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Chapter 40 
Antibiotics Affecting Protein 
Synthesis 
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilki...
Physiology 
• In all cells, the process of protein synthesis is divided 
into two sections: transcription and translation....
Protein Synthesis 
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Aminoglycosides 
• The aminoglycosides have been in use since 1944. 
• They are extremely effective antibiotics for treati...
Gentamicin: Core Drug Knowledge 
• Pharmacotherapeutics 
– Serious infections 
• Pharmacokinetics 
– Distribution: through...
Gentamicin: Core Drug Knowledge (cont.) 
• Contraindications and precautions 
– Hypersensitivity, pregnancy and lactation ...
Gentamicin: Core Patient Variables 
• Health status 
– Past medical and any kidney problems 
• Life span and gender 
– Oto...
Gentamicin: Nursing Diagnoses and 
Outcomes 
• Risk for Injury related to potential drug-related allergic 
reactions or ne...
Gentamicin: Nursing Diagnoses and 
Outcomes (cont.) 
• Imbalanced Nutrition: Less than Body Requirements, 
related to drug...
Gentamicin: Nursing Diagnoses and 
Outcomes (cont.) 
• Disturbed Sensory Perception related to potential 
ototoxicity 
– D...
Gentamicin: Planning and Interventions 
• Maximizing therapeutic effects 
– Make sure that patients receive the full cours...
Gentamicin: Teaching, Assessment, and 
Evaluations 
• Patient and family education 
– Patients should not take the drug if...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Question 
• Gentamicin is effective against which ...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Answer 
• E. All of the above 
• Rationale: Gentam...
Lincosamides 
• They are very toxic drugs. 
• Their use must be monitored and limited to situations 
with infections by ba...
Clindamycin: Core Drug Knowledge 
• Pharmacotherapeutics 
– Aerobic gram-positive cocci and several anaerobic 
gram-negati...
Clindamycin: Core Drug Knowledge 
(cont.) 
• Contraindications and precautions 
– Hypersensitivity, pregnancy, and lactati...
Clindamycin: Core Patient Variables 
• Health status 
– Assess for allergy to medication. 
• Life span and gender 
– Asses...
Clindamycin: Nursing Diagnoses and 
Outcomes 
• Risk for Injury related to allergic reactions 
– Desired outcome: The pati...
Clindamycin: Nursing Diagnoses and 
Outcomes (cont.) 
• Imbalanced nutrition: Less than Body Requirements, 
related to dru...
Clindamycin: Planning and Interventions 
• Maximizing therapeutic effects 
– Make sure that the patient receives the full ...
Clindamycin: Teaching, Assessment, and 
Evaluations 
• Patient and family education 
– Advise patients to contact the pres...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Question 
• What is the most serious adverse react...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Answer 
• B. Pseudomembranous colitis 
• Rationale...
Macrolide Antibiotics 
• The macrolide antibiotics have been in use since 1952. 
• They are characterized by molecules mad...
Erythromycin: Core Drug Knowledge 
• Pharmacotherapeutics 
– Treating Legionnaire disease, Mycoplasma 
pneumoniae pneumoni...
Erythromycin: Core Drug Knowledge 
(cont.) 
• Contraindications and precautions 
– Allergy to medication 
• Adverse effect...
Erythromycin: Core Patient Variables 
• Health status 
– Assess medical history and allergies. 
• Life span and gender 
– ...
Erythromycin: Nursing Diagnoses and 
Outcomes 
• Risk for Injury related to possible allergic reactions 
– Desired outcome...
Erythromycin: Planning and Interventions 
• Maximizing therapeutic effects 
– Reconstitute erythromycin with sterile water...
Erythromycin: Teaching, Assessment, and 
Evaluations 
• Patient and family education 
– Encourage patients to take the com...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Question 
• Grapefruit juice will decrease the ser...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Answer 
• B. False 
• Rationale: Instruct the pati...
Oxazolidinones 
• Oxazolidinones are the first new class of antibiotics 
developed specifically for treating methicillin-r...
Linezolid: Core Drug Knowledge 
• Pharmacotherapeutics 
– Treatment of VRE and MRSA 
• Pharmacokinetics 
– Administered: o...
Linezolid: Core Drug Knowledge (cont.) 
• Contraindications and precautions 
– Hypersensitivity 
• Adverse effects 
– Diar...
