Macrolides

Here is our outline on Macrolides. Please let us know if this information is correct and pertinent to the teaching of safe administration.

Thank you for your valuable input!

Anne Fator & Damian Ellis

Macrolides- called broad-spectrum antibiotics

They are active against most gram-positive bacteria and moderately active against some gram-negative bacteria.

Includes:

• ·         Azithromycin (Zithromax)

• ·         Clarithromycin (Biaxin)

• ·         Erythromycin (E-Mycin)

Action:

• ·         Binds to the 50S ribosomal subunits and inhibits steps of protein synthesis, bacteriostatic in low-moderate doses, bactericidal in high doses.

Indications:

• ·         Upper and lower respiratory infections

• ·         Skin and soft tissue infections

• ·         Diptheria

• ·         Impetigo contagiosa

• ·         Chlamydial infections

• ·         Legionnaires’ disease

• ·         Pneumococal pneumonia

• ·         Acute pelvic inflammatory disease

• ·         Intestinal amebiasis

• ·         Helicobacter pylori

• ·         Mycobacterial species

• ·         Gram positive and negative organisms

Routes:

• ·         Oral

• ·         IV

Side effects/Adverse effects:

• ·         Nausea

• ·         Vomiting

• ·         Diarrhea

• ·         Abdominal cramping

• ·         Rash

• ·         Pruritus

• ·         Tinnitus

• ·         Superinfections

• ·         Vaginitis

• ·         Urticaria

• ·         Stomatitis

• ·         Hearing loss

• ·         Anaphylaxis

• ·         Hepatotoxicity

Pharmacokinetics:

• ·         Readily absorbed from the GI tract.

• ·         Excreted in bile, feces, and a small amount in urine.

Drug Interactions:

• ·         Antacids may reduce peak levels when taken at the same time.

• ·         Increases serum levels of theophylline, carbamazepine, and warfarin.

• ·         Erythromycin should not be used with other macrolides.

Nursing Interventions:

• ·         Assess Vital signs and urine output.

• ·         Obtain a culture and sensitivity before starting therapy.

• ·         Check lab tests (liver enzyme values) to determine liver function.

• ·         Administer any antacids 2 hours before or 2 hours after use of azithromycin.

• ·         Administer oral azithromycin 1 hour before or 2 hours after meals.

• ·         Infuse IV macrolides slowly to avoid unnecessary pain.

Teaching:

• ·         Should be taken with full glass of water (not fruit juice).

• ·         Report persistent diarrhea.

• ·         Report nausea, vomiting, diarrhea, abdominal cramps, and itching.

• ·         Take with food if GI upset occurs.

• ·         Importance to completing full course of antibacterial as prescribed.

Contraindications:

• ·         Hypersensitivity

• ·         Caution: Hepatic dysfunction, lactation, renal dysfunction

Aminoglycosides

Hi, here is Jeana Pfalzer's and April Madera's outline on Aminoglycosides. Thank you for your help!

Aminoglycosides

 What are they?

•  Aminoglycosides are antibiotics
• Aminoglycosides act by inhibiting bacterial protein synthesis and are used against gram-negative bacteria such as E. coli, Proteus, and Pseudomonas 
• Some gram positive cocci are resistant to aminoglycosides, therefore penicillin or cephalosporins are effective
• Aminoglycosides are used mostly for serious infections
• when administered with penicillins, the effects of aminoglycosides are decreased

Absorption

• They are not absorbed in the gastrointestinal tract
• They are not able to cross into the cerebrospinal fluid
• They cross through the given blood-brain barrier in children but not adults
• These are commonly via intramuscular and intravenous routes
• Two aminoglycosides given by oral route include neomycin and paromomycin

        Neomycin

• used as a preoperative bowel antiseptic

        Paromomycin

• used in treating intestinal amebiasis and tapeworm infestation

Examples of aminoglycosides include: Gentamicin, Tobramycin, and Streptomycin

 Gentamicin Sulfate

• used to treat infections caused by gram-negative organisms. It is used to treat inflammatory disease and it is effective against Staphylococcus aureus
• given intramuscular or intravenous
• side effects include anorexia, nausea, vomiting, rash, tremors, tinnitus, pruritus, and mnuscle cramps

