J2 Pharm Antibiotics and antifungals

bacteriostatic inhibitors

- inhibit bacterial protein synthesis a. Meds are bacteriostatic: suppress bacterial growth and replication but do not out right kill bacteria -Second line drugs for infections resistant to first line

clindamycin adverse effects

-(CDAD) 10-20 watery stool/day a. mucus and blood b. usually develop w/in week of treatment but can be 4-6 wk after treatment -ab pain, fever, leukocytosis -report more than 5 diarrhea/day -DC and give vanco ii. diarrhea unrelated to c.diff iii. hypersensitivity reactions (rash) iv. EKG changes, hypotension, cardiac arrest -Seen with rapid infusion

clarithromycin action and uses

-Action: inhibition of protein synthesis -Uses: resp tract infection, skin infect, H. pylori infection

Ciprofloxacin-fluroquinolones action

-Broad spectrum that distrupt DNA replication and synthesis of proteins or cell wall -Action: bactericidal as result of inhibition of enzyme necessary for DNA replication

treating onchomycosis PO

-PO: Itraconazole and terbinafine -Incorporated into the keratin as nail grows ii. Course of treatment: 3-6 months iii. Cure rate: relatively low iv. Adverse effects: GI disturb: nausea, vomit, ab pain 1. Skin reactions

tetracycline nursing considerations

-Take with meals to minimize GI upset -Avoid admin to kids under 8 -Avoid admin to pregnant women -Notify prescriber if significant diarrhea develops -Use sunscreen and protective clothing -Teach s/s fungal infection -Ideal to take on an empty stomach with a full glass of H2O -Increase dose of OC or alternative form of BC

The nurse should include which instructions when teaching a patient about tigecycline therapy?

-Use sunscreen when you are outside." -If you have diarrhea more than five times a day, notify your healthcare provider -Avoid using this drug if you are pregnant.

clotrimazole adverse effects with intravaginal application

1. Burning & lower abdominal cramping 2. Stinging, erythema, edema, uricaria, pruitius and peeling

polyene antibiotic ampho B interactions

1. Nephrotoxic drugs: aminoglycosides: Gentamycin, streptomycin, cyclosporine a. Additive nephrotoxic risk 2. NSAIDS: additive nephrotoxic risk 3. Flucytosine: Antifungal effects of Flucytosine are potentiated with the concurrent use of amphotericin B

clarithromycin admin

ER, IR and granules for solution 1. IR and granules well absorb with food 2. ER not well with food 3. Heaptic metabolism

clotrimazole adverse with topical use

Stinging, erythema, edema, itching, peeling and burning

Ciprofloxacin-fluroquinolones pediatric uses

UTI caused by E.coli and post exposure treatment of anthrax

Itraconazole adverse effects

well tolerated in reg doses 1. GI distress (most common) 2. Rash 3. Headache 4. Abdominal pain 5. Cardiac suppression: negative inotropic actions a. Return to normal 12 hours after dosing b. Not for pt with HF and superficial fungal infection c. If severe fungal infection can still give it 6. Liver injury

Ciprofloxacin-fluroquinolones nursing considerations

-Available PO or IV -Can be taken with/without food -Take no sooner than 6 hours after or 2 hours before ingesting cationic compounds or milk & dairy -Sunscreen & protective clothing -risk tendon rupture & report early v-Monitor INR & reduce dose of warfarin if needed -Monitor theophylline level reduce dose if needed

polyene antibiotic ampho B hypokalemia and hemotaolical considerations

-Hypokalemia: monitor K, give K supplements -Hemotological effects: Obtain baseline CBC, Hct & monitor weekly

4 classes of systemic antifungals

1. Polyene antibiotics 2. Azoles 3. Echinocandins 4. Pyrimidine analogs

itraconazole considerations

1. Take with food and/or a cola beverage 2. Take antacids & other drugs that reduce gastric acidity 1 hour before or 2 hours after Itraconazole 3. Instruct about s/sx of liver dysfunction notify prescriber 4. Inform about s/sx of heart failure, dc drug & 5. Seek immediate medical attention

tetracyclines absorb

1. Tetracycline, demeclocylcine and doxycycline are reduced by food 2. Decreased absorption with calcium supplements, milk products, iron supplements, magnesium laxatives and most antacids

Ciprofloxacin-fluroquinolones increase levels of

1. Theophylline 2. Warfarin: PT 3. Tinidazole (antifungal) 4. Toxicity can result

tetracyclines duration

1. short acting: tetracycline low lipid solubility 2. Intermediate 3. Long: doxycycline and minocycline are highly lipid soluble

patient is scheduled to receive intravenous amphotericin B. Which medication should a nurse administer as pretreatment before the infusion?

