Antibiotics/Anti-Infectives

Question 1

Gentamicin
Tobramicin
Amikacin
Neomycin sulfate

Answer 1

AMINOGLYCOSIDES

Action: bacterioCIDAL. Inhibits protein synthesis for GRAM NEGATIVE bacteria

Indication: Tx of severe systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues, acute pelvic inflammatory disease, TB (streptomycin)
Usually prescribed x7-10 days

Adverse: OTOTOXICITY, nephrotoxicity
Anorexia, nausea, vomiting, diarrhea

Considerations: check CN VIII (HEARING). teach to immediately report tinnitus, vertigo, nystagmus, ataxia. Audiograms if given long term.
Check renal function (BUN, Cr)
Encourage fluids, small frequent meals
Genta: check peak 2h after Med given, check trough at time of dose/prior to med.
Monitor for sx of bacterial overgrowth, photosensitivity
Neomycin - ophthalmic - remove infective exudate around eyes before administration of ointment

Question 2

Cephalexin 
Cefoxitin 
Ceftriaxone 
Cefepime 
Fosamil

Answer 2

CEPHALOSPORINS (1st, 2nd, 3rd, 4th, and 5th generations, respectively)

Action: bacterioCIDAL. inhibits bacterial cell wall synthesis

Indications: pharyngitis, tonsillitis, otitis media, upper/lower respiratory tract infections, dermatological infections, UTIs
Gonorrhea
Septicemia
Meningitis
Perioperative prophy 

Adverse: abdominal pain, nausea, vomiting, diarrhea
Increase risk of bleeding, hypoprothrombinemia
Rash, thrombophlebitis (IV), abscess formation (IM/IV)
SUPERINFECTIONS

Considerations:
Take with food. Liquid form to kids. 
Have Vitamin K available for hypoprothrombinemia.
Avoid ETOH 
CROSS ALLERGY WITH PENICILLINS
Monitor renal/hepatic function
Monitor for thrombophlebitis 
Can cause false positive with COOMBS (complicate cross-matching for transfusion)

Question 3

Ciprofloxacin

Levofloxacin

Answer 3

FLUOROQUINOLONES

Action: bacterioCIDAL. interferes with DNA replication in GRAM NEGATIVE bacteria

Indications: txt of infection caused by E COLI and other bacteria, chronic bacteria prostatitis, acute sinusitis, postexposure inhalation anthrax

Adverse: HA, nausea, diarrhea
Elevated BUN, AST, ALT, Cr, AP
Decreased WBC and Hct 
Rash, photosensitivity
ACHILLES TENDON RUPTURE 
SEIZURE

Nursing considerations: culture and sensitivity before starting therapy
Take 1-2h AFTER MEALS with glass of water. Encourage fluids. If needed administer antacids 2h AFTER MED
Cipro- CONTRA children <18 yo.
Avoid caffeine

Question 4

Vancomycin

Answer 4

GLYCOPEPTIDE

Action: bacterioCIDAL. prevents bacterial cell wall synthesis

Indications: treatment of resistant staph infections, pseudo membranous enterocolitis DUE TO C DIFF

Adverse: thrombophlebitis, abscess formation, nephrotoxicity, OTOTOXICITY

Considerations:
monitor renal function and hearing
Poor oral absorption –> IV admin. Peak 5 min, duration 12-24h
Avoid extravasation during therapy - may cause necrosis (IRRITANT)
Give antihistamine if RED MAN SYNDROME - decreased BP, flushing of face and neck from admin too fast
Contact HCP if signs of SUPERINFECTION (VANCOMYCIN RESISTANT ENTERO…): sore throat, fever, fatigue

Question 5

clindamycin hcl

Answer 5

LINCOSAMIDE

Action: both bacterioSTATIC and bacterioCIDAL. Suppresses protein synthesis by preventing peptide bond formation.

Indications: Staph, Strep, etc.

