Antibiotics Flashcards
Amoxicillin
Functional Classification
Antiinfective, antiulcer
Amoxicillin
Mechanism of Action
Interferes with cell wall replication of susceptible organisms; the cell wall, rendered osmotically unstable, swells and bursts from osmotic pressure; bactericidal: lysis mediated by bacterial cell wall autolysins
Amoxicillin
Uses
Treatment of skin, respiratory, GI, GU infections, otitis media, gonorrhea; for gram-positive cocci (Staphylococcus aureus, Streptococcus pyogenes, Streptococcus faecalis, Streptococcus pneumoniae), gram-negative cocci (Neisseria gonorrhoeae, Neisseria meningitidis), gram-positive bacilli (Corynebacterium diphtheriae, Listeria monocytogenes), gram-negative bacilli (Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Salmonella); Beta-lactase-negative organisms; prophylaxis of bacterial endocarditis; in combination with other products for treatment of Helicobacter pylori
Amoxicillin
Contraindications
Hypersensitivity to penicillins
Amoxicillin
Side Effects
CNS: headache, SEIZURES, agitation, confusion, dizziness, insomnia
GI: Nausea, Vomiting, Diarrhea, increased AST, ALT, abdominal pain, glossitis, colitis, PSEUDOMEMBRANOUS COLITIS, jaundice, cholestasis
HEMA: anemia, increased bleeding time, BONE MARROW DEPRESSION, GRANULOCYTOPENIA, HEMOLYTIC ANEMIA
INTEG: Urticaria, Rash
SYST: ANAPHYLAXIS, RESPIRATORY DISTRESS, SERUM SICKNESS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, EXFOLIATIVE DERMATITIS
Amoxicillin
Nursing Considerations
ASSESS:
- I&O ratio; report hematuria, oliguria because penicillin in high doses is nephrotoxic
- Hepatic studies: AST, ALT
- Blood studies: WBC, RBC, Hgb, Hct, bleeding time
- Renal studies: urinalysis, protein, blood, BUN, creatinine
- C&S before product therapy; product may be given as soon as culture is taken
- PSEUDOMEMBRANOUS COLITIS: bowel pattern before, during treatment; diarrhea, cramping, blood in stools; report to prescriber
- Skin eruptions after administration of penicillin to 1 wk after discontinuing product
- Respiratory status: rate, character, wheezing, tightness in chest
- ANAPHYLAXIS: rash, itching dyspnea, facial/laryngeal edema
PERFORM/PROVIDE
- Adrenaline, suction, tracheostomy set, endotracheal intubation equipment on unit
- Adequate intake of fluids (2L) during diarrhea episodes
- Scratch test to assess allergy after securing order from prescriber; usually done when penicillin is only product of choice
Amoxicillin
Anaphylaxis Treatment
Withdraw product, maintain airway; administer EPINEPHrine, aminophylline, O2, IV corticosteroids
Azithromycin
Functional Classification
Antiinfective
Azithromycin
Chemical Classification
Macrolide (azalide)
Azithromycin
Mechanism of Action
Binds to 50S ribosomal subunits of susceptible bacteria and suppresses protein synthesis; much greater spectrum of activity than erythromycin; more effective against gram-negative organisms
Azithromycin
Uses
Mild to moderate infections of the upper respiratory tract, lower respiratory tract; uncomplicated skin and skin structure infections caused by Moraxella catarrhalis, Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Streptococcus agalactiae, Mycoplasma pneumoniae, Haemophilus influenzae, Clostridium, Legionella pneumophilia; NGU or cervicitis due to Chlamydia trachomatis; in children: acute otitis media (H. influenzae, M. catarrhalis, S. pneumoniae) PO; acute pharyngitis/tonsillitis (group A streptococcal) PO; acute skin/soft tissue infections PO; community-acquired pneumonia (Chlamydia pneumoniae, H. influenzae, M. pneumoniae, S. pneumoniae) PO; pharyngitis/tonsillitis (S. pyogenes); prophylaxis of disseminated Mycobacterium avium complex (MAC)
Azithromycin
Contraindications
Hypersensitivity to azithromycin, erythromycin, any macrolide
Azithromycin
Side Effects
CNS: dizziness, headache, vertigo, somnolence, myasthenia gravis
CV: palpitations, chest pain
EENT: hearing loss, tinnitus, loss of smell (anosmia)
GI: Nausea, Vomiting, Diarrhea, HEPATOTOXICITY, abdominal pain, stomatitis, heartburn, dyspepsia, flatulence, melena, CHOLESTATIC JAUNDICE, PSEUDOMEMBRANOUS COLITIS, tongue discoloration
GU: vaginitis, moniliasis, nephritis
HEMA: anemia
