January 7, 2011

Pharmacology 2: Drugs that affects Microbiological Infections

Richard Benedict S. Roxas, RN,MD

Chemotherapeutic Agents – drugs that interfere with the growth and destruction of microorganism
1. Antibacterials  Bacteria
a. Bacteriostatic  It doesn’t kill the bacteria but it stops the growth and replication
- Immune system function  Natural Killer Cells will destroy the delayed growth of the
susceptible bacteria.
- Cocktail Agent  Bacteriocidal agent + Bacteriostatic  Kill the bacteria (PTB agents: HRZE)
b. Bacteriocidal  Kills the bacteria by damaging the cell membrane and or the DNA in the nucleus
the bacteria
2. Anti-fungals  Fungi

3. Anti-protozoal  Amoeba/Chlamydia

4. Anti-parasitic  Damages the function of the parasite (paralyzing the smooth muscles of the ascaris
 Respiratory arrest on the Ascaris lumbricoides)

They both beneficial they kill bacteria.

5. Chemotherapy  Anti-mutated cells

Nursing Responsibilities in Handling Antibiotics and other chemotherapeutic agents:

A. Proper Storage Handling:

- Prevents the potency and & efficacy damage

- Extreme temperature that may change chemical bonding (HEAT)
a. Not exposed sunlight
b. Not higher than the room temperature (35C)
c. Boiling point/ Hot
-------------------------------------------
Net effect  may change the bonding of the chemical structure that lead to two possible
consequences:
a. Precipitation ( Via IV )  Embolism, Thrombophlebitis, Obstruction to the IV flow
b. Change of potency or action no effect

- Promote Labeling and Correct Classifying the Drugs in a stock room

- Prevent Contamination
a. Use gloves, goggles (Powder), mask
- Expiration Date Monitoring
- Prevent Medical Error.
a. 1st step in preparing and administering the drug is compare the drug label to the medication sheet.
B. Initiating the Drug Order:

- Check the Doctors Order (Dose/Timing/Availability), Rational drug use (Is this really for the
management of????)
- Secure the Culture & Sensitivity Test  Give you Specific Antibiotic  RATIONAL DRUG USE
a. Sputum
b. Blood
c. Fecal & Urine
d. CSF
e. Dressing, wound site
f. Contraptions and other appliances
g. Vaginal & PENILE secretions

- EMPERIC THERAPY  While waiting for the CST we can use this type of management. Drug that is give
(BROAD SPECTRUM AGENT)  It risk RESISTANCE, risk killing normal flora SUPERINFECTION (FUNGAL
INFECTION if antibiotic used, Ex: Pseudomembranous colitis)

- Be careful on the instruction BID/QID  should never be written in the drug prescription should not
be interpreted as 4 tablets/day or 2 tablets/day rather (promotes toxic effects/overdosing & resistance)
 every 12 hours, every 6 hours respectively.  Bioavailability & t1/2 (half life)
- Check Sensitivity & Allergic Reactions  check the following:
a. History of Allergic Reaction to agent  YOU MUST NOT STOP THE AGENT AT ONCE, but rather
VERIFY THE INQUIRY  Do some investigation and series of test.
b. History of Allergic reactions (Skin asthma/bronchial asthma history)
- Agents are also immunogen  can stimulate APC to activate MHC to cause immunomodulating
effects.

c. Check (skin test > circular margin for 30 minutes  MD: positive)

d. Monitor: for the signs of HISTAMINE ACTIVATION: Hyperacidity (H2 receptor activation), Skin
rashes, Dyspnea ( Chemoreceptor reflex), wheeze (Bronchoconstriction), dizziness, hypotension 
MGT: (Stop agent, Epinephrine)

- Secure the availability and feasibility of cost (Promoting BFAD approved agents/Generic Agents) :
Example Viraday (retroviral or anti HIV) INDIA

C. Maintenance and Safety

- Prevent Toxicity
a. Right Dose, Right time, Route
b. Monitor Blood Serum levels (SGPT, BUN & Creatinine)  LIVER/RENAL
c. Monitor the other Physical Attributes:
a. Serum electrolytes (Na+, K+)  ( Hyoponatrmia & Hyperkalemia)
b. CBC
-Agents that cause Pancytopenia & Aggranulocytosis (Immuno-suppression, anemia, bleeding)
- WBC : Elevated > 10,000 or Reduced <2000 (in active infection)

SIRS vs. Sepsis:

 c. Vital signs
d. Urine output 0.5cc/kg/hr (adult), 1cc/kg/hr  Pedia neonate
e. Chest X-ray, Culture (sputum/urine/blood/CSF)
f. VIRAL LOAD ( CD4 count and Viral Load)  HIV infected patients Ex: 200: 140,000 (AIDS). Normal
(1500: 0)
d. Monitor Blood serum levels (Agent)  OPTIONAL

- Prevent and Maintain Drug Serum Levels  efficacy of Microcidal/microstatic actions

a. Correct Instructions
b. Compliance to Drug
c. Check Drug Interactions (Antacids/Alcohol/ and agents that has synergistic or antagonistic action)
- When you say this  it is not always prevent, but sometimes you promote how?

a. PTB  COCTAIL OF AGENTS  2HRZE

b. HIV COCTAIL OF AGENTS  COMBIVIR (Zidivudine + Lamivudine)

- Watch out other unwanted drug actions: (SIDE EFFECT/ADVERESE REACTION)

a. Bronchoconstriction, Skin allergy, Hypotension  Anaphylactic Shock

b. Steven Johnson  Blister

c. Renal Failure

d. Ototoxicity, Neuropathy

e. Seizure

- Promote Universal Precaution  Hand washing and sterile technique

a. Needle (No recapping)

- Referral System  CDC & Military (Reportable suspected communicable disease)

a. Police and qualified MD

d. Discharge & Rehabilitation

1. Compliance Medication (Chronic  HIV)

2. Health teachings Transmission Disease, Vaccination, educate susceptible
3. Terminate the agent after consuming the last dose and do not self medicate
4. Encourage and Mandate the patient to RETURN TO THE DOCTOR ON THE SCHEDULED
APPOINTMENT