HFHS Orientation - Anti-infective Drugs PDF

# Pharmacology Study Guide ## Anti-infective Drugs ### General Information - Culture & sensitivity tests must be done before administering first dose - Verify allergy status - the most common drug allergy is to penicillin - IM or IV- inject or infuse slowly to minimize local irritation & phlebiti...

# Pharmacology Study Guide ## Anti-infective Drugs ### General Information - Culture & sensitivity tests must be done before administering first dose - Verify allergy status - the most common drug allergy is to penicillin - IM or IV- inject or infuse slowly to minimize local irritation & phlebitis - Dehydration decreases excretion of drug and may raise drug levels to toxicity - Assess therapeutic response: Reduction in fever, increased appetite, increased sense of well-being, decreased WBC's, wound healing, etc. - Assess for superinfections, particularly of fungal origin (Candida most common), characterized by oral thrush, nausea and/or diarrhea, abdominal cramps, white vaginal discharge, severe perineal itching, stomatitis, glossitis - Teach patients to complete entire prescribed therapy even if they feel cured. Incomplete therapy increases potential for relapse, or drug resistance may develop - The most common antibiotics given at Henry Ford Health includes Piperacillin/tazobactam, ciprofloxacin, levofloxacin, cefazolin, vancomycin, cefepime, gentamicin, tobramycin, cetriaxone, clindamycin, and azithromycin ### A. Penicillins: Amoxicillin, Ampicillin, Augmentin, Nafcillin Sodium, Pipercillin sodium, Penicillin G (aqueous), Penicillin VK, Trimox, Unasyn 1. **Indications:** Penicillins are antibiotics used to treat many different types of infections, such as tonsillitis, pneumonia, ear infections, bronchitis, urinary tract infections, gonorrhea, and infections of the skin, just to name a few. 2. **Serious Adverse Reactions:** - Anaphylaxis - Neutropenia - Leukopenia - Thrombocytopenia - Hepatotoxicity 3. **Nursing Considerations:** - Give with full glass of water on empty stomach - Do not give with acidic fruit juice - it decomposes the medication 4. **Patient Education:** - Seek emergency medical treatment if they experience signs and symptoms of an allergic reaction such as: shortness of breath, hives, swelling of the lips, face or tongue, rash, or fainting - Contact physician if they experience severe or bloody diarrhea and abdominal cramping if being discharged on penicillin - Penicillin may decrease the effectiveness of birth control pills and a second method of birth control while taking penicillin may be necessary to ensure protection from unintended pregnancy ### B. Tetracycline: Doxycycline (Vibramycin), Minocycline, and Tetracycline 1. **Indications:** Tetracycline is used for different types of bacterial infections including urinary tract infections, acne, gonorrhea, and chlamydia 2. **Serious Adverse Reactions:** - Neutropenia - Thrombocytopenia - Hepatotoxicity - Superinfection - Hemolytic anemia - Anaphylaxis 3. **Nursing Considerations:** - Effectiveness reduced with antacids, iron salts, & foods high in calcium - Give 1 hour before meals or 2 hours after meals - Give with a full glass of water. Adequate water should be taken with each dose to prevent irritation of the esophagus 4. **Patient Education:** - Warn to stay out of the sun, photosensitivity manifested by exaggerated sunburn Do not use tetracycline during tooth development, i.e., last trimester of pregnancy, neonatal period, and childhood until age 8 - may cause permanent discoloration of teeth & may inhibit fetal skeletal growth - Do not take dairy products, iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours of taking tetracycline. These products may reduce the effectiveness of tetracycline - Throw away any unused tetracycline when it expires or when it is no longer needed. Do not take any tetracycline after the expiration date printed on the label. Expired tetracycline can cause a dangerous syndrome resulting in damage to the kidneys - Stop taking the tetracycline and seek