Pharmacology Ch. 30 - Macrolides, Tetracyclines, Aminoglycosides, and Fluoroquinolones

The nurse is teaching a group of nursing students about aminoglycosides. Which statement by the nurse regarding aminoglycosides is true?

"Aminoglycosides can potentiate warfarin toxicity." [Aminoglycosides kills intestinal bacterial flora that produce vitamin K. Vitamin K plays a significant role in blood clotting. Therefore, aminoglycosides administered along with warfarin (Coumadin) may cause warfarin toxicity. Normal gut flora balances the effects of oral anticoagulants such as warfarin (Coumadin). Therefore, aminoglycosides can potentiate warfarin toxicity. Aminoglycosides cannot be used by lactating women because these drugs are present in breast milk and may cause adverse effects in the infant. Concurrent use of aminoglycosides and loop diuretics increases the risk for ototoxicity. Aminoglycosides are not used alone to treat gram-positive infections; they are given in combination with penicillin.]

A nursing instructor is discussing tigecycline (Tygacil) therapy with a group of nursing students. Which statement does the nursing instructor most likely to make?

"Avoid administering tigecycline (Tygacil) to a 7-year-old with Lyme disease." [Tetracyclines such as tigecycline (Tygacil) should not be given to children between 4 months and 8 years of age. They can cause discoloration of the permanent teeth and tooth enamel hypoplasia in both fetuses and children and possibly retard fetal skeletal development if taken by the mother during pregnancy. The medication can be administered to older patients per the advice of a primary health care provider. These patients may suffer from some minor adverse effects.]

A patient is prescribed demeclocycline (Declomycin) for the treatment of a respiratory infection. What instruction does the nurse give to the patient to ensure safe administration of the drug?

"Avoid the consumption of dairy products."

The nurse is performing a follow-up assessment of a patient who was prescribed tetracycline (Sumycin) for a respiratory infection. The nurse finds that the infection is still present; however, the patient reports taking the drug as prescribed. What question does the nurse ask the patient to determine the cause of drug ineffectiveness in this situation?

"Did you co-administer iron supplements?" [Tetracycline (Sumycin) may not be compatible with all foods and drugs. Iron, calcium, and magnesium may chelate the drug, making it unavailable for absorption. Therefore, the nurse should ask the patient about the use of iron supplements. The drug should be taken with food or with a full glass of water to avoid gastrointestinal upset. The drug, when taken as prescribed, should exhibit its therapeutic effect. The patient's history is not suggestive of non-adherence with the prescribed regimen as the patient reports taking the medications as prescribed.]

A nursing student is preparing a care plan for a patient who is on macrolides for an upper respiratory tract infection. Which statements by the nursing student need correction?

"I should dilute 500 mg of azithromycin (Zithromax) in 1000 mL of fluid." "I should stop the medication when the symptoms of infection have subsided." "I should give a full glass of fruit juice when administering oral azithromycin (Zithromax)."

A primary health care provider prescribes an antacid to a patient who is taking ciprofloxacin (Cipro). What information will the nurse mention while counseling the patient?

"Take the antacid 2 hours before the drug."

A nursing student asks the nursing instructor about the mechanism of bacteriostatic action of tetracycline. Which answer by the nursing instructor is correct?

"Tetracycline inhibits protein synthesis."

The patient has been ordered azithromycin (Zithromax) and asks the nurse why the medication does not have to be taken as often as other antibiotics that have previously been ordered. What is the nurse's best response?

"This drug has a longer duration of action than some of the other antibiotics." [Azithromycin (Zithromax) is one of the newer macrolide antibiotics. It has a longer duration of action as well as fewer and less severe gastrointestinal side effects than erythromycin]

Which instruction will the nurse include in the discharge teaching for a patient receiving tetracycline?

"Use sunscreen and protective clothing when outdoors."

The nurse is setting up an intravenous infusion pump to administer a dose of vancomycin (Vancocin) to a patient. What is the slowest rate that the drug may be infused?

60 minutes [Rapid infusion of vancomycin results in a red man syndrome, a response resulting in histamine release and chills, fever, tachycardia, pruritus, rash, or a red face, neck, upper body, back, and arms. It can be alleviated by the slow infusion of vancomycin over a 60- to 120-minute period. For this reason, the nurse should set the pump at 60 minutes. Rapid infusions at 30 minutes may also cause hypotension.]

Which patient is a potential candidate for antibiotic therapy involving aminoglycoside?

A patient with Pseudomonas aeruginosa pneumonia

The nurse is reviewing a patient's laboratory reports and finds the serum concentration of amikacin (Amikin) to be normal. What value did the nurse observe?

A serum concentration of 25 to 30 mcg/mL is considered the normal concentration of amikacin (Amikin)

The nurse is assessing a patient with pneumonia who is prescribed amikacin (Amikin). After reviewing the medication history, the nurse finds that the patient is taking anticoagulants. What should the nurse primarily monitor in the patient?

