NCM 206: Pharmacology

SOURCES OF DRUGS
1. PLANTS - human for threonine
Pharmacology
eg . digitalis (purple foxglove)
● From Greek word Pharmakon, Vincristine (periwinkle)
“drug”; and “ study” Morphine (opium poppy)
● How drugs interact within 2. ANIMALS/ANIMAL PRODUCTS-
biological systems to affect pigs for alanine
functionsul Eg. insulin-from pigs and cows
● It is the study of the interactions ● Animal Insulin - Alanine
that occur between a living ● Human Insulin - Threonine
organism and exogenous Vaccine-killed attenuated
chemicals that alter normal microorganism from horse
biochemical function 3. SYNTHETIC VERSION- uses
Drug genetic engineering to alter
bacteria to produce chemicals that
● A substance or mixture of
are therapeutic and effective
substances used in the diagnosis,
4. INORGANIC COMPOUNDS-
cure, treatment or prevention of
these are salts of various elements
disease
which can have therapeutic effects
PHARMACODYNAMICS in the human body and are used to
● Study of the biochemical and treat various conditions.
physiological effects of drugs; Eg. aluminium (antacid for
drug’s mechanism of action hyperacidity)
Fluoride (prevention of dental
PHARMACOKINETICS (ADME)
carries and osteoporosis)
● Study of the absorption,
CLASSIFICATION OF DRUGS
distribution, biotransformation
(metabolism) and excretion of ● PRESCRIPTION OF DRUGS
drugs ● Prescription is an order (often in
written form) by a qualified health
PHARMACOTHERAPEUTICS
care professional to a pharmacist
● Study of how drugs may best be or other therapist for a treatment to
used in the treatment of illness; be provided to the patient.
which drug would be most or least ● COMPONENTS
appropriate to use for a specific - Date & time the drug is
disease, what dose would be written
required - Drug name
PHARMACOGNOSY - Drug dosage
- Route of administration
● Study of drugs derived from herbal
- Frequency & duration of
and other natural sources
administration
TOXICOLOGY - Signature of the physician
● Study of poisons and poisonings;
deals with the toxic effects of
substances on the living organism.
 - Distributed ilegally; are used for
PART OF A PRESCRIPTION
non-medical purposes, generally to
● SUPERSCRIPTION alter mood or feeling
- Descriptive patient Eg. Heroin, Marijuana, Nubain,
information (name, age, cytotec
address)
- Date prescribed
- Rx symbol DRUGS NAMES
● INSCRIPTION 1. Chemical Name- a systematically
- Name & dosage strength of derived name which identifies the
prescribed medication chemical structure of the drug;
● SUBSCRIPTION shows the exact chemical
- Dispensing instructions for constitution of the drug and exact
the pharmacist placing of atoms.
● SIGNATURA Eg. N-Acetyl-para-aminophenol
- Directions for the clients 2. Generic Name/ Nonproprietary
● PRESCRIBER’S SIGNATURE Name- given before drug becomes
official; reflects some important
pharmacological or chemical
characteristic of the drug
Eg. acetaminophen
3. Brand (Trade) Name- followed by
the symbol R(in a circle); indicates
the name is registered, that its use
is restricted to the owner of the
drug, who is usually the
manufacturer of the product.
Eg. Biogesic

NOTES SOURCES OF DRUG INFORMATION

- Threonine for humans
● Pharmacopeia
- Alanine for pigs
● Formulary
- First drug being produce synthetic
● Nursing textbook
version (aspirin)
● Package insert
2. NON-PRESCRIPTION DRUGS
● Reference books
- Also known as over the counter
1. PDR
drugs
2. Drug facts & comparisons
Eg. Paracetamol
3. Nursing drug
3. INVESTIGATIONAL DRUGS
guide/handbook
- Drugs that are subjected to clinical
● Journals
studies in order to evaluate the
1. Medical letter
usefulness of the drug in treating
2. American journal of nursing
the disease for which it is claimed
● Internet
to be effected
Ex. Covid Vaccines
4. ILLICIT DRUGS OR STREET DRUGS

