| Nursing Considerations for Pateints Receiving Carbapenems: Assessment: History and Examination: 2: Perform physical assessment to: | establish baseline data for assessing the effectiveness of the drug and the occurrence of any adver |
| New class of broad-spectrum antibiotics effective against
gram + and Gram – bacteria.
are bactericidal
Inhibit cell membrane synthesis in susceptible bacteria. | Carbapenems |
| Carbapenems:
Usual Indications: 500 mg intravenous (IV), over 1 h every 8 h for 5-14 d
Dosage/Route: Treatment of complicated intra-abdominal infections or clomplicated UTIs, including pyelonephritis, caused by susceptible bacteria. | Doripenem (Doribax |
| Carbapenem: Doripenem (Doribax): Usual Indications: | 500 mg intravenous (IV), over 1 h every 8 h for 5-14 d |
| Carbapenem: Doripenem (Doribax): Dosage/ Route: | Treatment of complicated intra-abdominal infections or clomplicated UTIs, including pyelonephritis, caused by susceptible bacteria. |
| Carbapenem: Doripenem (Doribax):
Usual Indications:
Dosage/Route: | 500 mg intravenous (IV), over 1 h every 8 h for 5-14 d
Treatment of complicated intra-abdominal infections or clomplicated UTIs, including pyelonephritis, caused by susceptible bacteria. |
| Carbapenems: Usual Indications: 1 g/d IV or intramuscular (IM) for 5-14 d
Dosage/Route: Treatment of community-acquired pneumonia, complicated genitourinary infections, acute pelvic infections, complicated intra-abdominal infections, skin and skin-structure infections. | Ertapenem (Invanz) |
| Carbapenems: Ertapenem (Invanz): Usual Indications: | 1 g/d IV or intramuscular (IM) for 5-14 d |
| Carbapenems: Ertapenem (Invanz): Dosage/Route: | Treatment of community-acquired pneumonia, complicated genitourinary infections, acute pelvic infections, complicated intra-abdominal infections, skin and skin-structure infections. |
| Carbapenems: Ertapenem (Invanz):
Usual Indications:
Dosage/Route: | 1 g/d IV or intramuscular (IM) for 5-14 d
Treatment of community-acquired pneumonia, complicated genitourinary infections, acute pelvic infections, complicated intra-abdominal infections, skin and skin-structure infections. |
| Carbapenems:
Usual Indications: 250-500 mg IV q6-8 h or 500-750 mg IM q12h
Usual Indication: Pediatric:
<1 wk: 25 mg 25mg/kg q12h IV
1-4 wk: 25 mg/kg q8h IV
4 wk-3 mo: 25 mg/kg q6h IV
> or = 3 mo: 15-25 mg/kg q6h IV
Dosage/Route: Treatment of serious respiratory, intra-abdominal, urinary tract, gynecological, bone and joint, skin and skin-structure infections: septicemia, endocarditis, bone and joint infections, and polymicrobic infections | Imipenem-cilastatin (Primaxin) |
| Carbapenem: Imipenem-cilastatin (Primaxin): Usual Indications (non-pediatric or adult): | 250-500 mg IV q6-8 h or 500-750 mg IM q12h |
| Carbapenem: Imipenem-cilastatin (Primaxin): Pediatric: <1 wk: | <1 wk: 25 mg 25mg/kg q12h IV |
| Carbapenem: Imipenem-cilastatin (Primaxin): Pediatric: 1-4 wk: | 1-4 wk: 25 mg/kg q8h IV |
| Carbapenem: Imipenem-cilastatin (Primaxin): pediatric: 4 wk-3 mos: | 4 wk-3 mo: 25 mg/kg q6h IV |
| Carbapenem: Imipenem-cilastatin (Primaxin): Pediatric: > or = 3 mos: | > or = 3 mo: 15-25 mg/kg q6h IV |
| Carbapenem: Imipenem-cilastatin (Primaxin): Dosage or Route: | Dosage/Route: Treatment of serious respiratory, intra-abdominal, urinary tract, gynecological, bone and joint, skin and skin-structure infections: septicemia, endocarditis, bone and joint infections, and polymicrobic infections |
| Carbapenems:
Usual Indications: Adult: 500- 1000 mg IV q8h
Usual Indications: pediatric: 500 mg-2 q IV q8h, depending on infection being treated.
