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NUR 326 > Antibacterial Medications > Flashcards

Antibacterial Medications Flashcards

1
Q

trimethoprim, trimethoprim/
sulfamethoxazole (Bactrim, Septra) therapeutic use

A
  • Sulfonamides
  • Trimethoprim and sulfamethoxazole work together to treat:
  • Urinary tract infections
  • Pneumocystis pneumonia
  • Shigella enteritis (shigellosis, also called traveler’s diarrhea)
  • Chronic bronchitis (acute phase)
  • Acute otitis media in children
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2
Q

trimethoprim, trimethoprim/
sulfamethoxazole (Bactrim, Septra) adverse reactions

A

GI symptoms: nausea, vomiting, anorexia
* Allergic skin reactions
* Blood cell deficiencies (thrombocytopenia, leukopenia, anemia,
agranulocytosis, aplastic anemia )
* Superinfection – Clostridium difficile-associated diarrhea (CDAD): or
Candida infections
* Severe rash, including Stevens-Johnson syndrome
* Kernicterus

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3
Q

trimethoprim, trimethoprim/
sulfamethoxazole (Bactrim, Septra) nursing interventions

A
  • Monitor for and report severe symptoms.
  • Monitor for rash and hives.
  • Monitor for and report severe diarrhea.
  • Monitor and report rash and/or blisters on skin to provider.
  • Encourage patient to drink plenty of fluids
  • Monitor I & O
  • Monitor CBCs and Urinalysis throughout treatment
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4
Q

trimethoprim, trimethoprim/
sulfamethoxazole (Bactrim, Septra) medication administration

A
  • Available as a fixed-dose combination in tablets, liquid solution, and IV
    form.
  • Give oral dose with 8 oz. of water.
  • Administer intermittent IV infusion slowly (over 60 to 90 min) and with
    recommended dilution.
  • Drink at least 1,200 to 1,500 mL water/day during treatment with this
    drug.
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5
Q

trimethoprim, trimethoprim/
sulfamethoxazole (Bactrim, Septra) client education

A
  • Report symptoms to provider.
  • Take with food to minimize GI symptoms.
  • Report rash and hives to provider.
  • Report fatigue, pallor, easy bruising, or new infections to provider.
  • Report watery or bloody diarrhea to provider.
  • Report pain in mouth, difficulty eating, or vaginal burning/discharge.
  • Report onset of rash and/or blisters on the skin to provider.
  • Warn clients that sulfonamides decrease the effectiveness of oral
    contraceptives; use alternate form of contraception.
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6
Q

trimethoprim, trimethoprim/
sulfamethoxazole (Bactrim, Septra) contraindications and precautions

A

CONTRAINDICATIONS
* Women who are pregnant or nursing
* Allergy to sulfonamides, trimethoprim, cyclooxygenase-2 inhibitors
(celecoxib [Celebrex])
* Clients with megaloblastic anemia caused by folic acid deficiency
* Children under 2 months
* Pharyngitis caused by group A beta-hemolytic streptococci
* Hyperkalemia
* Severely impaired urine creatinine clearance

PRECAUTIONS
* Decreased kidney or liver function
* Hypersensitivity to sulfites used as preservatives (wine, foods), other
drugs related to sulfonamides (acetazolamide, thiazide diuretics,
tolbutamide)
* Suppressed bone marrow
* Clients at risk for megaloblastic anemia (clients with alcoholism,
pregnant women, clients who are debilitated)

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7
Q

trimethoprim, trimethoprim/
sulfamethoxazole (Bactrim, Septra) interactions

A
  • Alcohol with the drug may cause a disulfiram-type reaction.
  • May increase effects of warfarin, phenytoin, tolbutamide (and other
    sulfonylurea oral antidiabetic drugs).
  • Taken with methotrexate, clients may have increased
    immunosuppression.
  • Reduced effectiveness of oral contraceptives (use alternative
    contraception).
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8
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) therapeutic use

