ANTIFUNGAL DRUGS Antifungal drugs

Fungi o Antimycotic drugs

o Polyenes (amphoteracin B and nystatin
 Are single-celled or multicellular organisms whose
o Azoles (ketoconazole)
primary role on the planet is to serve as
o Antimetabolites (flucytosine)
decomposers of dead plants and animals, returning
their elements to the soil for recycling o Echinocandins (caspofungin)
 includes mushroom, yeast and molds. o Antiprotozoals (atovaquone)
 Also known as Dermatophytes
Drugs for Systemic Antifungal infections
 Cause superficial fungal infections involving the
integumentary system, including thee mucous o Amphotericin B(Fungizone Abelcet, amphotec)
membranes, hair, nails and moist skin areas and o Anidulafugin (Eraxis)
respiratory tract o Caspufungin acetate (Cancidas)
Lungs o Flucytosine (5-fluorocytosine, ancobon)
o Micafungin (Mycamine)
 Serve as a route for invasive fungi to enter the body
and infect internal organ. Amphotericin B (Fungizone)

Classification of Fungal Infection  Drug of choice for systemic fungal infections and
currently with close supervision because it can
1. Opportunistic Infection cause number of serious side effects.
 Usually occur in the immunocompromised or  Amphotericin B is effective against numerous
debilitated population (patient who have cancer to fungal diseases, including histoplasmosis,
AIDS) or those taking antibiotic, corticosteroid, Cryptococcosis, Aspergillosis, blastomycosis, and
chemotherapy, or other immunosuppressives candidiasis (systemic infection)
Candida - are part of the normal flora of the mouth, Itraconazole
skin, intestines and vagina
 Drug of choice for the treatment of less severe
 Examples of opportunistic infection ate Systemic infections
Aspergillosis, Cryptococcosis, mucormycotic
2. Non opportunistic Infection Flucytosine (ancobon)
 such as sporotrichosis, blastomycosis,  Sometimes combined with Amphotericin B in the
histoplasmosis and coccidioidomycosis, can occur pharmacotherapy of severe candidiasis
in any individual.  Can cause immunosuppression and liver toxicity
Mycoses - fungal disease and resistance has become a major problem.

Classification of Mycoses

1. Superficial mycoses
 Affect the scalp, skin, nails and mucous Pharmacokinetics of Amphotericin B
membranes such as the oral cavity and vagina
 Mycoses in this type are often treated with topical  Highly protein bound and has a long haft life
drugs because the incidence of side effects is much  5% of the drug is excreted in the urine
lower using this route of administration
 Superficial fungal infections - are sometimes called Pharmacodynamics of Amphotericin B
Dermatophytic
 Amphotericin B is not absorbed from the GT tract
2. Systemic Mycoses  Administered IV in low doses in treating systemic
fungal infection
 Are those affecting internal organs, typically the  Peak effect occurs 1 to 2 hours after IV infusion
lungs, brain and digestive organs. and the duration is 20 hours
 It affects multiple body system and are sometimes
fatal to client with suppressed immune system. Side Effects and Adverse Reactions of amphotericin B
 Systemic myc0ses requires aggressive oral or
 Flush
parenteral medications that produce more adverse
effects than the topical agents  Fever
 Chills
Antifungal drugs/antimycotic drugs  Nausea
 Vomiting
 Are used to treat fungal infections.
 Hypotension, paresthesia, thrombophlebitis
 They are fungistatic or fungicidal depending upon the
susceptibility of the fungus and the dosage
  Nephrotoxicity and electrolyte imbalance o Voriconazole (Vfend)
especially hypokalemia and hypomagnesemia (low  Are used for both systemic and topical infections
potassium and magnesium level)
Clotrimazole (Mycelex)
Nursing Considerations: Systemic antifungal therapy
 Drug of choice for superficial fungal infections of
1. Careful monitoring of client’s condition and providing the skin, vagina and mouth
education as it relates to the prescribed drug treatment
2. [Link] with clients with known Most common adverse Effect of Systemic Azole are:
hypersensitivity to antifungal drugs  Nausea and vomiting, severe nausea may require
3. [Link] cautiously in those with renal impairment or dose reduction or concurrent administration of
severe bone marrow Suppression and in pregnancy antiemetic
4. 4.0btain baseline C/S prior to beginning therapy  Anaphylaxis and rash
5. Obtain baseline and periodic lab test including blood  Menstrual irregularities
urea nitrogen (BUN), creatine CBC, electrolytes and  Gynecomastia in men and decline in testosterone
liver function test level
6. Obtain V/S especially pulse and blood pressure, for  Decreased libido and temporary sterility in men
baseline data because clients with heart disease may
develop fluid overload
7. Closely monitor intake and output as well as weight
8. Immediately report oliguria, changes intake and output
ratios, hematuria or abnormal renal function tests Nursing considerations: Azole Antifungals
9. Can cause ototoxicity, assess for hearing loss, vertigo,
unsteady gait or tinnitus. 1. Contraindicated to client with hypersensitivity to
azole antifungals
Client Teaching 2. Used with caution in clients with renal impairments
3. Obtain BUN, creatine and liver function 3 test
1. [Link] the full course
before therapy begins and throughout the course of
2. [Link] all scheduled appointments and laboratory
treatment
visits for testing
4. [Link] not give ketoconazole (Nizoral) to clients
3. [Link] use
with chronic alcoholism, because additive
4. [Link] changes in appetite, weight loss, or
hepatoxicity may occur
jaundice
5. [Link] for GI side effects like nausea, vomiting,
5. [Link] reliable contraception and notify your
abdominal pain or diarrhea
healthcare provider if pregnancy is planned or
6. 6. Monitor for signs of hepatoxicity Like, pruritus,
Suspected
jaundice, dark urine and skin rash
6. [Link] urine output and drink plenty of fluids
7. [Link] any change in urine output Client Teachings: Azole drugs
Azole 1. [Link] the full course of treatment
2. Report the use of any other prescription or OTC
 Azole groups is effective against candidiasis
medications, herbal remedies, or dietary
(superficial and systemic)
supplements
 It consists of two different chemical classes the
3. Avoid alcohol use
imidazole and the triazoles.
4. Monitor urine output and drink plenty of water
Azole antifungal drugs 5. Practice reliable contraception and notify your
health care provider if pregnancy is planned or
 Interfere with the biosynthesis of ergosterol, suspected
which is essential for fungal cell membranes. 6. mediately report increased Gl distress, anorexia,
Azole class weight loss, jaundice, yellow sclera or dark urine
7. If diabetic, increase the frequency of blood glucose
 the largest and most versatile group of monitoring and report hypoglycemia
antifungals.
 Drugs in this class have broad spectrum and Drugs for superficial fungal infections
maybe used to treat any fungal infection Superficial mycoses
Ketoconazole  Are generally not severe.
 The first effective antifungal drug that was orally  Agents used to treat superficial mycoses are:
absorb o Nystatin (Mycostatin, nilstat, nystex)
o Fluconazole (Diflucan), o Terbinafine (Lamisil)
o intraconazole (Sporanox), o Tolnaflate (Aftate, Tinactin)
o Ketokonazole (Nizoral) Superficial antifungal drugs
 o Much safer than their systemic counterparts Anti-Protozoal Drugs