Dosage/Route: Treatment of bacterial meningitis, complicated skin and skin-structure infections, intra-abdominal infections | Meropenem (Merrem IV) |
| Carbapenems: meropenem (Merrem IV): Usual Indications: Adult: | 500- 1000 mg IV q8h |
| Carbapenems: meropenem (Merrem IV): Usual Indications: Pediatric: | pediatric: 500 mg-2 q IV q8h, depending on infection being treated. |
| Carbapenems: meropenem (Merrem IV): Dosage/Route | Dosage/Route: Treatment of bacterial meningitis, complicated skin and skin-structure infections, intra-abdominal infections |
| Carbapenems: meropenem (Merrem IV):
Usual Indications:
Adult: and;
Pediatric:
Dosage/Route | Usual Indications: Adult: 500- 1000 mg IV q8h
Usual Indications: pediatric: 500 mg-2 q IV q8h, depending on infection being treated.
Dosage/Route: Treatment of bacterial meningitis, complicated skin and skin-structure infections, intra-abdominal infections |
| Carbapenems serious infections caused by susceptible bacteris, leading to cell death: 11 & etc
S. P
H. I
M. C
S . A
S. P
E. C
P
K. P
C. C
El
Bf | Streptococcus Pneumoniae (or S. Pneumonia or Pneumonia)
Haemophilus influenzae (or H. Influenza or Influenza)
Moraxella Catarrhalis (or M. Catarrhalis or M. Catarhalis [sa ppt])
Staphylococcus Aureus (or S. Aureus)
Streptococcus Pyrogenes ( or S. Pyrogenes)
Escherichia Coli ( or E. coli)
Peptostrptococcus
Klebisella Pneumoniae (or K. Pneumoniae)
Clostridium clostridioforme ( or C. clostridioform)
Eubacterium lentum
Bacteroides fragilis; and etc. |
| Carbapenems are indicated for treating serious: | intraabdominal, urinary tract, skin and skin structure, bone and joint, and gynecological infections |
| Carbapenems are rapidly absorbed if given what route?; and
reach peak levels at the end of ??? if given IV. | Rapidly absorbed IM and reach peak levels at the end of infusion if given IV. |
| true or false: Carbapenems are Widely distributed throughout the body, and known to cross placenta and breast milk. | False,
Carbapenems are widely distributed throughout the body, 'not known if they cross placenta and breast milk.' |
| Carbapenems are excreted ??? in urine; and
half-life is? | unchanged;
1-4 hours. |
| Newer class of Carbapenems. Given IV every 8 hrs. by 1hr. infusion for 5-14 days. | Doripenem |
| Can be given IM or IV. Given onc a day for 5-14 days. Depending on infection. | Ertapenem |
| combination of imipenem, w/c interferes with cell
wall synthesis and causes bacterial cell death. Cilastatin, inactivates the imipenem and leads to increased urinary excretion of the drug and decreased renal toxicity. Can be given IM or IV. Approved for use in children. | Imipenem-cilastatin |
| 1st drug of Carbapenem class, given IV over 1 hr. q8hrs; 5-14 days | Meropenem |
| Carbapenems Contraindications and cautions: C/I in some conditions: a | known allergy in to any carbanems or beta- lactams |
| Carbapenems Contraindications and cautions: C/I in some conditions: b | seizure disorders- w/c could be exacerbated by the drug |
| Carbapenems Contraindications and cautions: C/I in some conditions: | meningitis- safety of pt’s. with meningitis has not been established. |
| Carbapenems Contraindications and cautions: C/I in some conditions: | Lactation- not known whether this drugs enter breast milk, potentially could cause serious effects on infants. |
| Carbapenems Contraindications and cautions: C/I in some conditions: | a
b
c
d |
| Carbapenems Contraindications and cautions: Use caution during pregnancy- because? | carbapenems used to treat only severe infections. Drug must be carefully weighed against potential adverse effect on fetus. |
| Carbapenems Contraindications and cautions: Test urine function regularly, because? | they depend on the kidney for excretion and are toxic to kidneys. |
| Carbapenems Contraindications and cautions: is not recommended for use in patients younger than 18 yrs.
old. | Ertapenem |
| Carbapenems Contraindications and cautions: is associated w/ development of pseudomembranous colitis and used w/ caution in pt’s. w/ inflammatory bowel disorders. | Meropenem |
| Carbapenems: Adverse effects: a | toxic effects on GI tract |
| Carbapenems: Adverse effects: b | pseudomembranous colitis |
| Carbapenems: Adverse effects: c | clostridium difficile diarrhea |
| Carbapenems: Adverse effects: d: can lead to serious dehydration & electrolyte imbalance | Nausea and vomiting |
| Carbapenems: Adverse effects: e: | Monitor pts. to deal w/new infection before it becomes overwhelming. |
| Carbapenems: Adverse effects: f:
Include:
When combined with other drugs: | CNS effects-
Include: headache, dizziness, altered mental state.
