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Class Mechanism Uses Adverse/SE Nursing Implications

-allergic rx: anaphylaxis infrequent
-Inhibits cell wall synthesis -infections: caused by but can be fatal -assess for allergies
by inhibiting cross-linking aerobic, Gram + organisms -pain at IM site Penicillinase Resistant PCN: hepatoxic & blood
PENICILLINS of polymers required for -lg doses leads to CNS effects dyscrasias
bacterial cell wall -rash Aminopenicillins=broad spectrum PCN
-ampicillin + sulbactam (Unasyn): inhibit beta-

-narrow spectrum -diarrhea (oral dose)


-clavulanatic acid + amoxicillin=Augmentin

-aminopencilllins -ampicillin is leading cause of
-anti-pseudomonas pseudomembranous colitis-C. difficile
-toxic rash: 8-10 days after therapy
-allergic rx-cross-allergy in some pts -CSF penetration w/ 3 generation
-inhibits bacterial cell wall Four generations:
allergic to PCN -assess for previous allergies; fewer allergic Rx than
synthesis, similar to PCN -pain at IM injection site PCN—DC if allergic
1 : Gram + organisms
CEPHALASPORINS nd -rash; abdomen, scalp & arms -monitor for seizures w/ renal dx
2 : incr. activity against

-pseudomembranous colitis— -may need to give w/ food

Gram –
rd C.difficile; diarrhea -monitor IV infusion closely
3 :decr. Gram + activity; incr.
-superinfections -monitor glucose levels in diabetic
Gram –; penetrates CNS
th DDIs: alcohol, NSAIDs, -monitor renal status: I&O, CrCl
4 : incr. beta-lactamase
anticoagulants, thrombolytics, -assess for superinfections; suggest yogurt

activity; incr. Gram + activity

Probenecid, bacteriostatic agents,

-must be administered parenterally

MONOBACTAMS -interference w/ cell wall -Gram – aerobic bacteria -pain or phlebitis @ admin site
-can be used for pts allergic to PCNs or
synthesis -UTI, septicemia, lower resp. -GI symptoms: N/V, diarrhea
tract infections, soft tissue-- -rash
aztreonam (AZACTAM)

-very broad spectrum -GI: N/V, diarrhea -IM or IV only

CARBAPENEMS -potent cell wall inhibitor -MRSA, P. aeruginosa -Hypersensitivity rx: rashes, pruritus -penetrates meninges
-resistant to beta- -P. colitis, seizures (rarely) -renally eliminated
imipenem,(PRIMAXIN) lactamase -MEROPENEM used for
meropenem (MERREM) resistant nosocomial

infections & meningitis, intra-

abdominal infections

-inhibits bacterial cell wall -narrow spectrum-primarily -ototoxicity (high doses)

synthesis (differs from against Gram+ (resistant -nephrotoxicity (high doses) -caution w/ other ototoxic/nephrotoxic drugs
PCN) infections) -neutropenia
-bactericidal -Staph (MRSA); Strep -“Red man/neck” syndrome
VANCONIN, LYPHOCIN - Pseudomembranous colitis -drug allergy
caused be C. difficile -give intermittent IV for best effect
DDIs: ototoxic & nephrotoxic drugs—
aminoglycosides, Amphotericin B,
Lasix, aspirin
Class Mechanism Uses Adverse/SE Nursing Implications
-broad spectrum, but -gastrointestinal irritation -food impairs absorption, avoid milk and antacids

widespread resistance limits -photosensitivity (best on empty stomach)

TETRACYCLINES -binds to 30S ribosomal use -CNS: dizziness or unsteadiness -ZITHROMAX (azithromycin) on empty stomach for
subunit, inhibiting st
-1 line for rickettsial -discoloration of teeth 5days
Short acting: binding of tRNA to infections (RMSF & typhus, -depression of bone growth in -doxycycline can be taken w/ food
Tetracycline, oxytetracycline mRNA-ribosome Q fever) children < 8yrs or fetuses -use protection from sunlight
complex -Lyme dx; Chlamydial dx -superinfections common -assess for signs of superinfection
Intermediate-acting: -inhibition of bacterial -Cholera, Mycoplasma (Staphylococcal enterocolitis, C. -administer w/ full glass of water
demeclocycline, methacycline protein synthesis pneumonia difficile) or Candida (throat, vagina & -stools may be yellow or green
-bacteriostatic -gonorrhea, chlamydia, bowel -tongue can discolor
-acne; Propionibacterium -hepatic toxicity from large doses -avoid taking old drug (bad rx)
dosycycline, minocycline
acnes -nephrotoxicity -avoid taking iron or vit C within 2-3 hrs
-Peptic ulcer dx-H. pylori -delayed blood coagulation
DDIs: Questran, iron, calcium binds & impair oral
absorption; decr. effectiveness of estrogen
contraceptives or PCN
-assess for frequent diarrhea, monitor wt

-inhibition of bacterial -may be used as alternative -GI irritation (oral erthromycin) -monitor for hepatoxicity
MACROLIDES protein synthesis to PCN G if allergic -N/V, diarrhea, abdominal cramping -give w/ water or food; best on empty stomach
-binds to 50s ribosome -PCN resistant Streptococcal -hepatoxicity in pregnancy -azithromycin should be given on empty stomach (5
and blocks addition of & Staphylococcal infections -cholestatic hepatitis days not 7-14)
new amino acids -Mycoplasma pneumoniae -> than 4 Gm/d=hearing loss -instruct not to chew or break capsules
erthromycin, -bacteriostatic (low) -thrombophlebitis when given IV
clarithromycin (BIAXIN), -bactericidal(high) -Mycobacterium avium DDIs: cytochrome P450 inhibitor-incr. levels of
azithromycin (ZITHROMAX) (clarithromycin) theophylline, carbamazepine, warfarin; prevents
binding of chloramphenicol & clindamycin to
ribosomes (antagonizes effects)

