pharmacology powerpoint

8/19/2019 Pharmacology Powerpoint

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PHARMACOLOGY

By:Nerissa Cabañero

Laiza Pineda


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Introduction Pharmacology – is te study o! te

e"ect o! dru#s on $i%in# or#anis&s

Medication – is a substancead&inistered !or dia#nosis' cure'treat&ent' or re$ie! o! a sy&(to& or

!or (re%ention o! disease) Drug* i$$icit$y obtained substance


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Prescription – a +ritten direction !or te(re(aration and ad&inistration o! a dru#

Pharmacy – is te art o! (re(arin#'

co&(oundin#' and dis(ensin# dru#s Pharmacist – a (erson $icensed to (re(are and

dis(ense dru#s and to &a,e u( (rescri(tions Pharmacopoeia – is a boo, containin# a $ist o!

(roducts used in &edicine' +it descri(tions o!te (roduct' ce&ica$ tests !or deter&inin#identity and (urity' and !or&u$as and(rescri(tions


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1. Generic name – is #i%en be!ore a dru#beco&es o-cia$$y an a((ro%ed &edication

* #enera$$y used trou#out te dru#.s use 2. Trade name – is te na&e #i%en by te dru#

&anu!acturer

* so&eti&es ca$$ed te /brand na&e. 3. Ofcial name – is te na&e under +ic it is

$isted in one o! te o-cia$ (ub$ications 4. Chemical name – is te na&e by +ic a

ce&ist ,no+s it0 tis na&e describes teconstituents o! te dru#


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P!"M!C#$T%C P! 12rst (ase o! dru# action 1disinte#ration – is te brea,do+n o! a

tab$et into s&a$$er (ieces 1disso$ution – is te disso$%in# o! te

s&a$$er (ieces in te GI 3uid be!oreabsor(tion)

1rate $i&itin# – is te ti&e it ta,es tedru# to disinte#rate and disso$%e tobeco&e a%ai$ab$e !or te body to absorb it)


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P!"M!CO'%(#T%CP!

1is te (rocess o! dru# &o%e&entto acie%e dru# action

-Absorption

-Distribution

-Excretion

-Metabolism or Biotransformation


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– is te (rocess by +ic a dru#(asses into te b$oodstrea&

* is te &o%e&ent o! dru#(artic$es !ro& te GI tract to body3uids by (assi%e absor(tion'

acti%e absor(tion' or (inocytosis


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1passi)e a*sorption – occurs &ost$y bydi"usion 4&o%e&ent !ro& i#er concentrationto $o+er concentration5) 6it te (rocess o!

di"usion' te dru# does not re7uire ener#y to&o%e across te &e&brane) 1acti)e a*sorption – re7uires a carrier suc

as an enzy&e or (rotein to &o%e te dru#a#ainst a concentration #radient) 8ner#y is

re7uired !or acti%e absor(tion) 1pinocytosis – is a (rocess by +ic ce$$s

carry dru# across teir &e&brane by en#u$2n#te dru# (artic$es)


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* !actors tat a"ect te rate absor(tion 4b$ood3o+' (ain' stress' un#er' !astin#' !ood'and (H5

1+rst pass e,ect – in +ic ora$ dru#s 2rst (ass

trou# te $i%er and are (artia$$y &etabo$ized(rior to reacin# te tar#et or#an)

1bioa%ai$abi$ity – is a sub cate#ory o! absor(tion)It is te (ercenta#e o! te ad&inistered dru# dosetat reaces te syste&ic circu$ation)

* !actors tat a$ter bioa%ai$abi$ity 4te dru#!or&' route o! ad&inistration' GI &ucosa and&oti$ity' !ood and oter dru#s' can#es in $i%er&etabo$is&5


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– is te (rocess by +ic te dru#beco&es a%ai$ab$e to body 3uids and

body tissues) is te trans(ortation o! a dru# !ro& its site o!

absor(tion to its site o! action) In3uenced by b$ood 3o+' its a-nity to te tissue'

and (rotein*bindin# e"ect 6en a dru# enters te b$ood strea&' it is carried

to te &ost %ascu$ar or#ans – $i%er' ,idneys' andbrain) Body areas +it $o+er b$ood su(($y – s,in'&usc$es – recei%es te dru# $ater)


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is a (rocess by +ic a dru# iscon%erted to a $ess acti%e !or&)

-i)er is te (ri&ary site o!&etabo$is&

Most dru#s are inacti%ated by $i%erenzy&es and are ten con%erted ortrans!or&ed by e(atic enzy&es toinacti%e &etabo$ites or +ater*so$ub$e substances !or e9cretion)


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* is te (rocess by +ic &etabo$ites and dru#sare e$i&inated !ro& te body)* te &ain route o! dru# e$i&ination is trou#

te idneys /urine0 * oter routes inc$ude e(atic &etabo$is&' bi$e'

!eces' $un#s' sa$i%a' s+eat and breast &i$,) * in3uences dru# e9cretion 4(H' ,idney disease51creatinine clearance – &ost accurate test to

deter&ine rena$ !unction * ; or ;< our urine co$$ection and a b$oodsa&($e * nor&a$ %a$ue: => to ?> &$@&in


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P!"M!COD(!M%CP!

is te study o! dru#concentration and its e"ects

on te body is te (rocess by +ic a dru#can#es te body 4a$ters ce$$

(ysio$o#y5


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1half-life – sy&bo$ized as t@;' o! adru# is te ti&e it ta,es !or one*a$! o!

te dru# concentration to be e$i&inated) Initia$$y:

A!ter = rs: >

A!ter rs: ;> A!ter ;< rs: ;)>

A!ter ?; ours: );>


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1Onset of action – te ti&e a!ter ad&inistration +ente body initia$$y res(onds to te dru#

* is te ti&e it ta,es to reac a &ini&u&e"ecti%e concentration

1Peak Plasma level – te i#est ($as&a $e%e$acie%ed by a sin#$e dose +en te e$i&ination rate o! adru# e7ua$s te absor(tion rate* occurs +en te dru# reaces its i#est b$ood or($as&a concentration