-seizures- when combined with other drugs. |
| Carbapenems: Adverse effects: | a
b
c
d
e
f |
| Indications: Treatment of community-acquired pneumonia, complicated genitourinary infections, complicated intra-abdominal infections, skin and skin-structure infections, and acute pelvic infections caused by susceptible bacteria.
Actions: Inhibits protein synthesis in susceptible strains of gram-negative bacteria, disrupting functional integrity of the cell membrane and causing cell death.
Pharmacokinetics:
Route- IM, IV
Onset- Rapid
Peak- 30-120 min
Half-life: 4 hours; excreted unchanged in the urine.
Adverse effects: Headache, dizziness, nausea, vomiting, pseudomembranous clolitis, rash, pain at injection site. | Ertapenem |
| Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: 1 | Assess for possible contraindications or cautions: known allergy to any carbapenem or beta-lactam (obtain specific information about the nature and occurrence of allergic reactions), history of renal disease, history of seizures and current pregnancy or lactation status, and inflammatory bowel disorders. |
| Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: 2: Perform physical assessment to: | establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy. |
| Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: Perform culture and sensitivity test at the site of infection to: | ensure appropriate use of the drug. |
| Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: Conduct orientation and reflex assessment to: | evaluate any central nervous system (CNS) effects of the drug. |
| Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: Assess vital signs to: | Respiratory rate and adventitious sounds to monitor for signs of infection or hypertension reactions; temperature to assess for signs and symptoms of infection. |
| Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: Perform renal function tests to determine: | baseline function of the kidneys and, possibly, the need to adjust dose. |
| Nursing Considerations for Patients Receiving Carbapenems: Assessment: History and Examination: 1-6 | congratulations |
| Nursing diagnoses related to Carbapenems drug therapy might include the following: 1-3 | Acute pain related to gastrointestinal (GI) or CNS effects of the drug.
Risk for infection related to loss of normal flora
Deficient knowledge regarding drug therapy |
| Carbapenems: Implementation With Rationale: 1: Check culture and sensitivity reports to ensure that: | this is the drug of choice for this patient. |
| Carbapenems: Implementation With Rationale: 2: Ensure that the patient receives the full course of the carbapenem as prescribed to: | increase effectiveness and decrease the risk for the development of resistant strains of bacteria. |
| Carbapenems: Implementation With Rationale: 3: Monitor the site of infection and presenting signs and symptoms (e.g., fever, lethargy) throughout the course of drug therapy.
Failure of these signs and symptoms to resolve may indicate the need to:
Arrange to continue drug therapy for at least 2 days after all signs and symptoms resolve to: | reculture the site;
decrease the development of resistant strains of bacteria |
| Carbapenems: Implementation With Rationale: 4: Monitor the patient regularly for signs of: | pseudomembranous colitis, severe diarrhea, or superinfections to effectively arrange for discontinuation of drug or decreased dose, as appropriate, if any of these toxicities occurs. |
| Carbapenems: Implementation With Rationale: 5: Provide safety measure to: | protect the patient if CNS effects, such as confusion, dizziness, or seizures, occur. |
| Carbapenems: Implementation With Rationale: 6: Provide small, frequent meals as tolerated to:
Also provide: | relieve GI discomfort; also provide
adequate fluids to replace fluid lost with diarrhea, if appropriate. |
| Carbapenems: Implementation With Rationale: 7: Ensure that patient is hydrated at all times during drug therapy to: | minimize renal toxicity from drug exposure. |
| Carbapenems: Implementation With Rationale: 8: Instruct the patient about the appropriate dosage regimen and possible adverse effects to: | enhance patient knowledge about drug therapy and to promote compliance. |
| Carbapenems: Implementation With Rationale: 9: Provide the following patient teaching: 1: | Take safety precautions, such as changing position slowly and avoiding driving and hazardous tasks, if CNS effects occur. |
| Carbapenems: Implementation With Rationale: 9: Provide the following patient teaching: 2: | Try to drink a lot of fluids and to maintain nutrition (very important) even though nausea, vomiting, and diarrhea may occur. |
| Carbapenems: Implementation With Rationale: 9: Provide the following patient teaching: 3: | Report difficulty breathing, severe headache, severe diarrhea, fever, and signs of infection. |
| Carbapenems: Implementation With Rationale: 1-9 | congratulations |
| Carbapenems: Evaluation: 1: Monitor patient response to the | drug (resolution of bacterial infection). |
| Carbapenems: Evaluation: 2: monitor for adverse effects: | (orientation and affect, superinfections, GI toxicity, severe diarrhea effects). |
| Carbapenems: Evaluation: 3:Evaluate effectiveness of the teaching plan (patient can: | name drug, dosage, possible adverse effects to watch for, and specific measures to help avoid adverse effects.) |
| Carbapenems: Evaluation: 4: Monitor effectiveness of: | comfort and safety measures and compliance with the therapeutic regimen. |
| Carbapenems: Evaluation: 1-4 | congratulations |
| Introduced since 1960’s ; similar to Penicillin in structure.
