Macrolides, Tetracyclines, Aminoglycosides and Fluoroquinolones Flashcards by Elizabeth Seal

The action of macrolides is

bacteriostatic at low doses; bactericidal at high doses

binds to the 50S ribosomal subunit and inhibit protein synthesis.

How well did you know this?

Not at all

Perfectly

Are macrolides broad or narrow spectrum? Against which category of bacteria are they effective?

Broad spectrum

most gram+, some gram-

How well did you know this?

Not at all

Perfectly

Routes of administration for macrolides are

oral

IV - infuse slowly to avoid plebitis

How well did you know this?

Not at all

Perfectly

Macrolides are used for what types of infections?

mild to moderate infections of the 
respiratory tract, sinuses
GI tract
skin, soft tissue
diphtheria
impetigo contagiosa
sexually transmitted infections
mycoplasma pneumonia
legionnaire's disease

How well did you know this?

Not at all

Perfectly

Macrolides include

azithromycin
clarithromycin
erythromycin

How well did you know this?

Not at all

Perfectly

Before infusing azithromycin and erythromycin, they should be

diluted in NS or D5W to prevent phlebitis or pain

How well did you know this?

Not at all

Perfectly

The side effects/ adverse reactions of macrolides are

Hepatotoxicity
Tinnitus, ototoxicity
GI distress (pseudomembranous colitis)
Superinfection
conjunctivitis (z-pack)

How well did you know this?

Not at all

Perfectly

Interactions of Macrolides are

levels of theophylline (bronchodilator) carbamazepine (anticonvulsant) Warfarin (anticoagulant)

How well did you know this?

Not at all

Perfectly

Erythromycin should not be used with

other macrolides (fluconazole, ketoconazole) as there is a risk of sudden cardiac death

How well did you know this?

Not at all

Perfectly

What effect do antacids have on azithromycin

may reduce peak levels when taken at the same time

How well did you know this?

Not at all

Perfectly

Interventions for macrolides

C and S
Monitor liver enzymes
Take ALL of the prescribed medications
Take antacids 2hr before or after med administration
Give azithromycin 1 hr before or 2hr after meals with water

How well did you know this?

Not at all

Perfectly

Assessment for macrolides

Check for normal VS and Urine output
Check labs (liver); order periodically with long term use
Hx of current drugs (antacids?)

How well did you know this?

Not at all

Perfectly

Teaching for macrolides

Take All of the prescribed medication
Teach symptoms of superinfection
report all adverse rxn/side effects
report onset of loose stool (pseudomembranous colitis)

How well did you know this?

Not at all

Perfectly

The action of Lincosamides are

bacteriostatic and bactericidal

inhibit bacterial protein synthesis

How well did you know this?

Not at all

Perfectly

Lincosamides are effective against what category of bacteria

Gram+

s. aureus

How well did you know this?

Not at all

Perfectly

Lincosamides include

Clindamycin

Lincomycin

How well did you know this?

Not at all

Perfectly

Side effects/adverse reactions of lincosamides are

Rash
GI distress, colitis
anaphylactic shock

How well did you know this?

Not at all

Perfectly

Interactions of lincosamides include

kaolin and pectin decrease lincomycin absorption

- incompatible with aminophylline, phenytoin, barbiturates, and ampicillin.

How well did you know this?

Not at all

Perfectly

The action of Glycopeptides are

Bactericidal

Inhibits cell wall synthesis

How well did you know this?

Not at all

Perfectly

Glycopeptides include

Vancomycin

Telavancin

How well did you know this?

Not at all

Perfectly

The side effects and adverse reactions of vancomycin are

Pseudomembranous colitis
Blood dyscrasias

Redneck or red man syndrome
Ototoxicity
Nephrotoxicity
Stevens-Johnson syndrome

How well did you know this?

Not at all

Perfectly

The uses of Vancomycin are

serious bone, skin, or lower respiratory infections

How well did you know this?

Not at all

Perfectly

Vancomycin is effective against

gram+
S. aureus
clostridium difficile

How well did you know this?

Not at all

Perfectly

When given intermittantly Vancomycin should

be diluted in D5W, NS or LR and administered at a rate of 10mg/min for at least 60 minutes

How well did you know this?