50 mg of diphenhydramine [Benadryl] and 650 mg of acetaminophen

polyene antibiotic ampho B treatment

6-8 weeks or up to 3-4 months

polyene antibiotic ampho B hematologic effect

: bone marrow suppression, normochromic anemia 5. Thrombophlebitis

superficial mycoses

Candida species and dermatophycytes -Usually in mucous membranes and moist skin i. Hair, skin, nails

A nurse planning care for a patient who is receiving nystatin [Mycostatin] should establish which outcome on the care plan?

Decrease in mouth pain -used for candidiasis of the skin, mouth, esophagus, intestine, and vagina.

Which antifungal agent is used as a one-time oral dose to treat vaginal yeast infections?

Fluconazole

What does the nurse identify as an adverse effect of clindamycin [Cleocin] therapy?

Frequent loose, watery stools with mucus and blood

Which approach should a nurse take when administering an oral dose of levofloxacin [Levaquin]?

Give the medication with or without food -Levofloxacin should not be administered with milk products or antacids containing magnesium or aluminum, because this reduces absorption from the gastrointestinal (GI) tract.

A nurse is teaching a patient who is scheduled to start taking itraconazole [Sporanox]. Which statement by the patient would indicate understanding of the teaching?

If I notice my skin turning yellow or feel any nausea, I'll notify my healthcare provider. -may cause liver injury

Which laboratory result should a nurse monitor more frequently when a patient is receiving clarithromycin [Biaxin] and warfarin [Coumadin]?

International normalized ratio (INR)

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?

Metronidazole [Flagyl]

polyene antibiotic ampho B thrombophlebitis considerations

Observe infusion sites for s/sx erythema, swelling& pain a. Rotate infusion sites b. Administer through a large bore IV in a large vein c. Administer heparin before giving amphotericin B d. Consider central line

griseofulvin

PO for superficial mycoses i. Action: deposit into keratin precursor cells of skin, hair and nails 1. As infected keratin is shed it is replaced with healthy ii. Admin: PO enhanced with fatty meals iii. Uses: not active against candida iv. Adverse: HA, rash, insomnia, tired, GI

It is most important for the nurse to assess a patient taking itraconazole [Sporanox] for the development of what?

Pedal edema -negative inotropic actions and may cause a transient decrease in the ventricular ejection fraction, thus precipitating heart failure

polyene antibiotic ampho B infusion reaction considerations

Pre tx with diphenhydramine (benadryl) and acetamin a. Demerol or dantrolene may be given IV for rigors b. Use lipid based preparations of amphotericin B to minimize reactions c. Hydrocortisone to reduce fever and chills

Which cardiovascular finding does the nurse identify as a possible adverse effect of erythromycin [Ery-Tab] therapy?

Prolonged QT interval

A patient is receiving amphotericin B. The nurse identifies which medication as useful in preventing adverse effects of amphotericin B?

Renal injury from amphotericin B may cause severe hypokalemia. Serum potassium levels should be monitored more frequently and potassium supplements given to correct low plasma levels.

Which instruction should a nurse include in the discharge teaching for a patient who is to start taking tetracycline?

Use sunscreen and protective clothing when outdoors."

Azores

a. Broad spectrum antifunal drugs i. Lower toxicity and can be given PO ii. Inhibit metabolism of CYP450 drugs and can increase levels of many other drugs

clindamycin action

a. Can promote severe condition CDAD that can be fatal b. Action: inhibit micro-organism growth by preventing protein synthesis

Itraconazole interactions increase levels of

a. Cisapride b. Pimozide c. Dofetilide d. Quinidine: Concurrent use with these drugs can cause fatal dysrhythmias

treating onchomycosis

a. Difficult to irradiate b. Requires prolonged treatment c. Caused by candidia d. Cosmetic concern i. Treatment optional

