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Common side effect of INH.
- Peripheral neuritis
- (numbness, paresthesias, tingling in extremities)
How to minimize SE of peripheral neuritis from INH?
increase pyridoxine (Vit B-6) intake
What s/s should a pt report immediately when taking INH??
yellow eyes or skin (INH is hepatotoxic)
What should a pt do to avoid causing a rxn of redness, itching, flushing, sweating, tachycardia, headache or lightneadedness with INH?
avoid foods with tyraine (swiss cheese, tuna)
What drug colors sweat, tears, urine & feces orange?
What drug causes optic neuritis (decreases visual acuity & ability to discriminate b/w red & green)?
- ehtambutol (Myambutol)
- *report symptoms immediately
- -(take med with food if GI upset occurs)
Why should a pt return to clinic weekly for serum drug-level testing of cycloserine (Seromycin)? WHat is a good level?
- (TB drug)
- -monitor for potential neurotoxicity
- -lower than 30mcg/mL reduce incidence of neurotoxicity
What baseline studies need to be completed prior to INH therapy for TB?
- Liver enzyme levels
- -INH can cause hepatic enzymes to increase & can cause hepatitis
- -monitor during first 3 mos; longer if alcohol abuse or >50yoa
Three drugs that cause peripheral neuritis.
- rifabutin (Mycobutin)
- ethambutol (Myambutol)
- -all for TB
SE of ______ include signs of hepatitis, flu-like syndrome, low neutrophil ct, ocular pain or blurred vision.
_______ is associated with serum concentrations of VANCOMYCIN above 60 to 80 mcg/mL
Signs of hypersensitivity reaction to imipenem-cilastatin (Primaxin).
Shortness of breath, mouth and tongue swelling, and generalized itching.
Ampicillin should be taken ___________ to ensure adequate absorption.
on an empty stomach
AE of ampicillin (Principen).
- -may represent such conditions as pseudomembranous colitis.
Some ________ cause a disulfiram-like reaction when alcohol is consumed.
Which assessment should be performed prior to the administration of cefotaxime (Claforan)?
- Culture and sensitivity testing
- -to determine the causative organism and the appropriate drug therapy.
Similar to PCNs but widely used for gram (-).
This drug presents a risk of an allergic reaction as well as a risk of colitis.
Keflex, Ceclor, Rocephin, Maxiphime - what kind of drugs are these?
- (Category 1, 2, 3, 4)
Most common ADVERSE rxns with cephalosporins.
allergic rxns (same as penicillin)
Used to kill staph & strep, not effective against MRSA, usually given IV (or IM).
Ancef, Kefzol (Cephalosporins)
Broadest spectrum of any class of antibiotic.
How are carbapenems administered?
Drug that causes RED MAN Syndrome.
How is Vancomycin administered & why?
SLOW IV infusion (over 60 min) - to avoid red man syndrome
What labs would you monitor in a pt receiving vancomycin?
- BUN & Creatinine
- (risk of nephrotoxicity; watch peak & trough)
Possible AE of vancomycin?
- damage to tissues @ site of infusion
The "last chance" antibiotic.
S/S of Red Man Syndrome.
- RASH on upper body
When do you draw peak & trough for vancomycin?
- peak: 1 hr AFTER administering
- trough: 30 min PRIOR to administering
Drugs that inhibit cell wall synthesis.
Drugs that inhibit bacterial protein synthesis.
Tetracyclines are baterio______.
What types of bacteria do tetracyclines cover (in general)?
- broad spectrum gram (+) and gram (-)
- aerobic & anaerobic
Drug of choice for Rocky Mt spotted fever, typhus, cholera, Lyme disease, H.pylori, chlamydia, & syphillis. Why so few?
- so few b/c resistance
A major AE of tetracycline?
What should pts avoid who are on tetracyclines?
the sun! (photosensitivity)
Regarding meals, when should tetracyclines be taken?
- on an empty stomach (teaching pt)
- NO antacids with it!
Tetracyclines are primarily admistered via which route?
Macrolides are bacterio_____.
Alternative drug for patients with ALLERGY to PCN.
Drug of choice for Whooping cough, diphtheria, Legionnaires diseace, streptococci, H. influenza.
"Z-pac" is what kind of antibiotic?
Macrolide (inhibits protein synthesis)
Macrolides are known to cause ______ and ______.
- GI irritation
- liver damage
What type of drug is gentimicin (garamycin)?
Aminoglycoside (inhibits protein synthesis)
AE of amino glycosides and two examples.
- Gentimicin, Amikin
Labs to monitor for a pt on gentamicin.
BUN, creatinine (nephrotoxicity)
What would you see in a pt receiving amikin or gentimicin which would be a reason to STOP the med?
