PLT COLLEGE INC.

BAYOMBONG, NUEVA VIZCAYA

Institute of Health Sciences- College of Nursing

Pharma notes

ANTIBACTERIALS
1. PENICILLIN A natural antibacterial agent obtained from the mold genus Penicillin. A miracle drug during the WW1 It is referred as the beta lactam antibiotics; bactericidal. Indication treatment of streptococcal infections including pharyngitis, tonsillitis, scarlet fever, endocarditis. High doses are used to treat meningococcal meningitis. It is sensitive to gastric juices in the stomach and should be taken on an empty stomach. Adverse effects: nausea, vomiting, diarrhea, abdominal pain, sore mouth. Broad-Spectrum Penicillins ( Aminopenicillins) it is used to treat both gram(-) & gram (+) bacteria e.g. Ampicillin, Amoxicillin, Bacampicillin, Cyclacillin Penicillinase Resistant Penicillin ( Antistaphylococcal ) it is used to treat Penicillinase producing S. Aureus e.g. Cloxacillin, Dicloxacillin, Methicillin, Oxacillin Extended - Spectrum Penicillins ( Antipseudomonal) it is used to treat infections caused by Pseudomonas Aeroginosa and gram ( -) Bacillus that is difficult to eradicate. e.g. Carbenicillin Indalyn ( Geocillin), Piperacillin Sodium ( Pipracil), Piperacillin-Tazobactam ( Zosyn), Ticarcillin Clabulanate ( Timentin) Beta-Lactamase Inhibitors it inhibit the bacterial lactamases thus making the antibiotic effective extending its microbial effects. e.g. Amoxicillin Clavulanic Acid ( Augmentin), Ampicillin Sulbactam ( Unasyn) 2. CEPHALOSPORINS It is similar to Penicillin in structure an dactivity They have beta lactam structures and act by inhibiting the bacterial enzyme that is necessary for cell wall synthesis. Lysis to cell occurs and bacteria dies. Nephrotoxicity is associated with the use of Cephalosphorins particularly in patients with Renal insufficiency. FOUR GENERATION OF CEPHALOSPHORINS 1) First generation It is often used to client allergic to Penicillin. It is sensitive to gram(+) and moderate activity against gram (-) bacteria.

 E.g. Cefadroxil ( Duricef), Cephalexin ( Keflex), Cefazoin ( Ancef, Kefzol), Cepharadine ( Velosef), Cephapirin ( Cefadyl) 2) Second generation It has a broader spectrum against gram ( - ) bacteria E.g. Cefaclor ( Ceclor), Cofoxitin ( Mefoxin ), Cefuroxime ( Ceftin, Zinacef), Cefmetazole ( Zefasone), Cefonicid ( Monocid), Cefetetan ( Cefotam) 3) Third generation It is effective against gram (-) bacteria, less effective against gram (+) bacteria E.g. Ceftriaxone ( Rocephin), Cefdinir ( Omnicef), Cefixime ( Suprax), Cefotaxime ( Claforan), Ceftazidime ( Fortax, Fortum) 4) Fourth generation It is similar to the 3rd generation but resistant to most beta lactamase bacteria. It has a broader gram (+) coverage than 3rd generation E.g. Cefepime ( Maxipime) 3. MACROLIDES Action: bactericidal and bacteriostatic Indication: treatment of PID, intestinal amoebiasis, prophylaxis for endocarditis before dental procedures in patients with Valvular Heart Disease who are allergic to Penicillin. increased serum levels of digoxin can occur when given with Macrolides e.g. Erythromycin (E-mycin), Azythromycin (Zithromax) 4. TETRACYCLINES They were the first broad-spectrum antibiotics effective against gram (+) and gram (-) bacteria and many other organism such as mycobacteria, Rickettsia, Spirochetes and Clhamydiae. Action: it inhibit bacterial protein synthesis. Available and oral and topical forms of treatment of wide variety of infection including acne and minor skin infection. It is available as ophthalmic agent for Opthalmia Neonatorum. It should be used with caution in children younger than 8 y/o . Caution in patient with hepatic and renal dysfunction. When oral contraceptives are taken with tetracyclines, the effectiveness of the contraceptive decreases E.g. Tetracycline ( Terramycin), Doxycycline ( Vibramycin) 5. LINCOSAMIDES It inhibit bacterial protein synthesis and have both bacteriostatic and bactericidal actions, depending ondrug dosage.

