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Penicillins
A class of narrow-spectrum antibiotics used to treat bacterial infections.
Penicillin G benzathine
An intramuscular (IM) formulation of penicillin used for treating infections.
Penicillin V
An oral (PO) formulation of penicillin used for treating infections.
Penicillin G potassium
An intravenous (IV) and intramuscular (IM) formulation of penicillin.
Mode of Action
Destroys bacteria by weakening the bacterial cell wall; considered a beta-lactam antibiotic.
Therapeutic Use
Treats gram-positive cocci infections, including pneumonia, meningitis, and pharyngitis.
Adverse Effects/Complications
Includes allergies and anaphylaxis; monitor for allergic reactions.
Immediate Allergic Reaction
Occurs 2-30 minutes after administration.
Accelerated Allergic Reaction
Occurs 1-72 hours after administration.
Delayed Allergic Reaction
Occurs days to weeks after administration.
Renal Impairment
Monitor kidney function (creatinine, BUN) and I&O to assess renal function.
Electrolyte Imbalances
Hyperkalemia and dysrhythmias can occur with high doses of Penicillin G potassium.
Contraindications/Precautions
Contraindicated in clients with severe allergies to penicillin or cephalosporins.
Cross-allergy warning
Allergy to one penicillin means allergy to all penicillins.
Interactions
Penicillin inactivates aminoglycosides when mixed in the same IV solution.
Delayed Excretion with Probenecid
Probenecid delays penicillin excretion, prolonging its effects.
Nursing Intervention
Monitor for allergic reactions and instruct clients to report symptoms.
IM Injection Caution
Avoid injecting into nerves or arteries to prevent sensory/motor dysfunction.
Client Education for Penicillin V
Take with meals.
Client Education for Other Penicillins
Take with 8 oz water, 1 hour before or 2 hours after meals.
Completing Antibiotics
Complete the full course of antibiotics, even if symptoms resolve early.
Use of Additional Contraception
Penicillins can decrease the effectiveness of hormonal birth control.
Cephalexin
1st Generation cephalosporin available as capsules, tablets, and oral suspension.
Mode of Action of Cephalexin
Treats infections caused by gram-positive cocci.
Therapeutic Use of Cephalexin
Used to treat UTIs, post-op infections, pelvic infections, and meningitis.
Adverse Effects of Cephalexin
GI symptoms, Clostridium-difficile-associated diarrhea (CDAD)/C.diff, and possible cross-allergy to penicillin.
Contraindications for Cephalexin
Allergy to cephalosporin antibiotics or penicillin (possible cross-sensitivity).
Nursing Intervention for Cephalexin
Monitor and report blood stools or watery diarrhea; assess for cephalosporin or penicillin allergy before administration.
Client Education for Cephalexin
Take with food to decrease GI symptoms; report watery or blood diarrhea, unusual bruising or bleeding to the provider; do not drink alcohol.
Tetracycline
A protein synthesis inhibitor given orally on an empty stomach, 1 hour before or 2 hours after meals.
Therapeutic Use of Tetracycline
First antibiotic for Chlamydia, Mycoplasma, Rickettsial infections, gram-positive infections, cholera, and anthrax; treats acne vulgaris.
Adverse Effects of Tetracycline
GI symptoms, permanently discolored teeth in fetus and children, hepatotoxicity, superinfections, and photosensitivity.
Contraindications for Tetracycline
Pregnancy risk, children under 8 years, exposure to ultraviolet light, serious renal or liver failure.
Nursing Intervention for Tetracycline
Monitor and report GI symptoms, liver function tests, signs of superinfection, skin reactions, lymphadenopathy, and facial swelling.
Client Education for Tetracycline
Take with non-dairy foods if GI symptoms occur; report to provider if pregnant; wear protective clothing and sunscreen.
Ciprofloxacin
A fluoroquinolone antibiotic given orally and intravenously.
Mode of Action of Ciprofloxacin
Bactericidal due to inhibition of an enzyme necessary for DNA replication.
Therapeutic Use of Ciprofloxacin
Treats a wide range of bacterial infections including severe urinary tract disorders and prevents anthrax after inhalation.
Adverse Effects of Ciprofloxacin
Mild CNS symptoms, GI symptoms, Achilles tendon rupture, photosensitivity, and suprainfection.
Contraindications for Ciprofloxacin
Children under 18, tendon pain, and myasthenia gravis.
Interactions with Ciprofloxacin
Cationic compounds decrease absorption; plasma levels of theophylline and warfarin can increase with concurrent use.
Aminoglycoside
Gentamicin
Route of Aminoglycoside
Topical, Ophthalmic, IM/IV, Intrathecal forms
Mode of Action of Aminoglycosides
Aminoglycosides are bactericidal antibiotics that destroy micro-organisms by disrupting protein synthesis.
Therapeutic Use of Aminoglycosides
Gram-negative aerobic bacilli severe infections
Adverse Effects of Aminoglycosides
Ototoxicity and loss of balance, Nephrotoxicity, Respiratory depression, Rash
Contraindications for Aminoglycosides
Use with caution if known: Kidney disease, Liver disease, Myasthenia gravis
Interactions of Aminoglycosides
Penicillin inactivates aminoglycosides when in the same IV solution. Concurrent administration with other ototoxic medications increases the risk for ototoxicity.
Nursing Intervention for Aminoglycosides
Monitor for serum medication levels by measuring peak and troughs
Client Education for Aminoglycosides
Report onset: Tinnitus, Headache, Vertigo, Hearing loss, Increase in the output of dilute urine to the provider
Urinary Tract Analgesic
Phenazopyridine
Route of Phenazopyridine
PO
Mode of Action of Phenazopyridine
The medication is an azo dye that functions as a local anesthetic on the mucosa of the urinary tract.
