Pharmacology - Antibiotics

Front 1

Penicillins (examples)

Back 1

Penicillin G (Bicillin)
Amoxil (amoxicillin)
Omnipen (ampicilin)
Ticar (ticarcillin)
Zosyn (piperacillin-tazobactam)

Front 2

Penicillins
(side effects/contradictions)

Back 2

Side/Adverse Effects: Hypersensitivity,
nausea/vomiting, diarrhea/GI disturbances, renal impairment

Drug Interactions: Oral contraceptives,
Aminoglycosides

Front 3

Penicillins
(Nursing considerations)

Back 3

Take with full glass of water 1 hour before or 2 hours
after meals – except for Amoxicillin, bacampicillin,
pencillin V and Augmentin which may be taken with food
• Monitor for superinfections (mouth ulcers, vaginitis)
• Monitor for bleeding (high doses can decrease platelet
aggregation)
• Contraindicated in clients with allergies to cephalosporins
• Instruct to take on time and to finish full course of medication
• Report signs of allergic reaction such as hives, rash, itching, wheezing

Front 4

Macrolides - Bacteriostatic Inhibitors
(Examples)

Back 4

Erythromycin (E-mycin)

Clarithromycin (Biaxin)

Azithromycin (Zithromax)

Front 5

Macrolides - Bacteriostatic Inhibitors
(Side effects and contradictions)

Back 5

Side/Adverse Effects: GI discomfort (nausea, vomiting, epigastric pain), thrombophlebitis

Drug Interactions: Antihistamines, theophylline, carbamezepine, warfarin

Front 6

Macrolides - Bacteriostatic Inhibitors
(Nursing Considerations)

Back 6

*Contraindicated in liver disease
• Infusion of erythromycin must be slow and in a dilute solution to prevent thrombophlebitis
• Instruct client to complete entire course of therapy
• Notify health care provider of GI upset or allergic reactions

Front 7

Aminoglycosides
(Examples)

Back 7

Gentamicin (Garamycin)
Tobramycin (Nebcin)
Streptomycin (Neomycin)

Front 8

Aminoglycosides
(Side effects and contradictions)

Back 8

nephrotoxicity, neurotoxicity, ototoxicity, hypersensitivity,
nausea, vomiting, cramps, diarrhea, rash, tinnitus, pruritis

Drug Interactions: Coumadin, penicillin (will inactivate aminoglycosides when mixed in samesolution)

Front 9

Aminoglycosides
(Nursing Considerations)

Back 9

*Monitor peak and trough levels
• Monitor for s/s of superinfection
• Contraindicated with myasthenia gravis, renal disease, hearing loss
• Take on an empty stomach
• Notify health care provider of hearing loss, tinnitus, vertigo

Front 10

Peak and Trough Levels for Antibiotic Therapy

Back 10

Samples for peak levels should be collected 30 minutes after administration of medication.

Samples for trough levels should be collected prior to the next dose.

Front 11

Tetracyclines
(Examples)

Back 11

Tetracycline (Achromycin)

Doxycycline (Vibramycin)

Front 12

Tetracyclines
(Side effects and contraindications)

Back 12

nausea, vomiting, diarrhea, photosensitivity, stomatitis, nephrotoxicity, hepatotoxicity, superinfection, yellow-brown tooth discoloration

Medication Interactions: milk products, calcium supplements, iron supplements, magnesium containing laxatives and most antacids (these will decrease effectiveness of tetracycline)

Front 13

Tetracyclines
(Nursing Considerations)

Back 13

Take on an empty stomach with a full glass of water, except doxycycline and minocycline which may be taken with food.
• Administer at least 1 hour before and 2 hours after any food or supplements containing calcium and/or magnesium
• Use of tetracycline during pregnancy can cause staining of the deciduous teeth – avoid administration to children under 8 years of age

Front 14

Cephalosporins
(examples)

Back 14

cephalexin (Keflex)
cefaclor (Ceclor)
ceftriaxone (Rocephin)
cefepime (Maxipime)

Front 15

Cephlosporins
(SE and Contraindications)

Back 15

Allergic/hypersensitivity, bleeding tendencies, thrombophlebitis, pain with IM injection, cross allergy to penicillins, antibiotic associated pseudomembranous colitis

Medication Interactions: Intolerance to alcohol (Disulfiram reaction) and Probenecid (gout med)

Front 16

Cephlosporins
(Nursing considerations)

Back 16

• Should not be given to clients who have a severe allergic reaction to penicillins
• Use cautiously with renal impairment
• Monitor for bleeding if used with medications that promote bleeding (anticoagulants, NSAIDs)
• Should be taken with food
• Oral suspensions should be stored in refrigerator

Front 17

Monobactams
(examples)

Back 17

vancomycin (Vancocin)

azetreonam (Azactam)

Front 18

Monobactams
(SE and contraindications)

Back 18

Ototoxicity, infusion reaction (rash, flushing, tachycardia, hypotension), thrombophlebitis

Front 19

Monobactams
(Nursing considerations)

Back 19

• Use cautiously with renal impairment
• Assess for hearing loss
• Administer slowly over at least 60 minutes
• Peak blood levels should be collected 1-2 hours after completion of IV infusion. Therapeutic peak level – 30 to 40 micrograms/ml.