Abnormal bleeding

The laboratory reports of a patient confirm the presence of Enterobacter aerogenes infection. A nurse finds that the patient has a history of infection that was resistant to gentamicin (Garamycin) and tobramycin (Nebcin). Which medication will the nurse expect the primary health care provider to prescribe to the patient?

Amikacin (Amikin)

A patient is prescribed levofloxacin (Levaquin) for the treatment of a bacterial infection. During the assessment, the nurse finds that the patient is taking calcium supplements. The nurse instructs the patient to take calcium supplements 2 hours after taking levofloxacin (Levaquin). What could be the reason for this?

Calcium supplements interfere with levofloxacin (Levaquin) absorption.

Which drug is effective against Haemophilus influenza infections?

Chloramphenicol (Chloromycetin)

Which antibiotic medication is most beneficial to a patient who has an anthrax infection?

Ciprofloxacin (Cipro)

A patient with a history of gastric reflux is prescribed telithromycin (Ketek) therapy for community-acquired pneumonia. The patient experiences toxicity due to concomitant drug therapy. Which medication in the patient's prescription has led to this condition?

Cisapride (Propulsid)

Which antibiotic does the nurse administer if the culture of a patient with bacterial endocarditis reveals the presence of gram-positive Streptococcus?

Clindamycin (Cleocin)

Which drugs are effective against Staphylococcus aureus?

Daptomycin (Cubicin) Tigecycline (Tygacil) Doxycycline (Vibramycin)

The patient has been diagnosed with Legionnaires' disease. Which drug does the nurse anticipate the provider will order?

Erythromycin (E-Mycin)

Which macrolide is derived from the bacteria Streptomyces erythreus?

Erythromycin (E-Mycin)

Which class of drug is effective against Shigella?

Fluoroquinolones

The nurse is assessing a patient who is being treated with amikacin (Amikin). The patient has increased serum creatinine concentrations, for which loop diuretics are prescribed. What will the nurse primarily monitor in the patient?

Hearing ability

Which adverse effect is the nurse alert for in a patient who is taking tobramycin (Nebcin) as an antibiotic therapy?

Hearing loss

A patient diagnosed with an upper respiratory tract infection is on phenothiazine therapy for psychotic disorder. The nurse reviews the prescription and finds that azithromycin (Zithromax) has been prescribed by the primary health care provider to treat a respiratory infection. For which complication should the nurse closely monitor the patient?

Hepatotoxicity

A patient has been ordered telithromycin (Ketek) as well as simvastatin (Zocor). What is the nurse's best action?

Hold the medication and call the health care provider. [Telithromycin should not be taken with simvastatin owing to the risk of an increase in the medication which could cause toxicity. Separating the medications by 6 hours or taking the medication with milk or food will not lessen the risk of side effects. The nurse should not administer these medications together.]

The patient taking intravenous gentamicin (Garamycin) has elevated blood urea nitrogen (BUN). What is the nurse's best course of action?

Hold the medication. [Gentamicin (Garamycin) has a high potential for nephrotoxicity and is thus contraindicated in patients with elevated renal function tests such as BUN and creatinine. The nurse should hold the medication and call the health care provider. Increasing fluids will not decrease the patient's BUN.]

A nurse compares the characteristics of tetracyclines and glycopeptides. Which characteristic is common to both classes of antibiotics?

Inner ear damage and loss of balance as a side effect

The registered nurse is evaluating a nursing student who is caring for a patient on levofloxacin (Levaquin) for a urinary tract infection. Which action of the student nurse needs correction?

Instructing the patient to have caffeinated products

A patient suffering from an upper respiratory tract infection was prescribed medication to be taken once a day for 5 days. After taking the drug, the patient complains of nausea, diarrhea, and abdominal pain. The patient also develops conjunctivitis before completing the full course. Which is a characteristic of the drug prescribed to the patient?

It can cause hepatotoxicity in high doses. [The patient was prescribed azithromycin (Zithromax), which is a macrolide that is only prescribed to be taken once a day for 5 days due to its long half-life of up to 40 to 68 hours. The common side effects associated with this drug include nausea, diarrhea, and abdominal pain. It can also cause conjunctivitis as a side effect. Hepatotoxicity can occur when azithromycin (Zithromax) is taken in high doses with other hepatotoxic drugs. Clarithromycin (Biaxin) and erythromycin (E-Mycin) are readily absorbed from the GI tract, mainly by the duodenum. Azithromycin (Zithromax) is incompletely absorbed from the GI tract, and only 37% reaches systemic circulation. Because macrolides are excreted in urine in only small amounts, renal insufficiency is not a contraindication for the use of a macrolide such as azithromycin. Erythromycin (E-Mycin) should not be taken with clindamycin (Cleocin) or lincomycin (Lincocin) because these compete for receptor sites.]

Which drugs inhibit bacterial growth?

Lincomycin (Lincocin) Azithromycin (Zithromycin) Chloramphenicol (Chloromycetin)

Which medications are better absorbed from the gastrointestinal tract when taken with food?

Minocycline (Minocin) Doxycycline (Vibramycin)

After prescribing an aminoglycoside antibiotic to a patient with an enterococcal infection, the primary health care provider tells the nurse to administer the drug by the rectal route. Which drug will the nurse find in the patient's prescription?

