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

Trough

blood specimen collected immediately before med given

Peak

blood specimen collected 30 minutes after infusion finishes

S/E of Photosensitivity

Ciprofloxacin

Trimethoprim-Sulfamethoxazole

Tetracycline

S/E of SJS

Trimethoprim-Sulfamethoxazole

Erythromycin

S/E of Bone Marrow Depression

Ciprofloxacin

Trimethoprim-Sulfamethoxazole

Tetracycline

Clindamycin

Amphotericin B

Aminoglycosides

Gentamicin

Gentamicin Uses

Bactericidal -> gram negative aerobic infections

Gentamicin MOA

disrupts protein synthesis

Gentamicin AE

Nephrotoxicity

Ototoxicity -> Loss of coordination

Muscle twitching or weakness

GI: n/v

Gentamicin CI/ Caution

renal insufficiency/ dehydration, hearing issues, myasthenia gravis

Gentamicin DI

potent diuretic

any neuromuscular blocking drugs

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 and can lead to breakthrough seizures

Caution with IBD 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 HA, dizziness, and altered mental state

Cephalosporins

Cefaclor (2nd generation)

Cephalexin (1st generation)

Cefaclor/ Cephalexin Uses

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

Cefaclor/ Cephalexin MOA

destroys bacterial cell wall

Cefaclor/ Cephalexin CI

Cross-reactivity if history of allergic response with penicillin

Cefaclor/ Cephalexin AE

Nephrotoxicity

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

Superinfection

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

Cefaclor/ Cephalexin DI

pt. on oral anticoagulants may experience increase in bleeding

Alcohol -> pt. should avoid 72 hours post tx

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 QT interval

theophylline (increases levels)

coagulation modifiers (warfarin)

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

Amoxicillin MOA

affect bacterial cell wall

Amoxicillin CI

Allergy -> cross-sensitivity with cephalosporins and carbapenems

Amoxicillin AE

superinfection—c. diff

GI: n & v, diarrhea

Amoxicillin DI

Women use 2nd form of contraception during treatment -> can decrease birth control pill effectiveness

Aminoglycosides

Sulfonamides

trimethoprim-sulfamethoxazole

Trimethoprim-Sulfamethoxazole Uses

Bacteriostatic

Trimethoprim-Sulfamethoxazole MOA

blocks production of folic acid -> necessary for growth/ synthesis of new bacteria

Trimethoprim-Sulfamethoxazole CI

Pregnancy Cat X -> Teratogenic

Allergies to previous doses of sulfonamides, sulfonylureas, or thiazide diuretics

Immunosuppressed pts

Caution w/ renal disease or hx. of kidney stones

Trimethoprim-Sulfamethoxazole AE

GI: n & v, diarrhea, abdominal pain, anorexia, stomatitis

Hepatic injury

Renal- nephrotic syndrome, crystalluria (kidney stones), hematuria, proteinuria

CNS effects- HA, dizziness, vertigo, depression

Bone marrow depression

Photosensitivity

Steven-Johnsons syndrome

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

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

Use with caution in children (discoloration)

Tetracycline AE

Absorption is affected by -> esophageal ulcerations

Photosensitivity

Superinfection

Dental discoloration (yellow or brown)

GI: nausea/vomiting, diarrhea

Bone marrow depression

Tetracycline DI

Increased levels of digoxin and warfarin

Tetracycline Pt. Edu

Do not take with food -> GI upset

Licosamides

Clindamycin

Clindamycin AE

GI issues

Bone marrow depression

Skin infections

Macrolides

Erythromycin

Erythromycin Uses

UTIs/ URIs

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)

Erythromycin Pt. Edu

Take on an empty stomach

Vancomycin Uses

Bactericidal -> Staphylococcal infections, Gram + pathogens, C. diff

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 for TB

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

Isoniazid CI

Renal/Hepatic failure or 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 -> drug-induced hepatitis

Isoniazid DI

Severe reactions can occur with high concentrations of tyramine

EX: aged cheeses, smoked and processed meats, fermented foods, pickled foods

Antivirals

Acyclovir -> end in -vir or -dine

Acyclovir MOA

Works by inhibiting viral DNA replication

Acyclovir AE

HA, vertigo, dizziness,

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

Anti-fungal Agents

Amphotericin B (systemic)

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

Aminoglycosides -> additional risk for nephrotoxicity

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

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

Amphotericin B Instructions

Premedicate with Tylenol and Benadryl and hydrate with other IV fluids to prevent nephrotoxicity

Labs: kidney function

Amphotericin B AE

fever, chills, HA

hypokalemia

bone marrow suppression and blood dyscrasias (anemia/ thrombocytopenia)

Antiprotozoal Agents

Metronidazole

Metronidazole Uses

Prescribed for many GYN and colon treatments

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

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