Cephalosporins Antibiotics Nursing: Mechanism of Action, Pharmacology, Mnemonic, Generations NCLEX
Summary
TLDRThis video covers cephalosporins, a group of beta-lactam antibiotics used to treat gram-positive and gram-negative bacterial infections. The host explains the cross-sensitivity risk with penicillin, different generations of cephalosporins, their bacterial targets, and their role in inhibiting bacterial cell wall synthesis. Key nursing considerations include monitoring for allergies, creatinine and BUN levels, alcohol intolerance, pseudomembranous colitis, and hypersensitivity reactions. The video emphasizes the importance of patient education and recognizing adverse reactions to ensure effective treatment.
Takeaways
- 💉 Cephalosporins are a large group of beta-lactam antibiotics used to treat both gram-positive and gram-negative bacterial infections.
- 🔗 Cephalosporins are related to penicillins due to their similar chemical structure, and there is a cross-sensitivity risk for patients allergic to penicillin.
- 💊 Cephalosporins are typically administered either orally, intravenously (IV), or intramuscularly (IM), and can be recognized by the prefix 'CEF' or 'CEPH' in their names.
- 🔬 Cephalosporins are categorized into five generations, each targeting different bacterial infections, with newer generations having broader coverage.
- 🦠 First-generation cephalosporins target gram-positive bacteria like staphylococci and streptococci, while newer generations expand to more gram-negative bacteria.
- 🚑 Fifth-generation cephalosporins are the only ones effective against MRSA (methicillin-resistant Staphylococcus aureus).
- 🧱 Cephalosporins work by inhibiting cell wall synthesis, weakening the bacteria's protective layer (peptidoglycan) and causing bacterial cell death.
- ⚠️ Nurses need to monitor patients for potential allergic reactions, especially if they have a history of penicillin allergies.
- 🧪 Patients on cephalosporins should have their kidney function monitored (creatinine and BUN labs) since cephalosporins can be nephrotoxic.
- 📋 Cephalosporins can cause side effects such as alcohol intolerance, pseudomembranous colitis, hypersensitivity reactions, and increased bleeding risk due to lowered prothrombin levels.
Q & A
What are cephalosporins and how are they related to penicillins?
-Cephalosporins are a group of beta-lactam antibiotics used to treat gram-positive and gram-negative bacterial infections. They are related to penicillins because both contain a beta-lactam ring, leading to a cross-sensitivity risk for patients allergic to penicillin.
How can you identify a cephalosporin on a patient's medication list?
-Cephalosporins can be recognized by their generic names, which typically start with 'CE', 'CEF', or 'CEPH', such as cefazolin and cephalexin.
How are cephalosporins classified, and what does each generation target?
-Cephalosporins are divided into five generations. Each generation targets different types of bacteria. Older generations target mainly gram-positive bacteria, while newer generations have broader coverage, targeting both gram-positive and gram-negative bacteria.
What is the significance of the first generation of cephalosporins?
-The first generation primarily targets gram-positive bacteria like staphylococci and streptococci, and a few gram-negative bacteria like Klebsiella pneumoniae and E. coli.
What makes the third generation of cephalosporins unique compared to the earlier generations?
-The third generation expands coverage to more gram-negative bacteria like Proteus, but it lacks the broad gram-positive coverage of earlier generations. It also includes ceftazidime, which uniquely targets Pseudomonas aeruginosa.
Which generation of cephalosporins is effective against MRSA?
-The fifth generation of cephalosporins, particularly ceftaroline, is the only one effective against MRSA (Methicillin-resistant Staphylococcus aureus).
How do cephalosporins work to kill bacteria?
-Cephalosporins inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins, disrupting the cross-linking of peptidoglycan layers. This weakens the cell wall, causing the bacteria to rupture and die due to osmotic pressure.
What is a major nursing consideration when administering cephalosporins to patients with a penicillin allergy?
-Nurses should assess patients carefully for penicillin allergies, as there is a cross-sensitivity risk with cephalosporins, especially with older generations. A thorough investigation of the type of reaction to penicillin is crucial.
What is the disulfiram-like reaction associated with cephalosporins?
-Some cephalosporins can cause alcohol intolerance, leading to a disulfiram-like reaction when patients consume alcohol. Symptoms include nausea, vomiting, flushing, dizziness, and sweating. Patients should avoid alcohol for up to three days after their last dose.