emergency medical attention if the patient experiences serious side effects such as an allergic reaction, severe headache, vision changes or confusion, liver damage, bleeding or bruising, or severe fatigue - Inform doctor if any less serious side effects occur including nausea, vomiting, increased sensitivity of the skin to sunlight, swollen tongue, or yeast infection ### C. Aminoglycosides: Amikacin, Gentamycin (Garamycin), Streptomycin, Tobramycin 1. **Indications:** Aminoglycosides are antibiotics used to treat many different infections including serious infections. Infections such as cirrhosis, gonorrhea, pneumonia, septicemia, and urinary tract infections may be treated with aminoglycosides 2. **Serious Adverse Reactions:** - Nephrotoxicity - Ototoxicity - Agranulocytosis - Thrombocytopenia - Neurotoxicity 3. **Nursing Considerations:** - Nephrotoxicity is a serious side effect of aminoglycosides. If these side effects are present, the physician must be contacted before administering this medication. Risk increases in patient with poor renal function and the elderly. Monitor patient's BUN, creatinine, increase/decrease in frequency of urination, and increased thirst for signs of nephrotoxicity. Nephroxicity is limited if given for less than 5 days. - Monitor patient for signs of ototoxicity. This may include tinnitus, hearing impairment, and vestibular symptoms such as dizziness, nystagmus, vertigo, and ataxia. 4. **Patient Education:** - Do not take aminoglycosides without first talking to your doctor if you have: - Sulfite sensitivity - Kidney disease - Hearing loss or loss of balance due to ear problems - Parkinson's disease or a neuromuscular disorder such as myasthenia gravis - Do not use aminoglycosides without first talking to your doctor if you are pregnant or could become pregnant during treatment - Aminoglycosides may cause damage to the kidneys and/or nerves. Kidney function and drug levels in the blood may be monitored with blood tests during treatment - Tell your doctor if you experience hearing loss, dizziness, numbness, skin tingling, muscle twitching, or seizures, which may be signs of nerve damage ### D. Quinolones: Ciprofloxacin (Cipro), levofloxacin (Levoquin), moxifloxacin (Avelox) 1. **Indications:** Quinolones are used to treat many different types of infections such as bronchitis, community acquired pneumonia, chronic bacterial prostatitis, UTI, and sinusitis 2. **Serious Adverse Reactions:** - Anaphylaxis - Hypersensitivity reaction - Phototoxicity - Superinfection - Increased ICP - Seizures - Tendon weakness/rupture 3. **Nursing Considerations:** - Use with caution in renal or liver failure, geriatrics and with seizure disorders - Administer 2 hours before or after antacids, iron supplements, and multivitamins - Encourage plenty of fluids to minimize risk of crystalluria - Pediatric use not recommended - Avoid using with drugs used to treat heart rhythm disturbances (irregular heartbeats) with drugs such as quinidine (Cardioquin, Quinidex, Quinaglute, others), procainamide (Pronestyl, Procan SR, others), amiodarone (Cordarone, Pacerone, others), sotalol (Betapace), and others. Combination of quinolones and these drugs may prolong the QT interval and lethal dysrhythmias may result 4. **Patient Education:** - Before taking levofloxacin, tell your doctor if you: - have kidney disease - have a seizure disorder - have a heart condition known as prolongation of the QT interval - have a slow heart rate that is considered a medical condition - have low levels of potassium in your blood, are being treated for heart rhythm disturbances (irregular heartbeats) with drugs such as quinidine (Cardioquin, Quinidex, Quinaglute, others), procainamide (Pronestyl, Procan SR, others), amiodarone (Cordarone, Pacerone, others), sotalol (Betapace), and others - Levofloxacin is in the FDA pregnancy category C. This means that it is not known whether levofloxacin will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment. - It is not known whether levofloxacin passes into breast milk. Similar