CHEMOTHERAPEUTIC AGENTS

ANTIBIOTICS
1. AMINOGLYCOSIDES
Kill bacteria primarily by inhibitin pr!tein "ynthe"i"
USES:
U"e# primarily aain"t ram $%& micr!!rani"m" that ca'"e UTI( meniniti"( )!'n# in*ecti!n"( +
li*e threatenin "epticaemia",
They are the main"tay" in the treatment !* n!"!c!mial ram $%& in*ecti!n"
U"e# al"! be*!re "'rery t! re#'ce the n!rmal *l!ra c!ntent !* the inte"tinal tract,
Therapeutic outcome:
Primary therape'tic !'tc!me e-pecte# i" the eliminati!n !* bacterial in*ecti!n,
Nursin responsi!i"ities
A""e"" *!r any allerie" an# "ympt!m" !* hearin l!"" !r renal #i"ea"e
I* pt ha" ha# ane"the"ia )ithin the pa"t ./%01 h!'r"( chec2 t! "ee i* "2eletal m'"cle rela-ant )a"
a#mini"tere#, I* '"e#( )ithh!l# the me#icati!n
3! n!t mi- !ther #r'" in the "ame "yrine !r in*'"e t!ether )ith !ther #r'",
SIDE E##ECTS TO $E%O$T
Ot!t!-icity 4 #'e t! /
th
cranial ner5e #amae
Nephr!t!-icity 4 m!nit!r 'rinaly"i" an# 2i#ney *'ncti!n te"t" *!r abn!rmal re"'lt"6 rep!rt an
increa"in BUN an# creatinine le5el( #ecrea"in 'rine !'tp't !r #ecrea"in "peci*ic ra5ity
D$UG INTE$ACTIONS
Nephr!t!-ic p!tential
Ot!t-ic p!tential
Ne'r!m'"c'lar bl!c2a#e
Heparin an# entamicin are phy"ically inc!mpatible, 3O NOT mi- t!ether be*!re in*'"i!n,
Ampicillin( Piperacillin( Ticarcillin rapi#ly inacti5ate amin!lyc!"i#e", 3O NOT mi- t!ether !r
a#mini"ter t!ether at the "ame I7 "ite,
&. CE%'ALOS%O$INS
Are chemically relate# t! the penicillin" an# ha5e a "imilar mechani"m !* acti5ity,
Act by inhibitin cell )all "ynthe"i" in bacteria,
May be #i5i#e# int! r!'p"( !r enerati!n"( ba"e# primarily !n antimicr!bial acti5ity,
#I$ST GENE$ATION
Ha5e e**ecti5e acti5ity aain"t ram $8& micr!!rani"m" + relati5ely mil# acti5ity aain"t ram $%&
micr!!rani"m",
SECOND GENE$ATION
Ha5e "!me)hat increa"e# acti5ity aain"t ram $%& bacteria b't are m'ch le"" acti5e than the 9
r#
enerati!n aent",
T'I$D GENE$ATION
Acti5e aain"t P, aer'in!"a( a p!tent ram $%& micr!!rani"m,
#OU$T' GENE$ATION
Are br!a# "pectr'm( )ith b!th ram $%& an# ram $8& c!5erae,
USES
U"e# a" alternati5e t! pt" )ith allery t! penicillin( 'nle"" they are al"! alleric t! cephal!"p!rin"
U"e# *!r certain 'rinary + re"pirat!ry tract in*ecti!n"( ab#!minal in*ecti!n"( bacterimia( meniniti"
an# !"te!myeliti"
Therapeutic outcome
Eliminati!n !* bacterial in*ecti!n
Nursin responsi!i"ities
A""e"" *!r any allerie"( "ympt!m" !* renal #i"ea"e !r blee#in #i"!r#er"
Obtain ba"eline lab!rat!ry "t'#ie"
SIDE E##ECTS TO $E%O$T
3iarrhea
Sec!n#ary in*ecti!n"
Abn!rmal li5er an# renal *'ncti!n te"t"
Hyp!pr!thr!mbinemia 4 )ith !r )ith!'t blee#in
Thr!mb!phlebiti"
Electr!lyte imbalance
D$UG INTE$ACTIONS
Nephr!t!-ic p!tential
Anatci#"
H1 anta!ni"t"
Ir!n "'pplement"
Pr!beneci#
Alc!h!l
Other c!ntracepti5e"
(. #LUO$O)UINOLONES
Act by inhibitin the acti5ity !* 3NA yra"e( an en:yme that i" e""ential *!r the replicati!n !*
bacterial 3NA,
USES
Cipr!*l!-acin i" the *ir"t )ell t!lerate#( br!a#% "pectr'm !ral antibi!tic in the ;'in!l!ne "erie", It
#em!n"trate" rapi# bacterial acti5ity aain"t the path!en" that ca'"e n!"!c!mial an#
c!mm'nity ac;'ire# UTI
Gemi*l!-acin i" "imilar in "pectr'm !* acti5ity an# '"e t! le5!*l!-acin an# m!-i*l!-acin, It al"! ha"
an a#5antae !* !nce%#aily !ral #!"in
<!)er RTI
UTI
Therapeutic outcome:
Eliminati!n !* bacterial in*ecti!n,
Nursin responsi!i"ities
A""e"" *!r an# rec!r# any a"tric "ympt!m" be*!re initiati!n !* the therapy
A""e"" *!r any allerie"
ENSURE THAT THE PT IS NOT PREGNANT
=arn pt" !* p!""ible ph!t!t!-icity t! l!me*l!-acin
Pe#iatric therapy i" n!t rec!mmen#e# beca'"e !* the p!tential *!r permanent cartilae #amae,
SIDE E##ECTS TO E*%ECT
Na'"ea( 5!mitin( #iarrhea( #i"c!m*!rt
3i::ine""( liht hea#e#ne""
Ph!t!t!-icity
Ra"h
Abn!rmal lab re"'lt"
Ne'r!l!ic e**ect"
