Pharmacology- CH 91- Fluoroquinolones, metronidazole, Rifampin, etc.

metronidazole

Administration Infuse over 1 hour Adverse Effects: GI upset Neurotoxicity Suprainfection -- Candidiasis NO Alcohol ** Disulfiram (antabuse ) reaction Urine may turn dark reddish-brown (usually only happens with high doses over extended period of time) Metallic taste (common) - use hard candy to help

fluoroquinolones

MOA: Broad spectrum Disrupt DNA replication and cell division Oral administration= IV bioavailablity Prototype: Ciprofloxacin (Cipro) Others: ofloxacin, moxifloxacin, levofloxacin, gemifloxacin

2 (Daptomycin is one of the cyclic lipopeptides, a class of antibiotics that can kill gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). It may pose a small risk of myopathy (muscle injury). Patients should be warned about muscle injury and told to report any pain or weakness. In addition, CPK levels should be measured weekly. Increased urination and urinary urgency, abdominal bloating and diarrhea, and headache and visual disturbances are not associated with daptomycin.)

A patient is taking daptomycin [Cubicin]. The nurse should obtain a creatine phosphokinase (CPK) level when the patient shows what? 1 Increased urination and urinary urgency 2 Muscle pain and weakness 3 Abdominal bloating and diarrhea 4 Headache and visual disturbances

4 (The incidence of rash with gemifloxacin is much higher than with other fluoroquinolones. Women under 40 years of age are at greatest risk. Symptoms are severe in about 10% of patients who develop a rash; in the rest, symptoms are mild to moderate. As a rule, gemifloxacin-induced rash resolves spontaneously in 1 to 2 weeks, although some patients require treatment with systemic glucocorticoids. If rash develops, gemifloxacin should be discontinued.)

A patient taking gemifloxacin develops a rash. The nurse anticipates the healthcare provider to take which action? 1 No action is needed, because this is a temporary but expected side effect. 2 Continue the antibiotic with an anti-inflammatory medication. 3 Cut the dose of medication in half. 4 Discontinue the medication.

4 (Fluoroquinolones may result in tendinitis and rupture by disrupting the extracellular matrix of cartilage. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain or inflammation.)

A patient who takes ciprofloxacin [Cipro] and runs 6 miles daily tells a nurse about heel and calf tenderness. The nurse anticipates the healthcare provider to take which action? 1 No action is needed, because this is a temporary but expected side effect. 2 Continue the antibiotic with an anti-inflammatory medication. 3 Slow the running pace and walk more. 4 Discontinue the medication, because severe damage can result.

2 (Metronidazole is the treatment of choice for antibiotic-associated colitis caused by C. difficile. Rifaximin, daptomycin, and gemifloxacin are not used in the treatment of C. difficile infection.)

A patient who takes multiple antibiotics starts to experience diarrheal stools. The nurse anticipates administration of which antibiotic if a stool sample tests positive for Clostridium difficile? 1 Rifaximin [Xifaxan] 2 Metronidazole [Flagyl] 3 Daptomycin [Cubicin] 4 Gemifloxacin [Factive]

metronidazole (flagyl)

MOA: interferes with DNA Coverage Protozoa and anaerobic bacteria NO action against aerobic bacteria Uses: C.difficile (Drug of choice for) GI and Pelvic surgery H.Pylori

1 (Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin [Cipro], and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.)

After completing a course of ciprofloxacin [Cipro] for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? 1 The patient takes antacids on a daily basis. 2 The medication was stored in a cool, dry area. 3 The patient did not use sunscreen while taking the ciprofloxacin [Cipro]. 4 The patient took two doses of diphenhydramine [Benadryl] while on ciprofloxacin [Cipro] therapy.

systemic, 18

Because of concerns of tendon injury, _______ ciprofoxacin is avoided in children younger than _____ years old. But does have 2 approved pediatric uses: 1. treatment of complicated urinary tract and kidney infections caused by E. coli 2. post exposure treatment of inhalational anthrax

ciprofloxacin

Drug-Food interactions - Same as TETRACYCLINES Al, Mg, iron, zinc, Ca Milk/dairy products Give drug 6 hours after or 2 hours before these food/supplements. ** Reduces absorption by 90% Drug-Drug interactions Sucralfate, theophylline, warfarin, tinidazole

cephalosporins, clindamycin, ciprofloxacin

Drugs Most commonly associated with c diff: 1. 2. 3.

