Exam 3

• Always obtain culture and check allergies before giving antibiotics
• Broad spectrum antibiotics- given before culture and sensitivity results come back
• Superinfection- Secondary infection as a result of antibiotic therapy
• Super infection examples


  Yeast infection, c. diff
• Superinfection prevention

  Take probiotic, eat buttermilk, eat yogurt
• Nephrotoxic- Monitor BUN and creatinine
• Hepatotoxic- monitor ALT and AST
• Kidney damage- Leads to decreased urine output. Monitor I&O when patient is taking nephrotoxic drug
• Patient teaching when being discharged while on antibiotic

  Finish full course of antibiotic, immediately report allergic or adverse reactions
• Treatment for anaphylaxis

  Epinephrine, antihistamine, steroid
• Amoxicillin- broad spectrum antibiotic, mainly respiratory infections. Only given orally
• Amoxicillin considerations: decreased effects when taken with acidic fruits and juices. Can cause CDAD
• Cephalosporin consideration: Caution when giving cephalosporin in patient with penicillin allergy
• Macrolides considerations: Hepatotoxic when given in high doses. Monitor ALT and AST.
• Signs of liver damage- Jaundice, fatigue
• Red man syndrome- Occurs when vancomycin IV is given too quickly. Causes red blotching of skin, severe hypertension, tachycardia, tingling, dyspnea, paresthesia, and erythema
• Vancomycin toxicity- Nephrotoxicity and ototoxicity
• Tetracycline considerations- do not give to women in third trimester of pregnancy, patients taking other nephrotoxic drugs, children under 8, or women on oral contraceptives
• Tetracycline side effects: Superinfection, discoloration of teeth, tongue, and nails, photosensitivity, GI distress, teratogenic effects, nephrotoxicity
• Tetracycline interactions: Antacids, milk, and foods high in calcium inhibit absorption
• Tetracycline patient teaching: Wear sunscreen, finish entire course, do not take if planning on becoming pregnant
• Aminoglycoside adverse reactions: Ototoxicity and nephrotoxicity
• Ototoxicity signs- Hearing loss, ringing in ears, balance issues
• Fluoroquinolone side effects- photosensitivity, tendon rupture, tendinitis, CNS effects, exacerbation of myasthenia gravis, superinfection
• Levofloxacin interactions- Glucose must be monitored if taken with insulin
• Sulfonamides side effects: Blood disorders, photosensitivity, crystalluria, hematuria, elevated liver enzymes
• Sulfonamide patient teaching: Do not take if pregnant, increase fluid intake, do not take with antacids, wear sunblock and sunglasses, report any bleeding or bruising (signs of low platelet)
• Metronidazole- treats c. diff.

  Avoid alcohol to prevent disulfiram-like reaction
• First line treatment for TB: Ethambutol, Isoniazid, Pyrazinamide, Rifampin, Rifabutin, Rifapentine
• Antitubercular toxicity- Hepatotoxic

  Cannot take prophylactically with liver disease
• Antitubercular teaching:

  Isoniazid- May need vitamin b6 supplement

  Rifampin- bodily fluids may turn harmless orange color

  Ethambutol- Adverse effect of vision changes, must be reported immediately

  Antacid decrease absorption
• Isoniazid (NIH)- Treats TB. Can cause peripheral neuropathy due to B6 deficiency. Normally prescribed with B6 supplement to prevent neuropathy
• Amphotericin B- Polyene drug of choice for severe systemic fungal infections.

  Toxicity/ adverse reactions:

  Nephrotoxicity, bone marrow toxicity, electrolyte imbalance.

  Monitor BUN, creatinine, potassium, magnesium, and CBC
• Nystatin- treats candidiasis.

  Swish and swallow for liquid suspension
• Neuraminidase inhibitors (oseltamivir, zanamivir)- Treats flu. Must be given within 48 hours of symptom onset
• Acyclovir- treats herpes simplex

  Side effects: Leokupenia, decreased hemoglobin and hematocrit, kidney dysfunction

  Monitor: Urine output, BUN, creatinine, CBC
• Efavirenz (EFV)- Treats HIV.

  Side effects: Dizziness, abnormal dreams, impaired concentration, agitation, hallucinations, anxiety, nausea, diarrhea, liver failure
• Zidovudine- Treats HIV

  Side effects: N/V/D, headaches, myalgias, insomnia, elevated liver enzymes, hepatotoxicity
• -floxacin: fluoroquinolones
• -cycline: tetracyclines