Ch. 91: Miscellaneous Antibacterial Drugs: Fluoroquinolones and Metronidazole

what is one unique side effect of fluoroquinolones (rare)

tendon rupture, usually the achilles

what is the suffix for fluoroquinolones?

-cin

Ciprofloxacin [Cipro] uses

-*Drug of choice for anthrax -Infections: Respiratory, urinary tract (UTI), GI, bones, joints, skin, and soft tissue -Traveler's diarrhea

*what foods and drugs reduce the absorption of ciprofloxacin?

-Aluminum antacids -Magnesium antacids -Iron salts -Zinc salts -Sucralfate -dairy products

adverse effects of Cipro that are unique to older adults

-Confusion -somnolence -psychosis -visual disturbances -Myasthenia gravis

adverse effects of metronidazole

-Neurotoxicity -Allergy -Superinfections -Taste perversion

The patient is being discharged with continued ciprofloxacin therapy. When providing discharge teaching, the nurse should advise the patient to call the healthcare provider immediately if what develops? A. Pain in the heel of the foot B. Nausea C. Diarrhea D. Headache

A: Rarely, ciprofloxacin and other fluoroquinolones have caused tendon rupture, usually of the Achilles tendon. The incidence is 1 in 10,000 or less. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain, swelling, or inflammation. In addition, patients should refrain from exercise until tendinitis has been ruled out.

A patient has been prescribed oral ciprofloxacin [Cipro] for a skin infection. When administering the medication, it is most important for the nurse to do what? A. Monitor for a decrease in the prothrombin time (PT) if the patient is also taking warfarin [Coumadin] B. Withhold antacids and milk products for 6 hours before or 2 hours afterward C. Inform the healthcare provider if the patient has a history of asthma D. Assess the skin for Stevens-Johnson syndrome

B: Absorption of ciprofloxacin can be reduced by ingestion of antacids and milk products. Ingestion of these products should occur at least 6 hours before ciprofloxacin or 2 hours afterward.

A patient is diagnosed with C. difficile infection. The nurse anticipates administering which medication? A. Daptomycin B. Metronidazole C. Rifampin D. Rifaximin

B: Metronidazole is a drug of choice for C. difficile infection.

are they bacteriostatic or bacteriocidal?

bacteriostatic. Disrupt DNA replication and cell division

It is most important for the nurse to avoid administering oral ciprofloxacin to this patient with which food? A. Bananas B. Baked chicken C. Grapefruit juice D. Milk

D: Absorption of ciprofloxacin can be reduced by compounds that contain cations. Among these are (1) aluminum- or magnesium-containing antacids, (2) iron salts, (3) zinc salts, (4) sucralfate, (5) calcium supplements, and (6) milk and other dairy products, all of which contain calcium ions.

what is the main symptom of C. diff?

Loose, watery, bloody stools

what is Clostridium difficile infection (CDI) (also known as C. diff)

it is a Gram-positive, spore-forming, anaerobic bacilllus that infects the bowel

how are fluoroquinolones administered?

orally or IV

*ciprofloxacin increases the levels of what drugs?

-Theophylline -Warfarin -Tinidazole

who should avoid taking fluoroquinolones ?

-people under 18 years old -people over 60 years old -people taking steroids -people who have an an organ transplant

*adverse effects of ciprofloxacin [Cipro]

-GI: Nausea/vomiting, diarrhea, abdominal pain -Central nervous system (CNS): Dizziness, headache, restlessness, confusion, rarely seizures -Tendon rupture -Phototoxicity (light sensitive and easily sunburn) -Candida infections: Pharynx and vagina -Increased risk of Clostridium difficile infection (CDI)

uses for metronidazole

-Protozoal infections -Clostridium difficile infection (C. diff) -Helicobacter pylori (cause ulcers)

A patient has been prescribed ciprofloxacin for treatment of a urinary tract infection with Escherichia coli. Before administering the drug, it is most important for the nurse to assess the patient for a history of what? A. Hypertension B. Diabetes mellitus C. Myasthenia gravis D. Seasonal allergies

C: Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in patients with myasthenia gravis. Accordingly, patients with a history of myasthenia gravis should not receive these drugs

is Metronidazole [Flagyl] bactericidal or bacteriostatic?

bactericidal

are Fluoroquinolones broad or narrow spectrum

broad spectrum (Gram-negative and Gram-positive)

why do Ciprofoxacin and Levofloxacin often cause C. diff?

they kill off the normal flora in the bowel so the C. diff can easily flourish

what drugs help manage and treat C. diff?

vancomycin and metronidazole (Flagyl)