D$UG INTE$ACTIONS
Ir!n( antaci#"( "'cral*ate
Pr!beneci#
NSAI3"
3i#an!"ine
The!phylline
T!-icity in#'ce# by "par*l!-acin
T!-icity in#'ce# by m!-i*l!-acin
+. MAC$OLIDES
The macr!li#e" are e**ecti5e aain"t a )i#e 5ariety !* path!enic !rani"m"( partic'larly
in*ecti!n" !* the re"pirat!ry an# enital tract,
ACTIONS
The macr!li#e" are bacteri!"tatic !r bacterici#al in "'"ceptible bacteria,
The #r'" act by bin#in t! cell membrane" an# ca'"in chane" in pr!tein *'ncti!n,
USES
The"e antibi!tic" are e**ecti5e in the treatment !* in*ecti!n" ca'"e# by a )i#e rane !* ram%
neati5e an# ramp!"iti5e micr!!rani"m",
In a##iti!n( the #r'" are '"e# t! treat acne 5'lari" an# "2in in*ecti!n"(
in c!n>'ncti!n )ith "'l*!nami#e" t! treat 'pper re"pirat!ry in*ecti!n" ca'"e# by Hemophilus
influenzae,
and as prophylaxis be*!re #ental !r !ther pr!ce#'re" in patient" alleric t! penicillin,
AD,E$SE $EACTIONS
Relate# t! the a"tr!inte"tinal tract an# incl'#e na'"ea( 5!mitin( #iarrhea( an# ab#!minal pain,
Ab#!minal crampin( na'"ea( 5!mitin( #iarrhea,
Alleric reacti!n" ha5e been rep!rte# )ith the a#mini"trati!n !* erythr!mycin,
A" )ith alm!"t all antibacterial #r'"( p"e'#!membran!'" c!liti" may !cc'r ranin in "e5erity
*r!m mil# t! li*e threatenin,
CONT$AINDICATIONS
The"e #r'" are c!ntrain#icate# in patient" )ith a hyper"en"iti5ity t! the macr!li#e" an# patient"
)ith pre%e-i"tin li5er #i"ea"e,
NU$SING $ES%ONSI-ILITIES
It i" imp!rtant t! '"e the"e #r'" ca'ti!'"ly #'rin prenancy an# lactati!n,
Beca'"e a:ithr!mycin( erythr!mycin( an# tr!lean#!mycin are primarily eliminate# *r!m the b!#y
by the li5er( the"e #r'" "h!'l# be '"e# )ith reat ca'ti!n in patient" )ith li5er #y"*'ncti!n,
There i" a #ecrea"e# a"tr!inte"tinal ab"!rpti!n !* the macr!li#e" )hen a#mini"tere# )ith 2a!lin(
al'min'm "alt"( !r maal#rate,
INTE$ACTIONS
U"e !* the macr!li#e" increa"e" "er'm le5el" !* #i!-in
an# increa"e" the e**ect" !* antic!a'lant",
U"e !* antaci#" #ecrea"e" the ab"!rpti!n !* m!"t macr!li#e",
The macr!li#e" "h!'l# n!t be a#mini"tere# )ith clin#amycin( linc!mycin( !r chl!ramphenic!l6 a
#ecrea"e in the therape'tic acti5ity !* the macr!li#e" can !cc'r,
C!nc'rrent a#mini"trati!n !* the macr!li#e" )ith the!phylline may increa"e "er'm the!phylline
le5el",
.. LINCOSAMIDES
Are e**ecti5e aain"t many ram%p!"iti5e !rani"m"( "'ch a" "trept!c!cci an# "taphyl!c!cci,
Beca'"e !* their hih p!tential *!r t!-icity( the linc!"ami#e" are '"'ally '"e# !nly *!r the
treatment !* "eri!'" in*ecti!n" in )hich penicillin !r erythr!mycin $a macr!li#e& i" n!t e**ecti5e,
ACTIONS
The linc!"ami#e" act by inhibitin pr!tein "ynthe"i" in "'"ceptible bacteria( ca'"in #eath,
USES
The"e antibi!tic" are e**ecti5e in the treatment !* in*ecti!n" ca'"e# by a )i#e rane !* ram%
neati5e an# ramp!"iti5e micr!!rani"m",
The linc!"ami#e" are '"e# *!r the m!re "eri!'" in*ecti!n",
In "eri!'" in*ecti!n" they may be '"e# in c!n>'ncti!n )ith !ther antibi!tic",
AD,E$SE $EACTIONS
Ab#!minal pain( e"!phaiti"( na'"ea( 5!mitin( #iarrhea( "2in ra"h( an# bl!!# #y"cra"ia",
The"e #r'" al"! can ca'"e p"e'#!membran!'" c!liti"( )hich may rane *r!m mil# t! 5ery
"e5ere,
3i"c!ntin'in the #r' may relie5e mil# "ympt!m" !* p"e'#!membran!'" c!liti",
CONT$AINDICATIONS
The linc!"ami#e" are c!ntrain#icate# in patient" )ith hyper"en"iti5ity t! the linc!"ami#e"( th!"e
)ith min!r bacterial !r 5iral in*ecti!n"( an# #'rin lactati!n an# in*ancy,
NU$SING $ES%ONSI-ILITIES
It i" imp!rtant t! '"e the"e #r'" )ith ca'ti!n in patient" )ith a hi"t!ry !* a"tr!inte"tinal
#i"!r#er"( renal #i"ea"e( !r li5er impairment,
The ne'r!m'"c'lar bl!c2in acti!n !* the linc!"ami#e" p!"e" a #aner t! patient" )ith
m/asthenia ra0is 1an autoimmune 2isease mani3este2 !/ e-treme )ea2ne"" an#
e-ha'"ti!n !* the m'"cle"&,
INTE$ACTIONS