Based on their gram (-) spectrum & stability in the presence of
beta-lactamases.
4 generations, each group with its own
spectrum: | Cephalosporins |
| When was Cephalosporins introduced? | 1960's |
| 4 generations of Cephalosporins: largely effective with gram-positive bacteria that are affected by Penicillin G, as well as Gram negative bacteria, Proteus mirabilis, E. coli, & klebsiella pneumoniae. (PEcK)- bacterias that are susceptible to this generation of Cephalosporin | 1st generation |
| 4 generations of Cephalosporins: are effective against those strains, also Haemophilus influenzae, Enterobacter aerogenes, & Neisseria species. (HENPeCK).
are less effective against gram-positive bacteria. | 2nd generation |
| 4 generations of Cephalosporins: are weak against gram(+) bacteria but are more potent against gram (--) bacilli as well as against Serratia marcescens (HENPeCKS). | 3rd generation |
| 4 generations of Cephalosporins: are in development. have improved gram- positive spectrum and expanded gram-negative activity or 3rd generation cephalosporins.
Have a greater resistance to beta-lactamases than the third
generation cephalosporins.
Can cross blood brain barrier and are effective in meningitis.
Activity against nosocomial pathogens such as Enterobacter and
Acinetobacte. | 4th generation |
| active against gram (-) and gram (+) organisms including cephalosporin-resistant staphylococci and P. aerogunosa. | Cefepime (Maxipime) |
| Cephalosporins: 4th generation drugs: (new I think?): | Cefepime,
Cefluprenam,
Cefozopran,
Cefpirome,
Cefquinome |
| 4th generation Cephalosporin drugs: is more active against pneumococci | Cefpirome |
| First-Generation Cephalosporins:
Dosage/Route:
Adult: 1-2 g PO in a single or two divided doses; reduce dose in renal impariment
Pediatric: 30 mg/kg/d PO in divided doses q12h
usual indications: Treatment of UTIs, pharyngitis, and tonsilitis caused by group A beta-hemolytic stretptococci, as well as skin infections. | Cefadroxil (generic) |
| First-Generation Cephalosporins: Cefadroxil (generic) Dosage/Route:
Adult: | Dosage/Route:
Adult: 1-2 g PO in a single or two divided doses; reduce dose in renal impariment |
| First-Generation Cephalosporins: Cefadroxil (generic) Dosage/Route:
Pediatric: | Pediatric: 30 mg/kg/d PO in divided doses q12h |
| First-Generation Cephalosporins: Cefadroxil (generic) Dosage/Route:
Adult:
Pediatric: | Dosage/Route:
Adult: 1-2 g PO in a single or two divided doses; reduce dose in renal impariment
Pediatric: 30 mg/kg/d PO in divided doses q12h |
| First-Generation Cephalosporins: Cefadroxil (generic): Usual Indications: | usual indications: Treatment of UTIs, pharyngitis, and tonsilitis caused by group A beta-hemolytic stretptococci, as well as skin infections. |
| First-Generation Cephalosporins:
Dosage/Route:
Adult: 250-500 mg intramuscular (IM) or intravenous (IV) q4-8h; reduce dose in renal impairment.
Pediatric: 25-50 mg/kg/d IM or IV in three or four divided doses
Usual Indications: Treatment of respiratory tract, skin, genitourinary (GU), biliary tract, bone, joint, and myocardial infections, as well as sepsis. | Cefazolin (Zolicef) |
| First-Generation Cephalosporins: Cefazolin (Zolicef): Dosage/Route:
Adult: | Dosage/Route:
Adult: 250-500 mg intramuscular (IM) or intravenous (IV) q4-8h; reduce dose in renal impairment. |
| First-Generation Cephalosporins: Cefazolin (Zolicef): Dosage/Route:
Pediatric | Pediatric: 25-50 mg/kg/d IM or IV in three or four divided doses |
| First-Generation Cephalosporins: Cefazolin (Zolicef): Dosage/Route:
Adult:
Pediatric: | Dosage/Route:
Adult: 250-500 mg intramuscular (IM) or intravenous (IV) q4-8h; reduce dose in renal impairment.
