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ANTIBIOTICS/ANTI-INFECTIVES/ANTIVIRALS ANTIBIOTICS

Aminoglycosides
Common examples: Gentamicin (Garamycin) Tobramycin (Nebcin) Neomycin, Amikacin (Amikin), Streptomycin

WHAT I NEED TO KNOW AS A BRAND NEW NURSE


*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 *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. *1st and 2nd 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 (consider administration with Xylocaine), thrombophlebitis (administer over 60 minutes). *Over 50% are administered parenterally, refrigerate oral suspensions. *Monitor use in renal patients.

Cephalosporins
Common examples:

1st Generation
Cefazolin (Ancef, Kefzol) Cephalexin (Keflex)

2nd Generation
Cefaclor (Ceclor) Cefoxitin (Mefoxin) Cefprozil (Cefzil)

3rd Generation
Cefatoxamine ( Claforan) Ceftriaxone (Rocephin) Cefpodoxime (Vantin)

4th Generation
Cefepime (Maxipime)

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.

Penicilllins
Common 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

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/day Adverse 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 staining of teeth and/or delayed bone growth). *Photosensitivity and GI disturbances common. Adverse reactions include multiple GI complaints, skin rashes, suprainfections, phototoxicity, hepatotoxicity, anaphylaxis.

MISCELLANEOUS ANTIBIOTICS
Vancomycin

WHAT I NEED TO KNOW AS A BRAND NEW NURSE


*Severe Gram (+) infections *DOC for treatment of MRSA *Ototoxicity, Nephrotoxicity *Baseline hearing test recommended. *Peak and trough levels indicated. *Monitor BUN and creatinine levels. *Infuse over at least 60 minutes on an infusion pump and monitor BP and HR during administration due to risk of hypotension. *Adverse reactions include GI disturbance, skin rashes, fever and chills, confusion, seizures, ototoxicity, nephrotoxicity and Red Man Syndrome (a syndrome of flushing, hypotension and tachycardia) *Reserved for serious skin, wound and abscess infections *Adverse effects include GI complaints, fever, headache, dizziness, insomnia and rash *One of the broadest spectrums of any antibiotic class *Low incidence of adverse effects. Rash and GI complaints most common

Daptomycin (Cubicin) Class: Cyclic-lipopeptide Imipenem-cilastin (Primaxin) Class: Carbapenems Clindamycin (Cleocin)

*Broad spectrum antibiotic *Often used for oral infections *Associated risk of Pseudomembranous colitis limits use *Other adverse effects include rash, pruritis, difficulty swallowing *Primary use for the treatment of Vancomycin-resistant Enterococcus *Hepatotoxic, nephrotoxic *Other adverse effects include pain and irritation at IV site, GI complaints, muscle pain and rash *Effective for Vancomycin resistant MRSA infections *Cautious use in patients with history of hypertension or patients taking serotonin reuptake inhibitors; may precipitate a hypertensive crisis *Other adverse effects include thrombocytopenia, bleeding, GI complaints, fever

Quinupristin/Dalfopristin (Synercid) Class: Streptogramins Linezolid (Zyvox) Class: Oxazolidinones

ANTI-INFECTIVES
Antihelminthics
Common examples: Mebendazole (Vermox) Pyrantel (Antiminth, Pinworm caplets, Pin-X)

WHAT I NEED TO KNOW AS A BRAND NEW NURSE


*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 marrow suppression.

ANTIVIRALS/ WHAT I NEED TO KNOW AS A BRAND NEW NURSE ANTIRETROVIRALS


Antivirals - (Non-HIV) Herpesviruses
Common examples: Acyclovir (Zovirax) Valacyclovir (Valtrex) Famiciclovir (Famvir)

*Indicated for the treatment of HSV-1, HSV-2, CMV (Cytommeegalovirus), EBV (Epstein Barr), VZV (Varicella) *Do not cure patients of the virus. Used to relieve symptoms and decrease recurrence rate *For IV routes: Monitor I&O and encourage fluids, monitor BUN and creatinine. *Adverse effects vary with drug.

Influenza
Common examples: Oseltamivir (Tamiflu) Zanamivir (Relenza) Prophylaxis Amantadine (Symmetrel) Rimantidine (Flumadine)

*Prophylactic medications should be started within 48 hours after exposure. *Screen for history of substance abuse and/or suicide, may exacerbate preexisting mental disease. *Prevention of influenza through annual vaccination is the best alternative

Hepatitis
Common examples: Antivirals Adefovir dipivoxil (Hepsera) Entecavir (Baraclude) Tenofovir (Viread) Lamivudine (Epivir HBV)

*Indicated for the treatment of chronic Hepatitis B infections *Adverse effects include GI complaints, fatigue, and hepatotoxicity. *Monitor ALT, AST and blood counts.

Inteferons Peginterferon alfa-2a (Pegasys) Antivirals Ribavirin (Copegus, Virazole, Rebetol, Ribasphere)

*Indicated for the treatment of Hepatitis C *Adverse effects include fatigue, headache, malaise, anorexia, diarrhea, suprainfections, thrombocytopenia, suicidal thoughts *Flulike symptoms likely after IV administration. *Increase fluids to 2500ml or more/day and monitor I&O.

Antiretrovirals (HIV Infection)


Common examples: Fusion and Integrase Inhibitors Raltegravir (Isentress) Maraviroc (Selzentry) Enfuvirtide (Fuzeon)

*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

Protease Inhibitors Saquinavir mesylate (Invirase) Nelfinavir (Viracept) Iopinavir/Ritonavir (Kaletra)

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) Zidovudine or AZT (Retrovir)

*Adverse effects include rash, malaise, GI complaints, bone marrow suppression, neutropenia, anemia, neurotoxicity.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Efavirenz (Sustiva) Delavidrine (Rescriptor)

**Adverse effects include rash, GI complaints, parasthesia, hepatotoxicity, Stevens-Johnson syndrome. *Monitor ALT and AST.

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