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Chapter 40 Fall 2012
Chapter 40 Fall 2012
Aminoglycosides
The aminoglycosides have been in use since 1944. Effective antibiotics for treating severe infections. General use is limited because of the potential for serious adverse effects which are : Ototoxicity and nephrotoxicity Prototype drug: gentamicin.
Drug interactions
Acyclovir, amphotericin B, cephalothin, cisplatin, cyclosporine, loop diuretics, and vancomycin
Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Gentamicin is effective against what organism(s)? A. Pseudomonas aeruginosa B. Proteus mirabilis C. Klebsiella D. Enterobacter E. All of the above
Rationale
Gentamicin is effective against what organism (s)? E. All of the above 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. Gentamicin must be transported across the cell membrane in order to enter the cell and disrupt protein synthesis. This process requires oxygen; therefore, gentamicin and other aminoglycosides are ineffective against anaerobes.
Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Pharmacodynamics
Enters the bacterial cell and binds to bacterial ribosomes, suppressing protein synthesis.
Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
hypersensitivity
renal or hepatic dysfunction Adverse effects
Pseudomembranous colitis{Black Box warning} maculopapular rash, erythema, and pruritus , nausea and vomiting
Drug interactions are numerous
Desired outcome: the patient will remain injury free throughout drug therapy.
Question
What is the most serious adverse reaction of clindamycin administration? A. Respiratory arrest
B. Pseudomembranous colitis
C. Ventricular tachycardia D. Ototoxicity
Answer : B
Macrolide Antibiotics
The macrolide antibiotics have been in use since 1952. They are characterized by molecules made up of largering lactones.
Drug is easily inactivated by gastric acid ( various formulations are available to prevent this)
Peak 14 hours ( orally) : 1 hour ( intravenously) Metabolized: liver. Excreted: urine & bile.
Allergy to medication
Adverse effects GI symptoms, urticaria, maculopapular rash, erythema, and interstitial nephritis
Avoid Grapefruit juice increases the serum concentration of erythromycin and may cause toxicity /side effects
Take medication 1 hr. before or 2 hrs. after a meal
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.
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.
Rationale
Grapefruit juice will decrease the serum concentration of erythromycin. A. True
B. False
Answer : B Instruct the patient to avoid grapefruit or grapefruit juice because it increases the serum concentration of erythromycin and may cause adverse effects or toxicity.
Contraindicated in pregnancy since it can cause bone marrow depression or gray baby syndrome in the neonate.
Environment Assess environment where drug will be given.