lOMoARcPSD|16603486

HES 005 Session 3

Pharmacology (Southwestern University PHINMA)

Scan to open on Studocu

Studocu is not sponsored or endorsed by any college or university

Downloaded by yeddul min ([email protected])
 lOMoARcPSD|16603486

Pharmacology
STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR
Session 3

LESSON TITLE: ANTI-INFECTIVE AGENTS/ ANTIBIOTICS Materials:

LEARNING OUTCOMES: Book, Notebook, pens & paper
At the end of the lesson, the nursing student can:

1. Differentiate broad spectrum and narrow spectrum References:

drugs; Hayes, Evelyn R. Pharmacology: A Nursing
2. Define bacterial resistance to antibiotic; and, Process Approach: 6 th Edition. Singapore:
3. Explain ways to minimize bacterial resistance. Elsevier Saunders Company.
4. Explain how an antibiotic is selected for use in a Karch, Amy M. Focus on Nursing Pharmacology
particular clinical situation; 5th edition. Philedelphia: Lippincott William
5. Develop a drug study guide. (therapeutic action, and Wilkins
indication, contraindication, most common adverse
reaction and nursing responsibility) of the different
classes of antibiotics; and,
6. Discuss the use of antibiotics across the lifespan.

LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (10 minutes)

ANAGRAM
Rearrange the scrambled letters to form a word. Words are related to the lesson.
1. I T N B T I A I O C S

2. E L I N O G Y C O A M S I D S

3. P H N I C O R E A O L P S E

4. F Q U N O L O U I L O R O N E S

5. M I C R B A E O S L

6. C O S A L I N M D E I S

7. M A T C O M A S N B O

8. E N P I L N E C L I S

9. S A M U N I E L D F S O

10. T E N I E L S T C R C A Y

MAIN LESSON (45 minutes)

ANTI-INFECTIVE AGENTS

Development of Anti-infective Therapy

 1920s Paul Ehrlich worked on developing a synthetic chemical effective against infection-causing cells only.
Scientists discovered penicillin in a mold sample

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 1 of 10
Downloaded by yeddul min ([email protected])
 lOMoARcPSD|16603486

 1935 The sulfonamides were introduced

Mechanisms of Action
1. Interfere with biosynthesis of the bacterial cell wall
2. Prevent the cells of the invading organism from using substances essential to their growth and development
3. Interfere with steps involved in protein synthesis
4. Interfere with DNA synthesis
5. Alter the permeability of the cell membrane to allow essential cellular components to leak out

Mechanism of Anti-infective Agents

Anti-infective Activity
🞄 Anti-infectives vary in their effectiveness against invading organisms
🞄 Some are selective: they are effective only for a small number of organisms
🞄 Bactericidal: kill the cell
🞄 Bacteriostatic: prevent reproduction of the cell

Narrow Spectrum vs Broad Spectrum

1. Narrow spectrum of activity - Effective against only a few microorganisms with a very specific metabolic pathway or
enzyme
2. Broad spectrum of activity - Useful in treating a wide variety of infections

Human Immune Response

1. Goal of anti-infective therapy is reduction of the population of the invading organism
2. Drugs that eliminate all traces of any invading pathogen might be toxic to the host as well
3. Immune response is a complex process involving chemical mediators, leukocytes, lymphocytes, antibodies, and
locally released enzymes and chemicals

Problems with Treating Infections in Immunosuppressed Patients

 Anti-infective drugs cannot totally eliminate the pathogen without causing severe toxicity in the host
 These patients do not have the immune response in place to deal with even a few invading organisms

Resistance
 Anti-infectives act on a specific enzyme system or biological process; many microorganisms that do not act on a
specific system are not affected by the particular drug
 This is considered natural or intrinsic resistance to that drug

Acquired Resistance

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 2 of 10
Downloaded by yeddul min ([email protected])
 lOMoARcPSD|16603486

 Microorganisms that were once sensitive to the particular drug have begun to develop acquired resistance
 This results in serious clinical problems

Ways Resistance Develops

1. Producing an enzyme that deactivates the antimicrobial drug
2. Changing cellular permeability to prevent the drug from entering the cell
3. Altering transport systems to exclude the drug from active transport into the cell
4. Altering binding sites on the membranes or ribosomes, which then no longer accept the drug
5. Producing a chemical that acts as an antagonist to the drug