A
  • Penicillins
  • Treats broad-spectrum infections caused by gram-positive cocci and
    bacilli, such as ear and throat infections and urinary tract infections.
  • Amoxicillin treats gonorrhea caused by non-penicillinase-producing
    bacteria.
  • Addition of clavulanic acid increases spectrum of disorders treated by
    amoxicillin and its ability to kill bacteria.
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9
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) adverse reactions

A
  • GI symptoms: diarrhea, nausea, vomiting
  • Rarely may cause Clostridium difficile (C. Diff) superinfection (more
    frequent with other antibiotics than amoxicillin)
  • Superinfection with Candida albicans
  • Allergy to penicillin (rash, hives, wheezing and difficulty breathing)
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10
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) nursing interventions

A
  • Monitor for GI symptoms.
  • Monitor and report bloody stools or long-term watery diarrhea.
  • Monitor for and report Candida infections of mouth or vagina.
  • Expect to treat Candida infections with an antifungal agent.
  • Ask clients if they are allergic prior to administering the first dose.
  • Monitor for allergy manifestations and notify provider.
  • For injectable penicillins (IM or IV), keep client in facility for 30 min after
    administration and monitor for allergy.
  • Prepare to treat rash/hives with antihistamines; anaphylaxis with
    epinephrine and respiratory support.
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11
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) medication administration

A
  • Client should not crush or chew extended-release form.
  • Chew chewable forms before swallowing.
  • For infants or young children, place drops directly on tongue or mix
    with a small amount of juice or formula; ensure that child takes full
    dose.
  • Give at the beginning of meals to decrease GI symptoms and increase
    absorption.
  • Give amoxicillin with probenecid, if prescribed, to increase therapeutic
    activity of amoxicillin.
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12
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) client education

A
  • Report watery or bloody diarrhea to provider.
  • Take drug at the start of meals.
  • Report mouth pain or inability to eat.
  • Report vaginal burning, itching, and discharge.
  • Stop drug and notify provider for possible allergic reactions.
  • Call 911 for severe symptoms, such as difficulty breathing.
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13
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) contraindications and precautions

A

CONTRAINDICATIONS
* Allergy to penicillins, hypersensitivity to procaine and benzathine

PRECAUTIONS
* Renal impairment may need reduced dose

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14
Q

amoxicillin (Amoxil), amoxicillin/clavulanic acid (Augmentin) interactions

A
  • Probenecid increases penicillin blood levels.
  • Bacteriostatic agents may decrease therapeutic effects.
  • Reduced effectiveness of oral contraceptives.
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15
Q

erythromycin therapeutic use

A
  • Macrolides
    First-line of treatment for:
  • Legionnaires’ disease
  • Whooping cough
  • Acute diphtheria
  • Treatment of clients who are carriers of diphtheria
  • Some Chlamydia infections
  • Certain pneumonias
  • Treats common infections for clients who have a penicillin allergy
  • Ophthalmic ointment prevents eye infections in neonates
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16
Q

erythromycin adverse reactions

A
  • GI symptoms: nausea, vomiting, abdominal pain, and diarrhea
  • Cardiac symptoms: serious ventricular dysrhythmias can result in death
  • Ototoxicity: hearing loss, vertigo, and tinnitus (able to reverse when
    treatment ends)
  • Superinfection (C. diff-associated diarrhea, candidiasis)
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17
Q

erythromycin nursing interventions

A
  • Monitor for and report GI reactions (a decrease in the dose may stop
    symptoms).
  • Monitor for concurrent use of other drugs that increase erythromycin
    blood levels.
  • Question client about history of prolonged QT.
  • Monitor for and report signs of ototoxicity.
  • Monitor for and report superinfection.
  • Monitor liver function in long-term use
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18
Q

erythromycin medication administration

A
  • Available in four forms:
  • Erythromycin base: tablets, capsules, topical, and ophthalmic ointment
  • Erythromycin stearate: tablets
  • Erythromycin ethylsuccinate (EES): tablets
  • Erythromycin lactobionate: IV form
  • Give erythromycin base and erythromycin stearate on an empty
    stomach 1 hr before or 2 hr after a meal for best absorption; give with 8
    oz. of water.
  • If GI symptoms occur, may give with food.
  • Give EES enteric-coated forms of erythromycin with or without meals.
  • For IV form, follow dilution and rate recommendations to prevent
    thrombophlebitis.
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19
Q