INTEG: rash, urticaria, pruritus, photosensitivity
SYST: ANGIOEDEMA, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS
Azithromycin
Nursing Considerations
ASSESS:
- I&O ratio; report hematuria, oliguria with renal disease
- Hepatic studies: AST, ALT, CBC with differential
- Renal studies: urinalysis, protein, blood
- C&S before product therapy; product may be taken as soon as culture is taken; C&S may be repeated after treatment
- SERIOUS SKIN REACTIONS: STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, ANGIOEDEMA; DISCONTINUE IF RASH DEVELOPS, TREAT SYMPTOMATICALLY
- SUPERINFECTION: SORE THROAT, MOUTH, TONGUE; FEVER, FATIGUE, DIARRHEA, ANOGENITAL PRURITUS
- PSEUDOMEMBRANOUS COLITIS: DIARRHEA, ABDOMINAL PAIN, FEVER, FATIGUE, ANOREXIA; OBTAIN CBC, SERUM ALBUMIN
- Bowel pattern before, during treatment
- Respiratory status: rate, character; wheezing, tightness in chest: discontinue product
Azithromycin
Hypersensitivity Treatment
Withdraw product, maintain airway; administer EPINEPHrine, aminophylline, O2, IV corticosteroids
Clarithromycin
Functional Classification
Antiinfective
Clarithromycin
Chemical Classification
Macrolide
Clarithromycin
Mechanism of Action
Binds to 50S ribosomal subunits of susceptible bacteria and suppresses protein synthesis
Clarithromycin
Uses
Mild to moderate infections of the upper and lower respiratory tract, uncomplicated skin and skin-structure infections caused by Streptococcus pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, Moraxella catarrhalis, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Listeria monocytogenes, Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus, Mycobacterium avium complex (MAC); complex infection in AIDS patients; Mycobacterium avium intracellulare, Helicobacter pylori in combination with omeprazole, H. parainfluenzae
Clarithromycin
Contraindications
Hypersensitivity to this product or macrolide antibiotics
Clarithromycin
Side Effects
CV: VENTRICULAR DYSRHYTHMIAS, QT PROLONGATION
GI: Nausea, Vomiting, Diarrhea, HEPATOTOXICITY, Abdominal Pain, stomatitis, heartburn, anorexia, Abnormal Taste, PSEUDOMEMBRANOUS COLITIS
GU: vaginitis, moniliasis
HEMA: leukopenia, thrombocytopenia, increased INR
INTEG: rash, urticaria, pruritus, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS
MISC: Headache, hearing loss
Clarithromycin
Nursing Considerations
ASSESS:
- INFECTION: wound characteristics, urine, stool, sputum, WBC, temp; C&S before product therapy; product may be given as soon as culture is taken; C&S may be repeated after treatment
- For ulcers: abdominal pain, bleeding in stools, emesis
- Renal, hepatic studies; report hematuria, oliguria
- Bowel pattern before, during treatment
- Respiratory status: rate, character, wheezing, tightness in chest; discontinue product
- Allergies before treatment, reaction to each medication
- QT PROLONGATION, VENTRICULAR DYSRHYTHMIAS: monitor ECG, cardiac status in those with underlying cardiac abnormalities
- SERIOUS SKIN REACTION: Stevens-Johnson syndrome, toxic epidermal necrolysis; product should be discontinued immediately
Clarithromycin
Hypersensitivity Treatment
Withdraw product, maintain airway, administer EPINEPHrine, aminophylline, O2, IV corticosteroids
Ceftriaxone (Rocephin)
Functional Classification
Broad-spectrum antibiotic
Ceftriaxone (Rocephin)
Chemical Classification
Cephalosporin (3rd generation)
Ceftriaxone (Rocephin)
Mechanism of Action
Inhibits bacterial cell wall synthesis, renders cell wall osmotically unstable, leads to cell death
Ceftriaxone (Rocephin)
Uses
Gram-negative bacilli: Haemophilus influenzae, Escherichia coli, Enterobacter aerogenes, Proteus mirabilis, Klebsiella, Citrobacter, Enterobacter, Salmonella, Shigella, Acinetobacter, Bacteroides fragilis, Neisseria, Serratia; gram-positive organisms: Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus; serious lower respiratory tract, urinary tract, skin, gonococcal intraabdominal infections; septicemia, meningitis, bone, joint infections; otitis media; PID
Ceftriaxone (Rocephin)
Contraindications
Hypersensitivity to cephalosporins, infants <1 mo
Ceftriaxone (Rocephin)
Side Effects
CNS: head, dizziness, weakness, paresthesia, fever, chills, SEIZURES, dyskinesia
