Ppt chapter 41

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 41

Drugs that Are Miscellaneous Antibiotics

Chapter 41

Drugs that Are Miscellaneous Antibiotics


QuestionQuestion

• Quinolones are effective for aerobic gram-negative and gram-positive infections.

– A. True

– B. False


AnswerAnswer

• A. True

• Rationale: Quinolones are effective for treating aerobic gram-negative and gram-positive infections.


Quinolones/Fluoroquinolones Quinolones/Fluoroquinolones • Quinolones/Fluoroquinolones are effective for aerobic gram-

negative and gram-positive infections.

• Like cephalosporins, quinolones are subdivided into generations.

– First-generation quinolones are used only to treat uncomplicated urinary tract infections (UTIs).

– Second-generation fluoroquinolones have increased gram-negative and systemic activity.

– Third-generation fluoroquinolones have extended activity against gram-positive pathogens.

– Fourth-generation fluoroquinolones have extended activity against Pseudomonas.

• Prototype drug: ciprofloxacin (Cipro)


Ciprofloxacin: Core Drug Knowledge Ciprofloxacin: Core Drug Knowledge

• Pharmacotherapeutics

– Active against aerobic gram-negative organisms

• Pharmacokinetics

– Administered: oral, parenteral, and topical. Metabolism: liver. Excreted: urine and feces.

• Pharmacodynamics

– Inhibits deoxyribonucleic acid (DNA) gyrase, an enzyme needed for bacterial DNA replication


Ciprofloxacin: Core Drug Knowledge (cont.)Ciprofloxacin: Core Drug Knowledge (cont.)

• Contraindications and precautions

– Allergy, pregnancy, and lactation

• Adverse effects

– Arthropathy, GI upset, headache, and restlessness

• Drug interactions

– Many potential drug–drug interactions due to metabolism


Ciprofloxacin: Core Patient Variables Ciprofloxacin: Core Patient Variables

• Health status

– Assess for GI disease, renal or hepatic dysfunction.

• Life span and gender

– Assess pregnancy and lactation status.

• Lifestyle, diet, and habits

– Assess diet and caffeine use.

• Environment

– Assess the environment where the drug will be given.


Ciprofloxacin: Nursing Diagnoses and Outcomes Ciprofloxacin: Nursing Diagnoses and Outcomes

• Diarrhea related to adverse drug effects

– Desired outcome: The patient will avoid dehydration, maintain fluid intake, and contact the prescriber if diarrhea persists.

• Imbalanced Nutrition: More or Less than Body Requirements related to GI effects, alteration in taste, and superinfections

– Desired outcome: The patient will maintain body weight and contact the prescriber if persistent adverse effects alter nutritional status.


Ciprofloxacin: Nursing Diagnoses and Outcomes (cont.)Ciprofloxacin: Nursing Diagnoses and Outcomes (cont.)

• Risk for Injury related to drug-induced dizziness, confusion, and other CNS effects

– Desired outcome: The patient will remain free of injury and contact the prescriber about persistent CNS disturbances.

• Risk for Impaired Tissue Integrity related to drug-induced photosensitivity

– Desired outcome: The patient will take measures to protect his or her skin from prolonged sun exposure.


Ciprofloxacin: Planning and InterventionsCiprofloxacin: Planning and Interventions

• Maximizing therapeutic effects

– Coordinate the administration of drugs to decrease potential drug–drug interactions.

• Minimizing adverse effects

– Institute safety measures to protect the patient if CNS effects occur. For patients with adverse GI effects, provide small, frequent meals as tolerated.


Ciprofloxacin: Teaching, Assessment, and EvaluationsCiprofloxacin: Teaching, Assessment, and Evaluations

• Patient and family education

– It is important to explain that ciprofloxacin is prescribed for a particular infection.

– It is important to instruct patients to complete the full course of drug therapy, even when they feel better.

• Ongoing assessment and evaluation

– Due to the possibility for overgrowth of candidal organisms with ciprofloxacin therapy, monitor patients closely during treatment.