Linezolid: Core Patient Variables 
• Health status 
– Assess medical history. 
• Life span and gender 
– Pregnancy Categor...
Linezolid: Nursing Diagnoses and 
Outcomes 
• Deficient Fluid Volume related to nausea, vomiting, and 
diarrhea from linez...
Linezolid: Nursing Diagnoses and 
Outcomes (cont.) 
• Risk for Injury related to hypertensive crisis 
– Desired outcome: T...
Linezolid: Planning and Interventions 
• Maximizing therapeutic effects 
– Administer at evenly spaced intervals. 
• Minim...
Linezolid: Teaching, Assessment, and 
Evaluations 
• Patient and family education 
– Explain dietary restrictions, focusin...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Question 
• Linezolid is classified as a Pregnancy...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Answer 
• C. C 
• Rationale: Linezolid is classifi...
Streptogramins 
• Streptogramins are the newest class of antibiotics. 
• Designed to eradicate “superbugs” resistant to ot...
Quinupristin/Dalfopristin: Core Drug 
Knowledge 
• Pharmacotherapeutics 
– Serious or life-threatening infections associat...
Quinupristin/Dalfopristin: Core Drug 
Knowledge (cont.) 
• Contraindications and precautions 
– Hypersensitivity 
• Advers...
Quinupristin/Dalfopristin: Core Patient 
Variables 
• Health status 
– Assess health history and contraindications to 
med...
Quinupristin/Dalfopristin: Nursing 
Diagnoses and Outcomes 
• Pain related to IV administration 
– Desired outcome: The pa...
Quinupristin/Dalfopristin: Nursing 
Diagnoses and Outcomes (cont.) 
• Risk for Injury related to potential superinfection ...
Quinupristin/Dalfopristin: Planning and 
Interventions 
• Maximizing therapeutic effects 
– The medication should not be a...
Quinupristin/Dalfopristin: Teaching, 
Assessment, and Evaluations 
• Patient and family education 
– Teach patients the po...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Question 
• Quinupristin/dalfopristin is best admi...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Answer 
• B. PICC line 
• Rationale: Because injec...
Tetracyclines 
• The tetracyclines were developed as semisynthetic 
antibiotics based on the structure of a common soil mo...
Tetracycline: Core Drug Knowledge 
• Pharmacotherapeutics 
– Rickettsia species, Mycoplasma pneumoniae, and 
Chlamydia tra...
Tetracycline: Core Drug Knowledge 
(cont.) 
• Contraindications and precautions 
– Allergy, pregnancy, or lactation 
• Adv...
Tetracycline: Core Patient Variables 
• Health status 
– Assess medical status. 
• Life span and gender 
– Pregnancy Categ...
Tetracycline: Nursing Diagnoses and 
Outcomes 
• Risk for Injury related to potential superinfection or 
allergic drug rea...
Tetracycline: Nursing Diagnoses and 
Outcomes (cont.) 
• Imbalanced nutrition: Less than Body Requirements, 
related to ad...
Tetracycline: Planning and Interventions 
• Maximizing therapeutic effects 
– To maximize absorption, oral preparations sh...
Tetracycline: Teaching, Assessment, and 
Evaluations 
• Patient and family education 
– Advise women of childbearing age t...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Question 
• Tetracycline should not be administere...
Answer 
• A. True 
• Rationale: Tetracycline forms an insoluble chelate with 
aluminum, bismuth, calcium, iron, magnesium,...
Miscellaneous Antibiotics that Affect 
Protein Synthesis 
• Miscellaneous antibiotics include chloramphenicol and 
spectin...
Chloramphenicol: Core Drug Knowledge 
• Pharmacotherapeutics 
– True broad-spectrum antibiotic 
• Pharmacokinetics 
– Admi...
Chloramphenicol: Core Drug Knowledge 
(cont.) 
• Contraindications and precautions 
– Toxic reaction to the medication 
• ...
Chloramphenicol: Core Patient Variables 
• Health status 
– Assess medical history. 
• Life span and gender 
– Assess preg...
Chloramphenicol: Nursing Diagnoses and 
Outcomes 
• Risk for Injury related to drug-induced adverse effects, 
such as bloo...
Chloramphenicol: Planning and 
Interventions 
• Maximizing therapeutic effects 
– Oral chloramphenicol should be administe...
