In today's video we're talking about penicillin and penicillinase resistant antibiotics. There's
a few clues in this word I want to share with you today so we're going to be capturing all of that
right after this. All right so we're talking penicillins today and I put a lot on the board
here and it may feel a bit overwhelming but we're going to make this really easy for you today.
So penicillin is the classification and penicillinase-resistant antibiotics is
also the classification, these two drugs together. You'll notice that they end in cillin - so here we
have penicillin g penicillin v this is a direct correlation right here. The first penicillins
to be used were back in the 1920s and these were our classifications penicillin g
penicillin v now they're used for gram-positive skin infections primarily
but you want to make sure that the drug you're giving matches the illness so you want to go to
your drug guide as a nurse and just check and of course penicillin g has got three other categories
uh just to grab my book here Penicillin G benzathine, Penicillin G potassium, and Penicillin
G procaine. So you want to make sure that you're using the right drug for the right reason. Now
what you can do to remember how they're given is Penicillin G is given IV and IM injection.
So I think of the sign g in sign language looks like a needle and that's how I can remember pen G
is injection. Penicillin V is oral so take your v like scoops to put your food into your
mouth. Okay. So there's one quick distinction that we can make just by looking at the word
Now the other thing is it's the wall the double l stands for wall, in my brain that's just how it
works, so we're going to focus on the cell wall which is the site of action. So when we have a
healthy cell we know that our cells reproduce and they create daughter cells, replications.
When it's infected with bacteria it does the same and we start to notice that we have an
infection. Maybe you have a fever, you've got some swelling, you've got redness tenderness you've got
an infection in your skin. We're going to look to penicillin. Now penicillin is site-specific,
meaning it will not attach to a healthy cell and prevent a healthy cell from replicating,
these are targeted to the bacteria cells and when they attach to the receptor they
get inside the cell and they actually prevent that cell wall from replicating
a strong cell wall, and so it starts to erode away at the cell wall and because
the pressure inside the cell wall is so great it actually just bursts it dies we call that lysis.
Cell wall death - lysis. But over time bacteria have gotten a little bit smart to the ways that
penicillin works and they created penicillinase. So penicillinase is an enzyme and it actually
would prevent penicillin from reaching that cell wall so that it could continue to duplicate.
Well we couldn't accept that could we? As a human race what would we be if we accepted
that first rebuttal - no no no no - we need to up our game right? So no no no is a clue. The next
three drugs um no no man we are not accepting this nafcillin, so you see it still ends in -cillin,
oxacillin, methicillin, these were all created to prevent the enzyme that the bacteria had generated
from stopping penicillin. So what the penicillinase-resistant antibiotics do
is they still can attach to the same receptor site but they get around they get around that.
So they're not detected by penicillinase. So those are some really quick clues as to
where you can find, how to categorize these medications so no man: Nafcillin, oxacillin
and methicillin are the semi-synthetic ones that were created as a result of penicillins becoming
ineffective. So we needed to trump bacteria and we did. The extended-spectrum look at gram-negative
and gram-positive and that's ampicillin and amoxicillin. Now how can you remember how these
are given? Amp vial IV; amoxicillin is the oral version. Okay so let's have a little bit of fun
shall we? I've changed the board and on this side of the board all the drug names I just talked to
you about and on this side are the three different classifications penicillin, penicillinase
resistance, and extended spectrum penicillin. I want you to pause this video I'm going to
hop on the screen pause this video and match up those drugs with the type of penicillin it is.
All right did you get them? So remember our no man oops there it is nafcilin, oxacillin, methicillin
were all penicillinase resistance; amoxicillin and ampicillin we had to amp up for the extended
spectrum; and pen g, pen v are penicillin - excellent! Let's move on to the next piece.
All right so as we mentioned earlier penicillin g has the three different kinds penicillin g
benzathine is often used for syphilis and group a streptococcal, upper respiratory infections so
these are fairly limited in its application at this point. Penicillin g potassium is again a
natural penicillin just like the others and it is often used for things like anthrax,
clustering infections, diphtheria and I think syphilis was also on here - as well
syphilis, again um and serious streptococcal infection all right and then penicillin g procaine
is again used for bacterial endocarditis it can be used in diphtheria as an adjunct
and rat bite fever, streptococcal infections where there are severe
infections, and again syphilis. So syphilis comes across in all the pen g.Penicillin v
is used for pneumococcal infections streptococcal infections and um vincent infection okay.
Just to name a few. Penicillinase resistant these are still gram positive skin infections
and no gram negative coverage. It's the extended spectrum penicillins that have the
gram negative and the gram positive so like your UTIs your E Coli those kind of things.
Now these penicillins help to rid the body of bacteria that's causing infection and so
they're very selective in the cells that they will approach. So they will not enter into a healthy
cell they will only enter into the bacterial cell in which they have been pre-programmed
to go after. So they are not effective against viruses such as the cold they're only bacteria.
So if you go in and you have a cold you're asking for ampicillin the doctor is not going to give
that to you for a viral infection because it simply won't have an effect. All right so we
come back to the word penicillin in general we have some commonalities among all of these three,
um they end in -cillin, every one of these drugs you recognize will be a penicillin of some sort,
it affects the cell wall so that's the two l's; that's where it has its site of action.
Now when it comes to side effects we know that out with all antibiotics we can have nausea,
vomiting, diarrhea because there's a loss of some normal flora with the
the penicillin and the antibiotic use but there's some important ones I want you to consider.
So using pen as a clue - when you're looking at side effects and things you need to look for
think of your light pen and how you need to look inside the mouth when you do an assessment. So
anybody on penicillin you should be following up to look inside to see if they have any infection
of the lining of the mouth if their tongue is swollen or if there's a furry tongue.
So the lining of the mouth would be stomatitis, the tongue swelling would be glossitis,
and then the furry tongue is the other piece and since we're talking about the mouth;
they are given, the ones that are given orally, you want to give them without food ideally.
Penicillins are sensitive to the pH in your stomach. So if you're on a pH inhibitor you may
want to talk about when would be the best time to navigate those two medications so that you
can maximize the gastric acid breaking down the penicillin to get the effectiveness that we want.
Now of course if it's causing too much upset then you can take it with food but ideally
it's an hour before you eat or two hours after you eat okay. Now there's two classifications
of drugs you need to know in order to make sure that they're not being given at the same time.
Ideally we want to avoid co-administering medications of penicillin with tetracyclines
or with aminoglycosides. So tetracyclines will decrease the effectiveness of penicillin
and penicillin will decrease the effectiveness of aminoglycoside,
so you want to be making sure you're talking with your doc if you're on both or your pharmacist
if you're on both. All right I think it's time for an NCLEX question. So the nurse is
providing education to a patient about his new medication amoxicillin what should the nurse
teach the patient about side effects? Pause this video now and consider the four options.
If you guess c) your tongue may change color and look furry, that's the correct answer.
Now a is incorrect because we worry about diarrhea, not constipation; b is incorrect
because tetracyclines need to be taken at a different time and d is incorrect because a
rash would potentially be an allergic reaction. Now if you have any tips on how to remember all
the pieces around penicillin administration drop them below. Now if you haven't already subscribed
hit that subscribe hit that bell and we will see you in the next video make it a great day guys