NURSING PROCESS IN
 a. Identification of the therapeutic
PHARMACOLOGY
intent for every medication
1. Assessment b. Side effects to be expected and
● Forms the basis on which reported
care is planned, c. Identification of the recommended
implemented & evaluated. dosage and route of administration
ADPIE d. Scheduling of the administration of
A- assessment medication\
D-diagnosis e. Teaching the patient to keep
P-Plan written records of his responses
I-implement f. Additional teaching as needed:
E- evaluatiion Eg. techniques of administration,
● Subjective Data proper storage of medication
● Objective Data
● The nurse is most often the one person who INTERVENTION /IMPLEMENTATION
follows the client to assess the client’s ● NURSING ACTIONS necessary to
response to drugs. ANTICIPATE DRUG accomplish GOALS or expected
RESPONSE! outcomes.
● DEPENDENT NURSING
ACTIONS
DRUG HISTORY
● INTERDEPENDENT NURSING
a. To evaluate the patient’s need for medication ACTIONS
b. To obtain current and ast use of medicines ● INDEPENDENT NURSING
(OTC medicines, prescribed medicines, ACTION
herbal products, illicit drugs) CLIENT TEACHING & EDUCATION
c. To identify problems related to drug therapy INCLUDES:
d. To identify risk factors in drug therapy ● Administration of Drug
NURSING DIAGNOSIS ● Assessment of Drug Effectiveness
● Self-Administration
- Made based on the analysis of assessment
● Diet
data
● Side effects
- May be ACTUAL or POTENTIAL
● Cultural Considerations
● KNOWLEDGE DEFICIT about drug action,
Check for:
administration & SE R/t cultural/ language
● Response to medications;
barrier or speech articulation problem
observations for S/S or the
● RISK for INJURY R/T forgetfulness.
development of adverse effects;
● Ineffective therapeutic regimen management
ability to receive pt. Education &
R/T lack of finances
self-administer meds; potential for
compliance
PLANNING
-is characterized by goal setting or EVALUATION
expected outcomes which represent
- Is an ongoing process that
patient goals and state of desired patient
assesses response to the
behaviour of responses that should result
following:
from the nursing care.
● The effectiveness of the
medication prescribed
Included are:
 ● Observation of signs and doses have been metabolized or
symptoms of recurring illness excreted.
● Development of the ide/ adverse - May result in drug toxicity
effects - Rate of consumption exceeds rate
● Effectiveness of the health of metabolism (eg. alcohol)
teaching or client education
DRUG INTERACTION
FACTORS INFLUENCING DRUG
ACTION
ADDICTIVE EFFECT
1. Age- most sensitive to the
response of drugs: ➔ 2 DRUGS with SIMILAR actions
a. Infants are taken for a DOUBLED
b. Very elderly EFFECT
2. Body Weight ➔ Ex. propoxyphene + aspirin=
a. Overweight- increase dosage added analgesic effect
b. underweight - decrease in dosage
c. Pediatrics- calculated mL of SYNERGISTIC EFFECT
drug/kgBW
➔ The combined effect of 2 drugs is
3. Metabolic Rate/Genetic Factors
> the sum of the effect of each
4. Illness
drug given alone
- pathologic conditions alter rate of
➔ Ex. amicillin +
absorption, distribution,metabolism
sulbactam+prolonged action of the
and excretion
antibiotic
Eg. clients in shock, who are vomiting,
with nephrotic syndrome or malnutrition, ANTAGONISTIC EFFECT
with kidney failure ➔ 1 drug interferes with the action of
5. Psychological Aspects another
- Attitudes and expectations ➔ Ex. tetracycline+antacid=
- Willingness to take medicines as DECREASE absorption of the
prescribed tetracyclin
6. Dependence- also known as addiction
or habituation INTERFERENCE
- Physical dependence- develops ➔ 1 drug inhibits the met./excretion of
withdrawal symptoms a 2nd drug, causing INCREASE
- Psychological dependence- activity of the 2nd drug
emotionally attached to the drug ➔ Ex.
7. Tolerance probenecid=spectinomycin=PROL
- Occurs when higher doses are ONGED antibacterial activity from
required to produce the same spectinomycin due to blocking
effect that lower doses once renal excretion by probenecid
provided INCOMPATIBILITY
- Can be caused by psychological
dependence ➔ Should not be mixed together or
8. Cumulative Effect administered at the same site.
- Of the next doses are administered ➔ Signs are haziness, a precipitate,
before previously administered or a change in color of solution
when mixed
 ➔ Ex. ampicillin+gentamicin=
ampicillin inactivities gentamicin
OTHER TERMINOLOGIES
● Desired action- expected
response
● Side effects
- Effects which result from
pharmacological effects of
the drug
- Actions other than intended
therapeutic effects resulting
from the pharmacological
action of a drug
● Adverse effect
- A range of undesirable
effects (unintended & specific receptors within the body
occurring at normal doses)
of drugs that cause mild to
severe reactions
● Toxicity
- Severe adverse effect;
quality of being poisonous
● Carcinogenicity
- Ability of the drug to induce
living cells to mutate and
become cancerous
● Teratogenicity
- Drug that induces birth
defects; cas=using
abnormal dev. of a fetus in
utero
● Photosensitivity- skin reaction d/t
exposure to sunlight\
● Hypersensitivity/Allergic
reaction- hypersensitive response
of the the client’s immunological
system in the presence of a drug
● Idiosyncratic Reaction - may
occur when the client is first
exposed to the drug; result of
abnormal; reactivity to a drug
caused by genetic differences
between the client and non
reacting individuals
PRINCIPLE OF DRUG ACTION
DRUGS do not create new cellular
functions but rather alter existing ones
Ex. antibiotic slows the growth and/or
reproduction of microbial organisms
DRUG ADDICTION is relative to the
psychological state which existed when
the drug was administered
DRUGS ,ay interact with the body in
several different ways:
- Alter the chemical composition of a
body fluid
- Accumulate in certain tissues
because of their affinity for a tissue
component
- By forming a chemical bond with
-
DIFFERENT DRUGS
- Whose molecules precisely fit into
a given receptor elicit a
comparable drug response; those
which do not perfectly fit produce
only a weak or no response at all.
- Ex. hormones
AGONIST-ANTAGONIST drugs exert
some agonist as well as antagonist
action
1. Agonist- drugs which interact with
a receptor to produce a response
2. Antagonist- drugs interact to
inhibitor prevent the action of an
agonist
Ex. Depression of CNS by narcotic
agonists morphine reversed by narcotic
antagonist narcan (naloxone)
PRINCIPLE APPLIED TO
PHARMACOLOGY
Check why the medication is given &
know the classification of the drug
How ill you know if the medication is
effective? What are your assessment
parameters in monitoring the effects of
drug?
E xactly what time should the medication
be given
C lenient teaching tips. What are the
therapeutic and side effects of the
medication?
K eys to giving it safely. You should be
able to identify interventions to counteract
the adverse effects of the drug.
EXCIPIENTS
● fillers or inert substance (additives)
used in drug preparation to allow
the drug to take on a particular
size and shap
● to enhance the drug’s dissolution
● Increases absorbability of a drug
Exxample
● K+ -> Penicillin Potassium
● Na+ -> Pen G Sodium