1Duration of action – is te $en#t o! ti&e te dru#as (ar&aco$o#ic e"ect

1Drug half-life (elimination half-life) – te ti&ere7uired !or te e$i&ination (rocess to reduce teconcentration o! te dru# to one*a$! +at it +as atinitia$ ad&inistration


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DEuc can#es re7uire tat te dru# interact +it s(eci2c&o$ecu$es and ce&ica$s nor&a$$y !ound in te body

1 receptor – usua$$y a (rotein' is $ocated on te sur!aceo! a ce$$ &e&brane or +itin te ce$$) A ce$$ &e&brane

contains rece(tors !or (ysio$o#ic or endo#enoussubstances suc as or&ones and neurotrans&itters) 1 Agonist – a dru# tat (roduces te sa&e ty(e o!

res(onse as te (ysio$o#ic or endo#enous substance * dru#s tat (roduce a res(onse

1 Antagonist – inibits ce$$ !unction by occu(yin#

rece(tor sites * dru#s tat b$oc, a res(onse * (re%ents natura$ body substances or oter dru#s !ro&acti%atin# te !unctions o! te ce$$ by occu(yin# terece(tor sites)


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Therapeutic e,ect

/desired e"ect.

is te (ri&ary e"ect intended'tat is' te reason te dru# is(rescribed


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1&ide e,ect

*/secondary e"ect.

*is one tat is unintended0 are(ysio$o#ic e"ects not re$ated todesired dru# e"ects

*e%en +it a correct dosa#e' side

e"ects occur and are (redicted


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1!d)erse reaction

*are &ore se%ere tan side e"ects

1Drug toicity

*de$eterious e"ects o! a dru# on an or#anis& ortissue

*resu$ts !ro& o%erdosa#e' in#estion o! a dru#intended !or e9terna$ use' and bui$d u( o! te

dru# in te b$ood because o! i&(aired&etabo$is& or e9cretion

*can be identi2ed by &onitorin# te ($as&a4seru&5 tera(eutic ran#e o! te dru#


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1Drug !llergy

*is an i&&uno$o#ic reaction to a dru# *+en a c$ient is 2rst e9(osed to a

!orei#n substance 4anti#en5' te body&ay react by (roducin# antibodies) Ac$ient can react to a dru# as to an

anti#en and tus de%e$o( sy&(to&so! an a$$er#ic reaction)


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1!naphylactic reaction

*a se%ere a$$er#ic reaction usua$$yoccurs i&&ediate$y a!ter te

ad&inistration o! te dru# *ear$iest sy&(to&s: subFecti%e

!ee$in# o! s+e$$in# in te &out

and ton#ue' acute sortness o!breat' acute y(otension' andtacycardia)


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1Drug Tolerance

*e9ists in a (erson +o asunusua$$y $o+ (ysio$o#ic res(onse

to a dru# and +o re7uiresincreases in te dosa#e to&aintain a #i%en tera(eutic e"ect


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1Drug interaction

*occurs +en te ad&inistration o!one dru# be!ore' at te sa&e ti&e

as' or a!ter anoter dru# a$ters tee"ect o! one or bot dru#s


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1&ynergestic

*is +en t+o di"erent dru#s increase

te action o! one or anoter dru#) 1%atrogenic disease

* 4disease caused unintentiona$$y by

&edica$ tera(y5 can be due to dru#tera(y


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Assess a c$ient.s status and obtain a&edication istory (rior to #i%in# any&edication to obtain base$ine data by

+ic to e%a$uate te e"ecti%eness o! te&edication

uestion any order tat is i$$e#ib$e or tatyou consider incorrect) Ca$$ te (erson +o

(rescribed te &edication !or c$ari2cation Be ,no+$ed#eab$e about te &edications

you ad&inister


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se on$y &edications tat are in ac$ear$y $abe$ed container

o not (our dru#s !ro& onecontainer to anoter

o not (our dru#s into te and

o not reca( need$es) o not use $i7uid &edications tat

are c$oudy or a%e can#ed co$or


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Ca$cu$ate dru# doses accurate$y) I! you areuncertain' as, anoter nurse to doub$e*cec,your ca$cu$ations

Ad&inister on$y &edications (ersona$$y(re(ared

Be!ore ad&inisterin# a &edication' identi!y tec$ient correct$y

o not $ea%e te &edications at bedside' +itcertain e9ce(tions I! a c$ient %o&its a!ter ta,in# an ora$

&edication' re(ort it to te nurse in car#e


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6en a &edication is o&itted !or anyreason' record te !act to#eter +it te

reason 6en a &edication error is &ade' re(ort

it i&&ediate$y to te nurse in car#e'te (ri&ary ea$t care (ro%ider)

Cec, te dru# $abe$ tree ti&es be!oread&inistration o! te &edication


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Three Times Chec 5or&a5e Medication

!dministration

*at the time o5contact 6ith thedrug *ottle orcontainer


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**e5ore pouringthe drug


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*a5ter pouringthe drug


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!pes of Me"icationOr"ers

stat order – indicates tat te &edication is tobe #i%en i&&ediate$y and on$y once

single order – or one*ti&e order is !or

&edication to be #i%en once at a s(eci2ed ti&e standing order – &ay or &ay not a%e a

ter&ination date) A standin# order &ay becarried out inde2nite$y unti$ an order is +ritten tocance$ it' or it &ay be carried out !or a s(eci2ed

nu&ber o! days prn order – or as*needed order' (er&its te

nurse to #i%e &edication +en' in te nurse.s Fud#&ent' te c$ient re7uires it)


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Essential Parts of aDrug Or"er

*!u$$ na&e o! te c$ient *date and ti&e te order is +ritten

*na&e o! te dru# to be ad&inistered *dosa#e o! te dru# *!re7uency o! ad&inistration

