Ppt chapter010

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction to Clinical Pharmacology

Chapter 10-Fluoroquinolones and

Miscellaneous Anti-Infectives


Introduction to AntibioticsIntroduction to Antibiotics

• As antibiotics became resistant to various microorganisms:

– Two broad-spectrum antibiotics were developed:

•Fluoroquinolones

•Aminoglycosides


FluoroquinolonesFluoroquinolones

• ciprofloxacin (Cipro)

• gatifloxacin (Tequin)

• lomefloxacin (Maxaquin)

• moxifloxacin (Avelox)

• ofloxacin (Floxin)


Fluoroquinolones: ActionsFluoroquinolones: Actions

• Bactericidal effect:

– Interferes with the synthesis of Bacterial DNA

•Prevents cell reproduction leading to death of the bacteria


Fluoroquinolones: UsesFluoroquinolones: Uses• Used to treat infections caused by gram

positive and gram negative microorganisms

• Used for the treatment of:

– Lower respiratory infections

– Bone and joint infections

– Urinary tract infections and infections of the skin

– Sexually transmitted diseases


Fluoroquinolones: Adverse ReactionsFluoroquinolones: Adverse Reactions

• Common adverse effects:

– Nausea; diarrhea; headache; abdominal pain or discomfort; dizziness

• Serious adverse effects:

– Photosensitivity and hypersensitivity

– Bacterial or fungal superinfections

– Pseudomembranous colitis


Fluoroquinolones: Contraindications and PrecautionsFluoroquinolones: Contraindications and Precautions• Contraindicated in patients:

– With a history of hypersensitivity; children younger than 18 years; during pregnancy; who cannot follow precautions regarding photosensitivity

• Used cautiously in patients:

– With renal impairment; history of seizures; geriatric patients; patients on dialysis


Fluoroquinolones: InteractionsFluoroquinolones: Interactions

Interactant drug Effect of interaction

Theophylline Increased serum level

Cimetidine (Tagamet) Hampers elimination of antibiotic

Oral anticoagulants Increased risk of bleeding

Antacids, iron salts, or zinc

Decreased antibiotic absorption

NSAIDs Risk of seizure


Misc. Drugs Inhibiting Cell Wall Synthesis: ActionsMisc. Drugs Inhibiting Cell Wall Synthesis: Actions

• Carbapenems-inhibits synthesis of the bacterial cell wall

• Vancomycin-inhibits bacterial cell wall synthesis and increases cell wall permeability.

• Monobactam-inhibits bacterial cell wall synthesis.


Misc. Drugs Inhibiting Cell Wall Synthesis: UsesMisc. Drugs Inhibiting Cell Wall Synthesis: Uses• Meropenem-intra-abdominal infections and

bacterial meningitis

• Imipenem-cilastatin serious infections, endocarditis, and septicemia.

• Doripenem-complicated urinary tract infections caused by bacteria.

• Vancomycin-gram-positive infections and infective–associated pseudomembranous colitis caused by Clostridium difficile

• Monobactams-gram-negative microorganisms


Linezolid: Actions and UsesLinezolid: Actions and Uses

• Bacteriostatic and bactericidal

• Used in the treatment of:

– Vancomycin-resistant enterococcus (VRE)

– Health care and community-acquired pneumonias

– Skin and skin structure infections


Linezolid: Adverse ReactionsLinezolid: Adverse Reactions

• Common adverse effects: Nausea; vomiting; diarrhea; headache and dizziness; insomnia; rash

• Less common adverse effects: Fatigue; depression; nervousness; photosensitivity

• Serious adverse effects: Pseudomembranous colitis; Thrombocytopenia


Linezolid: Contraindications and PrecautionsLinezolid: Contraindications and Precautions

• Contraindicated in patients:

– Who are allergic to the drug; pregnant (Pregnancy Category C) or lactating; with phenylketonuria

• Used cautiously in patients:

– With bone marrow depression; hepatic dysfunction; renal impairment; hypertension; hyperthyroidism


Linezolid: InteractionsLinezolid: Interactions

Interactant drug Effect of interaction

Antiplatelet drugs Increased risk of bleeding and thrombocytopenia

MAOIs antidepressants Decreased effectiveness

Large amounts of food containing tyramine

Risk of severe hypertension


Carbapenems: Action and UsesCarbapenems: Action and Uses

• Inhibit synthesis of the bacterial cell wall and cause the death of susceptible cells

• Meropenem: Used for intra-abdominal infections; bacterial meningitis

• Imipenem-cilastatin: Used to treat serious infections; endocarditis; septicemia

• Ertapenem: Used to treat serious infections; bacterial community-aquired pneumonia


