Pharmacology Drug Cards.

RN Pharmacology Anti-infectives

Adeline Samba DNP, MSN ed, RN

Nursing implications:

Obtain a sample for lab culture before initiating therapy.

1 Monitor for evidence of superinfection.

2 Tell patients to complete the course of treatment to prevent resistance strands from developing.

3 Monitor for N/V/D and anaphylaxis or allergic reaction.

4

Chapter 26: Penicillins, and Cephalosporins

Drug class Drugs Action and use

Adverse effects Nursing implications

Penicillin  

Amoxicillin, nafcillin, piperacillin

Bactericidal: Destroy bacteria cell wall  

Anorexia, nausea, vomiting, and diarrhea abdominal pain, dysphagia, rash, Hypersensitivity, anaphylaxis Superinfection Tongue discoloration, stomatitis

-Assess for allergy to penicillin or cephalosporins Have epinephrine available to counteract a severe allergic reaction.

Cephalosporin s Broad spectrum   TABLE 26.5

Cefazolin, cefuroxime Ceftriaxone Cefepime, ceftaroline

Bactericidal: Destroy bacteria cell wall

anorexia, nausea, vomiting, headache, dizziness, itching, and rash, nephrotoxicity. Increased bleeding, seizures Nephrotoxicity  

-May cause a disulfiram-like reaction if taken with alcohol. Flushing, dizziness, Headache, nausea, vomiting, and muscular cramps -Assess for allergy to cephalosporins or penicillin - Advise patient to take medication with food if gastric irritation occurs.

Chapter 27: Macrolides, Oxazolidinones, Lincosamides, Glycopeptides

Macrolides Erythromycin Azithromycin Clarithromycin fidaxomicin

Bacteriostatic: Prevent protein synthesis within bacterial cells Strep infections, STDs

nausea, vomiting, diarrhea, and abdominal cramping, hepatotoxicity

Monitor vital signs, liver function,

Oxazolidinones  

linezolid (Zyvox) Treat MRSA, and VRE Inhibits protein synthesis

headache, nausea, vomiting, diarrhea, anemia, and thrombocytopenia, serotonin syndrome.

 

Lincosamides Clindamycin   hairy skin, nausea, vomiting, diarrhea, CDAD, erythema, pruritus, superinfection, headache, candidiasis, and back pain.

 

Glycopeptides vancomycin (Vancocin)

Inhibits cell wall synthesis

Anaphylaxis, superinfection Red neck or red man syndrome Occurs when IV too rapid Severe hypotension Red blotching of face, neck, chest, and extremities Disulfiram-like reaction to alcohol Ototoxicity and nephrotoxicity

-Monitor peak and trough -Administer slowly over 1 hour -Monitor kidney function -Administer antihistamine to treat redman syndrome Therapeutic range: Trough: 5–20 mcg/mL Peak: 30–40 mcg/mL

Chapter 28: Tetracyclines, Aminoglycosides, and Fluoroquinolones

Tetracycline Wide spectrum

Doxycycline, demeclocycline

Bacteriostatic: Inhibit protein synthesis

Anaphylaxis, superinfection Photosensitivity, diplopia Discoloration of permanent teeth Do not give to children younger than 8 years Ototoxicity, hepatotoxicity, nephrotoxicity  

-Monitor liver and kidney function. -Do not take while pregnant -Not given to children below 8 years

Aminoglycosid es Mostly gram -ve

gentamicin neomycin (Neo- fradin) tobramycin (TOBI) amikacin

Bactericidal; prevents protein synthesis

Anaphylaxis, superinfection, seizures Photosensitivity, anemia, stomatitis, GI distress Ototoxicity, nephrotoxicity, neurotoxicity Clostridium difficile–associated diarrhea Stevens-Johnson syndrome

-Assess intake and output -Assess renal function -Note peak and trough levels -increase fluid intake Peak: 5–8 mcg/mL Trough: <1–2 mcg/mL

Fluoroquinolon es Broad spectrum

ciprofloxacin (Cipro) norfloxacin (Noroxin) levofloxacin (Levaquin)

Bactericidal: Alter DNA of bacteria, causing death

Photosensitivity, eye damage, visual disturbances GI distress, dysgeusia Tendinitis, tendon rupture  

Use sunscreen. Monitor kidney function. Monitor blood glucose. Levofloxacin can increase the effects of oral hypoglycemics

Chapter 29: Sulfonamides and Nitroimidazoles Antibiotics

Drug class Drugs Action and use Adverse effects Nursing implications

Sulfonamides Broad spectrum

Sulfamethoxazole Sulfamethoxazole and trimethoprim(SMX- TMP,)

Bacteriostatic: Prevent synthesis of folic acid, TX of UTIs, PJP

Anaphylaxis Photosensitivity GI distress, stomatitis Insomnia, tinnitus Crystalluria, renal failure Blood dyscrasias Stevens-Johnson syndrome

-Avoid exposure to the sun or -wear sunscreen -Monitor CBC -Give with a full glass of water  

Nitroimidazoles metronidazole (Flagyl) Intraabdominal and gynecologic infections Interferes with DNA

Headache, dizziness, insomnia, weakness Dry mouth, dysgeusia, GI distress Tongue/tooth discoloration Peripheral neuropathy, seizures Disulfiram-like reaction