Chloramphenicol: Teaching, Assessment, 
and Evaluations 
• Patient and family education 
– Explain the importance of compl...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Question 
• A serious and potentially life-threate...
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 
Answer 
• A. True 
• Rationale: “Gray baby” syndro...
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  1. 1. Chapter 40 Antibiotics Affecting Protein Synthesis Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  2. 2. Physiology • In all cells, the process of protein synthesis is divided into two sections: transcription and translation. • Initially, transcription occurs within the nucleus, producing messenger ribonucleic acid (mRNA). • This mRNA migrates from the nucleus to the cytoplasm. During this step, mRNA goes through different types of maturation, including one called splicing, during which the noncoding sequences are eliminated. • Translation occurs in the cytoplasm. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  3. 3. Protein Synthesis Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  4. 4. Aminoglycosides • The aminoglycosides have been in use since 1944. • They are extremely effective antibiotics for treating severe infections. • However, their general use is limited because of the potential for serious adverse effects. • Prototype drug: gentamicin Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  5. 5. Gentamicin: Core Drug Knowledge • Pharmacotherapeutics – Serious infections • Pharmacokinetics – Distribution: throughout the body except CS; higher concentration in kidneys than serum • Pharmacodynamics – Entering the bacterial cell and binding to the 30S ribosomal subunit Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  6. 6. Gentamicin: Core Drug Knowledge (cont.) • Contraindications and precautions – Hypersensitivity, pregnancy and lactation • Adverse effects – Neurotoxicity, nephrotoxicity, ototoxicity, and neuromuscular blockade • Drug interactions – Acyclovir, amphotericin B, cephalothin, cisplatin, cyclosporine, loop diuretics, prostaglandin synthetase inhibitors, and vancomycin Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  7. 7. Gentamicin: Core Patient Variables • Health status – Past medical and any kidney problems • Life span and gender – Ototoxic to the fetus, assess pregnancy status. • Lifestyle, diet, and habits – Assess the nutritional status of the patient. • Environment – Assess the environment where the drug will be Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins given.
  8. 8. Gentamicin: Nursing Diagnoses and Outcomes • Risk for Injury related to potential drug-related allergic reactions or neuromuscular blockade or suppression of bone marrow function – Desired outcome: The patient will remain free of injury and will contact the prescriber if unusual adverse effects occur. • Diarrhea related to drug effects – Desired outcome: The patient will avoid dehydration, maintain fluid intake, and contact the prescriber if diarrhea persists. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  9. 9. Gentamicin: Nursing Diagnoses and Outcomes (cont.) • Imbalanced Nutrition: Less than Body Requirements, related to drug-induced GI effects or superinfection – Desired outcome: The patient will maintain body weight and report any persistent adverse effect. • Risk for Injury related to CNS effects – Desired outcome: The patient will remain free of injury and contact the provider if confusion, disorientation, or depression occurs. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  10. 10. Gentamicin: Nursing Diagnoses and Outcomes (cont.) • Disturbed Sensory Perception related to potential ototoxicity – Desired outcome: The patient will report sensory or perceptual changes to the prescriber. • Excess Fluid Volume related to potential nephrotoxicity – Desired outcome: The patient will report any weight gain exceeding 3 lb to the health care prescriber. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  11. 11. Gentamicin: Planning and Interventions • Maximizing therapeutic effects – Make sure that patients receive the full course as prescribed at around-the-clock intervals. – Do not give at the same time as extended penicillin. • Minimizing adverse effects – Maintain blood levels of gentamicin within a therapeutic margin that is very narrow. – Monitor for signs of ototoxicity and nephrotoxicity. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  12. 12. Gentamicin: Teaching, Assessment, and Evaluations • Patient and family education – Patients should not take the drug if pregnant or breast-feeding. – Teach patients how to identify, report, and manage signs and symptoms of allergic reaction and adverse effects. • Ongoing assessment and evaluation – Coordinate the care of the patient to ensure that other potentially nephrotoxic or ototoxic drugs are not added to the treatment plan. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  13. 13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Gentamicin is effective against which of the following organism(s)? – A. Pseudomonas aeruginosa – B. Proteus mirabilis – C. Klebsiella – D. Enterobacter – E. All of the above
  14. 14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • E. All of the above • Rationale: Gentamicin is effective in managing infections caused by gram-negative bacilli. • Susceptible organisms include Pseudomonas aeruginosa, Proteus mirabilis, Escherichia coli; Klebsiella, Enterobacter, Serratia, and Citrobacter species; and staphylococci.
