Pharm, part 47: Immune Medications - Antibiotics - Cell Wall Inhibitors

September 25, 2021 Updated: October 10, 2021 5 min read

Full Transcript

Hi, I'm Cathy with Level Up RN. In this video, I am going to continue my coverage of antibiotics. In our last video, we talked about antibiotics that affect protein synthesis. In this video, we are going to talk about antibiotics that affect cell wall synthesis. And at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key facts I'll be covering in this video. So definitely stay tuned for that. And if you have our pharmacology flashcards, definitely pull those out so you can follow along. These are available on leveluprn.com.

The first medication I'm going to cover in this video is vancomycin, and this is a very important medication for you to know as a nurse. So if you're going to be working on a medsurg floor, you're going to be giving this medication frequently. And in terms of top five medications, you have to know four nursing school and a nursing practice. I definitely would include this medication in the top five.

So vancomycin is used for serious bacterial infections. It destroys the bacterial cell wall.

It has several serious side effects, which include autotoxicity, nephrotoxicity and an infusion reaction called Red Man Syndrome. This is where the patient gets a red, itchy rash. Usually occurs if we infuse vancomycin too quickly. So if we slow it down and/or give them diphenhydramine or Benadryl, we can usually manage this and not have them get Red Man Syndrome. Vancomycin can also cause phlebitis, so inflammation at the IV site. So if a patient has to be on vancomycin for a while, we usually have them get a pick line, a central line and give the infusion of vancomycin through that pick line.

Key points with this medication. Vancomycin has a low therapeutic index, meaning there's a very narrow range of doses that are safe for the patient. So we need enough vancomycin to be effective. But the amount at which vancomycin is toxic is very close to that minimum effective concentration.

So we're going to be closely monitoring the patient's blood levels and we're going to need to get their trough levels of vancomycin. So we would pull that trough level right before the patient is about to get their next dose. We're also going to want to closely monitor the patient's kidney function because of the side effect of nephrotoxicity.

So our little cool chicken hint here on the card to help you remember this medication is the red man drives the van. And this man is driving in the van. He's listening to music too loudly, which is causing hearing damage, and he's not drinking enough water, which is causing kidney damage. So this little story is intended to help you remember that vancomycin can cause Red Man syndrome, autotoxicity and kidney toxicity.

Next up, we have our penicillin, which include penicillin G and amoxicillin.

These medications are used for bacterial infections, and they work against the bacterial cell wall.

Side effects include GI upset, so nausea and vomiting and diarrhea. Also, penicillins are notorious for causing an allergic reaction in many patients. So you definitely need to assess your patient for a history of allergic reactions to penicillin or cephalosporins before administration. Another side effect of penicillins includes a super infection. So when we give the patient an antibiotic such as penicillin, it kind of nukes and paves their bacterial flora, which can give rise to these super infections, such as C diff. So we never want our patient to take antibiotics unnecessarily because of this risk for super infection.

So with penicillins, again, you're going to assess for allergies before administration.

And then after administration, you're going to monitor the patient for an allergic response.

Then we have an extended release penicillin, which is piperacillin tazobatam. And this medication would be used for moderate to severe bacterial infections, including infections that are penicillin resistant.

Side effects again include GI upset super infection. This medication can also cause phlebitis, so inflammation at the IV site. It also carries the risk for hepatotoxicity as well as nephrotoxicity.

So in addition to assessing our patient for a history of allergies to penicillins or cephalosporins, we're also going to want to monitor our patient's liver and renal function during therapy because of that side effect of hepatotoxicity and nephrotoxicity.

Next, we have our cephalosporins, which include medications such as cephalexin, ceftriaxone and cefepime. So they all start with that cef.

We would use these medications for bacterial infections, and they work against the bacterial wall just like penicillins.

Side effects include GI upset, possibility for an allergic reaction and super infections. So very similar side effects to penicillins. So again, you're going to want to assess your patient for a history of allergies to penicillins or cephalosporins.

Before therapy, you also want to advise your patient to not consume alcohol during therapy.

Then the last drug class we're going to cover in this video are carbapenems, which includes imipenem cilistatin.

So this medication is used for serious bacterial infections. This is a broad spectrum antibiotic.

Side effects include GI upset, rash, super infection and the possibility for seizures. So again, with this medication, you're going to want to assess for a history of allergic response to medications such as penicillin or cephalosporins or these carbapenems. Because sometimes people who have had a history of reaction to penicillins or cephalosporins may react to carbapenems as well.

All right, time for a quiz. I have three questions for you. First question, what antibiotic can cause autotoxicity, nephrotoxicity and Red Man syndrome? The answer is vancomycin. Question number two, if your patient has a penicillin allergy, they may also have an allergic response to what medication class? It's actually two possible answers here. One is cephalosporins, the other is carbapenems. Question number three. Trough levels will need to be monitored when your patient is on vancomycin. True or false? The answer is true because vancomycin has a very low therapeutic index, so we're going to be closely monitoring the patient's blood levels to get the dosing just right.

Okay, that's it. I hope this video has been super helpful for you. If you've got value out of it, definitely leave me a comment. I would love to hear from you. Next, we have our cephalosporins, which include medications such as cephalexin ceftriaxone and cefepime, so they all start with that cef. We would use these medications for bacterial infections. Next, we have our cephalosporins, which include medications such as cephalexin, cepha-- sorry.


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