Macrolides, Tetracyclines, Aminoglycosides and Fluoroquinolones Flashcards
The action of macrolides is
bacteriostatic at low doses; bactericidal at high doses
binds to the 50S ribosomal subunit and inhibit protein synthesis.
Are macrolides broad or narrow spectrum? Against which category of bacteria are they effective?
Broad spectrum
most gram+, some gram-
Routes of administration for macrolides are
oral
IV - infuse slowly to avoid plebitis
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
Macrolides include
azithromycin
clarithromycin
erythromycin
Before infusing azithromycin and erythromycin, they should be
diluted in NS or D5W to prevent phlebitis or pain
The side effects/ adverse reactions of macrolides are
Hepatotoxicity Tinnitus, ototoxicity GI distress (pseudomembranous colitis) Superinfection conjunctivitis (z-pack)
Interactions of Macrolides are
levels of theophylline (bronchodilator) carbamazepine (anticonvulsant) Warfarin (anticoagulant)
Erythromycin should not be used with
other macrolides (fluconazole, ketoconazole) as there is a risk of sudden cardiac death
What effect do antacids have on azithromycin
may reduce peak levels when taken at the same time
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
Assessment for macrolides
Check for normal VS and Urine output
Check labs (liver); order periodically with long term use
Hx of current drugs (antacids?)
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)
The action of Lincosamides are
bacteriostatic and bactericidal
inhibit bacterial protein synthesis
Lincosamides are effective against what category of bacteria
Gram+
s. aureus
Lincosamides include
Clindamycin
Lincomycin
Side effects/adverse reactions of lincosamides are
Rash
GI distress, colitis
anaphylactic shock
Interactions of lincosamides include
- kaolin and pectin decrease lincomycin absorption
- incompatible with aminophylline, phenytoin, barbiturates, and ampicillin.
The action of Glycopeptides are
Bactericidal
Inhibits cell wall synthesis
Glycopeptides include
Vancomycin
Telavancin
The side effects and adverse reactions of vancomycin are
Pseudomembranous colitis
Blood dyscrasias
Redneck or red man syndrome
Ototoxicity
Nephrotoxicity
Stevens-Johnson syndrome
The uses of Vancomycin are
serious bone, skin, or lower respiratory infections
Vancomycin is effective against
gram+
S. aureus
clostridium difficile
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
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
