Ch. 39 Antibiotics Part 2.Pg. 614-628

Here’s a digestible summary of Chapter 39: Antibiotics Part 2, covering key points, mechanisms, indications, adverse effects, and nursing considerations for these important antibiotics.

🔹 Overview of Antibiotics Part 2

This chapter focuses on more potent antibiotics used to treat serious or drug-resistant infections. Most are parenteral (IV/IM) antibiotics due to their stronger effect and need for close monitoring. The chapter also addresses multidrug-resistant organisms (MDROs) such as MRSA, VRE, ESBLs, and CROs.

🔹 Multidrug-Resistant Organisms (MDROs)

💡 Nursing Action: Strict isolation precautions, hand hygiene, and judicious antibiotic use are essential to prevent spread.

🔹 Key Antibiotic Classes in Chapter 39

🔹 Drug Profiles & Nursing Considerations

1⃣ Aminoglycosides (Gentamicin, Tobramycin, Amikacin, Neomycin)

✔ Used for: Severe gram-negative infections (Pseudomonas, E. coli, Klebsiella)
✔ Route: Mostly IV/IM, except neomycin (oral/topical)
✔ Major Risks: Ototoxicity (hearing loss) & Nephrotoxicity (kidney damage)
✔ Nursing Considerations:

• Monitor drug levels (peak & trough to prevent toxicity).

• Assess hearing & renal function (BUN, creatinine).

• Increase fluid intake to flush out nephrotoxic effects.

2⃣ Fluoroquinolones (Ciprofloxacin, Levofloxacin)

✔ Used for: UTIs, pneumonia, skin infections, anthrax
✔ Route: IV/PO
✔ Major Risks:

• Tendon rupture (Black Box Warning)

• QT prolongation (arrhythmias)

• CNS effects (dizziness, headache, confusion) ✔ Nursing Considerations:

• Avoid dairy, calcium, antacids (reduce absorption).

• Monitor ECG in cardiac patients.

• Caution in elderly due to CNS effects.

3⃣ Clindamycin

✔ Used for: Anaerobic infections, bone infections, sepsis
✔ Major Risks: C. difficile colitis (Black Box Warning)
✔ Nursing Considerations:

• Monitor for diarrhea (possible C. difficile infection).

• Encourage probiotics to reduce GI side effects.

• Avoid in patients with bowel disease (Crohn’s, colitis).

4⃣ Metronidazole (Flagyl)

✔ Used for: C. difficile, anaerobic infections, STDs
✔ Major Risks:

• Metallic taste

• Disulfiram reaction (severe vomiting with alcohol) ✔ Nursing Considerations:

• Avoid alcohol for at least 48 hours after last dose.

• Monitor liver function.

• Watch for neuropathy with long-term use.

5⃣ Nitrofurantoin (Macrobid)

✔ Used for: Uncomplicated UTIs
✔ Major Risks:

• Pulmonary fibrosis with long-term use

• GI upset ✔ Nursing Considerations:

• Take with food to reduce GI upset.

• Avoid in renal failure (CrCl <60 mL/min).

• Urine may turn brown—this is normal!

6⃣ Vancomycin

✔ Used for: MRSA, C. difficile (oral form)
✔ Major Risks:

• Nephrotoxicity (kidney damage)

• Ototoxicity (hearing loss)

• Red Man Syndrome (if infused too fast) ✔ Nursing Considerations:

• Monitor trough levels before next dose.

• Infuse over ≥60 minutes to prevent Red Man Syndrome.

• Check renal function (BUN, creatinine).

7⃣ Daptomycin

✔ Used for: VRE, MRSA skin infections
✔ Major Risks: Myopathy, rhabdomyolysis
✔ Nursing Considerations:

• Monitor CK levels (watch for muscle pain).

• Avoid statins (increases muscle toxicity).

🔹 Key Nursing Actions for ALL Antibiotics

✔ Assess for allergies (especially penicillin & cephalosporin cross-sensitivity).
✔ Monitor WBC count & symptoms of infection (fever, redness, swelling).
✔ Teach about completing the full antibiotic course to prevent resistance.
✔ Watch for superinfections (C. difficile, oral thrush, vaginal yeast infections).
✔ Adjust doses for renal impairment (aminoglycosides, vancomycin, fluoroquinolones).
✔ Monitor for common side effects: nausea, diarrhea, rash, dizziness.