=hen 2a!lin !r al'min'm i" a#mini"tere# )ith the linc!"ami#e"( the ab"!rpti!n !* the
linc!"ami#e i" #ecrea"e#,
=hen the linc!"ami#e" are a#mini"tere# )ith the ne'r!m'"c'lar bl!c2in #r'" $#r'" that are
'"e# a" a#>'nct" t! ane"thetic #r'" that ca'"e paraly"i" !* the re"pirat!ry "y"tem& the acti!n !*
the ne'r!m'"c'lar bl!c2in #r' i" enhance#( p!""ibly lea#in t! "e5ere an# pr!*!'n#
re"pirat!ry #epre""i!n,
NU$SING %$OCESS #O$ %TS. $ecei0in a Tetrac/c"ine4 Macro"i2e4 or Lincosami2e
Preadministration Assessment
It i" imp!rtant t! e"tabli"h an acc'rate #ataba"e be*!re the a#mini"trati!n !* any antibi!tic,
The n'r"e "h!'l# i#enti*y an# rec!r# "in" an# "ympt!m" !* the in*ecti!n,
E-ample" !* "!me !* the "in" an# "ympt!m" !* an in*ecti!n in 5ari!'" area" !* the b!#y are
pain( #rainae( re#ne""( chane" in the appearance !* "p't'm( eneral malai"e( chill" an# *e5er(
c!'h( an# ")ellin,
The n'r"e !btain" a th!r!'h allery hi"t!ry( e"pecially a hi"t!ry !* #r' allerie",
I* the patient ha" a hi"t!ry !* allerie" an# ha" n!t t!l# the primary health care pr!5i#er( the n'r"e
"h!'l# n!t a#mini"ter the *ir"t #!"e !* the #r' 'ntil thi" pr!blem i" #i"c'""e# )ith the primary
health care pr!5i#er,
Other lab!rat!ry te"t" "'ch a" renal an# hepatic *'ncti!n te"t"( c!mplete bl!!# c!'nt( an#
'rinaly"i" may al"! be !r#ere#,
5. %ENICILLINS
The antibacterial pr!pertie" !* nat'ral penicillin" )ere #i"c!5ere# in ?@1/ by Sir Arth'r Alemin
)hile he )a" per*!rmin re"earch !n in*l'en:a,
Ten year" later( Briti"h "cienti"t" "t'#ie# the e**ect" !* nat'ral penicillin" !n #i"ea"e%ca'"in
micr!!rani"m",
H!)e5er( it )a" n!t 'ntil ?@.? that nat'ral penicillin" )ere '"e# clinically *!r the treatment !*
in*ecti!n",
Alth!'h '"e# *!r m!re than BC year"( the penicillin" are "till an imp!rtant an# e**ecti5e r!'p !*
antibi!tic" *!r the treatment !* "'"ceptible path!en" $#i"ea"e%ca'"in micr!!rani"m"&,
There are 3our roups o3 penici""ins:
nat'ral penicillin"(
penicillina"e%re"i"tant penicillin"(
amin!penicillin"(
e-ten#e#%"pectr'm penicillin",
E6amp"es o3 penici""ins
Nat'ral penicillin"Dpenicillin G an# penicillin 7
Penicillina"e%re"i"tant penicillinDcl!-acillin( #icl!-acillin( na*cillin
Amin!penicillin"Dampicillin( am!-icillin( bacampicillin
E-ten#e#%"pectr'm penicillin"Dme:l!cillin( piperacillin( ticarcillin
D$UG $ESISTANCE
Beca'"e the nat'ral penicillin" ha5e been '"e# *!r many year"( #r'%re"i"tant "train" !*
micr!!rani"m" ha5e #e5el!pe#( ma2in the nat'ral penicillin" le"" e**ecti5e than "!me !* the
ne)er antibi!tic" in treatin a br!a# rane !* in*ecti!n",
Bacterial re"i"tance ha" !cc'rre# )ithin the penicillin",
-acteria" resistance is the a!i"it/ !* bacteria t! pr!#'ce "'b"tance" that inacti5ate !r #e"tr!y
the penicillin,
One e-ample !* bacterial re"i"tance i" the ability !* certain bacteria t! pr!#'ce penici""inase4 an
en:yme that inacti5ate" penicillin,
The penicillina"e%re"i"tant penicillin" )ere #e5el!pe# t!
c!mbat thi" pr!blem,
Action o3 penici""in
Bacteria )ithin the b!#y ca'"e" in*ecti!nEEEEEA#mini"trati!n !* penicillinEEEEECa'"e" bacteria
t! ")ell( r'pt're( !r a""'me 'n'"'al "hape"EEEEEBacteria e5ent'ally #e"tr!ye#,
The penicillin" may beF
!acterici2a" 12estro/ !acteria7
!acteriostatic 1s"o8 or retar2 the mu"tip"ication !* bacteria&,
I2enti3/in the Appropriate %enici""in
T! #etermine i* a "peci*ic type !* bacteria i" "en"iti5e t! penicillin( cu"ture an2 sensiti0it/ tests
are per3orme2.
A c'lt're i" per*!rme# by placin in*ecti!'" material !btaine# *r!m area" "'ch a" the "2in(
re"pirat!ry tract( an# bl!!# !n a c'lt're plate that c!ntain" a "pecial r!)in me#i'm,
Thi" r!)in me#i'm i" G*!!#H *!r the bacteria,
USES
1. In3ectious Disease
The nat'ral an# "emi"ynthetic penicillin" are '"e# in the treatment !* bacterial in*ecti!n" #'e t!