drugs are known to affect bone development. Do not take levofloxacin without first talking to your doctor if you are breastfeeding a baby. - Take each dose with a full glass of water (8 ounces). Drink several extra glasses of fluid each day to prevent the formation of crystals in the urine. - Do not take antacids that contain magnesium or aluminum (e.g., Tums or Rolaids), the ulcer medicine sucralfate (Carafate), or vitamin or mineral supplements that contain iron or zinc for a minimum of 2 hours before or 2 hours after a dose. Taking antacids, sucralfate, or vitamin or mineral supplements too close to a dose can greatly decrease the effects of the antibiotic. ### E. Cephalosporins **First Generation:** cefazolin (Ancef, Kefzol), cefadroxil (Duricef), cephalexin (Keflex) **Second Generation:** cefamandole (Mandol), cefuroxime (Zinacef), cefoxitin (Mefoxin), cefotetan (Cefotan), cefuroxime (Ceftin), cefonicid (Monocid), cefmetazol (Zefazone) **Third Generation:** ceftizoxine (Cefizox), cefoperazone (Cefobid), cefprozil (Cefzil), cefotaxine (Claforan), ceftazidine (Fortaz), ceftriaxone (Rocephin), cefixime (Suprax), cefpodoxine (Vantin) **Fourth Generation:** cefepime (Maxipime) 1. **Indications:** Cephalosporins may be used to treat different types of bacterial infections such as bronchitis, pneumonia, blood infections, bone and joint infections, meningitis, abdominal infections, skin infections, ear infections, gonorrhea, pelvic inflammatory disease, and urinary tract infections. 2. **Serious Adverse Reactions:** - Anaphylaxis - Severe nausea, vomiting or diarrhea - Mucous or blood in the stool - Unusual bleeding or bruising 3. **Nursing Considerations:** - Broad spectrum antibiotic structurally related to penicillin. Ask about penicillin allergies - If allergic to penicillin, a third-generation cephalosporin medication may be tolerated. Use with caution - Cephalosporins are rapidly absorbed PO, IM, and IV - They all have similar sounding & similarly spelled names. Use care if taking phone/verbal orders and request clarification as needed - Persistent temperature elevations may be indicative of drug-induced fever - Prolonged serum half-life (15 hours) and reduced total clearance in the elderly 4. **Patient Education:** - Before using cephalosporins, tell your doctor if you have had: - Kidney disease - Liver disease - Bleeding or blood clotting problems - Gastrointestinal disease such as colitis or gallbladder problems - May decrease effectiveness of birth control pills and a second method of birth control while taking penicillin may be necessary to ensure protection from unintended pregnancy - Do not use cephalosporins if you have ever had an allergic reaction to penicillin without first consulting the physician - Seek emergency medical treatment if patient experiences signs and symptoms of an allergic reaction such as: shortness of breath, hives, swelling of the lips, face or tongue, rash, or fainting ### F. Macrolides Erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin/sulfisoxazole (Pediazole) 1. **Indications:** Macrolides are used to treat many different types of bacterial infections, such as tonsillitis, bronchitis, pneumonia, whooping cough, Legionnaire's disease, chlamydia, gonorrhea, skin infections, and others 2. **Serious Adverse Reactions:** - Anaphylaxis - Hepatotoxicity - Thrombophlebitis - Ventricular arrhythmias - Bradycardia - Hypotension 3. **Nursing Considerations:** - Monitor the patient for an allergic reaction with the combination erythromycin and sulfisoxazole if the patient has ever had an allergic reaction to diuretics, a sunscreen containing PABA, or a sulfonamide - Monitor for signs of overdose that may include decreased appetite, nausea, vomiting, diarrhea, dizziness, headache, abdominal discomfort, drowsiness, fever, and unconsciousness - Give medication with a full glass of water and encourage increased fluid intake daily unless contraindicated - Monitor patient for irregular pulse or arrhythmias if on a cardiac monitor - If on a monitor, be sure to measure