Anti-Infectives

Question 1

Amikcin, gentamicin, tobramycin (Tobrex)

Answer 1

Drug class: aminoglycosides
Purpose: Treatment of severe systemic infections of CNS, respiratory system, GI tract, urinary tract, bone, skin, and soft tissues.
Side effects: use during pregnancy can result in bilateral congenital deafness, ototoxicity, nephrotoxicity, neurotoxicity, allergic reaction, vertigo, tinnitus
Nursing Consideration:
- IV over 30 min to 1 hr; IM by deep, slow injection, never subQ
Careful monitoring of blood levels
Check peak -= 2 hours after med given
Check trough- at time of dose/prior to med
- Monitor for signs of superinfection
- Immediately report hearing or balance problesm
Encourage fluids to 8-12 glasses/day

Question 2

amoxicillin/clavulanate (Augmentin)

Answer 2

Class: aminopenicillin inhibitors
Purpose: treatment of LRI, sinus and skin infections, otitis media, pneumonia, and impetigo
Side Effects: HA, agitation, insomnia, N/V/D, increased liver enzymes, l\oliguria, vaginitis, bone marrow suppression, hypo/hyperkalemia, hypernatremia, respiratory distress
Nursing considerations:
- Shake the suspension before administering each dose
- can be mixed with drinks, give with a meal to increase absorption nd reduce GI effects
- Give at equal intervals around to the clock to maintain blood levels
- Discard unused suspension after 14 days
-Nephrotoxic with high doses

Question 3

amphotericin B (Abelcet)

Answer 3

Class: antifungals
Purpose: treatment of invasive fungal infections
Side effects: blood, kidney, heart, liver abnormalities, GI upset, hypokalemia, skin irritation and thrombosis if IV infiltrates, rash, fever, chills, malaise, hypotension, HA, nephrotoxicity, ototoxicity.
Nursing Considerations:
- Do not mix with other drugs
- Monitor Vs, report fever or change in function, especially nervous system
- Meticulous care and observation of injection site
- Potential benefits must be balanced against serious side effects

Question 4

fluconazole (Diflucan)

Answer 4

Class: antifungals
Purpose: treatment of vaginal, esophageal, and systemic candidiasis and of crytococcal meningitis
Side effects: N/D, HA, abdominal pain, hepatotoxicity
Nursing considerations:
- Prothrombin time is increased after warfarin usage
- Take missed dose ASAP, but do not double dose
- Monitor glucose levels, especially in diabetics

Question 5

hydroxychloroquine (Plaquenil)

Answer 5

Class: antimalarials
Purpose: management of lupus erythematosus, rheumatoid arthritis, and malaria
Side Effects: eye disturbances, N/V, anorexia, photosensitivity, dizziness, HA, hypotension, skin changes, ototoxicity.
Nursing considerations:
- peak 1-2 hours
- take at the same time each day to maintain blood level
- Give with meats to decrease GI distress
- For malaria, prophylaxis should be started 2 weeks before exposure and continue for 4-6 weeks after leaving exposure area

Question 6

quinine sulfate (Qualaquin)

Answer 6

Class: antimalarials
Purpose: treamtent of malaria
Side effects: 
eye distrubances, N/V, anorexia, h\tachycardia, hypotension, thrombocytopenia, tinnitus
Nurisng consideration: 
- peak 1-3 hours, 
 take at the same time each day to maintain blood level 
- may increase digoxin levels
- do not crush

Question 7

metronidazole (Flagyl)

Answer 7

Class: antiprotozoals
Purpose: treatment of a wide variety of infection including trichomoniasis, giardiasis, and bacterial vaginosis.
Side effects: HA, dizziness, N/V/D, abd cramps, metallic taste, darkened urine, depression, blurred vision, neurotoxicity
Nursing considerations:
- IV immediate onset, PO peak 1-2 hours
- Treatment of both partners is necessary in trichomoniasis
- Do not drink alcohol or preparations containing alcohol during and 48 hours after use; disulfiram-like reaction can occur.

Question 8

isoniazid (Laniazid)

Answer 8

Class: antituberculars
Purpose: treatment and prevention of tuberculosis
Side effects: peripheral neuropathy, liver damage, n/v
Nursing considerations:
- PO/IM: onset rapid, peak 1-2 hours, duration up to 24 hours
- Contact provider if signs of hepatitis
- Contact provider if signs of peripheral neuropathy: numbness, tingling, or weakness
- Monitor liver test
- Do not skip or double doses

Question 9

acyclovir (Zovirax)

Answer 9

Class: antivirals
Purpose: treatment of herpes and varicella
Side Effects:
HA, blood dyscrasias, N/V/D, thrombocytopenia purpura, nephrotoxicity, tremors, lethargy
Nursing consideration:
- IV: onset immediate, peak immediate
- PO: absorbed min, onset unknown, peak 90 min
- Do not break, crush, or chew capsules
- PO: take w/o regard to meals with a full glass of water
0 If a dose is missed, take ASAP, up to 1 hr before the next dose
- Contact provider if signs of superinfection