Itraconazole uses

active against broad spectrum of fungal pathogens 1. Blastomycosis 2. Histoplasmosis 3. Paracoccidioidmycosis 4. Sporothrichosis

polyene antibiotic ampho B uses

active against broad spectrum of pathogenic fungi 1. Drug of choice for most systemic mycoses a. leishmaniasis (sand fly fever) b. before this drug fungal infections were fatal 2. Reserved for treating infection that are progressive and potentially fatal

polyene antibiotic ampho B action

acts on fungal cell membrane to increase permeability resulting in intracellular leakage leading to cell death 1. Binds to ergosterol, cell wall needs this otherwise not effected by ampho B

Ciprofloxacin-fluroquinolones interactions cationic compounds

admin 6 hours before or 2 hours after cipro 1. Aluminum-or magnesium antacids 2. Iron salts 3. Zinc salts 4. Sucralfate 5. Milk and Dairy a. Decrease absorption of Cipro

Linezolid-oxazolidinone action

bacteriostatic inhibitor of protein synthesis i. Works against multiresistant gram + pathogens ii. Cross resistance with other agents is unlikely

polyene antibiotic ampho B nephrotoxic considerations

baseline kidney function (BUN and creat) a. Monitor weekly b. Monitor I&O c. Infuse 1 L of saline on day of infusion d. Avoid nephrotoxic drugs

A patient is receiving amphotericin B. It is most important for the nurse to monitor which laboratory result?

creatine

polyene antibiotic ampho B hypokalemia

damage to kidneys a. Give supplements

clarithromycin adverse effect

diarrhea, nausea and distorted taste 1. May prolong QT

A nurse assessing a patient who is 12 years old should associate which complication with the patient's receiving tetracycline as a younger child?

discolor of teeth

tetracyclines elimination

eliminated by kidney and liver 1. Tetracycline and demeclocycline are elmintaed in urine and should not be given to pt with renal impair 2. Long acting tetracyclines are eliminated by liver so give these if renal impairment

tetracycline adverse effects GI discomfort

epigastric burning, cramps, nausea, vomit and diarrhea 1. Give with meals but may decrease absorb 2. Avoid dosing at bedtime to prevent ulcers

polyene antibiotic ampho B infusion reactions

fever, chills, rigor, HA a. Proinflammatory cytokines b. Begins 1-3 hr after starting and lasts 1 hr c. PRETREAT with diphenhydramine plus acetaminophen d. IV merperidine if rigors occur e. Phlebitis: change sites often and pretreat with heparin

metronidazole interactions

i. Disulfiram-like reaction with alcohol 1. Severe hang over ii. Inhibits inactivation of warfarin

metronidazole adverse effects

i. GI discomfort: n&v, dry mouth, metallic taste ii. Dark urine iii. CNS symptoms iv. CNS symptoms v. Numb of extremities vi. Ataxia, seizures

clindamycin considerations

i. Instruct pts. to take oral dose with full glass of water ii. Complete entire course of med even if symptoms abate before full course is over iii. Report significant diarrhea (>5 watery stools/day) to prescriber

Linezolid-oxazolidinone interactions

i. MAOIs (cocaine, ephedrine, pseudoepinepherine) 1. Hypertensive crisis ii. Food with tyramine 1. Hypertensive crisis iii. SSRIS (paroxetine, duloxetine) 1. Serotonin syndrome

tetracycline med/food that decrease absorb of tetracycline

i. Milk products ii. Calcium supplements iii. Iron supplements iv. Magnesium-containing laxatives v. Most antacids vi. Oral contraceptives decrease efficacy vii. Admin tetracycline 1 hour before or 2 hour after ingestion of chelating agent

Linezolid-oxazolidinone nursing considerations

i. Not for pt with phenylketonuria ii. Food decreases the rate of absorption but not the extent iii. Blood counts to be done weekly iv. Oral suspension CANNOT be given to pts. with phenylketonuria v. Teach pts. to avoid food that contain tyramine`

metronidazole considerations

i. Report s/sx of GI distress ii. Advise that dark urine is a harmless effect iii. Notify and dc med if CNS symptoms develop iv. No alcohol v. Monitor pt INR adjust warfarin dose accordingly 1. Decrease dose

tetracycline adverse effects teeth discolor

ii. Yellow brown tooth discolor: bind to calcium in developing teeth 1. Dose dependent 2. Stain deciduous teeth of fetus, will not effect permanent teeth of fetus 3. Discolor of permanent teeth happens when taken age 4mo-8yr old

