Antibiotics - Penicillins: Nursing pharmacology

Penicillins are antibiotics that got their name from the penicillium mold from which they were originally extracted. They belong to the pharmacological group of beta lactam antibiotics because they have a beta lactam ring in their structure.

Penicillins are used to treat a wide range of infections, including streptococcal infections like pharyngitis, tonsillitis, scarlet fever and endocarditis as well as pneumococcal infections.

Staphylococcal infections, diphtheria, anthrax and syphilis. Now to build their cell walls.

Bacteria need an enzyme called DD transpeptidase or penicillin binding protein or PBP for short penicillins like all beta lactam antibiotics bind to this enzyme thanks to their beta lactam ring and prevent it from working.

Now, some bacteria have developed resistance to beta lactam antibiotics. The most notable is staphylococcus aureus, which has developed an enzyme called beta lactamase or penicillinase that breaks down the beta lactam ring within the antibiotic, rendering it ineffective.

So, penicillins are further classified into four groups. Basic penicillins, broad spectrum or aminopenicillins, penicillinase resistant or anti staphylococcal penicillins and extended spectrum or anti pseudomonal penicillins.

Basic penicillins include penicillin v, which is given orally and penicillin. G, which is administered intramuscularly or intravenously.

In addition, there's a specific penicillin G called penicillin, g benzathine, which is a long acting penicillin that's only administered intramuscularly.

These are quite effective against common gram positive bacteria. So, they're used to treat upper respiratory infections, otitis media, pneumonia, rheumatic fever, erysipelas, skin and soft tissue infections.

And ST is like syphilis. However, they don't work well against most gram negative bacteria.

On the other hand, broad spectrum penicillins include amoxicillin, which is given orally and ampicillin, which is administered orally intramuscularly or intravenously.

They're effective against a wide variety of gram negative bacteria. So, they're useful to treat respiratory gastrointestinal genitourinary and skin infections.

Ampicillin is also useful for more serious infections that require an intravenous administration like meningitis, endocarditis and septicemia.

Next are penicillinase resistant medications or anti staphylococcal penicillins. These include dicloxacillin, which is given orally as well as nafcillin and oxacillin which are administered intramuscularly or intravenously.

They were created. To fight bacteria like staphylococcus aureus, which often have the beta lactamase enzyme making them resistant to other penicillins.

Finally, there's piperacillin, an extended spectrum penicillin, which is combined with tazobactam, a beta lactamase inhibitor that's administered intravenously.

This medication combination has more gram negative coverage. Most notably, it's effective against pseudomonas, aeruginosa.

That's why it's also called an anti pseudomonal penicillin. Penicillins are generally safe and well tolerated.

The most common side effects include gastrointestinal disturbances like nausea, vomiting and diarrhea. In addition, allergy to penicillin is quite common and clients typically present with urticaria, pruritus and anaphylaxis.

Other serious side effects of penicillins include hypersensitivity reactions. Stevens Johnson syndrome and erythema multiforme.

Some clients taking penicillins may even experience seizures especially when taking high doses. In addition, penicillins can also affect the healthy bacterial flora.

Making clients more susceptible to super infections by more resistant pathogens, including fungal infections, like vaginitis and candidiasis and more rarely clostridioides, difficile infection or CD for short.

More specifically a frequent side effect of penicillin. G is pain at the site of injection.

In addition, accidental intra arterial injection or injection near a major peripheral nerve can result in severe neurovascular damage and tissue necrosis.

Amoxicillin can cause eosinophilia anemia and thrombocytopenia. Finally, some penicillins can cause interstitial nephritis and renal tubular damage.

As far as contraindications go. There's not many of them mainly hypersensitivity to penicillins and they should be used cautiously in clients with hypersensitivity to other beta lactams like cephalosporins and carbenin.

Since there can be cross reactivity, penicillins should also be used with caution during pregnancy, breastfeeding and in clients with renal disease.

Finally, penicillin, G benzathine has a boxed warning against its use intravenously regarding interactions. The effect of penicillins is increased by probenecid and decreased by tetracyclines.

Penicillins. On the other hand, increase the effects of methotrexate and warfarin and decrease the effect of oral contraceptives.

In addition, broad spectrum penicillins should not be combined with allopurinol since it increases the risk of developing a skin rash.

Penicillinase resistant penicillins, decrease the effectiveness of live virus vaccines so they shouldn't be given together.

Ok. When caring for a client who has been prescribed penicillin g intravenously for treatment of neurosyphilis.

First perform a baseline assessment including vital signs and their current signs and symptoms such as rash, abnormal gait numbness in the extremities, confusion, sensory neural hearing loss and headaches.

Then review their recent laboratory test results including CBC renal and hepatic function as well as diagnostic test results including VDRL and lumbar puncture.

Next, regarding client education, explain to your client that the medication will treat the infection causing their symptoms and that the medication will be administered intravenously over two weeks.

Then review with them some common side effects. They may experience such as nausea and vomiting and reassure them that you'll be monitoring them over the course of treatment.

All right, when preparing to administer penicillin g intravenously, be sure your client is adequately hydrated and has a patent IV and an indwelling urinary catheter in place while infusing the medication, monitor fluid intake and output as well as the insertion site for a local reaction.

Be sure to instruct your client to let you know if they experience pain or discomfort at the insertion site. Also make sure to rotate IV sites regularly during treatment.

Closely monitor them for signs of a hypersensitivity reaction, which can include shortness of breath, throat tightness or difficulty swallowing as well as hypotension and tachycardia.

In addition, monitor them for signs of a super infection including fever, abdominal pain and severe or bloody diarrhea, or white patches on the inner cheeks, tongue or roof of the mouth, as well as signs of renal damage, which can include decreased urine output blood in the urine or unusual weight gain.

Finally, while caring for a client, receiving penicillin, G continue to monitor the development of side effects and evaluate for the therapeutic response by looking at signs of infection resolution and absence of symptoms.

All right, it's a quick recap. Penicillins belong to the pharmacological group of beta lactam antibiotics and are used to treat a wide range of infections, including streptococcal infections, like pharyngitis, tonsillitis, scarlet fever and endocarditis, pneumococcal infections, staphylococcal infections, diphtheria anthrax and syphilis.

They work by binding to the enzyme penicillin binding protein or a PBP for short to prevent it from working. Penicillins are further classified into four groups.

Basic penicillins, broad spectrum or aminopenicillins, penicillinase resistant or anti staphylococcal penicillins and extended spectrum or anti pseudomonal penicillins.

The most common side effects include gastrointestinal disturbances like nausea, vomiting and diarrhea, as well as hypersensitivity reactions when caring for a client receiving penicillin.

Nursing considerations include performing a baseline assessment, monitoring for side effects and evaluating for the therapeutic response.

Client education is focused on what clients can expect during