🔹 Summary

This chapter focuses on powerful antibiotics for severe infections. Multidrug-resistant organisms (MDROs) like MRSA, VRE, ESBLs, and CROs require stronger, often IV-only antibiotics. Aminoglycosides, fluoroquinolones, vancomycin, and metronidazole require careful monitoring for toxicity & interactions.

Here's a digestible breakdown of Aminoglycosides & Resistant Infections, covering key points, drug mechanisms, indications, adverse effects, and nursing considerations.

🔹 Multidrug-Resistant Organisms (MDROs) & Their Treatment

Multidrug-resistant organisms (MDROs) are bacteria resistant to one or more classes of antibiotics, making infections difficult to treat. These include MRSA, VRE, ESBLs, and CROs.

💡 Key Nursing Considerations:

• Strict isolation precautions to prevent hospital-acquired infections.

• Proper hand hygiene before & after patient contact.

• Monitor cultures & susceptibility reports for correct antibiotic use.

🔹 Aminoglycosides

Aminoglycosides are potent, bactericidal antibiotics used for severe gram-negative infections. Due to their toxicity, they are reserved for serious infections and require therapeutic drug monitoring.

✔ Common Aminoglycosides:

• Gentamicin

• Tobramycin

• Amikacin

• Neomycin (only oral/topical)

✔ Mechanism of Action:

• Binds to 30S ribosomes, inhibiting bacterial protein synthesis.

• Causes bacterial cell death (bactericidal).

• Works synergistically with beta-lactams (penicillins & cephalosporins).

✔ Indications:

• Serious gram-negative infections (Pseudomonas, E. coli, Klebsiella).

• UTIs, pneumonia, sepsis.

• Endocarditis (in combination with beta-lactams).

• Pre-op bowel prep (Neomycin).

✔ Routes of Administration:

• IV/IM (Most common for systemic infections).

• Inhalation (Tobramycin for lung infections like cystic fibrosis).

• Oral (Neomycin only for gut decontamination).

🔹 Therapeutic Drug Monitoring

Due to nephrotoxicity (kidney damage) and ototoxicity (hearing loss), serum drug levels must be monitored.

✔ Peak Level: 30-60 mins after IV infusion (not always required for once-daily dosing).
✔ Trough Level: Right before next dose (ensures drug is clearing properly).
✔ Toxicity Risk: Trough levels >2 mcg/mL increase nephrotoxicity & ototoxicity.

💡 Key Nursing Actions:

• Monitor renal function (BUN, creatinine).

• Assess for hearing loss & balance issues (ototoxicity).

• Ensure proper dosing based on renal function.

🔹 Adverse Effects

Who is at highest risk?

• Renal impairment (pre-existing kidney disease).

• Older adults.

• High-dose or long-term therapy.

• Concurrent use of nephrotoxic drugs (vancomycin, amphotericin B, NSAIDs).

🔹 Key Drug Interactions

💡 Nursing Tip: Avoid aminoglycosides in patients on loop diuretics to prevent hearing loss!

🔹 Nursing Considerations

✔ Monitor for toxicity:

• Daily renal labs (BUN, creatinine).

• Hearing tests if long-term therapy.

• Assess for dizziness & tinnitus.

✔ Adjust dosing for renal function:

• High creatinine? Lower dose or extend dosing interval.

✔ Ensure proper administration:

• Give beta-lactams (penicillins, cephalosporins) FIRST to help aminoglycosides penetrate bacteria.

• Do NOT mix aminoglycosides & beta-lactams in the same IV (they inactivate each other!).

✔ Teach patients:

• Report hearing changes immediately.

• Increase fluid intake to protect kidneys.

• Complete full course of therapy to prevent resistance.

🔹 Summary

🔸 Aminoglycosides are potent antibiotics used for severe infections but require careful monitoring due to nephrotoxicity & ototoxicity.
🔸 MRSA, VRE, ESBLs, & CROs are major health threats, requiring special antibiotic treatment.
🔸 Therapeutic drug monitoring (peak & trough) is essential to prevent toxicity.
🔸 Beta-lactams (penicillins/cephalosporins) should be given before aminoglycosides for best effect.
🔸 Monitor kidney function, hearing, and drug interactions closely.

Here’s a digestible breakdown of Aminoglycosides, Quinolones, and Miscellaneous Antibiotics, including mechanisms, indications, adverse effects, and nursing considerations for quick learning.