Carbapenems: Adverse ReactionsCarbapenems: Adverse Reactions

• Common adverse reactions:

– Nausea

– Vomiting

– Diarrhea

– Rash

– Abscess, tissue sloughing, or phlebitis at the injection site


Carbapenems: Contraindications, Precautions, and InteractionsCarbapenems: Contraindications, Precautions, and Interactions• Contraindicated in patients: Who are allergic

to cephalosporins and penicillins; with renal failure; children younger than 3 years; pregnant/lactating women

• Used cautiously in patients: With CNS disorders; seizure disorders; renal or hepatic failure

• Excretion of carbapenems: Inhibited with probenecid


Spectinomycin: Action and UsesSpectinomycin: Action and Uses

• Exerts action by interfering with bacterial protein synthesis

• Used for treating gonorrhea in patients who are allergic to penicillins; cephalosporins; or probenecid


Spectinomycin: Adverse ReactionsSpectinomycin: Adverse Reactions


– Soreness at the injection site

– Urticaria

– Dizziness

– Rash

– Chills, fever, and hypersensitivity reactions


Spectinomycin: Contraindications, Precautions, and InteractionsSpectinomycin: Contraindications, Precautions, and Interactions

• Contraindicated in patients: With known hypersensitivity to the drug

• No known safe use with pregnant/lactating women and infants/children

• Interaction: No significant drug or food interactions are known


Aztreonam: Action, Uses, and Adverse ReactionsAztreonam: Action, Uses, and Adverse Reactions

• Monobactam - has bactericidal action


– Gram-negative microorganisms

• Adverse reactions:

– Nausea; vomiting; diarrhea; hypotension; rash; headache; pseudomembranous colitis


Aztreonam: Contraindications, Precautions, and InteractionsAztreonam: Contraindications, Precautions, and Interactions• Contraindicated in patients: With known

hypersensitivity to the drug; during pregnancy and lactation

• Used cautiously in patients: With renal or hepatic impairment

• Interaction:

– Patient’s sensitive to penicillins, cephalosporins, or carbapenem: Cross-sensitivity


Daptomycin: Action, Uses, and Adverse ReactionsDaptomycin: Action, Uses, and Adverse Reactions

• Cyclic lipopeptides


– Complicated skin and skin-structure bacterial infections


– Nausea; vomiting; diarrhea; hypotension; rash; headache; pseudomembranous colitis


Daptomycin: Contraindications, Precautions, and InteractionsDaptomycin: Contraindications, Precautions, and Interactions• Contraindicated in patients: With known

hypersensitivity to the drug; during pregnancy and lactation

• Used cautiously in patients: Taking warfarin (Coumadin)


Vancomycin: Action and UsesVancomycin: Action and Uses• Inhibits bacterial cell wall synthesis and

increases cell wall permeability - acts against susceptible gram-positive bacteria


– Serious gram-positive infections that do not respond to treatment with other anti-infectives

– Anti-infective–associated pseudomembranous colitis caused by Clostridium difficile


Vancomycin: Adverse ReactionsVancomycin: Adverse Reactions


– Nephrotoxicity

– Ototoxicity

• Other adverse reactions:

– Nausea; chills; fever; urticaria; sudden fall in blood pressure with parenteral administration; skin rashes


Vancomycin: Contraindications, Precautions, and InteractionsVancomycin: Contraindications, Precautions, and Interactions• Contraindicated in patients: With known

hypersensitivity to the drug

• Used cautiously in patients: With renal or hearing impairment; during pregnancy and lactation

• Interaction:

– Other ototoxic and nephrotoxic drugs: Additive effects may occur


Quinupristin/Dalfopristin: Action, Uses, and Adverse ReactionsQuinupristin/Dalfopristin: Action, Uses, and Adverse Reactions• Bacteriostatic agent


– Vancomycin-resistant Enterococcus faecium (VREF)


– Irritation in the vein; incompatibility with saline or heparin flush solutions; nausea, vomiting, and diarrhea


Quinupristin/Dalfopristin: Contraindications, Precautions, and InteractionsQuinupristin/Dalfopristin: Contraindications, Precautions, and Interactions

• Contraindicated in patients: With known hypersensitivity to the drug; during pregnancy and lactation

• Interaction:

– Serum levels of the following drugs may increase: Antiretrovirals; antineoplastic and immunosuppressants; calcium channel blockers; benzodiazepines; cisapride


Nursing Process: AssessmentNursing Process: Assessment• Preadministration assessment:

– Take and record vital signs and identify symptoms and history of drug allergies

– Primary health care provider may order:

•Culture and sensitivity – To be done before first dose of the drug is given

•Renal and hepatic function tests; CBC; urinalysis


Nursing Process: Assessment (cont’d)Nursing Process: Assessment (cont’d)

