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Sulfonamides- static, prevent bacterial synthesis of folic acid; broad spectrum Trimethoprimsulfamethoxazole (bactrim, septra) UTIs, otitis media,

bronchitis Silver sulfadiazine (silvadene topical cream) burn Sulfasalazine (azulfidine) ulcerative colitis, chrons disease allergic to salicylates AE- sulfa allergy, photosens, n&V, diarrhea, pancreatitis, agranulocytosis, anemia, crystalluria, convulsions, orangeyellow skin & urine, stevens-johnson syndrome- red papules on extremities, no pain or itching, treat w/ topical corticosteroids, antihistamines, emollients Implications- hydrate (crystalluria), stomatits, do not give with antacids; effects of anti-coagulants, oral glycemics, anti-seizure Tetracyclines- inhibit protein synthesis of bacteria, used in penicillinallergic pts. Tetracycline (achromycin) Demeclocycline (declomycin) oral Doxycycline (vibramycin) vein irritation Uses- clamydia,

mycoplasma, rickettsia, acne, h.pyloric, pleural effusions, PID pregnant, nursing, children<8 b/c teeth enamel AE- discoloration of teeth, retard fetal skeletal development, superinfections, bulging fontanelles in neonates, thrombocytopenia, exacerbate systems in lupus, gi upset, photosensitivity Implications- give w/food, dont give w/in 2hrs before or 3hrs after dairy or antacids Urinary tract agentsbacterialcidal, short term treatment, avoid catheterization, encourage fluids Nitrofurantoin (macrobid, macrodantin) Phenazopyridine (pyridium) not antiinfective, given for pain -lactum antibacterialsbacterialcidal, inhibit synthesis of cell walls Penicillin- from molds, staph & strep, resistance problems Uses- pharyngitis, tonsillitis, scarlet fever, syphilis, meningitism edocarditis, pneumococcal infections, staphyloccal, gonococcal AE- lethargy, hallucinations, depression, coma, convulsions, N&V, diarrhea, anemia,

bleeding time, bone marrow suppression, hyperkalemia/hypokale mia, taste alterations, hives, rash, most common- uticaria, pruitus, angioedema Basic penicillinspenicillin g procaine, penicillin g benthazine, penicillin g sodium, pen v potassium Penicillin- resistant penicillins- able to resist breakdown by penicillin destroying enzyme penicillinase- nafcillin, cloxzcillin, dicloxacillin, oxacillin Aminopenicillinspresence of free amino acids- amoxicillin, ampicillin, bacampicillin Extended-spectrum penicillins- ticarcillin, ampicillin, amoxicillinm, piperacillin, carbenicillin, timentin, zosyn Nursing implicationsPen v K- best absorbed on empty stomach 1hr before or 2 hr after, avoid acidic juice; Amoxicillin & carbenicillin- best absorbed if taken w/food Oral contraception reduced; false + urine glucose; very irritating to tissue and veins; blood dyscrasias; k & Na levels; probenecidslow renal excretions & serum levels Hypersensitivity reaction- do skin test 1st; epinephrine, oxygen, endotracheal intubation,

tracheostomy, hydrocortisone Cephalosporinsbroader than penicillin, less resistant, similar action, more active against gramUses- resp tract infections, bone & joint infections, septicemia, UTIs 1st generation: gram+; limited gramcefazolin cephapirin cephalexin cephradine 2nd generation: gram+, w/enhanced gramcefaclor cefuroxime cefamandole cefoxitin 3rd generation: more potent than 2&3 against gram-; less on gram + ceftazidime ceftazine ceftriaxone 4th generation: more resistant to -lactamse cefepime AE- similar to penicillin; GI upsets, bone marrow suppression Nursing implicationsasses for allergies, temp., blood count, bleeding & clotting time, renal studies, hepatic function studies, diarrhes, bloody stools, addominal pain, give with food or milk Carbapenems- cidal, broadest, preserved for most complicated infections (bone, joint, skin, pelvic), hospital

use only, not used 1st line drug therapy Imipenum-cilastatin (primaxin) Meropenem (merrem) Monobactam aztreonam (azactam)- against aerobic gram-; cidal, lysis of cell wall; e.coli, klebsiella, pseudomonas; preserves normal flora AE- drug-induced seizure activity Nursing implicationsallergies, neurologic assessment, asses hearing levels, GIdiarrhea N&V Macrolides- static, inhibit protein synthesis, treat upper and lower resp infections, skin, soft tissue, LEGIONNAIRES DIS. Erythromycin Azithromycin Clarithromycin AE- palpitaions, chest pain, HA, dizziness, vertigo, N&V, hapatoxicity, burn, diarrhea, stomatitis, flatulence, jaundice, rash, pruritis, thrombophlebitis, hearing loss, tinnitus Nursing implicationsAbsorption enhanced on an empty stomach, asses function, liver & renal function, interactions with WARFARIN (bleeding time), contraceptive failure Aminoglycosides- cidal,

potent, poor oral absorbtion, systemic infections, used w/othe antibiotics to create a synergistic effect, pseudomonas, e.coloi, proteus, klebsiella, serratia, suppress intestinal bacteria Gentamycin Kanamycin- sterile bowel Neomycin- sterile bowel decontaminate GI Tobramycin Amikacin Streptomycin CAUTION!! Cause fetal harm, deafness in children, serum drug levels monitored and adjusted, can be nephrotoxic & ototoxic, BUN & serum creatinine, hearing loss, dizziness, tinnitus, sense of fullness in ear, 8th cranial nerve Fluoroquinolonespotent, cidal, broad, alters dna of bacteria, safer than aminoglcosides, excellent oral absorption, Uses- UTIs, prostatitis, STDs, anthrax, resp. infections Ciprofloxacin Levofloxacin Gatifloxacin AE- superinfections, nausea, constipation, oral candisis, dysphagia, rash, pruritis, uticaria, photosensitiveity, fever, chills, blurred vision, tinnittus Nursing measures for

AMINO & FLUROaccurate weights, monitor BUN, serum creatinine, Peak & trough levels, hydration, photosensitivity, avoid antacids MISC. ANTIBIOTICSflagyl- HIV/aids Macrodantin- UTI ANTITUBERCULARTB effects lungs, growing ends of bones, brain, requires combination drug therapy MOA- inhibit protein & cell wall synthesis 1st line drugsINH- given prophylactic, can cause pyridoxine deficiency & liver toxicity; peripheral neuritis Ethambutol (Myambutol) Rifampin (rifadin)- red discoloration, contraceptives Streptomycinototoxicity, nephrotoxicity AE- oto & nephrotoxicity, GI disturbance, blood dyscrasias Nursing implicationsVit b6 to prevent neuropathy w/INH; hepatoxicity w/ INH & rifampin; discontinuation can reactivate TB; sputum cultures; infection control; noncompliance; give w/ food

ANTIFUNGALantimycotic- candidasis & histoplasmosis, immune system Amphotercin B- drug of choice AE- fever chills hypotension tachycardia malaise muscle pain joint pain anorexia N&V HA Give antipyretic, antihistamines, antiemetics, & pain med to AE ANTIPRASITICStropical climates, malaria, intestinal amebiasis, pneumocystosis, trichomoniasis, scabies, lice, hookworm, pinworm AE- hypotension, anemia, pruritis, anorexia, dizziness, HA, agranulocytosis, darkened urine, stomach cramps, fatigue, chills, night sweats, SOB, bronchspasms Atovaquone (mepron) Metronidazole (flagyl) Nursing implicationsmonitor urine output & liver function studies, admin w/food, avoid raw fish or under cooked meat, for STD avoid sex