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Glycopeptides
Vancomycin HCL (VANCOCIN)
– is a glycopepticde bactericidal antibiotic used in
the 50’s to treat staphylococcus infections.
-inhibits
bacterial cell wall synthesis and is active against many gram-positive
microorganisms.
-used for s. aureus-resistant infections and cardiac
surgical prophylaxis in clients with penicillin allergy. -Given orally for tx of staphylococcal
enterocolitis and antibiotic-associated pseudomembranous colitis due to
Clostridium difficile.
-Vanco has become ineffective for treating
enterococci.
–Given IV for severe infections d/t MRSA;septicemia;
and bone, skin and lower respiratory tract infections that don’t respond or are
resistant to other antibiotics.
-Peak action is 30 minutes after the end of
infusion.
-30% protein bound and has a half life of 6
hours.
-When not given orally, it is not absorbed
systemically and is excreted in the feces.
-Serum vanco levels should be monitored as it can
cause nephrotoxicity and ototoxicity.
-Intermittent doses should be diluted in 100 ml for
500 mg and 200ml for 1g of D5W, NS or RL and administered at a rate of 10mg/min
or a minimum of 60 minutes.
-side effects-chills, dizziness, fever, rashes,
nausea, vomiting, thrombophlebitis.
Rapid infusion can cause red man syndrome or red neck syndrome.
-Adverse reactions include vascular collapse,
ototoxicity, temporary or permanent loss of balance, permanent hearing loss,
nephrotoxicity, eosinophilia, neutropenia and Stevens-Johnson syndrome, severe
hypotension, thachycardia, tingling and cardiac arrest and red neck syndrome.
Drug Interactions –when taking dimenhydrinate
(Dramamine) with vanco can maks ototoxicity.
The risk of nephrotoxicity and ototoxicity may be potentiated when vanco
is given with furosemide, aminoglycosides, amphotercin B, colistin, cisplatin,
cyclosporine. Vanco may inhibit
methotrexate excretion and increase methotrexate toxicity. The absorption of oral vanco may be decreased
when given with cholestyramine and colestipol.
Nursing Considerations-Assess for
improvement/worsening of the infection
-Record i/o, report
hematuria,
-Monitor hearing
function
-Monitor bp-sudden drop
may indicate red man syndrome
-Monitor integumentary
and respiratory systems
-Administer
antihistamine if suspect red man syndrome
-Report sore throat,
fatigue –could be a sign of superinfection
Teach
- take entire course of
medication, must be taken at regular intervals around the clock,
Telavancin (Vibativ)
- is a semisynthetic derivative of vancomycin.
- inhibits bacterial
cell wall
synthesis by binding to the D-
Ala-D-Ala
terminus of the peptidoglycan in the cell wall.
Also, disrupts bacterial
membranes .
-used for treating gram pos skin infections and
MRSA.
-Once-daily dosing via IV administration.
-90% protein bound, half life 9 hours
-Excretion-
|
76% in urine, <1% in feces
|
-Side
Effects- nausea, vomiting, constipation, diarrhea,
stomach pain, loss of appetite, chills,
dizziness, foamy appearance in urine, unusual or unpleasant taste,
vaginal itching or discharge, mild skin rash or itching, redness or pain around
the IV needle.
-Adverse effects –bloody diarrhea, drowsiness, confusion, mood changes,
increased thirst, swelling, weight gain, feeling short of breath, oliguria,
anuria, hearing
loss, red neck syndrome, hives, difficult breathing; swelling of your face,
lips, tongue, or throat and blood dyscrasias.
Drug Interactions - increases in the PT, INR, aPTT, and ACT
Bleomycin
-Inhibits synthesis of DNA and RNA ; derived from
streptomyces verticillus
-used to tread cancer of the head, neck, penis,
cervix, vulva of squamous cell origin, lymphosarcoma, Hodgkin’s and
non-Hodgkin’s disease, reticulum cell sarcoma, testicular cardinoma and as a
sclerosing agent for malignant pleural effusion.
-Routes- subq, IM, IV, intrapleural
-Side effects- pain at tumor site, HA, confusion,
nausea, vomiting , anorexia, stomatitis, weight loss, ulceration of mouth and
lips, hypotension, confusion, fever, chills, wheezing, rash, hyperkeratosis,
nail changes, alopecia, pruritis, acne, striae, peeling, hyuperpigmentation,
fibrosis, pneumonitis, pulmonary toxicity, raynaud’s phenomenon
-Contraindications- pregnancy, breast feeding,
hypersensitivity, prior reaction.
-Preacautions –pts> 70 yo, renal, hepatic, respiratory
probs.
-Half life-2h, metabolized in liver, 50% excreted in
urine.
-Interactions-avoid live virus vaccines concurrently
-increase toxicity- other antineoplastics,
radiation, general anesthesia
-decreases serum phenytoin levels
Nursing Considerations
-Assess –IM test dose
in lymphoma 1-2 units before 1st and second doses
-Pulmonary FunctionTests’s
– 1-2 weeks prior to tx
-VS to assess for
infection
-BUN and Creatinine to
assess for nephrotoxicity
-for respiratory
distress
-mouth for sores,
ulcers, pain, dysphagia, oral bleeding
-sx anaphylaxis—rash,
pruritis, urticaria, purpuric lesions, flushing, wheezing, low bp
Evaluate –size of tumor
Teach
-report changes in breathing, cough
fever
-hair may be lost during tx
-avoid foods that are hot, spicy,
have citric acid or a rough texture
-report mouth problems and examine
daily
-Use contraception and avoid
breastfeeding
-avoid vaccines during tx
References
Kee, J., Hayes, E., & McCuistion, L. (2012). Pharmacology:
A Nursing Process Approach. St. Louis, Missouri: Elsevier Saunders.
Mosby. (2010). Mosby's Nursing Drug Reference,
23rd Edition. Elsevier.
Telavancin. (2014). In Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Telavancin.
Telavancin. (2014). In Rx
List: The Internet Drug Index.
Retrieved from http://www.rxlist.com/vibativ-drug.htm