"'"ceptible micr!!rani"m",
Penicillin" may be '"e# t! treat in*ecti!n" "'ch a" 'rinary tract in*ecti!n"( "epticemia( meniniti"(
intra%ab#!minal in*ecti!n( !n!rrhea( "yphili"( pne'm!nia( an# !ther re"pirat!ry in*ecti!n",
E-ample" !* in*ecti!'" micr!!rani"m" $bacteria& that may re"p!n# t! penicillin therapy incl'#e
!n!c!cci( "taphyl!c!cci( "trept!c!cci( an# pne'm!c!cci,
&. %roph/"a6is
Penicillin i" !* n! 5al'e in the treatment !* 5iral !r *'nal in*ecti!n",
H!)e5er( the primary health care pr!5i#er !cca"i!nally )ill pre"cribe penicillin a" proph/"a6is
$pre5enti!n& aain"t a p!tential "ec!n#ary bacterial in*ecti!n that can !cc'r in a patient )ith a
5iral in*ecti!n,
In the"e "it'ati!n" the 5iral in*ecti!n ha" )ea2ene# the b!#yI" #e*en"e" an# the per"!n i"
"'"ceptible t! !ther in*ecti!n"( partic'larly a bacterial in*ecti!n,
Penicillin al"! may be pre"cribe# a" pr!phyla-i" *!r a p!tential in*ecti!n in hih%ri"2 in#i5i#'al"(
"'ch a" th!"e )ith a hi"t!ry !* rhe'matic *e5er,
AD,E$SE $EACTIONS
mil# na'"ea( 5!mitin( #iarrhea( "!re t!n'e !r m!'th( *e5er( an# pain at in>ecti!n "ite,
Penicillin can "tim'late a h/persensiti0it/
An!ther a#5er"e reacti!n that may be "een )ith penicillin( a" )ell a" )ith alm!"t all antibi!tic"( i"
a superin3ection $a "ec!n#ary in*ecti!n that !cc'r" #'rin antibi!tic treatment&
'/persensiti0it/ reactions to penici""in
S2in ra"h
Urticaria $hi5e"&
Snee:in
=hee:in
Pr'rit'" $itchin&
Br!nch!"pa"m $"pa"m !* the br!nchi&
<aryn!"pa"m $"pa"m !* the laryn-&
Ani!e#ema $al"! calle# ani!ne'r!tic e#ema&D")ellin !* the "2in an# m'c!'" membrane"(
e"pecially ar!'n# an# in the m!'th an# thr!at
Hyp!ten"i!nDcan pr!re"" t! "h!c2
Sin" an# "ympt!m" re"emblin "er'm "ic2ne""Dchill"( *e5er( e#ema( >!int an# m'"cle pain(
an# malai"e
Anaphylactic "h!c2( )hich i" a "e5ere *!rm !* hyper"en"iti5ity reacti!n( al"! can !cc'r,
Anaphylactic "h!c2 !cc'r" m!re *re;'ently a*ter parenteral a#mini"trati!n b't can !cc'r )ith !ral
'"e,
Other A20erse $eactions
hemat!p!ietic chane" "'ch a" anemia( thr!mb!cyt!penia $l!) platelet c!'nt&( le'2!penia $l!)
)hite bl!!# cell c!'nt&( an# b!ne marr!) #epre""i!n,
=hen penicillin i" i5en !rally( l!""iti" $in*lammati!n !* the t!n'e&( "t!matiti" $in*lammati!n !*
the m!'th&( #ry m!'th( a"triti"( na'"ea( 5!mitin( an# ab#!minal pain !cc'r,
=hen penicillin i" i5en intram'"c'larly $IM&( there may be pain at the in>ecti!n "ite,
Irritati!n !* the 5ein an# phlebiti" $in*lammati!n !* a 5ein& may !cc'r )ith intra5en!'" $I7&
a#mini"trati!n,
CONT$AINDICATIONS
Penicillin" are c!ntrain#icate# in patient" )ith a hi"t!ry !* hyper"en"iti5ity t! penicillin !r the
cephal!"p!rin",
%$ECAUTIONS
Penicillin" "h!'l# be '"e# ca'ti!'"ly in patient" )ith renal #i"ea"e( prenancy $Prenancy
Cate!ry C&( lactati!n $may ca'"e #iarrhea !r can#i#ia"i" in the in*ant&( an# in th!"e )ith a
hi"t!ry !* allerie",
Any in#icati!n !* "en"iti5ity i" rea"!n *!r ca'ti!n,
The #r' i" al"! '"e# )ith ca'ti!n in patient" )ith a"thma( renal #i"ea"e( blee#in #i"!r#er"( an#
a"tr!inte"tinal #i"ea"e,
INTE$ACTIONS
S!me penicillin" $ampicillin( bacampicillin( penicillin 7& may inter*ere )ith the e**ecti5ene"" !* birth
c!ntr!l pill" that c!ntain e"tr!en,
There i" a #ecrea"e# e**ecti5ene"" !* the penicillin )hen it i" a#mini"tere# )ith the tetracycline",
<are #!"e" !* penicillin can increa"e blee#in ri"2" !* patient" ta2in antic!a'lant aent",
S!me rep!rt" in#icate that )hen !ral penicillin" are a#mini"tere# )ith beta%a#reneric bl!c2in
#r'"( the patient may be at increa"e# ri"2 *!r an anaphylactic reacti!n,
Ab"!rpti!n !* m!"t penicillin" i" a**ecte# by *!!#,
In eneral( penicillin" "h!'l# be i5en ? h!'r be*!re !r 1 h!'r" a*ter meal",
9. SUL#ONAMIDES
S'l*!nami#e" are anti!acteria" aents4 meanin the/ are acti5e aain"t bacteria,
An!ther term that may be '"e# t! #e"cribe the eneral acti!n !* the"e #r'" i" anti:in3ecti0e
beca'"e they are '"e# t! treat in*ecti!n" ca'"e# by certain bacteria,
e-ample" !* "'l*!nami#e preparati!n", S'l*a#ia:ine( "'l*i"!-a:!le( an# "'l*amethi:!le
ACTIONS
The "'l*!nami#e" are primarily !acteriostatic4 8hich mean" they "l!) !r retar# the
m'ltiplicati!n !* bacteria,
Thi" bacteri!"tatic acti5ity i" #'e t! "'l*!nami#e anta!ni"m t! para%amin!ben:!ic aci# $PABA&(
a "'b"tance that "!me( b't n!t all( bacteria nee# t! m'ltiply,
Once the rate !* bacterial m'ltiplicati!n i" "l!)e#( the b!#yI" !)n #e*en"e mechani"m" $)hite
bl!!# cell"& are able t! ri# the b!#y !* the in5a#in micr!!rani"m" an# there*!re c!ntr!l the
in*ecti!n,
USES
The "'l*!nami#e" are !*ten '"e# t! c!ntr!l 'rinary tract in*ecti!n" ca'"e# by certain bacteria
"'ch a" Escherichia coli, Staphylococcus aureus, and Klebsiella-Enterobacter.