• Ongoing assessment:

– Monitor patient’s vital signs and for any adverse reactions during the first 48 hours

•Notify any adverse reaction to the primary health care provider before the next dose of the drug is due


Nursing Process: Nursing DiagnosisNursing Process: Nursing Diagnosis• Anxiety

• Risk for impaired comfort

• Risk for impaired skin integrity and injury

• Acute pain

• Diarrhea

• Risk for impaired urinary elimination

• Disturbed sensory perception: Auditory


Nursing Process: PlanningNursing Process: Planning

• The expected outcome includes an optimal response to therapy based on the reason for administration of the anti-infective:

– Management of adverse drug reactions

– Decrease in anxiety

– Understanding of and compliance with the prescribed treatment regimen


Nursing Process: ImplementationNursing Process: Implementation• Promoting an optimal response therapy:

– Observe patients for adverse reactions: Notify primary health care provider

– Intramuscular administration: Monitor, record and develop a plan for rotating injection sites

– Intravenous administration: Monitor needle site; check rate of infusion; inspect the vein


Nursing Process: ImplementationNursing Process: Implementation

• Promoting an optimal response therapy (cont’d):

– Nursing Alert: IV dose of vancomycin

•Administer over 60 minutes; closely monitor the infusion rate and the patient’s blood pressure

•Report patient’s complaints of difficulty hearing or tinnitus

•Monitor the fluid intake and output



• Monitoring and managing patient’s need:

– Anxiety

•Reassure the patient that every effort will be made to reduce pain and discomfort although complete pain relief may not always be possible


Nursing Process: ImplementationNursing Process: Implementation• Monitoring and managing patient’s need

(cont’d):

– Diarrhea

•Check and record the color and consistency of each stool

– Acute pain at injection site

•Inform the patient about discomfort

•Use proper flush solution


Nursing Process: ImplementationNursing Process: Implementation• Monitoring and managing patient’s need

(cont’d):

– Impaired urinary elimination

•Monitor for nephrotoxicity; record intake and output and appearance of the urine

– Disturbed sensory perception: Auditory

•Monitor for ototoxicity; report any ringing in the ears, difficulty hearing, or dizziness



• Educating the patient and family

– Explain the importance of taking the drug at prescribed time intervals and as directed

– Advise about the importance of completing the entire course of treatment

– Explain the necessity of contacting the primary health care provider immediately if symptoms occur



• Promoting an optimal response therapy (cont’d):

– Patients receiving:

•Antacid: Administer ciprofloxacin and moxifloxacin 2-4 hours before or 6-8 hours after the antacid

•intramuscular (IM) and intervenes (IV) anti-invectives: observe injection sites for tenderness, redness, swelling and infection



• Monitoring and managing patient’s need:

– Anxiety

•Assure patient will be made comfortable

– Impaired comfort: Increased fever

•Monitor body temperature; check vital signs every 4 hours if the temperature is elevated; notify primary health care provider if temperature rises over 101° Fahrenheit



• Monitoring and managing patient’s need (cont’d):

– Impaired skin integrity

•Caution patients to wear cover-up clothing when outside in addition to sun block preparations; Educate patients that glare during hazy or cloudy days can cause skin reactions as much as when the sky is clear




– Acute pain: Tissue injury

•Inspect needle site, rate of infusion, vein for signs of tenderness, pain, and redness




– Diarrhea

•Check the patient’s stools and reports any incidence of diarrhea or the presence of blood and mucus immediately




– Impaired urinary elimination

•measure and record intake, output ratio and appearance of the urine. If changes report immediately for possible nephrotoxicity.




– Disturbed sensory perception: Auditory

•Detect any problems with hearing and report them to the primary health care provider immediately



• Educating the patient and family

– Explain the adverse reactions of specific prescribed antibiotic

– Advise about the signs and symptoms of potentially serious adverse effects



• Educating the patient and family (cont’d)

– Explain the necessity of contacting the primary health care provider immediately if symptoms occur

– Develop a teaching plan to include the information that appears in the Home Care Checklist


Nursing Process: EvaluationNursing Process: Evaluation

• The therapeutic effect is achieved; infection is controlled; bowel is cleansed sufficiently if surgery is to occur

• No pain or injury with intact hearing

• Fluid intake and output is appropriate


Nursing Process: Evaluation (cont’d)Nursing Process: Evaluation (cont’d)

• Adverse reactions are identified, reported, and managed

• Patient and family demonstrate understanding of the drug regimen

• Patient verbalizes the importance of complying with the prescribed therapeutic regimen


End of Presentation

Ppt chapter010

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