Adverse: nausea, diarrhea. Colitis may appear 2-9days or several weeks after starting meds
LIVER TOXICITY.
Vaginitis, rash

Considerations: administer with full glass of water to prevent esophageal ulcers
Monitor for persistence vomiting, diarrhea, fever, abdominal pain/cramping
Monitor for SUPERINFECTIONS

Question 6

Erythromycin

Azithromycin

Answer 6

MACROLIDES

Action: bacterioSTATIC and bacterioCIDAL. Binds to cell membranes and causes changes in protein function

Indications: acute infections
Acne and skin infections
Upper respiratory tract infections
Prophy before dental procedures for pts allergic to PCN with valvular heart disease

Adverse effects: abdominal cramps, diarrhea
Confusion, uncontrollable emotions
HEPATOTOXICITY
SUPERINFECTION

Considerations: take Med 1h BEFORE or 2h AFTER meals with full glass of water
Take around the clock to maximize effectiveness
Monitor liver function - primarily excreted through bile (good for renal pts)

Question 7

Amoxicillin
Ampicillin
Methicillin
Nafcillin
Penicillin G, Penicillin V

Answer 7

PENICILLINS

Action: bacterioCIDAL. Inhibit cell wall synthesis

Indications: GRAM POSITIVE organisms, moderate to severe infections, syphilis, gonococcal infections, Lyme disease

Adverse: glossitis, stomatitis, gastritis, diarrhea, skin rashes
Renal, hepatic, hematological abnormalities
Nausea, vomiting
SUPERINFECTION
Hypersensitivity reactions

Considerations: culture and sensitivity before tx
Monitor serum electrolytes and cardiac status if given IV
Monitor and rotate injection sites
Good mouth care
Yogurt/buttermilk if diarrhea develops - monitor for loose, foul-smelling stool and change in TONGUE
Stay on schedule, take missed drugs asap, do not double dose
Take careful history of penicillin reaction - catch allergy.
CROSS ALLERGY WITH CEPHALOSPORINS

Question 8

sulfasalazine
Trimethoprim/sulfamethoxazole
Sulfisoxazole

Answer 8

SULFONAMIDES

Action: bacterioSTATIC. Competitively antagonize paraminobenzoic acid, essential component of folic acid synthesis, causing cell death

Indications: ulcerative colitis, Crohn’s disease, rheumatoid arthritis
Otitis media, conjuctivitis
Meningitis, toxoplasmosis
UTIs

Adverse: peripheral neuropathy
Crystalluria, proteinuria (sulfisox)
Photosensitivity, GI upset, stomatitis (sulfasalazine)
Skin eruption, agranulocytosis (sulfasalazine)
Allergy, blood dyscrasias, rash (trimethoprim)

Hypersensitivity reaction

Considerations: C&S before therapy
Take on empty stomach with glass of water, take ATC,
“encourage” (force) fluid intake (8 glasses/day). Maintain ALKALINE urine. bicarbonate may be indicated to elevate pH
Avoid Vitamin C, which acidifies urine (sulfisox)
Protect from exposure to light
Good mouth care
Trimethoprim: never IM; IV given slowly over 60-90 min

Question 9

Doxycycline
Minocycline
Tetracycline

Answer 9

TETRACYCLINES

Action: bacterioSTATIC. Inhibits protein synthesis of susceptible bacteria

Indications: 
Syphilis, gonorrhea, chlamydia
Malaria prophy, acne
Chronic periodontitis, H pylori (in combination with others)
Anthrax (doxy), Lyme (tetra)

Adverse: discoloration/inadequate calcification of primary teeth of fetus if taken during pregnancy
Glossitis, dysphasia, diarrhea, rash
Renal, hepatic, hematological abnormalities, GI upset (tetra)
Photo toxic reactions
SUPERINFECTIONS

Considerations: take 1h BEFORE/2-3H AFTER meals. Do not take with antacids, milk, iron preparations
Note expiration date - becomes highly NEPHROTOXIC. Monitor renal function
Protect from sunlight, topical may stain clothing
Use backup contraception - impacts effectiveness oral contraceptives
tetra - assess for change in bowel habits, perineal rash, ‘hairy’ tongue.
Monitor I&Os
Doxy - check pt tongue for Monilia infection

Question 10

Bacitracin ointment
Neosporin cream
Povidone-iodine solution
Silver sulfadiazine cream
Tolna flake cream
Nystatin cream

Answer 10

Adverse effects
Bacitracin - nephrotoxicity, OTOTOXICITY
Neosporin - nephrotoxicity, OTOTOXICITY 
Povidone- irritation
SS - neutropenia, burning
Tolna- irritation
Nystatin - contact dermatitis

Considerations:
Bacitracin - overgrowth of no susceptible organisms can occur
Neosporin - allergic dermatitis
Povidone-iodine - don’t use around eyes. May stain skin. Don’t use full strength on mucus membranes.
SS - use cautiously if sensitive to SULFONAMIDES
Tolna- use small amount, for duration prescribed
Nystatin - do not use occlusive dressings