PHARMACOKINETICS
PHASES OF DRUG THERAPY Is the process of drug movement to
achieve drug action.
3 phases of drug action:
4 Processes
● Pharmaceutic ● Absorption
● Pharmacokinetic ● Distribution
● Pharamcodynamic ● Metabolism
● Excertion

PHARMACEUTIC PHASE ABSORPTION

Disintegration - Breakdown of a tablet into
smaller particle
Dissolution - Dissolving process of the
smaller particles in the GIT fluid prior to
absorption
Depends on: Rate Limiting and Excipient
The movement of drug particles from the
GI tract to body fluids by passive
absorption, active absorption, or
pinocytosis.
Lipid soluble & non-ionized are absorbed
faster than water soluble & ionized drugs

PASSIVE ABSORPTION - drug molecule

move from a region of relatively high to
low concentration without requiring energy

ACTIVE ABSORPTION - process that

uses energy to actively move a molecule
across a cell membrane

RATE LIMITING - time it takes the for the

drug to disintegrate and dissolve and
become available for the body to absorb
PINOCYTOSIS - process by which cells
DISTRIBUTION
carry drug across the membranes
engulfing the drug particles Is the process by which the drug becomes
available to body fluids and body tissues.
Factors Affecting Absorption:
1. Blood flow Factors influencing drug distribution:
2. Pain a. blood flow
3. Stress and food b. affinity to the body tissues
4. Exercise c. protein-binding effect
5. Nature of absorbing How are drugs distributed?
surfacetransport of drug molecules ● Protein binding
is faster through a single layer of ● Blood-brain barrier
cells (intestinal epithelium) than ● Placenta & breastmilk
the transverse layers of cells (skin)
6. Drug solubility PROTEIN BINDING - Drugs that bind with
7. pH specific protein component such as
8. Drug concentration albumin and globulin.
9. Dosage form Example:
10. Hepatic first-pass effect – anticonvulsants - albumin
inactivation of drug by enzymes in Antidysrhythmics - globulin
the liver before the drug reaches
the systemic circulation for The portion of the drug that is bound to
distribution. > bioavailability- the protein is inactive (do not cause
percentage of the administered pharmacological response)
drug dose that reaches the
systemic circulation The portion of the drug that is unbound is
11. Enterohepatic recycling- called FREE Drug which is an active drug
absorption of drug from the bile (causes pharmacological response)
into the small bowel and then into
the circulating system. When 2 highly protein-bound drugs are
12. Route of administration- linked to given concurrently, DRUG TOXICITY may
blood supply result

DRUG TOXICITY - too much of free drug

released in the circulation (eg. two highly
CHON- bound drugs and low albumin)

BLOOD - BRAIN BARRIER

● Is a process system of cellular
activity that keeps foreign
invaders/poisons away from the
CNS.
● High lipid soluble drugs are more
likely to pass the blood barrier.
● Antibiotics can not pass this BBB
● CNS effects by medications are
result of indirect drug effects and
 not the actual reaction of the drug
EXCRETION
to the CNS.

