Cephalosporins Antibiotics Nursing: Mechanism of Action, Pharmacology, Mnemonic, Generations NCLEX

Summary

This 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

00:00

💊 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.

05:01

💉 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.

10:02

🦠 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.

Keywords

💡Cephalosporins

Cephalosporins are a large group of beta-lactam antibiotics used to treat bacterial infections. In the video, they are explained as targeting both gram-positive and gram-negative bacteria, depending on their generation. They are related to penicillin due to their similar chemical structure, and they inhibit bacterial cell wall synthesis.

💡Beta-lactam antibiotics

These antibiotics, including both cephalosporins and penicillins, share a chemical structure known as the beta-lactam ring. This structure is critical for their function in inhibiting bacterial cell wall synthesis. In the video, the beta-lactam ring is described as essential for disrupting the bacteria’s cell wall, leading to bacterial death.

💡Cross-sensitivity

Cross-sensitivity refers to the risk that a patient allergic to one type of drug (like penicillin) may also be allergic to another related drug (like cephalosporins). The video emphasizes the importance of nurses assessing patients for potential allergies to penicillin, as this could indicate a risk for allergic reactions to cephalosporins.

💡Generations of Cephalosporins

Cephalosporins are divided into five generations, with each generation targeting different types of bacteria. In the video, first-generation cephalosporins are said to primarily target gram-positive bacteria, while later generations expand to cover more gram-negative bacteria and more resistant infections, such as MRSA with the fifth generation.

💡Gram-positive and gram-negative bacteria

These terms describe two main categories of bacteria, distinguished by their cell wall structure. Gram-positive bacteria have a thicker peptidoglycan layer, while gram-negative bacteria have a thinner layer but an additional outer membrane. Cephalosporins’ effectiveness varies depending on these bacterial types, and the video explains how different generations target each.

💡Peptidoglycan layer

The peptidoglycan layer is a vital component of bacterial cell walls, providing structural support. Cephalosporins work by disrupting the synthesis of this layer, leading to bacterial death. The video details how this disruption compromises the bacteria’s ability to withstand osmotic pressure, causing them to rupture and die.

💡Penicillin-binding proteins (PBPs)

These are enzymes in bacteria that help with the cross-linking of the peptidoglycan layer. Cephalosporins bind to these proteins, preventing them from performing their function, which weakens the bacterial cell wall. The video explains how this binding disrupts the bacteria’s protective layer, contributing to its death.

💡MRSA (Methicillin-resistant Staphylococcus aureus)

MRSA is a type of bacteria that is resistant to many antibiotics, including methicillin. The video highlights that the fifth generation of cephalosporins is effective against MRSA, making it a key tool in fighting resistant infections.

💡Hypersensitivity reactions

These are allergic reactions that can range from mild skin rashes to severe anaphylaxis. The video stresses the importance of monitoring patients for signs of hypersensitivity, especially since cephalosporins have a cross-sensitivity risk with penicillin.

💡Nephrotoxicity

Nephrotoxicity refers to the potential for cephalosporins to cause damage to the kidneys, particularly when used in high doses or in patients with pre-existing kidney conditions. The video advises nurses to monitor patients' kidney function through creatinine and BUN levels, as cephalosporins can be harmful to renal health.

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