PHARMACOLOGY Symptomati and accurate

c remedies
Appropriatenes
PHARMACOLOGY AND THERAPEUTICS s
Greater
 Is a branch of medicine concerned with the prevention Safe if chance of
instructions wrong
of disease and treatment of suffering. Safety
in the label medication,
are dosing
PHARMACOLOGY followed frequency

 Branch of science that studies drug and medicines SOURCE OF DRUGS

THERAPEUTICS
PLANTS
 How it can affect

PHARMACOTHERAPEUTICS

 Application of drugs for disease prevention and ANIMALS Drugs MINERALS

treatment suffering.

CLASSIFICATIOON OF THERAPEUTIC AGENTS

Drug (Insulin) Alternative CHEMICAL
Biologics Therapies

 DRUGS
EVALUATION OF DRUG
 Is a chemical agent capable of producing biological
responses in the body (therapeutic or adverse.
PRECLINICAL (1-3 YEARS)
 Any chemical that affects the physiological process of a Healthy animal; Culture human cells
Drug effectiveness at different doses and
for adverse effect
living organism.
 Is a chemical agent that can help or harm.

 BIOLOGICS (INSULIN) CLINICAL (2-10 YEARS)

Healthy and with disease volunteers Therapeutic dosage; adverse effects

 Agent naturally produced in animal cells,

microorganisms, or by the body itself.
 Non-synthetic chemicals used to treat variety of
REVIEW OF NEW DRUG APPLICATION (EXTENDED CLINICAL EVALUATION) (2 mo - 7 years)
disorders and illness Large Groups
Clinical effectiveness; safety and dosage
range
 Examples: hormones, antibodies, vaccines.

DRUG DISPENSING POST MARKETING SURVEILLANCE

General Public Further proof of the therapeutic and
Types Criteria Advantage Disadvantage harmful effects

s s
Prescribe Purchasing Has Cannot be DRUG CLASSES, SCHEDULES & CATHEGORIES
d drugs Appropriatenes Doctor’s used urgently
s Safety order Therapeutic
Needs medical
More consultation Effects
specific and Therapeutic
Need medical
accurate
consultation
Clinical Effects
Accurate
medication, Drug
dosing, classification
frequency Mechanism of
Action
are
provided Phamacology

Over-the- Purchasing Easy to No control Specific Action

Counter acquire over the drugs
Drugs

Less specific  DRUGS:

 DRUG: CARDIOVASCULA PROPRIETARY drug was given
CALCIBOC (nifedipine) Ex. Paracetamol
Therapeutic Classification TRADE/BRAND/ Assigned by company
 Lower blood pressure PROPRIETARY marketing the drug
 ANTIHYPERTENSIVE Ex: Biogesic
Pharmacologic NAME OF DRUGS
 Blocking calcium channel blockers
 CALCIUM CHANNEL BLOCKERS  CHEMICAL NAME
 Description of chemical composition of drug
 Commonly used by chemist
o E.g., 4-dimenthylamino-
ADVIL (Ibuprofen) 1,4,4a.5.5a.6.11.12q. octahydro-
Therapeutic Classification 3,6,10,12,12a-pentahydroxy-6-
methyl-1,11-dioxo-2-
 Decreases Pain
napthacenecarboxamide
 ANALGESIC
o Also known as tetracycline
Pharmacologic
 GENETIC NAME
 Inhibits prostaglandin synthesis  Also known as non-proprietary name
 PROSTAGLANDIN INHIBITOR  Assigned and given by USAN (United States
Adopted Name Council of the USP)
 Often derived from the chemical name
o Tetracycline (Achromycin)
ZANTAC (ranitidine HCI)
o Erythromycin (Erythrocin)
Therapeutic Classification o Paracetamol (Biogesic)
 Decreases gastric acid secretion o Ibuprofen (Alaxan)
 ANTI ULCER  BRAND NAME
Pharmacologic  Also known as “trade name” or proprietary
 Inhibits action of histamine on H2 receptor site name
 H2 RECEPTOR ANTAGONIST  Given by the company or manufacturer
 It has a trade mark
o Biogesic (paracetamol)
o Zantac (ranitidine HCI)
AMINOPHYLLINE (Ventolin) o Calcibloc (nidedipine)
Therapeutic Classification
 Dilates bronchial airway BRAND NAME VS. GENERIC NAME
 BRONCHODILATOR
Pharmacologic
 Stimulates beta2 receptors
 BETA2 RECEPTOR AGONIST Bioavailability
Ingredients
DRUG CLASSES Desired
Compressio
Ability to effects
n
PROTOTYPE DRUG reach target
cells
Therapeutic
 Well-understood drug model with which other drugs in Formulation
Effects
pharmacological class are compared. Example,
morphine is the prototype of opioid analgesics;
penicillin is the prototype of antibacterial drugs.