(book, 540) Protozoa

Nystatin (Mycostatin)  Single celled animals

 These parasites often thrive in condition, where
 Administered orally or topically to treat candida sanitation and personal hygiene are poor and
infections population density is high
 Available in suspension, cream, ointment and  Protozoal infection often occurs in clients who are
vaginal tablet immunocompromised
 Poorly absorb via Gl tract however the oral tablet
form is to treat intestinal candidiasis Antiprotozoal agents
 More common used is in oral suspension for
 Used in the treatment of protozoan infections
candida infections in the mouth
Anti-protozoal drugs
Griseofulvin (Fulvicin)
 Are medicine or drugs used totreat infections or
 Is an inexpensive, older agent given the oral route
disease caused by protøzoa
that is indicated for mycoses of the skin, hair and
 These drugs destroy protozoa or prevent their
nails that have not responded to conventional
growth and ability to produce.
topical preparations
 Available in liquid, tablet and injectable forms
Itraconazole (Sporanox)and Tebinafine(Lamisil)
Common diseases caused by protozoa are:
 Are oral preparations that have the advantage of
 Malaria, Amoebiasis, sleeping sickness
accumulating in nail beds, allowing them to remain
 Toxoplasmosis, trichomoniasis
active many months after therapy is discontinued
 Pnuemocystis Carinii Pnuemonia (PCP)
Miconazole and Clotrimazole
Prototype:
 Are over the counter drugs (OTC) drug of choice
a. antimalarial drugs
for vulvovaginal candida infections.
o Atovaquone and proguanil (malarone)
Tolnaflate and Undecyclenic acid
o Chloroquine hydrochloride(aralen)
 Frequently used to treat athletes’ foot and jock itch o Hydrochloroquinesulfate (Plaquenil)
o Mefloquine (Lariam)
Nursing Considerations
o Primaquine Phosphate
1. Assess for signs of contact dermatitis, if this o Pyrimethamine (Daraprim)
present withhold the drug and notify the primary o Quinine (Quinam)
health care provider
2. Do not use superficial antifungals, such as nystatin b. Antiamebiasis
(mycostatin), intravaginally during pregnancy to
o Metronidazole (Flagyl)
treat infection caused by Gardnerella vaginalis or
o Furozolidone (Furoxone), lodoquinol
trichomonas species
3. Use cautiously in clients who are lactating Mechanism of action
4. The medications maybe "swished and Swallowed"
when used to treat oral candidiasis. Monitor for a. Antimalarial
side effects such as nausea, vomiting and diarrhea  Alters protozoal DNA, depleting folates
when the client is taking high doses and reducing nucleic acid production
5. Monitor for signs of improvement in the mouth and b. Antiamoeba
tongue to evaluate the effectiveness of the  Block protein synthesis
medication
Nursing Considerations for antimalarial drugs
Client teaching: superficial antifungal therapy
1. Antimalarial drugs are contraindicated in clients
1. Complete the full course of treatment: some with hematological disorders or severe skin
infections require pharmacotherapy for several disorders such as psoriasis or during pregnancy
months 2. Used cautiously in client’s with pre-existing
2. If self-treating with OTC preparations, follow the cardiovascular disease and those who are lactating
direction carefully and notify the health care 3. Initial lab works include a CBC, liver and renal
provider if symptoms do not resolve in 7 to 10 days function test and a test for G6PD deficiency.
3. Abstain from sexual intercourse until treatment for Chloroquine (Aralen) may precipitate anemia in
vaginal infection has been Completed clients with G6PD deficiency and may cause bone
4. Perform oral hygiene before using oral lozenges or marrow depression.
swish-and swallow formulations
 4. Obtain baseline ECG because of potential cardiac 3. Used cautiously in clients with peripheral
complications associated with antimalarial drugs neuropathy or pre-existing liver disease and if there
5. Obtain baseline V/S especially BT, BP and hearing is a history of bone marrow depression, because the
and vision testing drug may cause leukopenia
6. Monitor for GI side effects such as vomiting, 4. Safety and efficacy have not been established to
diarrhea and abdominal pain; oral antimalarials can children
be given with food to reduce Gl upset. 5. Obtain initial lab test including a CBC and thyroid
7. Assess for signs of allergic reactions such as and liver function studies
flushing, rashes, edema and pruritus 6. Obtain a baseline V/S and evaluate other drugs
8. Monitor for signs of toxicity, which includes taken by the client for compatibility with
tinnitus with quinine, and severe cardiac antiprotozoal drugs.
complications and CNS complications such as 7. Closely monitor V/S and thyroid function during
seizures and blurred vision with chloroquine therapy because serum iodine may increase and
cause thyroid enlargement with iodoquinol
Client teaching: antimalarial drugs (Yodoxin)
1. Complete the full course of treatment 8. Monitor for GI distress: oral medications can be
2. Take the drugs with food to decrease Gl upset given with food to decrease the incidence of nausea
3. Change position slowly to avoid dizziness and vomiting.
4. Practice reliable contraception and notify your 9. Clients taking metronidazole (Flagyl) may
health care provider if pregnancy is planned or Complain of a dry mouth and metallic taste
suspected 10. Monitor for CNS toxicity such as seizures,
5. Avoid alcohol use paresthesia, and for allergic reaction such as
6. Use caution while performing hazardous activities urticaria and pruritus
7. Immediately report flushing, rashes, edema, Client Teaching: Non-Malarial drugs
itching, tinnitus, blurred vision or seizures
1. Complete the full course of treatment
Pharmacotherapy of Non malarial protozoal Infections 2. Take the drug with foods to decrease GI upset
Plasmodium 3. Practice reliable contraception notify the health
care provider if pregnancy is planned or suspected
 the most significant protozoal disease worldwide, 4. Avoid using hepatotoxic drugs including alcohol to
infections caused by other protozoans affect avoid a possible disulfiram-like reaction (flushing,
significant numbers of people in endemic areas. tachycardia, severe headache, palpitations,
This includes: hypotension, dyspnea
 Amoebiasis, toxoplasmosis, giardiasis 5. Recognize the urine may turn reddish brown as an
 Cryptosporidiosis, trichomoniasis effect of the medication
6. Have any sexual partners treated concurrently to
 trypanosomiasis, leishmaniasis prevent reinfection
7. Immediately report seizures, numbness in limbs,
Amoebiasis nausea, vomiting, hives or itching
 Severe form of diarrhea, the primary Symptoms is
amebic dysentery

Metronidazole (Flagyl)

 traditional drug of choice for non-malarial

protozoal infections like Amoebiasis

Tinidazole (Tindamax)

 Approved by FDA for the treatment of

trichomoniasis, giardiasis and amoebiasis
 This drug is similar to metronidazole but has longer
duration of action that allows for less frequent
dosing.

