Ppt chapter 41

Chapter 41
Drugs that Are Miscellaneous
Antibiotics
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
• Quinolones are effective for aerobic gram-negative and
gram-positive infections.
– A. True
– B. False

Answer
• A. True
• Rationale: Quinolones are effective for treating
aerobic gram-negative and gram-positive infections.

Quinolones/Fluoroquinolones
• Quinolones/Fluoroquinolones are effective for aerobic gram-negative
and gram-positive infections.
• Like cephalosporins, quinolones are subdivided into
generations.
– First-generation quinolones are used only to treat
uncomplicated urinary tract infections (UTIs).
– Second-generation fluoroquinolones have increased
gram-negative and systemic activity.
– Third-generation fluoroquinolones have extended
activity against gram-positive pathogens.
– Fourth-generation fluoroquinolones have extended
activity against Pseudomonas.
• Prototype drug: ciprofloxacin (Cipro)

Ciprofloxacin: Core Drug Knowledge
• Pharmacotherapeutics
– Active against aerobic gram-negative organisms
• Pharmacokinetics
– Administered: oral, parenteral, and topical.
Metabolism: liver. Excreted: urine and feces.
• Pharmacodynamics
– Inhibits deoxyribonucleic acid (DNA) gyrase, an
enzyme needed for bacterial DNA replication

Ciprofloxacin: Core Drug Knowledge
(cont.)
• Contraindications and precautions
– Allergy, pregnancy, and lactation
• Adverse effects
– Arthropathy, GI upset, headache, and restlessness
• Drug interactions
– Many potential drug–drug interactions due to
metabolism

Ciprofloxacin: Core Patient Variables
• Health status
– Assess for GI disease, renal or hepatic dysfunction.
• Life span and gender
– Assess pregnancy and lactation status.
• Lifestyle, diet, and habits
– Assess diet and caffeine use.
• Environment
– Assess the environment where the drug will be given.

Ciprofloxacin: Nursing Diagnoses and
Outcomes
• Diarrhea related to adverse drug effects
– Desired outcome: The patient will avoid
dehydration, maintain fluid intake, and contact the
prescriber if diarrhea persists.
• Imbalanced Nutrition: More or Less than Body
Requirements related to GI effects, alteration in taste,
and superinfections
– Desired outcome: The patient will maintain body
weight and contact the prescriber if persistent
adverse effects alter nutritional status.

Ciprofloxacin: Nursing Diagnoses and
Outcomes (cont.)
• Risk for Injury related to drug-induced dizziness,
confusion, and other CNS effects
– Desired outcome: The patient will remain free of
injury and contact the prescriber about persistent
CNS disturbances.
• Risk for Impaired Tissue Integrity related to drug-induced
photosensitivity
– Desired outcome: The patient will take measures to
protect his or her skin from prolonged sun exposure.

Ciprofloxacin: Planning and Interventions
• Maximizing therapeutic effects
– Coordinate the administration of drugs to decrease
potential drug–drug interactions.
• Minimizing adverse effects
– Institute safety measures to protect the patient if
CNS effects occur. For patients with adverse GI
effects, provide small, frequent meals as tolerated.

Ciprofloxacin: Teaching, Assessment, and
Evaluations
• Patient and family education
– It is important to explain that ciprofloxacin is
prescribed for a particular infection.
– It is important to instruct patients to complete the
full course of drug therapy, even when they feel
better.
• Ongoing assessment and evaluation
– Due to the possibility for overgrowth of candidal
organisms with ciprofloxacin therapy, monitor
patients closely during treatment.

Question
• The most clinically important adverse reaction is
– A. Photosensitivity
– B. Arthropathy
– C. Hepatotoxicity
– D. Neurotoxicity

Answer
• B. Arthropathy
• Rationale: The most clinically important adverse reaction
is arthropathy (joint disease).
• This often irreversible adverse reaction tends to occur in
children under 18 years of age.

Cyclic Lipopeptides
• Daptomycin (Cubicin) is the only drug in a new class of
antibiotics called cyclic lipopeptides.
• This class of antibiotics has a substantially different
mechanism of action than that of other antibiotic drugs.
• Another benefit of daptomycin is its ability to retain
potency against antibiotic-resistant gram-positive
bacteria.

Daptomycin: Core Drug Knowledge
• Pharmacotherapeutics
– Used to manage complicated skin infections
• Pharmacokinetics
– Administered: IV. T½: 9.4 hours. Excreted: kidneys.
• Pharmacodynamics
– Binds to the bacterial membrane and interferes with
the integrity of the cell wall

Daptomycin: Core Drug Knowledge (cont.)
• Contraindications and precautions
– Hypersensitivity
• Adverse effects
– Constipation, diarrhea, nausea, vomiting, and
injection site reactions
• Drug interactions
– No clinically important drug–drug interactions have
been identified.

Daptomycin: Patient Variables
• Health status
– Assess medical history for contraindications to the
drug.
• Life span and gender
– Pregnancy Category B drug
• Environment
– Used in hospital or home care environment

Daptomycin: Nursing Diagnoses and
Outcomes
• Acute Pain related to myopathy
– Desired outcome: The patient will contact the
health care provider should pain or tingling in the
extremities occur.
• Risk for Infection related to overgrowth of nonsusceptible
organisms
– Desired outcome: The patient will report signs of
superinfection to the prescriber.
• Fatigue related to metabolic and hematopoietic
alterations
– Desired outcome: The patient will immediately
report signs of fatigue to the health care provider.

Daptomycin: Nursing Diagnoses and
Outcomes (cont.)
• Imbalanced Nutrition: Less than Body Requirements,
related to drug-induced GI effects, such as nausea,
vomiting, diarrhea, or dyspepsia
– Desired outcome: The patient will maintain
consistent body weight and consult the prescriber
about persistent adverse effects that affect
nutritional status.
• Diarrhea related to drug therapy
– Desired outcome: The patient will avoid
dehydration, maintain fluid intake, and contact the
prescriber about persistent diarrhea.

Daptomycin: Planning and Interventions
• Maximizing therapeutic effects
– Before administration, visually inspect daptomycin
for particulate matter and discoloration.
– Administer daptomycin with 0.9% sodium chloride
injection or lactated Ringer’s solution.
• Minimizing adverse effects
– Evaluate the IV site before administering
daptomycin.

Daptomycin: Teaching, Assessment, and
Evaluations
• Patient and family education
– Explain the potential adverse effects and need for
periodic blood monitoring.
– Teach patients the importance of reporting diarrhea,
muscle pain or tingling, and fatigue.
– Advise patients to stop taking HMG-CoA reductase
inhibitors.
• Ongoing assessment and evaluation
– Evaluate for resolution of the presenting infection.

Question
• Daptomycin is used to treat
– A. Respiratory infections
– B. Osteomylitis
– C. Carditis
– D. Complicated skin infections

Answer
• D. Complicated skin infections
• Rationale: Daptomycin is used to manage
complicated skin and skin structure infections.

Ppt chapter 41

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