NAMES OF DRUG BIOAVAILABILITY

CHEMICAL Chemical composition:  Physiologic ability of the drug to reach its target
Ex: para-amino-benzene cells and produce its effects.
Molecular structure:
Ex:NH3
GENERIC/NON Original designation that the CONTROLLED SUBSTANCES AND SCHEDULE
 Are categories from which commonly abused drugs or  An effective drug is one that elicits the responses for
those commonly to cause dependency were classified. which is given.
 Effectiveness is the most important property a drug can
have.
.
 SAFETY
.
 A safety drug is defined as one that cannot produce
. harmful effects – even if administered is very high doses
and for a very long time.
 Harm can be reduced by proper drug selection and
 SCHEDULE V proper dosing.

 Lowest abused potential compared to Schedule IV  SELECTIVITY

 Accepted medical uses
 One that elicits only the response for which it is given.
 May lead to limited physical or psychological
 There is no such thing as a wholly selective drug
dependence
because all drugs cause side effects.
o E.g. over-the-counter cough medicine with
codeine
DRUG DOSAGE PREPARATION

 SCHEDULE IV SOLID LIQUID

 Tablet  Syrup
 Lower abused potential compared to Schedule III
 Capsule  Suspension
 Accepted medical uses  Parenterals
 May lead to limited physical or psychological
dependence
MEDICATION ERROR AND RISK REDUCTION
o E.g. Valium, Darvon, Talwin
o Use with prescription ADMINISTERING MEDICATIONS SAFELY

 SCHEDULE III  Asses client’s health status

 Obtain medication history
 Moderate/less abuse potential than Schedules I and II  Determine whether the route of administering is
 Accepted for medical uses suitable.
 May lead to moderate physical dependence and high  Medication errors can occur at all stages of the
psychological dependence medication administration process: prescribing,
o E.g. morphine, anabolic steroids and transcribing, dispensing, administering, or
barbiturates. monitoring.
o Use with prescription  Nurses who do not follow the ten rights of medication
administration contribute to medication errors.
 SCHEDULE II  Common reasons why nurses do not follow the “rights”
include
 .  Poor pharmacologic knowledge
 .  Miscalculations
 .  Interruptions
 Increased workloads
 Fatigue

 SCHEDULE I TABLE 35.7 SAFETY STRATEGIES TO PREVENT

MEDICATION ADMINISTRATION ERRORS
 Highest abuse potential
 Not accepted for medical use, for research and analysis STAGE SAFETY STRATEGY
only
PRESCRIING  Computerized provider order entry
 May lead to severe physical dependence
 Medication reconciliation at times of
o E.g Heroin, marijuana (cannabis) transitions in care
methaqualone  Computerized provider order entry
TRANSCRIBING
to eliminate handwriting errors
PROPERTIES OF IDEAL DISPENSING  Clinical pharmacists to manage the
medication dispensing process.
 EFFECTIVENESS  Use of “tall man” lettering (e.g.,
DOPamine and DOBUTamine) to
  Always check a medication’s expiration date.
minimize confusion between look-
alike, soundalike, or confusing  Perform hand hygiene between clients. Antiseptic gels
medications. are appropriate to use if hands are not visibly soiled.
 Automated dispensing cabinets for
high-risk medications.
TEN ‘RIGHTS’ OF MEDICATION ADMINISTRATION
ADMINISTERING  Follow the “five rights” of medication RIGHT MEDICATION
administration.  The medication given was the medication orders.
 Institute strategies to minimize
interruption while nurse is RIGHT DOSE
administering medications.  The dose ordered is appropriate for the client.
 Use BCMA to ensure medications are  Give special attention if the calculation indicates
given the correct client. multiple pills or tablets or a large quantity of a liquid
 Use smart infusion pumps fo IV medication. This can be an indication that math
infusions. calculation may be incorrect.
 Keep current in pharmacology  Double-check calculations that appear questionable.
knowledge and medication  Know the usual dosage range of the medication.
calculations.  Question a dose outside of the usual
 Identify high-alert medication (e.g.,
anticoagulants, sedatives, insulin, RIGHT TIME
and opioids).  Give the medication at the right frequency and at the
time ordered according to agency policy.
PRACTICE GUIDELINES : ADMINISTERING  Medications should be given within the agency
MEDICATIONS guidelines.

