7.-10. Macrolides, Lincosamides, Fluoroquinolone, & Aminoglycosides

PO

mode of administration of macrolides

erythromycin, azithromycin, clarithromycin, dirithromycin

sample medications of macrolides

erythromycin (ery tab)

used for legionnaire's disease, corynebacterium diptherae, ureaplasma, syphillis, mycoplasma, chlamydial infections.

azithromycin (zithromax)

mild to moderate respi infection, urethritis, otitis media, pharyngitis, and tonsilitis

clarithromycin (klaricid)

respi, skin, sinus, and maxillary infections

dirithromycin

upper and lower respiratory tract infections and pharyngitis or tonsilities

digoxin and anticoagulants

INTERACTION - their levels increase due to macrolides

anticoagulants, theophyllines, and carbamazepine or corticosteroids

INTERACCTIONS OF MACROLIDES - they increase the effect of what substances

clindamycin, lincomycin, and chloramphenicol

INTERACTION of MACROLIDES - what decreases the effect of macrolides

cycloserine (TB med)

INTERACTIONS OF MACROLIDES - this increases the risk for renal toxicity

oral contraceptives

INTERACTIONS OF MACROLIDES - their efficiency is lost

antacids

macrolides interaction - decrease the absorption of macrolides

macrolide action

Inhibits protein synthesis by binding to 50S ribosomal subunit, preventing RNA to mRNA, causing bacterial death if the concentration is high enough

50S ribosomal subunit

The macrolides target which feature of the bacterial cell?

• listeria monocytogenes,

• pelvic inflammatory disease,

• urti,

• intestinal amebiasis,

• prophylaxis for endocarditis,

• ocular infections,

• acne vulgaris

indications for macrolides

neisseria gonorrhea

pelvic inflammatory disease is caused by

• H. influenzae,

• streptococcus pneumoniae,

• mycoplasma pneumoniae,

• staphylococcus pneumoniae

what causes URTI

Group A beta-hemolytic streptococcus infection

macrolides act as prophylaxis for endocarditis, which is also known as what?

Group A Beta Hemolytic Streptococcus Infection (GABHS)

dangerous when u have sore throat

rheumatic heart failure

if GABHS reaches 6 times, what happens

contraindications and cautions of macrolides

- Allergy

- Ocular preparations: viral, fungal, or mycobacterial infections of the eye can cause loss of normal flora

- Caution should be used in patients with hepatic dysfunction, myasthenia gravis, and lactation

adverse reactions of macrolides

- abdominal cramping, anorexia, diarrhea, vomiting, hepatotoxicity

- confusion, abnormal thinking, and uncontrolled emotions

- hypersensivity

- superinfections

- palpitations and chest pain

telithromycin (ketek)

this is a treatment for pneumonia that causes patients to have difficulty focusing and accommodating to light

nursing considerations for macrolides

- give drug on empty stomach 1 hr before or 2 hrs after meals

- take the drug with a full 8 oz glass of water

- monitor for liver damage

8 oz glass of water

how many oz when drinking with macrolide

lincosamides

Antibiotic that is effective against many GRAM POSITIVE but high potential for TOXICITY

PO, IM

mode of administration of lincosamides

clindamycin (cleocin)

lincomycin (lincocin)

sample medications of lincosamides

pharmacokinetics of lincosamides

- rapidly absorbed from GI tract

- crosses placenta and enters breast milk

- metabolized in liver and excreted in urine and feces

aluminum based antacids

decrease absorption of lincosamides

neuromuscular blocking durgs

increase action of neuromuscular blocking drug

change protein function and prevent cell division (BACTERIOSTATIC) or cause cell death (BACTERICIDAL)

action of lincosamides

- hypersensitivity

- minor viral and bacterial infections

- lactation and infancy

contraindications of lincosamides

gi, hepatic, renal

precautions when using lincosamides

neuromuscular blockade

poses danger to patients with MYASTHENIA GRAVIS (autoimmune, muscle weakness and fatigability)

