Ppt chapter 41

1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 41
Drugs that Are Miscellaneous
Antibiotics

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Question
•Quinolones are effective for aerobic gram-negative and
gram-positive infections.
–A. True
–B. False

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Answer
•A. True
•Rationale: Quinolones are effective for treating
aerobic gram-negative and gram-positive infections.

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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
•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.)
•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
•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
•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.)
•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 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
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.

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
•The most clinically important adverse reaction is
–A. Photosensitivity
–B. Arthropathy
–C. Hepatotoxicity
–D. Neurotoxicity

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Answer
•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
•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
•Pharmacotherapeutics
–Used to manage complicated skin infections
•Pharmacokinetics
–Administered: IV. T
½
: 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.)
•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
•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
•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.)
•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 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
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.

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
•Daptomycin is used to treat
–A. Respiratory infections
–B. Osteomylitis
–C. Carditis
–D. Complicated skin infections

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Answer
•D. Complicated skin infections
•Rationale: Daptomycin is used to manage
complicated skin and skin structure infections.