 Nurses who administer medications are responsible for RIGHT ROUTE

their owns actions. Question any order that is illegible  Give the medication by the ordered route.
or that you consider incorrect. Call the provider who  Make certain that the route is safe and appropriate
prescribed the medication for clarification for the client.
 Be knowledgeable about the medications you RIGHT CLIENT
administer. You need to know why the client is
 Medication is given to the intended client
receiving the medication. Look up the necessary  Check the client’s identification band with each
information if you are not familiar with the medication. administration of a medication.
 Federal laws govern the use of controlled substances.  Know the agency’s name alert procedure when
Keep these medications in a locked place. clients with the same or similar last names are on the
 Use only medications that are in clearly labeled nursing unit.
container. RIGHT CLIENT EDUCATION
 Do not use liquid medications that are cloudy or have  Explain information about the medication to the
changed color. Oral suspension is an exception. client (e.g.,why receiving, what to expect, any
precautions).
 Calculate drug doses accurately. If you are uncertain,
ask another nurse to doble-check your calculations. RIGHT DOCUMENTATION
 Administer only medications personally prepared.  Document medication administration after giving it,
 Before administering a medication, identify the client not before.
correctly using the appropriate means of identification,  If time of administration differs from prescribed
such as checking the identification bracelet. time, note the time on the MAR and explain the
reason and follow-through activities (e.g., pharmacy
 Do not leave medications at the bedside, with certain states medication will be available in 2 hours) in
exception (e.g., nitroglycerin, cough syrup). Check nursing notes.
agency policy.  If time medication is not given, follow the agency’s
 If a client vomits after taking an oral medication, report policy for documenting the reason why.
this to the nurse in charge, or the primary care provider, RIGHT TO REFUSE
or both.
 Adult clients have the right to refuse any medication.
 Take special precautions when administering certain
 The nurse’s role is to ensure that the clients is fully
medications; for example, have another nurse check the informed of the potential consequences of refusal ad
dosages of anticoagulants, insulin, and certain IV to the healthcare provider.
preparations.
RIGHT ASSESSMENT
 Most hospital policies require new orders from the
primary care provider for a clients post-surgery care.  Some medications require specific assessment prior
to administration (e.g., apical pulse, blood pressure,
 When a medication is omitted for any reason, record the
laboratory results).
fact together with the reason.  Medication order may include specific parameters
 When a medication error is made, report immediately for administration (e.g., do not give if pulse less than
to the nurse in charge, the primary care provider, or 60 or systolic blood pressure less than 100.
both.
 b. Rate of dissolution
RIGHT EVALUATION
 Conduct appropriate follow-up (e.g., was desired c. Tissue perfusion
effect achieved or not? Did the client experience any d. Degree of ionization & pH of the environment:
side effects or adverse reactions?). a. “acid to acid; basic to basic”
e. Drug-drug or drug-food interaction
f. Lipid solubility

CHECK THREE TIMES FOR SAFE MEDICATION

 DISTRIBUTION
ADMINISTRATION
FIRST CHECK Methods in which drugs are transported by body fluids are
transported by body fluids to site of action.
 Read the MAR and remove the medication(s) from
the clients drawer. Verify that the clients name and  Factors affecting the distribution:
room number match the MAR. a. Tissue perfusion: primary factor
 Compare the label of the medication against the b. Lipid solubility
MAR. c. Drug – protein complexes
 If the dosage does not match the MAR, determine if d. General or selective :
you need to do a math calculation. Selective: presence of barriers
 Check the expiration date of the medication.  Blood-brain barrier
SECOND CHECK  Fetal – placental barrier