erythromycin client educations

A
  • Take with food if GI symptoms occur.
  • Report continuing symptoms to provider.
  • Report palpitations and fainting spells to the provider.
  • Report hearing loss, vertigo, and tinnitus to provider.
  • Report bloody or watery diarrhea.
  • Report mouth pain with white patches on the oral mucosa, or vaginal
    discomfort and discharge.
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20
Q

erythromycin contraindications and precautions

A

CONTRAINDICATIONS
* Allergy to erythromycin or other macrolide antibiotic
* History of prolonged QT syndrome
* Hypokalemia
* Hypomagnesemia

PRECAUTIONS
* GI disorders
* Liver disorders

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21
Q

erythromycin interactions

A
  • Decreases blood levels of chloramphenicol and clindamycin antibiotics.
  • Increases blood levels of multiple drugs, including digoxin, warfarin,
    and theophylline.
  • Drugs that inhibit the enzyme CYP3A4 increase erythromycin levels
    (verapamil, azole antifungals, protease inhibitors for HIV, diltiazem)
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22
Q

imipenem (Primaxin) therapeutic use

A
  • Carbapenems
  • Treats serious infections caused by multiple types of organisms
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23
Q

imipenem (Primaxin) adverse reactions

A
  • GI symptoms: nausea, vomiting (may occur if IV infusion is too rapid)
  • Thrombophlebitis at IV site
  • Possible cross-sensitivity with other antibiotics with beta-lactam ring
    (penicillins, cephalosporins)
  • Superinfection
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24
Q

imipenem (Primaxin) nursing interventions

A
  • Follow recommendation rate when infusing IV form.
  • Monitor for nausea during infusion; treat with antiemetic.
  • Monitor IV site for redness and swelling during infusion.
  • Assess for and report antibiotic allergy prior to infusing imipenem.
  • Monitor for secondary infections, such as oral candidiasis.
  • Lab testing should include AST, BUN, LDH, as well as testing for bilirubin
    and increased creatinine
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25
Q

imipenem (Primaxin) medication administration

A
  • Only available for IM or IV use.
  • IM and IV forms are not interchangeable–assure and use the correct
    form for prescription.
  • Follow recommendations for rate and dilution when infusing IV doses.
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26
Q

imipenem (Primaxin) client education

A
  • Report nausea, especially when it occurs during IV infusion.
  • Report pain, swelling, or redness at IV site.
  • Report all drug allergies to provider.
  • Report mouth pain and difficulty chewing and swallowing.
  • Report vaginal irritation and discharge.
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27
Q

imipenem (Primaxin) contraindications and precautions

A

CONTRAINDICATIONS
* Allergy to carbapenems
* Allergy to penicillin

PRECAUTIONS
* Allergy to cephalosporins
* Seizures
* Renal impairment

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28
Q

imipenem (Primaxin) interactions

A
  • Monobactam, penicillin, and cephalosporin antibiotics may decrease
    the effects of imipenem.
  • Probenecid decreases renal excretion and cyclosporine increases the
    risk for seizures.
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29
Q

tetracycline, doxycycline, minocycline therapeutic use

A
  • Tetracyclines
  • First-choice antibiotic for:
  • Chlamydia infections
  • Mycoplasmal infections
  • Rickettsial infections (such as typhus)
  • Syphilis and gram-negative infections in clients with penicillin allergy
  • Gram-positive infections (tetanus)
  • Cholera
  • Anthrax
  • Treats acne vulgaris (topical and oral forms)
30
Q

tetracycline, doxycycline, minocycline adverse reactions

A
  • GI symptoms: nausea, vomiting diarrhea, abdominal pain
  • Permanently discolors deciduous teeth of fetus (after 4th month
    gestation) and permanent teeth in young children (under 8ys old)
  • Hepatotoxicity (especially in large doses or to pregnant/postpartum
    women)
  • Superinfections (C. diff, Candida infections)
  • Photosensitivity (severe sunburn-type reaction with sun exposure)
  • Suppression of long-bone growth in premature infants
31
Q

