Aminoglycosides and Fluoroquinolones
You are preparing to discharge a patient who is taking ciprofloxacin. What guidance would you offer this patient to prevent crystalluria?
"Drink at least 2 liters of fluids per day." Crystalluria is a potential side effect of taking fluoroquinolones such as ciprofloxacin. Patients should be instructed to drink two to three quarts of fluids each day to decrease the risk of developing the condition
A nurse has been performing vigilant assessments of a patient who is receiving doses of intravenous gentamicin, each over 30 minutes. A blood sample for peak gentamicin levels should be drawn
30 minutes after the drug has finished infusing Blood for peak levels of gentamicin is drawn 30 minutes after the completion of a 30-minute intravenous (IV) administration or immediately after a 60-minute IV administration and 45 to 60 minutes after intramuscular (IM) administration.
A client with a severe infection has an order for IV gentamicin and IV penicillin. How will the nurse administer these medications?
Administer the gentamicin IV and wait 1 hour and administer the penicillin. Gentamicin and penicillin should never be administered in the same syringe or the same solution. When both antibiotics are prescribed for the client, they must be administered at separate times using Y tubing.
You are writing a plan of care for a patient taking an oral fluoroquinolone. What would be an appropriate intervention to include in this plan?
Avoid concomitant use of nephrotoxic drugs. Since fluoroquinolones can impair renal function, concomitant use of other nephrotoxic drugs should be avoided when possible. Patients should consume two to three liters of fluid each day to lessen renal effects.
The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication?
Cheese Clients taking oral ciprofloxacin should avoid calcium-containing foods while taking this medication.
Which of the following drugs is likely to be administered as a first-line treatment for anthrax exposure?
Ciprofloxacin
The client has been taking levofloxacin IV since admission 12 hours ago for a urinary tract infection. The nurse assesses the client's temperature at 99.8ºF. What is the nurse's best response?
Continue to monitor vital signs. The provider should be notified if the client's temperature is greater than 101ºF.
A client is prescribed ciprofloxacin for an acute sinus infection. The nurse knows that this anti-infective medication belongs to which drug category?
Fluoroquinolones
The nursing student correctly identifies the class of drugs that exerts their bactericidal effect by interfering with the synthesis of bacterial DNA, thus preventing cell reproduction and leading to death of the bacteria, as which of the following groups?
Fluoroquinolones
Which of the following classes of antibiotics is a direct inhibitor of DNA synthesis in bacteria?
Fluoroquinolones
Which of the following drugs would be classified as an aminoglycoside?
Gentamicin
Once-daily aminoglycoside (ODA) dosing has replaced multiple daily dosing in many patients. What is the rationale behind ODA dosing?
Higher efficacy with less nephrotoxicty
Why must a client who is receiving aminoglycosides be kept well hydrated?
Hydration decreases drug concentration in serum and body tissues.
What is a contraindication to use of a fluoroquinolone?
Lactation Fluoroquinolones are contraindicated in patients with known allergy to any fluoroquinolone and in pregnant or lactating patients because potential effects on the fetus and infant are not known.
A male client is NPO as a consequence of a cerebrovascular accident sustained 3 years ago. His care is managed at home by his wife, and he receives all medications via gastrostomy tube. The health care provider orders a fluoroquinolone for the client to treat an infection. The nurse would instruct the client's wife to administer the medication in what way?
On an empty stomach
The client has been prescribed a drug that must be taken on an empty stomach. The nurse knows that to administer a medication on an empty stomach, it is given in which way?
One hour prior to a meal or two hours after the mea
A male client develops a wound infection, and the health care provider orders once-daily intravenous multiple-dose regimens of aminoglycosides. What kinds of monitoring does the nurse expect the provider to order?
Peak and trough serum levels Multiple-dose regimens (conventional dosing) of aminoglycosides must be carefully monitored with evaluation of peak and trough serum levels.
A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction?
Photosensitivity
Aminoglycosides are used in the treatment of infections caused by what gram-negative microorganisms?
Pseudomonas Escherichia coli Klebsiella The major clinical use of parenteral aminoglycosides is to treat serious systemic infections caused by gram-negative microorganisms such as Pseudomonas and Proteus species, Escherichia coli, Klebsiella, Enterobacter, and Serratia species
A patient is to begin taking tobramycin (Nebcin) for a nosocomial infection. Which of the following assessments should the nurse prioritize?
The peak and trough blood levels Peak and trough levels should be closely monitored with serious infections being treated with tobramycin
A 30-year-old woman who is in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye that is crusted with purulent exudate. The clinician suspects a bacterial, rather than viral, etiology. How will the client's pregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis?
The use of ciprofloxacin is contraindicated in pregnancy.