Nursing Considerations Non malarial drugs

1. Antiprotozoal therapy is contraindicated in clients

with blood dyscrasias or active organic disease of
the CNS and during the 1st month of pregnancy
2. Contraindicated in alcoholics; the medication is not
administered until more than 24 hours after the
clients last drink of alcohol
  Vidarabine (Vira-A), Amantidine (Symmetrel)
 Ribavarin (Virazole), Zidovidine (Retrovir)

Mechanism of Action

 Inhibit virus specific enzymes involve in DNA

synthesis. They control the growth of virus but it
does not cure

Adverse effects: antiviral drugs

 Granulocytopenia, thrombocytopenia
 Nausea, nervousness, headache
 Nephrotoxicity

Acyclovir

 was introduced as an antineoplastic drug and then

later was found to be effective against herpes virus
especially to herpes zoster (Shingles)
 It interferes with the viral synthesis of DNA,
thereby short- circuiting its replication

Oseltamivir phosphate (Tamiflu)

 Use to treat acute uncomplicated influenza

Penciclovir (Denavir) Treatment for herpes labialis

Nursing considerations:

1. Pregnant and breastfeeding precautions

2. Administer IV antivirals to avoid crystallization in
renal tubules
ANTIVIRAL DRUGS 3. Give Ribavirin only with aerosol generator
4. Monitor CBC and creatinine level
Viruses 5. Refer for signs of bleeding
6. Take amantadine after meals
 Are nonliving agents that infect bacteria plants, and
animals. Antiviral HIV drugs
 Contain none of the cellular organelles necessary
for self-survival that are present in living organisms  Reverse transcriptase inhibitor
 More difficult to eradicate than most type of  Protease inhibitors
bacteria
 Viruses enter healthy cells and use their Reverse transcriptase inhibitors
deoxyribonucleic (DNA) and ribonucleic acid  Didanosine (Videx)
(RNA) to generate more viruses  Zalcitabine (Hivid)
Antiviral drugs  Zidovudine (Retrovir)

 Are class of medication used specifically for Protease Inhibitor

treating viral infections rather than bacterial ones
 Indinavir (Crixivan)
 Most antivirals are used for specific viral
 Ritonavir (Norvir)
infections.
 Antiviral drugs do not destroy their target
pathogen; instead they inhibit their development.

Broad spectrum antiviral- is effective against a wide

range of viruses

Therapeutic Use: Antiviral drugss

 They designed to help deal witb HIV, herpes

viruses, hepatitis B and C viruses, and influenza A
and B.

Prototype:

 Acyclovir (Zovirax, Ganciclovir (Cytovene)

 Nursing Considerations

1. Treat all the family members for nematodes

infection to prevent recurrence
2. Praziquantel must swallowed rapidly because of its
bitter taste to avoid gagging
3. Other antihelmintic drugs should be chewed
4. Complete the full course of treatment
5. Have close personal contacts treated Concurrently
to prevent reinfestation.
6. Report itching and hives, fatigue, fever, anorexia,
dark urine and abdominal pain.

ANTI HELMINTHIC DRUGS

Helminths

 Consist of various species of parasitic worms

which have more complex anatomy, physiology
and life cycles than the protozoans
 The most common site for helminthiasis (worm
infestation) is in the intestines
 Other sites for parasitic infestation are the
lymphatic system, blood vessels, and liver

Ascariasis- the most common helminth disease in the world.

Group of helminths includes:

1. Cestodes (tapeworms
2. Trematodes (Flukes)
3. Intestinal nematodes (Round worms
4. Tissue invading nematodes (tissue round Worms
and filariae

Anthelmintic drugs

 Are medicines that rid the body of parasitic worms

 Available with physician’s prescription

Prototype:

 Mebendezole (vermox), thiabendazole

 Niclosamide (Niclocide),
 Piperazine (Antepar)
 Praziquantel (Biltricide)

Actamer - antihelminthic drug that is effective against flukes

Mechanism of action: anthelminthic drugs

 Paralyze larva and adult helminths by acting on

parasite microtubules

Adverse Effects:

 GI distress - anorexia, vomiting nausea and

occasionally diarrhea and stomach Cramps, urinary
odor (thiabendazole
 Neurologic problems - dizziness, weakness
headache and drowsiness, fatigue
 Note: The primary goal of antibiotic therapy is to kill
enough bacteria, of to slow the growth of the infection, so
that natural body defenses can overcome the invading agent.

Anti-infective Agents

Anti-infective

 Is a general term for any medication that is

effective against pathogens.

 Although antibiotic is more frequently used, this

term refers only to natural substances produced by
microorganism that can kill another microorganism

Bactericidal/bactericidal

 Medications that accomplish this goal by killing the

bacteria

Bacteriostatic

 This drug will not kill the bacteria but instead slow
their growth, depending on the body's natural
defense to dispose microorganism

 Growth slowing drugs

Mutation or errors in genetic code

 Microorganism have the ability to replicate

extremely rapidly.

 Occur spontaneously and randomly throughout the

bacterial chromosomes.

Acquired resistance

 Clients develops an infection that is resistant to

conventional drug therapy.