the QT interval and notify physician if the interval is prolonged 4. **Patient Education:** - Take the medication exactly as ordered by the physician - Do not take if pregnant without consulting your physician - Avoid prolonged exposure to sunlight. The medication may increase the sensitivity of the skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable. ### G. Sulfonamides: Trimethoprim/sulfamethoxazole (Bactrim DS, Bactrim SS, Septra DS) 1. **Indications:** Sulfonamides are used to treat infections such as urinary tract infections, bronchitis, ear infections (otitis), traveler's diarrhea, and Pneumocystic carinii pneumonia 2. **Serious Adverse Reactions:** - Hypersensitivity reactions, such as Stevens-Johnson syndrome - Hematopoietic disorders, such as acute hemolytic anemia - Urinary tract abnormalities such as the deposit of sulfonamide crystals within the tissue of the urinary tract - Hepatitis rarely; focal or diffuse necrosis of the liver 3. **Nursing Considerations:** Monitor for overdose symptoms which may include nausea, vomiting, decreased appetite, diarrhea, headache, yellowing of the skin or eyes, decreased urine production, bloody urine, and coma. 4. **Patient Education:** - This medication affects folic acid in your body, which is necessary for the normal development of a baby. Do not take sulfamethoxazole and trimethoprim without first talking to your doctor if you are pregnant. - Sulfamethoxazole and trimethoprim pass into breast milk and may harm a nursing baby. Do not take this medication without first talking to your doctor if you are breast-feeding a baby. - Sulfamethoxazole and trimethoprim are not approved for use in children younger than 2 months of age - Take each dose with a full glass of water - Avoid prolonged exposure to sunlight. Sulfamethoxazole and trimethoprim may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable. - Stop taking sulfamethoxazole and trimethoprim and seek emergency medical attention if you experience any of the following serious side effects: an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives); unusual bleeding or bruising, or yellow skin or eyes ### H. Antituberculars: Isoniazide (INH), Rifampin (Rifadin), Mycobutin (Rifabutin); may be combined with moxifloxacin (a quinolone). 1. **Indications:** Rifampin and INH are antibiotics. They prevent bacteria from multiplying and are used to treat and to prevent tuberculosis (TB). Rifabutin is used to prevent mycobacterium avium complex in people with advanced Human Immunodeficiency Virus (HIV) infection. Rifabutin will not effectively treat active tuberculosis, and it may cause the infection to become resistant to treatment. Long-term treatment with drug combinations is needed (can be as long as two years). 2. **Adverse Reactions:** - INH includes: - Peripheral neuropathy - Nausea, vomiting - Elevated AST, ALT levels - May impart a harmless red-orange color to body secretions including urine, saliva, sputum, sweat, and tears - Rifampin includes: - Headache - Fatigue - Heartburn - Elevation of liver enzymes - Rifabutin includes: - Anorexia - Nausea - Thrombocytopenia - Transient leukopenia 3. **Nursing Considerations:** - These drugs are used with caution in patients with renal or liver impairment, or gastric ulcers - Inform patients taking rifampin that drug may impart a harmless red-orange color to body secretions (urine, saliva, sputum, sweat, and tears) - Give on an empty stomach, one hour before and two hours after meals. If Gl upset is severe, may take with food - Monitor patient for fever, chills, muscle or bone pain, blurred vision, eye pain or redness, excessive tiredness or weakness, a sore throat, unusual bleeding or bruising, or yellow skin or eyes and notify the physician 4. **Patient Education:** - Symptoms of overdose might include nausea, vomiting, tiredness, abdominal pain, yellow skin or eyes, and unconsciousness - Do not wear contact lenses while taking Rifabutin or Rifampin. The medication may turn the tears, sweat, saliva, urine, feces, and contact lenses a red-orange