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Final

NURS 303 Final: ABX

5 Pages
32 Views
Fall 2016

Department
Nursing
Course Code
NURS 303
Professor
Jennifer Lyn Baumbusch
Study Guide
Final

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ABX, Lilley et al., 718-740
of 1 5
**drugs with respiratory indications are marked with asterisks**
Empirical antibiotic therapy: abx is selected by ability to kill microorganism known to be the most
common cause of infection. Specimens from suspected area should be cultured in an attempt to
ID a causative orgamisnm. Cultures should be obtained before therapy is initiated.
Prophylactic abx therapy: used to prevent infection.
Therapeutic efficacy—
therapeutic response: decrease in specific signs and symptoms of infection
subtherapeutic: signs and symptoms do not improve (d/t incorrect route, inadequate drainage of
abscess, poor drug penetration to infected area, insufficient serum levels of drug, bacterial
resistance)
Abx therapy is considered toxic when serum levels are too high, or when pt. has an allergic
reaction or other major adverse reaction to drug, incl., rash, itching, hives, fever, chills, joint
pain, difficulty breathing, or wheezing. GI discomfort/diarrhea are common, not severe enough o
require discontinuation.
Superinfections can occur when abx reduce or eliminate normal bacterial flora.
Second infection follows first infection from external source
Resistance: major cause is overprescription. Another factor is tendency of many patients not to
complete abx regimen.
Host factors: age, allergy history, kidney and liver function, pregnancy, genetic characteristics,
site of infection, host defences
Pedi: tetracyclines may affect dev’t of teeth or bones. Fluoroquinolones may affect bone or
cartilage devt. Sulfonamines may displace bilirubin from albumin and precipitate kernicterus
(hyperbilirubinemia) in neonates
"
Geri: Depending on liver and kidney function, dosage adjustments may be necessary
Penicillins and sulphonamides - often allergic reactions, incl. anaphylactic shock
ALWAYS CHART: difficulty breathing, significant rash, hives, severe GI intolerance.
Teratogens: drugs that cause devt abnormalities in fetus
Respiratory Drugs
RTI = respiratory tract infection
URT = upper respiratory traft
LRT = lower respiratory tract
URI/LRI = upper/lower respiratory tract infection
Drug profiles
ABX, Lilley et al., 718-740
of 2 5
Natural Penicillins
Penicillin G and Penicillin V potassium
G: given IV/IM - great for treating syphilis
V potassium: PO only
Suitable for infections with gram-positive organisms such as Streptococcus pneumonia
and Staphylococcus spp.
Penicillinase-respistant penicillins
Cloxacillin sodium
Resists penicillinase-induced breakdown by staphylococci. However, S. aureus is
resistant.
Aminopenicillins
**amoxicillin**
ENT, GU, skin infections
susceptible respiratory, skin, and urinary tract infections
ampicillin
PO or parenterally
Extended Spectrum penicillins
Piperacillin (IV), pivmecillinam (PO)
Only class effective against Pseudomonas spp.
Stable against Proteus spp. infections
Often suitable for intestinal infections
First-Generation Cephalosporins
Cefazolin sodium
gram-positive bacteria primarily
Cephalexin
PO only
gram-positive bacteria primarily
Second-Generation Cephalosporins
Cefoxitin sodium
gram-positive, some gram-negative
can kill anaerobic bacteria
suitable prophylactic for abdominal surgery (kills intestinal bact.)
Injectable only
Cefuroxime sodium
Parenteral
Prophylactic
Broader gram-negative spectrum than 1st gen, but narrower than 3rd gen.
Does not kill anaerobic bacteria
Injectable
PO (cefuroxime axetil only - activated through hydrolysis in liver)