Therapeutic Use of Phenazopyridine
Relieves Burning, Pain, Urgency, Frequency related to urinary tract irritation caused by infection, Trauma, Surgery
Adverse Effects of Phenazopyridine
Liver damage including: Hepatitis, Liver failure, Peripheral neuropathy, CNS symptoms, GI symptoms
Contraindications for Phenazopyridine
Acute kidney injury, Chronic kidney disease
Nursing Intervention for Phenazopyridine
Assess the client for urgency, frequency, and pain on urination before and throughout therapy
Client Education for Phenazopyridine
Changes urine color to orange and can stain clothes. Take with meals to minimize GI issues. Can cause dizziness. Educated to rise slowly initially.
Antimycobacterial
Isoniazid
Route of Isoniazid
Tablets, Oral syrup, IM
Mode of Action of Isoniazid
This medication is highly specific for mycobacteria. Isoniazid inhibits growth of mycobacteria by preventing synthesis of mycolic acid in the cell wall.
Therapeutic Use of Isoniazid
Treatment for active and latent tuberculosis (TB)
Adverse Effects of Isoniazid
Peripheral neuropathy, Hepatotoxicity, Hyperglycemia if the client is diabetic
Contraindications for Isoniazid
Severe liver damage from any cause
Interactions of Isoniazid
Isoniazid inhibits metabolism of phenytoin, leading to buildup of medication and toxicity.
Nursing Intervention for Isoniazid
Monitor for and report: GI symptoms, Signs of liver damage, Level of liver enzymes throughout therapy
Client Education for Isoniazid
Report jaundice, Abdominal pain, Unusual fatigue, Numbness, Tingling, Pain in hands or CNS symptoms to provider
Antifungal, polyene
Amphotericin B
Route of Amphotericin B
IV infusion, Oral (PO) suspension
Mode of Action of Amphotericin B
Amphotericin B is an antifungal agent that acts on fungal cell membranes to cause cell death.
Therapeutic Use
Treatment of severe systemic fungal infections: (candidiasis, aspergillosis, cryptococcosis, mucormycosis) and nonopportunistic mycoses.
Adverse Effects/Complications
Infusion reaction, Chills, Fever, Tachycardia, Hypotension, Headache, Nausea, Renal toxicity, Red blood cell suppression.
Contraindications/Precautions
Allergy to amphotericin, Lactation.
Interactions
Aminoglycosides (gentamicin, streptomycin, cyclosporine) have additive nephrotoxic risk when used concurrently with antifungal medications. Antifungal effects of flucytosine are potentiated with concurrent use of amphotericin B. Azole antibiotics increase levels of multiple medications, including digoxin, warfarin, and sulfonylurea antidiabetic medications.
Nursing Intervention
Administer prescribed diphenhydramine (Benadryl) and acetaminophen (Tylenol) before beginning infusion. Monitor vital signs and for symptoms during infusion.
Client Education
Be aware that infusion reaction may occur and notify staff for beginning symptoms. Comply with laboratory testing. Report increasing fatigue to the provider.
Antiprotozoal
Metronidazole.
Route (Metronidazole)
Tablets, capsules, sustained-release capsules, topical cream, vaginal gel, and IV infusion. Give oral dose 1 hour before or 2 hours after a meal for best absorption.
Mode of Action (Metronidazole)
Metronidazole is a broad-spectrum antimicrobial with bactericidal activity against anaerobic microorganisms.
Therapeutic Use (Metronidazole)
IV → treats anaerobic bacterial infections. Oral → treats some bacterial infections and protozoal infections.
Adverse Effects/Complications (Metronidazole)
GI symptoms, CNS symptoms, Darkening of urine, Anorexia, Dry mouth.
Contraindications/Precautions (Metronidazole)
Active CNS diseases, Pregnancy risk → teratogenic.
Interactions (Metronidazole)
Alcohol causes a disulfiram-like reaction (facial flushing, vomiting, dyspnea, tachycardia). Metronidazole inhibits inactivation of warfarin, phenytoin, and lithium.
Nursing Intervention (Metronidazole)
Monitor for and report: Severe GI symptoms, CNS symptoms.
Client Education (Metronidazole)
Take just before, with, or after a meal if GI symptoms occur. Instruct clients they may experience a metallic taste, Headache, Dizziness. Advise clients to avoid alcohol.
Antiviral
Acyclovir.
Route (Acyclovir)
Oral capsules and tablets, Oral liquid suspension, Topical cream and ointment, IV forms.
Mode of Action (Acyclovir)
Acyclovir and ganciclovir prevent the reproduction of viral DNA and thus interrupts cell replication.
Therapeutic Use
Treats herpes 1 and 2
Varicella-zoster virus
A virus that causes chickenpox and shingles.
Adverse Effects/Complications - Topical form
Burning, itching at application site
Adverse Effects/Complications - Oral
GI symptoms, headache, vertigo
Adverse Effects/Complications - IV
Renal toxicity, CNS toxicity, Thrombophlebitis
Contraindications/Precautions - Buccal form
Milk protein concentrate
Nursing Intervention
Monitor and report severe skin reactions
Nursing Intervention
Infuse IV form slowly
Nursing Intervention
Hydrate client during and for 2 hours following infusion to maintain urine output
Client Education
Instruct client that uses OTC lotion and creams may delay or alter the effectiveness of the treatment
Client Education
Instruct female clients with genital herpes to get a yearly pap smear
Nucleoside Reverse Transcriptase Inhibitor (NRTI)
Zidovudine