Pharmacology Chapter 19: Key terms, Notes, PrepU

discontinue the drug immediately and return to the clinic.

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:

The use of ciprofloxacin is contraindicated in pregnancy.

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?

take the vitamins at least 2 hours before or after taking ciprofloxacin.

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

Fluoroquinolones

A client is prescribed ciprofloxacin for an acute sinus infection. The nurse knows that this anti-infective medication belongs to which drug category?

The client has chronic renal failure

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?

Administer the gentamicin IV and wait 1 hour and administer the penicillin.

A client with a severe infection has an order for IV gentamicin and IV penicillin. How will the nurse administer these medications?

True

A client's risk for ototoxicity, nephrotoxicity, and neurotoxicity increases dramatically if he or she receives an aminoglycoside in conjunction with a potent diuretic. True or False

Ciprofloxacin (Cipro)

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?

Peak and trough serum levels

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?

In the home using oral drugs

A male client is concerned that he cannot afford to have his wife's community-acquired pneumonia (CAP) treated in the hospital. He has limited health insurance, and the cost of intravenous antibiotic therapy is prohibitive. According to the American College of Chest Physicians' position statement, where will the client's wife be treated?

30 minutes after the drug has finished infusing.

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

"I will only drink enough water to swallow the drug."

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?

interfering with DNA synthesis in the bacterial cell

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?

Drugs that decrease the effects of cipro

Aluminum Didanosine, quinapril

Herbs/ Food that effect cipro

Aluminum, magnesium, calcium, and iron containg herbs and foods Dairy Dong Quai Enteral feedings St. Johns wort

Gentamicin ( Garamycin) Action

Aminoglycosides penetrate the cell the cell walls of susceptible bacteria and bin irreversibly to 30S and 50S ribosomal suunits, intracellular structures that synthesize proteins

culture and sensitivity

Before the selection of an aminoglycoside to treat a client's wound infection, what would the nurse expect the health care provider to order?

Clients with anemia.

Clients at increased risk for adverse reactions to either aminoglycosides or fluoroquinolones include all of the following EXCEPT:

Drugs that increase the effect of Cipro

Fosphenytoin Angiotension Probenecid

Ciprofloxacin (Cipro) adverse effects

Generally well tolerated GI- include nausea, vomiting, and abdominal discomfort Fluoroquinolones Black Box warning increased disabling risk of tendinitis and tenon rupture but also to the significant risk of peripheral neuropathy, CNS and Cardiac effects, and dematologic and hypersensitivity reactions Fluoroquinolones Black Box warning the drug class may exacerbate muscle weakness in persons with myasthenia gravis

Recommend loading dose for aminoglycosides

Gentamicin: 1 to 2.5 mg/kg Tobramycin: 1 to 2.5 mg/kg' Amikacin: 5 to 7.5 mg/kg

Higher efficacy with less nephrotoxicty

Once-daily aminoglycoside (ODA) dosing has replaced multiple daily dosing in many patients. What is the rationale behind ODA dosing?

Continue to monitor vital signs.

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?

Cheese

The nurse instructs the client who is taking oral ciprofloxacin to avoid which food while taking this medication?

Renal function

The nurse is preparing to administer amikacin to a client with a complicated Staphylococcus aureus infection. What assessment should the nurse prioritize?

antacids

The nurse should advise the client to avoid taking which medication at the same time as a fluoroquinolone?

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?

False

Today, aminoglycosides are replacing many older antibiotics due to their low risk of toxicity. True or False

Aminoglycoside

Used to treat serious infections by inhibiting bacterial protein synthesis by binding to ribosomal subunits. After initial dose, dosage is adjusted according to plasma concentrations of the individual patient. Gentamicin ( Garamycin) is the prototype

Oral administration for more serious infections

What is the advantage of fluoroquinolones over aminoglycosides?

oral (PO)

What route of administration is most commonly used for the administration of ciprofloxacin when prescribed to an older adult client?

every 4 hours

When administering a fluoroquinolone intravenously, the nurse should check the vital signs at which frequency?

Ototoxicity and nephrotoxicity

When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions?

bactericidal

When describing the action of fluoroquinolones to treat infection to a group of nursing students, which action would the instructor most likely include?

Oral

When preparing to administer a fluoroquinolone, the nurse understands that the majority of drugs belonging to this class are administered by which route?

Levofloxacin

Which of the following medications is contraindicated in children?

Nephrotoxicity Ototoxicity Neurotoxicity

While administering aminoglycosides to clients, the nurse must be aware of what toxicities that can result from their use? (Select all that apply.)

"Drink at least 2 liters of fluids per day."

You are preparing to discharge a patient who is taking ciprofloxacin. What guidance would you offer this patient to prevent crystalluria?

Avoid concomitant use of nephrotoxic drugs.

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?

To suppress intestinal bacteria.

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:

Action of Ciprofloxacin (Cipro)

acts by interfering with enzymes required for synthesis of bacterial DNA and therefore necessary for bacterial growth and replication. Fluoroquinolones are bactericidal agents that cause cell death

Ototoxicity

adverse effects on the structures of the ear, especially the cochlea and auditory nerve

Extended interval dosing

dosing regimen that provides once-daily administration of an aminoglycoside with demonstrated decreased nephrotoxicity and ototoxicity while maintaining therapeutic efficacy also called pulse dosing

Pharmacokinetics of ciprofloxacin

is well absorbed from the upper GI tract, like all quinolones; it achieves bioavilability.

Use of Ciprofloxacin (Cipro)

most potent fluoroquinolone against gram negative bacteria. May be used to treat infections of the repiratory, genitourinary, and GI tracts, as well infections of bones, joints, skin, and soft tissues. No longer recommended for use for gonococcal disease can be used for acute sinusitis, lower respiratory infections, pneumonia, skin and soft tissue infections, prostatitis, and UTI

Adverse effects in getamicin

nephrotoxicity, occurs in pt with renal impairment ototoxicity may develop after extened use dizziness, vertigo, tinnitus, and hearing loss Nephropathy, numbness, skin tingling, and muscle twitching,

Postanitbiotic effect

persistent effect of an antimicrobial on bacterial growth after brief exposure of the organisms to a drug

Gentamicin ( Garamycin) pharmakinetics

poorly absorbed from the GI tract It is rapidly and completely absorbed from IM site and reaches peak effects in 30 to 90 mins IV administration the peak effects occurs 30 min after 30 min infusion

Concentration- dependent bactericidal effect

relation of bactericidal ability of a drug to its concentration; the greater the concentration of the drug, the faster and more extensive the killing of the bacteria. The goal is to maximize concentration of the drug.

Fluoroquinolones

synthetic drugs with activity against gram negative and some gram positive organisms Ciprofloxacin (Cipro) is the prototype Newer Fluoroquinolones have been developed w/ a broder spectrum f activity that provides improved coverage of gram positive organisms and in one case anarobes

Gentamicin ( Garamycin) Use

the major clincal use of gentamicin (most commonly with other antibacterial agents) is empiric therapy for serious infection caused by susceptible aerobic gram negative organisms. treatment of infections such as septicemia, respiratory infection, UTI, intra abdominal infection, Osteomyelitis

Nursing implications for Cipro

watch for foods that effect cipro enteral feedings should be discontinued for 1 to 2 hours prior to and after cipro watch for hypoglycemia administer over 60mins