tetracycline, doxycycline, minocycline nursing interventions

A
  • Give with non-dairy foods if symptoms occur.
  • Monitor and report GI symptoms (decreased dose can be required).
  • Determine if client could be pregnant before giving drug to women of
    childbearing age.
  • Monitor liver function tests.
  • Monitor for symptoms of liver damage.
  • Monitor for signs of superinfection.
  • Monitor for skin reaction.
  • Monitor for lymphadenopathy and facial swelling
32
Q

tetracycline, doxycycline, minocycline medication administration

A
  • Give orally on an empty stomach 1 hr before or 2 hr after meals; give
    with non-dairy food if client is unable to tolerate.
  • Do not give right before bedtime.
  • Topical form treats acne vulgaris.
  • IM and IV tetracycline are given only if oral form cannot be tolerated by
    client.
  • Shake solution well before measuring.
  • Ensure that outdated drug is not administered (causes a type of kidney
    dysfunction).
  • Another tetracycline (doxycycline [Vibramycin]) can be given more
    effectively with food and safely in clients with renal failure.
33
Q

tetracycline, doxycycline, minocycline client education

A
  • Take with non-dairy foods if GI symptoms occur.
  • Report symptoms to provider.
  • Report to provider if pregnant.
  • Giving the drug to children under the age of 8 should be avoided.
  • Report jaundice, abdominal pain, or fatigue to provider.
  • Report mouth pain and difficulty chewing or swallowing.
  • Report vaginal irritation/discharge.
  • Report watery or bloody stools.
  • Wear protective clothing and wear sunscreen for sun exposure.
34
Q

tetracycline, doxycycline, minocycline contraindications and precautions

A

CONTRAINDICATIONS
* Pregnancy risk – teratogenic
* Children younger than 8 years
* Allergy to tetracycline
* Exposure to ultraviolet light
* Serious renal or liver failure

PRECAUTIONS
* History of liver or kidney disorder

35
Q

tetracycline, doxycycline, minocycline interactions

A
  • Absorption decreased by antidiarrheals containing kaolin; supplements
    and antacids containing calcium, magnesium, or aluminum.
  • Dairy products and supplements with iron or zinc decrease absorption.
  • Tetracyclines decrease effectiveness of oral contraceptives.
36
Q

cephalexin (Keflex) therapeutic use

A
  • First generation cephalosporins
  • Cephalexin is a first-generation cephalosporin that treats infections
    caused by gram-positive cocci.
  • Subsequent generations of cephalosporins (drugs from the second to
    fifth generation) become:
  • more active against gram-negative bacteria.
  • more resistant to beta-lactamase (gram-positive) bacteria.
  • more able to penetrate cerebrospinal fluid to treat infections, such as
    meningitis.
37
Q

cephalexin (Keflex) adverse reactions

A
  • GI symptoms: diarrhea and nausea
  • Clostridium difficile-associated diarrhea (CDAD), which is rare, may be
    from a superinfection
  • Possible cross-allergy to penicillin allergy (especially for clients with a
    history of severe penicillin allergy)
  • Risk for hemorrhage with cefotetan (Cefotan) only
  • Thrombophlebitis (cephalosporins infused via IV only)
  • Cefotetan (Cefotan): disulfiram-like reaction if client takes with alcohol
38
Q

cephalexin (Keflex) nursing interventions

A
  • Monitor and report bloody stools or watery diarrhea to provider.
  • Assess for cephalosporin or penicillin allergy before giving drug; inform
    provider.
  • Prepare to treat rash/hives with antihistamines; anaphylaxis with
    epinephrine and antihistamines.
  • Monitor prothrombin and bleeding time.
  • Expect to administer vitamin K if bleeding occurs.
  • Monitor for thrombophlebitis during IV infusion; for occurrence, stop
    infusion and change IV site.
  • Follow recommendations when diluting IV cephalosporins; infuse
    slowly.
  • Inform client that a disulfiram-like reaction will occur with the
    combination of the drug and alcohol.
39
Q