CV: HEART FAILURE, syncope
EENT: Oral Candidiasis
GI: Nausea, Vomiting, Diarrhea, Anorexia, pain, glossitis, BLEEDING; increased AST, ALT, bilirubin, LDH, alk phos; abdominal pain, PSEUDOMEMBRANOUS COLITIS; cholestasis
GU: PROTEINURIA, vaginitis, pruritus, Candidiasis, increased BUN, NEPHROTOXICITY, RENAL FAILURE
HEMA: LEUKOPENIA, THROMBOCYTOPENIA, AGRANULOCYTOSIS, anemia, NEUTROPENIA, LYMPHOCYTOSIS, EOSINOPHILIA, PANCYTOPENIA, HEMOLYTIC ANEMIA
INTEG: rash, urticaria, dermatitis
RESP: dyspnea
SYST: ANAPHYLAXIS, SERUM SICKNESS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS
Ceftriaxone (Rocephin)
Nursing Considerations
ASSESS:
- Sensitivity to penicillin, other cephalosporins
- NEPHROTOXICITY: increased BUN, creatinine; urine output: if decreasing notify prescriber
- Blood studies: AST, ALT, CBC, Hct, bilirubin, LDH, alk phos, Coombs’ test monthly if patient is on long-term therapy
- Electrolytes: K, Na, Cl monthly if patient is on long-term therapy
- PSEUDOMEMBRANOUS COLITIS: bowel pattern daily; if severe diarrhea occurs, product should be discontinued
- IV site for extravasation, phlebitis
- ANAPHYLAXIS: rash, urticaria, pruritus, chills, fever, joint pain, angioedema; may occur a few days after therapy begins
- Bleeding: ecchymosis, bleeding gums, hematuria, stool guaiac
- OVERGROWTH OF INFECTION: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
Ceftriaxone (Rocephin)
Anaphylaxis Treatment
EPINEPHrine, antihistamines; resuscitate if needed
Cephalexin (Keflex)
Functional Classification
Antiinfective
Cephalexin (Keflex)
Chemical Classification
Cephalosporin (1st generation)
Cephalexin (Keflex)
Mechanism of Action
Inhibits bacterial cell wall synthesis; renders cell wall osmotically unstable, leads to cell death; lysis mediated by cell wall autolytic enzymes
Cephalexin (Keflex)
Uses
Gram-negative bacilli: Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Klebsiella; gram-positive organisms: Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus; upper, lower respiratory tract, urinary tract, skin, bone infections; otitis media
Cephalexin (Keflex)
Contraindications
Hypersensitivity to cephalosporins, infants <1 mo
Cephalexin (Keflex)
Side Effects
CNS: headache, dizziness, weakness, paresthesia, fever, chills, SEIZURES (with high doses)
GI: nausea, vomiting, Diarrhea, Anorexia, pain, glossitis, bleeding; increased AST, ALT, bilirubin, LDH, alk phos; abdominal pain, PSEUDOMEMBRANOUS COLITIS
GU: proteinuria, vaginitis, pruritus, candidiasis, increased BUN, NEPHROTOXICITY, RENAL FAILURE
HEMA: LEUKOPENIA, THROMBOCYTOPENIA, AGRANULOCYTOSIS, anemia, NEUTROPENIA, LYMPHOCYTOSIS, EOSINOPHILIA, PANCYTOPENIA, HEMOLYTIC ANEMIA
INTEG: rash, urticaria, dermatitis
RESP: dyspnea
SYST: ANAPHYLAXIS, SERUM SICKNESS, superinfection, STEVENS-JOHNSON SYNDROME
Cephalexin (Keflex)
Nursing Considerations
ASSESS:
- Sensitivity to penicillin and other cephalosporins
- NEPHROTOXICITY: increased BUN, creatinine; URINE OUTPUT: IF DECREASING, NOTIFY PRESCRIBER
- I&O daily
- Blood studies: AST, ALT, CBC, Hct, bilirubin, LDH, alk phos, Coombs’ test monthly if patient is on long-term therapy
- Electrolytes: K, Na, Cl monthly if patient is on long-term therapy
- PSEUDOMEMBRANOUS COLITIS: bowel pattern daily; if severe diarrhea occurs, product should be discontinued
- ANAPHYLAXIS: rash, urticaria, pruritus, chills, fever, joint pain; angioedema; may occur a few days after therapy begins; discontinue product, notify prescriber immediately, keep emergency equipment nearby
- Bleeding ecchymosis, bleeding gums, hematuria, stool guaiac daily
- OVERGROWTH OF INFECTION: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
Cephalexin (Keflex)
Anaphylaxis Treatment
EPINEPHrine, antihistamines; resuscitate if needed
Doxycycline
Functional Classification
Antiinfective
Doxycycline
Chemical Classification
Tetracycline
Doxycycline
Mechanism of Action
Inhibits protein synthesis, phosphorylation in microorganisms by binding to 30S ribosomal subunits, reversibly binding to 50S ribosomal subunits; bacteriostatic
Doxycycline
Uses
Syphilis , Chlamydia trachomatis, gonorrhea, Rickettsia, lymphogranuloma venereum, uncommon gram-negative/gram-positive organisms, malaria prophylaxis, chronic periodontitis, acne, anthrax, Lyme disease
