pharm dump 4

antibiotics

Aminoglycosides

• Uses: treats E coli, klebsiella, pneumoniae, proteus mirabilis, pseudomonas, aeruginosa. It’s a bactericidal

• Caution: pregnancy potential deafness of fetus, pts with: nephrotoxicity, ototoxicity, or renal impairment

• AE: ototoxicity, nephrotoxicity, irreversible deafness, confusion, disorientation, numbness, weakness

• Administration: Administer via IV or IM, as oral absorption is poor

• Monitoring: 

  • Assess kidney function (BUN,creatinine) regularly to detect nephrotoxicity

  • Monitor for signs of ototoxicity (e.g, numbness, muscle weakness)

• Precautions: 

  • Use cautiously in pts with pre-existing kidney or hearing issues. 

  • Avoid concurrent use with other nephrotoxic or ototoxic drugs

• Poorly absorbed in GI tract

• Streptomycin & Amikacin —> mycobacterial infections

• Gentamicin —> eye or ear infections

• Tobramycin —> eye infections, pseudomonas infections 

• Neomycin —> hepatic encephalopathy, before colorectal surgeries (the surgery is v invasive)

Carbapenems

• Broad spectrum antibiotic effective against gram-positive & gram-negative bacteria. Reserved for treating severe infections, caused by multidrug resistant (MDR) bacteria

• Examples: Dorpipenem, ertapenem, meropenem, impinenem

• Contraindications: Meropenem don’t use under 18 y/o, test renal function due to toxicity 

• AE: superinfections, toxic effects on GI tract, C.diff, dehydration, NV, hallucination

• Nursing considerations: monitor for oral or vaginal candidiasis, monitor for signs of c.diff

Cephalosporins

• Very common!

• Ex:

  • First generation: Cefalexin (Keflex), Cefadroxil (Duricef), & Cefazolin (Ancef) (v/common pre-op)

  • Second generation: Cefuroxime (ceftin), cefaclor (ceclor), & cefprozil (cefzil), cefotetan, cefoxitin

  • Third generation: ceftriaxione (rocephin), ceftoaxime (claforan), and cefixime (suprax)

  • Fourth generation: cefepime (maxipime)

  • Fifth generation: ceftazidime (fortaz) and ceftaroline (zevtera)

  • Other: cefdinir (cefdin) and cefditoren (spectrin)

First generation cephalosporins: cefalexin (keflex), cefadroxil (duricef), and cefazolin (ancef)

• Uses: treat bacterial infections caused by gram-positive bacteria, IE, skin & soft tissue infections, UTIs, pneumonia, ear infections, & prophylactic to the OR

• AE: C.difficle, colitis, yeast infections, signs of kidney issues (flank pain), S/S of new or reoccuring infection. Can cause thrombophlebitis. They are caustic to vein —> why we administer via a pump

• Nursing considerations: educate pt on s/s of yeast infections preventative measures, complete full course, monitor blood urea nitrogen (BUN) and creatinine

• Cautions: pts hepatic or renal impairment

• Simple trick: FA/PHA; “Cefazolin, cefadroxil, cephalexin”

Second generations cephalosporins: cefuroxime (ceftin), cefaclor (ceclor), and cefprozil (cefzil), cefoxitin

• Uses: bacterial infections, UTIs, skin & soft tissue infections, respiratory infections, otitis media, bone & joint infections

• AE: Stevens-Johnshon syndrome, toxic epidermal necrolysis

• Nursing considerations: pts w allergy to PCN, breastfeeding lead to diarrhea of infant

• Contrainidcations: Hx of PCN allergy, ceruoxime-liquid formula has sucrose careful with diabetics, also avoid antacids 1-2 hrs prior 

• Everything else”= “Cefoxitin, Cefotetan, Cefmetazole, Cefprozil, Cefaclor, Cerfuoxime”

Third generation cephalosporins - Ceftriaxone (rocephin), cefotaxime (claforan), and cefixime (suprax)

• Uses: broad-spectrum antibiotics, treats wide variety of bacterial infections, respiratory infections, respiratory infections, meningitis, gonorrhea (suprax), abdominal, pelvic, joint & bone infections), sepsis, lyme ds, prophylaxis to OR, neonatal sepsis

• AE: C.diff, colitis, yeast infections, leukopenia, thrombocytopenia, (ceftriaxone), Rocephin (risk of bleeding), esp in pts with poor nutrition, kidney or liver disease, and those with a vitamin K deficiency & elevated liver & kidney tests

• Nursing considerations: cefotaxime IV-admin slow can get life-threatening <3 arrhytmias, instruct pt to report any persistent diarrhea (it can cause c.diff), pt to report any bleeding (thrombocytopenia) or easy bruising, avoid alcohol

• Contraindications: *Penicillin allergy, hyperbillirubinemia in neonates, ceftriaxone is contraindicated, efotaxime (claforan) if allergy to lidocaine (only if given IM)

