Antibiotics NUR 210 Unit 10 (2023) Galen PPP.pptx

Macrolides, Tetracyclines, Aminoglycosides, and Fluoroquinolones NUR 210 Unit 10  Action Inhibits protein synthesis Macrolides: Azithromycin Use Used when patients are allergic to PCN/Cephalospori...

Macrolides, Tetracyclines, Aminoglycosides, and Fluoroquinolones NUR 210 Unit 10  Action Inhibits protein synthesis Macrolides: Azithromycin Use Used when patients are allergic to PCN/Cephalosporins For stronger bacterial infections  Side effects/adverse reactions Blurred vision, headache, drowsy, fatigue GI distress Macrolides: Photosensitivity Azithromycin Allergic reaction/anaphylaxis Tinnitus - ototoxicity Superinfection Hepatotoxicity Stevens-Johnson syndrome  Contraindications/cautions Allergy Heart issues (dysrhythmias) Macrolides: Hepatic/Renal dysfunction Azithromycin Interactions Levels of warfarin increase. Levels of digoxin increase Oral birth control Nursing Process - Assessment Macrolides: Vital signs Azithromycin I & O; urinary output Check labs for liver/kidney function Drug history Medical history  Nursing interventions Obtain culture and sensitivity (C&S) before therapy. Monitor vital signs & urine output Macrolides: Monitor liver enzymes and for S/S of liver issues Azithromycin Monitor for superinfection Administer antacids 2 hours before or 2 hours after macrolides. Give azithromycin 1 hour before or 2 hours after meals with full glass of water – no fruit juice Use sunscreen Ok to give with food with stomach upset  Evaluation- Macrolides: Azithromycin How do we know the medication worked?  Action/Uses Started in the 1950’s Serious infections Glycopeptides: MRSA Vancomycin Bacteria have developed a resistance to this drug (VRE) Given Oral IV – slowly!  Chills, dizzy Side GI distress Effects/Adverse Thrombophlebitis (given in a central line Reactions – IV) Glycopeptides: Nephrotoxic Vancomycin Ototoxic Can lead to permanent hearing loss because of cranial nerve damage Can lead to permanent loss of balance Stevens Johnson syndrome  Red-man syndrome – giving it too fast can cause a rash to face, neck, back, and chest - toxic effect Glycopeptides: Vancomycin Other symptoms can include hypotension, tachycardia, wheezing, and sometimes itching  Nursing interventions Obtain C&S before therapy. Monitor vancomycin levels (peak and trough) Glycopeptides: Administer over 1 to 2 hours IV. Monitor BP. Vancomycin Monitor IV site. – usually a central line Monitor renal function tests including creatinine clearance as ordered on renal patients Hearing. Monitor patient for superinfection. How do we know it worked - evaluation Tetracyclines: Use Doxycycline Many types of infections or allergy to PCN/cephalosporins  Side effects/adverse reactions Stomatitis, GI distress Photosensitivity Tetracyclines: Discoloration of permanent teeth Doxycycline ◦ Do not give to children younger than 8 years or pregnant women Superinfection Hepatotoxicity Stevens Johnson syndrome  Interactions Dairy products, iron Digoxin and warfarin (risk for toxicity) Tetracyclines: Decreases K level Doxycycline Contraindications Children under 8 Pregnant women (teratogenic and tooth damage) Decreases effects of oral contraceptives Renal or hepatic disorder Nursing Process - Assessment Tetracyclines: Vital signs Doxycycline Urine output Check labs if available – liver and kidney Drug history/medical history  Nursing interventions Nursing Process - Obtain C&S before giving drug. Tetracyclines: Monitor VS and urine output Doxycycline Administer 1 hour before or 2 hours after meals. Can give with food if stomach upset – no dairy Monitor kidney and liver function.  Store out of light and extreme heat. Advise patient to use sunscreen. Teaching- Teach patient to report superinfection. Tetracyclines: Warn patient to avoid milk, iron, antacids. Doxycycline Tell patient to use effective oral hygiene Take all of the med Teach to side effects and how to manage and the adverse reactions to report To use another form of birth control Tetracyclines: Doxycycline How do we know the medication worked? Aminoglycosides: Use Gentamicin More serious infections 1 Usually given IV  Side effects/adverse reactions Aminoglycosides: Confusion/tremors/headache/GI distress Allergy Gentamicin 1 Superinfection Ototoxicity Blood dyscrasias (platelet, RBC’s, WBC’s) Nephrotoxicity SJS  Interactions Aminoglycosides: Warfarin Gentamicin 1 Contraindications Renal disease OLDER ADULTS – last