Doxycycline
Contraindications
Pregnancy (D), children <8yr, hypersensitivity to tetracyclines, esophageal ulceration
Doxycycline
Side Effects
CNS: fever
CV: pericarditis
EENT: dysphagia, glossitis, decreased calcification of deciduous teeth, oral candidiasis, tooth discoloration
GI: Nausea, Abdominal Pain, Vomiting, Diarrhea, anorexia, enterocolitis, HEPATOTOXICITY, flatulence, abdominal cramps, gastric burning, stomatitis
GU: Increased BUN
HEMA: EOSINOPHILIA, NEUTROPENIA, THROMBOCYTOPENIA, HEMOLYTIC ANEMIA
INTEG: Rash, Urticaria, Photosensitivity, Increased Pigmentation, EXFOLIATIVE DERMATITIS, pruritus
MS: bone growth retardation (<8yr old)
SYST: STEVENS-JOHNSON SYNDROME, ANGIOEDEMA, ANAPHYLAXIS
Doxycycline
Nursing Considerations
ASSESS:
- I&O ratio
- Blood studies: PT, CBC, AST, ALT, BUN, creatinine
- Signs of infection
- ALLERGIC REACTIONS: rash, itching, pruritus, angioedema
- Nausea, vomiting, diarrhea; administer antiemetic, antacids as ordered
- OVERGROWTH OF INFECTION: fever, malaise, redness, pain, swelling, drainage, perineal itching, diarrhea, changes in cough or sputum
- IV site for phlebitis/thrombosis; product is highly irritating
- After C&S is obtained, do not wait for results
Erythromycin
Functional Classification
Antiinfective
Erythromycin
Chemical Classification
Macrolide
Erythromycin
Mechanism of Action
Binds to 50S ribosomal subunits of susceptible bacteria and suppresses protein synthesis
Erythromycin
Uses
Infections caused by Neisseria gonorrhoeae; mild to moderate respiratory tract, skin, soft-tissue infections caused by Bordetella pertussis, Borrelia burgdorferi, Chlamydia trachomatis; Corynebacterium diphtheriae, Haemophilus influenzae (when used with sulfonamides); Legionella pneumophila, Legionnaire’s disease, Listeria monocytogenes; Mycoplasma pneumoniae, Streptococcus pneumoniae, syphilis: Treponema pallidum
Erythromycin
Contraindications
Hypersensitivity, preexisting hepatic disease (estolate)
Erythromycin
Side Effects
CNS: SEIZURES
CV: DYSRHYTHMIAS, QT PROLONGATION
EENT: hearing loss, tinnitus
GI: Nausea, Vomiting, Diarrhea, HEPATOTOXICITY, abdominal pain, stomatitis, heartburn, anorexia, PSEUDOMEMBRANOUS COLITIS
GU: Vaginitis, Moniliasis
INTEG: rash, urticaria, pruritus, thrombophlebitis (IV site)
SYST: ANAPHYLAXIS
Erythromycin
Nursing Considerations
ASSESS:
- INFECTION: temp, characteristics of wounds, urine, stools, sputum, WBCs at baseline and periodically
- I&O ratio; report hematuria, oliguria in renal disease
- Hepatic studies: AST, ALT if patient is receiving long-term therapy
- Hearing at baseline and after treatment
- Renal studies: urinalysis, protein, blood
- C&S before product therapy; product may be given as soon as culture is taken; C&S may be repeated after treatment
- PSEUDOMEMBRANOUS COLITIS: diarrhea with blood, mucus; abdominal pain, fever; product should be discontinued immediately, notify prescriber
- ANAPHYLAXIS: generalized hives, itching, flushing, swelling of lips, tongue, throat, wheezing; have emergency equipment nearby
- QT PROLONGATION: may occur (IV >15mg/min); those with electrolyte imbalances, congenital QT prolongation, elderly at greater risk; correct electrolyte imbalances before treatment, ECG
PERFORM/PROVIDE
-Adequate intake of fluids (2L) during diarrhea episodes
Erythromycin
Hypersensitivity Treatment
Withdraw product; maintain airway; administer EPINEPHrine, aminophylline, O2, IV corticosteroids
Imipenem/cilastatin
Functional Classification
Antiinfective-miscellaneous
Imipenem/cilastatin
Chemical Classification
Carbapenem
Imipenem/cilastatin
Mechanism of Action
Interferes with cell-wall replication of susceptible organisms; osmotically unstable cell wall swells, bursts from osmotic pressure; addition of cilastatin prevents renal inactivation that occurs with high urinary concentrations of imipenem
Imipenem/cilastatin
Uses
Serious infections caused by gram-positive Streptococcus pneumoniae, group A beta-hemolytic streptococci, Staphylococcus aureus, enterococcus; gram-negative Klebsiella, Proteus, Escherichia coli, Acinetobacter, Serratia, Pseudomonas aeruginosa, Salmonella, Shigella, Haemophilus influenzae, Listeria sp.