*route o! ad&inistration *si#nature o! te (erson +ritin# te

order


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DProcess o5!dministeringMedications7 ) Identi!y te c$ient ;) In!or& te c$ient ?) Ad&inister te dru# ) Record te dru# ad&inistered ) 8%a$uate te c$ient.s res(onse

to te dru#


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#ight Me"ication$Drug

*te &edication #i%en +as te&edication ordered


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#ight Dose

*te dose is a((ro(riate !or tec$ient

*doub$e*cec, ca$cu$ations *,no+ te usua$ dosa#e ran#e o!

te &edication

*7uestion a dose outside o! teusua$ dosa#e ran#e


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#ight ime

*#i%e te &edication at te ri#t !re7uency and atte ti&e ordered

*&edications sou$d be #i%en +itin ? &inutes

be!ore or a!ter te scedu$ed ti&e *ad&inister dru#s tat are a"ected by !oods' suc

as tetracyc$ine' be!ore &ea$s *ad&inister dru#s tat can irritate sto&ac' suc

as (otassiu& and as(irin' +it !ood *it is a nurse.s res(onsibi$ity to cec, +eter te

c$ient is scedu$ed !or any dia#nostic (rocedurestat +ou$d contraindicate te ad&inistration o!&edication


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#ight #oute

*#i%e te &edication by te ordered route *&a,e certain tat te route is sa!e and

a((ro(riate !or te c$ient *assess te c$ient.s abi$ity to s+a$$o+ be!ore

ad&inistration o! ora$ &edications *do not crus or &i9 &edications in oter

substances

*use ase(tic tecni7ue +en ad&inisterin#dru#s

*stay +it te c$ient unti$ ora$ dru#s a%e beens+a$$o+ed


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#ight %lient

*&edication is #i%en to teintended c$ient

*cec, c$ient.s identi2cation band+it eac ad&inistration o!&edication


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#ight %lient E"ucation

*e9($ain in!or&ation about te &edication tote c$ient

*C$ient teacin# a$so inc$udes tera(eutic(ur(ose' (ossib$e side e"ects o! te dru#'any dietary restrictions or re7uire&ents' s,i$$o! ad&inistration' and $aboratory &onitorin#

*tis ri#t is a (rinci($e o! in!or&ed consent'+ic is based on te indi%idua$ a%in# te,no+$ed#e necessary to &a,e decisions


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#ight Documentation

*docu&ent &edicationad&inistration a!ter #i%in# it' not

be!ore' tis inc$udes: na&e o! tedru#' te dose' route' ti&e anddate' nurse.s initia$s or si#nature


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#ight to #efuse

*adu$t c$ients a%e te ri#t tore!use any &edication

*te nurse.s ro$e is to ensure tatte c$ient is !u$$y in!or&ed o! te(otentia$ conse7uences o! re!usa$

and to co&&unicate te c$ient.sre!usa$ to te ea$t care (ro%ider


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#ight Assessment

*Eo&e &edications re7uire s(eci2cassess&ents (rior to

ad&inistration *Medication orders &ay inc$ude

s(eci2c (ara&eters !or

ad&inistration


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#ight Evaluation

*conduct a((ro(riate !o$$o+*u(


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i l


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8asic 9ormula

D : ; !

6ere D is te desired dose 4dru#dose ordered by te ea$t care(ro%ider5 is te one*and dose 4dru#dose on $abe$ o! container J%ia$'bott$eK

: is te %eic$e 4dru# !or& in+ic te dru# co&es Jtab$et'ca(su$e' $i7uidK

! is te a&ount ca$cu$ated to

d i h


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8ody 6eight

con%ert te (ounds to ,i$o#ra&s i!necessary /l* < 2.2;g0

deter&ine dru# dose (er B6 by &u$ti($yin#

as !o$$o+s:

drug dose = *ody 6eight ; client>s

dose per day !o$$o+ te basic !or&u$a' ratio and

(ro(ortion &etod to ca$cu$ate te dru#dosa#e

7 C l l ti


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7 Calculating%ntra)enous9luid7Method %? threestep

) a&ount o! so$ution &i$$i$iters@our 4&$@r5

Hours to ad&inister

;) Mi$$i$iters (er our &i$$i$iters@ &inute4&$@&in5

&inutes

?) &i$$i$iters (er &inute dro(s (er &i$$i$iter o! Iset dro(s@&inute 4#tt@&in5


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Method %%? t6ostep

) A&ount o! 3uid

&i$$i$iters@our 4&$@r5 Hours to ad&inister

;) &i$$i$iters (er our dro(s (er &i$$i$iter dro(s

(er &inute 4#tt@&in5 &inutes

I! te &i$$i$iters (er our is ,no+n' ten use ste( ;to deter&ine te dro(s (er &inute


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Method %%%? onestep

A&ount o! 3uid dro(s (er &i$$i$iter 4I set5

dro(s@ &inute4#tt@&in5ours to ad&inister &inutes (er our 45


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Antibacteria$ and anti&icrobia$s aresubstances tat inibit te #ro+t o!or ,i$$ bacteria and oter&icroor#anis&s 4&icrosco(icor#anis&s inc$udin# %iruses' !un#i'(rotozoa' and ric,ettsiae5) ecnica$$y'te ter& antibiotic re!ers to ce&ica$s(roduced by one ,ind o!&icroor#anis& tat inibits te #ro+to! or ,i$$s anoter)


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1Bacteriostatic dru#s – inibit te#ro+t o! bacteria 4tetracyc$ine

and su$!ona&ides5 1Bactericida$ dru#s – ,i$$ te

bacteria 4(enici$$ins and

ce(a$os(orins5


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Penicillin

*a natura$ antibacteria$ a#ent obtained !ro& te&o$d #enus Penicillium' +as introduced to te&i$itary durin# 6or$d 6ar II and is considered toa%e sa%ed &any so$diers. $i%es) It beca&e +ide$y

used in and +as $abe$ed a /&irac$e. dru#)6it te ad%ent o! (enici$$in' &any c$ientssur%i%ed +o +ou$d a%e nor&a$$y died !ro&+ound and se%ere res(iratory in!ections)

