IV/Pharm Integumentary drugs part 2

Tetracyclines

• Broad-spectrum antibiotics
• Used for rickettsial infections, intestinal amoebiasis, skin and soft tissue infections, uncomplicated infections of the urethra, endocervix, and rectum, acne, mycoplasma pneumonia (walking pneumonia), and Lyme disease
• Used as adjunctive therapy for Helicobacter pylori and anthrax
• Adverse Reactions: GI upset (vomiting, diarrhea, epigastric distress, stomatitis, sore throat), skin rashes, hepatotoxicity (jaundice, monitor liver function tests), superinfections (e.g., C. difficile)
• Photosensitivity: avoid sun, tanning beds, tanning lamps; cover arms and legs, wear wide-brimmed hat for face and neck protection; sunscreen may or may not be effective
• Contraindications: Hypersensitivity, pregnancy (especially second half, may stain baby's teeth), lactation, children under 8-9 years old
• Pregnancy category D
• Cautious Use: Renal impairment, liver impairment, chronic care (may increase risk of digitalis toxicity in patients with heart disease)
• Administration: Give on an empty stomach with a full glass of water, except for medications and terramycin. If GI distress, give with food.
• Nursing Alert: Do not give with dairy products, antacids, magnesium laxatives, or products containing iron. Administer tetracyclines 2 hours before or after iron products.
• Drug Interactions: Antacids decrease tetracycline effectiveness, oral anticoagulants increase bleeding, contraceptives decrease contraceptive effectiveness, digoxin increases risk of digoxin toxicity, calcium-rich foods impair absorption

Macrolides

• Used for prophylaxis before dental and other procedures in patients allergic to penicillin (against rheumatic fever and bacterial endocarditis), Legionnaires' disease, pertussis (whooping cough), acute diphtheria, chlamydial infections, mycoplasma pneumonia (walking pneumonia), and streptococcal infections
• Adverse Reactions: GI upset (nausea, vomiting, diarrhea, abdominal pain, cramping, pseudomembranous colitis), visual disturbances, ototoxicity (monitor hearing before, during, and after treatment), thrombophlebitis, prolonged QT interval (increased risk of life-threatening dysrhythmia and sudden cardiac death)
• Contraindications: Hypersensitivity, pre-existing liver disease, pre-existing prolonged QT interval
• Cautious Use: Liver dysfunction, myasthenia gravis, pregnancy (category B and C), lactation
• Administration: Give on an empty stomach with 8 oz of water unless GI upset, then give with food. Avoid other medications impacting liver function.
• Exceptions: Azithromycin, clarithromycin, erythromycin
• Nursing Alerts: Monitor PT and INR if patient is taking Coumadin, monitor liver function if taking for longer than two weeks. Do not combine with diltiazem (Cardizem) or verapamil
• Drug Interactions: Antacids decrease macrolide absorption, digoxin increases digoxin levels, increases risk of bleeding with anticoagulants, decreases macrolide therapeutic activity with clindamycin, lincomycin, and chloramphenicol, increases theophylline levels with theophylline.

Lincosamides

• Used to treat serious infections when penicillin or erythromycin are not effective.
• Usually used in conjunction with other antibiotics
• Effective against a wide range of gram-negative and gram-positive microorganisms
• Adverse Reactions: GI upset (nausea, vomiting, diarrhea, esophagitis, abdominal pain), skin rash, blood dyscrasias
• Contraindications: Hypersensitivity to lincosamides; minor bacterial or viral infections
• Cautious Use: GI disorders, renal disease, liver impairment
• Administration: Give 1-2 hours before or after medication administration. Give clindamycin with food or a full glass of water.

Fluoroquinolones

• Broad-spectrum, bactericidal antibiotics
• Used to treat infections caused by gram-positive and gram-negative microorganisms (lower respiratory and GI infections, bone and joint infections, UTIs, and skin infections)
• Adverse Reactions: GI upset (nausea, diarrhea, vomiting, headache, abdominal pain), dizziness, Achilles tendon rupture (contraindicated in those under 18 unless absolutely necessary), photosensitivity, allergic reactions, superinfections (bacterial or fungal), pseudomembranous colitis (increased with Ciprofloxacin), yeast and thrush
• Contraindications: Hypersensitivity, children under 18, pregnancy, patients unable to follow photosensitivity precautions; those who have experienced tendon rupture with previous fluoroquinolone use
• Cautious Use: Renal impairment, history of seizures, geriatric patients, patients on dialysis
• Drug Interactions: Theophylline increases serum level, cimetidine (Tagamet) hampers antibiotic elimination, anticoagulants increase risk of bleeding, antacids, iron salts, or zinc decrease antibiotic absorption, dairy products decrease absorption
• Administration: Increased fluid intake, administer ciprofloxacin and moxifloxacin 2 to 4 hours before or 6 to 8 hours after taking antacids.