nclex review antibiotics-
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8/13/2019 NCLEX REVIEW Antibiotics-
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ANTIBIOTICS/ANTI-INFECTIVES/ANTIVIRALS
ANTIBIOTICS WHAT I NEED TO KNOW AS A BRAND NEW NURSEAminoglycosides
Common examples:
Gentamicin (Garamycin)
Tobramycin (Nebcin)Neomycin, Amikacin (Amikin),
Streptomycin
*Indicated for serious Gram (-) infections
*Given parenterally for systemic use, because poorly absorbed from the GI tract
*Irreversible Ototoxicity, Nephrotoxicity
*Baseline 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.
*Neomycin available in topical form*Streptomycin generally restricted to the treatment of TB
Cephalosporins
Common examples:
1stGenerationCefazolin (Ancef, Kefzol)Cephalexin (Keflex)
2nd
GenerationCefaclor (Ceclor)
Cefoxitin (Mefoxin)
Cefprozil (Cefzil)
3rd
GenerationCefatoxamine ( Claforan)
Ceftriaxone (Rocephin)
Cefpodoxime (Vantin)
4th
GenerationCefepime (Maxipime)
*Indicated for Gram (-) infections and those patients who cannot tolerate Penicillins
*5-15% incidence of Cross-sensitivity to Penicillins, however, may be a good alternative when
Penicillins 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.
*1stand 2
ndgenerations 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 (consider
administration with Xylocaine), thrombophlebitis (administer over 60 minutes).
*Over 50% are administered parenterally, refrigerate oral suspensions.*Monitor use in renal patients.
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Macrolides
Common examples:Azithromycin (Zithromax, Z-Pak)
Clarithromycin (Biaxin)
Erythromycin (Erythrocin)
*Broad-spectrum antibiotic*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.
PenicilllinsCommon examples:
Penicillin G (Bicillin)Penicillin V (Pen VK)
Nafcillin, Oxacillin
Ampicillin (Principen)
Amoxicillin (Amoxil,Trimox)
Ampicillin/Sulbactam
(Unasyn)
Amoxicillin/Clavulanate
(Augmentin)Ticarcillin (Ticar)
Peperacillin/Tazobactam
(Zosyn)
*Treatment of Gram (+) infections*5-15% incidence of Cross-sensitivity to Cephalosporins.
*Give separately from Aminoglycosides, may inactivate.*Generally well tolerated. 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 H20, not
acidic juices.
Fluoroquinolones
(Quinolones)Common examples:
Ciprofloxacin (Cipro, Septra)
Gatifloxacin (Tequin, Zymar)Levofloxacin (Levaquin)
Moxifloxacin (Avelox)
*Treatment of Gram (-) organisms and some Gram (+) infections
*Generally not used as a first-line antibiotic
*Antacids, mineral supplements and multivitamin interfere with absorption up to 90% when given
together*Monitor BUN and creatinine levels.*Monitor I&O
*Adverse effects include: GI complaints, dizziness, headache, sleep disturbances, suprainfections,
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.*Cipro DOC for Anthrax exposure
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Sulfonamides
Common examples:Trimethoprim/Sulfamethoxazole
(Bactrim, Septra)
Sulfisoxazole (Gantrisin)
Sulfisoxasole/Erythromycin(Pediazole)
Silver Sulfadiazine (Silvadene)**Topical form
Sulfacetemide (Cetamide)
**Opthalmic drops
*Broad spectrum activity*Oftenprescribed for the treatment of UTIs
*Increase fluids to 2000-3000 ml/dayAdverse effects include GI complaints, skin rashes, suprainfections, crystalluria, renal damage,phototoxicity, hyperkalemia, blood dyscrasias, Stevens-Johnson syndrome, anaphylaxis.
Tetracyclines
Common examples:
Doxycycline (Vibramycin)
Tetracycline (Sumycin)Tigecycline (Tygacil)
*Broad spectrum activity
*Take on an empty stomach to maximize absorption, although may not be tolerated unless
administered with food.*Strong affinity for Calcium, do not administer with antacids or dairy products.
*Contraindicated during pregnancy, lactation and children < 8 years (May cause permanent stainingof teeth and/or delayed bone growth).*Photosensitivity and GI disturbances common.
Adverse reactions include multiple GI complaints, skin rashes, suprainfections, phototoxicity,
hepatotoxicity, anaphylaxis.
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ANTI-INFECTIVES WHAT I NEED TO KNOW AS A BRAND NEW NURSEAntihelminthics
Common examples:
Mebendazole (Vermox)Pyrantel (Antiminth, Pinworm
caplets, Pin-X)
*Treat entire family and close personal contacts to prevent reinfestation
*Teach good personal hygiene, handwashing, frequent laundering of clothes and bed linens*Adverse effects are rare, may experience GI complaints as the worms die, look for S&S of intestinal
blaockage.
Not recommended during pregnancy or for patients < 2 years.
Antimalarials
Common examples:
Hydroxychloroquine(Plaquenil)
*Easier to prevent the disease of malaria than to treat it. Persons traveling to infested areas should take
prophylactic antimalarials prior to travel.*Adverse effects include GI complaints, headache, agitation, photophobia, agranulocytosis, EKG
changes.
*Baseline CBC and EKG indicated with long-term therapy.
Antiprotozoals
(nonmalarial)
Common examples:Metronidazole (Flagyl)
*Dual activity against bacteria and parasites*May cause dark or reddish brown discoloration of urine
*Cautious use with known hepatic disease
*Adverse effects include GI complaints, headache, dizziness, thrombophlebitis, bone marrowsuppression.
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Antiretrovirals (HIV
Infection)
Common examples:
Fusion and Integrase Inhibitors
Raltegravir (Isentress)
Maraviroc (Selzentry)Enfuvirtide (Fuzeon)
Protease Inhibitors
Saquinavir mesylate (Invirase)Nelfinavir (Viracept)
Iopinavir/Ritonavir (Kaletra)
Nucleoside/Nucleotide Reverse
Transcriptase Inhibitors
(NRTIs)Zidovudine or AZT (Retrovir)
Non-Nucleoside Reverse
Transcriptase Inhibitors
(NNRTIs)
Efavirenz (Sustiva)
Delavidrine (Rescriptor)
*Monitor CD4+ Tcell counts and HIV RNA viral load with all Antiretrovirals
*Administer in combination therapy only.*Adverse effects include abdominal pain, fatigue, GI complaints, neutropenia, thrombocytopenia,
nephrotoxicity,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
*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.
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