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Adverse effects of antimicrobials
hypersensitivity=anaphylaxis usually within 5-30 minutes
acute interstitial nephritis
hematuria, oliguria, proteinuria, pyuria
reversible monitor creatinine/BUN
pseudomembranous colitis
Pseudomembranous colitis
severe diarrhea with blood, pus, and mucus
swelling of the toungue and troat
What solutions are most antibiotics diluted wtih
D5 1/4NS
D5 1/2NS
Vancomycin is infused over ________ hours?
up to 2 hours
Beta Lactam

Penicillin G is used to treat?

DOC-streptococcoal pharyngitis
Prevent-Rheumatic fever, bacterial enocarditis
Given-PO,IM, IV
When given drugs IV, what should be done before administering?
check infusion rate


tube patency
Beta Lactam

Penicillin V
derivative of Penicillin G
Oral Form- penicillin-ase resistant penicillins
DOC- penicillin G resistant staphylococci

Naficillin- Nurse should remember ? when giving this drug IV?
very irritating to the vein
may be administered with bicarbonate
Non compatible with any other drug
could crystallize= STOP IV STAT
Infuse= over 1 hour
To appropriately manage clients receiving anti-infective drugs you must
1. treat the bug with the appropriate drug. 2.Cultures, when ordered, should be obtained prior to giving the initial dose of the anti-infective drug
To maximize the therapeutic effect anti-infectives, how should doses be scheduled?
1.Doses should be scheduled and given in evenly spaced intervals.
2.The full course of therapy should always be completed.
To minimize adverse effects of anti-infectives
1. adhere to the 6 rights of drug administration, the manufacturer's instructions, and appropriately educate the client and family
What are some drugs closely related to Tetracycline
1.semi synthetic broad spectrum antibiotics. the prototype.
3. related drugs=
Doxyclycline used to treat Lyme disease
Minocycline: used to treat carriers of Neisseria meningitis
Demeclocycline: used to treat tumors that secret anti diuretic hormone
Tetracycline is used to treat? How is it given? Contraindications
STDs, acne, uncomplicated infections caused by Chlamydia


contraindications: known allergy, pregnancy and lactation, children
Adverse effects of Tetracycline on the GI, immune, and neurologial.
GI: diarrhea, nausea, vomiting, damage to enamel
immune: super infection, bone marrow depression
neurological: photosensitivity
Tetracycline drug/drug interactions and food/drug interactions
Drug/drug interactions=Penicillin G, oral contraceptives

Food/drug interactions= food and dairy products
What can happen if a pregnant woman or child is taking tetracycline?
pregnant= brown the teeth and depress bone growth of unborn children

Children =staining the teeth
What is the infusion rate for tetracycline?
IVBP= 1-4 hours
Nursing actions to minimize adverse effects of tetracycline?
1.Administer 1 hour before or 2 hours after meals
2.Be sure that the client is adequately hydrated
3.Provide appropriate client education
4.advise client to avoid sunlight or to protect skin
5.instruct how to take drug, symptoms to report
6.advise client not to take with milk
instruct females to use alternative method of contraception while taking the drug
What antibiotics can cause birth control pills to be ineffective.

think taps!
What are some general guidelines when administering antibiotics
1.take on empty stomache or light snack
2.take with a full glass of water
3.if nausea is persistant DO NOT stop taking medication=call doctor

What is the prototype ?
Trimethoprim-Sulfamethoxasole- (Bactrim) is the prototype