While preparing the medication (e.g., pouring, drawing up, or

placing unopened package in a medication cup), look at the  METABOLISM OR BIOTRANSFORMATION
medication label and check against the MAR.
Process by which the body inactivates the drug and makes it to be
THIRD CHECK excreted.
Recheck the label on the container (e.g., vial, bottle, or unused
 Primary site: Liver
unit dose medications) against the MAR before returning to its
storage place or before giving the medication to the client. o Role of Hepatic microsomal enzyme system: P-450
system
PHARMAKONETICS  Other sites: Gl tract, lungs, kidney, blood cells
 Enzyme induction drugs
‘PHARMACO” Medicine  Prodrugs
“KINETICS” Movement or motion  Factors affecting metabolism:
a. Age: Pediatric and Geriatrics
PHARMACOKINETICS
b. Illness
 Study of drug movement throughout the body
What is the implication of First – Pass Effect?
 “what the body does to the drug”
First – pass effect
 BASIC CONCEPTS:  Breakdown of oral drugs in the liver immediately after
absorption.
PLASMA MEMBRANES:
 EXCRETION
 Two main processes of drug movement : Process by which the drugs are removed from the body.
1. Diffusion
2. Active transport  Primar site Kidney:
 Characteristics:  Other sites:
1. Made up of liquids o Lungs, Glands (saliva, sweat, breastmilk), Bile
2. With proteins  Factors affecting excretion:
3. Composed of molecules a. Characteristic of drugs:
o Lipid – soluble & non-ionized; ionized & water –
soluble drugs
FOUR PROCESSES: PHAMACOKINETICS
o pH of drug and filtrate
 A - Absorption
 D - Distribution KEY CONCEPTS: PHARMACOKINETICS
 M - Metabolism HALF – LIFE
 E - Excretion
Length of time required for plasma concentration to decrease
 ABSORPTION by half after administration

Drug moves from site of administration to the bloodstream.

TERATOGENIC EFFECT
 Factors affecting absorption:  physical deformity to the growing fetus.
a. Route of administration
WEEK 4 - ANTIMALARIAL, ANTIPROTOZOAL AND
ANTHELMINTIC DRUGS

PROTOZOAL INFECTIONS

 Parasites Protozoa: live in or humans

 Malaria
 Leishmaniasis
 Amebiasis
 Giardiasis
 Trichomoniasis

MALARIA

 Caused by Plasmodium protozoa

 Four different Plasmodium species

WEEK 5 : ANTIBIOTICS ANTIBIOTIC THERAPHY

ANTIBIOTICS
 EMPIRIC THERAPHY
 Chemical that is able to inhibit growth of specific
 Treatment of an infection before specific culture
bacteria or cause the death of susceptible bacteria.
information has been reported or obtained
 Medications used to treat bacterial infections
 Ideally, before beginning antibiotic therapy, the
suspected areas of infection should be cultured to  PROPHYLACTIC THERAPHY
identify the causative organism and potential antibiotic
 Treatment with antibiotics to prevent an infection, as in
susceptibilities
intraabdominal surgery or after trauma.

THERAPEUTIC GOAL: ACTIONS OF ANTIBIOTICS

 Reduce the population of pathogenic bacteria to a
 BACTERICIDAL : “Kills” bacteria
number the body’s immune system can control.
 BACTERIOSTATIC : “inhibit” growth of susceptible
bacteria, rather than killing them immediately; will
BACTERIA eventually lead to bacterial death

PREVENTING THE DEVELOPMENT OF

RESISTANCE

 Identify bacteria
 Correct drug choice
 Full course of therapy
 Avoid inappropriate use

ANTIBIOTICS
 Careful selection of correct antibiotic
 Broad – spectrum
GRAM-POSITIVE  Narrow – spectrum
 Bacteria that take a positive (blue-violet) stain and are “CULTURE AND SENSITIVITY TEST”
frequently associated with infections of the respiratory  DRUG RESISTANT (those bacteria that possess
tract and soft tissues. mutations making them incentive to effect of antibiotic
 Hypersensitivity reaction
 Take the medication in full course (round the clock)
GRAM-NEGATIVE  Superinfection (diarrhea, bladder pain, painful
 Bacteria that accept a negative (red) stain and are urination or abnormal vaginal discharge)
frequently associated with infections of the GU or GI  Nosocomial infection
tract  Iatrogenic infection

HOW BACTERIA IS BEING REPRODUCED IN THE BODY?

