicillins cont,Routes PO, IM, IV Adverse effects Hypersensitivity most common Nursing considerations VS, assess previous reactions, lab (electrolytes, renal function, ECG, Observe for IV reaction within 30 min; client teaching Prototype: Pen G Potassium,Obj.9 Discuss various cephalosporin preparations,Action/Use Bacteriocidal by attaching to penicillin binding proteins to inhibit cell wall synthesis Gram negative infections and when less expensive penicillins are not tolerated; 5-10% of people allergic to penicillin are also allergic to cephalosporins Adverse reactions Hypersensitivity; kidney toxicity PrototypeCefotaxime (Claforan),Cephalosporin classifications,First generation Most effective against gram +; beta lactamase producing organisms usually resistant Second generation More potent, broader spectrum, moderately resistant to beta lactamase organisms Third generation Longer duration of action, resistant to b-lactamase Drugs of choice for pseudomonas, klebsiella, neisseria, salmonella and H. influenza Fourth generation-treat CNS infections,Cephalosporins,Nursing considerations Assess for bleeding disorders-check PT levels Assess kidney and liver function labs Assess concurrent meds: (NSAIDS) Monitor I IM inj. painful,Obj. 10 Discuss tetracycline , including nursing implications,Action/Use Bacteriostatic; inhibits protein synthesis to slow microbial growth Rocky Mtn Spotted fever, typhus, cholera, Lyme disease, peptic ulcers (caused by H. pylori), chlamydial infections S/E n/v, diarrhea, photosensitivity, permanent discoloration of teeth 8 yo,Tetracycline cont,Nursing considerations Avoid use 8 yo, avoid sunlight/UV exposure; monitor labs (CBC, liver function, kidney function) Teach importance of oral and perineal hygiene due to super infections Do not take with milk products, iron supplements, or antacids; wait 1-3 hrs before taking antacids; wait 2 hrs before and after taking lipid lowering drugs (Ca+ and iron bind with tetracycline),Obj. 11 Describe the uses, s/e, nursing implications of the various aminoglycosides,Action/use Bacteriocidal; inhibits protein synthesis Aerobic gram neg bacteria (e. coli, seratia, proteus, klebsiella, pseudomanas); administered with other antibiotic for entercocci infections. S/E Irreversible ototoxicity, nephrotoxicity, respiratory paralysis Prototype: Gentamycin (Garamycin),Aminoglycosides cont,Nursing considerations Monitor for ototoxicity (How?) Monitor for nephrotoxicity (How?) Provide optimal oral hygiene IV administration should be done slowly Poorly absorbed via GIonly route is IV Monitor peak and trough levels for toxicity,Quinolones/fluoroquinolones First introduced in 1962 Currently four generations Macrolides Low doses-bacteriostatic High doses-bacteriocidal,Obj. 12 Discuss uses of quinolones and macrolides,Action/Use Bacteriocidal;inhibit enzymes (DNA gyrase and topoisomerase) to affect DNA synthesis;gram neg microbes Respiratory, GI, GU tracts; skin and soft tissue; newer agents very effective against anerobes S/E/route n/v; ADVERSE: dysrhythmias,liver failure and CNS changes; not used in pregnancy; caution in children; oral BID Prototype:Ciprofloxicin (Cipro),Quinolones,Nursing considerations: Assess hypersensititivity; report neurologic effects Phototoxicitity Dont take with vitamins/mineral supplements (or wait 2 hrs before and after Monitor labs I & O Take all the prescription,Quinolones,Action/Use Binds to bacterial ribosome to inhibit synthesis (act inside cell); bacteriostatic; effective against gram + and -;treats whooping cough, Legionaires disease, H. influenza and Mycoplasma pneumoniae Newer drugs synthesized from erythromycinless GI disturbance S/Every few Prototype: erythromycin (E-Mycin),Macrolides,Nursing considerations Do not use in pregnancy Assess history of hypersensititivity Monitor labs (liver and kidney, INR) Macrolides decrease warfarin metablism and excretion,Macrolides,Clindamycin (Cleocin) Grm + and effectiveness Use: oral infections Contraindication: hypersensitivity Limited use due to association w pseudomenbranous colitis,# 13 Describe Misc. drugs,Sulfonamides Action:bacteriostatic, broad spectrum, used for UTI Classified by route of administration Systemic and topical Systemic Sulfisoxazole (Gantrisin) topical Sulfadoxine (Fansidar)- not 1st choice drug Contraindicated in pregnancy and infants 2 years (promotes jaundice);low soluability causes crystals in urine,Misc. agents cont,Vancomycin ( Vancocin) Imipenim (primaxin),Misc. agents,Ketolides glycylcyclines,Misc agents,14: patient education for anbx,Tuberculosis: Cause: Incidence: Treatment: prolonged due to cell wall resistance to pe