Macrolides, Miscellaneous Antibiotics, Sulfonamides, Tetracyclines and Urinary Antiseptics and TB Treatment

erythromycin and azithromycin

what are the two macrolides we need to know?

macrolides

this inhibits protein synthesis leading to cell death; acts as a penicillin substitute and is over prescribed

macrolides

this med is used for newborns as an ophthalmic ointment to prevent rheumatic fever, gonorrhea, syphilis, chlamydia, & pertussis and treat STIs, respiratory infections, and prokinetically with diabetes

PO, IV, ophthalmic (newborn only)

pharmacokinetics for macrolides

liver disease (BBW), GI effects (pseudomembranous colitis), CNS effects (mobility of emotions), cardiac effects (prolong QT)

what are the adverse effects of macrolides? (4)

abdominal pain and diarrhea

what are symptoms of pseudomembranous colitis to watch out for?

liver disease, inflammatory bowel disease, drug interactions (Warfarin, Digoxin), do not use with patients on fluconazole and/or diltiazem

what are the contraindications/use with cautions for macrolides? (4)

antacids reduce absorption, assess medications patient is receiving for interactions

nursing considerations for macrolides (2)

clindamycin

this med is a misc that is used for topical staph infections and systemic for very serious infections such as toxic shock

fatal pseudomembranous colitis

what is the BBW for clindamycin?

vancomycin

what is the med example for lipoglycopeptides?

vancomycin

there aren’t a lot of uses for this antibiotic because of resistance but it can be used PO to treat C Diff and to treat MRSA

vancomycin resistant enterococcus

what does VRE stand for?

nephrotoxic, IV is vesicant, red man syndrome

what are the adverse effects of vancomycin? (3)

vesicant

a chemical agent or drug that causes severe skin, eye, and tissue damage by producing painful, fluid-filled blisters and tissue death

trough (before 4th dose)

most important thing you need to do with vancomycin!!!

vancomycin

this medication might be the reason to receive a CVC due to its vesicant effects

red man syndrome

when vancomycin is given too quickly it can cause a rash on the face, neck, and trunk. This is called…

linezolid

this medication is used to treat vancomycin resistant staph aureus (VRSA). it is part of oxazolidinone antibiotic

linezolid

we don’t use this medication for long term therapy due to its serious hematologic and neurologic complications

Don’t take with SSRIs, SNRIs, TCAs, or MAOIs (BBW) and bone marrow depression

what are the adverse effects of linezolid? (2)

linezolid interferes with serototin breakdown in the brain causing an increase in serotonin

why is there a black box for linezolid regarding selective serotonin reuptake inhibitors (SSRI), selective norepinephrine reubtake inhibitors (SNRI), tricyclic antidepressants (TCA), and monoamine oxidase inhibitors (MAOI)?

serotonin syndrome and CBC monitoring

what are the nursing considerations for linezolid? (2)

shivering, sweating, muscle twitching, seizures

what are the s/sx of serotonin syndrome? (4)

chloramphenicol

this is a misc broad spectrum IV antibiotic that is used for VRE, meningitis, plague, cholera, and typhoid fever

hospitalization recommended due to irreversible aplastic anemia; monitor for bone marrow suppression by watching CBC

what is the BBW for chloramphenicol and how do we monitor?

daptomycin

this is a misc med used for complicated skin and skin structure infections, bacteremia caused by S. Aureus

gentamicin

what medication is often used with daptomycin?

statins because risk of musculoskeletal complications

which medication class should you not take daptomycin with and why?

rifaximin

this is a misc med that is very effective at treating Traveler’s diarrhea caused by E.coli and treats hepatic encephalopathy

hepatic encephalopathy

this is a condition where the person has liver impairment/failure which causes a buildup of ammonia that messes with the person’s brain

B.

Your patient is receiving IV vancomycin and develops a rash on the face, neck, and trunk. What is the nurse’s priority action?

A. notify the provider
B. slow down the infusion
C. recommend a CBC to be drawn
D. be prepared to give IV benadryl

B.

Which of the following patients would it be safe to administer azithromycin to?