*!oods &ay decrease te absor(tion o! &any

(enici$$ins tat are ta,en ora$$y' tere!ore tose(enici$$ins sou$d be ta,en +it a !u$$ #$ass o!+ater our be!ore !ood inta,e or ; ours a!ter&ea$ ti&e) A&o9ici$$ins and baca&(ici$$in are(enici$$ins tat are una"ected by !ood)

G l !d #, t


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General !d)erse #,ectsto !nti*acterial Drugs

*a$$er#y or y(ersensi%ity

*su(erin!ection

*or#an to9icity


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8asic Penicillins

1penicillin G procaine 4Crystici$$in' 6yci$$in5 – !or

&oderate$y serious in!ections) E$o+IM absor(tion +it (ro$on#ed action)

1penicillin G *en@athine 4Bici$$in5

– Lon#*actin# (enici$$in +en #i%enby inFection) sed as (ro(y$a9is !orreu&atic !e%er)


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1penicillin G sodium


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8road&pectrumPenicillins/!minopenicillins0 *are used to treat bot #ra&*

(ositi%e and #ra&*ne#ati%e

bacteria) 1amoicillin /!moil0

!moicillincla)unalate

/!ugmentin0 – treat&ent o! $o+erres(iratory in!ections' otitis &edia'sinusitis' s,in in!ections' Is


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1ampicillin /PolycillinA Omnipen0 – 2rstbroad*s(ectru& (enici$$in) > o! te dru# isabsorbed by GI tract) 8"ecti%e #ra&*ne#ati%e

and #ra&*(ositi%e bacteria) Indi%idua$s +it(enici$$in a$$er#ies &ay a$so be a$$er#ic toa&(ici$$in)

1ampicillinsul*actam /$nasyn0 – sa&e asa&(ici$$in)

1*acampicillin Cl /&petro*id0 – sa&e asa&(ici$$in) is absorbed) It is ydro$yzed toa&(ici$$in durin# absor(tion !ro& te GI tract)

Penicillinase"esistant


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Penicillinase"esistantPenicillins /!ntistaphylococcalPenicillins0

*are used to treat (enici$$inase*(roducin# E)aureus)

1Cloacillin /Tegopen0 – !or &ost#ra&*(ositi%e bacteria$ in!ections 1Dicloacillin sodium /Dynapen0 Methicillin /&taphcillin0 – 2rst

(enici$$inase* resistant (enici$$in)sed to treat sta(y$ococca$in!ection)


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1(a5cillin /na5cinA $nipen0 – Hi#$ye"ecti%e a#ainst (enici$$in G*resistant

sta(y$ococcus aureus) Notreco&&ended !or ora$ use because o!its instabi$ity in #astric Fuices)

1Oacillin sodium /ProstaphlinA

8actocil0 – !or (enici$$in*resistantsta(y$ococci) As e"ecti%e as&etici$$in)

#tended&pectrum


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#tended&pectrumPenicillins /!ntipseudomonal

Penicillins0 *are #rou( o! broad*s(ectru& (enici$$ins) is

#rou( o! dru# is e"ecti%e a#ainstPseudomonas aeruginosa, a #ra&*ne#ati%e

baci$$us tat is di-cu$t to eradicate) esedru#s are a$so use!u$ a#ainst&any #ra&*ne#ati%e or#anis&s suc as Proteus s(()'Serratia s(()' Klebsiella pneumoniae'Enterobacter s(()' and Acinobacter s(() e

anti(seudo&ona$ (enici$$ins are not(enici$$inase*resistant) eir (ar&aco$o#icaction is si&i$ar to tat o! a&ino#$ycosides'but tey are $ess to9ic tan a&ino#$ycosides)


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1Car*enicillin indanyl /GeocillinA Geopen0 – te 2rst (enici$$in*$i,e dru# de%e$o(ed to treatin!ections caused by Pseudomonas aeruginosa

and Proteus s(() It contains $ar#e a&ounts o!sodiu&) se +it caution +en ad&inisterin#to c$ients +it y(ertension or con#esti%e eart!ai$ure)

1Me@locillin sodium /Me@lin0 – !or serious

in!ections' es(ecia$$y because o! Pseudomonasaeruginosa. It can be #i%en in co&bination+it a&ino#$ycosides and ce(a$os(orins toobtain syner#estic e"ects)


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1Piperacillin sodium /Pipracil0 – orserious in!ections) Can be #i%en be!ore

and a!ter sur#ery) Pri&ari$y used !or#ra&*ne#ati%e or#anis&s) reat&ent!or se(tice&ia0 bone0 Foint0 res(iratory0and urinary tract in!ections)

1Piperacillinta@o*actam /Bosyn0 –to treat a((endicitis' s,in in!ections'(neu&onia


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1Ticarcillin disodium /Ticar5 – e"ecti%ea#ainst #ra&*(ositi%e and #ra&*ne#ati%ebaci$$i) sed to treat res(iratory' urinary'

re(roducti%e' s,in' and so!t tissuein!ections) It can be #i%en in co&bination+it a&ino#$ycosides !or syner#istic e"ect)

1Ticacillincla)ulanate /Timentin0 –

e"ecti%e !or treatin# se(tice&ia and $o+erres(iratory tract' urinary tract' s,in' bone' Foint in!ections)


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*asses !or a$$er#y to (enici$$in orce(a$os(orins

*cec, $aboratory resu$ts'es(ecia$$y $i%er enzy&es

*record urine out(ut


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*send a sa&($e o! &ateria$ !ro& te in!ectedarea to $aboratory !or cu$ture to deter&ineantibiotic susce(tibi$ity 4a$so ,no+n as CSE5

be!ore antibiotic tera(y is started) *cec, si#ns and sy&(to&s o! su(erin!ection'

s@s9 are sto&atitis 4&out u$cers5' #enita$discar#e 4%a#initis5' and ana$ or enita$ itcin#)