Imipenem/cilastatin
Contraindications
Hypersensitivity to this product or amide local anesthetics, or carbapenems; AV block, shock (IM)
Imipenem/cilastatin
Side Effects
CNS: fever, somnolence, SEIZURES, confusion, dizziness, weakness, myoclonus
CV: hypotension, palpitations, tachycardia
GI: Diarrhea, Nausea, Vomiting, PSEUDOMEMBRANOUS COLITIS, HEPATITIS, glossitis
GU: RENAL TOXICITY/FAILURE
HEMA: EOSINOPHILIA, NEUTROPENIA, decreased Hgb, Hct
INTEG: rash, urticaria, pruritus, pain at inj site, phlebitis, erythema at inj site
RESP: chest discomfort, dyspnea, hyperventilation
SYST: ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME
Imipenem/cilastatin
Nursing Considerations
ASSESS:
- Renal studies: creatinine/BUN
- INFECTION: increased temp, WBC, characteristics of wounds, sputum, urine or stool culture
- Sensitivity to penicillin–may have sensitivity to this product
- Renal disease: lower dose may be required
- Bowel pattern daily; if severe diarrhea occurs, product should be discontinued; may indicate pseudomembranous colitis
- ALLERGIC REACTIONS, ANAPHYLAXIS: rash, urticaria, pruritus, wheezing, laryngeal edema; may occur a few days after therapy begins; have epinephrine, antihistamine, emergency equipment available
- OVERGROWTH OF INFECTION: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
Imipenem/cilastatin
Anaphylaxis Treatment
EPINEPHrine, antihistamines; resuscitate if needed
Penicillin G and Penicillin V
Functional Classification
Broad-spectrum antiinfective
Penicillin G and Penicillin V
Chemical Classification
Natural Penicillin
Penicillin G and Penicillin V
Mechanism of Action
Interferes with cell-wall replication of susceptible organisms; lysis is mediated by cell-wall autolytic enzymes, results in cell death
Penicillin G and Penicillin V
Uses
Respiratory infections, scarlet fever, erysipelas, otitis media, pneumonia, skin and soft-tissue infections, gonorrhea; effective for gram-positive cocci (Staphylococcus, Streptococcus pyogenes, S. viridans, S. faecalis, S. pneumoniae), gram-negative cocci (Neisseria gonorrhoeae), gram-positive bacilli (Actinomyces, Bacillus anthracis, Clostridium perfringens, C. tetani, Corynebacterium diphtheriae, Listeria monocytogenes), gram-negative bacilli (Escherichia coli, Proteus mirabilis, Salmonella, Shigella, Enterobacter, Streptobacillus moniliformis), spirochetes (Treponema pallidum)
Penicillin G and Penicillin V
Contraindications
Hypersensitivity to penicillins, corn
Penicillin G and Penicillin V
Side Effects
CNS: lethargy, hallucinations, anxiety, depression, twitching, COMA, SEIZURES, hyperreflexia
GI: Nausea, Vomiting, Diarrhea, increased AST, ALT, abdominal pain, glossitis, colitis, PSEUDOMEMBRANOUS COLITIS
GU: OLIGURIA, PROTEINURIA, HEMATURIA, Vaginitis, Moniliasis, GLOMERULONEPHRITIS, RENAL TUBULAR DAMAGE
HEMA: anemia, increased bleeding time, BONE MARROW DEPRESSION, GRANULOCYTOPENIA, HEMOLYTIC ANEMIA
META: hypo/hyperkalemia, alkalosis, hypernatremia
MISC: ANAPHYLAXIS, SERUM SICKNESS, STEVENS-JOHNSON SYNDROME, Local Pain, tenderness and fever with IM inj
Penicillin G and Penicillin V
Nursing Considerations
ASSESS:
- INFECTION: temp; characteristics of sputum; wounds; urine; stools before, during, after treatment; C&S before therapy; product may be given as soon as culture is taken
- I&O ratio; report hematuria, oliguria because penicillin in high doses is nephrotoxic; renal tests: urinalysis, protein, blood
- Any patient with compromised renal system because product is excreted slowly with poor renal system function; toxicity may occur rapidly
- Hepatic studies: AST, ALT
- Blood studies: WBC, RBC, Hct, Hgb, bleeding time
- PSEUDOMEMBRANOUS COLITIS: diarrhea, mucus, pus; bowel pattern before, during treatment
- Respiratory status: rate, character, wheezing, tightness in chest
- Allergies before initiation of treatment, reaction of each medication; because of prolonged action, allergic reaction may be prolonged and severe; watch for anaphylaxis: rash, dyspnea, pruritus, laryngeal edema; skin eruptions after administration of penicillin to 1wk after discontinuing product