What adverse reactions should nurses monitor for when administering cephalosporins?
-Nurses should monitor for nephrotoxicity, pseudomembranous colitis (caused by C. difficile), hypersensitivity reactions like anaphylaxis, thrombo-phlebitis at IV sites, pain at IM injection sites, and increased bleeding due to hypoprothrombinemia.
Outlines
💊 Introduction to Cephalosporins and Their Cross-Sensitivity with Penicillin
This paragraph introduces cephalosporins, a group of beta-lactam antibiotics used to treat both gram-positive and gram-negative bacterial infections. It emphasizes the structural similarity between cephalosporins and penicillin due to the beta-lactam ring, explaining the cross-sensitivity risk for patients allergic to penicillin. Nurses should carefully assess patients for penicillin allergies and investigate the type of reactions experienced.
💉 Recognition, Administration, and Classification of Cephalosporins
Here, the focus is on identifying cephalosporins based on the 'CE' prefix in their generic names, like cefazolin and cephalexin. It outlines how cephalosporins are administered—parenterally (IM, IV) or orally. The paragraph also introduces the five generations of cephalosporins, explaining that older generations have a narrow spectrum, targeting mainly gram-positive bacteria, while newer generations have broader antibacterial activity.
🦠 First and Second Generations of Cephalosporins
The first generation of cephalosporins is described as effective primarily against gram-positive bacteria like staphylococci and streptococci, with limited gram-negative activity. The second generation expands coverage to include more gram-negative bacteria such as Haemophilus influenzae and Neisseria gonorrhoeae. Two specific drugs in this generation, cefoxitin and cefotetan, target anaerobes like Bacteroides fragilis.
🔬 Third, Fourth, and Fifth Generations of Cephalosporins
This paragraph discusses the third, fourth, and fifth generations of cephalosporins. The third generation targets more gram-negative bacteria but has less activity against gram-positive ones. Notably, ceftriaxone should not be administered with calcium due to precipitation risks, and ceftazidime is effective against Pseudomonas. The fourth generation (e.g., cefepime) covers both gram-positive and gram-negative bacteria, including Pseudomonas. The fifth generation is the only one that targets MRSA, with ceftaroline being an example.
🔬 Mechanism of Action: Inhibiting Bacterial Cell Wall Synthesis
Cephalosporins work by inhibiting bacterial cell wall synthesis, which is essential for bacterial survival. The peptidoglycan layer within the bacterial cell wall provides strength, allowing the bacteria to withstand osmotic pressure. Cephalosporins disrupt the formation of this layer, leading to cell wall weakness, rupture, and bacterial death. This mechanism applies to both gram-positive (with a thick peptidoglycan layer) and gram-negative bacteria (with a thinner layer).
🧬 Peptidoglycan Synthesis and Cephalosporin Interference
This paragraph elaborates on the composition of the peptidoglycan layer, which consists of NAM (N-acetylmuramic acid) and NAG (N-acetylglucosamine) molecules cross-linked by penicillin-binding proteins (PBPs). Cephalosporins, with their beta-lactam ring, bind to PBPs, preventing proper cross-linking, which results in a defective cell wall. The inability to withstand osmotic pressure causes the bacterial cell to rupture and die, which is the desired therapeutic outcome.
🩺 Nursing Considerations and Patient Education
Nurses play a crucial role in assessing patients for allergies before administering cephalosporins, particularly in patients with penicillin allergies. They should monitor the effectiveness of the treatment and educate patients about potential adverse effects, such as nephrotoxicity and alcohol intolerance (disulfiram-like reaction). Monitoring kidney function (BUN and creatinine levels) is essential, especially for patients with renal issues or high doses of cephalosporins.
⚠️ Common Adverse Effects and Complications
The paragraph discusses the adverse effects of cephalosporins, including pseudomembranous colitis caused by Clostridium difficile and gastrointestinal disturbances like nausea, vomiting, and diarrhea. Nurses must monitor stool patterns for signs of severe C. difficile infection and educate patients on how to minimize common GI side effects by taking oral cephalosporins with food.
🌡️ Monitoring for Hypersensitivity and IV Complications
This paragraph addresses hypersensitivity reactions to cephalosporins, including rashes, intense itching, and anaphylaxis. Nurses should discontinue the medication and inform the physician if these symptoms occur. They should also monitor for thrombo-phlebitis when administering IV cephalosporins and be mindful of severe pain when given intramuscularly.