Not at all

Perfectly

Route of administration for Vancomycin are

oral | IV

Interventions for Vancomycin are

``` C and S Monitor Peaks and troughs Administer IV over 1 to 2 hours Rotate sites Monitor BP Monitor IV Monitor renal function tests and hearing Monitor for superinfection ```

Drug interactions for Glycopeptides are

- Dimenhydrinate (Dramamine) can mask ototoxicity w/ Vancomycin - Increased risk of nephro- ototoxicity with furosemide, aminoglycosides, amphotericin B colistin, cisplatin, and cyclosporine. - Vancomycin inhibits methotrexate excretion - Oral absorption decreased with cholestyramine and colestipol

The action of Tetracyclines is

Bacteriostatic | inhibition of protein synthesis

Tetracyclines are effective against

gram+ and gram- (broad) Helicobacter pylori Treatment for acne (oral, topical)

Route of administration for tetracyclines are

oral IM IV

Side effects and adverse reactions of Tetracyclines are

Photosensitivity hepatotoxicity, nephrotoxicity, CNS toxicity discoloration of permanent teeth GI distress (pseudo. colitis), Stomatitis blood dyscrasia Superinfection

Due to resistance, Tetracycline is not effective against

pneumococcal and gonococcal infections.

Tetracyclines taken with aminoglycosides can lead to

nephrotoxicity

Tetracyclines taken with oral contraceptives and penicillins

cause decreased efficacy of the contraceptives and penicillins.

Tetracyclines taken with milk or calcium containing drugs can cause

decreased absorption of the tetracyclines EX.dixycyline, minocycline have better absorption with milk.

Antacids or other iron-containing drugs can cause _____ when taken with tetracyclines

non-absorption of tetracycline in the GI tract

Short-acting tetracyclines include

tetracycline

Intermediate-acting tetracyclines include

demeclocycline

Long-acting tetracyclines include

doxycycline | Take with milk and food

When taken with tetracyclines, Digoxin has ____. What are the s/s?

increased absorption leading to toxicity s/s - bradycardia, visual disturbances, HA, N/V/D

Assessment for Tetracyclines

VS Check labs, esp. renal and liver fx Hx of diet and drugs

Labs testing for kidney and liver fx are

kidney - BUN, serum creatinine | liver - AST, ALT, bilirubin

Interventions for tetracyclines are

C and S Administer 1hr before or 2hr after meals Monitor kidney and liver fx Record VS and urine output

Teaching for tetracyclines are

``` Take the entire course of medication Store out of light and heat Avoid if pregnant DO NOT GIVE to children under age 8 Wear sunblock and protective clothing Watch for signs of superinfection avoid milk, iron, and antacids Administer 1hr before or 2hr after meals Use good oral hygiene to prevent mouth ulcers (stomatitis) ```

The action of aminoglycosides is

bactericidal | inhibits bacterial protein synthesis

Aminoglycosides are effective against

gram- E. coli Proteus pseudomonas

Aminoglycosides include

streptomycin sulfate gentamicin sulfate kanamycin sulfate tobramycin sulfate

The route of administration for aminoglycosides is

IM IV eye drops (some, like Neomycin, can be given orally)

The uses of aminoglycosides are

serious infections of gram- bacterias

Side effects/adverse rxns for Aminoglycosides are

photosensitivity superinfection ototoxicity nephrotoxicity

If taken with penicillins he effect on aminoglycosides is

decreased efficacy

Interventions for aminoglycosides are

``` Check C and S Draw BUN and creatinine before admin Monitor renal function, hearing loss monitor superinfection monitor peak and trough levels Monitor U/O (at least 30mL/hr) May have frequent urinalysis ```

Teaching for aminoglycosides

increase fluids unless CI report side effects (NV, tremors, tinnitus, pruritis, cramps) Use sun block and protective clothing

The action of fluoroquinolones (Quinolones) is

broad spectrum bactericidal | to interfere with enzyme DNA gyrase

fluoroquinolones (Quinolones) are effective against

gram+ and gram- streptococcus pneumoniae salmonella

fluoroquinolones (Quinolones) are used for

Bone and joint infections Bronchitis and pneumonia gastroenteritis UTI, gonorrhea

The route of administration for fluoroquinolones (Quinolones) is

oral | IV

fluoroquinolones (Quinolones) include

Ciprofloxacin | Levofloxacin

Side effects/Adverse rxns for fluoroquinolones (Quinolones) include

``` Rash, urticaria tinnitus, photosensitivity GI upset, pseudo. colitis Superinfection Hematuria crystalluria ```

Drug interactions for fluoroquinolones (Quinolones) include

Antacids decrease absorption rate | Levofloxacin increases effect of oral contraceptives, hypoglycemics, theophylline, and caffeine.

Interventions for fluoroquinolones (Quinolones) are

``` C and S renal fx tests Infuse IV over 60-90 min increase fluid intake >2000mL/d Avoid caffeine Report signs of superinfections Take with full glass of water 2hr before or after antacids ```