Chapter 12
Antiinfective Medications
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
1
Learning Objectives
 Identify the major antiinfective drug categories and the
organisms against which they are effective
 Outline the most important things to teach the patient who
is taking antiinfective drugs
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Learning Objectives (cont.)
 Define "spectrum" and explain what this word means in
antiinfective therapy
 List some of the most common adverse reactions to
medications used to treat infections
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Overview
 Pathogen
 Bacteria
 Fungi
 Viruses
 Antimicrobials
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Learning Objectives
 Identify the major antiinfective drug categories and the
organisms against which they are effective
 Outline the most important things to teach the patient who
is taking antiinfective drugs
5
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991
by Mosby, an imprint of Elsevier Inc.
Penicillins
 Main antibiotic for years
 Broad-spectrum drug of choice
 Overuse
 Penicillin-resistant strains
Action and Uses
 Interferes with creation of the mucopeptide cell wall
 Bacteriocidal
 Used to treat multiple infections
 Allergies
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Penicillin Medications
 Natural PCNs
 penicillin G
 Given IM; procaine /aqueous
forms used to treat gonorrhea
 penicillin V
 penicillin VK+
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 Penicillinase resistant
 cloxacillin
 cicloxacillin
 naficillin
 oxacillin
MORE Penicillins
• Aminopenicillins:
Broad Spectrum
– amoxicillin
• Amoxil / Trimox
– amoxicillin/ clavulanate
• Augmentin
– ampicillin
– ampicillin/ sulbactam
• Unasyn
• Extended Spectrum
– pipercillin
– pipercillin/ tazobactam
• Zosyn
– ticarcillin
• Ticar
– ticarcillin/ clavulanate
• Timentin
Penicillins (cont.)
Adverse Reactions
 Neuropathy
 High parenteral doses
 Skin eruptions
 GI symptoms
 Urticaria
 Laryngeal edema
 Anaphylaxis
Drug Interactions: PCN negates oral contraceptives!!!
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Penicillins (cont.)
Nursing Implications and Patient Teaching
 Assessment
 Signs of infection and allergies
 Diagnosis
 Planning
 10-day regimen
 Implementation
 Route of administration
 Evaluation
 Patient Teaching
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Sulfonamides
 Broad-spectrum antiinfective
 Bacteriostatic action: inhibits folic acid synthesis in the cell
Action and Uses
 Urinary tract infections
 Effectively treats multiple microorganisms
 Preoperative and postoperative therapy for bowel surgery
11
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Sulfonamides (cont.)
Adverse Reactions
Drug Interactions
 Potentiate
 Decrease effectiveness
Nursing Implications and Patient Teaching
 Contraindications
 Take on an empty stomach
12
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Sulfonamides
 Plain
 sulfadiazine
13
 Mixtures
 trimethoprim/
 sulfamethizole
sulfamethoxazole
 sulfasalazine
 Azulfidine
 Bactrim
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 Septra
 Sulfatrim
Tetracyclines
Actions and uses
 Broad-spectrum antibiotics
Adverse Reactions
 GI upset
Nursing Implications
 Not for pregnant patients or children under 8 years of age
 Can cause sensitivity to light (photosensitivity) so counsel patient to
be careful about sun exposure
 Take on empty stomach and avoid dairy within 2 hours of taking
drug.
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Tetracyclines
 doxycycline
 minocycline
 oxytetracycline
 tetracycline
 Take on an empty stomach.
 Never give to pregnant woman or child under 8. Will turn teeth
green/grey permanently.
 Binds with calcium products
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Macrolides: Broad Spectrum
 Zithromax; Z pack
 azithromycin
 Biaxin
 clarithromycin
 E-Mycin / EES
 Erythromycin
Bacteriostatic or bacteriocidal depending on dosage concentration.
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Cephalosporin History
 The first generation cephalosporins are mostly active against gram positive bacteria and
vary with their delivery routes and uses.
 Second generation cephalosporins are modified to increase spectrum against gram
negative bacteria but have reduced effects against gram positive bacteria. These agents
also have better membrane penetration and more B-lactamase resistance.
 Third generation cephalosporins include effects against pseudomonas infections, they are
also useful in multi-resistant hospital acquired infections.
 Fourth generation cephalosporins are even more efficacious. They have an increased
spectrum over third generation drugs and are excellent in multiple drug resistance
patterns. The only currently available agent in this generation is cefepime.
 http://sitemaker.umich.edu/medchem10/cephalosporins_2
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by Mosby, an imprint of Elsevier Inc.
Cephalosporin medications
(all have kef-; cef-; or ceph in generic name
 1st generation
 2nd generation
 Duricef
 Ceclor
 cefadroxil
 Keflex
 cephalexin
 Ancef
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 cefaclor
 Cefzil
 cefprozil
 Ceftin
 Cefazolin
 Cefurozime
 Bacteriocidal
 Bacteriocidal
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More Cephalosporins
 3rd generation
 4th generation
 Omnicef (cefdinir)
 Maxipime
 Maxipime (cefepime)
 Claforan (cefotaxime)
 Fortaz (ceftazidime)
 Cefizox (cefizoxime)
 Rocephin (ceftriaxone)
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 cefepime
Cephalosporin Continued
 Made from molds like PCN.