Broad spectrum antibiotic

 are effective against many different species of

pathogens

Narrow spectrum antibiotic

 Effective against only one or a restricted group of

microorganisms

Culture and sensitivity test

 Process of growing the pathogen and identifying

the most effective antibiotic

Superinfection

 Appearance of secondary infection

 Occur when microorganisms normally present in

the body are destroyed

Host flora

 Normal microorganism, inhabit the skin, upper

ANTITUBERCULAR AGENT
respiratory, genitourinary and intestinal tract
Anti-infective Agent
  Antitubercular o Rifampin (Rifadin, Rimactane)

 Antifungals o Rifapentine (Priftin)

 Antivirals o Rifater: combination of PZA with INH and

rifampin.
 Antiprotozoal
o Streptomycin
 Anthelminthics
(adverse effect on book p. 507)
Antitubercular drugs
2. Second line drugs
Tuberculosis
 More toxic and less effective than the first line
 Is caused by the acid-fast bacillus Mycobacterium drugs
tuberculosis or tubercle bacillus.
 Used when resistance develops.
 One of the world’s major health problems, killing
one person than any other infectious disease, o Amikacin (Amikin)
including acquired immunodeficiency syndrome
(AIDS)-immune dis order characterized by o Capreomycin (Capastat Sulfate)
opportunistic diseases o Ciprofloxacin (Cipro)
Tubercles- slow growing mycobacterium usually become
o Cycloserine (Seromycin)
dormant, existing inside cavities
o Ethionamide (Trecator-SC)
Antitubercular drugs
o Kanamycin (Kantrex)
 Agents that treat tuberculosis

Streptomycin o Ofloxacin (Floxin)

 The first drug used to treat TB, ands given Combination of INH and PZA
parenteral antibiotic  Is approved for tuberculosis prophylaxis ih HIV
Isoniazid (INH) positive patients for a short-term therapy of 2
months.
 Was the first oral drug preparation effective
against the tubercle bacillus and was Rifampin and PZA
discovered in 1952.  Recommended to HIV positive patient with
 A bactericidal drug that inhibits tubercle cell positive TB skin test as prophylactic for 2 months
wall synthesis and blocks pyridoxine (Vit.B6), Isoniazid
which is used for intracellular enzyme
production.  The primary antitubercular drug used and may
cause isoniazid-induced liver damage
Note: Drug therapy of TB differs from that of most other
infections. Mycobacteria have a cell wall that is resistant to  Must be taken with Pyridoxine (Vit B6) to avoid
penetration by antibiotic. deficiency and peripheral neuropathy.

o 6 to 12 months medications to reach the isolated 2 Types of Mycobacteria Infects Humans

microorganism in the tubercles.
1. Mycobacterium Leprae
o 24 months is needed when the clients develop
 Responsible for leprosy
multidrug resistant
 Treated with multiple drugs, usually
o 6 to 24 months-different combinations of drugs
beginning with rifampin
may be used. At least 2 and sometimes 4 or more
antibiotics is administered Concurrently 2. Mycobacterium Avium Complex (MAC)
2 Broad Categories of Antitubercular Drugs  Causes infection of the lungs, most
commonly observed in AIDS.
1. First line drugs
Macrolides Azithromycin (Zithromax) and Clarithromycin
 Are safer and generally the most effective
(Biaxin)
o Ethambutol (Myambutol)
 Effective drugs against MAC
id (INH) Pyrazinamide (PZA) Multi Drugs Therapy
 o Isoniazid and Rifampin 5. Use caution to a client with history of convulsion
disorder
o Isoniazid, Rifampin and Ethambutol
6. Use caution with in clients having chronic liver
o Isoniazid, Rifampin and Pyrazinamide disease or alcoholism because of the risk of hepatic
injury due to the production of toxic levels of drugs
Pharmacokinetics
metabolites.
 UNH – well absorbed in the GI tract
7. Ethambutol ((Myambutol) is contraindicated in
 Administered IM clients with optic neuritis

 Has low protein binding rate (10%) 8. Antituberculosis drugs interact with oral
contraceptives and decrease their effectiveness,
 Half-life: 1-4 hours female clients with childbearing potential should
use an alternative form of birth control
 Isoniazid is metabolized in the liver and
75% of the drug excreted in the urine Client Teaching:
Pharmacodynamic 1. Immediately report yellow eye and skin, loss of appetite,
dark urine or unusual tiredness
 Inhibits cell wall synthesis of the tubercle bacillus
2. Take supplemental vitamin B^ as ordered to reduce risk
 Peripheral neuropathy is an adverse reaction to of adverse effects
isoniazid, so pyridoxine (vitamin B6) is usually
taken to decrease probability of neuropathy 3. If taking isoniazid, avoid food containing tyramine, such
as age cheese, smoked and pickled fish, beer, and red
 Should not be taken with alcohol will increase the wine, bananas and chocolate
incidence of peripheral neuropathy
4. Wash hands frequently and cover the mouth when
 Antacids decreases isoniazid absorption coughing, or sneezing. Properly dispose of soiled tissues

5. If taking oral contraceptives, use an alternative form of

 If phenytoin is taken with isoniazid, the effect of
birth control during antitubercular drug therapy
phenytoin will decrease
6. Complete the full course of treatment
Side Effects and Adverse Effects

 Isoniazid – peripheral neuropathy

 INH, Rifampin, Streptomycin – hepatotoxicity

patient may develop headache, blood dyscrasias, Tetracyclines
paresthesia, GI distress and ocular toxicity  Acts by inhibiting bacterial protein synthesis, by
 Rifampin – turns body fluid orange binding to the bacterial ribosome and have a
bacteriostatic effect
 Ethambutol – may develop dizziness, confusion,
hallucination and joint pains  Is isolated from streptomyces aureofaciens in 1948

Streptomycin – ototoxicity, optic nerve toxicity,  The first broad spectrum antibiotics effective
encephalopathy, angioedema, CNS and respiratory against gram positive and gram-negative bacteria
depression nephrotoxicity and ototoxicity and many other organisms – mycobacteria,
rickettsia, spirochetes and chlamydia.
Nursing Consideration:
Example of tetracycline drugs
1. Assess for the presence of or history of a positive
tuberculin skin test, positive sputum culture, or a o Demeclocycline (declomycin)
close contact to a person recently infected with TB o Doxycycline (vibramycin, others)
2. Assess the patient for a history of alcohol abuse,
o Minocycline (minocin)
AIDS, liver disease, or kidney disease because
many antituberculosis drugs are contraindicated in o Methacycline (rondomycin)
those conditions
o Tetracycline (achromycin, others)
3. Assess for concomitant use of immunosuppressant
drugs o Tigecycline (tygacil)

4. Use caution in clients with renal dysfunction, Therapeutic Effects:

pregnancy and lactation
 Rocky mountain spotted fever

 Typhus
  Cholera 8. Provide alternative contraceptives methods during
the course of therapy
 Lyme disease
9. Use with caution in clients with impaired kidney or
 Peptic ulcer caused by helicobacter pylori liver function
 Chlamydial infections 10. Contraindicated to pregnancy or lactation and
children below 8 years old.
Adverse Effects:
Client Teachings
 GI system – N/V, diarrhea is the common,
abdominal pain 1. Do not save medication, because toxic effects may
occur if it is taken past the expiration date
 Musculoskeletal – tetracycline accumulates on
teeth and bones leading to weakening of the 2. Do not take these medications with milk products,
bones/teeth and permanent staining and iron supplements, magnesium – containing
discoloration laxatives or antacids

