Tetracyclines

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This post is for Bonnie Lee and Jisun Kang. Please let us know if we have missed anything, your feedback is greatly appreciated.

Thank you,
 Bonnie & Jisun

Tetracylcines:

·         Isolated from Streptomyces in 1948.

·         First broad-spectrum antibiotic effect against gram positive and gram-negative bacteria and other organisms.

Action

·         This medication is used to treat bacterial infections through inhibiting the bacterial protein synthesis and have a bacteriostatic effect

Indications 

·         Short-Acting Tetracycline

tetracycline (Sumycin)

-          is used for infections caused by  Gram-positive and gram-negatice microorganisms for Pneumonia and other respiratory tract infections, Skin disorders, Chlamydia, Gonorrhea, syphilis, Rickettsia Infections

 

·         Intermediate-Acting Tetracycline  

                demaclocycline HCl (Declomycin)

-          is used for gram-positve and gram-negative bacteria 

·         Long-Acting Tetracycline   

doxycycline hycalate (Vibramycin)

minocycline HCl (Minocin)

-          is used for bacterial infections and acne 

• Glyclycclines

 Tigecycline (Tygacil)

-          Used for complicated skin and intrabdominal infections

 

Interactions

•        My increase effect of warfarin

•        May decrease effects of oral contraceptives

•        Antacids

•        Sucralfate may prevent absorption

•        Antiadiarrheal medications

•        Barbituates

•        Calcium in foods or dairy products

 

Route 

·         Oral – most frequent and newer oral preparation, such as doxycycline and minocycline are rapidly and completed absorbed. It is recommended that Tetracylcine be taken on an empty stomach except for doxycycline and minocycline. 

·         IM – causes pain on injection and tissue irritation and is seldom used 

·         IV – to treat severe infections

 

Contraindications

•        Hypersensitivity,

•        Severe hepatic disease or renal disease

•        Pediatrics: Children under the age of 8 should not be prescribed Tetracyclines due to the permanent/irreversible discoloring of teeth.

•        Pregnancy: Should not be taken in 1^st trimester of pregnancy due to teratogenic affects

•        Lac: Lactation

 

Side/Adverse Effects

·         GI disturbances: nausea, vomiting, and diarrhea, esophagitis

·         Dizziness

·         Photosensitivity may occur  (especially Declomycin)

·         Rashes

·         Hepatoxicity

·         Pancreatitis

·         Blood Dyscrasias

·         Hypersensitivty

·         Superinfections due to the disruption of intestinal flora 

 Nursing implications

·         Obtain a patient’s history: allergy to tetracycline, liver or renal dysfunction, pregnancy, lactation, dietary intake and drugs client currently takes.

·         Check renal and liver function. (BUN, Serum creatinine, AST, ALT, Bilirubin)

·         Assess and record vital sign and urine output.

·         Check culture and sensitivity before starting antibiotic therapy

·         Administer oral medication on an empty stomach, 1 hour before or 2 hours after meals.

·         Do not give with antacids. (If antacids must be used, give them 3 hours after the dose of tetracycline.)

·         Do not administer during pregnancy. (teratogenic effect)

·         Do not use outdated drugs. (nephrotoxic effect)

·         Monitor laboratory values regularly for liver and kidney functions. (Liver enzymes, BUN, Serum creatinine) 

Patient teaching

·         Educate patients to take tetracycline on an empty stomach, 1 hour before or 2 hours after meals, with a full glass of water.

·         Instruct patients not to take the drug with milk products, iron, and antacids.

·         Advise patients to check expiration date on the bottle of tetracycline.

·         Instruct patients to store tetracycline away from light and extreme heat.

·         Encourage patients to use sun block and protective clothing during sun exposure. (photosensitivity)

·         Advise patients to use additional contraceptive techniques to avoid pregnancy. (The desired action of oral contraceptives can be lessened when taken with tetracycline.)

·         Warn parents that children less than 8 years old should not take tetracycline. (discoloration of permanent teeth)

·         Teach patients to use effective oral hygiene several times a day. (stomatitis)

·         Instruct patients to report signs of a superinfection. (mouth ulcers, anal or genital discharge)

·         Advise patients to take the full course of tetracycline.

 References

Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2012). Pharmacology. A nursing process approach.

                 St. Louis, MO: Elsevier.

http://web.squ.edu.om/med-lib/med_cd/e_cds/Nursing%20Drug%20Guide/mg/tetracycline_hydrochloride.htm

Vallerand, A. ,  Sanoski, C. A. & Deglin, J., & (2013). Davis's drug guide for nurses. (13^th ed).

             Philadelphia: F.A. Davis Company.