nclex review antibiotics-

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.

nclex review antibiotics-

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