*e9a&ine c$ient !or a$$er#ic reaction to te

(enici$$in (roduct *a%e e(ine(rine a%ai$ab$e to counteract a

se%ere a$$er#ic reaction


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*cec, c$ient !or b$eedin#' a decrease in($ate$et a##re#ation &ay resu$t)

*&onitor body te&(erature and

in!ectious area *di$ute te antibiotic !or I use in an

a((ro(riate a&ount o! so$ution *ad%ise c$ient to ta,e &edication +it

!ood i! #astric irritation occurs and tota,e ora$ (enici$$in our be!ore or ;ours a!ter &ea$s to a%oid de$ay in dru#absor(tion)


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Cephalosporins

In


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irst

8"ecti%e a#ainst #ra&*(ositi%e bacteria'suc as stre(tococci and &oststa(y$ococci) 8"ecti%e a#ainst &ost#ra&*ne#ati%e bacteria' suc asEscherichia coli and s(ecies o! Klebshiella'Proteus' Salmonella' and Shigella.

*Ce!adro9i$' ce!azo$in sodiu&'ce(a$e9in' ce(a$otin' ce(a(irinsodiu&' ce(radine


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Eecond

Ea&e e"ecti%eness as te 2rst#eneration) ese antibiotics (ossess abroader s(ectru& a#ainst oter #ra&*

ne#ati%e bacteria' suc as Haemophilusinfuenzae' Neisseria gonnorhea)Neisseria meningitides' Enterobacter s(()' and se%era$ anaerobic or#anis&s)

*ce!ac$or' ce!a&ando$e' ce!&etazo$esodiu&' ce!onicid sodiu&' ce!oranide'ce!otetan' ce!o9itin sodiu&' ce!(rozi$&onoydrate' ce!uro9i&e


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ird

Ea&e e"ecti%eness as te 2rst and second#enerations) A$so e"ecti%e a#ainst #ra&*ne#ati%e bacteria' suc as Pseudomonas

aeruginosa' Serratia s(()' and Acinobacter s(() Less e"ecti%e a#ainst #ra&*(ositi%ebacteria)

*ce!dinir' ce29i&e' ce!o(erazone'

ce!ota9i&e' ce!(odo9i&e' ce!tazidi&e'ce!tria9one' ce!tizo9i&e sodiu&' ce!tibuten'&o9a$acta& disodiu&' ce!ditoren (i%o9i$


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ourt

Ei&i$ar to te tird #eneration)Resistant to &ost beta*$acta&ase

bacteria) Has a broader #ra&*(ositi%eco%era#e tan te tird #enerations)8"ecti%e a#ainst E.coli' Klebshiella'Proteus' stre(cocci' certain

sta(y$ococci' and P. aeruginosa. *ce!e(i&e


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*assess !or a$$er#y to ce(a$os(orins) *record %ita$ si#ns and urine out(ut) Re(ort

abnor&a$ 2ndin#s' +ic &ay inc$ude an

e$e%ated te&(erature or decrease in urineout(ut) *ceac, $aboratory resu$ts' es(ecia$$y tose tat

indicate rena$ and $i%er !unction' suc as b$oodurea nitro#en' seru& creatinine' as(artate

a&inotrans!erase' a$anine a&inotrans!erase' a$,a$ine (os(atase' andbi$irubin) Re(ort abnor&a$ 2ndin#s) se tese$aboratory resu$ts !or base$ine %a$ues)


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*cu$ture te in!ected area be!ore ce(a$os(orintera(y is started) e or#anis& causin# tein!ection can be deter&ined by cu$ture' and te

antibiotics sensiti%e to te or#anis& aredeter&ined by cu$ture and sensiti%ity 4CSE5 *cec, !or si#ns and sy&(to&s o!

su(erin!ection' es(ecia$$y i! c$ient ta,es i#doses o! a ce(a$os(orin (roduct !or a

(ro$on#ed (eriod) Eu(erin!ection is usua$$ycaused by te !un#a$ or#anis& Candida in te&out 4&out u$cers5 or in te #enita$ area'suc as te %a#ina 4%a#initis5


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*re!ri#erate ora$ sus(ensions' !or Ice(a$os(orins' di$ute in ana((ro(riate a&ount o! 3uids 4>*&$5

*Ad&inister I ce(a$os(orins o%er?* &inutes ; to < ti&es a day

*&onitor %ita$ si#ns' urine out(ut'and $aboratory resu$ts) Re(ortabnor&a$ 2ndin#s)


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C$ient teacin#

*,ee( dru#s out o! reac o! s&a$$ ci$dren *instruct c$ient to re(ort si#ns o!

su(erin!ection *ad%ise c$ient to in#est butter&i$, or

yo#urt to (re%ent su(erin!ection o! teintestina$ 3ora +it $on#*ter& tera(y o! ace(a$os(orin)

*instruct c$ient to ta,e co&($ete course o!&edication e%en +en sy&(to&s o!in!ection a%e ceased)

*obser%e !or y(ersensiti%ity reactions)


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Eide 8"ects

*anore9ia' nausea' %o&itin#'

eadace' dizziness' itcin#' andras)

iet

*ad%ise c$ient to ta,e &edication +it!ood i! #astric irritation occurs)


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Macrolides

*inc$udin# azitro&ycin' c$aritro&ycin'diritro&ycin' erytro&ycin) At $o+ to &oderatedoses' &acro$ides a%e Bacteriostatic e"ect' and+it i# dru# doses' te e"ect is bactericida$)

Macro$ides can be ad&inistered ora$$y orintra%enous$y 4I5 but not intra&uscu$ar$y 4IM5because it.s too (ain!u$)

*&acro$ides are acti%e a#ainst &ost #ra&*(ositi%ebacteria and &oderate$y acti%e a#ainst so&e#ra&*ne#ati%e bacteria) Resistant or#anis&s &ay

e&er#e durin# treat&ent) Macro$ides are used totreat &i$d to &oderate in!ections o! te res(iratorytract' sinuses' GI' s,in' and so!t tissue' as +e$$ asdi(teria' i&(eti#o conta#iosa' and Es)


