antibiotics current

Bactrim (trimethoprim/sulfamethoxazole): class and action?

Sulfonamide, folate antagonist; blocks two enzymes (dihydropteroate synthase, dihydrofolate reductase) in bacterial folate synthesis

Bactrim: main uses?

UTI and infections from E. coli, Klebsiella, Staph aureus, Strep pneumoniae, Shigella

Bactrim: serious adverse effects?

SJS, hypersensitivity, agranulocytosis, aplastic anemia, renal failure, hepatotoxicity, C. diff

Bactrim: contraindications?

Sulfa allergy, pregnancy, neonates under 6 weeks, liver damage, renal insufficiency, megaloblastic anemia, drug-induced thrombocytopenia

Bactrim: key client teaching?

Full glass of water, finish the course, cover skin and use sunscreen, report rash and unusual bleeding or bruising

Bactrim: key interactions?

Phenytoin, warfarin, digoxin, ACE inhibitors, diuretics, dofetilide, dapsone

Rifampin (Rifadin): class and use?

Antitubercular (rifamycin); active and latent TB, meningococcal carrier prophylaxis, Legionella, Staph aureus

Rifampin: action?

Bactericidal; inhibits bacterial DNA-dependent RNA polymerase

Rifampin: signature side effect?

Orange-red discoloration of urine, saliva, tears, and sweat

Rifampin: why give with other TB drugs?

Prevents drug resistance

Rifampin: how to give oral dose?

1 hr before or 2 hr after meals (with food if GI upset, though food lowers absorption)

Rifampin: serious adverse effects?

Hepatotoxicity, blood dyscrasias, flu-like syndrome, DRESS (stop the drug)

Rifampin: key teaching?

Soft contact lenses may stain permanently, no alcohol, report abdominal pain, fatigue, or jaundice, use different birth control

Rifampin: key interactions?

Lowers levels of oral contraceptives, warfarin, HIV protease inhibitors; isoniazid and pyrazinamide add liver toxicity

Amphotericin B (Fungizone): class and action?

Polyene antifungal; binds ergosterol in the fungal cell membrane, causing cell death

Amphotericin B: use?

Severe systemic fungal infections (invasive candidiasis, aspergillosis, cryptococcal meningitis, blastomycosis, histoplasmosis)

Amphotericin B: infusion reaction?

Chills, fever, tachycardia, hypotension, headache, nausea 1 to 2 hr into infusion; subsides within 4 hr

Amphotericin B: what to give before infusion?

Diphenhydramine (Benadryl) and acetaminophen (Tylenol)

Amphotericin B: main adverse effects?

Nephrotoxicity, hypokalemia, hypomagnesemia, anaphylaxis, anemia

Amphotericin B: what to monitor?

Daily electrolytes (especially K+ and Mg), BUN and creatinine every few days, weight, I&O, CBC

Amphotericin B: why avoid rapid infusion?

Serious hypokalemia, hypotension, arrhythmias, and shock

Amphotericin B: when to stop infusion?

Immediately if respiratory distress occurs

Amphotericin B: key interactions?

Nephrotoxins (aminoglycosides, vancomycin, furosemide, cyclosporine) raise kidney risk; corticosteroids add hypokalemia; hypokalemia raises digoxin toxicity

Amphotericin B: contraindications?

Allergy to amphotericin, lactation

Penicillins: class and action?

Beta-lactam antibiotics; block cell wall synthesis by binding penicillin-binding proteins, causing cell lysis

Penicillins: examples?

Amoxicillin, amoxicillin/clavulanic acid (Augmentin), nafcillin, piperacillin/tazobactam

Penicillins: uses?

Sinusitis, ENT, lower respiratory, skin, UTI, H. pylori, endocarditis prophylaxis before dental procedures

Penicillins: first nursing action before first dose?

Ask about allergy to penicillins

Penicillins: injectable precaution?

Keep client in facility 30 min after IM or IV dose and watch for allergy

Penicillins: how to give?

At the beginning of meals to reduce GI upset and increase absorption

Penicillins: treating allergic reactions?

Antihistamines for rash or hives; epinephrine and respiratory support for anaphylaxis

Penicillins: serious adverse effects?