🩸 Impact on Coagulation and Final Nursing Considerations
Cephalosporins can lower prothrombin levels, increasing the risk of bleeding due to their effect on vitamin K’s role in clotting. Nurses should monitor the patient’s PT/INR levels and observe for unusual bleeding or bruising. The paragraph concludes with a reminder of key nursing duties, including monitoring kidney function, educating patients about alcohol intolerance, and assessing for hypersensitivity reactions.
Mindmap
Keywords
💡Cephalosporins
💡Beta-lactam antibiotics
💡Cross-sensitivity
💡Generations of Cephalosporins
💡Gram-positive and gram-negative bacteria
💡Peptidoglycan layer
💡Penicillin-binding proteins (PBPs)
💡MRSA (Methicillin-resistant Staphylococcus aureus)
💡Hypersensitivity reactions
💡Nephrotoxicity
Highlights
Cephalosporins are a large group of beta-lactam antibiotics used to treat both gram-positive and gram-negative bacterial infections.
Cephalosporins have a similar chemical structure to penicillins due to the presence of a beta-lactam ring, leading to cross-sensitivity risks in patients allergic to penicillin.
Cephalosporins are typically administered via IM, IV, or orally, and can be identified by 'CEF' or 'CEPH' in their generic names.
Cephalosporins are divided into five generations, each targeting different types of bacteria with varying levels of spectrum and effectiveness.
First-generation cephalosporins primarily target gram-positive bacteria like staphylococci and streptococci, with limited action against gram-negative bacteria.
Second-generation cephalosporins expand coverage to additional gram-negative bacteria such as Haemophilus influenzae and Neisseria gonorrhea.
Third-generation cephalosporins target even more gram-negative bacteria, including Proteus, and include drugs like Ceftriaxone, which should not be administered with calcium solutions.
Fourth-generation cephalosporins, like cefepime, have a broad spectrum that covers both gram-positive and gram-negative bacteria, with enhanced action against Pseudomonas.
Fifth-generation cephalosporins, such as ceftaroline, are the only ones capable of targeting MRSA.
Cephalosporins work by inhibiting bacterial cell wall synthesis, leading to the breakdown of the peptidoglycan layer and causing bacterial cell death due to osmotic pressure.
The beta-lactam ring in cephalosporins binds to penicillin-binding proteins, disrupting the cross-linking process essential for a strong bacterial cell wall.
Nurses must monitor for nephrotoxicity by checking creatinine and BUN levels, particularly in patients with renal insufficiency.
Patients should avoid alcohol while taking cephalosporins due to a potential disulfiram-like reaction, causing nausea, vomiting, and dizziness.
Nurses should monitor for pseudomembranous colitis, a severe infection caused by C. difficile, by assessing stool patterns for severe watery diarrhea and abdominal cramps.
Cephalosporins can cause hypersensitivity reactions, including skin rashes, itching, and in severe cases, anaphylaxis.