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*assess %ita$ si#ns and urine out(ut

*cec, $aboratory tests !or $i%er

enzy&e %a$ues to deter&ine $i%er!unction)

*obtain a istory o! dru#s c$ient

current$y ta,es)


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*obtain a sa&($e !ro& te in!ected area and send to te$aboratory !or 4CSE5 test be!ore startin# azitro&ycin tera(y)

*&onitor E' urine out(ut' and $aboratory %a$ues' es(ecia$$y$i%er enzy&es

*&onitor c$ient !or $i%er da&a#e resu$tin# !ro& (ro$on#ed useand i# dosa#e o! Macro$ides' suc as azitro&ycin) Ei#ns o!$i%er dys!unction inc$ude e$e%ated $i%er enzy&e $e%e$s and Faundice)

*ad&inister ora$ azitro&ycin our be!ore &ea$s or ; oursa!ter &ea$s) Gi%e +it a !u$$ #$ass o! +ater and not !ruit Fuice)Gi%e te dru# +it !ood GI u(set occurs) Ce+ab$e tab$etssou$d be ce+ed and not s+a$$o+ed +o$e)

*!or I azitro&ycin' di$ute in an a((ro(riate a&ount o!so$ution

*ad&inister antacids eiter ; ours be!ore or ; ours a!terazitro&ycin


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C$ient eacin#*instruct c$ient to ta,e !u$$ course o!

antibacteria$ a#ent as (rescribed) ru#

co&($iance is &ost i&(ortant !or a$$antibacteria$s)

Eide 8"ects*nausea' %o&itin#' diarrea' abdo&ina$

cra&(s' and itcin#)*instruct c$ient to re(ort onset o! $oose

stoo$s or diarrea


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-incosamides

*inibit bacteria$ (rotein syntesis and a%e botbacteriostatic and bactericida$ actions'de(endin# on dru# dosa#e

189) C$inda&ycin and $inco&ycin 1C$inda&ycin* is &ore +ide$y (rescribed tan

$inco&ycin because it is acti%e a#ainst &ost#ra&*(ositi%e or#anis&s' inc$udin#Eta(y$ococcus aureus and anaerobic or#anis&s)

*is absorbed better tan $inco&ycintrou# te GI tract and &aintains i# seru&dru# concentration)


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Eide 8"ects and Ad%erse Reactions

*GI irritation' suc as nausea'

%o&itin#' and sto&atitis) Ras&ay a$so occur) Ee%ere ad%ersereactions inc$ude co$itis and

ana(y$actic soc,


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:ancomycin

*Its use +as a$&ost abandoned because o! &anyre(orts o! ne(roto9icity and ototo9icity)Ototoicity resu$ts in da&a#e to te auditory or%estibu$ar branc o! crania$ ner%e III) Euc da&a#e

can resu$t in (er&anent earin# $oss 4auditorybranc5 or te&(orary or (er&anent $oss o! ba$ance4%estibu$ar branc5) anco&ycin is sti$$ used a#ainstdru#*resistant S. aureus and in cardiac sur#ica$(ro(y$a9is !or indi%idua$s +it (enici$$in a$$er#ies)Eeru& %anco&ycin $e%e$s sou$d be &onitored)

*as beco&e resistant !or treatin# enterococci)uinu(ristin@da$!o(ristin are t+o co&bined resistantenterococci 4R85 in!ections) Antibiotic*resistantenterococci can cause endocarditis)


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'etolides

*are ne+ c$assi2cation o! antibiotics' +icare structura$$y re$ated to Macro$ides) e2rst dru# in tis c$ass is telithromycin

/'ete0 used !or adu$ts o! = years ando$der to treat acute cronic broncitis'acute bacteria$ sinusitis' and co&&unityac7uired (neu&onia) ese disorders are

usua$$y caused by Streptococcus pneumoniae and Haemophilus infuenza)


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Eide 8"ects and Ad%erse Reactions *%isua$ disturbances' sto&atitis'

#$ossitis' #astritis' nausea' %o&itin#'abdo&ina$ distention' 3atu$ence'ora$ and %a#ina$ candidiasis'consti(ation' and +atery stoo$)

*&ay a$so $ead to an e9acerbationo! &yastenia #ra%is


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Tetracycline

*is iso$ated !ro& Streptomyces aureoaciens in


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*assess %ita$ si#ns and urine out(ut *cec, $aboratory resu$ts' es(ecia$$y tose tat

indicate rena$ and $i%er !unction' suc as BN'

seru& creatinine' as(artate a&inotrans!erase'a$anine a&inotrans!erase' and bi$irubin *obtain istory o! dietary inta,e and dru#s

c$ient current$y ta,es) airy (roducts'antacids' iron' ca$ciu&' and &a#nesiu&

decrease dru# absor(tion) i#o9in absor(tionis increased' +ic &ay $ead to di#ita$isto9icity


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*obtain a sa&($e !or cu$ture !ro& tein!ected area and send to te $aboratory !ora cu$ture and sensiti%ity test) Antibiotic

tera(y can be started a!ter te cu$turesa&($e as been ta,en) *ad&inister tetracyc$ine our be!ore

&ea$s or ; ours a!ter &ea$s !or absor(tion) *&onitor $aboratory %a$ues !or $i%er and

,idney !unctions0 tese inc$ude $i%erenzy&es' BN' and seru& creatinine) *record E and O)


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Client Teaching

*instruct c$ient to store tetracyc$ine out o! te $i#t ande9tre&e eat) etracyc$ine deco&(oses in $i#t andeat' causin# te dru# to beco&e to9ic)

*ad%ise c$ient to cec, te e9(iration date on te bott$e

o! tetracyc$ine0 out*o!*date tetracyc$ine can be to9ic) *in!or& +o&an +o is conte&($atin# (re#nancy +oas an in!ection to te$$ er ea$t care (ro%ider and toa%oid ta,in# tetracyc$ine because o! (ossib$eterato#enic e"ect)

