Anti-Infective Agents UAB NUR 328

Bactericidal Meds

directly lethal to the microbe

Bacteriostatic Meds

slows the rate of growth of the microbe and leaves it to the immune system to destroy the organism

Aminoglycosides

Gentamicin

Gentamicin Uses

Bactericidal -> gram negative aerobic infections

Gentamicin MOA

disrupts protein synthesis

Gentamicin Dosage

Providers adjust dosages based on serum drug levels (peak & trough) and creatinine clearance

Trough- blood specimen collected immediately before med given

Peak- blood specimen collected as ordered- 30 minutes after infusion finishes

Gentamicin AE

Nephrotoxicity -> watch kidney labs

Ototoxicity (could be permanent) -> hearing an loss of balance

Loss of coordination

Muscle twitching or weakness'

GI issues/ allergic rxn

Gentamicin CI/ Caution

If patient on a potent diuretic or any neuromuscular blocking drugs (drug-drug interactions), has renal insufficiency, hearing issues or myasthenia gravis

Carbapenems

imipenem + cilastatin

Imipenem + Cilastatin Uses

Bactericidal -> broad-spectrum beta-lactam effective against gram + and gram – bacteria

Imipenem + Cilastatin MOA

destroys bacteria cell wall

Imipenem + Cilastatin CI

allergy- possible cross-sensitivity to penicillin or cephalosporins

Sz disorders/drugs prescribed for seizures (reduces their effectiveness, can lead to breakthrough seizures)

Caution with inflammatory bowel disease and pregnancy/lactation

Imipenem + Cilastatin AE

Renal toxicity

GI: diarrhea/bloody/mucus -> c. diff/ pseudomembranous colitis, N/V

Superinfection (colitis, black furry tongue, vaginal yeast infection)

CNS effects like headache, dizziness, and altered mental state

Cephalosporins

Cefaclor (2nd generation)

Cephalexin (1st generation)

Cefaclor/ Cephalexin Uses

Bactericidal -> action against gram positive and gram negative bacteria depending upon drug (broad-spectrum)

Cefaclor/ Cephalexin MOA

destroys bacterial cell wall

Cefaclor/ Cephalexin CI

Cross-reactivity if history of allergic response with penicillin -> ok with mild allergy

if client on oral anticoagulants may experience increase in bleeding so needs to be monitored for s/s

Alcohol -> pt. should avoid

Cefaclor/ Cephalexin AE

Nephrotoxicity

GI: diarrhea/blood/mucus -> C. diff/pseudomembranous colitis, N/V, abdominal pain, anorexia, flatulence

Superinfection

CNS effects like headache, dizziness, and altered mental state, paresthesia

Fluroquinolones

Ciprofloxacin

Ciprofloxacin Uses

Bactericidal -> broad-spectrum

Ciprofloxacin MOA

inhibition of enzyme necessary for DNA replication

Ciprofloxacin CI

exacerbation of muscle weakness in clients with myasthenia gravis

Pts who are very active

Ciprofloxacin AE

tendinitis, Achilles tendon rupture

Photosensitivity

peripheral neuropathy, CNS effects

GI: diarrhea- C diff., N/V, dry mouth

Superinfection- thrush or vaginal yeast infection

Bone marrow depression

Ciprofloxacin DI

cardiac drugs that increase QTc interval, theophylline (increases levels), coagulation modifiers (warfarin), and GI drugs like antacids

Dairy products decrease absorption

Increased muscle weakness with corticosteroids

Penicillin and Penicillinase-Resistant Antibiotics

Amoxicillin, ampicillin, amoxicillin-clavulanate

Amoxicillin Uses

Bactericidal -> used to treat a variety of “coccal” infections (streptococcal, pneumococcal, gonococcal, meningococcal, etc.)

Amoxicillin MOA

affect bacterial cell wall

Amoxicillin CI

Allergy -> remember cross-sensitivity with cephalosporins and carbapenems

Amoxicillin AE

allergic reaction/hypersensitivity

superinfection—c. diff

s/s problem at injection site or IV site

GI: n & v, diarrhea

Amoxicillin DI

Women use 2nd form of contraception during treatment as penicillin's can decrease birth control pill effectiveness

Aminoglycosides can decrease effectiveness and increase AE

Sulfonamides

trimethoprim-sulfamethoxazole

Trimethoprim-Sulfamethoxazole Uses

Bacteriostatic

Trimethoprim-Sulfamethoxazole MOA

block production of folic acid, which is necessary for growth/ synthesis of new bacteria

Trimethoprim-Sulfamethoxazole CI

Pregnancy Cat X -> Teratogenic

Allergies to previous doses of sulfonamides, sulfonylureas, or thiazide diuretics because cross-sensitivities

Immunosuppressed pts due to bacteriostaticity

Caution w/ renal disease or hx. of kidney stones

Trimethoprim-Sulfamethoxazole AE

GI: n & v, diarrhea, abdominal pain, anorexia, stomatitis, and hepatic injury

Renal- nephrotic syndrome, crystalluria, hematuria, proteinuria

CNS effects- HA, dizziness, vertigo, depression

Bone marrow depression

Photosensitivity

Steven-Johnsons syndrome; other signs of hypersensitivity

Trimethoprim-Sulfamethoxazole DI

sulfonylurea drug -increased risk for hypoglycemia occurs

Trimethoprim-Sulfamethoxazole Labs

Renal labs and CBC

Stevens-Johnson Syndrome/ Toxic Epidermal Necrolysis (TEN)