Transcripts
hey everyone it's Sarah with registered
nurse rn.com and in this video I'm going
to be covering the antibiotic group
known as cephalosporins so let's get
started cephalosporins are a large group
of beta-lactam antibiotics that can be
used to treat gram-positive and
gram-negative bacterial infections now
cephalosporins are related to another
group of beta-lactam antibiotics known
as the penicillins and the reason that
they're related is because they have a
similar chemical structure they both
contain this beta-lactam ring so because
of this there is a cross sensitivity
risk for your patient if they're
allergic to penicillin because patients
who are allergic to penicillin can
potentially be allergic to
cephalosporins especially those older
generations of cephalosporins so as a
nurse you want to make sure that you're
aware of this cross-sensitivity risk and
that you really assess your patient's
medication allergies if they tell you
that they're allergic to penicillin
investigate that a little bit see what
type of reaction that they had to
penicillin and if if it was really a
true hypersensitivity reaction which
we're going to talk about a little bit
later on now what medications are
considered a cephalosporin and how do
you expect to administer them as a nurse
well typically they are administered
parentorally so I am or IV or orally and
whenever you're trying to recognize them
on a patient's medication list it's
fairly easy because since we're dealing
with cephalosporins which that word
starts with CE majority of those generic
names are also going to have CE at the
beginning of them and you'll either see
Seth like CEF or ceph c-e-p-h-a-l for
example here are some first generation
cephalosporins we have cefazolin and we
have cephalexin so see that's CE the CEF
or ceph that tells me hey I'm dealing
with a cephalosporin so one thing you
want to remember about cephalosporins is
that they can be divided into
generations and so far there are five
generations of cephalosporins and
depending on the generation they will
Target different types of bacteria for
example the older generations of
cephalosporins they have a narrow reach
so they don't Target as much bacteria
compared to the newer Generations where
they can really have a broad reach and
they tackle some serious bacterial
infections so let's take a look at these
five generations and talk about what
they target so first up is the first
generation of cephalosporins and this
generation mainly targets gram-positive
cockeye like staphylococci and
streptococci now it can Target a few
gram-negative bacteria like klebsiella
pneumoniae and E coli into medications
included in this generation include
cefazolin and cephalexin next is a
second generation of cephalosporins and
this generation can Target what the
first generation did but it expands
coverage to include some more
gram-negative such as haemophilus
influenzae and niceria gonorrhea now one
thing about this generation is that it
can also Target some gram-negative
anaerobes such as bacteroides fragilis
now there's two particular medications
in this generation that can do that and
it's cephoxetine and cephotetan and a
few other medications included in the
second generation include cephal Chlor
and cephyroxine next up is the third
generation encephalosporins now this
generation goes after even more
gram-negative bacteria like Proteus and
some gram-positive but it does not have
as much reach as that first and second
generation and a few medications
included in this generation include
cephotoxin Ceftriaxone and what you want
to remember about this medication is
that you don't want to administer it
with calcium Solutions because it could
cause calcium precipitation and then
another one is ceftazidine and this
medication is the only one in the group
that actually targets pseudomonas
ergonosa then we have the fourth
generation and this generation has a
wide Target it can Target both Grandpa
positive amgram negative bacteria and it
has even better coverage for pseudomonal
infections and a medication included in
this generation is like cefepime and
then lastly the fifth generation this
generation can Target gram-negative and
gram-posit bacteria and is actually the
only cephalosporin generation that can
take on MRSA and one medication that is
a fifth generation cephalosporin is
called cephyroline now let's talk about
how cephalosporins work to treat
bacterial infections so overall
cephalosporins have a bacterial subtle
effect on bacteria meaning that they
kill them and how they do this is that
they inhibit cell wall synthesis So
within the cell wall you have a very
important protective layer that is
really responsible for keeping that
bacteria strong and firm and being able
to withstand certain pressures within
the cell and that layer is known as
peptidoglycan so depending on if we're
talking about a gram-positive or
gram-negative bacteria yeah this
thickness of this layer can really vary
in gram-posited bacteria that
peptidoglycan layer is extremely thick
whereas on gram-negative bacteria they
have an outer membrane and then you have
a thinner peptidoglycan layer so
regardless of the thickness of this
layer this layer is very important
because it provides a very strong
protective shell in a sense for that
bacteria and it also helps that cell
withstand the intense osmotic pressure
that is occurring within it therefore if
we can affect how this peptidoglycan
layer is synthesized hence created we
can cause this cell to lose its strong
protective layer and we can cause this
cell to be affected by that intense
osmotic pressure that's within the cell
causing it to rupture and die and that's
exactly what we want to happen because
we want to kill this bacteria that's
affecting the pain patient so now let's
talk about how this layer is hence
created synthesized and then talk about
how cephalosporins affect the synthesis
so peptidoglycan is a polymer and it is
made up of a network of polysaccharide
strands and amino acids so if we took
this layer and we blew it up we could
see exactly what it is made up of you
would see in acetylmaramic acid which is
known as Nam and then right beside of it