🔹 Aminoglycosides

Overview

Aminoglycosides are potent, bactericidal antibiotics used to treat serious gram-negative infections. Due to poor oral absorption, they are primarily IV, IM, or inhaled. Neomycin is the only one given orally or topically.

✔ Common Aminoglycosides & Uses

✔ Mechanism of Action

• Inhibits bacterial protein synthesis by binding to 30S ribosomal subunit.

• Bactericidal effect → Kills bacteria rather than just inhibiting growth.

• Works synergistically with beta-lactams (penicillins, cephalosporins, carbapenems).

✔ Key Nursing Considerations

• Therapeutic Drug Monitoring (TDM) required due to toxicity risk.

• Check renal function (BUN, creatinine) & hearing regularly.

• Avoid concurrent use with nephrotoxic/ototoxic drugs (vancomycin, loop diuretics).

• Ensure proper peak & trough levels for IV administration.

⚠ Adverse Effects

🔹 Quinolones (Fluoroquinolones)

Overview

Quinolones are broad-spectrum, bactericidal antibiotics that disrupt bacterial DNA replication.
They are used for respiratory, urinary, skin, GI, and bone infections.

✔ Common Quinolones & Uses

✔ Mechanism of Action

• Inhibits bacterial DNA replication by blocking DNA gyrase & topoisomerase IV.

• Bactericidal effect → Kills bacteria directly.

✔ Key Nursing Considerations

• Avoid in pregnancy & children (affects cartilage development).

• Monitor ECG for QT prolongation (especially with amiodarone or disopyramide).

• Separate from antacids, calcium, iron, zinc (reduces absorption).

• Do not take with dairy (reduces effectiveness).

• Administer IV over 1-1.5 hours to prevent adverse effects.

⚠ Black Box Warnings

1. Tendonitis & tendon rupture (especially in older adults, renal disease, or glucocorticoid use).

2. CNS effects (seizures, confusion, hallucinations).

3. Peripheral neuropathy.

4. Exacerbation of myasthenia gravis.

5. Aortic rupture risk.

⚠ Adverse Effects

⚠ Drug Interactions

🔹 Miscellaneous Antibiotics

These antibiotics don’t fit into standard categories but are important for specific infections.

✔ Common Miscellaneous Antibiotics & Uses

🔹 Nursing Considerations for Miscellaneous Antibiotics

🔹 Summary of Key Points

✅ Aminoglycosides: Used for severe gram-negative infections, require therapeutic drug monitoring, and can cause nephrotoxicity & ototoxicity.
✅ Quinolones: Broad-spectrum, treat UTIs, respiratory, and skin infections, but increase risk of tendon rupture, CNS effects, and QT prolongation.
✅ Miscellaneous antibiotics: Include clindamycin, metronidazole, nitrofurantoin, vancomycin, and linezolid, each with unique indications and adverse effects.
✅ Nursing priorities: Monitor renal function, hearing, ECG, drug interactions, and signs of C. difficile infection.

Here’s a concise and structured breakdown of Clindamycin, Colistimethate, Daptomycin, Linezolid, Metronidazole, Nitrofurantoin, Quinupristin-Dalfopristin, Telavancin, and Vancomycin, covering their uses, mechanisms, adverse effects, and nursing considerations for easy learning.

🔹 Miscellaneous Antibiotics

These drugs do not belong to major antibiotic classes but are important for specific infections.

Clindamycin (Cleocin)

✅ Indications:

• Anaerobic infections (gut, pelvic infections, lung abscess)

• Chronic bone infections

• Skin & soft tissue infections (Staph & Strep)

• Streptococcal pharyngitis (penicillin allergy)

✅ Mechanism:

• Inhibits bacterial protein synthesis (50S ribosome binding).

• Bactericidal or bacteriostatic, depending on drug concentration.

✅ Key Nursing Considerations:

• Monitor for C. difficile infection (high risk of pseudomembranous colitis).

• Avoid in ulcerative colitis & infants <1 month.

• Watch for neuromuscular blockade with muscle relaxants (may enhance respiratory depression).

⚠ Adverse Effects:

Colistimethate (Colistin)

✅ Indications:

• Carbapenem-resistant infections (CRO)

• Serious gram-negative infections (Pseudomonas, Acinetobacter)

✅ Mechanism:

• Disrupts bacterial membranes, leading to cell death.

✅ Key Nursing Considerations:

• High risk of nephrotoxicity & neurotoxicity.