PLACENTA & BREASTMILK ● Process of eliminating substances

● Drugs readily pass through the
placenta and affect the developing
fetus.
● Drugs are secreted into breastmilk
and therefore have the potential to
affect the neonate.
METABOLISM/BIOTRANSFORMATION
● Chemical changes a substance
undergoes in the body such as by
the action of enzyme
● Drugs are metabolized in both the
GI tract and liver (primary site of
metabolism.
● Most drugs are inactivated by liver
enzymes and are converted to
water soluble substances (inactive
metabolites) for renal excretion
Liver disease such as cirrhosis & hepatitis
affect drug metabolism
Half life [t ½]
● Time it takes for ½ of the drug
concentration to be eliminated
depression (drows
by body organs or tissues, as part
of a natural metabolic activity.
● KIDNEYS – MAIN ROUTE of
elimination [ free, water soluble,
unbound drug
● Others : BILE, FECES, LUNGS,
SALIVA, SWEAT & BREASTM
● URINE pH –influences drug
excretion
Acid urine --- elimination of
weak base drugs
Alkaline urine – elimination
of weak acid
PHARMACODYNAMIC PHASE
● Is the study of drug concentration
and its effects on the body.
● Drug response can cause a
primary and secondary physiologic
effect.
● The primary effect is desirable and
the secondary effect may be
desirable or undesirable.
Example: diphenhydramine (Benadryl)
1° effect = treats allergy
2° effect = central nervous system

RECEPTOR THEORY - drug act through

receptors by binding to the receptor to
produce (initiate) a response or to block
(prevent) a response

The better the drug fits ate the receptor

site, the more biologically active the drug
is.

DRUG ACTIONS:
● Replace or act as substitutes for
Eg. Half – life of 650mg of Aspirin
missing chemicals
● Increase or stimulate certain
cellular activities
● Depress or slow cellular activities
 ● Interfere with the functioning of
foreign cells such as invading
organisms
ONSET of action: time it takes to reach
the minimum effective concentration
[MEC] after a drug is administered
PEAK of action: condition that occurs
when the drug reaches its highest blood or
plasma concentration
DURATION of action: length of time the
drug has a pharmacological effect
AGONISTS: drugs that produce a
response.
ANTAGONISTS: drugs that block a
response
ANTI-BACTERIALS
ANTIMICROBIALS /ANTIBACTERIAL–
inhibit the growth of or kill bacteria/
microorganisms
ANTIBIOTICS – chemicals that are
produced by 1 kind of microorganism that
inhibits the growth of or kills another
PHARMACOKINETICS
◻ Must only penetrate the bacterial cell
wall in sufficient concentration; must have
affinity to the binding sites .
◻ TIME drug remains at the binding site =
INCREASE EFFECT;
◻ Controlled by DISTRIBUTION, HALF-
LIFE & ELIMINATION
◻ Most are not highly CHON bound =
longer HALF-LIFE greater concentration
at binding sites; mostly eliminated from
the body through URINE after the 7th half-
life
PHARMACODYNAMICS
◻ DRUG CONCENTRATION & AFFINITY
is needed to achieve MEC necessary to
halt growth of microorganism.
◻ CONSTANT increase drug
concentration above MEC
=BACTERICIDAL EFFECT
◻ FREQUENCY, DOSE & DURATION of
drug administration depends on: ■
Severity of infection ■ Site of infection ■
Type of pathogen ■ Immunocompetence
of the host ■ Adverse effects ■
Continuous infusion regimen VS.
intermittent dosing ■ Once daily dosing =
less severe adverse reactions ; increase
adherence
RESISTANCE TO ANTIBACTERIALS
◻ INHERENT or NATURAL – occurs
without previous exposure to the
antibacterial drug
◻ (gram (-) pseudomonas aeruginosa
resistant to Pen G
◻ ACQUIRED - caused by PRIOR
exposure to antibacterial
◻ Responsible for causing Penicillin
resistance = PENICILLINASE
enzyme that metabolizes PenG = drug is
ineffective
◻ CAUSES : mutant bacteria- grown a TX: antihistamine, epinephrine,
thicker cell wall transfer of genetic bronchodilators
instruction to another bacterial species 2) SUPERINFECTION – secondary
infection due to disturbed normal flora;
To beat the problem: occur with use of broad spectrum
◻ NEW ANTIBIOTICS ARE antibiotics
DEVELOPED. == linezolid (Zyvox) 3) ORGAN TOXICITY – damage to
> Methicillin-resistant staphylococcus – organs that are involved in drugs
> VRE- vancomycin-resistant enterococci metabolism & excretion (liver & kidneys)
& penicillin-resistant streptococci aminoglycosides = OTOTOXIC &
> Quiniupristin/dalfopristin (Synercid) NEPHROTOXIC
against VRE and treatment of
bacteremia, S. aureus & strepotoccus
CATEGORIES OF ANTIBACTERIALS
pyrogenes
◻ DEVELOPMENT OFANTIBIOTIC ◻ Penicillins
RESISTANT DISABLERS ◻ Cephalosporins
-disable antibiotic-resistant mechanism in ◻ Tetracyclines
the bacteria ◻ Aminoglycosides
◻ BACTERIAL VACCINE – against ◻ Macrolides and Lincosamides
pneumococcus - PNEUMONIA & ◻ Vancomycin
MENINGITIS ◻ Chloramphenicols
◻ PREVENT ANTIBIOTIC ABUSE ◻ Fluoroquinolones
◻ COMPLIANCE and MULTI ANTIBIOTIC ◻ Sulfonamides
THERAPY ◻ Peptides