Ma*eni#e $S'l*amyl!n& an# "il5er "'l*a#ia:ine $Sil5a#ene& are t!pical "'l*!nami#e" '"e# in the
treatment !* "ec!n#% an# thir#%#eree b'rn",
AD,E$SE $EACTIONS
The "'l*!nami#e" are capable !* ca'"in a 5ariety !* a#5er"e reacti!n", S!me !* the"e are
"eri!'" !r p!tentially "eri!'"6 !ther" are mil#,
The *!ll!)in hemat!l!ic chane" may !cc'r #'rin "'l*!nami#e therapyF
Aranu"oc/tosis;2ecrease in or "ac< o3 ranu"oc/tes4
a type !* )hite bl!!# cell
Throm!oc/topenia;2ecrease in the num!er o3
platelet"
Ap"astic anemia;anemia 2ue to 2e3icient re2
bl!!# cell pr!#'cti!n in the b!ne marr!)
Leu<openia;2ecrease in the num!er o3 8hite
bl!!# cell"
The"e are e-ample" !* a "eri!'" a#5er"e reacti!n,
An!re-ia $l!"" !* appetite& i" an e-ample !* a mil# a#5er"e reacti!n, Unle"" it bec!me" "e5ere
an# pr!n!'nce# )eiht l!"" !cc'r"( it may n!t be nece""ary t! #i"c!ntin'e "'l*!nami#e therapy,
7ari!'" type" !* hyper"en"iti5ity $alleric& reacti!n" #'rin "'l*!nami#e therapy( incl'#in
Ste5en"%J!hn"!n "yn#r!me(
urticaria 1hi0es74 pruritus $itchin&( an# enerali:e# "2in er'pti!n",
Ste0ens:=ohnson s/n2rome is mani3este2 !/
*e5er( c!'h( m'"c'lar ache" an# pain"( an# hea#ache( all !* )hich are "in" an# "ympt!m" !*
many !ther #i"!r#er",
Other a#5er"e reacti!n" that may !cc'r #'rin therapy incl'#e na'"ea( 5!mitin( #iarrhea(
ab#!minal pain( chill"( *e5er( an# stomatitis 1in3"ammation o3 the m!'th&,
Cr/sta""uria 1cr/sta"s in the urine7 ma/ occur 2urin a#mini"trati!n !* a "'l*!nami#e
CONT$AINDICATIONS
Patient" )ith hyper"en"iti5ity t! the "'l*!nami#e"( #'rin lactati!n( an# in chil#ren le"" than 1
year" !l#,
n!t '"e# near the en# $at term& !* prenancy $Prenancy Cate!ry 3&,
I* the "'l*!nami#e" are i5en near the en# !* prenancy( "ini*icant bl!!# le5el" !* the #r' may
!cc'r( ca'"in >a'n#ice !r hem!lytic anemia in the ne!nate,
n!t '"e# *!r in*ecti!n" ca'"e# by r!'p A beta%hem!lytic "trept!c!cci beca'"e the "'l*!nami#e"
ha5e not been "h!)n t! be e**ecti5e in pre5entin the c!mplicati!n" !* rhe'matic *e5er !r
l!mer'l!nephriti",
%$ECAUTIONS
The "'l*!nami#e" are '"e# )ith ca'ti!n in patient" )ith renal !r hepatic impairment an# br!nchial
a"thma,
The"e #r'" are i5en )ith ca'ti!n t! patient" )ith allerie",
Sa*ety *!r '"e #'rin prenancy ha" n!t been e"tabli"he# $Prenancy Cate!ry C( e-cept at
term&,
INTE$ACTIONS
=hen a "'l*!nami#e i" a#mini"tere# )ith an !ral antic!a'lant( the acti!n !* the antic!a'lant
may be enhance#,
The ri"2 !* b!ne marr!) "'ppre""i!n may be increa"e# )hen a "'l*!nami#e i" a#mini"tere# )ith
meth!tre-ate,
=hen a "'l*!nami#e i" a#mini"tere# )ith a hy#ant!in( the "er'm hy#ant!in le5el may be
increa"e#,
S'l*!nami#e" may inhibit the $hepatic& metab!li"m !* the !ral hyp!lycemic #r'" t!lb'tami#e
$Orina"e& an# chl!rpr!pami#e $3iabine"e&, Thi" )!'l# increa"e the p!""ibility !* a hyp!lycemic
reacti!n,
>. TET$ACYCLINES
A r!'p !* anti%in*ecti5e" c!mp!"e# !* nat'ral an# "emi"ynthetic c!mp!'n#",
They are '"e*'l in "elect in*ecti!n" )hen the !rani"m "h!)" "en"iti5ity t! the tetracycline"( "'ch
a" in ch!lera( R!c2y M!'ntain "p!tte# *e5er( an# typh'",
ACTIONS
The tetracycline" e-ert their e**ect by inhibitin bacterial pr!tein "ynthe"i"( )hich i" a pr!ce""
nece""ary *!r repr!#'cti!n !* the micr!!rani"m,
The 'ltimate e**ect !* thi" acti!n i" that the bacteria are either #e"tr!ye# !r their m'ltiplicati!n rate