Neomycin (Mycifradin)

Which antibiotic is used in patients who have infections of the eyes, ears, or skin and for suppressing bowel flora before bowel surgery?

Neomycin (Neo-Fradin)

A patient who is being treated for a neuromuscular disease has been ordered telithromycin (Ketek). What is the nurse's highest priority action?

Notify the health care provider.

A patient who is scheduled for an appendectomy has been prescribed neomycin (Neo-Fradin) by the primary health care provider. Which nursing action is most suitable in this situation?

Oral administration of neomycin (Neo-Fradin) before the surgery

The registered nurse is teaching a nursing student about the side effects of different antibacterials and the corresponding patient teachings to be provided. Which patient does the nursing student select as receiving the correct teaching?

Patient on Nalidixic acid (NegGram) directed to avoid operating hazardous machinery while taking the drug

While reviewing the medication chart of a patient, the nurse finds that the patient is on a combination of tetracycline (Sumycin), metronidazole (Metro), and bismuth subsalicylate (Bismatrol). Which condition does the nurse suspect in this patient?

Peptic ulcer

Which action does the nurse take if a patient receiving intravenous vancomycin (Vancocin) complains of facial pruritis?

Programs the vancomycin to infuse at a slower rate

Which bacterium is sensitive to gentamycin (Garamycin)?

Pseudomonas aeruginosa

The primary health care provider prescribes vancomycin (Vancocin) to a patient who has a streptococcal infection. What will the nurse assess in the patient to ensure safe administration of the drug?

Renal function

The primary health care provider prescribed daptomycin (Cubicin) to a patient with MRSA (Methicillin-resistant Staphylococcus aureus) infective endocarditis. On reviewing the medical history, the nurse finds that the patient is currently receiving hyperlipidemic drug therapy as well. For which complication should the nurse monitor in the patient?

Rhabdomyolysis

A patient who is on nonsteroidal antiinflammatory drug therapy is diagnosed with a severe lower respiratory tract infection. The primary health care provider prescribed levofloxacin (Levaquin). Which complication will the patient most likely develop?

Seizures

Which laboratory reports will the nurse evaluate if the patient is administered vancomycin (Vancocin) and tobramycin (Nebcin)?

Serum creatinine

While reviewing the blood reports of a patient who is on amikacin (Amikin) therapy, the nurse finds that the serum drug concentration is 2 mcg/mL. What further laboratory reports will the nurse check to ensure the patient's safety?

Serum creatinine concentration [Amikacin (Amikin) is an aminoglycoside antibiotic. Aminoglycosides have the potential to cause nephrotoxicity, and thus the patient's serum drug concentrations should be monitored regularly. The usual serum drug concentration of aminoglycosides is expected to be ≤1 mcg/mL (considered as safe range). Concentrations higher than this may cause adverse effects. Therefore, the nurse should check the serum creatinine concentration to evaluate proper renal function]

Which bacterial infection is effectively treated by both tigecycline (Tygacil) and minocycline (Minocin)?

Staphylococcus aureus infection

The primary health care provider instructs a nurse to administer intravenous vancomycin (Vancocin). During infusion, the patient has excessive sweating and reports itching on the face and neck. What is the best nursing intervention in this situation?

Stop the administration of the vancomycin (Vancocin) infusion.

The nurse is assessing a patient who has tuberculosis-associated plague. Which medication will the nurse expect the primary health care provider to prescribe?

Streptomycin (Plantomycin)

What was the first aminoglycoside that became available for the treatment of tuberculosis?

Streptomycin (Streptomycin)

The nurse has administered the morning dose of tobramycin (Nebcin) to a patient according to the prescription. In the evening, the nurse collects a blood sample from the patient and observes that the serum drug concentration is >2 mcg/mL. What does the nurse infer from this?

The patient is at risk of renal dysfunction.

The nurse is caring for multiple patients receiving antibiotics. Which patient will the nurse assess first?

The patient who is taking amikacin with furosemide (Lasix) [The risk of ototoxicity with amikacin is increased for patients taking furosemide. The nurse should assess this patient first. A patient who has started antibiotic therapy would be expected to have a fever. Gastric upset is common with this antibiotic. Ciprofloxacin (Cipro) is recommended for patients 18 years and older.]

A primary health care provider instructs a nurse to administer vancomycin (Vancocin) to a patient. The nurse administers intravenous vancomycin (Vancocin) to the patient over 1 hour. Why will the nurse do this?

To prevent hypotension

Why will the nurse administer gentamicin (Garamycin) intravenously to a patient over a period of 60 minutes or longer?

To prevent neuromuscular blockade

The nurse is caring for a patient who is on antibiotic therapy for cardiac surgical prophylaxis. The nurse observes red blotching of the face, neck, and chest of the patient. Which medication is associated with this side effect of "red man" syndrome?

Vancomycin (Vancocin)

Which drug may cause cardiac death when used in combination with erythromycin (E-Mycin)?

Verapamil (Calan)