Tobramycin

• effective against pseudomonas aeruginosa
• given intravenous or intramuscular
• hearing changes and urinary output should be monitored. this aminoglycosides has fewer toxic effects than others

Streptomycin

• streptomycin was the first aminoglycoside
• used with antituberculosis drugs
• ototoxicity is a major prblem with this drug

Dosage and Route

• Amikacin 15 mg/kg q 8 hr IM, IV
• Gentamicin 1 mg/kg q 8 hr IM, IV
• Streptomycin 1 g/day initially decreased to 1 g 2-3 times weekly IM
• Tobramycin 0.75-1.25 mg/kg q 6 hr

Side Effects of Aminoglycosides

•  ototoxicity 
• nephrotoxicity- renal function, drug dose, and age are factors that determine this
• drug dosing is important with younger children and older adults
• prolonged use could result in superinfection
• serum aminoglycoside levels should be monitored to avoid adverse reactions

Contraindications

• hypersensitivity to aminoglycosides or bisulfites

Drug Interactions

• effects of aminoglycosides are decreased when given with a penicillin
• the drug action of oral anticoagulants may increase when taken together with aminoglycosides
• the risk of ototoxicity increases when ethacrynic acid is given simultaneously

Nursing Implications

• assess for infection (vital signs, wound appearance, sputum, urine, stool, WBC) at beginning of and throughout therapy
• obtain specimens for culture and sensitivity before initiating therapy  
• monitor intake and output and daily weights to assess hydration status and renal function
• assess for signs of superinfection (fever, upper respiratory infection, vaginal itching or discharge, increasing malaise, diarrhea)
• evaluate eighth cranial nerve function by audiometry before and throughout therapy. hearing loss is usually in the high-frequency range
•   monitor renal function by urinalysis, specific gravity, BUN, and creatinine before and throughout therapy
• may cause increased BUN, AST, ALT, serum alkaline phosphate, bilirubin, creatinine, and LDH concentrations
• monitor blood levels periodically. Draw blood for peak levels 1 hr. after IM injection and 30 min. after IV infusion is complete. Trough levels should be drawn just before next dose

Implementation

• IM administration should be deep into well developed muscles. Alternate injection site
• Y-site compatibility and incompatibility should be considered
• in case if there is vestibular dysfunction, nausea, vomiting, headache, or fever then drug should be discontinued

Patient Teaching

• Instruct patient to report if there is loss of hearing feeling of fullness in head
• to report headache, dizziness, or renal impairment
• instruct patient to keep hydrated (1500 - 2000 ml/day) during therapy

Evaluation

• therapeutic response if there is absence of fever, draining wounds, etc.

References
 

Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2012). Pharmacology: A nursing process approach (7th ed.). St. Louis, MO: Elsevier Saunders.

Pagkalis, S., Mantadakis, E., Mavros, M. N., Ammari, C., & Falagas, M. E. (2011). Pharmacological Considerations for the Proper Clinical Use of Aminoglycosides. Drugs, 71(17), 2277-2294. doi:10.2165/11597020-000000000-00000

  
 

Metronidazole/Flagyl

Hello, here is my outline on Metronidazole. As a nurse, I believe the most important focus areas the patient teaching and nursing implications. Thank you for taking the time to review this.

Metronidazole/Flagyl

Antibiotic that disrupts DNA function of susceptible bacteria.

Indications

Used to treat various disorders associated with organisms in the GI tract. Also used to treat intra abdominal infections, gynecological infections, skin infections, lower resp. tract infections, bone and joint infections, septicemia, and endocarditis.

§     Clostridium Difficile

§     Amebic dysentery

§     Amebic liver abcess

§     Trichomoniasis

§     Peptic ulcer disease due to H. Pylori

§     Prophylaxis for colorectal surgery

Dosage/Routes

PO:

Anaerobic infections – 7.5mg/kg Q6Hr

Trichomoniasis – 250mg Q8Hr for 7 days or single 2g dose

Amebiasis – 500-750mg Q8Hr for 5-10 days

H. Pylori – 250mg QID or 500mg BID for 1-2 weeks

Bacterial Vaginoses – 750mg daily for 7 days

IV:

Anaerobic Infections- initial dose 15mg/kg then 7.5mg/kg Q6-8hr or 500mg q2-8hr

Pre-op prophylaxis – 15mg/kg 1 hr prior to surgery, then 7.5mg/kg 6 and 12 hours after

Amebiasis – 500-750mg q8hr for 5-10 days

Contraindications

Hypersensitivity to metronidazole

First semester of pregnancy

Nursing Implications

§  Assess patient for s/s of infection prior to beginning therapy, and throughout the course of the therapy

§  Obain specimens for C&S prior to initiating therapy. First dose can be given before results receiving results.

