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ANTIBIOTICS/ANTI-INFECTIVES
ANTIBIOTICS
WHAT I NEED TO KNOW AS A BRAND NEW NURSE
Aminoglycosides Common examples:Gentamicin (Garamycin)Tobramycin (Nebcin)Neomycin
Irreversible Ototoxicity, NephrotoxicityBaseline hearing test recommended.Peak and trough levels indicated.Monitor BUN and creatinine levels.Increase fluids 1500-2000 ml/day.Adverse effects include GI complaints, rash, fever, pain or swelling at the injection site, dizziness,tinnitus, suprainfections and anaphylaxis.
Cephalosporins Common examples:st^1 GenerationCefazolin (Ancef, Kefzol)Cephalexin (Keflex)nd^2 GenerationCefaclor (Ceclor)Cefoxitin (Mefoxin)Cefprozil (Cefzil)rd^3 GenerationCefatoxamine ( Claforan)Ceftriaxone (Rocephin)th^4 GenerationCefepime (Maxipime)
10-15% incidence of Cross-sensitivity to Penicillins, however, may be a good alternative whenPenicillins not tolerated.Contraindicated for patients who have had an anaphylactic allergic reaction to penicillin.*4 Generations – generally the higher the generation the better the Gram (-) coverage.st^ *1and 2
nd^ generations Do Not cross the blood/brain barrier – ineffective for neurological infections. Adverse reactions commonly include skin rashes, GI complaints. More rarely seen: suprainfections,pseudomembraneous enterocolitis and anaphylaxis.Specific adverse reactions: Bleeding tendencies (monitor PT), IM injection pain (consideradministration with Xylocaine), thrombophlebitis (administer over 60 minutes).Over 50% are administered parenterally, refrigerate oral suspensions.Monitor use in renal patients.
Macrolides Common examples:Azithromycin (Zithromax)Clarithromycin (Biaxin)Erythromycin (Erythrocin)
Good alternative for patients allergic to Penicillin.Administer on an empty stomach, destroyed by gastric acids and acidic fruit juice.Contraindicated with known liver disease, increased liver function tests with prolonged use.Adverse effects include GI complaints, suprainfections, hepatotoxicity, dysrhythmias, ototoxicity,pseudomembranous colitis, and anaphylaxis.
Penicilllins Common examples:Penicillin GPenicillin V (Pen VK)Nafcillin, OxacillinAmpicillin (Principen)Amoxicillin (Amoxil,Trimox)Ampicillin/Sulbactam(Unasyn)Amoxicillin/Clavulanate(Augmentin)Ticarcillin (Ticar)Peperacillin/Tazobactam(Zosyn)
10-15% incidence of Cross-sensitivity to Cephalosporins.Give separately from Aminoglycosides, may inactivate.Adverse reactions range from mild rash, N/V, to severe anaphylaxis.Monitor use in renal patients*Oral absorption limited by the presence of food, empty stomach preferred, administer with H
2 0, not
acidic juices.
Quinolones(Fluoroquinolones) Common examples:Ciprofloxacin (Cipro, Septra)Gatifloxacin (Tequin, Zymar)Levofloxacin (Levaquin)Moxifloxacin (Avelox)
Antacids interfere with absorptionMonitor BUN and creatinine levels.Monitor I&OAdverse effects include: GI complaints, dizziness, headache, sleep disturbances, supraAinfections,phototoxicity, cardiotoxicity, and tendon/joint toxicity (associated with small risk of tendon rupture).*Contraindicated in pregnancy and patients < 18 years of age, except with Anthrax exposure.
Sulfonamides Common examples:Trimethoprim/Sulfamethoxazole(Bactrim, Septra)Sulfisoxazole (Gantrisin)Sulfisoxasole/Erythromycin(Pediazole)Silver Sulfadiazine (Silvadene)**Topical form
*Increase fluids to 2000-3000 ml/dayAdverse effects include GI complaints, skin rashes, suprainfections, crystalluria, renal damage,phototoxicity, hyperkalemia, blood dyscarsias, Stevens-Johnson syndrome, anaphylaxis.
Antiprotozoals(nonmalarial) Common examples:Metronidazole (Flagyl)
May cause dark or reddish brown discoloration of urineCautious use with known hepatic disease*Adverse effects include GI complaints, headache, dizziness, thrombophlebitis, bone marrowsuppression.
Antivirals - (Non-HIV) Common examples: Acyclovir (Zovirax)Valacyclovir (Valtrex)----------------------------------------- Influenza Common examples:Oseltamivir (Tamiflu)Zanamivir (Relenza) Prophylaxis Amantadine (Symmetrel)Rimantidine (Flumadine)----------------------------------------- Hepatitis Common examples: Antivirals Ribavirin (Copegus, Virazole,Rebetol, Ribasphere)Adefovir dipivoxil (Hepsera)Entecavir (Baraclude)Lamivudine (Epivir HBV) Inteferons Peginterferon alfa-2a (Pegasys)
For IV routes: Monitor I&O and encourage fluids, monitor BUN and creatinine.Adverse effects vary with drug.---------------------------------------------------------------------------------------------------------------------------Prophylactic medications should be started within 48 hours after exposure.Screen for history of substance abuse and/or suicide, may exacerbate preexisting mental disease.---------------------------------------------------------------------------------------------------------------------------Adverse effects include GI complaints, fatigue, and hepatotoxicity.Monitor ALT, AST and blood counts.Adverse effects include fatigue, headache, malaise, anorexia, diarrhea, suprainfections,thrombocytopenia, suicidal thoughtsFlulike symptoms likely after IV administration.*Increase fluids to 2500ml or more/day and monitor I&O.
Antiretrovirals Common examples: -----------------------------------------Integrase Inhibitors Raltegravir (Isentress)----------------------------------------- CCR5 Inhibitors Maraviroc (Selzentry) -----------------------------------------Fusion Inhibitors Enfuvirtide (Fuzeon) Protease Inhibitors Saquinavir mesylate (Invirase)----------------------------------------- Nucleoside/Necleotide ReverseTranscriptase Inhibitors(NRTIs) Zidovudine or AZT (Retrovir)----------------------------------------- Non-Nucleoside ReverseTranscriptase Inhibitors(NNRTIs) Efavirenz (Sustiva)Delavidrine (Rescriptor)
Monitor CD4+ Tcell counts and HIV RNA viral load.---------------------------------------------------------------------------Administer in combination therapy only.Adverse effects include headache and GI complaints.---------------------------------------------------------------------------Administer in combination therapy only.Adverse effects include abdominal pain, cough, dizziness, pyrexia, rash, upper respiratory infections,hepatotoxicity and increased risk of myocardial infaction.Use caution when administering to patients with known cardiac disease.Monitor ALT and AST.---------------------------------------------------------------------------Subq injection, site reactions occur in nearly all patients.Adverse effects include fatigue, GI complaints, neutropenia, thrombocytopenia, and nephrotoxicity.Resistance develops rapidly, always administer in combination therapy with at least one NRTI.St John's Wort contraindicated, greatly reduces efficacy.Adverse effects include GI complaints specifically severe diarrhea, anemia, leucopenia,lymphadenopathy, hemorrhagic colitis, and pancreatitis.---------------------------------------------------------------------------Adverse effects include rash, malaise, GI complaints, bone marrow suppression, neutropenia,anemia, neurotoxicity.---------------------------------------------------------------------------Adverse effects include rash, GI complaints, parasthesia, hepatotoxicity, Stevens-Johnsonsyndrome.Monitor ALT and AST.