Preventing Resistance
1. Limit the use of antimicrobial agents to the treatment of specific pathogens sensitive to the drug being used
2. Make sure doses are high enough, and the duration of drug therapy long enough
3. Be cautious about the indiscriminate use of anti-infectives

Identification of the Pathogen

1. Identification of the infecting pathogen is done by culture
2. A culture of a tissue sample from the infected area is done
o A swab of infected tissue is allowed to grow on an agar plate
o Staining techniques and microscopic examination identify the bacterium
3. Stool can be examined for ova and parasites

Sensitivity of Pathogen
1. Shows which drugs are capable of controlling the particular microorganism
2. Important to be done for microorganisms that have known resistant strains
3. Along with a culture, identifies the pathogen and appropriate drug for treatment

Factors Affecting Prescribing Anti-infective Agents

1. Identification of the correct pathogen
2. Selection of the right drug
–One that causes the least complications for that particular patient
–One that is most effective against the pathogen involved
Combination Therapy
1. Use of a smaller dosage of each drug
2. Some drugs are synergistic
3. In infections caused by more than one organism, each pathogen may react to a different anti-infective agent
4. Sometimes, the combined effects of the different drugs delay the emergence of resistant strains

Adverse Reactions to Anti-infective Therapy

1. Kidney damage
2. Gastrointestinal (GI) tract toxicity
3. Neurotoxicity
4. Hypersensitivity reactions
5. Superinfections

Prophylaxis of Anti-infective Agents

 People traveling to areas where malaria is endemic
 Patients who are undergoing gastrointestinal or genitourinary surgery
 Patients with known cardiac valve disease, valve replacements, and other conditions requiring invasive procedures

ANTIBIOTICS

 Antibiotics are defined as: Chemicals that inhibit specific bacteria

Types of Antibiotics
1. Bacteriostatic - Substances that prevent the growth of bacteria
2. Bactericidal - Substances that kill bacteria directly

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 3 of 10
Downloaded by yeddul min ([email protected])
 lOMoARcPSD|16603486

Signs of Infection
1. Fever
2. Lethargy
3. Slow-wave sleep induction
4. Classic signs of inflammation (redness, swelling, heat, and pain)

Goal of Antibiotic Therapy

Decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the
invaders

Selecting Treatment
• Identification of the causative organism
• Based on the culture report, an antibiotic is chosen that is known to be effective at treating the invading organism

Bacteria Classification
1. Gram-positive - The cell wall retains a stain or resists decolorization with alcohol
2. Gram-negative - The cell wall loses a stain or is decolorized by alcohol
3. Aerobic - Depend on oxygen for survival
4. Anaerobic - Do not use oxygen

I. Aminoglycosides - A group of powerful antibiotics used to treat serious infections caused by gram-negative aerobic
bacilli
• Common medications:
– Amikacin (Amikin)
– Gentamicin (Garamycin)
– Kanamycin (Kantrex)
– Neomycin (Mycifradin)
– Streptomycin
– Tobramycin (Nebcin, Tobrex)

• Bactericidal
• Indications: treatment of serious infections caused by susceptible bacteria
• Action: inhibit protein synthesis in susceptible strains of gram-negative bacteria causing cell death
• Pharmacokinetics
– Poorly absorbed from the GI tract but rapidly absorbed after IM injection, reaching peak levels within 1 hour
– Widely distributed throughout the body, crossing the placenta and entering breast milk
– Excreted unchanged in the urine and have an average half-life of 2 to 3 hours
– Depend on the kidney for excretion and are toxic to the kidney
• Contraindications: Known allergies, renal or hepatic disease, and hearing loss
• Adverse effects: Ototoxicity and nephrotoxicity are the most significant
• Drug-to-drug interactions: Diuretics and neuromuscular blockers

II. Cephalosporins
• Similar to penicillin in structure and activity
• Action - Interfere with the cell-wall–building ability of bacteria when they divide
• Indication - Treatment of infection caused by susceptible bacteria
• Pharmacokinetics
– Well absorbed from the GI tract
– Metabolized in the liver, excreted in the urine
• Contraindications: Allergies to cephalosporins or penicillin
• Adverse effect: GI tract
• Drug-to-drug interactions: Aminoglycosides, oral anticoagulants, and ETOH

