Chapter 91 - Miscellaneous Antibacterial Drugs

Certain interactions with Ciprofloxacin (Cipro) can cause absorption to be reduced. What drugs or products cause a reduction in absorption of Cipro?

-Aluminum antacids -Magnesium antacids -Milk and dairy products

What are some side effects to be aware of when administering Ciprofloxacin (Cipro)?

-GI issues -CNS (dizziness, headache, restlessness) -Tendon rupture*** -phototoxicity -Increased risk of clostridium difficile infection***

What are the uses of metronidazole (flagyl)?

-Protozoal infections (spores.. C. Diff) -infections caused by obligate anaerobes

Certain interactions with Ciprofloxacin (Cipro) can cause absorption to be increased. What drugs or products can cause an increase in absorption of Cipro?

-Theophylline (for asthma) -Warfarin (anticoagulant) -Tinidazole (antifungal)

What is C. Diff usually managed with?

-metronidazole (Flagyl) -vancomycin

The bacteria produces a spore that is resistant to what things?

-alcohol -drying -and temperature. Must use soap and water to flush the stuff off of skin

What are some adverse effects to be aware of when using metronidazole (flagyl)?

-neurotoxicity -allergy -superinfections -taste perversion (metalic tasting)

Ciprofloxacin (Cipro) is the drug of choice for what?

Antrax*** also: -respiratory infections -UTIs -GI infection Bone, joint, skin, and soft tissue infections

Is metronidazole (Flagyl) bacteriostatic or bactericidal?

Bactericidal

Are fluoroquinolones bacteriostatic or bactericidal?

Bacteriostatic. They disrupt DNA replication and cell division (messes with folic acid)

Are fluoroquinolones broad-spectrum or narrow spectrum?

Broad-spectrum

What is an example of a fluoroquinolone?

Ciprofloxacin (Cipro)

How can fluoroquinolones be administered?

orally or IV

Fluoroquinolones are generally mild in side effects, but they do have one serious, but odd one. What is it?

It can cause the achilles tendon to rupture.

What is Clostridium Difficile (C. Diff) bacterium?

It is a gram-positive, spore-forming, anaerobic bacillus that infects the bowel.

A patient who takes multiple antibiotics starts to experience diarrheal stools. The nurse anticipates administration of which antibiotic if a stool sample tests positive for Clostridium difficile? A) Rifaximin [Xifaxan] B) Metronidazole [Flagyl] C) Daptomycin [Cubicin] D) Gemifloxacin [Factive]

The answer is B, Metronidazole is the treatment of choice for antibiotic-associated colitis caused by C. difficile. Rifaximin, daptomycin, and gemifloxacin are not used in the treatment of C. difficile infection.

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

The answer is 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.

After completing a course of ciprofloxacin [Cipro] for a skin infection, the patient says, "I took the whole bottle of pills, but my infection hasn't gotten any better." Which additional information should the nurse recognize as most significant? A) The patient takes antacids on a daily basis. B) The medication was stored in a cool, dry area. C) The patient did not use sunscreen while taking the ciprofloxacin [Cipro]. D) The patient took two doses of diphenhydramine [Benadryl] while on ciprofloxacin [Cipro] therapy.

The answer is A, Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin [Cipro], and many other drugs; therefore, this patient has not received the full dosing regimen, which is required if ciprofloxacin is to be effective against the infection. Storing the drug in a cool, dry area and using sunscreen or diphenhydramine would not disrupt the effectiveness of ciprofloxacin.

Which approach should a nurse take when administering an oral dose of levofloxacin [Levaquin]? A) Give the medication with or without food. B) Administer the drug with an oral dose of a magnesium-based antacid. C) Premedicate the patient with diphenhydramine [Benadryl]. D) Administer the drug with milk products.

The answer is A, Levofloxacin should not be administered with milk products or antacids containing magnesium or aluminum, because this reduces absorption from the gastrointestinal (GI) tract. However, this does not happen with most foods. Premedicating with diphenhydramine is unnecessary.

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

The answer is 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

The answer is 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. Ciprofloxacin can increase the PT if the patient is also taking warfarin. Use of ciprofloxacin is contraindicated in patients with a history of myasthenia gravis. Patients taking ciprofloxacin are at risk for development of phototoxicity.