*+arn (arents tat ci$dren $ess tan = years o$d

sou$d not ta,e tetracyc$ine because it can causedisco$oration o! (er&anent teet) *direct c$ient to ta,e te co&($ete course o!

tetracyc$ine as (rescribed)


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&ide #,ects

*encoura#e c$ient to use sun b$oc, and(rotecti%e c$otin# durin# sun e9(osure)Potosensiti%ity is associated +it

tetracyc$ine) *instruct c$ient to re(ort si#ns o! a

su(erin!ection 4&out u$cers' ana$' or#enita$ discar#e5

*teac c$ient to use e"ecti%e ora$y#iene se%era$ ti&es a day to (re%entto a$$e%iate &out u$cers 4sto&atitis5)


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iet

*educate c$ient to a%oid &i$,(roducts' iron' and antacids)

etracyc$ine sou$d be ta,en our be!ore &ea$s or ; ours a!ter&ea$s +it a !u$$ #$ass o! +ater) I!#astrointestina$ u(set occurs' tedru# can be ta,en +it nondairy!oods)


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!minoglycosides

*acts by inibitin# bacteria$ (roteinsyntesis)

*e a&ino#$ycosides antibioics areused a#ainst #ra&*ne#ati%e bacteria'suc as E.coli' Proteus s((' andPseudomonas s(() Eo&e #ra&*(ositi%e

cocci are resistant to a&ino#$ycosides'so (enici$$ins or ce(a$os((orins &ay beused)


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*record %ita$ si#ns and urine out(ut) Co&(aretese resu$ts +it !uture %ita$ si#ns and urineout(ut)

*assess $aboratory resu$ts to deter&ine rena$and $i%er !unctions' inc$udin# b$ood ureanitro#en' seru& creatinine' a$,a$ine(os(atase' a$anine a&inotrans!erase'as(artate a&inotrans!erase' and bi$irubin)Eeru& e$ectro$ytes sou$d a$so be cec,ed)

A&ino#$ycosides &ay decrease te seru&(otassiu& and &a#nesiu& $e%e$s) *obtain a &edica$ istory re$ated to rena$ or

earin# disorders)


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*send a sa&($e !ro& te in!ected area tote $aboratory !or cu$ture to deter&ineor#anis& and antibiotic sensiti%ity be!orea&ino#$ycoside is started)

*&onitor inta,e and out(ut) rine out(utsou$d be at $east &$@d) i&&ediate$yre(ort i! urine out(ut is decreased)rina$ysis &ay be ordered dai$y) Cec,

resu$ts !or (roteinuria' casts b$ood ce$$s' ora((earance) *cec, !or earin# $oss) A&ino#$ycosides

can cause ototo9icity)


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*e%a$uate $aboratory resu$ts and co&(are +itbase$ine %a$ues) Re(ort abnor&a$ resu$ts)

*&onitor %ita$ si#ns) Note i! body te&(erature

as decreased) *!or I use' di$ute te a&ino#$ycoside in >*;&$ o! nor&a$ sa$ine so$ution or de9trose > in+ater 4>65 so$ution and ad&inister in ?*&inutes)

*&onitor !or si#ns and sy&(to&s o!su(erin!ection suc as sto&atitis 4&out u$cers5'#enita$ discar#e 4%a#initis5' and ana$ or #enita$itcin#)


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Client teaching

un$ess 3uids are restricted' encoura#e c$ientto increase 3uid inta,e

*instruct c$ient ne%er to ta,e $e!to%er

antibiotics)

&ide #,ects *nausea' %o&itin#' tre&ors' tinnitus' (ruritus'

and &usc$e cra&(s *direct c$ient to use sun b$oc, and (rotecti%e

c$otin# durin# sun e9(osure) Potosensiti%itycan be caused by a&ino#$ycosides)


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)amiacin &O4 /amiin0 – Eyntetic deri%ati%eo! ,ana&ycin) 8"ecti%e a#ainst Pseudomonas s(() Hearin# can#es sou$d be &onitored)

;)gentamicin &O4 /garamycin0 'anamycin &O4 /antre0 – used ora$$y !or

e(atic co&a) 8"ecti%e a#ainst #ra&*ne#ati%ebacteria +it te e9ce(tion o! Pseudomonasaeruginosa) Monitor !or earin# $oss and urinaryout(ut)

?)(eomycin &O4 /Myci5radin0 – decreasesbacteria in te bo+e$ and is used as a(reo(erati%e bo+e$ antise(tic) It is a$so a%ai$ab$eas a to(ica$ antibiotic oint&ent


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/uinolones0

*te &ecanis& o! action o!3uoro7uino$ones is to inter!ere +it teenzy&e NA #yrase' +ic is needed to

syntesize bacteria$ deoribonuc$eic acid4NA5) eir antibacteria$ s(ectru&inc$udes bot #ra&*(ositi%e and #ra&*ne#ati%e or#anis&s) ey are bactericida$) is #rou( o! antibiotics is use!u$ in tetreat&ent o! urinary tract' bone' and Fointin!ections0 broncitis0 (neu&onia0#astroenteritis0 and #onorrea)


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1(alidiic acid /(egGram0 and Cinoacin/Cino*ac0 – urinary tract in!ection

1 (orEoacin /(oroin0 – !or urinary tractin!ection

CiproEoacin /Cipro0 – a((ro%ed use !orurinary tract in!ections0 $o+er res(iratory tractin!ections0 and s,in' so!t tissue' bone' and Fointin!ections)

1-e)o9loacin /le)auin0' sparEoacin/Bagam0' and Tro)aEoacin /tro)an0 are

used (ri&ari$y to treat res(iratory (rob$e&s'suc as co&&unity*ac7uired (neu&onia'cronic broncitis' acute sinusitis' Is' andunco&($icated s,in in!ections)