  15. 15. Lincosamides • They are very toxic drugs. • Their use must be monitored and limited to situations with infections by bacteria with known sensitivity. • Prototype drug: clindamycin (Cleocin) Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  16. 16. Clindamycin: Core Drug Knowledge • Pharmacotherapeutics – Aerobic gram-positive cocci and several anaerobic gram-negative and gram-positive organisms • Pharmacokinetics – Varies with route of administration. Metabolized: liver. Excreted: bile and urine. • Pharmacodynamics – Enters the bacterial cell and binds to bacterial ribosomes, suppressing protein synthesis Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  17. 17. Clindamycin: Core Drug Knowledge (cont.) • Contraindications and precautions – Hypersensitivity, pregnancy, and lactation • Adverse effects – Pseudomembranous colitis, maculopapular rash, erythema, and pruritus • Drug interactions – Neuromuscular blockers, aluminum salts, cyclosporine, benzoyl peroxide, tretinoin, and salicylic acid Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  18. 18. Clindamycin: Core Patient Variables • Health status – Assess for allergy to medication. • Life span and gender – Assess the growth and developmental level of the child or infant. • Lifestyle, diet, and habits – Assess lifestyle to ensure that the drug will be given Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins properly. • Environment – Assess the environment where the drug will be given.
  19. 19. Clindamycin: Nursing Diagnoses and Outcomes • Risk for Injury related to allergic reactions – Desired outcome: The patient will stop drug therapy and immediately report symptoms of allergic reaction to the prescriber. • Diarrhea related to drug effects – Desired outcome: The patient will avoid dehydration and report persistent diarrhea to the provider. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  20. 20. Clindamycin: Nursing Diagnoses and Outcomes (cont.) • Imbalanced nutrition: Less than Body Requirements, related to drug-related GI effects, alteration in taste, superinfections – Desired outcome: The patient will maintain body weight and report persistent symptoms affecting nutritional status. • Risk for Injury related to possible blood dyscrasias – Desired outcome: The patient will remain injury-free throughout drug therapy. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  21. 21. Clindamycin: Planning and Interventions • Maximizing therapeutic effects – Make sure that the patient receives the full course of clindamycin as prescribed. – Coordinate the administration of drugs to decrease potential undesired interactions. • Minimizing adverse effects – Clindamycin should be administered on an empty stomach with a full glass of water. – Report diarrhea to the provider immediately. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  22. 22. Clindamycin: Teaching, Assessment, and Evaluations • Patient and family education – Advise patients to contact the prescriber immediately if they experience diarrhea. – Teach patients to recognize and report symptoms of allergic reaction and superinfection. • Ongoing assessment and evaluation – Monitor the patient for the onset of diarrhea. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  23. 23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • What is the most serious adverse reaction of clindamycin administration? – A. Respiratory arrest – B. Pseudomembranous colitis – C. Ventricular tachycardia – D. Ototoxicity
  24. 24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • B. Pseudomembranous colitis • Rationale: Pseudomembranous colitis is the most serious side effect of clindamycin and carries a Black Box warning because of this side effect.