 Skin – photosensitivity and rashes 3. Wait 1 to 3 hours after taking tetracyclines before
taking antacids
Photosensitivity – an extreme sensitivity to ultraviolet rays
from the sun and other light sources. 4. Wait at least 2 hours before or after taking
tetracyclines before taking lipid-profile drugs such
Drug to Drug Interaction: as colestipol (colestid) and cholestyramine
(questran)
 Penicillin – decrease effectiveness
5. Complete the full course of treatment
 Oral contraceptives – decreases effectiveness.
Advice alternative methods of contraception 6. Immediately report abdominal pain, loss of
appetite, nausea and vomiting, visual changes and
 Digoxin – toxicity rises
yellowing of the skin
Drug – food interaction
7. Avoid exposure to direct sunlight: use sunscreen
 Dairy products – render unabsorbable and protective clothing to decrease the effects of
photosensitivity
 Give on an empty stomach
Macrolides
 Ca and Fe bind – decrease drug absorption
 Inhibit protein synthesis by binding to the bacterial
ribosome

 Bind to the bacterial cell ribosomes and change or

alter protein production/function leading to
Nursing Considerations: impaired cell metabolism and division
1. Assess for a history of hypersensitivity to  Effective against most gram positive and many
tetracyclines gram-negative species
2. Obtain C/S results before therapy is initiated  Indicated for the pharmacological treatment of
3. Assess for the presence or history of acne vulgaris, respiratory disorders
actinomycosis, anthrax, malaria, syphilis, UTI  Safe alternative to penicillin
rickettsia infection, and Lyme disease. Tetracycline
can treat all this disease. Example:

4. Perform CBC and kidney and liver functions o Azithromycin (Zithromax)

studies.
o Clarithromycin (biaxin)
5. Monitor the clients body temperature and WBC
and C/S results to determine the effectiveness of o Dirithromycin (dynabac)
the treatment and observe for superinfections
o Erythromycin (e-mycin,
6. Protect the patient from exposure to the sun with erythromycin)
adequate clothing and sunscreen
Azithromycin (Zithromax) – has extended half life that is
7. Instruct the patient to take the meds without food administered only for 3 to 4 days
and with full glass of water.
Erythromycin – the first macrolides, was derived from the
fungus like bacteria streptomyces erythreus in 1950
Indication: 10. Closely monitor client receiving warfarin
(coumadin) because macrolides may decrease
 For the treatment of whooping cough, legionnaires warfarin metabolism and excretion
disease and infection by streptococcus, H.
influenza, and Mycoplasma pneumoniae Client Teaching:

 Used against bacteria inside host cell such as 1. Complete the full course of treatment
listeria, chlamydia, diphtheria, pertussis and
gonorrhea 2. Do not take macrolides with fruit juices

Adverse effects: 3. Do not take other prescription drug or OTC

medications, herbal medicines, vitamins and
 GI system – diarrhea and abdominal cramps are the minerals without informing health care provider
most common side effects, anorexia, vomiting and
4. Immediately report severe skin rashes, itching or
pseudomembranous colitis.
hives, DOB, yellowish of skin or eyes, dark urine
 CNS – reversible hearing loss, tinnitus, vertigo or pale stools

 Skin – rashes, urticaria Aminoglycosides

 Hepatoxicity – if taken in large dose with other  Are bactericidal and act by inhibiting bacterial
hepatoxic drugs. protein synthesis and causing synthesis of
abnormal proteins.
 Anaphylaxis, ototoxicity, hepatoxicity,
superinfection is the serious adverse effect. Streptomycin – fist aminoglycosides and was named after
streptomyces griseus, the soil organism from it was isolated
Drug Interactions: in 1942

 Macrolides can increase serum level theophylline  Used to treat tuberculosis

(bronchodilator), carbamazepine (anticonvulsant),
and warfarin (anticoagulation) – closely monitor  Drug of choice to treat tularemia and bubonic
the drug serum level pneumonic forms of plaque

Therapeutic use:
 Erythromycin – should not be used with other
macrolides to avoid severe toxic effect o Reserved for serious systemic infections caused by
 Antacids – may reduce azithromycin peak levels aerobic gram-negative organisms including those
when taken at the same time caused by E. coli, Serratia, proteus, klebsiella and
pseudomonas
Nursing Considerations:
o Sometimes administered concurrently with
1. Assess for the presence of respiratory infection penicillin, cephalosporins, or vancomycin for
treatment of enterococci infections.
2. Assess for GI tract infections, skin and soft-tissue
infections, otitis media, gonorrhea o When used for systemic bacterial infection,
aminoglycosides are given parenterally (IM, IV)
3. Examine the patient for a history of cardiac
because they cannot be absorbed from GI tract and
disorders, because macrolides may exacerbate
cannot cross into the placenta
existing heart disease.
o Neomycin – frequently used as preoperative bowel
4. Assess for history of hypersensitivity
antiseptic
5. Obtain C/S testing before initiating macrolides
o Paromomycin – useful in treating intestinal
therapy.
amoebiasis and tapeworm manifestation given
6. Do not administer macrolides to client with serious orally
hepatic impairment
Example of Aminoglycosides Drugs:
7. Used cautiously in pregnant or breastfeeding
 Amikacin (amikin)
woman to avoid harm to the fetus or newborn
 Gentamicin (garamycin, others)
8. Macrolides should be used cautiously in clients
receiving Cyclosporine (sand immune) and drug  Kanamycin (kantrex)
level must be monitored because of high risk for
nephrotoxicity  Neomycin (mycifradin)

9. Perform coagulation laboratory studies such as  Netilmicin (netromycin)

international normalized ratio (INR)
 Paromomycin (humatin)
  Streptomycin o Ciprofloxacin (cipro) – an agent of choice for
postexposure prophylaxis of bacillus anthracis
 Tobramycin (nebcin)
o Moxifloxacin (avelox) and trovafloxacin (trovan) –
Adverse Reactions:
are highly effective against anaerobes
o Pain on the injection sites, rash, fever, nausea,
o Levofloxacin (Levaquin) – is used primarily to
diarrhea, dizziness and tinnitus
treat respiratory problems such as CAP, chronic
o Nephrotoxicity, ototoxicity, anaphylaxis – serious bronchitis, acute sinusitis, and UTI
adverse reaction of aminoglycosides
Fluoroquinolones drugs:
Ototoxicity – recognized by hearing impairment, dizziness,
1. First Generation
loss of balance, persistent headache and ringing in the ear
(tinnitus) o Nalidixic acid (neogram) – the first drug
in this class, approved in 1926
Nephrotoxicity – is recognized by abnormal urine function
test such as elevated serum creatinine or BUN o Had a narrow spectrum of activity and was
restricted use to UTI
Nursing Consideration:
2. Second Generation
1. Assess the client for a history of previous allergic
to aminoglycosides o Ciprofloxacin (cipro)
2. Monitor for nephrotoxicity and ototoxicity during o Norfloxacin (noroxin)
the course of the therapy
o Ofloxacin (floxin)
3. Assess baseline auditory and vestibular functions
prior administration and throughout the therapy o Lomefloxacin (maxaquin)
4. Assess baseline renal function and obtain results of 3. Third Generation
urinalysis
o Gatifloxacin (tequin)
5. Used with caution in neonates, infants and elderly
clients o Levofloxacin (Levaquin)