cephalexin (Keflex) medication administration

A
  • Cephalexin is only available as capsules, tablets, or oral suspension.
  • Other cephalosporins may be available for oral, IM, or IV use.
  • Be careful to differentiate between cephalosporin prescriptions; generic
    names may be very similar.
40
Q

cephalexin (Keflex) client education

A
  • Take with food to decrease GI symptoms.
  • Report watery or bloody diarrhea to provider.
  • Stop drug and notify provider for possible allergic reactions.
  • Call 911 for severe symptoms, such as difficulty breathing.
  • Report unusual bruising or bleeding to provider.
  • Report burning, pain, or swelling at IV site during infusion of
    cephalosporin.
  • Inform client about the potential for nausea, vomiting, severe
    headache, and hypotension with the combination of the drug and
    alcohol.
41
Q

cephalexin (Keflex) contraindications and precautions

A

CONTRAINDICATIONS
* Allergy to cephalosporin antibiotics
* Allergy to penicillin (possible cross-sensitivity)
* Carnitine deficiency or milk protein allergy: cefditoren (Spectracef) only
* Any alcohol use causes a disulfiram-like reaction: cefotetan (Cefotan) only

PRECAUTIONS
* Renal failure
* GI disease

42
Q

cephalexin (Keflex) interactions

A
  • Probenecid causes prolonged effect of most cephalosporins
  • Alcohol or any drug that promotes bleeding: cefotetan (Cefotan) only
  • IV calcium and ceftriaxone (Rocephin) only
43
Q

vancomycin (Vancocin) therapeutic use

A
  • Vancomycin
  • Severe infections
  • Methicillin-resistant Staphylococcus aureus infections (MRSA)
  • Infections in clients with an allergy to penicillin
  • Clostridium difficile-associated diarrhea (CDAD)
44
Q

vancomycin (Vancocin) adverse reactions

A
  • Renal failure secondary to nephrotoxicity
  • Hypotension, tachycardia and flushing of the face and trunk (“red man”
    syndrome) occur with rapid IV infusion
  • Rare – ototoxicity (usually reversible)
  • Thrombophlebitis at IV site and tissue damage with IV infiltration
45
Q

vancomycin (Vancocin) nursing interventions

A
  • Administer over 1 hr by IV infusion. Follow recommendations for
    dilution.
  • Monitor vital signs during infusion.
  • Monitor vancomycin trough levels.
  • Monitor BUN and creatinine levels.
  • Assess IV infusion for redness and swelling.
  • Assure that the IV is patent during infusion.
46
Q

vancomycin (Vancocin) medication administration

A
  • Give orally for C diff infections
  • Give IV for all other infections.
  • Administer slowly IV and follow recommendations for dilution.
  • Infuse separately, if possible (incompatible in solution with many other
    IV drugs).
47
Q

vancomycin (Vancocin) client education

A
  • Report flushing and feelings of faintness during IV infusion.
  • Instruct clients to report tinnitus or perceived loss of hearing.
  • Instruct clients to report an increase or decrease in urine output.
  • Report pain, swelling, and redness at IV site immediately.
  • Report vertigo
48
Q

vancomycin (Vancocin) contraindications and precautions

A

CONTRAINDICATIONS
* Allergy to vancomycin
* Hypersensitivity

PRECAUTIONS
* Renal insufficiency (reduce dosage)
* Impaired hearing
* Colitis

49
Q

vancomycin (Vancocin) interactions

A
  • Drugs that are toxic to hearing or kidney increase the risk for ototoxicity
    or nephrotoxicity.
  • Vancomycin is incompatible in a solution with multiple other IV drugs.
50
Q

ciprofloxacin (Cipro) therapeutic use

A
  • Fluoroquinolones
  • Treats a wide range of bacterial infections, including severe urinary
    tract disorders.
  • Prevents anthrax (following inhalation of anthrax spores) in both adults
    and children.
51
Q