ANTIBIOTIC COMBINATIONS: PENICILLIN

> ADDITIVE EFFECT – equal to the SUM
◻ Natural antibacterial agent from MOLD
of the effects of 2 antibiotics
GENUS called PENICILLIUM NOTATUM
> POTENTIATIVE EFFECT – one
(1928, Alexander Fleming)
antibiotic potentiates the effect of the 2nd
◻ Moldy bread used on wounds to treat
antibiotic
infection (3500 yrs. Ago)
> ANTAGONISTIC – combination of a
◻ Referred to as Beta-Lactam –
drug that is BACTERICIDAL PENICILLIN
inactivated by Penicillinase
+ drug that is BACTERIOSTATIC,
◻ Both Bactericidal ( kills bacterial) and
TETRACYCLINE = desired effect may be
Bacteriostatic (inhibits growth of bacteria)
reduced
■ Interferes with the bacterial cell
SPECTRUM
wall synthesis by inhibiting
> NARROW SPECTRUM – against one
bacterial enzyme ; do not disrupt
type of organism
existing bacterial cell wall, but only
Penicillin & Erythromycin – FOR GRAM
newly forming and actively growing
(+) BACTERIA
cell wall
> BROAD SPECTRUM - against both
gram (+) & gram (-)
Tetracyline & Cephalosporins
◻ PENICILLIN G – primarily bactericidal;
GENERAL ADVERSE REACTIONS DOC for treating many infections caused
1) HYPERSENSITIVITY – rash, pruritus & by penicillin-sensitive organisms
hives ; severe anaphylactic shock
 > first penicillin administered
ORALLY and by Injection (ORAL –
only 1/3 of the dose is absorbed;
IM/IV—more effective in achieving
a therapeutic serum per level
◻ PROCAINE PENICILLIN G (Wycillin)-
extends the drug’s action; has milky color;
less painful during injection
◻ AQUEOUS PEN G – short duration of
action; IM route is very painful (IM or IV)
◻ PENICILLIN V – preferred for ORAL
adminstered.- 2/3 absorbed in GIT, but is
less POTENT; effective against mild-mod
Infection, including ANTHRAX.
◻ BROAD SPECTRUM PENICILLINS /
AMINOPENICILLIN
Used to treat both gram (+) and gram (-)
bacteria (E. Coli, H. Influenzae, Shigella
dysenteriae, Proteusmirabilis, Salmonella)
Costlier than penicillin; not
PENICILLINASE RESISTANT
Examples:
■ ampicillin (Ampicin) amoxicillin (Amoxin)
(most prescribed for adults & children)
■ bacampicillin (Penglobe)
■ amoxicillin-clauvanate (Amoxyclav,
Augmentin)
PENICILLINASE-RESISTANT
PENICILLIN/Antistaphylococcal
penicillin
Used to treat penicillinase-producing S.
aureus gram (+); not effective against
gram (-) organisms
Examples:
■ [Oral] cloxacillin (Prostaphlin-A),
dicloxacillin (Dynapen)
■ [Parenteral] methicillin (Staphcillin),
nafcillin (Vigopen)
■ Less effective than Pen G against gram
(+) organi
EXTENDED SPECTRUM PENICILLIN /
Antipseudomonal penicillin
> Effective against Pesudomonas
aeroginosa [gram (-)]
> Not penicliinase-resistant; effective
against gram (–) organism- == Proteus,
Klebsiella pneumoniae, Enterobacter
Less toxic than aminoglycosides
Examples:
Piperacillin, ticarcillin disodium
BETA-LACTAMASE INHIBITORS
> Penicillinase sensitive penicillin + Beta-
Lactamase inhibitors
Examples:
■ [O] amoxicillin (BSP) + clavulanic
acid ==Augmentin, Amoxyclav
■ [P] ampicillin (BSP) + sulbactam
== Unasyn
■ [P} piperacillin (ESP) +
tazobactam == Tazocin
PHARMACODYNAMICS
MODE of ACTION :
BACTERICIDAL – interfere with the ability
of susceptible bacteria to build their cell
walls – weaken the walls == SWELL then
BURST from osmotic pressure
ONSET : 0.5 HR
PEAK : 1-2 HR
DURATION : 6-8 HR
PHARMACODYNAMICS
[A] rapidly in the GIT---- peak level in 1 hr;
sensitive to gastric acid levels in the
stomach
◻ taken on empty stomach == ensure
adequate absorption
◻ [ + 1 glass of water, 1 hr ac or 2-3 hrs
pc]
[E] unchanged in the URINE; enter in
breastmilk – can cause DIARRHEA &
ADVERSE Reaction-baby
ADVERSE EFFECTS:
MAJOR = involve in GIT = N,V,D {mgt:
SFF}
■ glossitis, stomatitis, soremouth,
CEPHALOSPORINS
furry tongue[mgt: ice chips,
sugarless candy} rt loss of bacteria
from normal flora = superinfection ● Group of antibiotics chemically and
(may lead to yeast infections) pharmacologically related to
HYPERSENSITIVITY RXN = rash, fever, penicillin.
wheezing (anaphylactic shock and death) ● First introduced in 1960s;
PAIN & INFLAMMATION at injection FUNGUS (cephalosporium
site /Phlebitis {mgt: administer slowly, acremonium) discovered in
remove IV line, warm compress, gentle seawater (1948)
massage} ● Effective against gram + and gram
- bacteria
DRUG-LAB-FOOD INTERACTIONS: ● Resistant to beta-lactamase
DRUG : Increase effect with ASPIRIN, ● 1960 - cephalosporins used with
PROBENECID; Decrease effect with clinical effectiveness
Tetracyclines, erythromycin – antagonistic ● BACTERICIDAL or
{should be avoided or increase dosage of BACTERIOSTATIC depending
Penicillin, but increase AE}; if taken with upon:
contraceptive pills – OCP less effective -Susceptibility of the
LAB : elevate AST, ALT organism being treated
FOOD : decreased effect with acidic or -Dose used
juic -Tissue concentration of
the drug
NURSING CONSIDERATIONS -Rate at which bacteria are
Monitor for superinfections multiplying
Evaluate renal [BUN & creatinine] & liver
[AST,ALT] functions Notes:
Diarrhea r/t superinfections {mgt: take *bind to and block peptidoglycans
yogurt, more fluids} *Broad spectrum antibiotics
Inform physician before taking other meds *DOC for those that are allergic to
Cultures- prior to 1st dose penicillin
Alcohol is OUT!/ ask about allergies *Oral - to treat simple infections such as
Take full course of meds streptococcus - tonsilitis
Evaluate cultures, WBC, C&S *IV - Severe infections, faster effect for
infections such as meningitis
DRUG CALCULATIONS
 *prophylactic antibiotic (given ahead)
*Bacteriostatic (???)