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Description
ABX, Lilley et al., 718-740 1 of **drugs with respiratory indications are marked with asterisks** Empirical antibiotic therapy: abx is selected by ability to kill microorganism known to be the most common cause of infection. Specimens from suspected area should be cultured in an attempt to ID a causative orgamisnm. Cultures should be obtained before therapy is initiated. Prophylactic abx therapy: used to prevent infection. Therapeutic efficacy— therapeutic response: decrease in specific signs and symptoms of infection subtherapeutic: signs and symptoms do not improve (d/t incorrect route, inadequate drainage of abscess, poor drug penetration to infected area, insufficient serum levels of drug, bacterial resistance) Abx therapy is considered toxic when serum levels are too high, or when pt. has an allergic reaction or other major adverse reaction to drug, incl., rash, itching, hives, fever, chills, joint pain, difficulty breathing, or wheezing. GI discomfort/diarrhea are common, not severe enough o require discontinuation. Superinfections can occur when abx reduce or eliminate normal bacterial flora. Second infection follows first infection from external source Resistance: major cause is overprescription. Another factor is tendency of many patients not to complete abx regimen. Host factors: age, allergy history, kidney and liver function, pregnancy, genetic characteristics, site of infection, host defences Pedi: tetracyclines may affect dev’t of teeth or bones. Fluoroquinolones may affect bone or cartilage devt. Sulfonamines may displace bilirubin from albumin and precipitate kernicterus (hyperbilirubinemia) in neonates 
 Geri: Depending on liver and kidney function, dosage adjustments may be necessary Penicillins and sulphonamides - often allergic reactions, incl. anaphylactic shock ALWAYS CHART: difficulty breathing, significant rash, hives, severe GI intolerance. Teratogens: drugs that cause devt abnormalities in fetus Respiratory Drugs RTI = respiratory tract infection URT = upper respiratory traft LRT = lower respiratory tract URI/LRI = upper/lower respiratory tract infection Drug profiles ABX, Lilley et al., 718-740 2 of5 Natural Penicillins Penicillin G and Penicillin V potassium G: given IV/IM - great for treating syphilis V potassium: PO only Suitable for infections with gram-positive organisms such as Streptococcus pneumonia and Staphylococcus spp. Penicillinase-respistant penicillins Cloxacillin sodium Resists penicillinase-induced breakdown by staphylococci. However, S. aureus is resistant. Aminopenicillins **amoxicillin** ENT, GU, skin infections susceptible respiratory, skin, and urinary tract infections ampicillin PO or parenterally Extended Spectrum penicillins Piperacillin (IV), pivmecillinam (PO) Only class effective against Pseudomonas spp. Stable against Proteus spp. infections Often suitable for intestinal infections First-Generation Cephalosporins Cefazolin sodium gram-positive bacteria primarily Cephalexin PO only gram-positive bacteria primarily Second-Generation Cephalosporins Cefoxitin sodium gram-positive, some gram-negative can kill anaerobic bacteria suitable prophylactic for abdominal surgery (kills intestinal bact.) Injectable only Cefuroxime sodium Parenteral Prophylactic Broader gram-negative spectrum than 1st gen, but narrower than 3rd gen. Does not kill anaerobic bacteria Injectable PO (cefuroxime axetil only - activated through hydrolysis in liver) ABX, Lilley et al., 718-740 3 o 5 Third Generation Cephalosporins Great against gram-negative bacteria, but less useful against gram-positive than 1st or 2nd gen. Ceftazidime pentahydrate parenteral excellent coverage against difficult-to-treat gram-negative bacteria (Pseudomonas spp.) Ceftriaxone sodium extremely long-acting crosses BBB (great for meningitis!) IV and IM Fourth Generation Cephalosporins **Cefepime** Broad spectrum Increased activity against Enterobacter spp. (gram-negative) as well as gram-positive organs Used in treating UTIs, skin structure infections, and pneumonia Injectable only Carbapenams Broadest spectrum Often reserved for complicated body cavity and connective tissue infections in acutely ill hospitalized patients Risk of drug-induced seizures Imipenem-cilastatin Wide spectrum Cilastatin inhibits breakdown of imipenem Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins inside bact. Resistant to antibiotic-inhibiting actions Indicated for treatment of bone, joint, skin, soft tissue infections. Bacterial endocarditis d/ t S. aureus, intra-abdominal bact. infections, **pneumonia**, UTIs and pelvic infections, bact. sep
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