Avoid alcohol

Miscellaneous Antibiotics    

nitrofurantoin (Macrodantin)        

Primarily used for UTIs Disrupt bacteria cell wall formation

Hepatotoxicity, blood dyscrasias, dizziness, Headache, skin rash

 

Chapter 30: Antitubercular

Drug class Drug action Adverse effect Nursing implications

Antitubercular Isoniazid (INH) Inhibits bacterial cell wall synthesis

Dry mouth, GI distress, constipation Blurred vision, photosensitivity, tinnitus Drowsiness, dizziness, peripheral neuropathy Psychotic behavior, tremors, seizures Hyperglycemia, hepatotoxicity Thrombocytopenia, agranulocytosis

Give pyridoxine (vitamin B6) to prevent peripheral neuropathy. Monitor hepatic function tests. Emphasize importance of complying with drug regimen.

Antitubercular Rifampin   turns body fluids orange. Soft contact lens may be permanently discolored

 

Antitubercular ethambutol   Visual problems including blindness

 

Antitubercular Pyrazinamide   arthralgia and myalgia. May also cause hepatotoxicity and thrombocytopenia. Monitor LFTs and serum uric acid.

 

Chapter 30 :Antifungals

Antifungal Griseofulvin Disrupts cell division

Numbness, tingling, stomach ache, N,V,D, heart burn

 

Antifungal amphotericin B Bind to sterols in cell membrane lining, causing cell death

Neurotoxicity Renal toxicity Pulmonary infiltrates fever, shaking, chills, flushing, loss of appetite, dizziness, nausea, vomiting, headache, shortness of breath, and tachypnea.

Premedicate Antipyretic Antihistamines Corticosteroids NsAIDs Reliable IV access    

Antifungal nystatin Similar to Amphotericin B

Skin irritation, rash, pruritus GI distress Hyperglycemia, tachycardia Angioedema, bronchospasm Stevens-Johnson syndrome

 

Antifungal fluconazole Destroy cell wall Nausea, vomiting, diarrhea, stomach pain, Increased liver enzymes

 

Antiviral drugs

Antivir al

Acyclovir (Zovirax)

suppress replication of HSV-1, HSV-2, VZV

N,D headache, burning on topical application

 

Antivir al

Ganciclovir (Cytovene)

Used to treat infection with CMV

Bone marrow toxicity N,V headache seizures

 

Antivir al

Oseltamivi r (Tamiflu) zanamivir (Relenza)

Active against influenza types A and B

nausea and vomiting

 

Antiviral drugs

Antivira l

Ribavirin (Virazole)

infants with RSV infections

Rash, anemia, conjunctivitis, bronchospas m

 

Antivira l

Simeprevi r (Olysio)

hepatitis C Photosensitivi ty, rash, pruritus, nausea

 

Antivira l

Lamivudin e

Hepatitis B NVD  

31: Antimalarials and Anthelmintics

Antimalarial Chloroquine phosphate

Inhibit the growth of the parasite

anorexia, nausea, vomiting, diarrhea abdominal cramps headache, pruritus’, nervousness, visual impairment, insomnia, photosensitivity, hair discoloration. Seizures, confusion, psychosis , ototoxicity Renal impairment, hepatomegaly Hemolytic anemia Cardiovascular effects

Monitor renal and liver function by checking urine output and liver enzymes. Monitor the patient for impaired consciousness, Headache, or seizures. Monitor patients returning from malaria- endemic areas for malarial symptoms.

Antimalarial hydroxychloroqui ne

Same as above Same as above Same as above

Anthelmintic s

Ivermectin Destroy parasitic worms

Dizziness, Headache, pruritus, Lymph node swelling, Ocular opacity, tachycardia, Elevated hepatic enzymes

Assess the patient for complaints of anal itching and abdominal discomfort. Monitor the patient for adverse effects. Explain to the patient the importance of handwashing before meals and after use of the toilet

Chapter 32: Antiretroviral Drugs

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors

RTIs Zidovudine

interfere with HIV viral RNA- dependent DNA polymerase, resulting in inhibition of viral replication

BMS, Headache nausea, diarrhea, and abdominal pain

Drug of choice during pregnancy

Nonnucleoside reverse transcriptase inhibitor (NNRTI

Efavirenz (EFV) Binds directly to reverse transcriptase, inhibiting replication

Rash, nausea, diarrhea, CNS effects Safety precautions

Protease inhibitor Atazanavir (ATV) Inhibit enzyme needed for replication

Rash, nausea, vomiting, diarrhea, cough, fever

 

Fusion inhibitors  

enfuvirtide Inhibit fusion of virus Tolerable injection site reaction fatigue

 

Entry inhibitor  

maraviroc   fever, upper respiratory tract infection, flatulence, orthostatic hypotension, hepatotoxicity, rash, cough, abdominal pain, and dizziness.

 

integrase inhibitors raltegravir

Drug of choice for occupational exposure

GI symptoms, headache, pyrexia, increased total cholesterol, fatigue, rhabdomyolysis, insomnia, and rash that includes SJS

Drug of choice for occupational exposure

Reference

• Yeager, L.M.K.D.M.B.W. J. ([Insert Year of Publication]). Pharmacology (11th ed.). Elsevier Health Sciences (US).  https://pageburstls.elsevier.com/books/97 80323793179