Front 20

Sulfonamides
(examples)

Back 20

trimethoprim-sulfamethoxazole
(TMP-SMZ, Bactrim)

Front 21

Sulfonamides
(SE and contraindications)

Back 21

Hypersensitivity, blood dyscrasias, crystalluria, kernicterus, photosensitivity

Medication Interactions: Coumadin, Dilantin, sulfonylurea oral hypoglycemics

Front 22

Sulfonamides
(Nursing considerations)

Back 22

• Contraindicated in clients with folate deficiency
• Avoid use in pregnancy and lactation
• Use cautiously if renal dysfunction
• Take on an empty stomach with a full glass of water
• Stop medication at first indication of hypersensitivity
such as rash
• Observe for bleeding, sore throat or pallor (signs of blood dyscrasia)
• Increase fluid intake to prevent crystalluria
• Avoid prolonged exposure to sunlight

Front 23

Fluoroquinolones
(Examples)

Back 23

ciprofloxacin (Cipro)

Front 24

Fluoroquinolones
(SE and contraindications)

Back 24

GI discomfort, Achilles tendon rupture, suprainfection

Medication/food interactions: aluminummagnesium antacids, iron salts, sucralfate, milk and diary products (decrease absorption of Cipro); Theophylline (can lead to theophylline toxicity); Warfarin (can lead to warfarin toxicity)

Front 25

Fluoroquinolones
(Nursing considerations)

Back 25

• Do not administer to children <18 years of age due to increased risk of Achilles tendon rupture
• Dosage is decreased for renal dysfunction
• Administer cationic compounds 1 hr before or 2 hrs after Cipro
• Instruct to complete entire course of therapy

Front 26

Antiprotozoals
(examples)

Back 26

metronidazole (Flagyl)

Front 27

Antiprotozoals
(SE and contraindications)

Back 27

GI discomfort, darkening of urine, CNS symptoms such as numbness of extremities, ataxia, seizures

Alcohol ingestion may cause a Disulfiram-like reaction, warfarin

Front 28

Antiprotozoals
(nursing considerations)

Back 28

• Use cautiously in clients with renal dysfunction
• Avoid use in first trimester of pregnancy and use cautiously thereafter as it can pass through the placenta
• Advise clients to avoid alcohol consumption during therapy
• If taking warfarin, monitor PT/INR closely

Front 29

Antifungals
(examples)

Back 29

amphotericin B (Fungizone)

Front 30

Antifungals
(SE and contraindications)

Back 30

Infusion reactions, thrombophlebitis, nephrotoxicity, hypokalemia, bone marrow suppression

• Medication Interactions: Aminoglycosides (additive nephrotoxic risk), Flucytosine (potentiates effect)

Front 31

Antifungals

Back 31

• Commonly pretreated with Benadryl and Demerol as ordered to diminish infusion reactions
• Monitor for thrombophlebitis
• Obtain baseline renal function tests, notify health care provider if urine output decreases
• Administer additional IV saline as ordered
• Monitor potassium levels

Front 32

Antimycobacterials - Antituberculosis
(examples)

Back 32

Isoniazid (INH)
streptomycin
ethambutol
pyrazinamide

Front 33

Antimycobacterials - Antituberculosis
(SE and contraindications)

Back 33

Peripheral neuropathy, hepatoxicity

• Medication Interactions: Phenytoin (can cause toxicity); alcohol, rifampin and pyrazinamide (increases risk for hepatotoxicity)

Front 34

Antimycobacterials - Antituberculosis
(Nursing considerations)

Back 34

• INH is contraindicated in liver disease
• For active TB, direct observation therapy (DOT) is done to ensure compliance
• Take INH on empty stomach (1 hr before meals or 2 hrs after)
• Monitor for tingling, numbness, burning pain related to pyridoxine (vitamin B6) deficiency – treatment is 50-200 mg of B6 daily
• Monitor liver function tests and instruct client to avoid alcohol

Front 35

Antivirals
(examples)

Back 35

Acyclovir (Zovirax)
ganciclovir (Cytovene)
lamivudine (Epivir)
amantadine (Symmetrel)

Front 36

Antivirals
(SE and contraindications)

Back 36

phlebitis/inflammation at infusion site, nephrotoxicity, nausea, headache, diarrhea (with oral therapy), granulocytopenia, thrombocytopenia, reproductive toxicity

Front 37

Antivirals
(Nursing considerations)

Back 37

• Administer acyclovir slowly over 1 hr
• Ensure adequate hydration to minimize nephrotoxicity
• Obtain baseline CBC and platelet count
• Ganciclovir is teratogenic – avoid pregnancy and teach risk of sterility