polyene antibiotic nystatin adverse effects PO and topical

iii. Adverse effects w/ PO: GI disturbances iv. Adverse effects w/ topical admin: local irritation

metronidazole

protozoal infections and infections caused by obligate anaerobic bacteria

polyene antibiotic ampho B nephrotoxicity

renal impairment occurs in almost all pts a. Related to total dose over course of treatment b. If exceeds 4gm residual impairment is likely c. Infuse 1 L saline on days ampho is given d. Avoid other NSAIDS e. Renal and kidney function tests q 3-4 days f. If creat above 3.5 adjust dose

Linezolid-oxazolidinone uses

reserve for: i. vanco resistant enterococci ii. MRSA iii. Hospital acquired pneumonia-staph aureas or strep iv. Community acquired pneumonia-strep pneumonia v. Complicated and uncomplicated skin infections (MRSA, strep and staph) vi. NOT active against gram - bacteria

Itraconazole action

safer than ampho and can be PO i. Action: acts on fungal cell wall membranes to increase cell permeability which results in leakage of intracellular cations leading to cell death 1. Inhibits synthesis of ergosterol

clotrimazole uses

topical, drug of choice for dermatophytic infection and candidiasis of skin, mouth and vagina

polyene antibiotic nystatin uses

used only for candida i. Uses: drug of choice from intestinal candidiasis 1. Candida infections of a. Skin, mouth, esophagus, vagina

clindamycin uses

v. Drug of choice: gram + cocci 1. Severe group A strep 2. Gas gangrene 3. B. fragilis 4. Ab and pelvic infection

tetracycline interact with digoxin

viii. Can also increase digoxin levels 1. Drug level monitoring

clarithromycin interactions

warfarin, theophyilline, carbamazepine

tetracycline adverse effects

suppression of long bone growth in premature infants -photosensitivity -Hepatotoxicity: lethargy and jaundice, IV at high doses, Pregnant or post partum with kidney disease greatest risk -Renal toxicity: eliminated by kidneys 1. Tetracycline 2. Demeclocyline

Ciprofloxacin-fluroquinolones adverse effects

-GI upset -CNS effects -Candida infections of pharynx and vagina -Elederly: significant risk confusion, somnolence, psychosis -Tendon rupture: Achilles: Avoid in children under 18 -Phytotoxicity -Increase risk for c. diff -Exacerbation of muscle weakness in pt with myasthenia gravis

Which statements about CDAD associated with clindamycin therapy does the nurse identify as true?

-it is a potentially fatal condition -Patients usually experience abdominal pain. -Clindamycin therapy should be discontinued and vancomycin started

tetracyclines meds

-tetracycline (short acting) -Demeclocycline (intermediate acting) -Doxycycline (long acting) -Minocycline (long acting)

A nurse is administering an oral dose of itraconazole [Sporanox] to a patient at 10:00 AM. The nurse should administer a prescribed dose of famotidine [Pepcid] at which time?

9:00 AM -Medications that lower gastric acidity, such as famotidine [Pepcid], can reduce absorption of oral itraconazole [Sporanox].

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?

Antacids interfere with the absorption of quinolone antibiotics, such as ciprofloxacin [Cipro]

treating onchomycosis topical

Ciclopirox i. Applied 1x daily to nail and immediately adjacent skin ii. Remove once a week with alcohol iii. Side effects: minimal iv. Lengthy course of treatment: Up to 48 weeks v. Cure rate low: 12% vi. Recurrence rate 40% vii. Safer & cheaper than oral treatment

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?

Discontinue the medication, because severe damage can result.

clindamycin routes

PO, IV, IM, topical i. Not effected by food ii. Eliminated by hepatic metabolism to be converted and later excreted in urine iii. If hepatic and liver disease levels may get very toxic

A patient who has a vancomycin-resistant enterococci (VRE) infection is receiving linezolid [Zyvox]. Which laboratory result indicates that the patient is having an adverse effect?