4

The healthcare provider orders levofloxacin [Levaquin] 500 mg PO every day for 7 days. The available medication is levofloxacin 250-mg tablets. How many tablets should the patient take each day? 1 0.5 tablet 2 1 tablet 3 1.5 tablet 4 2 tablets

1, 3, 4 (Rifampin is useful in the treatment of tuberculosis and can be used for prophylaxis of meningitis caused by H. influenzae. The treatment of leprosy is an unlabeled use. Rifampin is indicated for treatment of carriers of meningococcal infection, but not for active meningococcal infection. Rifampin is not indicated for the treatment of C. difficile infection.)

The nurse identifies rifampin as useful in the treatment of which disorders? (Select all that apply.) 1 Tuberculosis 2 Active meningococcal infection 3 Leprosy 4 Prophylaxis of meningitis caused by Haemophilus influenzae 5 C. difficile infection

3 (In elderly patients, ciprofloxacin [Cipro] poses a significant risk of confusion, somnolence, psychosis, and visual disturbances. Metronidazole, rifampin, and daptomycin are not associated with confusion in elderly patients.)

The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients? 1 Metronidazole [Flagyl] 2 Rifampin [Rifadin] 3 Ciprofloxacin [Cipro] 4 Daptomycin [Cubicin]

3 (Fluoroquinolones pose a risk of phototoxicity. Accordingly, patients should avoid sunlight and sunlamps, and should use protective clothing and a sunscreen if they must go outdoors.)

The nurse notices tan lines around the arms of a female patient who is taking levofloxacin [Levaquin]. Which action should the nurse take? 1 No action is needed, because this is a temporary but expected side effect. 2 Continue the antibiotic with an anti-inflammatory medication. 3 Advise the patient to avoid sun exposure and wear sun screen when outside. 4 Discontinue the medication.

Ciprofloxacin

Uses: Respiratory tract, urinary tract, Bones, Joints, Skin/ soft tissue, Prevent anthrax Adverse Effects - GI upset - CNS effects (elderly) - Tendon rupture High risk: Elderly & Steroid use Avoid in kids under 18 - Photosensitivity - Dysrhythmias if on anti-dysrhythmia agent

1 (Levofloxacin should not be administered with milk products or antacids containing magnesium or aluminum, because this reduces absorption from the gastrointestinal (GI) tract. However, this does not happen with most foods. Premedicating with diphenhydramine is unnecessary.)

Which approach should a nurse take when administering an oral dose of levofloxacin [Levaquin]? 1 Give the medication with or without food. 2 Administer the drug with an oral dose of a magnesium-based antacid. 3 Premedicate the patient with diphenhydramine [Benadryl]. 4 Administer the drug with milk products.

ciprofloxacin

_______ inhibits 2 bacterial enzymes needed for DNA replication and cell division - rapidly bactericidal - Approved for infections of the: respiratory tract, urinary tract, GI tract, bones, joints, skin, soft tissues. - Preferred drug for preventing anthrax

daptomycin

_______ is the first representative of a new class of ABT - the cyclic lipopeptides.AKA Cubicin - has unique mechanism of action - can rapidly kill virtually all clinically relevant gram positive bacteria - including MRSA - devoid of significant drug interactions - only notable SE is possible muscle injury - Given once daily by IV infusion and there is no need to monitor plasma levels

adverse effects

________ _______ of ciprofloxacin: - GI reactions - CNS effects - Candida infections of the pharynx and vagina - rarely, seizures - In older adults, poses a significant risk of confusion, somnolence, psychosis and visual disturbances - rarely causes tendon rupture (achilles) - highest risk is 60 yo and older, those taking glucocorticoids, and those who have undergone a heart, lung or kidney transplantation. - Pose a risk of PHOTOTOXICITY - can exacerbate muscle weakness in patients with myasthenia gravis - this drug should be avoided

absorption

________ of ciprofloxacin can be reduced by compounds that contain cations Among these are: - aluminum and magnesium containing antacids - iron salts - zinc salts - sucralfate - calcium supplements - milk and other dairy products

metronidazole

_________ is used to treat protozoal infections and infections caused by onligate anaerobic bacteria (ex: c. diff) - Lethal to ANAEROBIC organisms only - Used for infections of: CNS, abdominal organs, bones and joints, skin and soft tissues, genitourinary tract - Drug of choice for C. difficile associated diarrhea - Drug employed for prophylaxis in surgical procedures associated with a high risk of infection by anaerobes - used in combo with other drugs for treatment of H Pylori

fluoroquinolones, ciprofloxacin

___________ are: - broad sprectrum - disrupt DNA replication and cell division - SE are generally mild, but all of them can cause tendinitis and tendon rupture - usually Achilles - 6 are currently available for systemic therapy - Prototype: _________