§  Monitor neuro status during IV infusions. Notify physician if numbness, paresthesia, weakness, ataxia, or seizure occurs.

§  Monitor INR because flayl increases the effects of warfarin

§  Administer PO dose with food or milk to minimize GI irritation.

§  Administer IV dose as a sloe infusion, each dose over 1 hour. Flagyl IV is pre-diluted and ready to use.

§  Phenobarbital may decrease the effectiveness of metronidazole

§  Cimetidine may decrease the metabolism of metronidazole.

Patient Teaching

§  Avoid alcoholic beverages for 48 hours after treatment. May cause a disulfiram reaction resulting in flushed face, headache, tachycardia, palpitations, hypotension, dyspnea, sweating, slurred speech, abdominal cramping, N/V.

§  Instruct patient to finish full course of medication, and take as directed.

§  Instruct patient that this medication may cause reddish brown urine

§  Instruct patient that this medication may cause a metallic taste

Side Effects:

Dizziness, headache, confusion, depression, irritability, weakness and insomnia

Nitrofurantoin

 

Nitrofurantoin

Trade names: Furadantin, Macrodantin

 

Dosage

v  Adult: PO 50-100mg  qid with meals and HS.

v  Child greater than 1 years of age: PO 1.25-1.75 mg/kg/d divided in 4 doses. Maximum dose 7mg/kg/d

 

What is it

v  Urinary anti-infective- inhibits bacterial enzymes and metabolism

v  Treats many gram-positive and gram-negative rods which include E.coli, Neisseria, streptococci, Staphyloccocus aureus.

v  Treats acute and chronic urinary tract infections

 

Pharmacokinetics

v  Well absorbed through GI tract- should be taken with food to decrease GI upset.

v  Avoid taking antacids at same time as these decrease absorption of drug.

v  Short half life of 20 minutes

v  Excretion occurs in urine as well as small amounts of bile

 

Pharmacodynamics

v  Low doses used for prophylactic use=bacteriostatic effect

v  High doses used for acute infections=bactericidal effect

v  Onset and duration of action is unknown

v  Peak occurs within 30 minutes

 

Assessment

v  Obtain urine culture and sensitivity prior to beginning of antibiotic

v  Assess renal and hepatic function

v  Obtain urine pH, desired is < 5.5 to maximum effectiveness of drug

v  Monitor urine output and specific gravity

v  Monitor for side effects which include anorexia, nausea, discoloration of urine to a brown/rust color, diarrhea, rash, pruritic, dizziness, headache, drowsiness

v  Monitor and assess for adverse reactions which include peripheral neuropathy, super infections (such as stomatitis, genital discharge or itching), hemolytic anemia, agranulocytosis. Life threatening reactions include anaphylaxis, hepatoxicity and Steven Johnson syndrome.

v  Known contraindications: moderate to severe renal impairment, oliguria, anuria, creatine clearance <40ml/min, infants less than 1 year of age, term pregnancy (this drug is a category B), lactation with infant suspected of having G-6-PD deficiencies

v  Known cautions in administration of drug include Vitamin B deficiency, electrolyte imbalances, and diabetes mellitus.

 

Teaching to patient

v  Do not crush or open capsules

v  Drug can stain teeth so should rinse mouth after administration

v  Shake suspension prior to administration

v  Keep at room temperature

v  Patient should not operate motor vehicle or machinery while on medication, as medication can make one drowsy

v  Instruct to report S&S of super infection such as white covering of the tongue, anogenital itching or discharge

v  Should avoid taking drug with antacids and probenecid as this decreases effectiveness of drug.

Tetracyclines

Hi!

This is the outline that Sunmin and I have made for our project on tetracyclines.  Please let me know if we have any incorrect information, are missing anything important, or if there is anything we should remove from the presentation.

Thank you very much for your help!