i" "l!)e#,
The tetracycline" are !acteriostatic 1capa!"e o3 s"o8in or retar2in the m'ltiplicati!n !*
bacteria&( )herea" the macr!li#e" an# linc!"ami#e" may be bacteri!"tatic !r !acterici2a"
$capable !* #e"tr!yin bacteria&,
USES
e**ecti5e in the treatment !* in*ecti!n" ca'"e# by a )i#e rane !* ram%neati5e an# ramp!"iti5e
micr!!rani"m",
'"e# in in*ecti!n" ca'"e# by Ric2ett"iae $R!c2y M!'ntain "p!tte# *e5er( typh'" *e5er( an# tic2
*e5er"&,
'"e# in "it'ati!n" in )hich penicillin i" c!ntrain#icate#( in the treatment !* inte"tinal amebia"i"(
an# in "!me "2in an# "!*t ti""'e in*ecti!n",
'"e# in the treatment !* 'nc!mplicate# 'rethral( en#!cer5ical( !r rectal in*ecti!n" ca'"e# by
Chlamydia trachomatis and as adjunctive treatment in "e5ere acne,
Tetracycline in c!mbinati!n )ith metr!ni#a:!le an# bi"m'th "'b"alicylate i" '"e*'l in treatin
Helicobacter pylori a bacteria in the stomach that can ca'"e peptic 'lcer&,
AD,E$SE $EACTIONS
Ga"tr!inte"tinal reacti!n" incl'#e na'"ea( 5!mitin( #iarrhea( epia"tric #i"tre""( "t!matiti"( an#
"!re thr!at,
S2in ra"he" al"! may be "een,
A photosensiti0it/ $ph!t!t!-ic& reaction ma/ !e seen 8ith this roup !* #r'"( mani*e"te# by
an e-aerate# "'nb'rn reacti!n )hen the "2in i" e-p!"e# t! "'nliht e5en *!r brie* peri!#",
The tetracycline" are n!t i5en t! chil#ren y!'ner than @ year" !* ae 'nle"" their '"e i"
ab"!l'tely nece""ary beca'"e the"e #r'" may ca'"e permanent yell!) ray% br!)n
#i"c!l!rati!n !* the teeth,
The '"e !* the tetracycline"( e"pecially pr!l!ne# !r repeate# therapy( may re"'lt in bacterial !r
*'nal !5err!)th !* n!n"'"ceptible !rani"m",
CONT$AINDICATIONS
i* the patient i" 2n!)n t! be hyper"en"iti5e t! any !* the tetracycline",
#'rin prenancy beca'"e !* the p!""ibility !* t!-ic e**ect" t! the #e5el!pin *et'", The
tetracycline" are cla""i*ie# Prenancy Cate!ry 3 #r'",
The"e #r'" al"! are c!ntrain#icate# #'rin lactati!n an# in chil#ren y!'ner than @ year" $may
ca'"e permanent #i"c!l!rati!n !* the teeth&,
%$ECAUTIONS?NU$SING $ES%ONSI-ILITIES
It i" imp!rtant t! '"e the tetracycline" ca'ti!'"ly in patient" )ith renal *'ncti!n impairment,
3!"e" reater that 1 K# can be e-tremely #amain t! the li5er,
The n'r"e "h!'l# care*'lly chec2 the e-pirati!n #ate" !* the tetracycline" be*!re a#mini"trati!n
beca'"e #era#ati!n !* the tetracycline" can !cc'r6 a*ter #era#ati!n( the aent" are hihly t!-ic
t! the 2i#ney",
INTE$ACTIONS
Antaci#" !r *!!#" hih in calci'm impair ab"!rpti!n !* the tetracycline",
=hen the tetracycline" are a#mini"tere# )ith !ral antic!a'lant"( an increa"e in the e**ect" !* the
antic!a'lant may !cc'r,
=hen tetracycline" are a#mini"tere# t! )!men '"in !ral c!ntracepti5e"( a #ecrea"e in the e**ect
!* the !ral c!ntracepti5e may be "een,
Thi" may re"'lt in brea2thr!'h blee#in !r prenancy,
=hen #i!-in i" a#mini"tere# )ith the tetracycline" there i" an increa"e# ri"2 *!r #iitali" t!-icity
Tetracycline" may re#'ce in"'lin re;'irement", Bl!!# l'c!"e le5el" "h!'l# be m!nit!re#
*re;'ently #'rin tetracycline therapy,
Nursin A"ert
!he nurse should not "ive tetracyclines alon" #ith dairy products mil$ or cheese%, antacids,
laxatives, or products containin" iron.
&hen these dru"s are prescribed, the nurse ma$es sure they are "iven ' hours before or after
the administration of a tetracycline.