ciprofloxacin (Cipro) adverse reactions

A
  • Mild CNS symptoms (dizziness, headache; confusion in older clients)
  • GI symptoms (nausea, vomiting, diarrhea)
  • Achilles tendon rupture (rare), especially in older clients, and clients
    taking glucocorticoids, and transplant recipients
  • Photosensitivity (sunburn-like reaction) even with indirect sun
    exposure, sunlamp exposure; may occur despite use of sunscreen
  • Severe adverse reactions include seizures, intracranial pressure,
    suicidal ideation, hepatotoxicity, anaphylaxis, and Clostridium difficile associated diarrhea (CDAD)
52
Q

ciprofloxacin (Cipro) nursing interventions

A
  • Monitor for and report GI symptoms (a decrease in the dose may need
    to occur).
  • Monitor for and report tendon pain during treatment (discontinue if
    pain occurs).
  • Don’t allow clients to go outdoors without covering their skin with
    clothing. They also need to apply sunscreen to areas of exposure.
53
Q

ciprofloxacin (Cipro) medication administration

A
  • Available in oral and IV forms.
  • IV:
    • Infuse slowly over at least 60 min; follow recommendations for dilution.
    • Incompatible with multiple other drugs in IV solution or IV tubing.
54
Q

ciprofloxacin (Cipro) client education

A
  • Report CNS symptoms to provider.
  • Decrease caffeine use during treatment.
  • Report GI symptoms to provider.
  • Report tendon pain to provider.
  • Avoid exposure to sunlight or sunlamp.
  • Wear clothes that fully cover the body and apply sunscreen to
    remaining areas of exposure.
  • Take antacids, iron, calcium, dairy products, and sucralfate 2 hr after or
    6 hr before oral ciprofloxacin.
  • Encourage patients to drink at least 1,500 to 2,000 mL of fluids/day
55
Q

ciprofloxacin (Cipro) contraindications and precautions

A

CONTRAINDICATIONS
* Allergy to any fluoroquinolone
* Tendon pain
* Myasthenia gravis

PRECAUTIONS
* Serious CNS disorders (seizure disorder)
* GI disorders
* Renal impairment
* Coumadin therapy
* Children under 18
* Pregnancy risk

56
Q

ciprofloxacin (Cipro) interactions

A
  • Antacids, iron preparations, calcium (including dairy products), and
    sucralfate (Carafate) decrease oral absorption.
  • Increases theophylline levels and the risk for CNS symptoms.
  • Increases warfarin (Coumadin) levels.
  • Concurrent use of erythromycin, quinidine, some antipsychotics, and
    tricyclic antidepressants can increase the risk for torsade de pointes in
    those susceptible.
  • Increased hypoglycemia may occur when taken concurrently with
    antidiabetic medication.
57
Q

gentamicin therapeutic use

A
  • Aminoglycosides
  • Gram-negative aerobic bacilli severe infections (all aminoglycosides).
  • Gentamicin (in combination with another antibiotic) treats severe
    infections that some gram-positive cocci cause.
  • Topical form for skin and eye infections.
58
Q

gentamicin adverse reactions

A
  • Elevated trough levels of drug (early signs include tinnitus, headache,
    and vertigo) can cause ototoxicity
  • Nephrotoxicity (polyuria, dilute urine, protein and casts in urine,
    elevated BUN, creatinine)
  • Ataxia (poor muscle control that causes clumsy voluntary movements)
59
Q

gentamicin nursing interventions

A
  • Monitor for and report tinnitus and other symptoms of early
    ototoxicity.
  • Monitor peak and trough blood levels.
  • Monitor laboratory values (BUN, creatinine, urine for protein and casts)
    and report elevations.
  • Evaluation of eighth cranial nerve with audiometry
  • Monitor I&O
60
Q

gentamicin medication administration

A
  • Available in topical, ophthalmic, IM/IV, and intrathecal forms
  • Ophthalmic drops
    • Gently press the inner canthus for 1 to 2 min after instilling drops to prevent systemic absorption.
    • Instruct the client to keep eyes shut for 1-2 min to maximize local absorption.
  • Topical cream
    • Don’t apply it to large skin areas.
    • There is a risk for toxicity with systemic absorption.
  • IM: Inject it deeply into a large muscle.
  • IV: Give it as an intermittent infusion, using recommendations for rate and dilution.
  • Intrathecal: Use a preservative-free form for intrathecal; discard portions you didn’t use.
61
Q

gentamicin client education

A
  • Report onset of tinnitus, headache, vertigo, or hearing loss to provider.
  • Report an increase in the output of dilute urine to provider.
62
Q

gentamicin contraindications and precautions

A

CONTRAINDICATIONS
* Allergy to any aminoglycoside
* Pregnancy risk – teratogenic

PRECAUTIONS
* Prior damage to acoustic nerve causes increased risk of hearing loss
* Presence of tinnitus or vertigo
* Renal disorders
* Chronic neuromuscular disorders
* Dehydration

