Chapter 91: Miscellaneous Antibacterial Drugs:

Adverse effects of metronidazole

neurotoxicity, allergy, superinfections

Polymixin B

topical treatment for the ears, eyes, and skin, and not used for systemic infections because of the risk of toxicity (can be given in drop form)

Fluoroquinolones

(end in oxacin) broad spectrum antibiotics that disrupt DNA replication and cell division

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.

A. Rationale: antacids interfere with the absorption of Cipro and many other drugs which means this pt has not received the full dose of the regimen

A pt is being discharged with continued ciprofloxacin therapy. When providing discharge teaching, the nurse should advise the pt to call the healthcare provider immediately if what develops? A. pain in the heel of the foot B. nausea C. diarrhea D. headache

A. Rationale: fluoroquinalones have caused tendon rupture (usually of the achilles tendon)

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. Pre-medicate the patient with diphenhydramine [Benadryl]. D. Administer the drug with milk products.

A. Rationale: this should not be administered with milk products because they decrease the absorption, and premeditating with Benadryl is unnecessary.

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

C.

Adverse effects of ciprofloxacin in older adult patients

confusion, somnolence, psychosis, visual disturbances and myasthenia gravis

Ciprofloxacin drug and food interactions

absorption is reduced by metal, milk, and dairy products, it can elevate drug levels like warfarin, tinidazole, and theophylline

Bacitracin

almost always used topically for bacterial infections and can go systemically and cause serious toxicity

Fidaxomicin

narrow spectrum antibiotic only indicated for C. diff infection

Rifampin

broad spectrum antibiotic used primarily to treat TB, always taken with another drug and can give it if someone is exposed to someone with H. flu

Ciprofloxacin

fluoroquinolone, drug of choice for anthrax, respiratory infections, UTI, and infections of the GI, joints, skin, and soft tissue

Route of administration of daptomycin

given once daily IV

Daptomycin

kills virtually all gram positive bacteria including MRSA; no significant drug interactions

The nurse identifies rifampin as useful in the treatment of which disorders? (Select all that apply.) A. Tuberculosis B. Active meningococcal infection C. Leprosy D. Prophylaxis of meningitis caused by Haemophilus influenzae E. C. difficile infection

A, C, and D Rationale: Rifampin is useful in the treatment of tuberculosis and can be used for prophylaxis of meningitis caused by H. influenzae. The treatment of leprosy is an unlabeled use. Rifampin is indicated for treatment of carriers of meningococcal infection, but not for active meningococcal infection. Rifampin is not indicated for the treatment of C. difficile infection.

A pt has been prescribed ciprofloxacin 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 pt is also taking warfarin B. withhold antacids and milk products for 6 hours before or 2 hours afterward C. inform the healthcare provider if the pt has a history of asthma D. assess the skin for Stevens-Johnson syndrome

B. Rationale: absorption can be reduced when combined with milk products

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

B. Rationale: daptomycin can cause muscle injury and patients should notify their physician if they experience any pain or weakness

A pt is diagnosed with C. diff infection. The nurse anticipates administering which medication? A. daptomycin B. metronidazole C. rifampin D. rifaximin

B. Rationale: metronidazole is the drug of choice for C. diff infections. Daptomycin can rapidly kill all gram positive bacteria including MRSA. Rifampin is used for treating TB and rifaximin is used to kill bacteria in the gut

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]

B. Rationale: metronidazole is the treatment of choice for C. diff infections

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.

C. Rationale: 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]

C. Rationale: 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.

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.

D.

Routes of administration of fluoroquinolones

orally or IV

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.

D. Rationale: 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.

It is most important for the nurse to avoid administering oral ciprofloxacin to this pt with which food? A. bananas B. baked chicken C. grapefruit juice D. milk

D. Rationale: the absorption of ciprofloxacin can be reduced by milk and dairy, iron zinc salts, aluminum or magnesium containing compounds, or calcium supplements.

Which main bacteria is resistant to ciprofloxacin?

S. aureus

Adverse effects of daptomycin

possible muscle injury; we must be careful about renal function

Metronidazole uses

protozoan infections, H. pylori infections and C. diff infections

Most prominent side effect of fluoroquinolones

tendon rupture

Pt's at risk when taking fluoroquinolones

those older than 60, those taking glucocorticoids, and those who have undergone kidney, heart, or lung transplantation

Mild adverse effects of ciprofloxacin

nausea/vomiting, diarrhea, abdominal pain, dizziness, headache, tendon rupture, PHOTOTOXICITY, candida infections, and increase risk of C. diff infections

Rifazimin

non-absorbable PO form of rifampin used for travelers diarrhea

A pt has been prescribed ciprofloxacin for treatment of a UTI from E. coli. Before administering the drug, it is most important for the nurse to assess the pt for a history of what? A. hypertension B. diabetes mellitus C. myasthenia gravis D. seasonal allergies

C. Rationale: ciprofloxacin and other fluoroquinolones can exacerbate muscle