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*record %ita$ si#ns and inta,e andurine out(ut) $uid inta,e sou$d

be at $east ;&$@d *assess $aboratory resu$ts to

deter&ine rena$ !unction: BN and

seru& creatinine *obtain a dru# and diet istory


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*obtain s(eci&en !ro& te in!ected site and send to te$aboratory !or cu$ture and sensiti%ity be!ore initiatin#antibacteria$ dru# tera(y)

*&onitor inta,e and out(ut)

*record %ita$ si#ns) Re(ort abnor&a$ 2ndin#s) *cec, $aboratory resu$ts' es(ecia$$y b$ood urea nitro#enand seru& creatinine) 8$e%ated %a$ues &ay indicate rena$dys!unction

*i! #astrointestina$ distress occurs' te dru# &ay be ta,en+it !ood)

*cec, si#ns and sy&(to&s o! su(erin!ection suc assto&atitis 4&out u$cers5' !urry b$ac, ton#ue' ana$ or#enita$ discar#e'a nd itcin#

*&onitor b$ood su#ar) Le%o3o9acin can increase tee"ects o! ora$ y(o#$yce&ics)


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Client Teaching

*teac c$ient to drin, at $east to =#$asses o! 3uid dai$y

*encoura#e c$ient to a%oidca"einated (roducts)


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&ide #,ects

*direct c$ient to a%oid o(eratin# azardous&acinery or o(eratin# a &otor %eic$e +i$eta,in# te dru# or unti$ dru# stabi$ity as occurredbecause o! (ossib$e dru# re$ated dizziness)

*in!or& c$ient tat (otosensiti%ity is a side e"ecto! &ost 3uoro7uino$ones) C$ient sou$d usesun#$asses' sun b$oc,' and (rotecti%e c$otin#+en in te sun)

*instruct c$ient to report side e"ects' suc asdizziness' nausea' %o&itin#' diarrea' 3atu$ence'abdo&ina$ cra&(s' tinnitus and ras) O$der adu$tsare &ore $i,e$y to de%e$o( side e"ects)

$nclassi+ed


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!nti*acterial Drugs

1C$ora&(enico$ 4C$oro&ycetin5 – +as disco%ered in


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&ul5onamides

*are one o! te o$dest antibacteria$a#ents

*tey are bacteriostatic because teyinibit bacteria$ syntesis o! !o$ic acid'+ic is essentia$ !or bacteria$ #ro+t)o$ic acid 4!o$ate5 is re7uired by ce$$s !or

biosyntesis o! ribonuc$eic acid 4RNA5'deo9yribonuc$eic acid 4NA5' and(rotein


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DEort*Actin#

1Eu$!adiazine 4&icrosu$!on5 – !or treat&ento! syste&ic in!ections) 6en ta,in# tisdru#' increase te 3uid inta,e

1Eu$!a&etizo$e 4Eu$!aso$' iosu$2$ orte5 –!or treat&ent o! Is) It is i#$y so$ub$e)

1Eu$2so9azo$e 4Gantrisin5 – (o(u$ar dru#!or treatin# Is because it is &ore so$ub$e

in urine) Ra(id$y absorbed !ro& GI tract)sed !or treat&ent and (ro(y$a9is !orotitis &edia)


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DInter&ediate*Actin#

1Eu$!a&eto9azo$e 4Gantano$5 – or Is' otitis &edia'and &enin#ococca$) A strain &enin#itis (ro(y$a9is)

1Eu$!asa$azine 4Azu$2dine' Ea$azo(yrin5 – !or treat&ent o!u$cerati%e co$itis' Cron.s disease' reu&atoid artritis) a,e a!ter eatin#) Eide e"ects inc$ude nausea' %o&itin#'

and b$oody diarrea) 1ri&eto(ri& – an antibacteria$ a#ent tat inter!eres

+it bacteria$ !o$ic acid syntesis si&i$ar$y to su$!ona&ides * antiin!ecti%e tat &ay be used a$one !or

unco&($icated Is * e"ecti%e a#ainst te #ra&*ne#ati%e bacteria

Proteus s(()' Klebsiella s(()'and E.coli 1Co*tri&o9azo$e – to treat I' otitis &edia' broncitis'

(neu&onia' Pneumocystis carinii in!ection' reu&atic!e%er' burns


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*assess c$ient.s rena$ !unction by cec,in#urinary out(ut' BN 4=*;> @d$5' seru&creatinine 4)>* )> @d$5 *deter&ine+eter te c$ient is y(ersensiti%e tosu$!ona&ides)

Obtain dru# istory o! dru#s c$ient current$yta,es)

*assess base$ine $aboratory resu$ts'

es()CBC) b$ood dyscrasias &ay occur as aresu$t o! i# doses o! su$!ona&ides o%er acontinuous (eriod' causin# $i!e*treatenin#conditions)


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*ad&inister su$!ona&ides +it a !u$$#$ass o! +ater

*record c$ient.s inta,e and out(ut) *&onitor E *obser%e !or e&ato$o#ic reaction tat

&ay $ead to $i!e*treatenin# ane&ias)8ar$y si#ns are sore troat' (ur(ura' and

decreasin# 6BC and ($ate$et counts) *Cec, !or si#ns and sy&(to&s o!

su(erin!ection)


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Client Teaching

*ad%ise (re#nant +o&an to a%oidsu$!ona&ides durin# te $ast ? &ontso! (re#nancy

*in!or& te c$ient not to ta,e antacids+it su$!ona&ides because antacidsdecrease te absor(tion rate)

*teac c$ient to ta,e te su$!ona&ide our be!ore or ; ours a!ter &ea$s +ita !u$$ #$ass o! +ater)


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&ide #,ects

*direct c$ient to re(ort bruisin# orb$eedin# tat cou$d be a resu$t o!dru#*induced b$ood disorder)

*ad%ise c$ient to a%oid directsun$i#t and to use sun b$oc, and(rotecti%e c$otin# to decrease te

ris, o! (otosensiti%e reactions)

pharmacology powerpoint

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