Pediatric: 25-50 mg/kg/d IM or IV in three or four divided doses |
| First-Generation Cephalosporins: Cefazolin (Zolicef): Usual Indications: | Usual Indications: Treatment of respiratory tract, skin, genitourinary (GU), biliary tract, bone, joint, and myocardial infections, as well as sepsis. |
| First-Generation Cephalosporins:
Dosage/Route:
Adult: 250 mg PO q6h
Pediatric: 25-50 mg/kg/d PO in divided doses
Usual indications: Treatment of respiratory, skin, bone, and GU infections; used for otitis media in children | Cephalexin (Keflex) |
| First-Generation Cephalosporins: Cephalexin (Keflex): Dosage/Route:
Adult: | Dosage/Route:
Adult: 250 mg PO q6h |
| First-Generation Cephalosporins: Cephalexin (Keflex): Dosge/Route:
Pediatric: | Pediatric: 25-50 mg/kg/d PO in divided doses |
| First-Generation Cephalosporins: Cephalexin (Keflex): Dosage/Route:
Adult:
Pediatric: | Dosage/Route:
Adult: 250 mg PO q6h
Pediatric: 25-50 mg/kg/d PO in divided doses |
| First-Generation Cephalosporins: Cephalexin (Keflex): Usual indications: | Usual indications: Treatment of respiratory, skin, bone, and GU infections; used for otitis media in children |
| First-Generation Cephalosporins (Table sa cephalosporin , 2): 3 kabuok, enumerate: | cefadroxil (generic)
Cefazolin (Zolicef)
Cephalexin (Keflex) |
| Second-Generation Cephalosporins:
Dosage/Route:
Adult: 250 mg PO q8h--- do not exceed 4g/d; must be taken every 8-12 h around the clock
Pediatric: 20 mg/kg/d PO in divided doses q8h; do not exceed 1g/d
Usual Indications: Treatment of respiratory tract infections, skin infections, UTIs, otitis media, typhoid fever, anthrax exposure
P or first to produce | Cefaclor (Ceclor) |
| Second-Generation Cephalosporins: Cefaclor (Ceclor): Dosage/Route:
Adult: | Dosage/Route:
Adult: 250 mg PO q8h--- do not exceed 4g/d; must be taken every 8-12 h around the clock |
| Second-Generation Cephalosporins: Cefaclor (Ceclor): Dosage/Route:
Pediatric: | Pediatric: 20 mg/kg/d PO in divided doses q8h; do not exceed 1g/d |
| Second-Generation Cephalosporins: Cefaclor (Ceclor): Dosage/Route:
Adult:
Pediatric: | Dosage/Route:
Adult: 250 mg PO q8h--- do not exceed 4g/d; must be taken every 8-12 h around the clock
Pediatric: 20 mg/kg/d PO in divided doses q8h; do not exceed 1g/d |
| Second-Generation Cephalosporins: Cefaclor (Ceclor): Usual Indications: | Usual Indications: Treatment of respiratory tract infections, skin infections, UTIs, otitis media, typhoid fever, anthrax exposure |
| Second-Generation Cephalosporins:
Dosage/Route:
Adult: 1-2 g IM or IV q6-8h; reduce dose with renal impairment
Pediatric: 80-160 mg/kg/d IM or IV in divided doses q4-6h
Usual Indications:
Treatment of sever infections; preoperative prophylaxis for cesarean section and abdominal, vaginal, biliary or colorectal surgery; more effective in gynecological and intra-abdominal infections than some other agents. | Cefoxitin (generic) |
| Second-Generation Cephalosporins:
Dosage/Route:
Adult: 250-500mg PO q12h for 10 d; reduce dose with renal impairment
Pediatric: 7.5-20 mg/kg PO q12h for 10d;
for child 6 mo-2 y of age, 75-15 mg/kg PO q12h for 10 d
Usual Indications: Treatment of pharyngitis, tonsilitis, otitis media, sinusitis, secondary bronchial infections, and skin infections | Cefprozil (generic) |
| Second-Generation Cephalosporins:
Dosage/Route:
Adult: 250 mg PO b.i.d.; 750 mg-1.5 g IM q8h; reduce dose with renal impairment
Pediatric: 125-250 mg PO b.i.d.; 50-100 mg/kg/d IM or IV in divided doses q6-8h
Usual Indications: Treatment of a wide range of infections as listed for other second-generation drugs; Lyme disease; preferred treatment in situations involving an anticipated switch from parenteral to oral drug use. | cefuroxime (Zinacef) |
| Second-Generation Cephalosporins (sa cephalosporins nga table, 2): | Cefaclor (Ceclor)
Cefoxitin (generic)
Cefprozil (generic)
Cefuroxime (Zinacef) |
| Third-Generation Cephalosporins:
Dosage/Route:
Adult: 300 mg PO q12h for 10 d; reduce dose with renal impairment