Your client is scheduled to undergo major abdominal surgery. A preoperative order for neomycin has been given. Neomycin is used preoperatively for the following reason:
To suppress intestinal bacteria. Neomycin and kanamycin may be given before bowel surgery to suppress intestinal bacteria and may be given before bowel surgery and to treat hepatic coma
The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone?
antacids The client should not take antacids or drugs containing iron or zinc at the same time as taking a fluoroquinolone because these drugs will decrease the absorption of the fluoroquinolones
When describing the action of fluoroquinolones to treat infection to a group of nursing students, which action would the instructor most likely include?
bactericidal
A client with a gram-negative bacterial infection has been prescribed a fluoroquinolone. During the preadministration assessment, the nurse should ensure that which laboratory tests, if prescribed, are obtained before the first dose of fluoroquinolones is administered to the client?
culture and sensitivity test The nurse should ensure that culture and sensitivity tests are done before the client receives the first dose of fluoroquinolones.
A 23-year-old man who works in construction calls the clinic to report that he has a rash all over his body, his skin is red, and it feels like it is burning. The nurse suspects that he is having a photosensitivity reaction from Lomefloxacin (Maxaquin), which was prescribed the day before. The nurse will instruct the client to:
discontinue the drug immediately and return to the clinic The nurse will instruct the client to discontinue the drug immediately and return to the clinic. These are signs and symptoms of a potentially serious photosensitivity reaction
After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication?
gram-negative infections
A nursing instructor is preparing a teaching plan for a nursing pharmacology class on the action of fluoroquinolones. Which action would the instructor most likely include?
interfering with DNA synthesis in the bacterial cell
The pharmacology instructor is discussing ways to decrease adverse effects on clients taking aminoglycosides. Which would the instructor include?
keeping the patient well hydrated
The nurse recognizes that what drug classification increases the risk of ototoxicity and nephrotoxicity when prescribed with gentamicin?
loop diuretics Loop diuretics given simultaneously with gentamicin increase the risk of nephrotoxicity by decreasing fluid volume, thereby increasing drug concentrations in serum and tissues. Loop diuretics may also contribute to ototoxicity
What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client?
oral
When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route?
oral
The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize?
renal function Amikacin is an aminoglycoside that may cause renal toxicity. Assessing renal function would be a priority.
A client with a gram-negative infection is being treated with an aminoglycoside. What system should the nurse expect to be tested daily while on this medication?
renal system Renal function should be tested daily because aminoglycosides depend on the kidney for excretion and if the GFR is abnormal it may be toxic to the kidney
A 45-year-old female patient is prescribed ciprofloxacin to treat a bronchial infection. A nursing assessment revealed that she started taking daily vitamin supplements about 2 years ago. To maximize the therapeutic effects of the ciprofloxacin therapy, the nurse should advise the patient to
take the vitamins at least 2 hours before or after taking ciprofloxacin
A client with a complex medical history is showing signs and symptoms of sepsis. What aspect of this client's health history would rule out the safe and effective use of an aminoglycoside antibiotic?
the client has chronic renal failure
Which of the following are examples of fluoroquinolones?
- ciprofloxacin (Cipro, - moxifloxacin (Avelox) - ofloxacin (Floxin) - levofloxacin (Levaquin)
A client is being given a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection. The nurse should warn the client about which of the following common adverse reactions?
- nausea - vomiting - diarrhea - headache - abdominal pain or discomfort - dizziness - photosensitivity
While administering aminoglycosides to clients, the nurse must be aware of what toxicities that can result from their use?
- nephrotoxicity - ototoxicity - neurotoxicity
Fluoroquinolones, such as norfloxacin (Noroxin), are commonly prescribed antibiotics given to treat which of the following?
- urinary tract infections - sexually transmitted diseases
It would be most important for a nurse to monitor which client for ototoxicity while on gentamicin therapy?
A 25-year-old male who has a hearing impairment Clients with a history of hearing impairment and 8th cranial nerve impairment have an elevated risk of ototoxicity.
Prior to administration of fluoroquinolones, which laboratory test should be obtained?
Culture and sensitivity It is most important that culture and sensitivity tests are obtained prior to the administration of the first dose of antibiotics, so that accurate information can be obtained
A client who takes zinc daily is diagnosed with a severe infection and is ordered levofloxacin (Levaquin). The nurse is aware that taking these two drugs may have what affect on the antibiotic?
Decreased absorption Antacids, iron salts and zinc can cause decreased absorption of the antibiotic
A 60-year-old male client with a diagnosis of bacteremia is being treated with intravenous gentamicin. After 4 days of treatment, the care team is pleased with the improvement in the client's condition and the effect of the drug treatment on his blood cultures. During morning care, the client has told the nurse that he is having ringing in his ears and woke up this morning with a pounding headache. How should the nurse respond to this client?
Hold the next scheduled dose of gentamicin until the health care provider has been consulted. To avoid permanent ototoxic damage, gentamicin should be withdrawn at the first sign of tinnitus or persistent headache.
A client is to receive gentamicin for treatment of an infection. Which of the following would be most important for the nurse to assess to establish a baseline?
auditory function Gentamicin, like other aminoglycosides, can cause ototoxicity leading to irreversible hearing loss. Therefore, it would be most important to determine the client's auditory function to establish a baseline for comparison.
When considering known adverse reactions to gentamicin therapy, the nurse should focus assessment of what body structure?
inner ears Gentamicin reaches higher concentrations in the kidneys and inner ears than in other body tissues; this is a major factor in nephrotoxicity and ototoxicity.
