Judy Miller Pharm

· Culture first! · Give at regular intervals · Check for superimposed infection (good/bad microbes out of wack · Take ALL of medicine Aminoglycosides (Mycins):
Penicillins
Cephalosporins (Cef- Kef):
Erythromycins (macrolydes) “Ilo”
Tetracycline

· These are not systemically absorbed when given by mouth! (these don’t include erythromycin) o Streptomycin o Gentamycin o Oral administration for bowel disinfection only, poorly absorbed from GI tract: Neomycin (prep for bowel sx to kill bacteria, or liver failure to kill off bacteria that cause ammonia which would put them in hepatic coma), Kanamycin o When given IV or IM can treat systemic infections o Adverse effects: think shape of ear and kidney § 8^th cranial nerve damage: hearing loss, tinnitus, balance § Nephrotoxicity: BUN, creatinine clearance, I&O check these! § Neuromuscular blockade: don’t give to MG § Check peaks and troughs!!! IV 30 min later, IM 60 min later to check peaks o An adult has been getting gent IV q8hrs. Which lab test to check? § BUN and serum creatinine o Adult gent q8h for days. Adverse rxn? § Tinnitus o Vancomycin: for severe infections, ATB induced pseudomembranous colitis § “mean-o-mycin Monitor ototoxicity and renal toxicity

· gram + and – infections: Gonococcus, meningococcus, penumococcus, streptococcus, treponema (will cause syphilis) o Allergic rxns! Minor to shock. o GI upset! NVD, but take PO on empty stomach. Probenicid increases blood levels of penicllin. o Penicillin V K 500 ordered. Took penicllin taken 2 mo ago. Nurse should: § Rarely get allergic rxn first time you take penicllin. You should observe for skin rashes and signs of rxn o Nurse telling pt about taking penicllin qid. Take: § On empty stomach at 6-hr intervals o Infant amoxicllin. Nurse tell parents: Give child all med in bottle. Suspensions have no potency after some weeks

· cephalexin (Keflex), cefazolin (ancef) o *** Cross allergy to penicllin. Allergic to penicllin, 25% chance they will be allergic to cephalosprorins. Ask them! o Renal toxic. o Keflex ordered. Allergy to penicllin. Appropriate initial action for nurse: Ask client to describe rxn. Many pts say allergy if they got diarrhea, or mild rash. Not really allergic rxn.

o Given to pts allergic to peniclllin. o Enteric coated tabs. Won’t disolve in stomach. Acid decreases activity of erythromycin. Don’t give with meals or acids! o Legionnaire’s: resp infection, mycoplasma (walking pneumonia), chlamydia, borrelia, helicobacter pylori o Erythromycin for adult. Nurses instruction: Take on empty stomach with full glass of water

· rickettsia, mycoplasma, chlamydia, acne. o No milk products, zinc or iron. o Photosensitivity. Causes rashes Gray teeth in children! Even second teeth. Don’t take under 8 or in pregnancy

· BIG GUNS! Used when nothing else works o severe toxicity, aplastic anemia (BM suppression) . Seious! Uses: H flu meningitis, typhoid fever, rocky mt spotted fever

· gram – bacteria including pseudomonas. Some gram + organisms. o Examples: norfloxacin (noroxin) used for UTI Ciprofloxacin (Cipro) used for systemic infections, achieves good serum levels

· : “sulfa, gant” o Sulfisoxazole, sulfasalazine o Uses: UTI, UC, Crohn, bowel prep o AE: skin (rash in sun), NV, renal (stones), GI, photosensitivity o Push fluids! o Sulfisoxasole, adult with UTI. Take with water and drink more fluids. Reason for instructions: Drinking fluids will help prevent stone formation

· Urinary antiinfectives: methenamine mandelate, mandelamine, Nitrofuradantin (acid urine works best! Drink cranberry), When hear dantins: think UTI!

o INH (Isonaiazid) § Liver toxicity, perpheral neuritis (give with Vit B6) nerve pain! Give pyrodoxine! B6 o PAS (para amino salicylate sodium: GI SE (give with meals) sounds like asprin- think GI o Rifampin (Rimactane) § Body fluids are red, affects drug actions. Affects birth control! o Ethambutol § Optic neurities (red/green color blind) § Elevated uric acid à gout Strept given IM, PAS with food, the rest on empty stomach. On 3-4 drugs for 9-12 mo.

o Acyclovir (zovirax) § For herpes, doesn’t cure or prevent transmission.

A. Nucleoside Analogues 1. Inhibit replication of HIV virus by inhibiting the transcription of RNA and DNA. 2. Drugs a. Didanosine (Videx) (ddl) b. Lamivudine (3TC) (Epivir) c. Stavudine (d4T) (Zerit) d. Zidovudine (AZT) (Retrovir) 3. Major adverse effect is bone marrow suppression 4. Teach patient and family a. Drugs do not cure AIDS but will control symptoms b. Call physician if signs of other infections such as sore throat or swollen lymph nodes c. Patient is still infective and must use methods to prevent transmission of AIDS virus • d. Avoid OTC products because of the many incompatibilities. B. Non Nucleoside Analogues 1. Inhibit replication of HIV virus; do not cure AIDS 2. Drugs a. Delavirdine (DLV) (Rescriptor) b. Nevirapine (NVP) (Viramune) 3. Side effects / nursing care a. Monitor liver enzymes b. Nevirapine decreases effectiveness of oral contraceptives c. Nevirapine is always given with at least one other antiviral to prevent resistance. d. Severe rash C. Protease Inhibitors 1. Inhibit replication of HIV virus; do not cure AIDS 2. Drugs a. Indinavir (Crixivan) b. Nelfinavir (Viracept) c. Ritonavir (Norvir) d. Saquinavir (Invirase) 3. Adverse Effects / Nursing Care a. Use cautiously with other drugs.. b. Take with food.

  A. Used to fungi or yeast infections that may be systemic such as histoplasmosis, vaginal such as candida or affect the skin such as tinea (ringworm). B. Amphotericin B (Fungazone) Treatment of systemic fungal infections such as histoplasmosis 1. Given IV 2. Very toxic a. Fever b. Hypokalemia c. Azotemia d. Blood dyscrasias due to bone marrow suppression 3. Give acetaminophen, diphenhydramine (Benadryl) and steroids prior to infusion to prevent adverse reactions C. Nystatin (Mycostatin) 1. Used to treat gastrointestinal and vaginal candida (yeast) infections. 2. Can be given orally as tablets, oral suspension (for thrush) or as vaginal tablets. 3. Tell patient to take medication for 2 weeks after symptoms improve to prevent reinfection.

o Yeast infections PO and vaginal