Rare, serious disorder of the skin and mucous membranes

Reaction to a medication

Begins with flu-like symptoms - followed by a painful red or purplish rash - then the affected skin dies and sheds

Treated like a burn

Tetracyclines

Tetracycline

Tetracycline Uses

Broad spectrum -> bacteriostatic

Prescribed for a lot of skin conditions -> ACNE

Tetracycline MOA

inhibits bacterial protein synthesis

Tetracycline CI

Allergies to past doses of tetracycline

Contraindicated in pregnancy/lactation because of effect on teeth and bones

Use with caution in children (discoloration)

Tetracycline AE

Absorption is affected by food, iron, calcium and other drugs in stomach: can cause esophageal ulcerations

Photosensitivity

Superinfection

Hypersensitivity

Dental discoloration (yellow or brown)

GI: nausea/vomiting, diarrhea

Bone marrow depression

Tetracyclines DI

Increased risk of bleeding on warfarin, digoxin

Licosamides

Clindamycin

Clindamycin AE

GI: n & v, fatal pseudomembranous colitis has occurred

Bone marrow depression

Skin infections

Macrolides

Erythromycin

Erythromycin Uses

May be used for prophylaxis (e.g. pre-dental)

Older antibiotics used to treat urinary tract infections (UTIs) and upper respiratory infection (URIs) and are often used when clients allergic to penicillin

Erythromycin MOA

inhibits protein synthesis

Erythromycin AE

GI: Abd. cramping, vomiting, diarrhea, risk for pseudomembranous colitis

Superinfection

Liver toxicity

Steven Johnson’s syndrome

Potential for hearing loss (ototoxicity)

CV: abnormal heart rhythms (some life-threatening)

Vancomycin Uses

Bactericidal -> Staphylococcal infections; gram + pathogens (MRSA strands, group A strep, streptococcus pneumoniae, c-diff)

May be used prophylaxis if the client allergic to penicillin

Vancomycin MOA

Binds to cell wall

Vancomycin AE

Nephrotoxicity, Ototoxicity

Red Mans Syndrome with rapid infusion

Hypersensitivity reactions (including anaphylaxis)

Superinfection [black, furry overgrowth on tongue; vaginal itching or discharge, loose or foul-smelling stools (pseudomembranous colitis)]

Red Man Syndrome

Symptoms are due to histamine release

Not the same as SJS - resolves on its own

Anti-Mycobacterials

Isoniazid (INH)

Isoniazid Uses

Often given together with rifampin, pyrazinamide, and ethambutol (multiple drug therapy)

INH is a first-line drug; oral therapy for a minimum of 6 months for TB

Isoniazid CI

Renal/Hepatic failure/ severe CNS dysfunction

caution w/ pregnancy/lactation and heavy alcohol usage

Isoniazid AE

Neuro: peripheral neuropathies, dizziness, HA, malaise, hallucinations, neuritis

GI: n & v, anorexia, stomach pain

Rifampin causes discoloration of body fluids (urine, sweat, tears); orange-tinged; can stain clothing and contact lenses

Toxic liver reactions can occur; avoid alcohol, wine, etc; drug-induced hepatitis

Isoniazid DI

Severe reactions can occur with the intake of food that has high concentrations of tyramine (aged cheeses, smoked and processed meats, fermented foods, pickled foods)

Antivirals

Acyclovir -> end in -vir or -dine

Acyclovir Uses

Treatment of herpes 1 and 2 infections, HSV encephalitis; acute shingles and chickenpox

Acyclovir MOA

Works by inhibiting viral DNA replication

Acyclovir AE

HA, vertigo, tremors, N/V, rash, GI upset, insomnia

Anti-fungal Agents

Amphotericin B (systemic) and Ketoconazole (superficial and systemic)

ends in -zole

Antifungal Agents AE

Ketoconazole can cause hepatoxicity and also affect sex hormones (gynecomastia w/ male and irregular menstrual flow with female clients)

Antifungal Agents DI

Avoid aminoglycosides due to additional risk for nephrotoxicity

Can increase levels of digoxin, warfarin, and sulfonylurea diabetic medications

Need to use an additional form of birth control if taking hormonal contraceptive

Amphotericin B Uses

systemic fungal infections

Amphotericin B

Premedicate with Tylenol and Benadryl

Must hydrate with other IV fluids to prevent nephrotoxicity

Labs: kidney function

Amphotericin B AE

fever, chills, HA

hypokalemia, bone marrow suppression and blood dyscrasias (any disorder of the blood like anemia/ thrombocytopenia)

Antiprotozoal Agents

Metronidazole

Metronidazole Uses

Prescribed for many GYN and colon treatments

Indications: pre-op and post-op prophylaxis for patients undergoing colorectal surgery

Sometimes used to treat C. diff

Metronidazole AE

HA, dizziness, ataxia, diarrhea

darkening of urine, metallic taste in the mouth

pseudomembranous colitis

Metronidazole DI

warfarin, lithium, phenytoin

Metronidazole Pt. Education

avoid alcohol for at least 3 days post-treatment