Tetracyclines

Origin

• ·      Isolated from Streptomyces aureofaciens bacteria in 1948
• ·      First broad-spectrum antibiotics.

Action

• ·      Tetracyclines inhibit bacterial protein synthesis and have a bacteriostatic effect.

Indications

• ·      Short-Acting Tetracycline [tetracycline (Sumycin)]:
• o  infections caused by gram-positive and gram-negative bacteria, respiratory and skin disorders, chlamydial infection, gonorrhea, syphilis, and rickettsial infections.
• ·      Intermediate-Acting Tetracycline [demeclocycline HCL (Declomycin)]:
• o   gram-positive and gram-negative bacteria.
• ·      Long-Acting Tetracyclines [doxycycline hyclate (Vibramycin), minocycline HCL (Minocin)]:
• o   bacterial infections and acne.

Route

• ·      Oral: newer tetracyclines (doxycycline and minocycline) are absorbed rapidly and completely
• ·      IM: seldom used, causes pain at injection site
• ·      IV: used for treatment of severe infections

Side effects

• ·      GI disturbances, such as nausea, vomiting, diarrhea, heartburn, and abdominal discomfort
• ·      Photosensitivity can occur, especially with demeclocycline (Declomycin).
• ·      Ototoxicity is possible with Minocycline (Minocin), which can damage the vestibular part of the inner ear, resulting in difficulties with balance.
• ·      Nephrotoxicity (Kidney toxicity) can occur when tetracycline is given in high doses with other nephrotoxic drugs
• ·      Super infections can result from the disruption in the body’s normal microbial flora

Contraindications

• ·      Pregnancy: Tetracycline can be teratogenic when taken during the first trimester.
• ·      Children younger than 8: tetracycline can irreversibly discolor the permanent teeth. Women in the last trimester of pregnancy should also avoid tetracycline for this reason.
• ·      Hypersensitivity, severe hepatic or renal disease

Nursing Implications

• ·      Assessment

·      Assess vital signs and urine output.

·      Check laboratory results, especially renal and liver function (BUN, serum creatinine, AST, ALT, and bilirubin).

·      Obtain a diet and drug history. Drug absorption is decreased in the presence of dairy products, antacids, iron, calcium, and magnesium.  Tetracyclines increase digoxin absorption, which could lead to digitalis toxicity.

• ·      Nursing Interventions

·      Obtain a culture from the infected area for a culture and sensitivity test. Antibiotic therapy can be started after cultures are taken.

·      Tetracycline should be administered 1 hour before or 2 hours after meals for optimum absorption.

Patient teaching

• ·      Tetracyclines should not be taken with magnesium or aluminum based antacids, milk products or other drugs high in calcium, or drugs containing iron.  These substances prevent absorption of the drug.
• ·      Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals.
• ·      Doxycycline and minocycline absorption is improved when taken with food.
• ·      Patients should not take tetracyclines if they are pregnant due to possibly teratogenic effects.
• ·      Tetracycline can decrease the effectiveness of birth control pills. Patients should use a second method of birth control while taking tetracyclines.
• ·      Patients should tell their doctor if they are breast-feeding.  Tetracycline passes into breast milk and may affect bone and tooth development in a nursing baby.
• ·      Tetracycline should not be given to children younger than 8 years old, because it can cause permanent yellowing or graying of the teeth, and can affect a child's growth.
• ·      Tetracycline can cause sunburn.  Patients should avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds) and wear sunscreen (minimum SPF 15) and protective clothing if they must be out in the sun.
• ·      Patients should not take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking tetracycline.
• ·      Unused tetracycline should be thrown away. Expired tetracycline can be toxic and can cause a dangerous syndrome resulting in damage to the kidneys.
• ·      Tetracycline should be stored in a dark place away from extreme heat.

Interesting information

• ·      In 2006, Moyer reported that “Patients are more likely to acquire Clostridium difficile infection if they take imipenem, ceftazidine, clindamycin, or moxifloxacin…however, patients who take tetracycline are less likely to get C difficile.” 

References

Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2012). Pharmacology. A nursing process approach. St. Louis, MO: Elsevier.

Moyer, P. (2006). Four antibiotics, in various classes, most likely to cause clostridium difficile infection. Retrieved from http://www.medscape.com/viewarticle/545269.