  25. 25. Macrolide Antibiotics • The macrolide antibiotics have been in use since 1952. • They are characterized by molecules made up of large-ring lactones. • Macrolides are bacteriostatic or bactericidal in susceptible bacteria. • Prototype drug: erythromycin Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  26. 26. Erythromycin: Core Drug Knowledge • Pharmacotherapeutics – Treating Legionnaire disease, Mycoplasma pneumoniae pneumonia, diphtheria, chlamydial infections, and chancroid • Pharmacokinetics – The drug is easily inactivated by gastric acid. Peak 1 to 4 hours. Metabolized: liver. Excreted: urine and bile. • Pharmacodynamics – Inhibiting RNA-dependent protein synthesis at the chain elongation step Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  27. 27. Erythromycin: Core Drug Knowledge (cont.) • Contraindications and precautions – Allergy to medication • Adverse effects – GI symptoms, urticaria, maculopapular rash, erythema, and interstitial nephritis • Drug interactions – Astemizole and terfenadine Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  28. 28. Erythromycin: Core Patient Variables • Health status – Assess medical history and allergies. • Life span and gender – Assess pregnancy and lactation status. • Lifestyle, diet, and habits – Instruct how to take the medication to avoid toxicity. • Environment – Assess the environment where the drug will be given. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  29. 29. Erythromycin: Nursing Diagnoses and Outcomes • Risk for Injury related to possible allergic reactions – Desired outcome: The patient will stop drug therapy and report any signs of allergic reaction immediately to the prescriber. • Diarrhea related to drug-induced GI upset – Desired outcome: The patient will avoid dehydration, maintain fluid intake, and contact the prescriber if diarrhea persists. • Risk for Infection related to potential for superinfection following drug therapy – Desired outcome: The patient will contact the provider if any signs of superinfection occur, for example, sore throat or fever. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  30. 30. Erythromycin: Planning and Interventions • Maximizing therapeutic effects – Reconstitute erythromycin with sterile water only. – Prepared infusion solutions that are stored at room temperature must be used within 8 hours. • Minimizing adverse effects – Because erythromycin can be very irritating to veins, it is important to administer IV infusions over 30 to 60 minutes. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  31. 31. Erythromycin: Teaching, Assessment, and Evaluations • Patient and family education – Encourage patients to take the complete course of antibiotics. – Advise patients to take erythromycin on an empty stomach, unless GI distress is unbearable. • Ongoing assessment and evaluation – Monitor for signs of allergic reactions, resolution of presenting signs and symptoms of infection, and signs of superinfection. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  32. 32. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Grapefruit juice will decrease the serum concentration of erythromycin. – A. True – B. False
  33. 33. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • B. False • Rationale: Instruct the patient to avoid grapefruit or grapefruit juice because it increases the serum concentration of erythromycin and may cause adverse effects or toxicity.
  34. 34. Oxazolidinones • Oxazolidinones are the first new class of antibiotics developed specifically for treating methicillin-resistant Staphylococcus aureus (MRSA) infections. • Prototype drug: linezolid (Zyvox) Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  35. 35. Linezolid: Core Drug Knowledge • Pharmacotherapeutics – Treatment of VRE and MRSA • Pharmacokinetics – Administered: oral or IV. Metabolism: liver. Excreted: Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins kidneys. • Pharmacodynamics – Blocking the early stages of the process bacteria use to make proteins
  36. 36. Linezolid: Core Drug Knowledge (cont.) • Contraindications and precautions – Hypersensitivity • Adverse effects – Diarrhea, headache, nausea, and vomiting • Drug interactions – Adrenergic and serotonergic agents Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  37. 37. Linezolid: Core Patient Variables • Health status – Assess medical history. • Life span and gender – Pregnancy Category C drug • Lifestyle, diet, and habits – Evaluate diet and alcohol use. • Environment – Assess the environment where the drug will be given. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  38. 38. Linezolid: Nursing Diagnoses and Outcomes • Deficient Fluid Volume related to nausea, vomiting, and diarrhea from linezolid therapy – Desired outcome: The patient will remain well hydrated throughout therapy. • Risk for Injury related to thrombocytopenia and pseudomembranous colitis – Desired outcome: The patient will remain free from injury and contact the health care provider immediately if any signs of bleeding or abdominal pain occur. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  39. 39. Linezolid: Nursing Diagnoses and Outcomes (cont.) • Risk for Injury related to hypertensive crisis – Desired outcome: The patient will remain normotensive by adhering to antihypertensive therapy and limiting foods or beverages with tyramine, caffeine, or alcohol. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  40. 40. Linezolid: Planning and Interventions • Maximizing therapeutic effects – Administer at evenly spaced intervals. • Minimizing adverse effects – To avoid hypertensive crisis, monitor the patient’s intake of food or beverages containing tyramine, caffeine, or alcohol. – Serial blood pressure readings should be obtained throughout therapy. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  41. 41. Linezolid: Teaching, Assessment, and Evaluations • Patient and family education – Explain dietary restrictions, focusing on food or beverages containing tyramine, caffeine, or alcohol. – Teach patients the signs and symptoms of thrombocytopenia and pseudomembranous colitis. • Ongoing assessment and evaluation – Monitor for efficacy of treatment and resolution of the presenting infection. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  42. 42. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Linezolid is classified as a Pregnancy Category ___ drug. – A. A – B. B – C. C – D. D – E. X
  43. 43. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • C. C • Rationale: Linezolid is classified as a pregnancy category C drug.