 Cell wall synthesis

 DNA synthesis
 Protein synthesis
 Folid Acid Synthesis
  Allergic reactions
I. Cell
wall inhibitors
a. Penicilin: (CILLIN)  Nausea and vomiting
b. Cephalosporin:  Serious blood abnormalities
(CEF)

SULFOAMIDES: NURSING IMPLICATIONS

II. DNA  Should be taken with at least 2000mL of fluid per day,
IV. Folic Acid
Inhibitor unless contraindicated
MECHANISM Inhibitor
Fluoroquinol OF ACTION Sulfonamides:  Oral forms should be taken with food or milk to reduce
ones:
(SULFA)
(XACIN)
GI updet

PENICILLINS
III. Protein synthesis inhibitors
a. Macrolides: (MYCIN)
b. Aminoglycosides: (MICIN/MYCIN)
CLASSES:
c. Tetracylines: (CYCLINE)
 Regular
 Pen V
DRUG CLASSIFICATION: “ACFMPST”  Pen G
 Broad-spectrum or augmented
1. Penicillin  Amino-pen
2. Sulfonamides  Augmented
3. Cephalosporin  Penicillinase-resistant
4. Macrolides  Cloxacillin
5. Aminoglycosides
6. Tetracyclines
PENICILLINS
7. Fluoroquinolones
 Some bacteria secrete an enzyme, beta-lactamase or
SULFONAMIDES: MECHANISM OF ACTION penicillinase
 This allows the bacteria to become resistant to effects of
 Bacteriostatic Action most penicillins
 Prevent synthesis of folic acid required for synthesis of  Beta-lactamase inhibitors:
purines and nucleic acid a. Sulbactam
b. Tazobactam
SULFONAMIDES: INDICATIONS *With specific penicillins

 Treatment of UTIs caused by susceptible strains of:

o Enterobacter spp., Escherichia coli, Klebsiella MECHANISM OF ACTIONS
spp., Proteus mirabilis, Proteus vulgaris,  Bactericidal
Staphylococcus aureus  ‘CELL WALL INHIBITOR’, inhibiting synthesis of the
 Nocardiosis (caused by Nocardia spp.) bacterial cell wall and causing rapid cell lysis
 Pneumocystis jiroveci pneumonia (PJP)  Beta-lactam ring (antibacterial activity)
o Co-trimoxazole  Most effective against fast-growing susceptible bacteria
 Upper respiratory tract infections
 Other uses PHARMACOKINETICS

 Absorption: varies widely for oral from; absorptionis

SULFONAMIDES: COMBINATION PRODUCT
slow after IM administration
 Trimethoprim/sulfamethoxazole (co-trimoxazole,  Distribution: highly bound to albumin and widely
Bactrim, septra) distributed
o Used to treat UTIs, PJP, otitis media, other  Metabolism: partially metabolized in the liver
conditions  Excretion: most penicillins are excreted in the urine
 Erythromycin/sulfisoxazole (Pediazole)
o Used to treat otitis media WHEN TO USE PENICILLINS
 Sulfisoxazole (Gantrisin)
 Gram (+) cocci and bacilli infections
o Used to treat otitis media, UTIs, other
 Some gram (-) cocci infections
conditions
 Some anaerobe infections
 Enterococcal infections
SULFOAMIDES: ADVERSE EFFECTS
  Gram (-) bacteria infection  ABSORPTION : oral absorption widely varies; many are
 Staphylococci infections given IV
 DISTRIBUTION: widely to most tissues and fluids
 3rd and 4th generation penetrate BBB and
WHEN TO NOT USE PENICILLINS appear in CSF
 Allergy to penicillin or cephalosporin  All cross the placental barrier
 Allergy to caine-type local anesthetics  METABOLISM : varies widely (extensive or unchanged)
 MANY Interactions!  EXCRETION
 NSAIDs  Excreted primarily in the urine
 Oral contraceptives  Some drugs in breast milk
 Warfarin  May be removed by hemodialysis

ADVERSE REACTIONS WHEN TO USE

 Nausea, vomiting, diarrhea, epigastric distress  Gram (+) and gram (-) bacterial infections
 Rash, allergic reaction  Each subsequent generation has increased activity
 Pain at IM injection site, phlebitis at IV infusion site against gram (-) organism and reduced activity against
 Resistant bacterial and fungal superinfections gram (+) organism

