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- gentamicin (Garamycin)
- HINT HINT!! They usually end in mycin
Aminoglycosides are …..
- Natural and semi-synthetic
- Poor oral absorption; no PO forms
- Very potent antibiotics with serious toxicities
- Kill mostly gram-negative; some
- gram-positive also
Aminoglycosides effect electrolytes ….
- Lowers K+ (cardiac function)
- Mg+ (nerve function)
Aminoglycosides used to kill….
- Pseudomonas spp., E. coli, Proteus spp., Klebsiella spp., Serratia spp.
- Often used in combination with other antibiotics for synergistic effect.
- BIG GUN!!!!
Adverse Effects Aminoglycosides
Aminoglycosides: Side Effects
Ototoxicity and nephrotoxicity are the most significant
Aminoglycosides require Therapeutic Drug Monitoring
- Peak= 30-60 min after infused
- Trough= immediately before administration of next dose
Must do what when giving Aminoglycosides?
- Flush between administration of other antibiotics
- Space of 2 hours between antibiotics
- 2000 to 3000 cc fluid each day
- Monitor Liver enzymes
- Monitor BUN and Creatinine
- Monitor K+ and Mg+
- Ciprofloxacin (Cipro) –anthrax, pneumonia, UTI, skin & joint infection
- Norfloxacin ( Noroxin)- not used as much
- Levofloxacin (Levaquin) – community pneumonia, resp.
Drug Interactions of Aminoglycosides
PCN & aminoglycoside = inactivates the aminogylcosides
- Excellent oral absorption
- Absorption reduced by antacids
- First oral antibiotics effective against gram-negative bacteria
Quinolones: Mechanism of Action
- Effective against gram-negative organisms and some gram-positive organisms
- Alter DNA of bacteria, causing death
- Do not affect human DNA
Quinolones: Therapeutic Uses
- Lower respiratory tract infections
- Bone and joint infections
- Infectious diarrhea
- Urinary tract infections
- Skin infections
- Sexually transmitted diseases
Quinolones: Side Effects
- Dizziness, HA, tinnitus
- Nausea and vomiting, diarrhea
- Flushing, rash
- Restlessness, fatigue, insomnia
- Ringing in ears (Levoquin)
- Oral hypoglycemics
- caffine (cipro –don’t drink coffee)
- take on empty stomach
Sulfonamides: Mechanism of Action
- Bacteriostatic action
- Prevent synthesis of folic acid
- Does not affect human cells growth
Sulfonamides: Therapeutic Uses
- Corneal ulcers
- Following eye injury
- Burns( Silvadene cream) – alters electrolytes
- Otitis media
- Lower respiratory tract infections
Sulfonamides: Bactrim combined with trimethoprim therapeutic Uses
- Used to treat UTIs
- otitis media
- eye infections
- lower respiratory tract infections
- pneumonia in AIDs patients
Sulfonamides: Side Effects
- Delayed skin reactions
- Peripheral neuropathy
Sulfonamides: Adverse Effects
- Hemolytic anemia
- Aplastic anemia
- Renal failure
Monitor what lab tests for renal function?
- BUN and Creatinine levels
- And Monitor UOP
for potential blood dyscrasias ( < WBC, < platelets, sore throat)
Sulfonamides can increase effects of what other drugs?
Coumadin and oral antihypoglycemics
Very important to take in __________ mL of fluids while on sulfonamides
Before beginning therapy
- assess drug allergies
- other labs
- Be sure to obtain thorough patient health history
- Assess for conditions that may be contraindications to antibiotic use
- Assess for potential drug interactions.
Antibiotics: Nursing Implications
It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy.
Assess for signs and symptoms of superinfection:
- Perineal itching
- Sore throat
- The most common side effects of antibiotics are
- nausea, vomiting, and diarrhea.
All oral antibiotics are absorbed better if taken with
at least 6 to 8 ounces of water.
Nursing Implications – Sulfonamides
- Should be taken with 2000 mL fluid/day
- Due to photosensitivity, avoid sunlight and tanning beds.
- These agents reduce the effectiveness of oral contraceptives.
How long should a pt be monitored when given PCN?
Monitor for 30 minutes.
The effectiveness of oral penicillins is decreased when taken
with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice.
Antibiotics: Nursing Implications Cephalosporins
- Orally administered forms should be given with food to decrease GI upset
- -- even though this will delay absorption.
- Some of these agents may cause an Antabuse-like reaction when taken with alcohol.
Antibiotics: Nursing Implications - Tetracyclines
- 6 to 8 ounces of fluid, preferably water.
- Due to photosensitivity, avoid sunlight and tanning beds
Antibiotics: Nursing Implications - Aminoglycosides
- Monitor peak and trough blood levels
- Symptoms of ototoxicity
- --dizziness, tinnitus, and hearing loss.
- Symptoms of nephrotoxicity
- --urinary casts, proteinuria, and increased BUN and serum creatinine levels.
Antibiotics: Nursing Implications - Macrolides
these agents are highly protein-bound and will cause severe interactions with other protein-bound drugs.
Antibiotics: Nursing Implications-Monitor for therapeutic effects:
- Disappearance of