• Note: the most commonly used due to broad spectrum, and potency (effective against a wide range of gram-negative bacteria and some gram-positive bacteria). Penetrate CSF to *Penetrate CSF to treat meningitis *, good pharmacokinetics (its absorbed & tolerated well)

• “ONE/TEN/IME: Ceftriaxone, ceftibuten, cefotaxime, ceftazidime, cefpodoxime, cefixime, cefdinir, moxalactam”

Fourth generation: Cefepime (Maxipime)

• Uses: pneumonia, febrile neutropenia, UTI, skin & soft tissue infections, complicated intra abdominal infections, bacterial meningitis & endocarditis

• Adverse effects: neurotoxicity, C.diff, kidney damage (urination freq & amnt can change. monitor BUN & creatinine levels), blood disorders (neutropenia & thrombocytopenia, liver damage, LFTS, superinfections

• Contraindications: PCN allergy or any cephalosporin, pts w Hx of brain Ds or seizures (exacerbate it)

• Nursing considerations: monitor pts with kidney disease risk for neurotoxicity, elderly at risk neurotoxicity, breastfeeding (infant=thrush) oral candida on baby. if mother needs to be on it, tell her to rinse babies mouth out.

• “Pi: Cefepime, Cepirome”

Fifth generation cephalosporins

• Drug: Teflaro (ceftaroline)

• Uses: Active against multi-drug resistant infections like MRSA (methicillin-resistant S.aureus) & VRSA (vancomycin-resistant S. aureus). Community acquired pneumonia and serious skin & soft tissue infections

• Administration: this drug is also injectable

• “Rol: Ceftaroline, ceftobiprole”

Fluoroquinolones

• Uses: effective against wide range bacteria, gram + / - organism (pneumonia, infections of bone, joint, skin, soft tissue, GI, UTI)

• AE: tendonitis, tendon rupture, metallic taste, hyper/hypoglycemia

• EX: ciprofloxacin (cipro), levofloxacin (levaquin), moxifloxacin, gemifloxacin

• Nursing: monitor for healing, changes in mental status, avoid dairy & antacids for 2 hr prioir, avoid excessive sun

• Drug-drug: iron, CA+, antacids

Natural penicillins

• EX: penicillin G benzathine, PCN G K+, PCN G procaine, PCN V (PCN VK)

• AE: Super infection (vaginal candidas), unusual bleeding (PLT tissue), confusion, seizures

• Nursing: long term use of PCN G check LFTs, check potassium levels they can inc, oral pcn V take on empty stomach, take @ night

• Drug-drug: avoid some vaccines, & tetracycline

• Contraindications: allergy to cephalosporin 

• Treats: penicillum mold, tonsillitis, scarlet fever, endocarditis, pneumococcal infections, staphylcoccal infections, diphteria, anthrax, syphillis

Antipseudomonal penicillins

• Piperacillin (Zosyn)- treats serious bacterial infections (sepsis). #1 drug for sepsis and usually will b triple antibiotics

• AE: C.diff, prolong use, seizures, hallucinations, acute kidney injury- monitor labs & urination

• Nursing: IV over @ least 30 mins (3-4 hr) monitor for therapeutic response

• Drug-drug: Vancomycin inc. risk of acute kidney injury, monitor if taking heparin or anticoagulants if inc. risk of bleeding

7 common side effects of amoxicillin

• Headache

• Diarrhea

• Stomach upset

• Vaginal yeast infection

• Abnormal taste sensation

• N/V

• Skin rash

Suflonamides

• AKA sulfa drugs, they inhibit bacterial growth, prevents bacteria from producing folic acid 

• EX: sulfadiazine, sulfamethoazole-trimethoprin (spetra) (v/common for UTIs)

• Treats: bacterial infections (UTI, skin, & respiratory infections such as bronchitis)

• Drug-drug: Any allergy to loop or thiazide diuretics, sulfa allergy obv, and read under “U”

• Sensitivity to sulfa and sun: allergic reactions common; can progress to Stevens-Johnson Syndrome & causes photosensitivity (use sunscreen, avoid tanning booths)

• Use caution with other meds:

  • Increases effects of:

    • Warfarin: inc. bleeding risk (inc. INR)

    • Phenytoin: inc. neurotoxicity

    • Sulfonylureas: inc. risk of hypoglycemia

  • Monitor labs (INR, blood glucose) & for signs ot toxicity

• Liver toxicity: can elevate liver enzymes, so monitor LFTs (esp. w long term use)

• Folic acid synthesis blocked: avoided during pregnancy (esp. 1st & 3rd trimester due to potential risk of birth defects or megaloblastic anemia & kernicterus) or if folate deficient (megaloblastic anemia)

• Adequate fluid intake: helps prevent crystalluria & renal injury

  • Recommended ~2L/day (unless contraindicated)