- severe pseudomembranous colitis

- hepatotoxicity

- pain

- skin infections

- bone marrow depression

adverse reactions of lincosamide

- monitor GI activity and fluiid balance

- stop at first sign of severe bloody diarrhea

nursing consideration in lincosamides

- rotate injection sites

- discontinue if PHLEBITIS occurs

parenteral considerations in lincosamides

lincosamides

what drug should you educate the family on the following:

- Take the drug at the prescribed times: do not omit or increase the dosage

- Take with a full glass of water

- Notify if the infection has worsened or if no improvement after 5 days has been noticed

- No alcoholic beverages

- Tetracycline can cause photosensitivity

tetracycline nursing process

Take with empty stomach, no dairy food, with full glass of water except for minocycline and doxycycline

minocycline and doxycycline

Take with empty stomach, no dairy food, with full glass of water except for WHAT?

macrolide nsg process

○ clarithromycin and azithromycin can be given without regard to meal

○ Dirithromycin is given with food

- Azithromycin suspension is given 1 hour 2 hours after meal

○ Erythromycin should be taken on empty stomach with 180 - 240 ml

clarithromycin and azithromycin

macrolides that can be given without regard to meal

dirithromycin

macrolide that is given with food

azithromycin suspension

macrolide given 1 hour before meals or 2 hrs after meal

erythromycin

macrolide that should be taken on empty stomach w 180-240 ml

lincosamides nsg process

- Food impairs absorption

- NPO x water 1-2H ac (before meals) and pc (after meals) lincomycin

○ Clindamycin can be taken without regard to meal

clindamycin

lincosamide that can be taken without regard to meal

food

impairs the absorption of lincosamides

PO and IV

mode of administration of fluoroquinolone

ciproflaxacin, norfloxacin, levofloxacin, moxifloxacin

sample medications of fluoroquinolone

ciprofloxacin (ciprobay)

anthrax, respiratory, skin, intra-abdominal infection, UTI, STD, and selected nosocomial infections

norfloxacin (lexiflox)

uti, prostatitis, STDs

levofloxacin (levox)

respi, urinary infection, prophylaxis for urinary and prostatic procedures

moxifloxacin (avelox)

respi, skin, and anaerobic infection, CAP

pharmacokinetics of fluoroquinolines

- Absorbed in the GI tract, metabolized in the liver, and excreted in the urine and feces

- Crosses the placenta and breast milk

iron salts, sucralfate, mineral supplements, or antacids

decrease the therapeutic effect of fluoroquinolones

theophylline

leads to increased theophylline levels; fluoroquinolone

NSAIDS

increase the risk of CNS stimulation; fluoroquinolone

Cimetidine

interferes with the elimination of antibiotics; fluoroquinolone

quinidine, procainamide, amiodarone, tetracycline, phenothiazines, erythromycin, and pentamide

lead to ventricular tachycardia; fluoroquinolone

oral anticoagulants

increase the risk of bleeding; fluoroquinolone

chocolate colored foods

what foods do u avoid so that u r not misguided that it is bleeding in fluoroquinolones

interfere w action of DNA enzymes (growth and reproduction of bacteria)