PHARMACOKINETICS & 2ND GENERATION CEPHALOSPORIN

PHARMACODYNAMICS “fo”/”fu” - CEFUROXIME, CEFOFETAN,
CEFONICID, CEFACLOR
A: PO well absorbed
D: 75-85% ➢ BROAD SPECTRUM against gram
M: (half-life) t ½ = 1.5 - 2.5 hr (-) bacteria diminished activity
E: unchanged in urine 60%-80% against gram (+) bacteria
➢ NOT affected by B-lactamases

SIDE EFFECTS
❖ Stomach discomfort
❖ Decreased appetite
1ST GENERATION CEPHALOSPORINS ❖ Skin rashes
“fa”/”pha” - CEFRADROXIL, CEFAZOLIN, ❖ Thrombocytopenia
CEPHALEXIN ❖ Increased liver enzymes
❖ Drug induced hemolytic diseases
➢ Effective against gram (+) and
gram (-) bacteria (BROAD INDICATED FOR:
SPECTRUM) ➔ Bone & joint infx
➢ Can be destroyed by B-lactamase ➔ Skin & soft tissue infx
produced by bacteria [PEck] ➔ Gynecological infx
➔ Intra abdominal infx
SIDE EFFECTS: ➔ LRTI
● Tongue/ throat swelling ➔ Serious UTI
● DUB ➔ Meningitis in children
● Lower Blood Pressure ➔ Blood infx
● Oral thrush or Candidiasis
● Diarrhea BACTERIA SUSCEPTIBLE
● AP ● PEcK + HEN
● Nausea ● Hemophilus influenzae
● Vomiting Hypersensitivity ● Enterobacter aerogenes
● Neisseria gonorrhea/meningitidis
INDICATED FOR:
❖ Respiratory infx
❖ Skin infx
❖ Genito Urinary
❖ Bone Infx Two (2) SUBGROUPS:
❖ Myocardial Infx
1. Cefuroxime & Cefprozil - increased
BACTERIA SUSCEPTIBLE coverage against H. influenza
● Proteus mirabilis
● Escherichia coli 2. Cephamycin - increased coverage
● Klebsiella pneumoniae against bacteroides species.
[strepto & staph]
Notes 3RD GENERATION CEPHALOSPORINS
“ft” - CEFTRIAXONE, CEFTRAZIDIME, use small gauge needle, large
CEFIXIME, CEFDINIR veins, alternate infusion sites}