PERFORM/PROVIDE
- EPINEPHrine, suction, tracheostomy set, endotracheal intubation equipment
- adequate fluid intake (2L) during diarrhea episodes
- scratch test to assess allergy after securing order from prescriber; usually done when penicillin is only product of choice
Penicillin G and Penicillin V
Anaphylaxis Treatment
Withdraw product; maintain airway; administer EPINEPHrine, aminophylline, O2, IV corticosteroids
Ciprofloxacin
Functional Classification
Antiinfective-broad spectrum
Ciprofloxacin
Chemical Classification
Fluoroquinolone
Ciprofloxacin
Mechanism of Action
Interferes with conversion of intermediate DNA fragments into high-molecular-weight DNA in bacteria; DNA gyrase inhibitor
Ciprofloxacin
Uses
Infection caused by susceptible Escherichia coli, Enterobacter cloacae, Proteus mirabilis, Klebsiella pneumoniae, Proteus vulgaris, Citrobacter freundii, Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Enterobacter, Campylobacter jejuni, Salmonella; chronic bacterial prostatitis, acute sinusitis, postexposure inhalation anthrax, infectious diarrhea, typhoid fever, complicated intraabdominal infections, nosocomial pneumonia, urinary tract infections
Ciprofloxacin
Contraindications
Hypersensitivity to quinolones
Ciprofloxacin
Side Effects
CNS: Headache, dizziness, fatigue, insomnia, depression, Restlessness, SEIZURES, confusion
GI: Nausea, Diarrhea, increased ALT/AST, dry mouth, flatulence, heartburn, Vomiting, oral candidiasis, dysphagia, PSEUDOMEMBRANOUS COLITIS
HEMA: BONE MARROW DEPRESSION
INTEG: Rash, pruritus, urticaria, photosensitivity, flushing, fever, chills, TOXIC EPIDERMAL NECROLYSIS
MISC: ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME, visual impairment, QT prolongation
MS: tremor, arthralgia, tendinitis, TENDON RUPTURE
Ciprofloxacin
Nursing Considerations
ASSESS:
- INFECTION: WBC, temperature before treatment, periodically
- CNS SYMPTOMS: headache, dizziness, fatigue, insomnia, depression
- Renal, hepatic studies: BUN, creatinine, AST, ALT
- I&O ratio, urine pH <5.5 is ideal
- ANAPHYLAXIS: fever, flushing, rash, urticaria, pruritus, dyspnea
- For tendon pain, especially in children
PERFORM/PROVIDE:
- Limited intake of alkaline foods, products: milk, dairy products, alkaline antacids, sodium bicarbonate; caffeine intake if excessive cardiac or CNS stimulation
- Increase in fluids to 3L/day to avoid crystallization in kidneys
Clindamycin
Functional Classification
Antiinfective-miscellaneous
Clindamycin
Chemical Classification
Lincomycin derivative
Clindamycin
Mechanism of Action
Binds to 50S subunit of bacterial ribosomes, suppresses protein synthesis
Clindamycin
Uses
Infections caused by staphylococci, streptococci, Rickettsia, Fusobacterium, Actinomyces, Peptococcus, Bacteroides, Pneumocystis jiroveci
Clindamycin
Contraindications
Hypersensitivity to this product or lincomycin, tartrazine dye; ulcerative colitis/enteritis, PSEUDOMEMBRANOUS COLITIS
Clindamycin
Side Effects
GI: Nausea, Vomiting, Abdominal Pain, Diarrhea, PSEUDOMEMBRANOUS COLITIS, anorexia, weight loss, increased AST/ALT, bilirubin, alk phos; jaundice
GU: Vaginitis, urinary frequency
INTEG: rash, urticaria, pruritus, erythema, pain, abscess at inj site
SYST: STEVENS-JOHNSON SYNDROME, EXFOLIATIVE DERMATITIS
Clindamycin
Nursing Considerations
ASSESS:
- INFECTION: C&S before product therapy; product may be given as soon as culture is taken
- VS, urine, stools, sputum
- Hepatic studies: AST, ALT if on long-term therapy
- BP, pulse in patient receiving product parenterally
- PSEUDOMEMBRANOUS COLITIS: bowel pattern before, during treatment; if severe diarrhea occurs, product should be discontinued
- Skin eruptions, itching dermatitis after administration
- Respiratory status: rate, character, wheezing, tightness in chest
- SERIOUS SKIN REACTIONS: Stevens-Johnson Syndrome, exfoliative dermatitis