  44. 44. Streptogramins • Streptogramins are the newest class of antibiotics. • Designed to eradicate “superbugs” resistant to other antibiotics. • Prototype drug: quinupristin/dalfopristin (Synercid) Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  45. 45. Quinupristin/Dalfopristin: Core Drug Knowledge • Pharmacotherapeutics – Serious or life-threatening infections associated with Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins VRE • Pharmacokinetics – Administered: IV. T½: 1 hour. • Pharmacodynamics – Inhibits bacterial protein synthesis by irreversibly blocking ribosome functioning
  46. 46. Quinupristin/Dalfopristin: Core Drug Knowledge (cont.) • Contraindications and precautions – Hypersensitivity • Adverse effects – Pseudomembranous colitis, superinfection, and hepatotoxicity • Drug interactions – Drugs that are metabolized by CYP3A4, a cytochrome Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins of P-450
  47. 47. Quinupristin/Dalfopristin: Core Patient Variables • Health status – Assess health history and contraindications to medication use. • Life span and gender – Pregnancy Category B drug • Environment – Assess the environment where the drug will be given. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  48. 48. Quinupristin/Dalfopristin: Nursing Diagnoses and Outcomes • Pain related to IV administration – Desired outcome: The patient will inform you immediately should pain at the injection site occur. • Diarrhea related to potential pseudomembranous colitis – Desired outcome: The patient will remain well hydrated throughout therapy and report any diarrhea immediately. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  49. 49. Quinupristin/Dalfopristin: Nursing Diagnoses and Outcomes (cont.) • Risk for Injury related to potential superinfection or hepatotoxicity – Desired outcome: The patient will remain free of injury throughout therapy. • Risk for Impaired Skin Integrity related to rash or pruritus. – Desired outcome: The patient will report itching or rash immediately to minimize potential for infection. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  50. 50. Quinupristin/Dalfopristin: Planning and Interventions • Maximizing therapeutic effects – The medication should not be administered with any other medications through a Y-site infusion. – Flush the line before and after administration with 5% dextrose and water. • Minimizing adverse effects – Administer these drugs in a peripherally inserted central catheter (PICC) or a central line whenever possible. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  51. 51. Quinupristin/Dalfopristin: Teaching, Assessment, and Evaluations • Patient and family education – Teach patients the potential adverse effects. – Advise patients to report any diarrhea immediately. • Ongoing assessment and evaluation – During infusion, monitor the IV site for signs of infiltration, edema, or phlebitis. – Question the patient regarding pain at the injection Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins site.
  52. 52. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Quinupristin/dalfopristin is best administrated via – A. Oral route – B. PICC line – C. Peripheral IV – D. Z-track IM
  53. 53. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • B. PICC line • Rationale: Because injection site problems are very common with the administration of quinupristin/dalfopristin, administer these drugs in a peripherally inserted central catheter (PICC) line whenever possible.