63
Q

gentamicin interactions

A
  • Other ototoxic drugs increase the risk for ototoxicity.
  • Amphotericin B (Fungizone), NSAIDS, or other nephrotoxic drugs
    increase the risk for nephrotoxicity.
  • Cephalosporins, vancomycin, and penicillin enhance the bactericidal
    effect of gentamicin.
  • Don’t mix multiple drugs in the same IV solution with gentamicin
    (penicillin, cephalosporins, heparin).
  • Can prolong respiratory paralysis in combination with neuromuscular
    blockers (pancuronium, succinylcholine [Anectine]).
64
Q

nitrofurantoin (Macrodantin) therapeutic use

A
  • Urinary tract antiseptic
  • Treatment and prevention of UTIs.
65
Q

nitrofurantoin (Macrodantin) adverse reactions

A
  • GI symptoms: nausea/vomiting and diarrhea
  • Respiratory symptoms:
    * Acute: chills/fever, cough, lasts 2 to 4 days
    * Subacute: cough, shortness of breath, lasts weeks to months and may be permanent
  • Permanent peripheral neuropathy (commonly in clients with impaired
    renal function)
  • Blood cell dysfunction (anemia, including hemolytic anemia,
    thrombocytopenia, neutropenia)
  • Tooth staining caused by contact with liquid suspension
  • Urine may also appear brownish (harmless side effect)
  • Dizziness, drowsiness, headache, and photosensitivity
  • Pulmonary distress
66
Q

nitrofurantoin (Macrodantin) nursing interventions

A
  • Monitor and report GI symptoms (dose may be reduced or form of drug
    may be changed to minimize symptoms).
  • Monitor and report respiratory symptoms (drug will be discontinued).
  • Monitor for and report symptoms of neuropathy.
  • Monitor laboratory values of blood components.
  • Do not crush capsules; dilute suspension in milk or juice before
    administration; have client rinse mouth if taking suspension.
  • Monitor I & O as well as bowel function
67
Q

nitrofurantoin (Macrodantin) medication administration

A
  • Available in oral capsules (Macrodantin and Macrobid) and liquid
    suspension (Furadantin).
  • Have client swallow capsules whole.
  • Dilute liquid suspension and have client rinse mouth after taking.
68
Q

nitrofurantoin (Macrodantin) client education

A
  • Take with food or milk.
  • Report acute or subacute respiratory symptoms, such as dyspnea,
    fever, or cough to the provider.
  • Report numbness, tingling, and weakness of the extremities.
  • Report fatigue, easy bruising, or repeated infections to provider.
  • Swallow capsules whole.
  • Dilute liquid suspension.
  • Rinse mouth after taking suspension.
69
Q

nitrofurantoin (Macrodantin) contraindications and precautions

A

CONTRAINDICATIONS
* Allergy to nitrofurantoin
* Impaired kidney function (with low urine creatinine clearance levels)
* History of jaundice caused by gallbladder disease
* Pregnancy at more than 38 weeks’ gestation
* During labor or delivery, lactating
* Infants less than 1 month

PRECAUTIONS
* Asthma or other respiratory disorders
* Liver disorders
* Kidney disorder that does not affect creatinine clearance
* Electrolyte imbalance
* Vitamin B12 deficiency

70
Q

nitrofurantoin (Macrodantin) interactions

A
  • Concurrent use with antacids will decrease absorption.
  • Probenecid increases the chance of toxicity.
  • Avoid use with drugs with the potential for pulmonary toxicity.

NUR 326 (27 decks)

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