III. Fluoroquinolones
• Relatively new class of antibiotics with a broad spectrum of activity
• Indications: treat infections caused by susceptible strains of gram-negative bacteria, including urinary tract, respiratory
tract, and skin infections
• Actions: interferes with DNA replication in susceptible gram-negative bacteria, preventing cell reproduction
• Pharmacokinetics
– Absorbed in the GI tract

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 4 of 10
Downloaded by yeddul min ([email protected])
 lOMoARcPSD|16603486

– Metabolized in the liver

– Excreted in the urine and feces
• Contraindications: Known allergy, pregnancy, and lactation
• Adverse effects: Headache, dizziness, and GI upset
• Drug-to-drug interactions: Antacids, quinidine, and theophylline

IV. Macrolides
• Antibiotics that interfere with protein synthesis in susceptible bacteria
• Indications: treatment of respiratory, dermatologic, urinary tract, and GI infections caused by susceptible strains of
bacteria
• Actions: bind to cell membranes causing a change in protein function and cell death; can be bacteriostatic or
bactericidal
• Pharmacokinetics
– Absorbed from the GI tract
– Metabolized in the liver, excreted in the bile to feces
• Contraindications: Allergy and hepatic dysfunction
• Adverse effects: GI symptoms
• Drug-to-drug interactions: Digoxin, oral anticoagulants, theophylline, and corticosteroids

V. Lincosamides
• Similar to macrolides but more toxic
• Action: Similar to macrolides
• Indications: Severe infections
• Pharmacokinetics: Well absorbed from the GI tract or IM
– Metabolized in the liver and excreted in the urine and feces
• Contraindications: Hepatic or renal impairment
• Adverse effects: GI reactions

VI. Monobactams
• Unique structure with little cross-resistance
• Action: Disrupts bacteria cell wall synthesis, which promotes the leakage of cellular content and cell death
• Indications: Treatment of infections caused by susceptible bacteria; UTI, skin, intra-abdominal, and gynecologic
infections
• Pharmacokinetics: Well absorbed from the IM injection; Excreted unchanged in the urine
• Contraindications: Allergy
• Adverse effects: GI and hepatic enzyme elevation

VII. Penicillins
• First antibiotics introduced for clinical use
• Action: Inhibit synthesis of the cell wall in susceptible bacteria, causing cell death
• Indications: Treatment of infections caused by streptococcal, pneumococcal, staphylococcal, and other susceptible
bacteria
• Pharmacokinetics: Well absorbed from the GI tract; Excreted unchanged in the urine
• Contraindications: Allergy; Caution in patients with renal disease
• Adverse effects: GI effects
• Drug-to-drug interactions: Tetracyclines and aminoglycosides

VIII. Sulfonamides
• Drugs that inhibit folic acid synthesis
• Action: Interfere with the cell-wall–building ability of dividing bacteria
• Indications: Treatment of infections caused by gram-negative and gram positive-bacteria
• Pharmacokinetics: Well absorbed from the GI tract; Metabolized in the liver and excreted in the urine
• Contraindications: Allergy and pregnancy
• Adverse effects: GI symptoms and renal effects related to the filtration of the drug
• Drug-to-drug interactions: Cross sensitivity with thiazide diuretics; Sulfonylureas

IX. Tetracyclines
• Developed as semisynthetic antibiotics based on the structure of a common soil mold
• Action: Inhibit protein synthesis in susceptible bacteria, preventing cell replication

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 5 of 10
Downloaded by yeddul min ([email protected])
 lOMoARcPSD|16603486

• Indications: Treatment of various infections caused by susceptible strains of bacteria and acne, and when penicillin is
contraindicated for eradication of susceptible organisms
• Pharmacokinetics: Adequately absorbed from the GI tract; Concentrated in the liver and excreted unchanged in the
urine
• Contraindications: Allergy, pregnancy, and lactation
• Adverse effects: GI, skeletal: damage to bones and teeth
• Drug-to-drug interactions: Penicillin G, oral contraceptive therapy, methoxyflurane, and digoxin

X. Antimycobacterials
• Contain pathogens causing tuberculosis and leprosy
• Action: Act on the DNA of the bacteria, leading to lack of growth and eventual bacterial death
• Indication: Treatment of acid-fast bacteria
• Pharmacokinetics: Well absorbed from the GI tract; Metabolized in the liver and excreted in the urine
• Contraindications: Allergy and renal or hepatic failure
• Adverse effects: CNS effects and GI irritation
 • Drug-to-drug interactions: Rifampin and INH can cause liver toxicity

CHECK FOR UNDERSTANDING (30 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:

Multiple Choice

1. The nurse is administering an anti-infective that is considered to be a bacteriocidal. Before beginning therapy, the
nurse should assess the client for:
a. Any neurologic abnormalities.
b. Cardiac history.
c. Hypersensitivity.
d. Respiratory conditions.
ANSWER: C
RATIO: The role of the nurse in drug therapy with penicillin involves careful history taking to assess for previous reactions to
penicillin.