resort Nursing Process - Assessment Aminoglycosides: VS, urine output Gentamicin Any labs that are available – renal/liver 1 Medical history including medications Peak and trough (if patient on med)  Nursing interventions Obtain C&S. Monitor VS & I/O Aminoglycosides: Monitor renal function, urine output – increase Gentamicin fluids 1 Monitor for ototoxicity Give IV slowly and diluted – usually central line Monitor peak and trough and other labs Monitor for superinfection Aminoglycosides: Gentamicin How do we know they worked - 1 evaluation Fluoroquinolones: Ciprofloxacin Ciprofloxacin (all end in “-floxacin”) Severe infections  Side Effects/Adverse Reactions GI upset CNS issues – HA, dizziness, tremors, Fluoroquinolones: nightmares Ciprofloxacin Photosensitivity Bradycardia Blood dyscrasia – RBC’s, WBC,s, platelets Superinfection Hepatotoxicity, Nephrotoxicity Tendon rupture  Side Effects/Adverse Reactions GI upset CNS issues – HA, dizziness, tremors, Fluoroquinolones: nightmares Photosensitivity Ciprofloxacin Bradycardia Blood dyscrasia – RBC’s, WBC,s, platelets Superinfection Hepatotoxicity, Nephrotoxicity Tendon rupture  Drug interactions Increases effect of oral hypoglycemics, Fluoroquinolones: caffeine. Ciprofloxacin Contraindications Renal/hepatic disease Neuromuscular disease Children under 14 Fluoroquinolones: Assessment Ciprofloxacin VS and urine output Any kidney/liver labs Drug and health history  Nursing interventions Obtain C&S. Infuse slow IV over 60 to 90 minutes. Fluoroquinolones: Monitor I & O Ciprofloxacin Increase fluid intake to more than 2000 mL/d. Check for superinfection Monitor blood sugar for diabetics for hypoglycemia)  Teaching Increase fluids Avoid caffeine Fluoroquinolones: Can cause dizziness – use care Levofloxacin Use sunblock – photosensitivity To side effects to expect and how to minimize them and what adverse reactions to report How do we know it worked?  Which teaching by the nurse has highest priority for the patient taking azithromycin? A. Instruct the patient to use sunblock and Practice Question protective clothing during sun exposure. #1 B. Instruct the patient to store the drug out of light and extreme heat. C. Inform parents that children younger than 8 years should not take the drug, to avoid tooth discoloration. D. Instruct the patient to report any loose stools or diarrhea.  Answer: D Rationale: The patient should be instructed Practice Question to report loose stools or diarrhea because of #1 possible pseudomembranous colitis. Photosensitivity during sun exposure is common with tetracyclines, which should not be given to children younger than 8 years; the drugs are affected by light and extreme heat.  Which statement by a patient who has received teaching on tetracycline therapy indicates that more teaching is indicated? A. “I will store the medication away from light and extreme heat.” Practice Question B. “I will use an additional contraceptive #2 technique because this drug may cause the oral contraceptive I take to be less effective.” C. “I will take this medication with an antacid.” D. “If my stomach becomes upset when taking this medication, I will take it with nondairy foods.”  Answer: C Practice Question Rationale: Patients taking tetracycline therapy should avoid milk products, iron, and antacids. #2 The medication should be stored away from light and extreme heat. Tetracycline can decrease the effectiveness of oral contraceptives.  A patient is ordered to receive vancomycin for a severe infection. It is most important for the nurse to assess the patient for the Practice Question development of #3 A. neurotoxicity. B. hepatotoxicity. C. ototoxicity. D. cardiotoxicity.  Answer: C Rationale: Vancomycin may cause Practice Question nephrotoxicity and ototoxicity. Ototoxicity #3 results in damage to the auditory or vestibular branch of cranial nerve VIII. Such damage can result in permanent hearing loss (auditory branch) or temporary or permanent loss of balance (vestibular branch).  A patient is receiving gentamicin therapy: 100 mg intravenously at 0800, 1600, and 2400. At 0730, the nurse is informed that peak and trough levels needs to be drawn. When is the Practice Question best time to obtain the peak level? #4 A. 0800 B. 0900 C. 1600 D. 2330 Practice Question Answer: B #4 Rationale: Blood should be drawn 45 to 60 minutes after drug has been administered for peak levels and minutes before next drug dosing for trough levels.