KEY NURSING ACTIONS WHEN NOT TO USE

 Obtain an allergy history  Allergy to penicillin
 Obtain appropriate specimens for C&S  Pregnancy or breast-feeding
 Watch for allergic reaction  History of GI disease, particularly colitis
 Instruct patient to avoid taking oral Penicillinwith
ACIDIC JUICES OR CARBONATED BEVERAGES
 Assess for superinfection ADVERSE REACTIONS
 Teach importance of compliance  Nausea, vomiting, diarrhea
 Rash, anaphylaxis
PENICILLIN: NURSING IMPLICATION  Pain at IM injection site, phlebitis at IV infusion site
 Super-infections
 Any patient taking a penicillin should be carefully  Nephrotoxicity
monitored for an allergic reaction for at least 30
minutes after its administration.
KEY NURSING ACTIONS
 The effectiveness of oral penicillin is decreased when
taken with caffeine, citrus fruit, cola beverages, fruit  Obtain allergy history prior to administration
juices, or tomato juice; administer with at least 6 ounces  Observe for allergic reaction; if present discontinue the
of water drug and notify the physician
 Caution when administering with aminoglycoside
CEPHALOSPORINS because it can increase the risk of nephrotoxicity
 Administration with ORAL ANTICOAGULANTS may
 1st generation: cefalexin increase bleeding
 gm (+), gm (-) PEcK  Disulfiram reaction:
 2nd generation: cefaclor  Concurrent or 72 hours after alcohol
 gm (-) HENPEck, ˂ gm (+) consumption
 3rd generation: cefixime, ceftriaxone  CNS & CVS symptoms
 gm (-) HENPEcKS
 4 generation: cefepime
th
CEPHALOSPORINS: NURSING IMPLICATIONS

MECHANISM OF ACTION  Orally administered forms should be given with food to

decrease GI upset, even though this will delay
 Bactericidal absorption
 “CELL WALL SYNTHESIS INHIBITORS”  Some of these drugs may cause a disulfiram
 Chemically and pharmacologically similar to penicillins (Antabuse)-like reaction when taken with alcohol
 And kill or inhibit many gram (+) and gram (-) bacteria,
and some anaerobic bacteria. MACROLIDES

PHARMACOKINETICS PROTOTYPE : Erythromycin

LONG ACTING : Azithromycin PHARMACOKINETICS

MECHANISM OF ACTIONS  ABSORPTION: oral absorption poor; most are given

parenterally
 Bactericidal or bacteriostatic  DISTRIBUTION: widely distributed into ECF fluids;
 “BACTERIAL PROTEIN SYNTHESIS INHIBITOR” minimal CSF penetration
 Indicated for patients allergic to penicillins  METABOLISM : most are not metabolized
 EXCRETION: unchanged in the urine
PHARMACOKINETICS

 Absorption: readily absorbed in GIT but decreased by WHEN TO USE

presence of food  Aerobic gram (-) bacilli and soe gram (+) bacterial
 DISTRIBUTION: widely to most tissues and fluids infections
 Cross the placental barrier and enters breast  Septicemia
milk  Postoperative pulmonary, intraabdominal, and serious
 Half-life: short (1.6 hrs) or long (68 hrs) recurrent urinary tract infections
 METABOLISM : liver  Infections of the bones, skin, soft tissues, and joints
 EXCRETION  Ammonia-forming bacterial infections in the GIT
 Mainly in bile and feces (erythromycin)  Staphylococcal infections
 Unchanged in the urine (azithromycin)  Serious pseudomonas infections
 Enterococcal infections
WHEN TO USE  Nosocomial infections
 Tuberculosis
 UPPER RESPIRATORY TRACT INFECTIONS  PID
 Pharyngitis
 Serious Klebsiella infection
 Diptheria
 Otitis Media
 LOWER RESPIRATORY TRACT INFECTIONS ADVERSE REACTIONS
 Legionnaire’s disease  Vestibular and cochlear ototoxicity
 Mycoplasma pneumonia  Nephrotoxicity
 Chlamydial infections  Neurotoxicity
 Nausea and vomiting; diarrhea
KEY NURSING ACTIONS  Hypersensitivity reactions

 Obtain allergy history prior to administration

 Give the drug on empty stomach
KEY NURSING ACTIONS
 Note for gastric irritation and diarrhea  Assess 8th cranial nerve function to detect vertigo and
 Caution with concurrent use of DIGOXIN which can hearing loss
increase in blood level  Monitor renal function for evidence of nephrotoxicity
 May suppress CTY P450, caution with other drugs  Promote fluid intake of 1.5 - 2.0 L/day
 Monitor peak and trough levels to evaluate drug
MACROLIDES: NURSING IMPLICATIONS effectiveness and prevent toxicity