A patient is taking daptomycin [Cubicin]. The nurse should obtain a creatine phosphokinase (CPK) level when the patient shows what? A) Increased urination and urinary urgency B) Muscle pain and weakness C) Abdominal bloating and diarrhea D) Headache and visual disturbances

The answer is B, Daptomycin is one of the cyclic lipopeptides, a class of antibiotics that can kill gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). It may pose a small risk of myopathy (muscle injury). Patients should be warned about muscle injury and told to report any pain or weakness. In addition, CPK levels should be measured weekly. Increased urination and urinary urgency, abdominal bloating and diarrhea, and headache and visual disturbances are not associated with daptomycin.

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

The answer is B, Metronidazole is a drug of choice for C. difficile infection. Daptomycin has a unique mechanism and can rapidly kill virtually all clinically relevant gram-positive bacteria, including MRSA. Rifampin [Rifadin] is a broad-spectrum antibacterial agent used primarily for tuberculosis. However, the drug is also used against several nontuberculous infections. Rifampin is useful for treating asymptomatic carriers of Neisseria meningitidis. Rifaximin [Xifaxan] is an oral, nonabsorbable analog of rifampin used to kill bacteria in the gut.

Fluoroquinolones should be discontinued immediately if what happens? A. Nausea, vomiting, or diarrhea is experienced. B. Dizziness, headache, or confusion occurs. C. Tendon pain or inflammation develops. D. Theophylline is prescribed for asthma.

The answer is C, Fluoroquinolones can cause tendon rupture and should be discontinued if tendon pain or inflammation develops.

The nurse notices tan lines around the arms of a female patient who is taking levofloxacin [Levaquin]. Which action should the nurse take? A) No action is needed, because this is a temporary but expected side effect. B) Continue the antibiotic with an anti-inflammatory medication. C) Advise the patient to avoid sun exposure and wear sun screen when outside. D) Discontinue the medication.

The answer is C, Fluoroquinolones pose a risk of phototoxicity. Accordingly, patients should avoid sunlight and sunlamps, and should use protective clothing and a sunscreen if they must go outdoors.

The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients? A) Metronidazole [Flagyl] B) Rifampin [Rifadin] C) Ciprofloxacin [Cipro] D) Daptomycin [Cubicin]

The answer is C, In elderly patients, ciprofloxacin [Cipro] poses a significant risk of confusion, somnolence, psychosis, and visual disturbances. Metronidazole, rifampin, and daptomycin are not associated with confusion in elderly patients.

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

The answer is 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. These cationic agents should be administered at least 6 hours before ciprofloxacin or 2 hours after.

A patient who takes ciprofloxacin [Cipro] and runs 6 miles daily tells a nurse about heel and calf tenderness. The nurse anticipates the healthcare provider to take which action? A) No action is needed, because this is a temporary but expected side effect. B) Continue the antibiotic with an anti-inflammatory medication. C) Slow the running pace and walk more. D) Discontinue the medication, because severe damage can result.

The answer is D, Fluoroquinolones may result in tendinitis and rupture by disrupting the extracellular matrix of cartilage. Because tendon injury is reversible if diagnosed early, fluoroquinolones should be discontinued at the first sign of tendon pain or inflammation.

A patient taking gemifloxacin develops a rash. The nurse anticipates the healthcare provider to take which action? A) No action is needed, because this is a temporary but expected side effect. B) Continue the antibiotic with an anti-inflammatory medication. C) Cut the dose of medication in half. D) Discontinue the medication.

The answer is D, The incidence of rash with gemifloxacin is much higher than with other fluoroquinolones. Women under 40 years of age are at greatest risk. Symptoms are severe in about 10% of patients who develop a rash; in the rest, symptoms are mild to moderate. As a rule, gemifloxacin-induced rash resolves spontaneously in 1 to 2 weeks, although some patients require treatment with systemic glucocorticoids. If rash develops, gemifloxacin should be discontinued.

The healthcare provider orders levofloxacin [Levaquin] 500 mg PO every day for 7 days. The available medication is levofloxacin 250-mg tablets. How many tablets should the patient take each day? A) 0.5 tablet B) 1 tablet C) 1.5 tablet D) 2 tablets

The answer is D, Two tablets that are each 250 mg would equal the ordered 500-mg daily dose.