A. patient with a history of alcoholism
B. patient with a history of dementia
C. patient with a history of inflammatory bowel disease
D. patient receiving QT-prolonging medications

sulfonamides

this medication class creates fake folic acid so the bacteria can’t use it to function

trimethropim-sulfamethoxazole (Bactrim), sulfadiazine, sulfasalazine

what are 3 examples of sulfonamides?

sulfonamides

this medication class is used to treat UTIs, salmonella, klebsiella, pseudomonas

hypersensitivity reaction common, GI effects (usual + pancreatitis), renal effects, hematologic effects (all the penias), dermatological effects (skin photosensitivity, stevens-johnson syndrome)

adverse effects for sulfonamides (5)

allergies to sulfa drugs or thiazide diuretics, megaloblastic anemia, renal disease, elderly, infants < 2 months, pregnancy

what are the contraindications and cautions for sulfonamides? (6)

CBC monitoring, BMP in elderly, sulfasalazone can stain skin

what are the nursing notes for sulfonamides? (3)

tetracycline, doxycycline, minocycline

what are the 3 examples of tetracyclines we need to know?

tetracyclines

this medication class is used to treat acne, COPD/asthma exacerbation, chlamydia, lyme disease, etc.

GI effects (esophagitis), dental/skeletal effects (permanent yellow/gray/brown discoloration and harm bone growth), dermatological effects (photosensitivity)

what are the adverse effects of tetracyclines? (3)

pregnancy/lactating mothers, use with caution in children <8, hepatic/renal dysfunction

what are the contraindications/use with caution for tetracyclines (3)

administer on empty stomach with lots of water, remain upright for minimum of 30 minutes, throw outdated medications away

nursing notes/patient education for tetracyclines (3)

antacids, iron, dairy, digoxin, anticoagulants

what are some foods and drugs that interact with tetracyclines? (5)

nitrofurantoin (Macrobid)

urinary antiseptic that is treatment and prophylaxis of UTIs but not to be used in elderly or in pregnancy

phenazopyridine (Pyridium)

most common urinary antiseptic; acts as a urinary analgesic, should be given with food, and produces reddish orange urine (meaning you can’t get a UA with it)

report yellow skin as it can be a sign of toxicity; don’t take more than 2 days or this chance increases

what is the BBW for phenazopyridine?

trimethoprim

this urinary antiseptic is a folate antagonist used in combination with sulfonamides and used for UTI’s and P. Jiroveci pneumonia (which is found in HIV patients)

A.

The nurse if caring for a patient receiving tetracycline for acne. The nurse is most concerned about which of the following?

A. esophagitis
B. prolonged QT interval
C. pseudomembranous colitis
D. anemia

lungs, lymph, pleurae, GI, bones/joints, kidneys, brain

what are areas that TB can effect in the body? (7)

TB

this is the leading cause of death worldwide for people with HIV

False

True or False: TB doesn’t have any drug resistance

mycobacterium tuberculosis

what is the causative agent for TB?

slow

is TB slow or fast growing?

water, soil, some animals

where can TB be found? (3)

transmission, primary infection, latent TB infection, active TB

what are the 4 phases of TB?

transmission

identify the phase of TB: person inhales airborne droplets

primary infection

identify the phase of TB: 2-10 weeks after the phase before, mild flu like symptoms

latent TB infection

identify the phase of TB: immune system stops bacterial growth, no s/sx or contagion

active TB

identify the phase of TB: happens due to further exposure or reactivation of latent TB due to weakened immune system

low grade fever, cough, fatigue, weight loss, night sweats, hemoptysis

what are the clinical manifestations (s/sx) of TB? (6)

Mantoux Skin Test, QuantiFERON-TB Gold, chest xray, sputum

what are the diagnostic tests for TB? (4)

10

the FDA has approved how many drugs for TB?

Rifampin, Izoniazid, Pyrazinamide, Ethambutol

what are the 4 main meds for TB?

aminoglycosides, fluroquinolones, delamanid, bedaquiline

what are the second line TB meds (only used for drug resistance)

2-3 weeks

how long can it take to start feeling better after starting treatment for TB?

direct observational therapy

this might be used for someone with TB when we are worried about noncompliance with their medications

report adverse symptoms and teach how disease is spread

what to teach your patients being treated for TB (2)

CNS effects (seizures), GI effects (usual + pancreatitis), liver toxicity (BBW)

what are the adverse effects of isoniazid? (3)

RUQ pain, no appetite, vomiting, jaundice

what are some x/xs of liver toxicity (4)

hepatic/renal dysfunction, CNS dysfunction (no if seizure disorder, monitor for peripheral neuropathy due to lack of B6 metabolism)

what are the contraindications/cautions for isoniazid? (2)

skin effects (red/orange color), GI effects, renal effects, superinfection with prolonged use

what are the adverse effects of rifampin (4)

hepatic dysfunction (caution), history of alcoholism (caution), must treat pt HIV before TB regime, pregnancy/lactation (3rd trimester)

what are the contraindications and cautions for rifampin? (4)

GI upset, hyperuricemia (treat gout first), hepatotoxicity

pyrazinamide adverse effects (3)

optic neuritis (difficulty distinguishing red from green)

ethambutol adverse effects (1)