 Indication; treatment of severe infections when Penicillins or Macrolides cannot be given. E.g. Clindamycin, Lincomycin 6. AMINOGLYCOSIDES A group of powerful antibiotics used to treat infections Adverse effects: ototoxicity irreversible deafness, confusion, numbness, tingling and weakness, palpitations, hypo or hypertension. Assess for renal and hepatic disease and pre-existing hearing loss. E.g. Amikacin ( Amikin), Gentamycin ( Garamycin), Kanamycin ( Kantrex), neomycin, Streptomycin, Paromamycin 7. SULFONAMIDES or SULFA DRUGS It inhibit folic acid synthesis Indications: Trachoma, UTI, STD The early sulfonamides were insoluble in urine thus crystalluria and hematuria were common problems thus urinary output should be monitored. Severe hypersensitivity reaction include erythema Multoforme ( Erythematous Macular, Papular or Vesicular eruption) Antacids decrease absorption rate of these drugs E.g. Cotrimoxazole ( Septra, Bactrium), Sulfasazine ( Azulfidine) 8. FLUOROQUINOLONES It is a new class of antibiotics in which the mechanism of action is to interfere with the enzyme DNA Gyrase, which is needed to synthesize bacterial DNA Their bacterial spectrum includes both gram (+) and gram (-) bacteria It is useful in the treatment of UTI, bone and joint infection, Bronchitis, Pneumonia, Gastroenteritis and Gonorrhea. E.g. Ciprofloxacin ( Ciprobay), Cinoxacin ( Cinobac), Levofloxacin ( Levox, Levaquin), Gatifloxacin ( Tequin), Trovafloxacin ( Trovan) 9. PEPTIDES Two Groups: a) Polymyxines ( Aerosporins) it is useful when bacteria is resistant to other antibacterial drugs. Can cause nephrotoxicity and nephrotoxicity b) Beacitricin ( Bacitracin USP) Available in ointment form ANTIBIOTIC THERAPY: Goal of antibiotic therapy is to decrease the population of the invading bacteria The longer an antibiotic has been use, the greater the chance of development of resistant strain. Antibiotics should only be used when necessary and not for treatment of viral infection such as Common Colds

 In some situation, antibiotics are used as a means of prophylaxis of potential complications In some cases, antibiotics are given tot promote synergy so that the combine effect is greater Use of antibiotics may result in development of super infections.

General/ Common Adverse effects:

Anorexia, Nausea and vomiting, Diarrhea, abdominal pain, super infections

Nursing Considerations:
1) 2) 3) 4) Check culture and sensitivity report Do skin testing to patient before parenteral antibiotic treatment Provide small frequent meals to ensure adequate nutrition. Increase fluid intake. Ensure the patient receive full course of antibiotic to increase effectiveness and decrease the risk of developing resistant strains of bacteria. 5) Monitor and report adverse effects like rashes, pruritus, urticaria that may lead to anaphylaxis.

ANTIMYCOBACTERIAL ANTIBIOTICS Mycobacteria group of bacteria that contain the pathogens that cause T.B And Leprosy. 1. Antituberculosis Drugs a. Primary

R- I-E-S
b. Second line Pyrazinamide, Kanamycin, Ethionamide 2. Leprostatic Drugs a. Dapsone b. Clofazimine ANTIVIRAL AGENTS 1) Agent for Influenza A and Respiratory Virus Amantadine ( Symmetrel ) Rabavirin 2) Agent for Herpes and Cytomegalovirus Zidovudine ( Retrovir) Nelfiravir ( Viracept)