c86; tetracyclines, macrolides, and others

macrolides (erythromycin)

- Broad-spectrum antibiotic - Usually bacteriostatic but can be bactericidal; depends on dose/bacteria - Used if patient is allergic to penicillin - Active against most gram-positive and some gram-negative bacteria

clindamycin (cleocin) adverse effects

- CDAD - Hepatic toxicity - Blood dyscrasias; bad things to developing BC - Diarrhea - Hypersensitivity reactions

macrolides (erythromycin) adverse effects

- GI - QT prolongation (torsades) and sudden cardiac death - superinfecitons - thrombophlebitis - transient hearing loss

tetracyclines adverse effects

- Gastrointestinal irritation - Effects on bone and teeth**** (stain teeth black, cant give to children/ pregnant women) - Superinfection - Hepatotoxicity - Renal toxicity - Photosensitivity and other effects

macrolides (erythromycin) MOA

- Inhibition of protein synthesis

clindamycin (cleocin)

- Inhibits protein synthesis - Can promote severe Clostridium difficile-associated diarrhea (CDAD) (can be fatal) - Active against most anaerobic bacteria (gram positive and gram negative) (tetanus) - Indicated only for certain anaerobic infections outside the central nervous system (CNS) - Used as an alternative to penicillin

tetracyclines Four members of the tetracycline family are available for systemic therapy:

- Tetracycline Demeclocycline - Doxycycline Minocycline

tetracyclines absorption

- Tetracyclines form insoluble chelates with calcium, iron, magnesium, aluminum, and zinc - Do not administer with calcium supplements, milk products, iron supplements, magnesium-containing laxatives, and most antacids

macrolides (erythromycin) therapeutic uses

- Whooping cough, - acute diphtheria, - Corynebacterium diphtheriae, - chlamydial infections, - M. pneumoniae, - group A Streptococcus pyogenes - May be used as an alternative to penicillin G in patients with penicillin allergy

tetracyclines

- broad spectrum antibiotics - inhibit protein synthesis - increasing bacterial resistance has emerged

tetracyclines major precautions

- eliminated primarily in urine; - they accumulate in patients with kidney disease - can cause discoloration of deciduous and permanent teeth - Diarrhea may indicate a potentially life-threatening suprainfection of the bowel (C. diff) - High-dose IV therapy has been associated with severe liver damage

tetracyclines uses

Treatment of infectious disease Treatment of acne Peptic ulcer disease/ helicobacter pylori Periodontal disease Rheumatoid arthritis Mycoplasma pneumoniae Lyme disease Anthrax

tetracyclines drug and food interaction absorption of tetracyclines is decreased if drug is given with:

Milk products Calcium supplements Iron supplements Magnesium-containing laxatives Most antacids

A patient is prescribed doxycycline (Vibramycin). If the patient complains of gastric irritation, what should the nurse do? A. Instruct the patient to take the medication with milk B. Tell the patient to take an antacid with the medication C. Give the patient food, such as crackers or toast, with the medication D. Have the patient stop the medication immediately and contact the health care provider

c. give the patient food, such as crackers or toast, with medication Tetracyclines form insoluble chelates with calcium, iron, magnesium, aluminum, and zinc; absorption is decreased. Tetracyclines should not be administered together with milk or antacids. Long-acting tetracyclines, such as doxycycline, may be taken with food; food does not affect absorption.

Before administering erythromycin to a patient for an upper respiratory tract infection, it is most important for the nurse to determine if the patient is also prescribed which drug? A. Guaifenesin [Guiatuss] B. Hydrocodone [Vicodin] C. Nitroglycerin [Tridil] D. Verapamil [Calan]

d. verapamil (calan) QT prolongation and sudden cardiac death have occurred in patients taking CYP3A4 inhibitors, such as calcium channel blockers (verapamil), azole antifungal drugs, HIV protease inhibitors, and nefazodone.

Torsades

prolonged QT interval - challenging to treat and is likely fatal unless the patient has rapid access to advanced life support. - Look for drugs that cause this interaction. - Ensure that the patient has a recent ECG for comparison.

QT interval represents:

ventricular repolarization in the heart