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pathopharm exam 4
CHAPTER 85 CEPHALOSPOIN
| Question | Answer |
|---|---|
| Cephalosporins | Most widely used group of antibiotics•Beta-lactam antibiotics •Similar to penicillin structure•Bactericidal•Usually given parenterally •Low toxicity |
| Mechanism of action | •Bind to penicillin-binding proteins (PBPs), disrupt cell wall synthesis, and cause cell lysis •Most effective against cells undergoing active growth and division |
| Resistance INCREASE ACTIVITY AGAINT GRAM NEGATIVE, AND ANAEROBE, INCREASE RESISTANCE TO DESTRCTION BY BRTA-LACTAMSES AND INCREASING ABILITY TO REACH CEREBROSPINAL FLUID | Beta-lactamases (cephalosporinases) •First-generation destroyed•Second-generation less sensitive •Third-, fourth-, and fifth-generation agents more resistant than first- and second-generation agents |
| Classification of Cephalosporins 1 | First generation Cephalexin Widely used for prophylaxis against infection in surgical patients; rarely used for active infections HIGHLY ACTIVE AGAINST GRAM-POSSITVE |
| 2 | SECOND GENERATION CEFOXITIN Rarely used for active infection INCREASE RESIST TO BETA-LACTAMASE |
| 3 | Third generation CEFOTAXIME Preferred therapy for several infections•Highly active against gram-negative organisms•Able to penetrate to cerebrospinal fluid (CSF) |
| 4 | Fourth generation Cefepime Commonly used to treat healthcare- and hospital-associated pneumonias, including those caused by the resistant organism Pseudomonas HIGHLY RESISTAN TO GRAM NEGATIVE |
| 5 | FIFTH GENERATION Infections associated with methicillin-resistant Staphylococcus aureus (MRSA)•Ceftaroline |
| ELIMINATION | KIDNEY |
| Drug interactions-CEFAZOLIN AND CEFOTETAN(ALCOHOL) CEFTIAXONE AND CEFOTETAN(BLEEDING) | Probenecid-DELAYS RENAL EXCRETON-PROLONG EFFECT •Alcohol-DISULFIRAM-LIKE •Drugs that promote bleeding- •Calcium and ceftriaxone-FATAL PRECIPITATE |
| ADVERSE REACTIONS | •Allergy-HYPERSENSITIVITY-MACULOPAPULAR RAHS OR BRONCHOSPASM •Bleeding-REDUCE PROTHOMBRIN LEVEL •Thrombophlebitis-USE LARGE VEINS TO AVOID PHLEBITIS(INFLAMMATION OF VEIN) •Other adverse effects |
| Carbapenems ARE? USED FOR PT WHO CANNOT BE TREATE WITH NARROW-SPECTRUM AGENT | Beta-lactam antibiotics have an extremely broad antimicrobial spectrum with low toxicity Not active against MRSA•Imipenem •Meropenem •Ertapenem •Doripenem HYPERSENSITIVITY CROSS-ALLERGY |
| Imipenem [Primaxin] IV | Active against most bacterial pathogens, including organisms resistant to other antibiotics •Highly active against gram-positive cocci and most gram-negative cocci and bacilli •Most effective beta-lactam antibiotic for use against anaerobic bacteria |
| Adverse effects and interactions | S/E-RASH, DRUG FEVER CROSS-ALLERGY ARD-NAUSEA, VOMITING AND DIARRHEA |
| Vancomycin [Vancocin, Vancoled] Inhibits cell wall synthesis RENAL FAILURE IRRTATING TO VEIN-WILL DESTROY SMALLER VEIN DOSING FOR SYSTEMIC INFECTION ALTERNATIVE FOR PT ALLERGIC TO PEN | Severe infections only•MRSA, Staphylococcus epidermidis, Clostridium difficile •Intravenous administration •Interactions adr=Ototoxicity (reversible or permanent)•“Red man” syndrome •Thrombophlebitis (common) •Thrombocytopenia (rare) •PT ALLER 2 PEN |
| Monobactam ARE? | Aztreonam [Azactam] •Binds to penicillin-binding protein 3 (PBP3) •Narrow antimicrobial spectrum •Gram-negative aerobic bacteria only •Must be given parenterally •ADR: similar to those of other beta-lactam antibiotics |
| Fosfomycin [Monurol] | single-dose therapy of uncomplicated (UTI) caused by Escherichia colior Enterococcus faecalis •Disrupts the synthesis of peptidoglycan polymer strands that compose the cell wall •S/E Diarrhea, headache, vaginitis, nausea |
| A patient is prescribed cefixime. The nurse should teach the patient to immediately report any signs of what? | Skin rash, hives, or itching Hypersensitivity reactions are common with cephalosporins |
| A patient is prescribed vancomycin orally for antibiotic-associated pseudomembranous colitis. The nurse will monitor the patient for what? | OTOTOXICITY The most serious (not common) adverse effect of vancomycin is ototoxicity. "Red man" syndrome occurs only with rapid intravenous administration. |
| A patient is prescribed cefazolin. It is most important for the nurse to teach the patient to avoid which substance while taking cefazolin | ALCOHOL Cefazolin and cefotetan can cause alcohol intolerance. A serious disulfiram-like reaction may occur if alcohol is consumed. Inform patients about alcohol intolerance and warn them not to drink alcoholic beverages. |
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Seka_nurse
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