  54. 54. Tetracyclines • The tetracyclines were developed as semisynthetic antibiotics based on the structure of a common soil mold. • They are broad-spectrum antibiotics that affect both gram-positive and gram-negative bacteria. • Over the years, major resistance has developed to tetracyclines. • Prototype drug: tetracycline Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  55. 55. Tetracycline: Core Drug Knowledge • Pharmacotherapeutics – Rickettsia species, Mycoplasma pneumoniae, and Chlamydia trachomatis • Pharmacokinetics – Administered: oral. Excreted: kidneys. • Pharmacodynamics – Inhibits or retards the growth of bacteria but does not kill them Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  56. 56. Tetracycline: Core Drug Knowledge (cont.) • Contraindications and precautions – Allergy, pregnancy, or lactation • Adverse effects – GI upset, photosensitivity, and rash • Drug interactions – Penicillin G, aluminum, bismuth, calcium, iron, magnesium, and zinc salts Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  57. 57. Tetracycline: Core Patient Variables • Health status – Assess medical status. • Life span and gender – Pregnancy Category D drug • Lifestyle, diet, and habits – Assess dietary intake. • Environment – Assess for exposure to sun. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  58. 58. Tetracycline: Nursing Diagnoses and Outcomes • Risk for Injury related to potential superinfection or allergic drug reaction – Desired outcome: The patient will experience no new infection and no preventable allergic reaction related to tetracycline. • Diarrhea related to drug-induced GI effects – Desired outcome: The patient will report any incidence of diarrhea and follow the prescriber’s recommendation. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  59. 59. Tetracycline: Nursing Diagnoses and Outcomes (cont.) • Imbalanced nutrition: Less than Body Requirements, related to adverse GI effects of nausea, vomiting, diarrhea, and altered taste – Desired outcome: The patient will maintain dietary intake to provide adequate nutrition. • Risk for Impaired Skin Integrity related to drug-induced photosensitivity – Desired outcome: The patient will dress appropriately and take adequate precautionary measures while outdoors to avoid unnecessary sunburn. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  60. 60. Tetracycline: Planning and Interventions • Maximizing therapeutic effects – To maximize absorption, oral preparations should be administered on an empty stomach either 1 hour before or 2 hours after any meals or other drugs. • Minimizing adverse effects – Monitor the patient to ensure that adequate fluids are given to replace fluid lost with diarrhea. – Wear protective clothing and sunscreen when outdoors. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  61. 61. Tetracycline: Teaching, Assessment, and Evaluations • Patient and family education – Advise women of childbearing age that tetracycline should not be taken during pregnancy or breast-feeding. – Advise patients to take tetracycline on an empty stomach. • Ongoing assessment and evaluation – Monitor renal status to detect and prevent hepatotoxicity and to observe for any signs of superinfection. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  62. 62. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Tetracycline should not be administered with antacids. – A. True – B. False
  63. 63. Answer • A. True • Rationale: Tetracycline forms an insoluble chelate with aluminum, bismuth, calcium, iron, magnesium, and zinc salts, which are frequently an ingredient in antacids. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  64. 64. Miscellaneous Antibiotics that Affect Protein Synthesis • Miscellaneous antibiotics include chloramphenicol and spectinomycin. • Used to treat large outbreaks of typhus • Prototype: chloramphenicol Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  65. 65. Chloramphenicol: Core Drug Knowledge • Pharmacotherapeutics – True broad-spectrum antibiotic • Pharmacokinetics – Administered: oral and IV. Peak 1 to 3 hours. • Pharmacodynamics – Inhibiting the protein synthesis of bacterial cells Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  66. 66. Chloramphenicol: Core Drug Knowledge (cont.) • Contraindications and precautions – Toxic reaction to the medication • Adverse effects – Aplastic anemia, hypoplastic anemia, thrombocytopenia, pancytopenia, and granulocytopenia • Drug interactions – Many different types of drugs Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  67. 67. Chloramphenicol: Core Patient Variables • Health status – Assess medical history. • Life span and gender – Assess pregnancy status. • Environment – Assess the environment where the drug will be given. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  68. 68. Chloramphenicol: Nursing Diagnoses and Outcomes • Risk for Injury related to drug-induced adverse effects, such as blood dyscrasias, gray baby syndrome, and CNS effects, including optic or peripheral neuritis, headache, depression, confusion, or delirium – Desired outcome: Regular and careful monitoring will protect the patient from permanent drug-related adverse effects. • Risk for Impaired Skin Integrity, rash and pruritus, related to topical drug use – Desired outcome: The nurse and patient will observe for and report signs of unusual skin reaction and contact the prescriber. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  69. 69. Chloramphenicol: Planning and Interventions • Maximizing therapeutic effects – Oral chloramphenicol should be administered on an empty stomach 1 hour before or 2 hours after meals. • Minimizing adverse effects – Monitor plasma concentrations at least weekly or more often in patients with hepatic or renal impairment. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  70. 70. Chloramphenicol: Teaching, Assessment, and Evaluations • Patient and family education – Explain the importance of completing therapy. – Teach patients the importance of measuring fluid intake and output accurately. • Ongoing assessment and evaluation – For patients receiving systemic therapy, coordinate serial monitoring of chloramphenicol plasma concentrations. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
  71. 71. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • A serious and potentially life-threatening adverse effect of chloramphenicol is “gray baby” syndrome. – A. True – B. False
  72. 72. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer • A. True • Rationale: “Gray baby” syndrome is most common in premature infants or newborns receiving chloramphenicol, whose hepatic systems have difficulty conjugating or excreting chloramphenicol.

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