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pathopharm exam 4

CHAPTER 84

QuestionAnswer
Penicillins Active against a variety of bacteria•Direct toxicity: Low •Principal adverse effect: Allergic reaction •Structure includes a beta-lactam ring •Beta-lactam family: Includes cephalosporins, aztreonam, imipenem, meropenem, and ertapenem
Mechanism of action Weaken the cell wall, causing bacteria to take up excessive water and rupture •Active only against bacteria undergoing growth and division •Bactericidal
Bacterial resistance •Inability of penicillins to reach their target•Inactivation of penicillins by bacterial enzymes
Mechanisms of Bacterial Resistance Three factors •Inability of penicillins to reach their targets•Inactivation of penicillins by bacterial enzymes•Production of penicillin-binding proteins (PBPs) that have a low affinity for penicillins
Cell Envelope Three layers• Thin cell wall and an additional outer membrane that is difficult to penetrate
Gram-positive cell envelope Thin cell wall and an additional outer membrane that is difficult to penetrateGram-negative cell envelope •Only two layers •Relatively thick cell wall that is easily penetrated
Penicillinases Beta-lactamases Enzymes that render penicillin inactive Bacteria can produce a large variety of these enzymes specific for penicillins (and other beta-lactam antibiotics)
Classification of Penicillins Narrow-spectrum penicillins •Penicillinase sensitiveNarrow-spectrum penicillins •Penicillinase resistantBroad-spectrum penicillinsExtended-spectrum penicillins
Penicillin G (Benzylpenicillin) SYPHILLIS, PHARYNGITIS(STREP) GASGANGRENE ANTHRAX FERROUS SALT Bactericidal to numerous gram-positive and some gram-negative organismsAdverse effects •Least toxic of all antibiotics •Penicillins are the most common cause of drug allergy
Penicillin Allergy Development of penicillin allergy CROSS-ALLERY-SENSITIVITY Skin tests for penicillin allergy LEAST TOXIC OUT OF THEM ALL WEAR ID BRACELET
PEN G HYERKALEMIA MGMNT of patients w/ HX of penicillin allergy Assess for penicillin allergy in each patient who will be receiving penicillin •HX of mild reaction, consider cephalosporin •If HX of anaphylaxis, avoid administration of penicillin or cephalosporins
Penicillin Allergy Immediate (reaction in 2 to 30 minutes) •Accelerated (reaction in 1 to 72 hours) •Delayed (reaction takes days or weeks to develop)
Anaphylaxis Laryngeal edema •Bronchoconstriction•Severe hypotension IMMEDIATE HYPERSENSITIVITY RECTION MEDIATE BY IGE
Penicillin Allergy Treatment •Epinephrine •Respiratory support(MONITOR BREATHING,) •Prevention: Skin testing
Drug Interactions PEN V IS MORE STABLE, MORE PO FORM Aminoglycosides(GENTAMICIN) INACTIVATE IT Bacteriostatic antibiotics Probenecid
Penicillinase-Resistant Penicillins NARROW-SPECTRUM-STAPH AUREUS AND EPIDERMIS RESISTANT=VANCOMYCIN Available in the United States •Nafcillin •Oxacillin •Dicloxacillin
Broad-Spectrum Penicillins Broad-spectrum penicillins (aminopenicillins) •Ampicillin -EFFECT A/G GRM NEGATIVE, LIKE PEN G CAUTION W/ KIDNEY IMPAIRMENT Adverse effects •Rash•Diarrhea •Amoxicillin - IN CHILDREN-LESS DIARRHEA
Extended-Spectrum Penicillins -Antipseudomonal penicillins USE W/AMINOGLYCOSIDE •Piperacillin•Broad-spectrum, but penicillinase sensitive •Effective against organisms susceptible to the aminopenicillins plus Pseudomonas aeruginosa, Enterobacter species, Proteus (indole positive), Bacteroides fragilis, and many Klebsiella specieS
Penicillin Combinations Beta-lactamase inhibitors •Clavulanic acid, tazobactam, sulbactam Extends antimicrobial spectrum when combined with penicillinase-sensitive antibiotics•Ampicillin/sulbactam [Unasyn]•Amoxicillin/clavulanic acid [Augmentin]•Piperacillin/tazobactam [Zosyn]
A patient with a history of a severe anaphylactic reaction to penicillin has an order to receive cephalosporin. What should the nurse do? Contact the health care provider for a different antibiotic. A few patients with penicillin allergy (about 1%) display cross-sensitivity to cephalosporins. If at all possible, patients with penicillin allergy should not be treated with any member of the penicillin family.
A prescriber states that a patient will need to receive penicillin intravenously. The nurse anticipates administering which drug? D. Potassium penicillin G Procaine penicillin G AND BENZATHINE=NEVER IV PENECILLIN V=ORAL
Which statement about allergic reactions to penicillin does the nurse identify as true? Anaphylactic reactions occur more frequently with penicillins than with any other drug . Allergy to penicillin can decrease over time. Epinephrine is the drug of choice for anaphylaxis. Vancomycin, erythromycin, and clindamycin are effective and safe alternatives for patients with penicillin allergy.
Created by: Seka_nurse
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