______ may occur with the use of antibiotics that affect protein synthesis.
(aminoglycosides, lincosamides, oxazalidinones, streptogramins, tetracyclines, and misc.)
Action of aminoglycosides?
enter bacterial cell wall -> bind to ribosomes -> prod. wrong amino acids ->
1. prevents bacterial reproduction
2. weakens the cell wall
3. cell wall rupture & death
Resistance that may occur with aminoglycosides like gentamicin?
many bacteria are resistant to aminoglycosides entering their cell walls
Why is gentamicin often given with other meds?
increase effectiveness or allow it to enter cell walls
lowest conc. in pt blood
should be drawn 30 minutes before the next dose
drug is at its highest conc.
draw 45 min (IV) to 1h (IM) after admin of a med
3 AE of gentamicin?
5 things to assess/monitor with admin of gentamicin?
2. I&O, creatinine, and BUN
3. neurovascular assessments
4. draw peak & trough levels
Why do gentamicin levels need to be monitored closely?
has a narrow therapeutic index
Important consideration with lincosamide?
Action of clindomycin?
enters cell -> binds to ribosomes -> suppresses protein synth -> cell death
Use for clindamycin?
serious to life-threatening infections
ABX group that should always be taken with food?
When a drug works by inhibiting protein synthesis it will usually be used for _____ infections.
Story for clindamycin?
Clinda loves Zelda. She is Link from Zelda (lincosamide). All she does is play vid games and eat. She eats so much she gets GI upset that causes pseudomembranous colitis, and is so sedentary that her blood has pooled (blood abnormalities).
Clindamycin common AE?
Serious AE of clindamycin?
Type of infections Tx by clindamycin?
S/S of pseudomembranous colitis?
Remembering prototype for macrolides?
macrolide - macro means big and ends with E
big E - erythromycin
Action of macrolides/erythromycin?
inhibits RNA-dependent protein synth at chain elongation step -> prevent reproduction
Interaction with macrolides/erythromycin?
absorption is diminished by food, dairy, & antacids
decrease effects of drug
Which ABX causes azotemia?
Contraindication with erythromycin?
Common AE of erythromycin?
GI distress even when admin IV
Nursing intervention to decrease GI AE in erythromycin?
small frequent meals, but remember to time them so they are not close to med admin b/c decrease med effects
4 serious AE of erythromycin?
2. pseudomembranous colitis
3. QT prolongation
4. ventricular tachycardia
Monitoring/assessment for pt on erythromycin?
1. monitor liver enzymes
2. have on telemetry if poss. or monitor frequently & educate pt what to look for
3. monitor for s/s of pseudomembranous colitis
4. HR for tachycardia
Admin of erythromycin IV?
admin very slowly to decrease irritation to the veins - at least 60 minutes
oxazolididones - zyvox
oxazolidinones/zyvox were the first new type of drugs dev to treat ____ & _____.
Diff b/t zyvox and other protein inhibiting ABX?
blocks early stages of protein synth - may prevent the dev of resistance & cross resistance
2 actions of zyvox?
1. inhibits protein synth in bacteria
2. nonselective MAOI actions
Interactions with Zyvox?
has serious drug & food interactions r/t MAOI actions:
Avoid: tyramine, alcohol, & caffeine
Common AE of Zyvox?
2 serious AE of Zyvox?
2. pseudomembranous colitis
Zyvox - Ox guts someone (pseudomembranous colitis) & they bleed so much they don't have platelets
What needs to be done if pt is an alcoholic and needs to take zyvox?
will need to call MD to see what to do r/t concern for W/D if don't take alcohol
can't take alcohol with zyvox
What are streptogramins designed to Tx?
Assessment that should be done prior to admin of zyvox?
assess platelets - if low don't give
Action of Synercid/streptogramins?
irreversibly blocks ribosome functioning -> inhibits protein synth
Use for Synercid/streptogramins?
Tx superbugs: VRE & MRSA
What may be required prior to admin of Synercid/streptogramins?
may need approval from infectious disease department before using
2 things that occur as ABX get more powerful?
have more AE & get more expensive
Why do streptogramins/Synercid have increased risk for drug interactions?
potent inhibitor of P450
3 common AE of Synercid?
1. injection site reaction/pain
Serious AE of Syndercid?
hepatotoxicity - very hepatotoxic
synercid - sinner drink too much and damage their liver
2 things to do prior to the admin of Synercid?
1. check C&S
2. assess liver LFT & bilirubin
Testing with Syndercid?
need bilirubin and LFT twice in first week then weekly
Considerations for admin of Synercid?
1. flush IV before & after admin with D5W - interacts with saline & heparin
2. prefer central line for admin
3. if no central line dilute in 250mL D5W & infuse over 1 h in largest vein possible
Action of tetracyclines?
retards bacterial growth by inhibiting protein synth
3 uses for tetracyclines?
1. serious infections when penicillin cannot be used: lyme disease, rocky mnt. spotted fever
2. acne vulgaris
3. chlamydia & other STD's
Problem with frequent use of tetracycline?
resistance is occurring
Interaction with tetracycline?
dairy products, vitamins/supplements, & antacids interfere with the absorption
Contraindications for tetracycline?
1. pregnant/breast feeding
2. CH < 8
Why is tetracycline contraindicated in pregnancy?
causes skel retardation
3 most common adverse effects with tetracycline?
1. GI distress: NVD & heartburn
3. tooth discoloration
2 serious AE of tetracycline?
1. skel. retardation in infants
What is azotemia?
high levels of nitrogenous wastes build up (urea, creatinine)