@. ANTI:TU-E$CULOSIS D$UGS
ACTIONS
M!"t antit'berc'lar #r'" are !acteriostatic 1s"o8 or retar# the r!)th !* bacteria& aain"t the
(. tuberculosis bacill'",
The"e #r'" '"'ally act t! inhibit bacterial cell )all "ynthe"i"( )hich "l!)" the m'ltiplicati!n rate
!* the bacteria,
Only i"!nia:i# i" bacterici#al( )ith ri*ampin an# "trept!mycin ha5in "!me bacterici#al acti5ity,
USES
Antit'berc'lar #r'" are '"e# in c!mbinati!n )ith !ther antit'berc'lar #r'" t! treat acti5e
t'berc'l!"i",
I"!nia:i# $INH& i" the !nly antit'berc'lar #r' '"e# al!ne,
=hile i"!nia:i# i" '"e# in c!mbinati!n )ith !ther #r'" *!r the treatment !* primary t'berc'l!"i"(
a primary '"e i" in pre5enti5e therapy $pr!phyla-i"& aain"t t'berc'l!"i",
A!r e-ample( )hen a #ian!"i" !* t'berc'l!"i" i" pre"ent( *amily member" !* the in*ecte#
in#i5i#'al m'"t be i5en pr!phylactic treatment )ith i"!nia:i# *!r L m!nth" t! ? year,
STANDA$D T$EATMENT
Stan#ar# treatment *!r t'berc'l!"i" i" #i5i#e# int! t)! pha"e"F the initial pha"e *!ll!)e# by a
c!ntin'in pha"e,
3'rin the initial pha"e( #r'" are '"e# t! 2ill the rapi#ly m'ltiplyin (. tuberculosis and to
prevent dru" resistance.
The initial pha"e la"t" appr!-imately 1 m!nth" an# the c!ntin'in pha"e appr!-imately . m!nth"(
)ith the t!tal treatment reimen la"tin *!r L t! @ m!nth"( #epen#in !n the patientI" re"p!n"e t!
therapy,
The initial pha"e m'"t c!ntain three !r m!re !* the *!ll!)in #r'"F i"!nia:i#( ri*ampin( an#
pyra:inami#e( al!n )ith either ethamb't!l !r "trept!mycin,
The C3C rec!mmen#" treatment t! bein a" "!!n a" p!""ible a*ter the #ian!"i" !* t'berc'l!"i",
The treatment rec!mmen#ati!n reimen i" *!r the a#mini"trati!n !* ri*ampin( i"!nia:i#( an#
pyra:inami#e *!r a minim'm !* 1 m!nth" $/ )ee2"&( *!ll!)e# by ri*ampin an# i"!nia:i# *!r .
m!nth" $?L )ee2"& in area" )ith a l!) inci#ence !* t'berc'l!"i",
In area" !* hih inci#ence !* t'berc'l!"i"( the C3C rec!mmen#" the a##iti!n !* "trept!mycin !r
ethamb't!l *!r the *ir"t 1 m!nth",
$ET$EATMENT
At time" treatment *ail" #'e t! n!nc!mpliance )ith the #r' reimen !r t! ina#e;'ate initial #r'
treatment,
=hen treatment *ail"( retreatment i" nece""ary,
Retreatment enerally incl'#e" the '"e !* *!'r !r m!re antit'berc'lar #r'", Retreatment #r'
reimen" m!"t !*ten c!n"i"t !* the "ec!n#ary #r'" ethi!nami#e( amin!"alicylic aci#(
cycl!"erine( an# capre!mycin, O*l!-acin an# cipr!*l!-acin may al"! be '"e# in retreatment,
At time" #'rin retreatment( a" many a" "e5en !r m!re #r'" may be '"e#( )ith the ine**ecti5e
#r'" #i"c!ntin'e# )hen "'"ceptibility te"t re"'lt" are a5ailable,
NU$SING %$OCESS
The %atient $ecei0in an Antitu!ercu"ar Dru
Preadministration Assessment
Once the #ian!"i" !* t'berc'l!"i" i" c!n*irme#( the primary health care pr!5i#er "elect" the #r'
that )ill be"t c!ntr!l the "prea# !* the #i"ea"e an# ma2e the patient n!nin*ecti!'" t! !ther",
Many lab!rat!ry an# #ian!"tic te"t" may be nece""ary be*!re "tartin antit'berc'lar therapy(
incl'#in ra#i!raphic "t'#ie"( c'lt're an# "en"iti5ity te"t"( an# 5ari!'" type" !* lab!rat!ry te"t"(
"'ch a" a c!mplete bl!!# c!'nt,
It al"! i" imp!rtant t! incl'#e a *amily hi"t!ry an# a hi"t!ry !* c!ntact"( i* the patient ha" acti5e
t'berc'l!"i"( a" part !* the a""e""ment,
3epen#in !n the "e5erity !* the #i"ea"e( patient" may be treate# initially in the h!"pital an# then
#i"chare# t! their h!me *!r "'per5i"e# *!ll!)%'p care( !r they may ha5e all treatment in"tit'te#
!n an !'tpatient ba"i",
Ongoing Assessment
=hen per*!rmin the !n!in a""e""ment( the n'r"e !b"er5e" the patient #aily *!r the
appearance !* a#5er"e reacti!n",
The"e !b"er5ati!n" are e"pecially imp!rtant )hen a #r' i" 2n!)n t! be nephr!t!-ic !r !t!t!-ic,
It i" imp!rtant t! rep!rt any a#5er"e reacti!n" t! the primary health care pr!5i#er,
In a##iti!n( the n'r"e care*'lly m!nit!r" 5ital "in" #aily !r a" *re;'ently a" e5ery . h!'r" )hen
the patient i" h!"pitali:e#,
Geronto"oic A"ert
)lder adults are particularly susceptible to a potentially fatal hepatitis #hen ta$in" isoniazid,
especially if they consume alcohol on a re"ular basis.