  • Monitor urine output & renal labs

Tetracyclines

• EX: tetracycline, demeclocycline, doxycycline, eravacycline, omadacycline, sarecycline, minocycline

• Indications: less commonly used; remains first line for: Rocky Mountain Spotted Fever, chlamydia, cholera, Lyme, anthrax, & H. Pylori

• Action: inhibit bacterial protein synthesis 

• Nursing:

  • Can cause teeth staining* - avoid in pregnancy & children under 8 yrs old

  • Cause photosensitivity- avoid light

  • Poorly absorbed when taken w minerals

  • Avoid calcium, iron, & magnesium-containing foods & medications

  • Avoid antacids, multivitamins, or dairy

Lincosamides

• Treats severe infections when PCN cannot be use (due to reasons such as allergy)

• Liver toxicity (with prolonged use)

• IV, PO, Topical routes (take PO w full glass of water to prevent esophageal irritation

• N/V (take w food to reduce sympt)

• C. diff infection risk (!HIGH RISK!: report diarrhea immediately) 

• Option for PCN allergic pts

Clindamycin

• Indications:

  • Gram +ve coverage

  • Skin & soft tissue infection

• Key SE:

  • Diarrhea

  • Clostridiolides difficile colitis (painful diarrhea)

  • Skin rash

• Remember: Clindamycin is a major CYP3A4 substrate, so take caution on a potential drug interaction

** Lipclycopeptides / Vancomycin

• Uses:

  • STRONG antibiotic for STRONG infections (MRSA & C.diff)

    • Vancomycin is a first line medication b/c it Vanquishes bacteria the best 

• Must-know SE: 

  • “RED MAN SYNDROME”:

  • (also called Vancomycin Flushing Syndrome)

  • Red rash on face, chest, and/or extremities 

  • Flushing & itching of the face & body

  • Hypotension

• Nursing considerations:

  • Intravenous administration = IV powder added to fluid 

  • Vancomycin think IV

  • Is also available in PO form 

  • Infuse over @ least 60 minutes

  • STOP the infusion if Vancomycin Flushing Syndrome occurs

    • If it happens, stop! give the pt benedryl/diphenhydramine. need an order for that tho

Macrolides

• Treat a wide range of infections caused by gram + & gram -

• Oral macrolides:

  • Mild to moderate bacterial infections (respiratory, GI, GU)

    • Erythromycin (babies eyes when born)

    • Azithromycin

    • Clarithromycin

• Also can b given IV or ointment

Agents for influenza A & respiratory viruses

• Agents to treat influenza A & RSV-

• EX: Oseltamivir (tamiflu), baloxavir, zanamivir, peramivir

• Contra: In pregnancy - tamiflu can b given late term 

• AE: 

  • NVD

  • Peramivir = leukopenia

  • Baloxavir = mental changes

  • Tamiflu = stabbing stomach pain

  • Zanamivir = can worsen breathing in asthma/copd

• Nursing considerations:

  • Zanamivir= assess resp status

  • Oseltamivir= educate to take w/food to dec. GI SE, take @ bedtime to dec. GI SE as well, watch for potential neuropsychiatric symptoms such as hallucinations, negative thoughts

Agents for herpes & cytomegalovirus

• EX:

  • Acyclovir is 1st line defense (treats HSV. genital herpes or cold sores)

  • Valacyclovir (valtrex- treats herpes & shingles)

  • Famiclovir (suppress herpes)

  • Peniclovir (treat cold sores)

• AE: NV, HA, Depression, parathesia, rash, hair loss

• Nursing considerations: educate pt meds do not cure, only treat, meds do not prevent spread of infection, rigorous hand washing after application of ointment.

Systemic Antifungal agents

• Azole antifungals

  • Most common: Fluconazole (diflucan) & voriconazole terbinafine (Lamisil)

  • Itraconazole, ketoconazole, posaconazole

• Treats: fungal infections like oral, vaginal, or esophageal candidiasis, nails

• These drugs are considered less toxic than some other antifungals, but may be less effective in severe & progressive infections

• AE: liver toxicity (hepatotoxicity), caution w pts with endocrine or fertility issues, anyone trying to conceive

• Nursing: monitoring liver function & lipid panel, assess cardiac status due to the risk of QT prolongation, must complete course of med

Echinocandin Antifungals

• EX: caspofungin, micafungin, anidulafungin

• Uses: invasive fungal infections caused by candida & aspergillus species. Esophageal candidiasis, intra-abdominal infections

• AE: hepativ toxiciity, hypokalemia, hypomagnesemia, phlebitis, hypotension

• Nursing con:

  • monitor LFTs

  • Micafungin= associated w bone marrow suppression

  • Administered IV, monitor for phlebitis. If phlebitis, take out & warm compress

  • Check I&O & electrolytes 

Other antifungals