• Can cause acute respiratory failure if inhaled.

• Monitor for paresthesia, dizziness, & vertigo.

⚠ Adverse Effects:

Daptomycin (Cubicin)

✅ Indications:

• MRSA & VRE infections (skin, bloodstream infections)

• Alternative for vancomycin-resistant infections

✅ Mechanism:

• Binds to bacterial membranes, causing cell death.

• Bactericidal.

✅ Key Nursing Considerations:

• Do NOT use for pneumonia (inactivated by lung surfactant).

• Monitor Creatine Phosphokinase (CPK) (risk of myopathy).

• Caution with statins (risk of rhabdomyolysis).

⚠ Adverse Effects:

Linezolid (Zyvox)

✅ Indications:

• MRSA & VRE infections

• Pneumonia & skin infections (Gram-positive only)

✅ Mechanism:

• Inhibits bacterial protein synthesis (50S ribosome).

• Bacteriostatic.

✅ Key Nursing Considerations:

• Risk of serotonin syndrome with SSRIs (watch for fever, tremors, confusion).

• Avoid tyramine-rich foods (aged cheese, wine, soy sauce → hypertensive crisis).

• Monitor platelet count (can cause thrombocytopenia).

⚠ Adverse Effects:

Metronidazole (Flagyl)

✅ Indications:

• C. difficile (2nd-line)

• Anaerobic infections (intra-abdominal, pelvic infections)

• Protozoal infections (Trichomoniasis, Giardia, Amebiasis)

✅ Mechanism:

• Disrupts bacterial DNA synthesis.

• Bactericidal.

✅ Key Nursing Considerations:

• Avoid alcohol (disulfiram reaction: nausea, vomiting, flushing, headache).

• Can cause metallic taste & dark urine (harmless but alarming to patients).

• Monitor for neurotoxicity (seizures, neuropathy).

⚠ Adverse Effects:

Nitrofurantoin (Macrobid)

✅ Indications:

• Uncomplicated UTIs (E. coli, S. aureus, Klebsiella)

✅ Mechanism:

• Disrupts bacterial cell wall & metabolism.

• Bactericidal in urine.

✅ Key Nursing Considerations:

• Contraindicated in renal failure (CrCl <30) (drug concentrates in urine).

• Can cause pulmonary toxicity with long-term use.

• May turn urine dark brown (harmless).

⚠ Adverse Effects:

Quinupristin-Dalfopristin (Synercid)

✅ Indications:

• VRE infections

• Complicated skin infections (MRSA, Streptococcus)

✅ Mechanism:

• Inhibits bacterial protein synthesis.

• Bactericidal.

✅ Key Nursing Considerations:

• High risk of phlebitis & infusion reactions (use central line).

• Monitor for myalgia & arthralgia (common side effects).

⚠ Adverse Effects:

Telavancin (Vibativ)

✅ Indications:

• MRSA skin infections & pneumonia

✅ Mechanism:

• Inhibits bacterial cell wall synthesis.

• Bactericidal.

✅ Key Nursing Considerations:

• Avoid in pregnancy.

• Monitor renal function (nephrotoxic).

• Risk of QT prolongation.

⚠ Adverse Effects:

Vancomycin (Vancocin)

✅ Indications:

• MRSA (IV)

• C. difficile (oral)

✅ Mechanism:

• Inhibits bacterial cell wall synthesis.

• Bactericidal.

✅ Key Nursing Considerations:

• Monitor trough levels (10-20 mcg/mL).

• Infuse over 60 min to prevent Red Man Syndrome.

• Monitor for nephrotoxicity & ototoxicity.

⚠ Adverse Effects:

It looks like you're working through a comprehensive nursing process framework for antibiotic therapy—assessment, planning, implementation, and evaluation. Here's a structured breakdown to help you organize the critical points.

Nursing Process for Antibiotic Therapy

This process ensures safe and effective use of antibiotics, minimizing adverse effects, toxicity, and resistance.

1⃣ Assessment 🩺

(Before and during antibiotic therapy, assess the following:)

🔹 General Assessment for All Antibiotics

✅ Allergy History

• Past reactions to antibiotics (e.g., rash, hives, anaphylaxis).

• Cross-sensitivity (e.g., penicillin & cephalosporins).

✅ Infection Status

• Signs of infection: fever, WBC count, local signs (redness, swelling, drainage).