- tinnitus, changes in hearing
- (signs of ototoxicity, can cause permanent hearing loss)
- increase in BUN or creatinine, protein in urine (nephrotoxicity)
Just like with vancomycin, _____ & ______ are checked with gentimicin & amikin.
peak & trough levels
Protein synthesis inhibitors that are effective against resistant infections but have significant AE that limit use.
Drugs that inhibit DNA replication.
Used to treat UTI, URI, GI, GU skin & soft tissue infections.
fluoroquinolones (inhibit DNA replication)
Fluoroquinolones are effective against gram ___ organisms.
AE of fluoroquinolones.
- GI toxicity
SERIOUS AE of fluoroquinolones.
Why would you need to immediately call HCP if taking fluoroquinolones?
- calf or leg pain (tendon rupture)
- -more in younger males
Drug interaction with fluoroquinolones?
- **anticoagulants, esp Coumadin
Sulfonamides work on gram _____ organisms.
positive (+) AND negative (-)
Two examples of sulfanomides.
Major AE to sulfanomides.
Main route of administration for sulfanomides.
Why are 3 meds given for TB?
decrease risk of resistance
Two primary drugs given for TB.
Closely monitor pts taking INH due to risk of ______.
- peripheral neuropathy
- optic neuritis
- blood dyscrasias
Vision changes or difficulty seeing is an important thing to report with pts taking ______.
INH (for TB)
Labs to monitor in pts taking INH for TB.
Liver enzymes (hepatotoxicity)
If a ______ drug is added to a pt with TB, they may have a resistant form.
Encourage pts to take ______ to decrease risk of peripheral neuropathy while taking INH.
____ can interact with tyramine foods.
Nystatin, Amp B, Difulcan - what type of drugs?
Systemic fungal infections are more often seen in what type of pts?
pts with immune suppression
What is nystatin?
- prototype for antifungal drugs -
- often used for superficial infections
If giving nystatin with other meds, when do you give it?
last, so it stays in the mouth and coats it
Two antifungals for systemic infections
- amphotericin B (Fungizone)
- fluconazole (Diflucan)
Things to monitor in pts taking amphotericin-B.
- *BUN & Creatinine, UOP (nephrotoxicity)
- *fluid & electrolytes (kidney damage)
- *BP, ECG (hypotension, dysrhytmias, cardiac arrest)
- IV site (phlebitis)
- *hearing loss, tinnitus (OTOtoxicity)
The safer systemic antifungal.
What is contraindicated for fluconazole (Diflucan)?
- chronic alcoholism (will cause severe N/V, & increased BP)
Fluconazole (Diflucan) causes ______ temporarily but it normally goes away.
What to monitor in pts taking flucanazole (Diflucan).
- s/s of hepatotoxicity
- BGL (esp diabetics)
- assess for NVD, abdominal pain
AE of high levels of chloroquine (Aralen).
- CNS & cardiovascular toxicity
- (treats malaria)
Prevents metabolism of heme, which then builds to toxic levels within the parasite.
chloroquine (Aralen), an anti-malarial drug
Med used for antiprotozoal (NOT used to treat malaria).
Drug that acts as antiprotozoal and also has antibiotic activity against anaerobic bacteria.
What is FLAGYL?
antiprotozoal (not for malaria), also antibiotic against anaerobes
Drug that produces a metallic taste in mouth.
What drug does metronidazole (Flagyl) interact with?
*Coumadin (increased bleeding)*
What happens when a pt taking metronidazole (Flagyl) drinks alcohol?
disulfram rxn (severe vomiting & GI distress)
What labs to monitor in pts taking chloroquine (Aralen)?
Hgb, Hct, CBC (bone marrow suppression, can potentiate anemia)
_______ will be one of the first signs associated with renal damage secondary to amikacin toxicity.
Tetracycline antibiotics should not be taken concurrently with what 3 things?
- dairy products,
- iron-containing preparations such as multivitamins,
- or antacids.
Aminoglycosides are ______ toxic. They may also cause ________.
- & neuro;
- neuromuscular blockade
Are liver fxn studies indicated for gentamycin?
No - it is NOT metabolized
Erythromycin toxicity is related to _______ dysfunction and may manifest itself with __________ pain.
- right upper quadrant
Clients experiencing drug-induced __________ will exhibit oliguria (low urine output).
______ or ______ may indicate an adrenergic response secondary to an allergic reaction (Cipro).
Nervousness or anxiety
Ciprofloxacin is excreted ________, and increasing ________ will help to prevent drug accumulation in the _______.
- fluid intake
Signs of anaphylaxis.
- edema of couth, tongue, pharynx, larynx
- seizures, hallucinations
- hypotension leading to cardio collapse
Ciprofloxacin (Cipro) therapy must be monitored carefully in clients with suspected ______ disorders, as this drug can be ________ at high doses, and can cause ______ when given by rapid IV infusion.