color. This effect may be permanent on contact lenses - Medication may decrease effectiveness of oral contraceptives and another form of birth control may be needed to prevent pregnancy during treatment - Treatment is long term from 6 months to 2 years ### I. Antiviral Agents Anti-Virals: CMV - Ganciclovir (Cytovene), Foscavir (Foscarnet), Valganciclovir (Valcyte), Cidofovir (Vistide) Anti-Virals: HIV - Zidovudine (Retrovir), Lamivadine/Zidovudine (Combivir) Anti-Virals: Hepatitis - Lamivudine (Epivir HBV), Interferon alfa 2b (Intron A) Anti-Virals: Herpes - Famciclovir (Famvir), Acyclovir (Zovirax), Valacylovir (Valtrex) Anti-Virals: Covid-19 - Veklury (Remdesivir) 1. **Indications:** - Anti-Virals: CMV - Used to treat and prevent infections caused by cytomegalovirus. This infection usually occurs in patients who have suppressed immune systems, such as patients with AIDS and organ transplant patients - Anti-Virals: HIV - Used to treat the human immunodeficiency virus (HIV), which causes the acquired immunodeficiency syndrome (AIDS). These medications are called reverse transcriptase inhibitors. They inhibit the reproduction of HIV. - Anti-Virals: Hepatitis - Used to treat chronic Hepatitis B - Anti-Virals: Herpes - Used to treat infections caused by herpes viruses. Illnesses caused by herpes viruses include genital herpes, cold sores, shingles, and chicken pox. - Anti-Virals: Covid-19-Used to treat SARS-CoV-2 virus which causes corona virus disease 2019. 2. **Serious Adverse Reactions:** - Thrombocytopenia - Neutropenia - Pancytopenia - Sepsis - Nephrotoxicity 3. **Drug Interactions:** Anti-viral medications can react with many drugs including over the counter and herbal medications. Contact the pharmacy for specific drug interactions. 4. **Nursing Considerations:** - Lactic acidosis and severe liver problems including fatal cases have been reported with anti-virals. Report to the physician if the patient experiences nausea, vomiting, shortness of breath, weakness in arms and legs, jaundice of skin, eyes or palate, or pain in the upper right-hand quadrant of the abdomen. - Monitor patient for signs and symptoms of pancreatitis - Monitor patient for signs and symptoms of bone marrow suppression 5. **Patient Education:** - Viral infections are contagious and can infect others, even during treatment. Avoid letting infected areas or body fluids come into contact with others. Frequent handwashing will help to prevent transmission. - Avoid high-risk activities such as the sharing of needles and unprotected sexual activity - Avoid alcohol intake with these medications. Alcohol may increase the risk of liver or pancreatic damage. ### J. Antifungal Agents: Amphotericin B, Nystatin (Mycostatin), Fluconazole (Diflucan) 1. **Indications:** Anti-fungal medications are used to treat fungal infections of the mouth, throat, esophagus, vagina, urinary tract, blood, and pneumonia. They are also used to prevent fungal infections from occurring in people with suppressed immune systems such as chemotherapy patients, organ transplant patients, and AIDS patients. 2. **Serious Adverse Reactions:** - Nystatin - Hypersensitivity (rare) - Amphotericin B - Electrolyte imbalance (severe hypokalemia) - Nephrotoxicity - Renal failure - Anaphylaxis - Fluconazole - Hepatotoxicity - Stevens-Johnson Syndrome - Angioedema - Seizures - Leukopenia 3. **Nursing Considerations:** - Nystatin - Used for treatment of cutaneous & mucocutaneous infections caused by Candida albicans - Available in cream, ointment, powder, vaginal tablets, and oral tablets - Immunosuppressed patients are sometimes instructed to suck on oral tablets because this provides prolonged contact with oral mucosa - Contact the pharmacist for other drug interactions including over the counter and herbal medications - Amphotericin B - Indicated for treatment of any type of progressive fungal infection that does not respond to conventional treatment. - Monitor kidney function for toxicity, i.e., creatinine - If line must be flushed, do not use heparin or saline (use D5W)