Chapter 19: Drug Therapy With Aminoglycosides and Fluoroquinolones
You are preparing to discharge a patient who is taking ciprofloxacin. What guidance would you offer this patient to prevent crystalluria? "Do not take antacids." "Take the medication as prescribed." "Drink at least 2 liters of fluids per day." "Limit fluids to a couple of glasses per day."
"Drink at least 2 liters of fluids per day." Explanation: 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. Although the nurse should instruct the patient to take the medication as prescribed and to avoid antacids, which can decrease absorption of the medication, neither measure will prevent crystalluria.
A nurse is teaching a client about the medication regimen surrounding fluoroquinolones. Which statement made by the client would indicate the need for additional education? "I will take all of my antibiotics." "I may have some abdominal pain with this medication." "If I have trouble breathing, I will call 911." "I will only drink enough water to swallow the drug."
"I will only drink enough water to swallow the drug." Explanation: Clients taking fluoroquinilones should increase, not limit, their fluid intake. It is important that the client take all of the prescribed antibiotics and understand adverse reactions, such as abdominal pain. Difficulty breathing may indicate hypersensitivity and is an emergency.
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 as soon as possible after the patient awakens in the morning. at the midpoint between scheduled doses. immediately after the third intravenous dose of the drug. 30 minutes after the drug has finished infusing.
30 minutes after the drug has finished infusing. Explanation: 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. Blood for trough levels is drawn just before the next dose.
A client with a severe infection has an order for IV gentamicin and IV penicillin. How will the nurse administer these medications? Administer the penicillin and immediately administer the gentamicin. Mix both antibiotics in an IV piggyback and administer over 1 hour. Administer the gentamicin IV and wait 1 hour and administer the penicillin. Mix the two antibiotics in one syringe and push it slowly over 5 minutes.
Administer the gentamicin IV and wait 1 hour and administer the penicillin. Explanation: 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.
The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication? Tuna Cheese Hamburger Chicken
Cheese Explanation: 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 Gentamicin Norfloxacin Tobramycin
Ciprofloxacin Explanation: Ciprofloxacin is currently recommended as the first-line treatment for suspected anthrax.
A local Bioterrorism Medical Team is learning about germ warfare. The team is instructed that a fluoroquinolone may be used to prevent an outbreak of anthrax. What fluoroquinolone would most likely be used? Norfloxacin (Noroxin) Gemifloxacin (Factive) Sparfloxacin (Zagam) Ciprofloxacin (Cipro)
Ciprofloxacin (Cipro) Explanation: Ciprofloxacin (Cipro) is the most widely used fluoroquinolone and is indicated for the prevention of anthrax infection. Gemifloxacin and sparfloxacin are most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Norfloxacin is recommended only for certain urinary tract infections.
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? Notify the health care provider. Administer an antipyretic. Continue to monitor vital signs. Administer an extra dose of levofloxacin.
Continue to monitor vital signs. Explanation: The provider should be notified if the client's temperature is greater than 101ºF. The nurse cannot discontinue or administer additional doses without a provider's order. The body's normal defense to infection is an elevated temp until it reaches 101 degrees. Only then would an antipyretic be given if ordered.
Before the selection of an aminoglycoside to treat a client's wound infection, what would the nurse expect the health care provider to order? Electrolyte panel Complete blood count Culture and sensitivity White blood count
Culture and sensitivity Explanation: The choice of aminoglycoside depends on local susceptibility patterns and specific organisms causing an infection.
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 Decreased elimination Increased absorption Increased elimination
Decreased absorption Explanation: Antacids, iron salts and zinc can cause decreased absorption of the antibiotic. There is no affect on elimination of the antibiotic.
After teaching a group of students about aminoglycosides, the instructor determines that the teaching was successful when the group identifies which drug as the prototype for this class? Kanamycin Neomycin Tobramycin Gentamicin
Gentamicin Explanation: Gentamicin is considered the prototype aminoglycoside.
Once-daily aminoglycoside (ODA) dosing has replaced multiple daily dosing in many patients. What is the rationale behind ODA dosing? Lower cost Higher efficacy with less nephrotoxicty Reduction in nursing effort Higher efficacy with less hepatotoxicity
Higher efficacy with less nephrotoxicty Explanation: The rationale for ODA dosing is a potential increase in efficacy with a reduced incidence of nephrotoxicity. Most patients can be successfully treated with one daily dose using this approach.