Pediatric: 7mg/kg PO q12h
Usual Indications: Treatment of respiratory infections, otitis media, sinusitis, laryngitis, bronchitis, skin infections | Cefdinir (generic; a suspension form is available for children) |
| Third-Generation Cephalosporins:
Dosage/Route:
Adult: 2-8 g/d IM or IV in divided doses q6-q8h; reduce dose with renal impairment
Pediatric: 50-180 mg/kg/d IM or IV in divided doses q4-q6h
Usual Indications: Treatment of moderate to severe sin, urinary tract, and respiratory tract infections; pelvic inflammatory disease; intra-abdominal infections; peritonitis; septicemia; bone infections; central nervous system (CNS) infections; preoperative prophylaxis | cefotaxime (Claforan) |
| Third-Generation Cephalosporins:
Dosage/Route:
Adult: 100-400 mg PO q12h; reduce dose with renal impairment
Pediatric: 5-10 mg/kg PO q12h for 7-14 d
Usual Indications: Treatment of respiratory infections, UTIs, gonorrhea, skin infections, and otitis media | Cefpodoxime (Vantin) |
| Third-Generation Cephalosporins:
Dosage/Route:
Adult: 1 g q8-12h IM or IV; reduce dose with renal impairment
Pediatric: 30-50 mg/kg q8-12h IM or IV
Usual Indications: Treatment of moderate to severe skin, urinary tract, and respiratory tract infections; intra-abdominal infections; septicemia; bone infections; CNS infections | Ceftazidime (Ceptaz, Tazicef) |
| Third-Generation Cephalosporins:
Dosage/Route:
Adult: 400 mg PO every day for 10 d; reduce dose with renal impairment
Pediatric: 9 mg/kg/d PO for 10d
Note: Once-a-day dosing increases compliance
Usual Indications: Treatment of pharyngitis, tonsilitis, exacerbations of bronchitis, otitis media | Cefibuten (Cedax; available in a suspension form for children) |
| Third-Generation Cephalosporins:
Dosage/Route:
Adult: 500mg-2 g IM or IV q8-12h; reduce dose with renal impairment
Pediatric: 50 mg/kg IM or IV q6-8h
Usual Indications: Treatment of respiratory, gynecological, pelvic inflammatory, intra-abdominal, skin, and bone and joint infections; also used for sepsis and meningitis | Cefizoxime (Cefizox) |
| Third-Generation Cephalosporins:
Dosage/Route:
Adult: 1-2 g/d IM or IV in divided doses b.i.d.-q.i.d.
Pediatric: 50-75 mg/kg/d IV or IM in divided doses q12h
Usual Indications: Treatment of moderate to severe skin, urinary tract, and respiratory tract infections; pelvic inflammatory disease; intra-abdominal infections; peritonitis; septicemia; bone infections; CNS infections; preoperative prophylaxis; off-label use for treatment of Lyme disease. | Ceftriaxone (Rocephin) |
| Fourth-Generation Cephalosporins:
Dosage/Route:
Adult & Pediatric: (>12 y); 200-400 mg PO b.i.d.; reduce dose with renal impairment
Usual Indications: Treatment of acute exacerbations of chronic bronchitis; pharyngitis and tonsilitis; skin and skin-structure infections | Cefditoren (Spectracef) |
| Fourth-Generation Cephalosporins:
Dosage/Route:
Adult: 0.5-2 g IM or IV q12h; must be injected for greatest effectiveness q12h for 7-10 d; reduce dose with renal impairment
Pediatric: 50 mg/kg per dose q12h IV or IM for 7-10 d
Usual Indications: Treatment of moderate to severe skin, urinary tract and respiratory tract infections | Cefepime (Maxipime) |
| Fourth-Generation Cephalosporins:
Dosage/Route: 600 mg IV over 1 h for 5-7 d community-acquired pneumonia or 5-14 d skin infections
Usual Indications: Treatment of skin and skin-structure infections; community-acquired pneumonia | Ceftaroline (Teflaro) |
| Cephalosporins: Therapeutic actions and indications: Cephalosporins are both ______ & ______, depending on dose and specific drug involved | bactericidal and bacteriostatic |
| Cephalosporins: Therapeutic actions and indications: Cephalosporins interferes with what of bacteria when they divide? | Cephalosporins interferes with the cell wall-building ability of bacteria when they divide |
| Cephalosporins: Therapeutic actions and indications: Cephalosporins prevent the bacteria from biosynthesizing what?