Client Teaching 4. Fourth Generation

1. Increase fluid intake o Gemifloxacin (factive)

2. Complete the full course of treatment o Moxifloxacin (avelox)

3. Immediately report tinnitus, high frequency hearing o Trovafloxacin mesylate (trovan)

loss, persistent headache, nausea or vertigo
Adverse effects:
4. Monitor clients for diarrhea, stomatitis, glossitis
and vaginal discharge.  GI system: nausea, vomiting and diarrhea – the
most common side effects
Fluoroquinolones
 Dry mouth, rash, restlessness, pain and
 Are bactericidal and effect DNA synthesis by inflammation at the insertion site, local burning,
inhibiting two bacterial enzymes: DNA gyrase and stinging and corneal irritation (ophthalmic)
topoisomerase
 CNS- dizziness insomnia, headache and depression
 To interfere with the enzyme DNA gyrase, which is
needed to synthesize bacterial deoxyribonucleic  Hema- bone marrow depression, photosensitivity
acid (DNA)
 Dysrhythmias (gatifloxacin and moxifloxacin) and
 Once served only for UTI’s because of the toxicity liver failure (trovafloxacin) – the most serious
adverse effects
Therapeutic use:
Contraindications and Precaution of Fluoroquinolones:
o Effective against some gram-positive organisms,
such as streptococcus pneumoniae and against  Found to cause significant damage to the cartilages
Hemophilus influenzae, P. aeruginosa, salmonella that they are given cautiously ot growing children
and shigella and adolescents less than 18 years old example
Ciprofloxacin (cipro)
o Useful in the treatment of UTI, bone and joint
infection, bronchitis, pneumonia, gastroenteritis  Pregnancy and lactation
gonorrhea, typhoid.
  Caution to client with epilepsy, cerebral 6. Give enoxacin (penetrex) and nofloxacin (noroxin)
atherosclerosis on an empty stomach

Nursing Considerations: 7. Administer fluoroquinolones at least 2 hours before

these drugs
1. Assess for allergic reaction to fluoroquinolones
8. Frequently monitor coagulation studies if these
2. Monitor WBC count – because the agent may antibiotics are administered concurrently with
decrease leukocytes warfarin (coumadin) – because of interactions that
3. Obtain culture and sensitivity test may lead to increase anticoagulation effects

4. Monitor clients with liver and renal dysfunction – 9. Monitor urine output and report quantities of less
because the drug is metabolized in the liver and than 1000 ml in 24 hours
excreted in the kidney 10. Inform clients receiving norfloxacin (noroxin) that
5. Antacids and ferrous sulfate may decrease the photophobia is possible
absorption of fluoroquinolones – reducing
antibiotic effectiveness

Client Teaching:

1. Wear sunglasses, avoid exposure to bright lights and direct sunlight when taking norfloxacin (noroxin)

2. Complete the full course of treatment

3. Immediately report signs of tendon pain or inflammation

Immediately report dizziness, restlessness, stomach distress, diarrhea, psychosis, confusion or irregular or fast heart rate

ANTIBACTERIAL AGENTS

Pathogen

 An organism that can cause a disease

Human Pathogens include:

a. Viruses

b. Bacteria

c. Fungi

d. Unicellular organisms

e. Multicellular animals

Pathogens may enter through:

a. broken skin

b. Ingestion

c. Inhalation

d. Contact with mucous membrane such as the nasal, urinary, or vaginal mucosa

Pathogenicity

 Ability of an organism to cause infection

Virulence

 Another common word used to describe pathogen

 Refers to the degree of pathology caused by the organism (Definition not from ppt)

Bacteria
  Are single celled organisms lacking a true nucleus and nuclear membrane.

CLASSIFYING A BACTERIA

1. One of the simplest methods of classifying bacteria is to examine them microscopically after a crystal violet Gram
stain is applied.  

a. Gram-positive bacteria - bacteria that contain a thick cell wall and retain a purple color after staining. 

Eg. staphylococci, streptococci, and enterococci, clostridium perfringens

b. Gram-negative bacteria - bacteria that have thinner cell walls will lose the violet stain.

Eg. bacteroides, Escherichia coli, klebsiella, pseudomonas, and salmonella.

2. A second descriptive method is based on cellular shape.

Bacteria assume several basic shapes that can be readily determined microscopically. 

a. Rod shapes are called bacilli

b. Spherical shapes are called cocci

c. Spirals are called spirilla

Staphylococci - cocci appear in clusters

Streptococci - cocci are arranged in chain

Note: Bacteria reproduce by cell division about every 20 minutes.

3. A third factor used to classify bacteria is based on their ability to use oxygen.

a. Aerobic - bacteria that thrive in an oxygen-rich environment

b. Anaerobic - bacteria grow best without oxygen

Antibacterial

 An agent that inhibits bacterial growth or kills bacteria

 Are prescribed to combat disease producing microorganism

NOTE: Antibacterial, antimicrobial, and antibiotic are frequently used interchangeably, there are some subtle differences in
meaning

Antibacterials and antimicrobials

 Are substances that inhibit bacterial growth or kill bacteria and other microorganisms

Antibiotics

 Refers to chemicals produced by one kind of microorganism that inhibits the growth of or kills another.