➢ BROADER gram (-) activity and DRUG INTERACTIONS

less activity against gram (+) ➔ Cefmetazole (1st) - Disulfiram-like
bacteria than 2nd gen reaction
➢ Resistance to B-lactamases ➔ Cefoperazone (3rd) + ALCOHOL =
flushing, dizziness, headache, N/V
INDICATIONS: ➔ Maxolactam - muscular cramps,
➢ As prophylaxis: chest pain, palpitions, dyspnea (may
● 1st line SBP (Spontaneous lead to extreme CV collapse,
bacterial peritonitis) convulsions & death)
● Biliary infx ➔ With
● Neuro-surgery related infx aminoglycosides/vancomycin-
● Post urologic procedure increased nephrotoxicity
infx ➔ With anticoagulant or
thrombolytics / NSAIDS -
➢ As therapy: increased RISK of bleeding {monitor
● CNS infx blood loss}
● GUT infx
● CAP ADVERSE REACTIONS
● Bone & joint infx ● NEPHROTOXICITY - RENAL
● Lyme Dse FAILURE
● Pseudomonas pneumonia ● SUPERINFECTIONS
● ANAPHYLAXIS
BACTERIA SUSCECPTIBLE
● HENPEcKS EDUCATION:
● Serratia marcescens ● Administer on an empty stomach
● Refrigerate ORAL suspension
SIDE EFFECTS ● False urine test for GLUCOSE with
❖ ORAL - GI: Flatulence, NAVDA use of clinitest tab or Benedict’s
(Nausea and Vomiting) (bloody solution, therefore use blood to
stool - {stop} / {best administered check for glucose level.
with food or milk - increases
absorption)
-BEST if taken on an empty
stomach
-IF with gastric irritation - take
with food
❖ Fever rash, pruritus,
headaches, vertigo (CNS
symptoms) = TETRACYCLINES
HYPERSENSITIVITY ● Isolated from STREPTOMYCES
REACTION {STOP} AUREOFACIENS in 1948.
❖ IV/IM - prolonged / high doses = ● 1st broad spectrum antibiotics
PHLEBITIS or effective against gram (+) bacteria
THROMBOPHLEBITIS {mgt: & many organisms
 [mycobacterium, rickettsiae, ● frequently prescribed for ORAL
spirochetes, chlamydiae] use, available also for IM [cause
● Not effective against S. aureus, pain on injection & tissue irritation];
Pseudomonas or Proteus IV route - treat severe infections
● Can be used against Mycoplasma ● Newer ORAL: DOXYCYCLINE,
pneumoniae. MINOCYCLINE,
● + Metronidazole and bismuth METHACYCLINE: rapidly &
subsalicylate == useful in treating complete absorbed
Helicobacter pylori (peptic ulcer) ● Not to be taken with MAGNESIUM
● ORAL and TOPICAL tetracycline - & ALUMINUM preparation
used to treat severe acne vulgaris (antacids), MILK-PRODUCTS
containing calcium or Iron-
MOA (MODE OF ACTION): containing drugs == prevent
- Inhibit bacterial protein synthesis absorption of the drug
(bacteriostatic) ● TAKEN on EMPTY STOMACH - 1
- Continuous use of tetra = resulted hr ac or 2 hrs pc (except
in bacterial resistance; increased doxycycline & minocycline)
resistance in the treatment of
pneumococci & gonococci INDICATIONS:
infections. ● PID (pelvic inflammatory dse.)
● Syphilis
CLASSIFICATIONS: ● Whipple dse
1. SHORT ACTING ● MRSA (Methicillin resistant stap.
- tetracycline {Tetracyn, Aureus)
Panmycin} >gram (+), gram ● VRE (Vancomycin resistant
(-), RT, skin disorders, enterococcus)
chlamydial, gonnorhea, ● Meningococcal prophylaxis
syphilis, ricketssial [t ½ = 6- ● CV dse (cardiovascular dse)
12 hrs]
- oxytetracycline Hcl SIDE EFFECTS & ADVERSE
{terramycin} > UTI REACTIONS:
● GI - NVD {nsg. Mgt: SFF, ice
2. INTERMEDIATE chips, replace fluids}
- demeclocycline HCI ● PHOTOSENSITIVITY - sunburn
(Declomycin) > broad reaction {nsg. Mgt: sunblock,
spectrum [t ½ = 10-17 hrs] clothing}
● TERATOGENIC EFFECT - not
3. LONG-ACTING (to be taken with taken 1st trimester (FDA: A&B =
