Unit 7 Medication

– no current accepted medical use
(Heroin, marijuana, LSD, amphetamines)

– current accepted medical use, high abuse, no TO, cannot be refilled (Cocaine, codeine, demerol, dilaudid, morphine, amphetamines, barbiturates)

- current accepted medical use, moderate
dependence, can be refilled x5, none after 6 months
(Opium, vicodin, tylenol with codeine, amphetamines, barbiturates)

- current accepted medical use, low dependence, can be refilled x5, none after 6 months (example Darvocet, librium, valium, barbiturates)

- current accepted medical use, limited dependence, can be refilled, may not require prescription (Donnagel, lomotil, robitussin)

occur most often at points of transition in care: admission to hospital, transfer from one department to another, discharge to home or another facility

because of their potentially toxic nature, they require special care when prescribing, dispensing, and/or administering

Bacteria that stains purple

Thick cell wall and outer capsule
–Streptococcus
–Staphylococcus
–Enterococcus
–Listeria

Bacteria that stains red

More complex cell wall and 2 membranes

More difficult to treat
–Salmonella
–E.coli
–Pseudomonas
–Neisseria meningitidis

the administration of antibiotics based on the practitioners judgment of the pathogens most likely to be causing an apparent infection

–Broad spectrum antibiotics started
•Aminoglycosides
•Quinolones
•2nd and 3rd generation cephalosporins

the administration of antibiotics based on known results of culture and sensitivity testing identifying the pathogen causing infection

–Narrow spectrum antibiotic
•Penicillins
•Vancomycin
•Macrolides

antibiotics taken before anticipated exposure to an infectious organism in an effort to prevent the development of infection

–After joint replacement or heart valve surgery when going to the dentist
–30 minutes before surgery starts

An infection occurring during antimicrobial treatment for another infection

a secondary microbial infection that occurs in addition to an earlier primary infection

•Examples:
–Vaginal yeast infection d/t atbx. use
–Development of c.diff after atbx.
–Development of viral pneumonia during treatment of bacterial pneumonia

Patients often expect/demand an atbx. Rx even when they don’t show signs of bacterial infection

reason why many treatable bacterial infections are resistant to atbx therapy

2nd reason: patients don’t finish prescribed atbx

•Only medication used:
–Sulfamethoxazole with trimethoprim (SMX-TMP)
(Bactrim, Septra, co-trimoxazole

•Broad spectrum
•Contraindications: sulfa allergy, pregnancy

•Used in treatment of UTI, URI, & staph. aureus

•Adverse effects:
–N/V/D, photosensitivity, HA, cough

•Interactions:
–Sulfonylureas
–Phenytoin
–Warfarin
–Oral contraceptives

•Derived from mold

•4 subgroups based on structure and type of bacteria they kill

•Indications
–Pneumonia
–Pharyngitis (strep)
–Syphillis (entercoccal)
–Gonorrhea (entercoccal)
•Contraindications
–Drug allergy******

PCN

•Adverse Reaction
–Urticaria, pruritis, N/V/D, anxiety, depression, lethargy

•Interaction
–Oral contraceptives, NSAIDS, warfarin

•Nursing Interventions
–Observe for s/sx allergic reaction

•Patient Teaching
–Complete
the prescription

s/sx

•Amoxicillin (Amoxil)
•Ampicillin
•Nafcillin
•Penicillin V potassium (Pen-Vee K)
•Piperacillin/tazobactam (Zosyn)
Ticarcillin/clavulanate (Timentin

Broad spectrum antibiotic, chemically similar to penicillin

Allergic reaction to PCN may have a cross sensitivity to ___________

Adverse effects: diarrhea, cramps, rash, pruritis,
redness, edema

Interactions: alcohol, antacids, iron, oral
contraceptives

•First Generation
–cefazolin (Ancef)
–cephalexin (Keflex)

•Second Generation
–cefoxitin (Mefoxin)
–cefuroxime (Ceftin)

Third Generation (penetrate blood-brain barrier)
–ceftriaxone (Rocephin)
–ceftazidime (Fortaz)

•Fourth Generation
–cefepime (Maxipime)
–cefdinir (Omnicef)

•Indications
–Upper and lower respiratory tract infections, syphilis, Lyme disease, gonorrhea, Listeria

Absorption enhanced when taken on an empty stomach
-Gastric irritation (take with food or snack)

•Contraindications
–Drug allergy

•Adverse Effects
–Palpitations, chest pain, HA, vertigo, N/V/D, rash, tinnitus

•Interactions
–Enhances effect and possible toxicity
(Carbamazepine, cyclosporine, digoxin, theophyliine and warfarin)

•Azithromycin (Zithromax)
•Clarithromycin (Biaxin)
•Dirithromycin- rarely used
•Erythromycin (E-mycin)

•Telithromycin (Ketek)
•Derived from erythromcyin A
-Use is limited d/t associated with liver damage

Indications: Anthrax, Gonorrhea, syphilis, Lyme disease, chlamydia, acne

•Contraindications
–Drug allergy
–Children under 8, pregnant, nursing

•Adverse Effects
–Discoloration of permanent teeth
–Retard fetal skeletal growth
–Photosensitivity
–Diarrhea
–Rash

•Interactions
–Anticoagulants, oral contraceptives
–Reduced absorption if taken with

•Antacids, antidiarrheal drugs, dairy products or iron preparations anticoagulants

•Demeclocycline (Declomycin)
•Doxycycline (Doryx)
•Tigecycline (Tygacil)

•Used for virulent infections
–MRSA
–VRE

•Not given orally-poor absorption
–Exception: neomycin

•Common drugs
–Amikacin, gentamicin, neomycin and tobramycin

•Monitored with blood levels (Peak and Trough)
–Nephrotoxicity
–Ototoxicity

•Contraindications
–Known drug allergy
–Infants, pregnancy, & lactation unless life-threatening

•Adverse Effects
–Duration of therapy short as possible
–HA, vertigo, rash, fever, neuromuscular paralysis

•Interactions
–Nephrotoxicity increases with use of

•Vancomycin, cyclosporine and amphotericin B
–Ototoxicity increases with use of
•Loop diuretics
–Reduce the level of vitamin K – intestinal flora is destroyed from med
•Warfarin

Potent, broad-spectrum antibiotic

•Indications
–Complicated UTI
–Commonly used for Respiratory, skin, GI, bone, joint infections and STD’s

•Contraindications
–Drug allergy

–Ciprofloxacin (Cipro)

–Levofloxacin (Levaquin)

–Therapeutic blood levels

–Red man syndrome

–Tyramine containing foods (aged cheese or wine, soy suace, smoked meats) can interact and raise BP

–Avoid alcohol for 24 hours before and 36 hours after Flagyl

Nitrofurantoin

–Not compatible with saline or heparin (D5W only)

–Adverse effects at infusion site

Clindamycin