C. diff, anaphylaxis, SJS, nephrotoxicity, seizures, hypersensitivity

Penicillins: what raises levels?

Probenecid

Penicillins: effect on oral contraceptives?

Reduced effectiveness

Penicillins: teaching to report?

Watery or bloody diarrhea, mouth pain, vaginal burning or discharge (superinfection)

Metronidazole (Flagyl): class and action?

Nitroimidazole; disrupts bacterial DNA, killing anaerobic organisms

Metronidazole: uses?

Anaerobic infections, C. diff diarrhea, bacterial vaginosis, amebiasis, giardiasis, trichomoniasis

Metronidazole: biggest teaching point?

No alcohol; disulfiram-type reaction

Metronidazole: common side effects?

Metallic taste, nausea, headache, dizziness, dark urine

Metronidazole: when to discontinue?

Seizures or peripheral neuropathy

Metronidazole: interactions?

Alcohol, disulfiram, IV nitroglycerin, citalopram, ritonavir; raises lithium levels; phenobarbital lowers levels

Metronidazole: contraindications?

Active CNS disease, pregnancy risk (teratogenic)

Metronidazole: oral timing?

1 hr before or 2 hr after meals for best absorption; with food if GI upset

Erythromycin: class and action?

Macrolide; bacteriostatic; binds 50S ribosomal subunit to block protein synthesis

Erythromycin: uses?

Respiratory infections, chlamydia, syphilis, neonatal conjunctivitis, PID, skin infections, rheumatic fever; gastroparesis off-label

Erythromycin: serious adverse effects?

QT prolongation, torsades de pointes, hepatotoxicity, ototoxicity, SJS (rare), superinfection

Erythromycin: contraindications?

Prolonged QT, hypokalemia, hypomagnesemia, macrolide allergy

Erythromycin: how to give base and stearate?

Empty stomach (1 hr before or 2 hr after meals) with 8 oz water; with food if GI upset

Erythromycin: what to teach the client to report?

Palpitations, fainting, hearing loss, vertigo, tinnitus, bloody or watery diarrhea

Erythromycin: interactions?

Raises digoxin, warfarin, theophylline; CYP3A4 inhibitors (verapamil, diltiazem, azoles, protease inhibitors) raise erythromycin levels

Ciprofloxacin (Cipro): class and action?

Fluoroquinolone; inhibits DNA gyrase and topoisomerase IV

Ciprofloxacin: uses?

UTI, respiratory, skin, bone and joint, GI infections, STIs, anthrax

Ciprofloxacin: signature adverse effect?

Tendinitis and tendon rupture; stop the drug at tendon pain

Ciprofloxacin: other adverse effects?

Peripheral neuropathy, CNS effects and seizures, QT prolongation, blood sugar swings, C. diff, rare aortic aneurysm or dissection

Ciprofloxacin: what lowers absorption?

Antacids, iron, calcium, dairy, sucralfate; take 2 hr after or 6 hr before the drug

Ciprofloxacin: contraindications?

Fluoroquinolone allergy, tizanidine, tendon disorders, myasthenia gravis

Ciprofloxacin: key teaching?

Cover skin and use sunscreen, cut caffeine, drink 1,500 to 2,000 mL fluid daily, report tendon pain and CNS symptoms

Ciprofloxacin: key interactions?

Raises theophylline and warfarin; more hypoglycemia with antidiabetics; torsades risk with erythromycin, quinidine, antipsychotics, tricyclics

Ciprofloxacin: IV rate?

Infuse over at least 60 min

Chloroquine (Aralen): use?

Prevents and treats malaria; treats amebiasis

Chloroquine: malaria prevention schedule?

Weekly tablets starting 1 to 2 weeks before exposure, weekly during exposure, and for 4 weeks after

Chloroquine: main adverse effects?

Visual disturbances, tinnitus, hearing loss, dysrhythmia, hypoglycemia, suicidal thoughts, change in consciousness

Chloroquine: what to assess?

Apical pulse, vision and hearing screens, CBC, liver labs, alcohol use

Chloroquine: contraindications?

