Classification of antimicrobials

Two schemes
1. Classification by susceptible organism
2. Classification by mechanism of action

1. Classification by susceptible organism
a. Narrow spectrum
b. Broad spectrum
2. Classification by mechanism of action
a. Drugs that inhibit cell wall synthesis
b. Drugs that increase cell wall permeability
c. drugs that inhibits protein synthesis
d. Drugs that inhibits bacterial synthesis of nucleic acid



Penicillin
Practically ideal drugs
Have low toxicity
Principal adverse reaction: allergic reactions
Mechanism of action
Weakens bacterial cell wall by preventing the
utilization of muramic acid peptide that is
needed for bacteria's outer cell wall
Nursing intervention
Question client abt history of allergic reactions
Observe for signs of hypersentivity and signs of
respiratory distress
Discontinue drug in cases of allergic reaction
Treat mild allergic reactions with phenergan
Administer oral penicillin on an empty stomach
Take with full glass of water, not with acidic fluids
Cephalosporins
Similar to penicillins in structure and activity
but act effectively against organisms that are
multiplying rapidly
M. A: inhibits bacterial cell wall synthesis
E.g. cephalexin, cefazolin, cefuroxime

Similar adverse reactions and nursing care
Aminoglycosides
Potent bactericidal
Used to treat serious infections
Eg. Amikacin, gentamycin, kanamycin,
streptomycin
Mechanism of action
Inhibit protein synthesis by binding
irreversibly to bacteria ribosome and
inhibiting the translation of mRNA to protein.
This leads to loss of functional integrity of the
bacterial cell membrane, causing cell death
Monitor the patient regulary for signs of
ototoxicity, nephrotoxicity, neurotoxicity and
bone marrow suppression
Tetracycline
Mechanism of action
Inhibit protein synthesis after uptake into a
susceptible organism.
Irreversibly binds to bacterial ribosome and interferes
with attachment of tRNA to mRNA.
Eg. Doxycycline
Precaution: causes permanent brownish yellow
discoloration of the teeth and softening of bones
if given in the last trimester of pregnancy or to
children under 8 yrs
Review of the autonomic nervous
system

ANS is a division of the peripheral nervous
system
The ANS is divided into the sympathetic and
parasympathetic divisions
Sympathetic-fight of flight
Parasympathetic rest and digestion

Adrenergic agonist
They are also called sympathomimetic drugs
because they mimic the effects of the
sympathetic nervous system (SNS).
Eg. Dobutamine,
dopamine
ephedrine,
epinephrine,
norepinephrine,
terbutaline,
salmeterol

Uses of adrenergics
Emergency drugs to treat acute cardiovascular,
respiratory and allergic disorders
Cardiac stimulant
Raise BP in hypotension
Bronchodilators ie in asthma COPD
Vasoconstriction to relieve edema in
respiratory tract

contraindications
Patients with pheochromocytoma
Patients with tarchyarrythmias

Nursing responsibilities

Adverse effects
Hypertension
Arrhythmia
Palpitation
Angina

Anticholinergic agents
Examples are atropine and scopolamine
They work by blocking the action of
acetylcholine and thereby blocking the action
of the parasympathetic nervous system.
They act by preventing the