!#o other antitubercular dru"s, rifampin and pyrazinamide, can cause liver dysfunction in the
older adult.
Careful observation and monitorin" for si"ns of liver impairment are necessary e", increased
serum aspartate transaminase, increased serum alanine transferase, increased serum bilirubin,
and jaundice%.
The n'r"e incl'#e" the *!ll!)in in*!rmati!n in the teachin plan )hen a "peci*ic antit'berc'lar #r' i"
pre"cribe#F
Ethambutol* !a$e this dru" once a day at the same time each #ay, I* a #!"e i" mi""e#( #! n!t
#!'ble the #!"e the ne-t #ay, N!ti*y the primary health care pr!5i#er !* any chane" in 5i"i!n !r
the !cc'rrence !* a "2in ra"h,
+soniazid* !a$e this dru" , hour before or ' hours a*ter meal", H!)e5er( i* a"tric 'p"et !cc'r"(
ta2e i"!nia:i# )ith *!!#, N!ti*y the primary health care pr!5i#er !* )ea2ne""( yell!)in !* the
"2in( l!"" !* appetite( #ar2enin !* the 'rine( "2in ra"he"( !r n'mbne"" !r tinlin !* the han#" !r
*eet, A5!i# tyramine%c!ntainin *!!#", T! pre5ent pyri#!-ine $5itamin BL& #e*iciency( L t! BC m
!* pyri#!-ine #aily may be pre"cribe#,
-yrazinamide* .otify the primary health care pr!5i#er i* any !* the *!ll!)in !cc'r"F na'"ea(
5!mitin( l!"" !* appetite( *e5er( malai"e( 5i"'al chane"( yell!) #i"c!l!rati!n !* the "2in( !r
"e5ere pain in the 2nee"( *eet( !r )ri"t", $N!teF Pain in the"e area" may be a "in !* acti5e !'t,&
/ifampin* !a$e the dru" once daily on an empty stomach $? h!'r be*!re !r 1 h!'r" a*ter meal"&,
A re##i"h br!)n !r re##i"h%!rane #i"c!l!rati!n !* tear"( "p't'm( 'rine( !r ")eat may !cc'r, S!*t
c!ntact len"e" may be permanently "taine# i* )!rn )hile the patient i" ta2in the #r', N!ti*y the
primary health care pr!5i#er !* any yell!) #i"c!l!rati!n !* the "2in( *e5er( chill"( 'n'"'al blee#in
!r br'i"in( an# "2in ra"h !r itchin, I* ta2in an !ral c!ntracepti5e( chec2 )ith primary health care
pr!5i#er beca'"e reliability !* the c!ntracepti5e may be a**ecte#,
1A. LE%$OSTATIC D$UGS
CLO#ABIMINE
ACTIONS AND USES
Cl!*a:imine i" primarily bacterici#al aain"t (. leprae.
The e-act m!#e !* acti!n !* thi" #r' i" 'n2n!)n,
Cl!*a:imine i" '"e# t! treat lepr!"y,
AD,E$SE $EACTIONS
Cl!*a:imine may ca'"e pimentati!n !* the "2in( ab#!minal pain( #iarrhea( na'"ea( an# 5!mitin,
CONT$AINDICATIONS4 %$ECAUTIONS4 AND INTE$ACTIONS
Cl!*a:imine i" '"e# ca'ti!'"ly in patient" )ith a"tr!inte"tinal #i"!r#er"( #iarrhea( an# #'rin
prenancy $Prenancy Cate!ry C& an# lactati!n,
I* cl!*a:imine i" '"e# #'rin prenancy( the in*ant may be b!rn )ith pimente# "2in,
DA%SONE
ACTIONS AND USES
3ap"!ne i" bacterici#al an# bacteri!"tatic aain"t (. leprae. !he dru" is used to treat leprosy.
0apsone may al"! be '"e# in the treatment !* #ermatiti" herpeti*!rmi"(
A chr!nic( in*lammat!ry "2in #i"ea"e,
AD,E$SE $EACTIONS
A#mini"trati!n !* #ap"!ne may re"'lt in hem!ly"i" $#e"tr'cti!n !* re# bl!!# cell"&( na'"ea(
5!mitin( an!re-ia( an# bl'rre# 5i"i!n,
CONT$AINDICATIONS4 %$ECAUTIONS4 AND INTE$ACTIONS
3ap"!ne i" '"e# )ith ca'ti!n in patient" )ith anemia( "e5ere car#i!p'lm!nary #i"ea"e( hepatic
#y"*'ncti!n( an# #'rin prenancy $Prenancy Cate!ry C&,
3ap"!ne i" c!ntrain#icate# #'rin lactati!n,
S'b"tantial am!'nt" !* #ap"!ne are e-crete# in brea"t mil2 an# can ca'"e hem!lytic reacti!n" in
ne!nate",
The %atient $ecei0in a Leprostatic Dru
-readministration 1ssessment
It i" imp!rtant t! per*!rm a c!mplete phy"ical e-aminati!n an# hi"t!ry be*!re the in"tit'ti!n !*
therapy,
The n'r"e e-amine" the in5!l5e# area" an# #e"cribe" them in #etail !n the patientI" rec!r# t!
pr!5i#e a #ataba"e *!r c!mpari"!n #'rin therapy,
ONGOING ASSESSMENT
The"e #r'" are !*ten i5en !n an !'tpatient ba"i",
Each time the patient i" "een in the clinic !r primary health care pr!5i#erI" !**ice( the n'r"e
per*!rm" a eneral phy"ical e-aminati!n( )ith partic'lar attenti!n i5en t! the a**ecte# area",