 Works against cell wall synthesis like PCN does.
 Can be allergic to cephalosporins if also allergic to PCN. Use
with caution.
 Give PO with food to decrease nausea and diarrhea side
effects
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Lincosamides
 Cleocin
 clindamycin
 Empty stomach with full glass of water
 May be give as a deep IM injection
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by Mosby, an imprint of Elsevier Inc.
Fluoroquinolones
(all generics end in floxacin)
 Cipro
 ciprofloxacin
 Levaquin
 levofloxacin
 Avelox
 moxifloxacin
 Maxaquin
 lomefloxacin
 All are excreted through the kidneys so check your patient’s renal
function
 Potent newer medication.
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Miscellaneous Medications
 Bacitracin
 Vancocin
 Vancomycin – slows cell wall synthesis; damages plasma
membrane making it susceptible to osmotic pressure; interferes
with RNA synthesis
Very irritating to the vein; dilute and give over 1 hour IV
23
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Aminoglycosides
 Used to treat gram
negative bacteria when
PCN is not an option
 Amikin
 amikacin
 Garamycin
 gentamicin
 Neo-fradin
 neomycin
 streptomycin sulfate
 TOBI (tobramycin sulfate)
24
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 Very ototoxic and
nephrotoxic!!!
 Assess renal function 1st.
 Encourage increased fluid
intake to flush kidneys.
 Draw ‘Peak and Through’
levels to assess therapeutic
levels.
WARNING
Allergic reactions can appear at any time
whether you have safely taken the drug
before or not. Be aware!
25
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Antituberucal drugs
 Primary treatment agents
 Retreatment agents
 INH/ Isoniazid
 isoniazid
 Seromycin Pulvules
 cycloserine
 Rifadin
 rifampin
 Kantrex
 kanamycin
 Priftin
 rifapentine
Prevention in HIV patients
Mycobutin (rifabutin)
26
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Antiparasitic Drugs
 Amebicides
 Aralen
 Chloroquine
 Ototoxic
 Flagyl/ Metrogel
 Metronidazole
 No alcohol intake
 Antihelminths
 Treat pinworms &
roundworms
 Can taste bitter
 Vermox
 mebendazole
 Pin-X
 pyrantel
 Mintezol
 thiabendazole
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Antimalarials
 4 aminoquinolones
 Aralen
 chloroquine
 Plaquenil
 hydroxychloroquine
28
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 8 aminoquinolones
 All of these drugs have
-quine in the generic
 primaquine phosphate
Antimalarials
 Folic acid agonist
 Daraprim
 pyrimethamine
 Miscellaneous agents
 doxycycline
 mefloquine
 quinine sulfate
Quinine is very bitter. Put in
the back of the mouth and
swallow quickly. Give fruit
drink/ sweet drink to rinse
mouth.
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Chapter 13 – Antivirals (have –vir)
 Zovirax
 acyclovir
 Symmetrel
 amantadine
 Famvir
 famciclovir
 Tamiflu
 oseltamivir phosphate
30
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 Virazole
 ribavirin
 Valtrex
 valacyclovir HCL
 Valcyte
 valganciclovir
 Relenza
 zanamivir
Antivirals
 Most have –vir in generic or brand name.
 Medications decrease the viral load but do not cure.
 Viristatic.
 Goal is to prevent opportunistic infections while the body
heals itself from the virus using the immune system
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Reverse transcriptase inhibitors
 Nucleoside Analogues
 Nonnucleoside Analogues
 Epivir – HBV
 lamivudine (3TC)
 Ziagen
 abacavir sulfate
 Retrovir
 zidovudine (AZT)
 Rescriptor
 delavirdine
 Viramune
 nevirapine
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Protease inhibitors
 Crixivan
 Indinavir
 Nephrolithiasis
 Viracept
 nelfinavir
 Norvir
 ritonavir
 Invirase
 saquinavir
33
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 Take prescribed dose at
ordered times.
 Skipping doses can lead to a
resistant strain of the virus.
 Standard precautions
continue to be needed.
 Look for ‘Crix belly’.
Antifungal medications
 Mycostatin - nystatin
 Fungizone - amphotericin B ***
 Diflucan - fluconazole
 GrifulvinV - griseofulvin
 Nizoral - ketoconazole
 Lamisil – terbinafine HCL
 Flagyl (metronidazole) can also be used
*** protect IV fluid from light. very potent; used only with
serious fungal infections
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Antifungal effects
 Mycotic infections take a while to cure.
 Phototoxicity – use sun screen; avoid summer sun hours
 Hepatotoxicity – watch the liver function studies
 Avoid alcohol with any of these drugs. The liver is busy
clearing out the med.
35
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 Questions?
36
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