Bacteriostatic

 Drugs inhibit the growth of bacteria 

Eg. tetracycline and sulfonamides have bacteriostatic effect

Bactericidal
  Drugs kill bacteria

Eg. penicillin and cephalosporins have a bactericidal effect

MECHANISM OF ANTIBACTERIAL ACTION

ACTION EFFECT DRUGS

a. Inhibition of cell wall  Bactericidal effect  Penicillin

synthesis
 Enzyme breakdown of cell  Cephalosporins
wall
 Bacitracin
 Inhibition of enzymes in
synthesis of cell wall  Vancomycin

b. Alteration of membrane  Bacteriostatic or bactericidal  Amphotericin B

permeability effect
 Nystatin
 Increase membrane
permeability. Loss of cellular  Polymyxin
substances causes lysis of the
 Colistin
cell

c. Inhibition of protein synthesis  Bacteriostatic or bactericidal  Aminoglycosides

effect
 Tetracyclines
 Interferes with protein
synthesis w/o affecting the  Erythromycin
normal cells
 Lincomycin
 Inhibit steps of protein 
synthesis

d. Inhibition of synthesis of  Inhibit synthesis of RNA and  Fluoroquinolones

bacterial ribonucleic acid DNA in bacteria.
(RNA) and deoxyribonucleic
acid (DNA)  Binds to nucleic acid and
enzymes needed for nucleic
acid synthesis

e. Interference with metabolism  Bacteriostatic effect  Sulfonamides

within the cell/ Interference
with cellular metabolism  Interferes with steps of  Trimethoprim
metabolism within the cell
 Isoniazid (INH)

 Nalidixic acid

 Rifampin
Pharmacokinetics 

 Antibacterial drugs must not only penetrate the bacterial cell wall concentration and have an affinity to the binding sites
on the bacterial cell

 Have a longer half-life 

 Steady state of the antibacterial drug occurs after the fourth to fifth half lives 

 Eliminated through the urine after the 7th half life 

Pharmacodynamics 

 The drug concentration at the site or exposure for the drug plays an important role in bacterial eradication 

 Antibacterial drugs are used to achieve a minimum effective concentration(MEC) necessary to halt the growth of a
microorganism 

Resistance to antibacterials 

 Bacteria may be sensitive or resistant to certain antibacterials. 

 When bacteria are sensitive to a drug, the pathogen is inhibited or destroyed

 If the bacteria are resistant to antibacterial, the pathogen continuous to grow, despite the administration of the
antibacterial drug 

Bacterial Resistance can be: 

a. Natural or inherent - resistance occurs without previous exposure to the antibacterial drug.

b. Acquired resistance - caused by prior to exposure to the antibacterial 

Nosocomial infection or Hospital acquired infection 

 infection acquired while patient is hospitalized 

Methicillin-resistant Staphylococcus aureus (MRSA) 

 Highly resistant bacteria 

 Resistant not only to methicillin, but to all penicillins and cephalosporins as well.

Vancomycin — treatment of choice for MRSA 

General adverse reaction to antibacterial drugs 

 Allergy/hypersensitivity reactions 

 Superinfection 

 Organ toxicity 

Allergy and hypersensitivity 

 allergic reaction to drugs may be mild to severe

 Sensitivity test must be performed prior to administration of the prescribed dose 

 Examples of mild reactions are rash, pruritus (severe itching of the skin, symptoms of various ailments) and
hives/urticaria (allergic skin reactions causing localized redness, swelling and itching.
  Example of severe response is anaphylactic shock. 

Anaphylaxis - a serious allergic response that often involves swelling, hives, lowered blood pressure

 Results in vascular collapse, laryngeal edema. Bronchospasm and cardiac arrest.

 If not treated immediately, it can be fatal. 

DOB - frequently the first symptoms of anaphylaxis. 

Antihistamine — treatment for mild allergic reaction 

Superinfection 

 Secondary infection that occurs when the normal microbial flora of the body is disturbed during antibiotic therapy. 

 Can occur in the mouth, respiratory tract, intestines, GUT and skin 

 Is rarely to develop when the drug is administered for less than 1 week 

 Nystatin-used for fungal infection of the mouth 

Organ toxicity 

 Liver and kidney are involved in drug metabolism and excretion. 

 Antibacterials may result in damage to these organs. 

 Example: aminoglycosides can be nephrotic (as well as ototoxic) 

NARROW SPECTRUM ANTIBIOTICS 

 Primarily effective against one type of organism 

 Example: Penicillin and erythromycin are used to treat infection caused by gram positive bacteria. 

BROAD SPECTRUM 

 Effective against gram positive and Gram-negative organisms

 Used to treat when the offending microorganism is not identified by C/S test

 Tetracyclines and cephalosporins 

Culture sensitivity test 

Culture 

 test to find germs (bacteria or a fungus) that can cause a disease 

Sensitivity

 test is to see what kind of medicine such as antibiotic, will work best to treat the illness or infection 

ANTIBACTERIAL AGENTS 

 Penicillin

 Cephalosporins

 Macrolides

 Tetracyclines 

 Aminoglycosides

 Fluoroquinolones 
PENICILLINS AND CEPHALOSPORINS 

Penicillin

 Natural antibacterial agent obtained from the mold genus Penicillium

 Miracle drug

 First mass produced antibiotic.

 Pen G was the first to be administered orally and by injection 

 Food interferes with absorption 

Penicillin V 

 Was the next type of penicillin produced

 Is effective against mild to moderate infections, including anthrax as a biological weapon of bioterrorism 

Pharmacotherapy with penicillin 

Penicillin — kill bacteria by disrupting their cell wall 

Gram-positive bacteria - most common affected by penicillin including streptococci and staphylococci

 Are indicated for the treatment of pneumonia, meningitis, skin, bone and joint infections

 Mainly referred to as beta lactam antibiotics 

Beta lactam ring 

 Portion of the chemical structure of penicillin that is responsible for its antibacterial activity.

 Interferes with bacterial cell wall synthesis by inhibiting the bacterial enzyme that is necessary for cell division and
cellular synthesis. 

Beta lactamase or penicillinase 

 Bacteria secretes an enzyme 

 Bacteria can produce a variety of enzymes that can inactivate penicillin and other beta-lactam antibiotics such as
cephalosporins. 

BASIC PENICILLINS 

 Penicillin G procaine

 Penicillin G benzathine

 Penicillin G sodium

 Penicillin V potassium 

Penicillinase-resistant penicillin (antistaphylococcal penicillin) 

 Effective against penicillinase- producing bacteria 

 Used to treat penicillinase producing S aureus

 Example: 

Oxacillin (prostaphlin, bactocill)

Cloxacillin (tegopen, cloxapen)

Dicloxacillin (dynapen)

Nafcillin (nafcil, unipen) 

Broad spectrum penicillin (aminopenicillin)

  Effective against a wide range of microorganism 

 Use to treat both Gram-positive and Gram-negative bacteria 

 Example: 

Ampicillin (polycillin,omnipen) 

Amoxicillin (Amoxil, trimox, himox) 

Amoxicillin — clavulanate (augmentin) 

Bacampicillin (spectrobid) 

Ampicillin — sulbactam (Unasyn) 

EXTENDED SPECTRUM PENICILLINS (anti pseudomonal penicillin)

 Effective against even more microbial species including pseudomonas aeruginosa, enterobacter, Klebsiella and
bacteroides fragilis.