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? Administer the next scheduled dose of gentamicin over 90 to 120 hours. Hold the next scheduled dose of gentamicin until the health care provider has been consulted. Continue the gentamicin as ordered and monitor the client's symptoms closely. Document the client's reports and integrate them into his plan of care.
Hold the next scheduled dose of gentamicin until the health care provider has been consulted. Explanation: To avoid permanent ototoxic damage, gentamicin should be withdrawn at the first sign of tinnitus or persistent headache. This supersedes the modification of the client's care plan and slowing down the infusion of the drug does not mitigate the potential for ototoxic effects.
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? (Select all that apply.) Profuse sweating Constipation Dizziness Nausea Headache
Nausea Headache Dizziness Explanation: Common adverse reactions to fluoroquinolones include nausea, vomiting, diarrhea, headache, abdominal pain or discomfort, dizziness, and photosensitivity, especially with lomefloxacin and sparfloxacin treatment.
When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route? Topical Oral Subcutaneous Intramuscular
Oral Explanation: Most fluoroquinolones are administered orally; levofloxacin and moxifloxacin may also be given intravenously.
Your patient is receiving a multiple-dose regimen of an aminoglycoside. On what serum drug levels will you base the patient's maintenance dose? Mean levels only Mean and trough levels Peak and trough levels Peak levels only
Peak and trough levels Explanation: In patients receiving aminoglycosides, both peak and trough serum levels are measured to maintain therapeutic levels without excessive toxicity. For accuracy, blood samples must be drawn at the correct times and the timing of drug administration and blood sampling must be accurately documented and based on institutional recommendations.
A young lifeguard has been prescribed moxifloxacin (Avelox). The nurse understands that the focus on education would be which adverse reaction? Muscle cramping Fatigue Photosensitivity Weakness
Photosensitivity Explanation: The lifeguard will be in the sun, and he is at risk for an exaggerated skin reaction. Weakness, fatigue and muscle cramping are not know adverse reactions to this medication, therefore with the client's job, photosensitivity is the highest priority.
The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize? Renal function Muscle strength Nutritional status Gastrointestinal function
Renal function Explanation: Amikacin is an aminoglycoside that may cause renal toxicity. Assessing renal function would be a priority. Although the drug can affect the GI tract leading to nausea, vomiting, diarrhea, and weight loss, which could lead to problems with nutrition and cause numbness, tingling and weakness, assessment of GI function, nutritional status, and muscle strength would be considered lower-priority assessments.
A client is prescribed ciprofloxacin for a urinary tract infection. The nurse is preparing to teach the client about the medication. What must the nurse include in the education plan? Take precautions to prevent photosensitivity. Take the necessary vitamins along with the drug. Take a missed dose, even if close to the next dose. Avoid foods high in sodium such as processed meats.
Take precautions to prevent photosensitivity. Explanation: Caution the client about possible photosensitivity and encourage the client to take precautions to avoid sunlight or ultraviolet light. A forgotten dose may be taken as soon as it is remembered, but not if it is almost time for the next dose. Some vitamins also can decrease the absorption of ciprofloxacin; they should be taken at least 2 hours before or after the administration of ciprofloxacin, never along with the drug. The client need not avoid foods high in sodium unless an underlying disease process is present.
The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone? antacids antidiabetic agents oral contraceptives antihypertensives
antacids Explanation: 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. There are no listed contraindications of giving fluoroquinolones with antihypertensives, antidiabetic agents, or oral contraceptives.
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: continue to take the drug; the rash will eventually subside. decrease the dosage by half until being seen by the health care provider. discontinue the drug immediately and return to the clinic. stop the drug for 3 days and then continue with the prescribed schedule.
discontinue the drug immediately and return to the clinic. Explanation: 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. The nurse should never tell the client to change a dosage schedule that involves stopping and starting a drug.
A client is prescribed ciprofloxacin 500 mg PO twice a day. When would the nurse most likely administer the drug? once daily PO, 4 hours after the meal twice daily PO, 2 hours after the meal once daily IM without regard to the meal every 12 hours IV without regard to the meal
twice daily PO, 2 hours after the meal Explanation: The nurse should administer ciprofloxacin twice daily PO, 2 hours after the meal. It is not advisable to administer ciprofloxacin to the client once daily PO, 4 hours after the meal, once daily IM without regard to the meal, or every 12 hours IV without regard to the meal.