-does not penetrate CNS


AMINOGLYCOSIDES -binds to 30S subunit -Gram – aerobic infections -Ototoxicity (dose-dependent & -IM or IV only; not absorbed orally
and produces abnormal only; Enterobacter, Proteus, cumulative) -short plasma t1/2; long inner ear & renal tubule t1/2
proteins Pseudomonas, Klebsiella, -nephrotoxicity (dose-dependent &
(gentamicin, tobramycin, -assess hearing & balance
-bacteriocidal (high) Serratia cumulative) -monitor serum drug levels—peaks/troughs :
amikacin) -serious or life-threatening -acute muscular paralysis (rare) ototoxicity when levels > 8-10 ug/ml
infections -dizziness, vertigo, ataxia -peak: 1hr after IM, 30 min after IV
For some microorganisms, -trough: prior to next dose
the combo of aminoglycoside -caution w/ anesthetics & muscle relaxants
& PCN/cephalosporin leads -monitor renal function-CrCl, I & O
to incr. synergistic -DO NOT administer or mix in syringe w/ other drugs
antibacterial activity
-topical w/ gentamicin, DDIs: PCN & cephalosporin (synergy)
tobramycin, neomycin ototoxic drugs: ethacrynic acid, Lasix
nephrotoxic drugs: methoxyluarne, Amphotericin B,
cephalosporins, polymixins, vancomycin, cisplatin
Class Mechanism Uses Adverse/SE Nursing Implications

-act as competitive inhibitor -broad spectrum -assess for allergy to sulfa, thiazide diuretics, oral
-Gram + coccus, Gram- bacilli -GI irritation: N/V, diarrhea, hypoglycemic agents

in synthesis of folic acid

-urinary tract infections, pancreatitis, hepatitis -encourage fluids; 2000-3000 cc/day
from precursors; inhibits
acute otitis media, ulcerative -hypersensitivity: skin rashes -monitor I & O
enzyme (dihydropteroate
colititis (Steven Johnson syndrome) -monitor CBS & WBC
SULFONAMIDES synthetase)
- infections on burned skin; -nephrotoxic (highly protein bound) -take on empty stomach if possible
SILVADENE -bone marrow toxicity-blood -don’t give sulfa to children <12 y/o
sulamethoxazole, dyscrasia (w/ G-P-6D deficient-

-photosensitivity-protect against sunlight (clothing)

sulfadiazine, sulfisoxazole hemolytic anemia) -check other drugs)
-crystalline aggregates in urine -sulfasalazine turn urine/skin yellow-orange

DDIs: hepatic metabolism inhibitor-leads to incr.


levels of warfarin, hypoglycemic agents, phenytoin

-inhibits dihydrofolic acid -active against Gram (-) -rare w/ trimethroprim alone -if possible, should be avoided during pregnancy &

TRIMETHOPRIM reductase enzy organisms; Proteus & -blood dyscrasias lactation

-penetrates tissues & Klebsiella -DO NOT USE in folate deficient patients
trimethoprim & concentrates in: breast -in combo w/ (Bactrim & -inform patients about sx of blood disorders
sulfamethoxazole=BACTRIM milk, bile, prostatic fluid, Septra) used to treat P.
or SEPTRA vaginal fluids, liver, spleen carinii, UTI;s, traveler’s
1:5 ratio--synergistic & kidney diarrhea

-interferes w/ bacterial -bactericidal concentrations in -GI-N/V, anorexia -instruct to monitor blood glucose
enzymes; damages DNA urine (not in blood or tissues) -pneumonititis or pulmonary fibrosis -may cause false positives on urine tests
NITROFURANTOIN -2 choice urinary tract -effective for UTIs; E.Coli, after long use -take w/ meals or snack
antiseptic Enterobacter, Klebsiella, -rashes, allergic rx -oral suspension may stain teeth-use straw & good
-Gram + & - organisms Proteus , enterococci & staph -urine turns brown (harmless) oral hygiene
-peripheral neuropathy

-interferes w/ bacterial -anaerobic infections: -GI irritation -may potentiate action of warfarin; observe for signs
DNA synthesis by causing Bacteroides, C. diff, H. pylori, -metallic taste of bleeding
strand breakage & loss of -toxic (disulfiram-like effect) w/ -caution about disulfiram rx
structure leads to inhibition -protozoal infections: alcohol -avoid in pregnancy
(FLAGYL) of nucleic acid synthesis Trichomoniasis, Amebiasis, -avoid in pts w/ CNS disease or blood dyscrasias
leads to cell death Giardiasis

-GI irritation: N/V, diarrhea -protect against sunlight

-inhibition of bacterial DNA -broad spectrum
QUINOLONES -CNS: dizziness, HA, tinnitus, -urine may be brown or bright orange
synthesis by inhibiting -UTI’s (Gram -) difficult to
seizures (rare), insomnia -monitor renal status
enzyme (DNA gyrase); treat w/ other drugs
Ciprofloxacin (CIPRO) -photosensitivity -may cause confusion in elderly
prevents supercoiling & -respiratory infections-
Levofloxacin (LEVAQUIN) -tendonitis -do not use w/ children
DNA replication cannot pneumonia, bronchitis
Ofloxacin (FLOXIN) -damage to growing cartilage -don’t take AL or Mg antacids
take place -bacterial diarrheas (E.coli,
Sparfloxacin (ZAGAM) -crystalluria w/ alkaline urine
-bactericidal Shigella, Salmonella) DDIs:CIPRO w/ theophylline & warfarin-lowers
-skin rash, itching, SOB, serum
Al & Mg antacids, sucralfate, iron, milk-blocks