action of fluoroquinolones

topoisomerase II and topoisomerase IV

2 types of DNA enzymes; important in replication and transccription for DNA

topoisomerase II

dna enzyme that target for gram neg - DNA GYRASE

topoisomerase IV

target for gram pos

Fluoroquinolones indication

- Gram (-) including Escherichia coli, Proteus

pseudomonas, Streptococcus and Staphylococcus

○ UTI Urinary Tract Infection

○ RTI Respiratory Tract Infection

○ STD

○ Skin infections

○ Bone and joint infections

allergy and pregnant CATEGORY C or lactating women

contraindication for fluoroquinolones

renal dysfunction, diabetes, history of seizures

caution use for fluoroquinolones

adverse reactions of fluoroquinolones

- CNS: headache, dizziness, insomnia, depression

- GI: nausea, vomiting, diarrhea, dry mouth

- Bone Marrow depression

○ Possibly, there is a problem with RBS production

- Others: fever, rash, and photosensitivity

- Bacterial overgrowth

- Tendonitis and tendon rupture

○ Tendonitis - inflammation of the

tendon

- Alterations in blood glucose

fluoroquinolones nsg considerations

- They are not routinely recommended for use in patients under 18 years of age

- Avoid sun and ultraviolet light exposure and use protective clothing and sunscreen

- Encourage oral fluid to decrease crystallization of the urine and promote secretion and decrease solubility characteristics.

patient and fam education on FLUOROQUINOLONES

refer for any sign of TENDONITIS, such as leg pain, shoulder or heel pain, periodic application of ice may help relieve pain; rest and avoid exercise

IM and IV

mode of administration of aminoglycosides

gentamicin, tobramycin, amikacin, streptomycin, kanamycin, neomycin

sample medications of aminoglycosides

gentamicin

aminoglycoside for pseudomonas

tobramycin

aminoglycoside for serious infections

amikacin

aminoglycoside for serious gram neg infection

streptomycin

aminoglycoside for 4th drug combination for TB severe infections

kanamycin

aminoglycoside for hepatic coma

neomycin

aminoglycoside for hepatic coma, topical infections, suppression of the GI flora

pharmacokinetics of aminoglycoside

rapidly absorbed after IM injection

action of aminoglycoside

- Inhibit Protein (CHON) synthesis in susceptible strains, which in turn leads to loss of functional integrity of the bacterial cell membrane causing cell death

- Bactericidal

gram neg bacteria (p. aeruginosa, e. coli, proteus species, klebsiella, enterobacter, serratia group)

indication for aminoglycosides

contraindication and caution for aminoglycosides

- Allergy to aminoglycosides

- Renal or hepatic disease

- Pre-existing hearing loss

*Ototoxicity is one of the adverse effects

- Active infection with herpes or mycobacterial infection

- Myasthenia gravis or Parkinsonism

- Lactation

- Caution with pregnancy (Category C&D)

Category C and D

schedule of pregnancy caution of aminoglycoside

adverse reactions of aminoglycoside

- CNS: ototoxicity, confusion, depression, disorientation and numbness, tingling and weakness

- Tinnitus: first sign of ototoxicity; ringing sensation

- Renal: may progress to renal failure

- Bone marrow depression

- GI: nausea, vomiting, diarrhea, weight loss, stomatitis, and hepatotoxicity

- Heart: palpitations, hypotension, hypertension

diuretics and cephalosporins

increase the risk of nephrotoxicity, ototoxicity, and neurotoxicity

neuromuscular blockade with paralysis possible

anesthetics, non depolarizing neuromuscular blockers, succinylcholine, citrate anticoagulated blood increase WHAT?

severe respiratory depression

neuromuscular blocking agents can cause...

aminoglycoside nsg intervention

assess patient history on parkinsonism, myasthenia gravis, existing hearing loss, active herpes infection

auditory and cns assessment

in physical examination considering aminoglycosides, what assessments should be done

urinary patterns and signs of peripheral and circumoral paresthesia (pins and needles sensation) and tinnitus

what to tell px and family to monitor when taking aminoglycosides

calcium salts

if respiratory depression occurs in taking aminoglycosides, what should you give

neomycin

what drug: determine the level of consciousness and ability to swallow for px w hepatic coma

aminoglycosides

what drug: monitor respiratory rate bc can cause neuromuscular blockade

fluoroquinolone

can be nephrotoxic; that's why u should encourage oral fluid

norfloxacin and enoxacin

fluoquinolone that can be taken on empty stomach

moxifloxacin

fq that is given once a day

ciprofloxacin

fq can be taken w/o regard to meals