- Allergies before treatment, reaction to each medication
PERFORM/PROVIDE:
- EPINEPHrine, suction, tracheostomy set, endotracheal intubation equipment on unit
- Adequate intake of fluids (2L) during diarrhea episodes
Clindamycin
Hypersensitivity Treatment
Withdraw product; maintain airway; administer EPINEPHrine, aminophylline, O2, IV corticosteroids
Gentamicin
Functional Classification
Antiinfective
Gentamicin
Chemical Classification
Aminoglycoside
Gentamicin
Mechanism of Action
Interferes with protein synthesis in bacterial cell by binding to ribosomal subunit, this causing misreading of genetic code; inaccurate peptide sequence forms in protein chain, thereby causing bacterial death
Gentamicin
Uses
Severe systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues caused by susceptible strains of Pseudomonas aeruginosa, Proteus, Klebsiella, Serratia, Escherichia coli, Enterobacter, Citrobacter, Staphylococcus, Shigella, Salmonella, Acinetobacter, Bacillus anthracis, acute PID
Gentamicin
Contraindications
Hypersensitivity to this product, other aminoglycosides; fungal/viral/mycobacterial infection
Gentamicin
Side Effects
CNS: confusion, depression, numbness, tremors, SEIZURES, muscle twitching, NEUROTOXICITY, dizziness, vertigo
CV: hypo/hypertension, palpitations, edema
EENT: OTOTOXICITY, Deafness, visual disturbances, tinnitus
GI: Nausea, Vomiting, Anorexia; increased ALT, AST, bilirubin; hepatomegaly, HEPATIC NECROSIS, splenomegaly
GU: OLIGURIA, HEMATURIA, RENAL DAMAGE, AZOTEMIA, RENAL FAILURE, NEPHROTOXICITY, proteinuria
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA, LEUKOPENIA, eosinophilia, anemia
INTEG: Rash, burning, urticaria, dermatitis, alopecia, photosensitivity
Gentamicin
Nursing Considerations
ASSESS:
- NEUROMUSCULAR DISEASE (MYASTHENIA GRAVIS, PARKINSON’S DISEASE, INFANT BOTULISM): paresthesias, tetany, positive Chvostek’s/Trousseau’s signs, confusion (adults), tetany, muscle weakness (infants); correct electrolyte imbalance
- Weight before treatment; calculation of dosage is usually based on ideal body weight but may be calculated on an actual body weight
- RENAL DISEASE: I&O ratio, urinalysis daily for proteinuria, cells, casts; report sudden change in urine output; urine pH if product is used for UTI; urine should be kept alkaline; urine for CCr testing, BUN, serum creatinine; lower dosage should be given with renal impairment (CCr <80ml/min); toxicity is increased in patients with decreased renal function if high doses are given
- VS during inf; watch for hypotension, change in pulse
- IV site for thrombophlebitis, including pain, redness, swelling q30min, change site if needed; discontinue, apply warm compresses to site
- Serum peak drawn at 30-60 min after IV inf or 60 min after IM inj and trough level drawn just before next dose; blood level should be 2-4 times bacteriostatic level; peak (5-10mcg/ml), trough (0.5-2mcg/ml), depending on type of infection
- HEARING DEFICITS: eighth cranial nerve dysfunction by audiometric testing; also ringing, roaring in ears, vertigo; assess hearing before, during, after treatment
- Dehydration: high specific gravity, decrease in skin turgor, dry mucous membranes, dark urine
- OVERGROWTH OF INFECTION: fever, malaise, redness, pain, swelling, perineal itching, diarrhea, stomatitis, change in cough or sputum
- C&S before starting treatment to identify infecting organism
- VESTIBULAR DYSFUNCTION: nausea, vomiting, dizziness, headache; product should be discontinued if severe
- Inj sites for redness, swelling, abscesses; use war, compresses at site
PERFORM/PROVIDE:
- Adequate fluids of 2-3L/day unless contraindicated to prevent irritation of tubules
- Supervised ambulation, other safety measures with vestibular dysfunction
Metronidazole (Flagyl)
Functional Classification
Antiinfective - miscellaneous
Metronidazole (Flagyl)
Chemical Classification
Nitroimidazole derivative
Metronidazole (Flagyl)
Mechanism of Action