White blood cell (WBC) count of 1200 units/L

Itraconazole interactions

a. Digoxin b. Cyclosporine c. Warfarin d. Sulfonylureas: increase in these drug levels with concurrent use of Itraconazole i. Concurrent use is contraindicated

Ciprofloxacin-fluroquinolones antimicrobial spectrum

broad spectrum i. Most aerobic gram - ii. Some gram + iii. Salmonella, shigella, E. coli, anthracis, meningococci iv. NOT useful for ANAEROBIC or C. diff v. Poor choice for staph

tetracyclines action

broad spectrum antibiotics that inhibit micro-organism growth by preventing protein synthesis and inhibit binding of tRNA to mRNA i. Bacteriostatic

macrocodes

broad spectrum antibitoics that inhibit bacterial protein synthesis

metronidazole action

broad spectrum antimicrobial with bactericidal activity against anaerobic micro-org i. Taken up by cells and converted to active form ii. Interacts with DNA to cause strand breakage and loss of structure resulting in cell death

tetracycline adverse effects super infection

c. diff notify provider if diarrhea occurs to be tested for C. diff 1. DC if C. diff is diagnosed a. Treat with vanco or metronidazole 2. Fungus in the mouth: thrush

doxycycline

can be given once daily i. Safer for pt with renal fail ii. Topical form

minocycline

can be taken with food i. Safe for pts with kidney disease ii. Expensive iii. Can damage vestibular system 1. Dizzy, light headed 2. Reduce symptoms of arthritis

opportunistic systemic fungal infection

candidiasis, aspergillosis, cryptococcis are in immunocompromised hosts

The nurse identifies which medication as posing a significant risk of causing confusion, somnolence, psychosis, and visual disturbances in elderly patients?

ciprofloxacin

fluconazole

fungastatic i. HL 30 hours so 1x day ii. Rare adverse effects: steven Johnson, hepatic necorosis, and anaphylaxis iii. DO NOT TAKE IN PREGNENACY

Linezolid-oxazolidinone adverse effects

generally well tolerated i. Diarrhea ii. Nausea iii. Headache iv. Reversible myelosuppression: anemia, leukopenia, thrombocytopina v. Neuropathy vi. Reversible optic neuropathy vii. Irreversible peripheral neuropathy-prolonged therapy viii. PO: phenylalanine

Itraconazole interactions drugs that raise gastric pH

greatly reduce absorb of oral itraconazole, give 1 hour before or 2 hours after a. Antacids b. H2 inhibitors c. PPIs

tetracyclines uses

has declined because of increased resistance and other antibiotics have greater selectivity and less toxicity Are 1st line for: -Rickettsial diseases -Infections caused by chlamydia trachomatis -Brucellosis -Cholrea -Pneumonia caused by mycoplasma pneumonia -Lyme disease -Anthrax -H pylori -Periodontal disease: doxycycline (PO and topical) and minocycline (topical) -Acne: topically and PO

Ciprofloxacin-fluroquinolones uses

infections of i. Respiratory tract ii. GU tract: most urinary infections iii. GI tract iv. Bones & Joints v. Skin & soft tissue vi. Drug of choice for prevention of anthrax in pts. who have inhaled anthrax spores vii. Not for staph

tetracycline

least expensive, most widely used

metronidazole uses

lethal to anaerobes only! -Infections of 1. CNS 2. abdominal organs 3. Bone & joints 4. Skin & soft tissue 5. GU tract 6. Drug of choice for CDI -Prophylaxis in high risk surgical procedures associated with high risk for anaerobic infection (Vagina, ab and colorectal) -H. pylori in combo with tetracycline and bismuth salicylate

clindamycin microbial action

limited use, systemic use for certain anaerobic bacteria located outside of CNS i. Gram + and - ii. Most gram + aerobes iii. Gram - aerobes are generally resistant iv. Widely used as alternative to penicillin

minoconazole

monistat i. Uses: thrush and vaginal candidias ii. Adverse: burning, itching iii. Interact: can intensify effects of warfarin

metronidazole route

most often IV slowly over 1 hr

tetracyclines distribute

poor penetration to CSF 1. Readily cross placenta

polyene antibiotic ampho B admin

poorly absorbed from GI tract 1. PO admin cant be used for systemic infection 2. Must be IV: large bore, central line 3. Conventional formula 4. 3 lipid formations: less toxicity and just as effective a. more expensive

democlocycline

stimulate urine flow, excessive urine, thrist and tiredness

The nurse identifies which drug as a short-acting tetracycline?

tetracycline