2. The client asks the nurse why the physician didn't prescribe the same antibiotic that he always takes for an infection.
The best response by the nurse would be:
a. "It doesn't matter which antibiotic is taken."
b. "Try this medicine, and if you're not better in 10 days, return to the office."
c. "You don't want to take the same antibiotic all the time."
d. "Bacteria can become resistant to some antibiotics.
ANSWER: D
RATIO: Antibiotics promote the development of drug-resistant bacterial strains by killing populations of bacteria that are
sensitive to the drug. The only bacteria remaining are those cells that possess mutations that made them insensitive to the
effects of the antibiotic.

3. A nurse is preparing to administer a broad-spectrum antibiotic medication to a client. An important nursing intervention
prior to administration regarding anti-infectives is:
a. Obtaining the culture report before starting any medication.
b. Performing a culture within 24 hours after starting the medication.
c. Performing the culture for evidence before administering the first dose of the anti-infective.
d. Administering medicine, and omitting performing cultures.
ANSWER: C
RATIO: The nurse should obtain specimens for culture and sensitivity before the start of antibiotic therapy. Laboratory tests
should be performed before beginning the anti-infective therapy, but the organism does not have to be identified before
starting medication.

4. A client has been on an antibiotic for two weeks for treatment of an ulcer caused by Helicobacter pylori. The client asks
the nurse why a superinfection is caused by this medication. The nurse responds:
a. "This is a secondary infection due to "Candida."

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 6 of 10
Downloaded by yeddul min ([email protected])
 lOMoARcPSD|16603486

b. "The infection has developed immunity to the current drug."

c. "The infection has become severe."
d. "The infection has a restricted group of microorganisms."
ANSWER: A
RATIO: A superinfection is a side effect of antibiotic therapy. The antibiotic destroys the body's normal flora, resulting in
another infection.

5. A client has been discharged with a prescription for penicillin. Discharge instructions includes which of the following?
a. Penicillin can be taken while breastfeeding.
b. The entire prescription must be finished.
c. All penicillin can be taken without regards to eating.
d. Some possible side effects include abdominal pain and diarrhea
ANSWER: B
RATIO: Many people will discontinue medication after improvement is noted. All antibiotics must be completed in their entirety
to prevent reoccurrence of infection.

6. An antimicrobial medication that has selective toxicity has which characteristic?

a. Ability to transfer DNA coding
b. Ability to suppress bacterial resistance
c. Ability to avoid injuring host cells
d. Ability to act against a specific microbe
ANSWER: C
RATIO: Selective toxicity refers to an antibiotic that has the ability to injure only invading microbes, not the host. Conjugation
is the process through which DNA coding for drug resistance is transferred from one bacterium to another. Antibiotics do not
suppress bacterial resistance, but rather promote the emergence of drug-resistant microbes. Antibiotics that are narrow
spectrum are active against only a few microbes.

7. The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what?
a. Resistant infection
b. Superinfection
c. Nosocomial infection
d. Allergic reaction
ANSWER: B
RATIO: Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and
yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection.

8. A client has been prescribed tetracycline. When providing information regarding this drug, the nurse would be correct in
stating that tetracycline:
a. Is classified as a narrow-spectrum antibiotic.
b. Is used to treat a wide variety of disease processes.
c. Has been identified to be safe during pregnancy.
d. Is contraindicated in children under 8 years of age.
ANSWER: D
RATIO: This drug has the ability to cause permanent mottling and discoloration of teeth, and therefore it is not good for
children under 8 years of age.

9. Important information to include in the client's education regarding taking aminoglycosides is that:
a. The drug can cause discoloration of teeth.
b. Fluid intake should be decreased to prevent retention.
c. This drug primarily is given orally, because it is absorbed in the GI tract.
d. A serious side effect is hearing loss.
ANSWER: D
RATIO: This anti-infective is noted for toxic effects on kidneys and vestibular apparatus. Clients should be monitored for
ototoxicity and nephrotoxicity during and after therapy. Hearing loss can occur after therapy.

