ANTIBIOTICS
What do we worry about cross-reactivity with PCN drugs and Cephalosporins?
-- the potential to be allergic to a drug with a similar structure
Can Monobactam drugs be given to pts with a PCN allergy?
Yes, Aztreonam is most commonly used when Gram negative coverage is needed in pts with PCN allergy
What labs should be monitored in pts taking Monobactam drugs?
LFT's
(1) What is the ending for Macrolide drugs?
(2) What is the ending of Tetracycline drugs?
(3) Why should a pt taking Tetracycline stay out of the sun?
(If you get these correct, 200 more points will be added)!
(1) "mycin"
(2) "cycline"
(3) Photosensitivity
--Permanent teeth discoloration (black); interfere with bone growth
Why are 3rd generations of cephalosporins used to tx meningitis?
-- Easily pass through the blood-brain barrier
-- Long actions so only needs to be given once a day
Why is lidocaine added to IM formulations of Carbapenem?
-- Doesn't hurt as much (IM injection is very painful)
-- Painful Tx of bone, joint, skin, and soft tissue infections, plus more.
What type of bacteria is tx with a Monobactam?
Gram - (No Gram +)
What is the name of 1 Monobactam drug?
-- Aztreonam (Azactam)
Why are Macrolide ABX drugs instilled in the eyes of newborns?
-- Chlamydial conjunctivitis
What are the important AEs of Cephalosporin drugs?
-- Diarrhea
-- Cramps
-- Rash
-- COLITIS
What is a potential serious AE of Carbapenem use?
-- SEIZURES
What is the name of 1 Carbapenem drug?
-- Imipenem-cilastatin (Primaxin)
What are the names of 2 Macrolides?
-- Erythromycin
-- Azithromycin (Zithromax)
-- Clarithromycin (Biaxin)
What superinfections can be seen in pts taking Tetracycline drugs?
What makes a Macrolide bacteriostatic vs. bactericidal?
Concentration in tissues
Why are Macrolide ABX special?
-- Can stimulate GI motility
-- Tx bacteria that reproduce in host cell
What are important pt education points for pts who are taking Erythromycin?
(If you get this correct, 100 more points will be added)!
-- Take as directed
-- Be sure to complete full course of drug tx
-- TAKE ROUND THE CLOCK Q 6 HRS
-- DO NOT TAKE WITH GRAPEFRUIT JUICE
-- DO NOT TAKE WITHIN 2 HOURS OF DAIRY PRODUCTS OR ANTACIDS
-- REDUCES EFFECTIVENESS OF ORAL CONTRACEPTIVES
-- Be aware this drug causes GI upset
-- THIS DRUG CAN MESS WITH EMOTIONS CRYING, LAUGHIN, ABNORMAL THINKING
What are the names of 3 Tetracycline drugs?
-- Tetracycline
-- Doxycycline (Vibramycin)
-- Minocycline
-- Tigecycline
-- Omadacycline
-- Sarecycline
-- Eravacycline
What are the important teaching points for pts taking Tetracycline drugs?
-- Take as directed
-- Avoid sunlight exposure and wear sun block
-- DO NOT GIVE TO CHILDREN < 8 CAUSES TEETH DISCOLORATION
-- Take round the clock q 6 hours
-- Take on an empty stomach
-- DO NOT TAKE WITHIN 2 HOURS OF DAIRY PRODUCTS OR ANTACIDS OR IRON, THESE GREATLY REDUCE ABSORPTION
-- REDUCES EFFECTIVENESS OF ORAL CONTRACEPTIVES
-- DONT TAKE EXPIRED TETRACYCLINE
-- DO NOT GIVE TO PREGNANT WOMEN
-Cefazolin (Ancef)
-Cephalexin (Keflex)
-Cefaclor
-Cefoxitin
-Cefotaxime
-Ceftazidime
-Ceftriaxone
-Cefepime
-Ceftaroline
Why are Carbapenems reserved for complicated infections?
-- Broadest spectrum antibacterial action
-- bactericidal and inhibit cell wall synthesis
-- Effective against many gram + organisms
What are important nursing considerations for pts taking any of the Beta-Lactam drugs?
-- Obtain pts allergy hx (ask open-ended questions, remember cross-sensitivity)
-- Obtain a culture and sensitivity before starting ABX
-- Assess baseline renal functions
-- Assess for the possibility of C. DIFF
-- IM administration should be done into a large muscle (painful)!
-- Do not add or mix IV administration with aminoglycosides
-- Assess for S/Ss of allergic reaction
-- Assess for improved signs of infection (reduced fever, no chills, no redness or drainage)
what are important educational points for pts taking any of the Beta-Lactam drugs?
-- Take as directed
-- Be sure to complete full course of drug Tx!
-- Don't consume alcohol while taking these drugs!
-- Educate when to take with food and when not
What AEs should you monitor in pts taking a Macrolide?
-- HEPATOTOXICITY
-- ALLERGIC REACTIONS
-- N/V/D
-- Hearing loss
-- Emotional lability