Direct-acting amebicide/trichomonacide binds and disrupts DNA structure, thereby inhibiting bacterial nucleic acid synthesis
Metronidazole (Flagyl)
Uses
Intestinal amebiasis, amebic abscess, trichomoniasis, refractory trichomoniasis, bacterial anaerobic infections, giardiasis, septicemia, endocarditis; bone, joint, lower respiratory tract infections; rosacea
Metronidazole (Flagyl)
Contraindications
Pregnancy 1st trimester, breastfeeding, hypersensitivity to this product
Metronidazole (Flagyl)
Side Effects
CNS: Headache, Dizziness, confusion, irritability, restlessness, ataxia, depression, fatigue, drowsiness, insomnia, paresthesia, peripheral neuropathy, SEIZURESm incoordination, depression, encephalopathy, ASEPTIC MENINGITIS
CV: flattening of T waves
EENT: blurred vision, sore throat, retinal edema, dry mouth, metallic taste, furry tongue, glossitis, stomatitis, photophobia, optic neuritis
GI: Nausea, Vomiting, Diarrhea, epigastric distress, Anorexia, constipation, Abdominal Cramps, Pseudomembranous Colitis
GU: darkened urine, vaginal dryness, polyuria, ALBUMINURIA, dysuria, cystitis, decreased libido, NEPHROTOXICITY, incontinence, dyspareunia, candidiasis
HEMA: LEUKOPENIA, BONE MARROW, DEPRESSION, APLASIA, THROMBOCYTOPENIA
INTEG: rash, pruritus, urticaria, flushing, STEVENS-JOHNSON SYNDROME
Metronidazole (Flagyl)
Nursing Considerations
ASSESS:
- INFECTION: WBC, wound symptoms, fever, skin or vaginal secretions; start treatment after C&S; for opportunistic fungal infections; superinfection: fever, monilial growth, fatigue, malaise
- Stools during entire treatment; should be clear at end of therapy; stools should be free of parasites for 1yr before patient considered cured (amebiasis)
- Vision by ophthalmic exam during, after therapy; vision problems often occur
- NEUROTOXICITY: peripheral neuropathy, seizures, dizziness, uncoordination, pruritus, joint pain; product may be discontinued
- ALLERGIC REACTION: fever, rash, itching, chills; product should be discontinued if these occur
- Renal, reproductive dysfunction: dysuria, polyuria, impotence, dyspareunia, decreased libido, I&O; weight daily
- SECONDARY MALIGNANCY: used only when indicated; avoid unnecessary use
Vancomycin
Functional Classification
Antiinfective-miscellaneous
Vancomycin
Chemical Classification
Tricyclic glycopeptide
Vancomycin
Mechanism of Action
Inhibits bacterial cell wall synthesis, blocks glycopeptides
Vancomycin
Uses
Resistant staphylococcal infections, pseudomembranous colitis, staphylococcal enterocolitis, endocarditis prophylaxis for dental procedure, diphtheroid endocarditis
Vancomycin
Contraindications
Hypersensitivity, previous hearing loss
Vancomycin
Side Effect
CV: CARDIAC ARREST, VASCULAR COLLAPSE (RARE), hypotension
EENT: Ototoxicity, Permanent Deafness, tinnitus, nystagmus
GI: NAUSEA, PSEUDOMEMBRANOUS COLITIS
GU: NEPHROTOXICITY, Increased BUN, Creatinine, Albumin, FATAL UREMIA
HEMA: LEUKOPENIA, EOSINOPHILIA, NEUTROPENIA
INTEG: chills, fever, rash, thrombophlebitis at inj site, urticaria, pruritus, necrosis (red-man syndrome), skin/subcutaneous tissue disorders
RESP: wheezing, dyspnea
SYST: ANAPHYLAXIS, SUPERINFECTION
Vancomycin
Nursing Considerations
ASSESS:
- INFECTION: WBC, urine, stools, sputum, characteristics of wound throughout treatment
- I&O ratio; report hematuria, oliguria; nephrotoxicity may occur
- Serum levels: peak 1hr after 1-hr inf 25-40mg/L, trough before next dose 5-10mg/L
- C&S
- Auditory function during, after treatment
- BP during administration; sudden drop may indicate rem-man syndrome
- Hearing loss, ringing, roaring in ears; product should be discontinued
- Skin eruptions
- Respiratory status: rate, character; wheezing, tightness in chest
- Allergies before treatment, reaction of each medication
PERFORM/PROVIDE:
- EPINEPHrine, suction, tracheostomy set, endotracheal intubation equipment on unit; anaphylaxis may occur
- Adequate intake of fluids (2L/day) to prevent nephrotoxicity
Amoxicillin
Chemical Classification
Aminopenicillin