 Carbenicillin (Geocillin,geopen)

 Piperacillin sodium (pipracil)

 Mezlocillin sodium (Mezlin)

 Piperacillin tazobactam (zosyn) 

Beta Lactamase Inhibitors

 Broad spectrum antibiotic (amoxicillin) combined with a beta lactamase (enzyme) inhibitor (clavulanic acid), resulting
antibiotic (amoxicillin-clavulanic acid [Augmentin]) inhibits the bacterial lactamases, making the antibiotic effective and
extending the microbial effect. 

 Oral use: amoxicillin-clavulanic acid (Augmentin)

 Parenteral use: ampicillin sulbactam (Unasyn), piperacillin-tazobactam (Zosyn) and ticarcillin-clavulanic acid
(Timentin) 

GENERAL SIDE EFFECTS AND ADVERSE REACTIONS 

Side effects and adverse reactions 

 Hypersensitivity

 Superinfection (occurrence of a secondary infection when the flora of the body is disturbed)

 Nausea

 Vomiting

 Diarrhea

 Rash

 Anaphylactic reaction 

NURSING INTERVENTIONS 

 Observe for hypersensitivity reaction 

 Carry out C/S test before the start of therapy

  Check for signs of superinfection like abdominal cramping and diarrhea 

 Examine patient for allergic reaction 

 Check for bleeding with high doses of penicillin

 Have epinephrine ready for severe allergic reaction 

 Monitor electrolytes and renal function test prior to and during therapy 

 Monitor for hyperkalemia and hypernatremia prior to and during the therapy. 

 Teach the client to take the medicine completely 

 Administer 1-2 hours before meals or 2 to 3 hours after meals for best absorption 

 Provide small frequent meal, frequent mouth care ice chips or sugarless candy to suck if stomatitis and sore throat occur 

 Wear a medical alert bracelet if allergic to penicillin 

 Do not give acidic fruit juices because it can inactivate the drugs antibacterial activity

 Encourage to increase fluid intake 

 Avoid use of penicillin while breastfeeding 

 Immediately report rash, severe abdominal or stomach cramps, abdominal tenderness, convulsions, decreased urine
output and severe watery diarrhea or bloody diarrhea

 Consult with your healthcare provider about taking probiotic supplements or cultured dairy products during antibiotic
therapy 

CEPHALOSPORINS 

 First discovered in seawater-fungus called cephalosporium acremonium 

 Are bactericidal and act by attaching to penicillin binding proteins to inhibit bacterial cell wall synthesis 

 Have a beta lactam ring that is mostly responsible for their antimicrobial activity. 

 The primary therapeutic use as a class is for gram negative infection and the clients who can't tolerate the less expensive
penicillin

 Effective against gram positive and Gram negative bacteria and resistant to beta lactamase (an enzyme that acts against
the beta lactam structure of penicillin)

 Cause bacteria cell lysis and bacterial cell dies 

Four Generations of Cephalosporins 

1. First generation cephalosporins 

 Most effective against gram positive bacteria (streptococci, and most staphylococci). Effective against most gram
negative bacteria (E. Coli, species of Klebsiella, Proteus, Salmonella and Shigella) 

Therapeutic Indication: respiratory tract (strep pneumonia) otitis media and skin infection

Drugs example: 

Cephalexin (Keflex) 

Cefazolin sodium (Ancef, kefzol) 

Cefadroxil (duricef) 

Cephapirin (cefadyl) 

2. Second generation cephalosporins

  More potent, more resistant to beta lactamase, and exhibit a broader spectrum against gram negative organisms
(Haemophilus influenzae, Neisseria gonorrhea, Neisseria meningitidis and several anaerobic organisms) than the first
generation drugs.

 Less effective against Gram-positive bacteria 

Drugs example: 

Cefaclor (ceclor)

Cefuroxime (ceftin, kefurox, zinacef) 

Cefmetazole (Zefazone). 

3. Third generation cephalosporins

 Have a longer duration of action than 2nd generation agents

 Broader spectrum against gram negative organisms, and are resistant to beta lactamase.

 Sometimes the drug of choice against infection by pseudomonas, klebsiella, neisseria, proteus, and haemophilus
influenza.

 Less effective against gram positive bacteria.

Drugs example: 

Cefixime (suprax)

Cefdinir (Omnicef) 

Ceftriaxone (rocephin)

Cefotaxime (claforan) 

4. Fourth generation cephalosporins 

 Effective against organisms that have developed resistance to earlier cephalosporins.

 3rd and 4th generation agents — are capable of entering the cerebrospinal fluid (CSF) to treat CNS infections.

 Effective against [Link], klebsiella, Proteus, streptococci, certain staphylococci, Pseudomonas aeruginosa 

Drugs example:

Cefepime (Maxipime) 

NOTE: monitor I/O, blood urea nitrogen (BUN), serum creatinine 

Side effects and Adverse reactions 

GI system - nausea, vomiting, diarrhea, anorexia, abdominal pain, and flatulence are common effects 

CNS - headache, dizziness, lethargy and paresthesia have been reported 

 Renal system - nephrotoxicity in individuals with existing renal disease. 

 Fatigue, pruritus, pain on the injection site. 

Pseudomembranous colitis, nephrotoxicity, and anaphylaxis - serious adverse reaction 

DRUG-to-DRUG Interactions: 
  If taken with alcohol — may result in disulfiram (Antabuse). Symptoms of this reaction include severe vomiting,
weakness, blurred vision and profound hypotension, nausea, flushing, dizziness, headache.

 Disulfiram like drug - a drug that causes an adverse reaction to alcohol 

Nursing Interventions

1. C/S should be done before the therapy 

2. Assess for the presence or history of bleeding disorders because cephalosporins may reduce prothrombin levels through
interference with vitamin K metabolism. 

3. Assess the renal and hepatic function, because most cephalosporins are eliminated by the kidney, and liver function is
important in vitamin K production.

4. Use with caution on clients with penicillin allergy 

5. Use with caution in pregnant or lactating women because the drug can be transferred to the fetus. 

CLIENT TEACHINGS

1. Avoid alcohol use 

2. Eat cultured dairy products to help discourage superinfection like yogurt, kefir 

3. May cause false positive urine glucose test 

4. Keep drugs out of reach of small children

5. Use childproof containers 

6. Report signs of superinfection - mouth ulcers, discharge from genital or anal area

7. Ingest buttermilk or yoghurt to prevent superinfection of intestinal flora 

8. Take complete course of medication even if infection have ceased 

9. Observe for hypersensitivity reaction