Other drugs used to treat UTIs include closely related drugs to sulfonamide.
Sulfadiazine -UTI's rheumatic fever, meningitis, toxoplasmosis
Sulfasalazine(azulidine)=ulcerative colitis, rheumatoid arthritis
What should be assessed before administering a sulfa antibiotic?
If the client has an allergy to PCN
they will probable have an allergic reaction to sulfa drugs
First line drugs used to treat tuberculosis include
5. Streptomycin.
Prototype for antitubercular drugs
Indications for the use of anit-TB drugs
indications: prevention or treatment susceptible mycobacterium infections
route of administration for TB drugs?
PO, I.M., excreted in urine,feces, sputum, present in breast milk
contraindications for TB antibiotic drugs?
pregnancy precautions:
chronic liver disease
renal insufficiency
seizure disorders
adverse effects of Tb antibiotic drugs ?
hepatitis, elevated liver enzymes, peripheral neuropathy, encephalopathy, impaired memory, toxic psychosis, endocrine changes, GI disturbance, hematological alterations, integumentary alterations
Interventions to minimize adverse effects of TB antibiotic drugs
give with food for GI upset
monitor appropriate labs for adverse drug effects, if hepatitis develops drug should be stopped
client and family education should be ongoing
it is important to stress the need for compliance with long term therapy and follow- up medical care for the duration of therapy
What symptoms would indicate that a client who is taking Isoniazid is experiencing hepatic toxicity?
What can be given with TB drugs to minimize peripheral neuropathy?
Pyridoxine = Vitamin B6 25-50mg q/day
If a client is taking TB antibiotic drugs and is experiencing peripheral neuropathy, what is the client at risk for?
Risk for falls
A client who is taking Isoniazid should be instructed to avoid which substances?
Prototype drug for Macrolides
Used mainly to treat systemic bacterial infections.
Classes include:
clindamycin and lincomycin
Provide effective bactericidal activity against: aerobic gram-negative bacilli; some aerobic gram-positive bacteria; mycobacteria; and some protozoa.
Aminoglycosides currently in use include
amikacin sulfate
gentamycin sulfate-narrow range=peak&trought
kanamycin sulfate
neomycin sulfate=suppression of intestinal bacteria=PO
netilmicin sulfate
paromomycin sulfate
streptomycin sulfate=noncomplicance could be fatal
tobramycin sulfate
Given IM or IV; absorbed poorly from the GI tract.
Distributed widely; cross the placental barrier but not the blood-brain barrier.
Not metabolized; excreted primarily by the kidneys.
Act as a bactericidal agents by interrupting protein synthesis in the microorganism
Most useful in treating
serious nosocomial infections such as bacteremia, peritonitis, and pneumonia; UTIÂ’s caused by enteric bacilli; CNS and eye infections
Amnoglycosides Interactions with other drugs can cause?
neuromuscular reactions, ototoxicity, and kidney toxicity
Aminoglycosides: Gentamicin= When are
peak and trough drawn ?
peak=30-60 after drug is gives
trough= just before dose is given
Aminoglycosides= Gentamicin= What is the peak range and the trough range
<2 = trough
Why is a peak and trough drawn with gentimicin=aminoglycoside??
because it is highly nephrotoxic
FLUOROQUINOLONES are used to treat.
Used to treat UTIÂ’s
Fluoroquilolones; drugs in this class

How are they given???

Mostly given PO
What adverse effects are associated with beta-lactam drugs and how may they be prevented or minimized?
Hypersensitivity: ask client about allergies to PCN before administering.
Phlebitis at IV site and pain at IM sites: mix according to directions and observe the site frequently.
Superinfection: use only when the organism has been identified.
Nausea and vomiting: administer with a full glass of water.
Diarrhea, colitis, pseudomembranous colitis: discontinue use and switch to another class of drug.
Nephrotoxicity: observe for adequate urine output; blood, urea, nitrogen; and serum creatinine.
Neurotoxicity: observe for confusion and neuromuscular irritability; if present, discontinue drug.
Bleeding: observe for ecchymosis and petechiae.
How are penicillins and other beta-lactam drugs excreted?
They are rapidly excreted by the kidneys in urine. An exception to this is nafcillin, which is excreted by the liver.
When giving injections of penicillin in an outpatient setting, it is recommended to keep clients in the area and observe them for at least 30 minutes. Why?
This time allows you to observe for hypersensitivity or anaphylaxis.
What are the signs and symptoms of anaphylaxis?
Rash, hives, difficulty breathing, dizziness, drop in blood pressure, fainting, and respiratory distress all signal an anaphylactic reaction that may be life-threatening.
For clients with renal impairment, which drugs in this chapter require reduced doses?
Most of the drugs, except nafcillin, require reduced doses.
What anti bacterial drugs from this chapter may cause pseudomembranous (antibiotic-associated) colitis?
Ampicillin and cephalosporins may cause pseudomembranous colitis.
Which viral infections may be prevented by administration of antiviral drugs?
Influenza A may be prevented by administering after exposure. AIDS may be prevented from transference to the fetus in utero with antiviral treatment. Viral vaccines may prevent poliomyelitis, measles, rubella, mumps, smallpox, chicken pox, and yellow fever. Vaccines are also available for influenza and rabies.
What are the major adverse effects associated with commonly used antiviral drugs? How would you assess for each of these adverse effects?
Many of these drugs are metabolized by the liver. LFTs and assessment of skin and sclera for jaundice are necessary. These drugs are primarily excreted by the kidneys, and creatinine clearance needs to be monitored as well as I&O and complaints of flank pain. Bone marrow depression can occur with ganciclovir.
Why is it important to monitor renal function in any patient receiving a systemic antiviral drug?
These drugs are primarily excreted by the kidneys.
List nursing interventions to prevent or minimize adverse effects of anti-HIV drugs.
The client may need antiemetics for nausea and vomiting. Promote a high-protein and high-calorie diet with snacks. Monitor laboratory values of viral loads, CD4+ count, CBC, creatinine clearance, and LFTs. Maintain hydration through PO fluids or IV as necessary. Monitor respiratory effort and rate. Minimize exposure to opportunistic infections. Good hand washing is necessary.

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