• Culture & Sensitivity (C&S): Always collect before starting antibiotics.

✅ Organ Function Monitoring

✅ Superinfection Risk

• Yeast overgrowth (oral thrush, vaginal infections).

• C. difficile risk (severe diarrhea with clindamycin, cephalosporins, fluoroquinolones).

✅ Medication & Interaction Screening

• Warfarin: Many antibiotics (e.g., macrolides, fluoroquinolones) ↑ INR (bleeding risk).

• Oral contraceptives: Rifampin ↓ effectiveness.

• Nephrotoxic Drugs: Aminoglycosides + vancomycin + NSAIDs → renal failure.

• CNS Effects: Fluoroquinolones → seizures, neuropathy risk.

✅ Age-Related Concerns

• Neonates & Elderly: ↓ renal clearance → adjust doses for aminoglycosides, vancomycin.

• Children: Tetracyclines cause permanent tooth discoloration (avoid <8 years).

2⃣ Planning: Goals & Outcomes 🎯

✅ Goals of Antibiotic Therapy

1. Infection resolves (↓ fever, WBC normalizes, symptoms improve).

2. No adverse effects (no nephrotoxicity, ototoxicity, or C. diff).

3. Therapeutic drug levels maintained (e.g., vancomycin troughs, aminoglycoside peaks/troughs).

4. Patient adheres to full antibiotic course (prevents resistance).

5. No drug interactions affecting effectiveness or causing harm.

3⃣ Implementation: Nursing Interventions 💉

🔹 General Administration Guidelines

✅ Ensure proper drug timing & administration:

• Fluoroquinolones: Separate from antacids, iron, dairy (↓ absorption).

• Macrolides (azithromycin, erythromycin): Take without food for best absorption.

• Tetracyclines: Avoid dairy, calcium, iron (chelation reduces absorption).

• Sulfonamides & Nitrofurantoin: Encourage hydration (prevent crystalluria).

• Vancomycin & Aminoglycosides: Monitor trough levels (prevent toxicity).

• Metronidazole (Flagyl): Avoid alcohol (severe vomiting, flushing).

✅ Monitor for adverse effects

• Allergic reaction? Stop the drug immediately, administer epinephrine if anaphylaxis occurs.

• Infusion reactions (e.g., Red Man Syndrome with vancomycin) → slow infusion.

• Monitor kidney function (BUN/creatinine) for nephrotoxic drugs.

• Check ECG if using drugs with QT prolongation risk.

✅ Teach patients about side effects & adherence:

• Complete full course (prevents resistance).

• Report any severe diarrhea (C. diff risk).

• Use additional contraception if on Rifampin.

• Avoid direct sun exposure (Tetracyclines & Fluoroquinolones cause photosensitivity).

✅ Infection Control Measures:

• Hand hygiene to prevent the spread of MRSA, VRE, ESBL, and CRO.

• Use PPE & contact precautions for multidrug-resistant organisms.

4⃣ Evaluation: Is the Antibiotic Working? ✅

🔹 Monitor for Therapeutic Effectiveness

✅ Clinical Signs of Improvement:

• ↓ Fever

• ↓ WBC count

• ↓ Drainage, redness, swelling

• Improved appetite, energy, & wound healing

✅ Negative Indicators (Complications):

• Persistent fever after 48 hours? → Possible resistance or wrong antibiotic.

• New diarrhea, oral thrush, vaginal discharge? → Superinfection.

• Hearing loss, dizziness, tinnitus? → Aminoglycoside/Vancomycin ototoxicity.

• Kidney function worsening? → Nephrotoxicity risk (↑ Creatinine, BUN).

✅ Lab Monitoring

📝 Summary: Key Takeaways

✅ Assessment: Check infection status, allergies, organ function, drug interactions.
✅ Planning: Ensure infection control, therapeutic monitoring, prevention of adverse effects.
✅ Implementation: Administer correctly, monitor for reactions, educate patients.
✅ Evaluation: Is the patient improving? Are there signs of toxicity or superinfection?

Case Study: Patient-Centered Care - Vancomycin

1⃣ What will you assess before starting the vancomycin infusion?

✅ Renal Function: Check BUN, creatinine, GFR to assess for nephrotoxicity risk.
✅ Hearing Status: Baseline audiometry test (risk for ototoxicity).
✅ Trough Level: If ordered, confirm vancomycin trough level before the next dose (should be 10-20 mcg/mL).
✅ Vital Signs: Monitor for baseline BP, HR, temperature before administration.
✅ Allergies: Check for previous reactions to vancomycin or glycopeptide antibiotics.
✅ Infusion Site: Assess IV site for redness, swelling, or phlebitis before starting infusion.