food) no risk factors, C = has risk
- doxycycline hyclate factors, B = contraindicated, X =
(Vibramycin) > bacterial cannot be used)
infection & acne ● DISCOLORS TEETH (irreversible)
- minocycline HCI (Minocin) - not taken last trimesters &
[t 1\2 = 11-20 hrs] children < 8yrs ; yellowish to
brownish
● BALANCE DIFFICULTY - damage
TETRACYCLINES to vestibular part of the inner ear
 (minocycline) {ngt. Mgt: promote 2. neomycin - used as preoperative
safety} bowel antiseptic
● NEPHROTOXICITY - if given in OTHERS: (treat pseudomonas)
high doses ● Gentamycin (1963) [IM/IV] >
● SUPERINFECTION - distrupt against gram (-) esp.
microbial flora {ngt. Mgt: oral Pseudomonas
hygiene} ● Kanamycin [PO/IM/IV] > for
hepatic coma
EDUCATION: (STOP) ● Tobramycin (1970) [IM/IV] > kill
● Sunlight sensitivity [decomposes in Pseudomonas
light/heat = TOXIC - store out of ● Amikacin (1970) [IM\IV] >
light & extreme heat] effective against Pseudo esp. If
● Take full glass of H20 resistant to gentamicin &
● O Antacid, IRON & MILK tobramycin
● Put drug into empty stomach ● Netilmicin (1980) [IM/IV] > less
toxic compared to other
DRUG INTERACTIONS: aminoglycosides
● ANTACIDS, IRON containing
drugs, MILK - prevent absorption PHARMACOKINETICS:
of Tetra {take 2hrs apart} Gentamycin
● ORAL CONTRACEPTIVES - PC: C (can’t rule out)
lessen effect of OCP
● PENICILLIN - decreased activity of Netilmicin (latest)
Penicillin PC: D(+ risk)
● AMINOGLYCOSIDES - increased
risk Nephrotoxicity [A] : IM, IV
[M] : T ½ short (SHL) - 3-4x a day,
AMINOGLYCOSIDES PB(protein bound) - low (w/ pharma
● ACT by inhibiting bacterial protein response)
synthesis (Bactericidal) [E] : unchanged in URINE
● Used against serious infections
caused by gram (-) bacteria [E.
coli, Proteus, Pseudomonas &
Serratia]
● Cannot be absorbed in the GIT,
cannot cross CSF (in adults only)
● Primarily administered IV
● DOC: Tularemia & Bubonic Plague SIDE EFFECTS:
● STREPTOMYCIN SULFATE (1st ● GI - NAV; rash, numbness,
aminoglycosides) - used in tremors, visual disturbances,
treatment of TB; derived from tinnitus, muscle cramps or
bacteriu, Streptomyces griseus in weakness, photosensitivity
1944, administered IV ADVERSE REACTIONS:
● URTICARIA, PALPITATIONS
ORAL PREPARATIONS: given to ● Thrombocytopenia
decrease bacteria in the bowel ● Superinfections - agranulocytosis
1. paromomycin - useful in treating ● Liver damage
intestinal amoebiasis & tapeworm
Most Serious:
● OTOXICITY - 8th cranial nerve
damage {Ngt. Mgt: promote safety}
● NEPHROTOXICITY - oliguria {Ngt.
Mgt: slowly administered}
● NEUROTOXICITY -
neuromuscular blockade,
numbness

INTERACTIONS:
● Penicillin - less effective
aminoglycoside
● Anticoagulant (Warfarin) -
increased its activity

NURSING INTERVENTIONS:
● Monitor periodical audiograms,
BUN/creatinine & vestibule
function studies over 10 days
therapy
● Adjust renal insufficiency
● Monitor VS, peak and serum levels
● For IV admin., dilute and
administer slowly to prevent
toxicity
● Monitor I & O, hydrate well before
and during therapy (flush in
between)
● If anorexia or nausea occurs, SFF
(small frequent feeding) meals
● Establish plan for safety if
vestibular nerve effects occur
● Administer other antibiotics 1 hour
before/after aminoglycosides
MIDTERMS
● Recommend using sunblock ^&
protective clothing when exposed
to the sun

“THE AMINO MICE” (toxic mice!!!)

“CAN’T HEAR” - OTOTOXICITY
“CAN’T PEE” - NEPHROTOXICITY
“CAN’T FEEL” - NEUROTOXICITY