Antibiotics Pharmacology For Nclex-Rn

Front 1

Penicillins - Side/Adverse Effects

Back 1

Hypersensitivity,
nausea/vomiting, diarrhea/GI disturbances,
renal impairment

Front 2

Penicillins - Drug Interactions

Back 2

Oral contraceptives, aminoglycosides

Front 3

Penicillins - NSG considerations/education for patients

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) - Side/Adverse Effects

Back 4

GI discomfort (nausea,
vomiting, epigastric pain), thrombophlebitis

Front 5

Macrolides - Drug Interactions

Back 5

Antihistamines,
theophylline, carbamezepine, warfarin

Front 6

Macrolides - Nursing Implications/Client Education

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 - Drugs

Back 7

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

Front 8

Aminoglycosides - Side/Adverse Effects

Back 8

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

Front 9

Aminoglycosides - Drug Interactions

Back 9

Coumadin, penicillin (will
inactivate aminoglycosides when mixed in same
solution)

Front 10

Penicillins - Drugs

Back 10

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

Front 11

Macrolides - Drugs

Back 11

Erythromycin (E-mycin),
Clarithromycin (Biaxin), Azithromycin
(Zithromax)

Front 12

When should peak levels be collected?

Back 12

30 minutes after admin of medication

Front 13

When should trough levels be collected?

Back 13

Prior to next dose

Front 14

Tetracyclines - Drugs

Back 14

Tetracycline (Achromycin),
Doxycycline (Vibramycin)

Front 15

Tetracylines - Side/Adverse Effects

Back 15

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

Front 16

Tetracyclines - Medication Interactions

Back 16

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

Front 17

Tetracyclines - NSG Implications/Client Education

Back 17

• 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 18

Cephalosporins - Drugs

Back 18

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

Front 19

Cephalosporins - Side/Adverse Effects

Back 19

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

Front 20

Cephalosporins - Medication Interactions

Back 20

Intolerance to alcohol
(Disulfiram reaction) and Probenecid

Front 21

Cephalosporins - NSG Implicatoins/Client Education

Back 21

• 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 22

Monobactams - Drugs

Back 22

Vancomycin (Vancocin),
azetreonam (Azactam)

Front 23

Monobactams - Side/Adverse Effects

Back 23

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

Front 24

Monobactams - NSG Implications/Client Education

Back 24

• 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 25

Sulfonamides - Drugs

Back 25

trimethoprim-sulfamethoxazole
(TMP-SMZ, Bactrim)

Front 26

Sulfonamides - Side/Adverse Effects

Back 26

Hypersensitivity, blood
dyscrasias, crystalluria, kernicterus,
photosensitivity
• Medication Interactions: Coumadin, Dilantin, sulfonylurea oral hypoglycemics

Front 27

Sulfonamides - NSG Implications/Client Education

Back 27

• 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 28

Fluoroquinolones - Drugs

Back 28

ciprofloxacin (Cipro)

Front 29

Fluoroquinolones - Side/Adverse Effects

Back 29

GI discomfort, Achilles
tendon rupture, suprainfection

Front 30

Fluoroquinolones - Medication/Food Interaction

Back 30

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 31

Fluoroquinolones - NSG Implications/Client Education

Back 31

• 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 32

Antiprotozoals - Drugs

Back 32

metronidazole (Flagyl)

Front 33

Antiprotozoals - Side/Adverse Effects

Back 33

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

Front 34

Antiprotozoals - Medication Interactions

Back 34

Alcohol ingestion
may cause a Disulfiram-like reaction, warfarin

Front 35

Antiprotozoals - NSG Implications/Client Education

Back 35

• 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 36

Antifungals - Drugs

Back 36

amphotericin B (Fungizone)

Front 37

Antifungals - Side/Adverse Effects

Back 37

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

Front 38

Antifungals - Medication Interactions

Back 38

Aminoglycosides
(additive nephrotoxic risk), Flucytosine
(potentiates effect)

Front 39

Antifungals - NSG Implications/Client Education

Back 39

• 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 40

Antimycobacterials (Antituberculosis) - Drugs

Back 40

Isoniazid (INH), streptomycin,
ethambutol, pyrazinamide

Front 41

Antimycobaterials - Side/Adverse Effects

Back 41

peripheral neuropathy, hepatotoxicity

Front 42

Antimycobaterials - Medication Interactions

Back 42

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

Front 43

Antimycobaterials - NSG Implications/ Client Education

Back 43

• 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 44

Antivirals - Drugs

Back 44

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

Front 45

Antivirals - Side/Adverse Effects

Back 45

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

Front 46

Antivirals - NSG Implications/Client Education

Back 46

• 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