Bacteria weakened cell wall swell and burst as a result of osmotic pressure within the cell. | Cephalosporins prevent the bacteria from biosynthesizing framework of cell walls |
| Cephalosporins: Therapeutic actions and indications: Selection of an antibiotic of this class depends on the? | sensitivity of the involved organism, the route of choice, and sometimes the cost involved. |
| Cephalosporins: Therapeutic actions and indications: Important to reserve cephalosporins for appropriate situation because? | cephalosporin-resistant bacteria are increasing in numbers. |
| Cephalosporins: Therapeutic actions and indications: Before therapy, perform 'what' to evaluate the causative organism and appropriate sensitivity to the antibiotic being used. | perform C/S test or Culture and Sensitivity test |
| Cephalosporins: Pharmacokinetics: Well absorbed from? | GI tract; others absorbed well after IM and IV administration |
| Cephalosporins: Pharmacokinetics: Are metabolized primarily in the?
and excreted in the? | Are metabolized primarily in the liver and excreted in the urine |
| Cephalosporins: Pharmacokinetics: Caution with ??? because either condition could alter drug metabolism and excretion | hepatic or renal impairment |
| Cephalosporins: Pharmacokinetics: True or False: is a teratogen? | Yes, Cephalosporins crosses placenta and breast milk |
| Cephalosporins: Pharmacokinetics: Can be used during pregnancy and lactation only if? | benefit outweighs potential risk of toxicity of fetus or neonate |
| Cephalosporins: Contraindications and cautions: 1: Not to be used with patients with known allergy to what? | Penicillin |
| Cephalosporins: Contraindications and cautions: 2: Caution with patient's suffering from what failure, to which it is toxic? | Caution with pt's. suffering from kidney failure, toxic to kidneys |
| Cephalosporins: Contraindications and cautions: 3 | Pregnant and lactation mothers, though potential effects on the baby is not yet known |
| Cephalosporins Drug to Drug Interactions: Cephalosporins and aminoglycosides increases risk of what?
-monitoring and evaluation of serum BUN and creatinine levels | nephrotoxicity |
| Cephalosporins Drug to Drug Interactions: With what drug interaction could experience increase bleeding | oral anticoagulants |
| Cephalosporins Drug to Drug Interactions: If with alcohol after 72 hours after D/C (or discontinued) may cause? | disulfram-like reaction |
| Cephalosporins Drug to Drug Interactions: Considerations: | Take cephalosporin on an empty stomach, if gastric irritation occurs may take with food. |
| Relatively new synthetic class of antibiotics with broad
spectrum activity.
activity against gram (-),(+), atypical organisms. | Flouroquinolones |
| Common fluoroquinolones are:
highly active against gram (-) pathogens. | Ciprofoloxacin, norfloxacin, & ofloxacin |
| Fluoroquinolones: Are enhanced activity against gram (+) pathogens while maintaining similar gram (-) activity.
Made synthetically, with mid adverse reactions. | New fluoroquinolones |
| What fluoroquinolone is widely used?
500-750 mg p.o.; 2mg/100ml IV is widely used
-effective against wide spectrum gram (-) bacteria.
-available in IM, IV, PO, topical forms
-approved for prevention of anthrax infection in the area that might be exposed to germ warfare.
-effective against RTI, middle ear, sinuses, genital organs, etc. | Ciprofloxacin (Ciprobay) |
| Fluoroquinolones: Are oral agents: | Gemifloxacin, lomefloxacin, and moxifloxacin |
| Fluoroquinolones: Is available in oral and IV forms: | Levofloxacin |
| Fluoroquinolones: can be given IV or or al and also available as an ophthalmic agent for the treatment of ocular infections caused by susceptible bacteria. | Ofloxacin |
| Fluoroquinolones: The newest drug, available in otic drops for topical treatment of swimmer's ear. | Finafloxacin |
| Fluoroquinolones: Dosage/Route:
Adult: 100-500 mg b.i.d. PO for up to 6 wk; reduce dose in renal failure
Pediatric: not recommended because of potential effects on developing cartilage.