 These drugs are highly protein-bound and will cause

severe interactions with other protein-bound drugs TETRACYCLINES
 The absorption of oral erythromycin is enhanced when
taken on an empty stomach, but because of the high MECHANISM OF ACTION
incidence of GI upset, many drugs are taken after a meal
 Bacteriostatic
or snack.
 “BACTERIAL PROTEIN SYNTHESIS INHIBITORS”

AMINOGLYCOSIDES
PHARMACOKINETICS
PROTOTYPE : Streptomycin  ABSORPTION:
 Absorbed systemically after oral
MECHANISM OF ACTION administration
 Food generally increases absorption
 Bactericidal
 “BACTERIAL PROTEIN SYNTHESIS INHIBITOR”  Mineral may affect absorption
  DISTRIBUTION: PROTOTYPE : Quinolone
 Widely distributed; cross the placental barrier
 METABOLISM MECHANISM OF ACTION
 Renal but mostly not metabolized
 EXCRETION  Broad-spectrum, systemic antibacterials
 Urine  “BACTERIAL DNA SYNTHESIS INHIBITOR”

WHEN TO USE PHARMACOKINETICS

 Gram (+) and gram (-) infections  ABSORPTION:

 Acne  Well absorbed rapidly from GIT
 SIADH (demeclocycline as diuretic)  Food
 DISTRIBUTION
WHEN NOT TO USE  Widely distributed
 Pregnancy
 METABOLISM
 Breast-feeding  Partially in the liver or unchanged
 Hypersensitivity  EXCRETION
 Children younger than 8 years (teeth discoloration)  Primarily unchanged in the urine

ADVERSE REACTIONS WHEN TO USE

 GI: nausea and vomiting, flatulence, bulky and loose  Aerobic gram (+) and gram (-) infections
stools, epigastric pains  Bone and joint infections
 Hypersensitivity reaction  Skin and soft-tissue infections
 Pancreatitis, hepatotoxicity  Intra-abdominal infections
 Photosensitivity reaction, rash  UTI Pneumonia
 Pain at IM injection site, phlebitis at IV site  Acute sinusitis
 Mild increase in BUN levels  Chronic bronchitis
 May stain teeth or contact lenses  Gonorrhea
 Endocervical and urethral chlamydial
infections
INTERACTIONS
 Pelvic inflammatory disease
 Antacids, calcium supplements, iron supplements, Mg-
containing laxatives, milk can reduce absorption
WHEN NOT TO USE
KEY NURSING ACTIONS  Children
 Cardiovascular disorder
 Obtain urine specimen for culture and sensitivity before  CNS disorder seizures
starting drug therapy.  Renal insufficiency
 If giving drug IV, monitor IV sites for sphlebitis  Cerebral ischemia
 Avoidance of milk products and drugs containing Ca,  Severe hepatic dysfunction
Mg, Al, or Fe
 Measures to take for sun exposure
 Use of alternative contraception during and 1 week ADVERSE REACTION
after therapy.  Nausea
 Crystalluria
TETRACYCLINES: NURSING IMPLICATIONS  Phototoxicity
 Diarrhea
 Milk products, iron preparations, antacids, and other
 Rash
dairy products should be avoided because of the drug-
binding that occurs.
 All medications should be taken with 6 to 8 ounces of INTERACTIONS
fluid, preferably water
 May increase serum levels of methylxanthines
 Due to photosensitivity, avoid sunlight and tanning beds
 Antacids reduce effectiveness if given 2 to 8 hours of
drug administration
FLUOROQUINOLONES
NURSING IMPLICATIONS

 Assess drug allergies; renal, liver, and cardiac function;

and other lab studies
 Obtain thorough patient health history, including
immune status
 Assess for conditions that may be contraindications to
antibiotics use or that may indicate cautions use
 Assess for potential drug interactions
 It is ESSENTIAL to obtain cultures from appropriate
sites BEFORE beginning antibiotic therapy.

MONITOR FOR THERAPEUTIC EFFECTS

 Improvement of signs and symptoms of infection
 Return to normal vital signs
 Negative culture and sensitivity tests
 Disappearance of fever, lethargy, drainage, and redness
Monitor for adverse reactions