Optic neuritis, psoriasis, prior visual changes from related drugs, prolonged QT

Chloroquine: key teaching?

Take just before or after a meal, sunglasses may help visual effects, report vision changes

Cephalexin (Keflex): class and use?

First-generation cephalosporin (beta-lactam); gram-positive cocci infections

Cephalosporins: how do later generations differ?

More gram-negative coverage, more beta-lactamase resistance, better CSF penetration (meningitis)

Cephalexin: biggest safety check?

Allergy to cephalosporins or penicillin (possible cross-sensitivity)

Cephalexin: how to give?

With food to decrease GI upset; oral only (capsule, tablet, suspension)

Cefotetan: unique risks?

Disulfiram-like reaction with alcohol and bleeding risk; vitamin K treats bleeding

Cephalosporins: what to monitor?

Allergy, bloody or watery stools, prothrombin and bleeding times, IV site for thrombophlebitis, I&O

Ceftriaxone: unique interaction?

IV calcium

Cephalosporins: what raises levels?

Probenecid

Carbapenems: examples and class?

Imipenem, meropenem, ertapenem; beta-lactam antibiotics with broad spectrum

Carbapenems: routes?

IM or IV only; the two forms are not interchangeable

Carbapenems: contraindications?

Allergy to carbapenems or penicillin

Carbapenems: precautions?

Cephalosporin allergy, seizures, renal impairment

Carbapenems: side effect with rapid IV infusion?

Nausea and vomiting; slow the infusion and treat with antiemetic

Carbapenems: key interaction?

Cyclosporine raises seizure risk; probenecid decreases renal excretion

Azoles (ketoconazole, itraconazole): action and use?

Block lanosterol synthesis; systemic fungal infections (less toxic than amphotericin B), candidiasis, tinea

Azoles: main adverse effects?

Hepatotoxicity, adrenal insufficiency, orthostatic hypotension, gynecomastia, jaundice

Azoles: what to monitor?

Liver enzymes before, during, and after therapy

Azoles: how to improve oral absorption?

Give with an acid medium such as cola

Azoles: what lowers absorption?

Antacids, proton pump inhibitors, H2 blockers; separate by at least 2 hr

Azoles: contraindications?

Azole allergy, liver disease, adrenal insufficiency, benzodiazepine use

Gentamicin: class and action?

Aminoglycoside; binds 30S ribosomal subunit to block protein synthesis

Gentamicin: use?

Severe gram-negative aerobic infections; with another antibiotic for some gram-positive cocci

Gentamicin: two major toxicities?

Ototoxicity (tinnitus, headache, vertigo, hearing loss) and nephrotoxicity (dilute urine, high BUN and creatinine)

Gentamicin: when to draw trough?

30 min before the 4th dose

Gentamicin: what to monitor?

Peak and trough levels, BUN, creatinine, urine protein, I&O, hearing (audiometry, cranial nerve VIII)

Gentamicin: contraindications?

Aminoglycoside allergy, pregnancy (teratogenic), myasthenia gravis

Gentamicin: IV compatibility rule?

Do not mix with penicillins, cephalosporins, or heparin in the same IV

Gentamicin: key interactions?

Amphotericin B, NSAIDs, vancomycin, other ototoxic or nephrotoxic drugs; prolongs paralysis with neuromuscular blockers

Gentamicin: ophthalmic teaching?

Press inner canthus 1 to 2 min after drops and keep eyes shut to limit systemic absorption

Acyclovir (Zovirax): class and action?

Nucleoside analogue; inhibits viral DNA polymerase to stop replication

Acyclovir: IV use?

Severe viral infections in immunocompromised clients

Acyclovir: IV nursing actions?

Infuse slowly; hydrate during and for 2 hr after; monitor BUN, creatinine, and IV site

Acyclovir: IV adverse effects?

Renal toxicity, CNS toxicity (restlessness, tremors, psychosis, seizures), thrombophlebitis, tissue damage with infiltration

Acyclovir: topical teaching?

Wear gloves or finger covers, avoid eyes, avoid scratching

Acyclovir: genital herpes teaching?

Use condoms; yearly Pap smear for women