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 7 of 10
Downloaded by yeddul min ([email protected])
 lOMoARcPSD|16603486

10. A client has been prescribed ciprofloxacin (Cipro). Important information that the nurse must know includes:
a. This medicine must be taken on an empty stomach to increase absorption.
b. This medicine is classified as an aminoglycoside and is given for systemic bacterial infections.
c. This medicine should be given with an antacid to increase the absorption and effectiveness of the medicine.
d. This medicine should not be given with the ordered multivitamin.
ANSWER: D
RATIO: Fluoroquinolones should not be given with multivitamins or mineral supplements, because they can reduce absorption
of the antibiotic by as much as 90%.

11. A nursing intervention for administering sulfamethoxazole-trimethoprim (Bactrim) to a client is to:

a. Have the client drink a full glass of water with the medicine.
b. Have the client drink a glass of milk.
c. Have the client take the medicine with solid foods.
d. Have the client take the medicine on an empty stomach.
ANSWER: A
RATIO: An adverse effect of this drug is the formation of crystals in the urine.

12. This antibiotic can have an adverse effect of dizziness, vertigo, and loss of hearing.
a. Chloramphenicol
b. Aminoglycoside
c. Vancomycin
d. Fluoroquinolones
ANSWER: B
RATIO: This antibiotic collect in the 8th cranial nerve causing neurotoxicity as manifested by dizziness, vertigo, and loss of
hearing.

13. A 60 year old male patient on fourth day of his antibiotic therapy complains of dizziness and nausea. Which is the
most appropriate nursing action?
a. Institute safety precaution and raise side rails.
b. Collaborate with the doctor about antibiotic therapy’s dosage and duration.
c. Provide comfort measures.
d. Instruct client to inform you if symptoms get worse.
ANSWER: B
RATIO: All other options are correct but it is best to address the main cause of the patient’s manifestations. Elderly patients
are more sensitive to neurologic and GI adverse effects of drugs.

14. A middle-aged woman came to the ER and complains of ringing in the ears, paresthesias of the extremities, and
erythema of the back. She also noticed that she had decreased urine output. What history of drug intake should the nurse
ask?
a. Oral contraceptive pills (OCPs)
b. Antifungals
c. Vancomycin
d. Trimethoprim-sulfamethoxazole
ANSWER: C
RATIO: Its toxicity includes ototoxicity, renal failure, and red man syndrome characterized by erythema on the neck and back,
paresthesia, chills, severe hypotension, and fever.

15. The physician orders penicillin for a patient with streptococcal pharyngitis. The nurse administers the drug as ordered,
and the patient has an allergic reaction. The nurse checks the medication order sheet and finds that the patient is allergic
to penicillin. Legal responsibility for the error is:
a. Only the nurse’s—she should have checked the allergies before administering the medication.
b. Only the physician’s—she gave the order, the nurse is obligated to follow it.
c. Only the pharmacist’s—he should alert the floor to possible allergic reactions.

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 8 of 10
Downloaded by yeddul min ([email protected])
 lOMoARcPSD|16603486

d. The pharmacist, physician, and nurse are all liable for the mistake
ANSWER: D
RATIO: The physician, nurse, and pharmacist all are licensed professionals and share responsibility for errors.

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER:
RATIO:

2. ANSWER:
RATIO:

3. ANSWER:
RATIO:

4. ANSWER:
RATIO:

5. ANSWER:
RATIO:

6. ANSWER:
RATIO:

7. ANSWER:
RATIO:

8. ANSWER:
RATIO:

9. ANSWER:
RATIO: _

10. ANSWER:
RATIO:

11. ANSWER:
RATIO:

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 9 of 10
Downloaded by yeddul min ([email protected])
 lOMoARcPSD|16603486

12. ANSWER:
RATIO:

13. ANSWER:
RATIO:

14. ANSWER:
RATIO:

15. ANSWER:
RATIO:

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

TWO ROSES AND A THORN

Each student must note two topics or concepts he or she enjoyed learning about, and another they didn’t like or still have
questions about.

For the next session, review Antifungal & Antiprotozoal Drugs

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 10 of 10
Downloaded by yeddul min ([email protected])