it's best friend you would see in acetyl
glucosamine which is known as nag and
they love to hang out really close to
each other they form these strands and
then these strands can stack on top of
each other now in order to be really
tightly close knit together they have to
be crosslings so this is a very
important process for this whole layer
in order for this layer to survive and
work it has to be properly cross-linked
together so coming off particularly Nam
are several amino acids and penicillin
binding proteins go and help cross-link
all these together so we can get this
nice tight Bond
so there are several types of penicillin
binding proteins particularly we're
talking about like trans peptase enzymes
that help this process happen therefore
if this cross-linking process doesn't
happen properly we get a faulty
peptoglycan layer that can't withstand
intense osmotic pressure which is
exactly what we want so what happens
with a cephalosporin as we've talked
about earlier it has a beta-lactam ring
this beta-lactam ring is going to go and
bind with this penicillin binding
protein hence affecting how this
cross-linking process happens
and whenever we have a bad cross-linking
process we're going to have a cell wall
that is no longer strong and protective
and it cannot withstand this intense
osmotic pressure within the cell wall
hence it ruptures and dies and we have
dead bacteria so now let's talk about
our role as a nurse whenever we're
administering these antibiotics so
before we even give the antibiotics we
need to make sure a patient is not
allergic to them and then just check and
make sure that they're not allergic to
penicillin as well because remember
there's a cross sensitivity risk with
these medications in addition while your
patient's taking them make sure that
they're aware of those important
education points and that they're
actually getting better is this actually
treating their infection and then you
want to monitor for those adverse
reactions that can happen with this
antibiotic group so to help us remember
all those Concepts let's remember the
first part of cephalosporins the cephala
so C is for creatinine and Bun labs to
monitor these Labs help us assess kidney
function and cephalosporins can be
nephrotoxic particularly if the
patient's having a high dose of these
medications or let's say that they have
some renal insufficiency going on
already they're definitely at risk for
this so as a nurse you want to make sure
you monitor their intake and their
output and in adults make sure that
they're putting out at least 30 ml of
urine per hour that helps us know the
hair kidneys are working and they're
producing urine e is for alcohol
intolerance and etoh is actually a
medical abbreviation used to represent
ethanol alcohol so this alcohol
intolerance can also sometimes be called
a disulframe-like reaction and it gets
its name from disulfiram which is
actually medication that can be
prescribed to treat alcohol addiction
its trade name is antabuse and whenever
a patient takes antabuse it will cause
them to become intolerant to alcohol
after they drink it now unfortunately if
a patient drinks alcohol or takes
medications with it in it it can
actually lead to signs and symptoms of
intolerance that would be similar to
this medication whenever they're taking
some types of cephalosporins so you want
to educate your patient that they don't
want to drink alcohol or take any
medications with alcohol in it because
it can happen up to three days after
their last dose of this antibiotic and
the signs and symptoms that can be
experienced are quite unpleasant they
can experience vomiting nausea flushing
sweating headache and dizziness P is for
pseudomembranous colitis and this is a
major infection and inflammation of that
large intestine that is caused by a C
diff infection now you may also see it
called antibiotic Associated colitis it
can be caused by other types of
antibiotics such as the fluoroquinolones
which we discussed earlier now how you
monitor for this as a nurse is you
assess your patient's stool pattern so
make sure the patient's not having
severe watery stool along with a fever
abdominal cramps and an elevated white
blood cell count which is known known as
leukocytosis and if they are having
these things you want to notify the
physician who could order a stool test
for you to collect the stool and send it
off for a C diff test now as a side note
sometimes these medications do cause GI
upset in patients where they'll have
vomiting diarrhea and nausea and
administering oral medications with food
may help decrease this but if your
patient's having those signs and
symptoms of the severe watery stool
they're having fever cramps white blood
cell count that is not normal and you
definitely want to report it and then H
is for hypersensitivity reactions so you
want to make sure you monitor your
patient for any intense itching any skin
rashes that are very red and noticeable
something similar here or in worst case
scenarios are starting to have
anaphylaxis where they're having facial
swelling they can't breathe and if this
happens of course you want to
discontinue the medication and notify
the physician immediately for further
orders A is for administering IV you
want to watch out for thrombo phlebitis
which will present as redness pain and
swelling at the ivy site and then if
you're ministering them I am through the
intramuscular route you want to be aware
that they can cause severe pain and
redness at the side so you want to use a
very large muscle for giving these
antibiotics I am and then lastly L which
is lowers prothrombin which is known as
hypoprothrombinemia which will increase
the patient's risk for bleedings because
what can happen is it affects vitamin
K's role in clotting which helps with
the creation of prothrombin so you would
monitor that PT on our level and then
just look at your patient make sure
they're not having any unusual bleeding
or bruising okay so that wraps up this
review over cephalosporins and if you'd
like to watch more videos in this series
you can access the link in the YouTube
description below
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