Usual indications: Treatment of infections caused by a wide spectrum of gram-negative bacteria. | Ciprofloxacin (Cipro) |
| Fluoroquinolones:
Dosage/Route:
Adult: 320 mg/d PO for 5-7 d
Usual Indications: Treatment of acute exacerbations of chronic bronchitis, community-acquired pneumonia | Gemifloxacin (Factive) |
| Fluoroquinolones:
Dosage/Route:
Adult: 250-750 mg/d PO or intravenous (IV); reduce dose in renal impairment
After exposure to anthrax: 500 mg/d PO or IV for 60 d
Usual Indications: Treatment of respiratory, urinary tract, skin, and sinus infections caused by susceptible gram-negative bacteria in adults; treatment after exposure to anthrax | Levofloxacin (Levaquin) |
| Fluoroquinolones:
Dosage/Route:
Adult: 400 mg/d PO or IV for 5-10 d; reduce dose in renal impairment
Usual Indications: Treatment of adults with sinusitis, bronchitis, or community-acquired pneumonia | Moxifloxacin (Avelox) |
| Fluoroquinolones:
Dosage/Route:
Adult: 400 mg PO q12h for up to 28 d; reduce dose in renal impairment
Usual Indications: Treatment of various urinary tract infections | Norfloxacin (Noroxin) |
| Fluoroquinolones:
Dosage/Route:
Adult: 200-400 mg q12h PO for up to 10 d; reduce dose in renal impairment
Usual Indications: Treatment of respiratory, skin, and urinary tract infections; pelvic inflammatory disease; ocular infections; otic form available for otitis media. | Ofloxacin (Floxin, Ocuflox) |
| Fluoroquinolones: Therapeutic actions and indications: 1: Fluoroquinolones enter the bacterial cell wall by? | passive diffusion through cannels in the cell membranes |
| Fluoroquinolones: Therapeutic actions and indications: 2: Once inside, they interfere with?
Leading to cell death because the bacterial cell wall is damaged, disrupting bacterial activity. | the action of DNA enzymes necessary for growth and reproduction of bacteria. |
| Fluoroquinolones: Therapeutic actions and indications: 3: Not recommended for use in?
because? | not recommended for use in children below 18 years old because of associated lesions in developing cartilage. |
| Fluoroquinolones: Therapeutic actions and indications: are indicated for treating infections: | UTI's, prostatitis, gonorrhea, anthrax, pneumonia, other RTI and infections of bones and joints |
| Fluoroquinolones: Pharmacokinetics: | absorbed in GI tract -> metabolized in liver-> excreted in urine and feces |
| Fluoroquinolones: Pharmacokinetics: Widely distributed and;
is it a teratogen? | Widely distributed in the body and cross the placenta and enter the breast milk |
| Fluoroquinolones: Pharmacokinetics: Caution with patients with? | renal and hepatic impairment, w/c could interfere w/ metabolism and excretion |
| Fluoroquinolones: Contraindications and cautions: 1: | Known allergy to any fluoroquinolones, pregnant and lactating women because of unknown effects on fetuses and infants |
| Fluoroquinolones: Contraindications and cautions: 2: Decrease the absorption & should not be given 2 hours following administration of the antibiotic | Antacids |
| Fluoroquinolones: Contraindications and cautions: Caution with what?
w/c could interfere drug excretion and seizure, w/c could be exacerbated by the drugs effects on cell membrane channels | Renal dysfunction |
| Fluoroquinolones: Adverse effects: 1: Generally associated with relatively mild adverse reactions: | Headache, dizziness, insomnia, and depression related to direct drug effects on the GI tract and possible stimulation of the chemoreceptor trigger zone in the CNS. |
| Fluoroquinolones: Adverse effects: 2: GI effects include: | nausea, vomiting, diarrhea, and dry mout. |
| Fluoroquinolones: Adverse effects: 3: Immunological effects include: | bone marrow depression |
| Fluoroquinolones: Adverse effects: 4: Other adverse effects are: | fever, rash, photosensitivity. |
| Fluoroquinolones: Adverse effects: 5: Instruct the patient to: | avoid sun and ultraviolet light exposure and to use protective clothing and sunscreens. |
| Fluoroquinolones: Drug to drug interactions: When taken with what? the therapeutic effects decreases. | iron salts, sucralfate, mineral supplements or antacids |
| Fluoroquinolones: Drug to drug interactions: If administration of 2 agents is necessary, should be taken? | 4 hours separated |
| Fluoroquinolones: Drug to drug interactions: Should not be taken with: | milk or other dairy products, antacids, magnesium laxatives, and iron supplements |
| Fluoroquinolones: Drug to drug interactions: Fatal cardiac reactions causing torsades de pointes if taken with: | quinidine, procainamide, amiodarone, sotalol, erythromycin, terfenadine, pentamidine, tricyclics, phenothiazines should be avoided unless hospitalized with cardiac monitoring |
| Fluoroquinolones: Drug to drug interactions: Increase fluid intake ->: | high urine output, preventing crystalluria |
| Fluoroquinolones: Drug to drug interactions: if with combination with Theophylline, leads to increased theophylline levels, because? | they are the same metabolic pathways |
| Fluoroquinolones: Drug to drug interactions: Theophylline dose should be: | decreased by half and serum theophylline should be monitored. |
| Fluoroquinolones: Drug to drug interactions: If combined with NSAID's: | risk of stimulation, especially those with seizures and be monitored closely. |