2⃣ Two days later, Mr. M complains of feeling “hot” in his face and neck, and itching in those areas. His face and neck are flushed. What do you suspect is happening?

✅ "Red Man Syndrome" – A histamine reaction due to rapid infusion of vancomycin.
➡ Symptoms: Flushing, itching, rash (face, neck, upper trunk), hypotension, tachycardia.
➡ This is NOT an allergic reaction but an infusion-related reaction.

🩺 Nursing Actions:
✅ Stop the infusion temporarily.
✅ Administer antihistamines (e.g., diphenhydramine).
✅ Restart infusion at a slower rate (over ≥90 minutes).

3⃣ What can you do to minimize complications during vancomycin infusions?

✅ Infuse vancomycin slowly (at least 60-90 minutes per dose).
✅ Monitor for "Red Man Syndrome" and premedicate with antihistamines if needed.
✅ Ensure adequate hydration (2L fluids/day) to prevent nephrotoxicity.
✅ Assess IV site frequently for phlebitis or extravasation.
✅ Monitor renal function (BUN, creatinine) and hearing changes.

4⃣ The physician orders measurement of vancomycin blood levels. What is the therapeutic goal when vancomycin levels are monitored?

✅ Trough Level Goal: 10-20 mcg/mL

• Mild infections (UTI, cellulitis): 10-15 mcg/mL

• Severe infections (MRSA, pneumonia, osteomyelitis): 15-20 mcg/mL
  ➡ If levels > 20 mcg/mL, risk of nephrotoxicity & ototoxicity increases.

5⃣ What is the single best action you can take to prevent the spread of Mr. M’s MRSA infection?

✅ Strict Hand Hygiene 🖐
➡ Before & after patient contact to prevent the spread of MRSA.
✅ Implement Contact Precautions (gown, gloves, dedicated equipment).
✅ Educate the patient & staff on infection control measures.

🔹 Review Questions & Answers

1. While assessing a woman who is receiving quinolone therapy for pneumonia, the nurse notices that the patient has a history of heart problems. The nurse will monitor for which potential cardiac effect of quinolone therapy?

✅ D. Prolonged QT interval (risk of arrhythmias)

2. A patient is receiving intravenous linezolid as part of treatment for an infected leg ulcer. The nurse will watch for which possible drug interactions with linezolid?

✅ B. SSRI antidepressant (risk of serotonin syndrome)
✅ D. Vasopressor (risk of hypertension)

3. When administering vancomycin, the nurse knows that which of these is most important to assess before giving the medication?

✅ A. Renal function (to prevent nephrotoxicity)

4. During therapy with an IV aminoglycoside, the patient says, “I’m hearing some odd sounds, like ringing, in my ears.” What is the nurse’s priority action?

✅ D. Stop the infusion immediately (sign of ototoxicity)

5. When giving IV quinolones, the nurse needs to keep in mind that these drugs may have serious interactions with which drugs?

✅ C. Oral anticoagulants (risk of bleeding)

6. The nurse is administering an IV aminoglycoside to a post-GI surgery patient. Which measures are appropriate?

✅ C. Monitor serum creatinine levels.
✅ D. Instruct the patient to report dizziness or ear fullness.

7. The order reads: “Give vancomycin, 1250 mg in 250 mL NS, IVPB every 12 hours. Infuse over 90 minutes.” What is the infusion pump setting?

✅ 250 mL ÷ 1.5 hours = 167 mL/hr

8. A patient has been receiving aminoglycoside tobramycin, and the nurse notes that the latest trough level is 3 mcg/mL. The next dose is due now. What is the nurse’s priority action?

✅ B. Hold the drug and notify the prescriber. (Trough > 2 mcg/mL = toxicity risk)

💡 Key Takeaways

• Monitor vancomycin trough levels (Goal: 10-20 mcg/mL).

• Infuse vancomycin over 60-90 minutes to prevent Red Man Syndrome.

• Check renal function & hearing before/during aminoglycoside or vancomycin therapy.

• Prevent MRSA spread with strict hand hygiene & contact precautions.

• Educate patients on completing antibiotics, avoiding alcohol (metronidazole), and drug interactions.