QuestionQuestion

• The most clinically important adverse reaction is

– A. Photosensitivity

– B. Arthropathy

– C. Hepatotoxicity

– D. Neurotoxicity


AnswerAnswer

• B. Arthropathy

• Rationale: The most clinically important adverse reaction is arthropathy (joint disease).

• This often irreversible adverse reaction tends to occur in children under 18 years of age.


Cyclic Lipopeptides Cyclic Lipopeptides

• Daptomycin (Cubicin) is the only drug in a new class of antibiotics called cyclic lipopeptides.

• This class of antibiotics has a substantially different mechanism of action than that of other antibiotic drugs.

• Another benefit of daptomycin is its ability to retain potency against antibiotic-resistant gram-positive bacteria.


Daptomycin: Core Drug Knowledge Daptomycin: Core Drug Knowledge

• Pharmacotherapeutics

– Used to manage complicated skin infections

• Pharmacokinetics

– Administered: IV. T½: 9.4 hours. Excreted: kidneys.

• Pharmacodynamics

– Binds to the bacterial membrane and interferes with the integrity of the cell wall


Daptomycin: Core Drug Knowledge (cont.)Daptomycin: Core Drug Knowledge (cont.)

• Contraindications and precautions

– Hypersensitivity

• Adverse effects

– Constipation, diarrhea, nausea, vomiting, and injection site reactions

• Drug interactions

– No clinically important drug–drug interactions have been identified.


Daptomycin: Patient Variables Daptomycin: Patient Variables

• Health status

– Assess medical history for contraindications to the drug.

• Life span and gender

– Pregnancy Category B drug

• Environment

– Used in hospital or home care environment


Daptomycin: Nursing Diagnoses and Outcomes Daptomycin: Nursing Diagnoses and Outcomes • Acute Pain related to myopathy

– Desired outcome: The patient will contact the health care provider should pain or tingling in the extremities occur.

• Risk for Infection related to overgrowth of nonsusceptible organisms

– Desired outcome: The patient will report signs of superinfection to the prescriber.

• Fatigue related to metabolic and hematopoietic alterations

– Desired outcome: The patient will immediately report signs of fatigue to the health care provider.


Daptomycin: Nursing Diagnoses and Outcomes (cont.)Daptomycin: Nursing Diagnoses and Outcomes (cont.)

• Imbalanced Nutrition: Less than Body Requirements, related to drug-induced GI effects, such as nausea, vomiting, diarrhea, or dyspepsia

– Desired outcome: The patient will maintain consistent body weight and consult the prescriber about persistent adverse effects that affect nutritional status.

• Diarrhea related to drug therapy

– Desired outcome: The patient will avoid dehydration, maintain fluid intake, and contact the prescriber about persistent diarrhea.


Daptomycin: Planning and InterventionsDaptomycin: Planning and Interventions

• Maximizing therapeutic effects

– Before administration, visually inspect daptomycin for particulate matter and discoloration.

– Administer daptomycin with 0.9% sodium chloride injection or lactated Ringer’s solution.

• Minimizing adverse effects

– Evaluate the IV site before administering daptomycin.


Daptomycin: Teaching, Assessment, and EvaluationsDaptomycin: Teaching, Assessment, and Evaluations

• Patient and family education

– Explain the potential adverse effects and need for periodic blood monitoring.

– Teach patients the importance of reporting diarrhea, muscle pain or tingling, and fatigue.

– Advise patients to stop taking HMG-CoA reductase inhibitors.

• Ongoing assessment and evaluation

– Evaluate for resolution of the presenting infection.


QuestionQuestion

• Daptomycin is used to treat

– A. Respiratory infections

– B. Osteomylitis

– C. Carditis

– D. Complicated skin infections


AnswerAnswer

• D. Complicated skin infections

• Rationale: Daptomycin is used to manage complicated skin and skin structure infections.

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Ppt chapter 41