ppt chapter 41
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Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 41
Drugs that Are Miscellaneous Antibiotics
Chapter 41
Drugs that Are Miscellaneous Antibiotics
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
• Quinolones are effective for aerobic gram-negative and gram-positive infections.
– A. True
– B. False
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AnswerAnswer
• A. True
• Rationale: Quinolones are effective for treating aerobic gram-negative and gram-positive infections.
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Quinolones/Fluoroquinolones 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)
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Ciprofloxacin: Core Drug Knowledge 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
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Ciprofloxacin: Core Drug Knowledge (cont.)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
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Ciprofloxacin: Core Patient Variables 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.
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Ciprofloxacin: Nursing Diagnoses and Outcomes 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.
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Ciprofloxacin: Nursing Diagnoses and Outcomes (cont.)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.
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Ciprofloxacin: Planning and InterventionsCiprofloxacin: 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.
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Ciprofloxacin: Teaching, Assessment, and EvaluationsCiprofloxacin: 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.
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QuestionQuestion
• The most clinically important adverse reaction is
– A. Photosensitivity
– B. Arthropathy
– C. Hepatotoxicity
– D. Neurotoxicity
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AnswerAnswer
• 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.
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Cyclic Lipopeptides 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.
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Daptomycin: Core Drug Knowledge 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
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Daptomycin: Core Drug Knowledge (cont.)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.
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Daptomycin: Patient Variables 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
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Daptomycin: Nursing Diagnoses and Outcomes 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.
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Daptomycin: Nursing Diagnoses and Outcomes (cont.)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.
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Daptomycin: Planning and InterventionsDaptomycin: 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.
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Daptomycin: Teaching, Assessment, and EvaluationsDaptomycin: 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.
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QuestionQuestion
• Daptomycin is used to treat
– A. Respiratory infections
– B. Osteomylitis
– C. Carditis
– D. Complicated skin infections
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AnswerAnswer
• D. Complicated skin infections
• Rationale: Daptomycin is used to manage complicated skin and skin structure infections.