Aminoglycosides are contraindicated for all of the following clients EXCEPT: Clients with acute renal failure. Clients with drug-resistant TB. Clients with multiple sclerosis. Clients with myasthenia gravis.
Clients with drug-resistant TB. Explanation: A BLACK BOX WARNING alerts health care professionals that these drugs are nephrotoxic and ototoxic and must be used very cautiously in the presence of renal impairment. The drugs must also be used cautiously in patients with myasthenia gravis and other neuromuscular disorders because muscle weakness may be increased. A second clinical use is for treatment of tuberculosis. Streptomycin may be used as part of a drug regimen for the treatment of multidrug-resistant tuberculosis (MDR-TR)
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 enhance intestinal bacteria. To suppress intestinal bacteria. To produce ammonia. To sterilize intestinal bacteria.
To suppress intestinal bacteria. Explanation: Neomycin and kanamycin may be given before bowel surgery to suppress intestinal bacteria. Neomycin and kanamycin may be given before bowel surgery and to treat hepatic coma. In hepatic coma, intestinal bacteria produce ammonia, which enters the bloodstream and causes encephalopathy. Drug therapy to suppress intestinal bacteria decreases ammonia production.
The nurse should notify the health care provider immediately if a client has this possible sign of serious neurotoxicity when a client is receiving an aminoglycoside. (Select all that apply.) Circumoral paresthesia Muscle twitching or weakness Numbness or tingling of the skin (peripheral paresthesia) Tremors
Tremors Circumoral paresthesia Numbness or tingling of the skin (peripheral paresthesia) Muscle twitching or weakness Explanation: The nurse should notify the provider immediately if a client has numbness or tingling of the skin, circumoral paresthesia, tremors, or muscle twitching or weakness.
A client's risk for ototoxicity, nephrotoxicity, and neurotoxicity increases dramatically if he or she receives an aminoglycoside in conjunction with a potent diuretic. False True
True Explanation: Avoid combining aminoglycosides with potent diuretics; this increases the incidence of ototoxicity, nephrotoxicity, and neurotoxicity. Renal toxicity, which may progress to renal failure, is caused by direct drug toxicity in the glomerulus, meaning that the drug molecules cause damage (e.g., obstruction) directly to the kidney.
A client who routinely takes antacids has been prescribed a oral fluoroquinolone for an infection. The nurse instructs the client to take the antibiotic at which times? Thirty minutes before or thirty minutes after the antacid One to two hours before, or four to five hours after the antacid Two to four hours before, or six to eight hours after the antacid Thirty minutes before the antacid
Two to four hours before, or six to eight hours after the antacid Explanation: When taking antacids, antibiotics should be taken two to four hours before, or six to eight hours after the antacid to prevent decreased absorption. The other times will interfere with the absorption rate of the oral fluoroquinolone.
The client has been prescribed a fluoroquinolone. The nurse knows that nursing interventions for clients taking fluoroquinolones include which? restrict fluid intake. increase fluid intake. increase sodium intake. restrict sodium intake.
increase fluid intake. Explanation: Clients taking fluoroquinolones should increase their fluid intake. Sodium ingestion is not affected.
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? disrupting the bacterial cell wall blocking ribosomal reading of mRNA interfering with DNA synthesis in the bacterial cell interfering with protein synthesis
interfering with DNA synthesis in the bacterial cell Explanation: The fluoroquinolones exert their bactericidal effect by interfering with the synthesis of bacterial DNA by not allowing the cell to reproduce. The tetracyclines are bacteriostatic and exert their effect by inhibiting bacterial protein synthesis. Penicillins act to disrupt the bacterial cell wall. The aminoglycosides exert their bactericidal effect by blocking the ribosome from reading the mRNA, a step in protein synthesis necessary for bacterial multiplication.
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. reduce the dosage of vitamin supplements. alternate the dosage of ciprofloxacin and vitamin supplements. reduce the dosage of vitamin supplements and double the dosage of ciprofloxacin.
take the vitamins at least 2 hours before or after taking ciprofloxacin. Explanation: If a patient taking vitamins or herbal supplements is prescribed ciprofloxacin, the nurse should advise the patient to take the vitamins at least 2 hours before or after taking ciprofloxacin. Changing or alternating the dosage must be determined by the prescriber.