ANTIBIOTICS / ANTIMICROBIAL DRUGS

A. AMINOGLYCOSIDES
Prototype: Gentamicin (Garamycin)
Action: Acts by suppressing protein synthesis in bacterial cell; bactericidal.
Use: serious gram-negative bacterial infections, eye infections.
Adverse effect: toxicity, nephrotoxicity, neuromuscular blockade, and hypersensitivity photosensitivity with topical
preparations
Related drugs:
1.
Amikacin (Amikin)
4.
Streptomycin

2.
3.

kanamycin (Kantrex) are given orally

Neomycin (Niobiotic) to prepare the bowel
for surgery

5.

Tobramycin

6.

Netilmicin

7. *Neomycin- given to persons in hepatic failure to reduce ammonia levels.

8.
9. B. PENICILLINS
10. Prototype: Penicillin G Potassium
11. Action: inhibits cells wall synthesis of microorganism; bactericidal
12. Use: Systemic infections caused by gram (+) cocci; syphilis, prophylaxis for rheumatic fever and bacterial
endocarditis
13. Adverse Effect: Hypersensitivity, G.I upset, potassium poisoning, irritation at injection site.
14. Nursing Implications: give oral form on an empty stomach with a full glass of water; IV solutions are
stable at room temperature for 24 hrs. only

15. Probenecid: may be given to increase blood levels of penicillin.

16. Related drugs:
17. 1. Penicillinase resistant penicillins
18. -used to treat infection caused by penicillinase producing organism.
19. Examples: a.) Nafcillin sodium
20.
21. 2. Aminopenicillins

b.) Cloxacillin

22.

-increased effectiveness against gram negative organism.

23. Examples
24. : a.) Ampicillin
26.
c.)
25.
b.) Amoxicillin
Bacampicillin
27. 3. Extended-spectrum penicillins
28.
-structurally similar to ampicillin but have an increased spectrum of activity against gram-negative
bacteria.
29. Examples: a.) Carbenicillin sodium
30.
b.) Piperacillin
31. 4. Penicillin / beta-lactamase inhibitor combinations
32.
-prevents destruction of penicillin by enzymes and extend the penicillins spectrum of antimicrobial
activity.
33. Examples: Amoxicillin / potassium clavulanate (Augmentin) Ampicillin/ Sulbactam (Unasyn)
34. C. CEPHALOSPORINS divided into 4 generations based on their spectrums of activity.
35. Prototype for first generation (ephalozorines- Cefazolin Sodium (Ancef)
36. Action: Inhibits bacterial cell wall synthesis; bactericidal.
37. Use: infection caused by gram-positive cocci; septicemia; serious intraabdominal infection.
38. Adverse Effect: Phlebitis at IV site; diarrhea, pseudomembranous colitis, hypersensitivity, fungal

44.

52.

59.
60.

overgrowth, discomfort at IM injection site, nephrotoxicity, hepatoxicity, bone marrow depression.

39. Nursing Implications:
40. 1. Assess for hx of penicillin allergy as there is a cross allergy between cephalosporin and penicillin.
41. 2. Dose will be reduced with renal and liver impairment
42. 3. Probenecid therapy will increase blood levels of cephalosporin.
43. Related drugs:
a.) Cephalexin (keflex)
45.
b.) Cephradine (Valosef)
nd
46. Prototype for 2 generation Cephalosporins Cefoxitin Sodium (Mefoxin)
47. Action: same as above
48. Use: infection caused by gram-negative and gram-positive bacteria; septicemia, pelvic skin soft tissue
infections, prophylaxis in abdominal or pelvic surgery; gonorrhea.
49. Adverse Effect: same as above
50. Nursing Implications: Lidocaine is used as diluent for IM injection and helps reduced pain of IM injection.
51. Related drugs:
a.) Cefaclor (Ceclor)
53.
b.) Cefuroxime sodium
54.
c.) Cefrozil
rd
55. Prototype for 3 generation Cephalosporins Cefotaxime (Claforan)
56. Use: Serious infections caused by gram-negative and gram-positive bacteria
57. Nursing Implication: Dont mix with aminoglycoside solutions; protect IV solution from light.
58. Related drugs:
a.) Ceftazidime
61.
c.) Cefixine
63.
e.) Cefpodoxime
b.) Ceftriaxone
62.
d.) Cefoperazone
64.
f.) Ceftibuten
th
65. Prototype for 4 generation Cephalosporins Cefepine (maxipene)
66. Use: UTI caused by E. coli or klebsiella pneumonia caused by streptococcus pneumoniae Pseudomonas
acryinosa or enterobacter.
67. Nursing Implication: have vit. K available if hypoprothombinemia develops.
68. Related Drug: Cefditoren
69. D. MACROLIDES
70. Prototype: Erythromycin
71. Action: Inhibits protein synthesis in bacterial cell, bacteriostatic.

72. Use: person allergic to penicillin, legionnaires Disease, mycoplasma pneumonia, intestinal dysenteric
amebiasis, acne, staphylococcal and streptococcal infections.
73. Adverse Effect: G.I irritation, superintations, allergic reactions, hepatitis, reversible hearing loss.
74. Nursing Implications:
75. -Take on empty stomach with a full glass of water.
76. -G.I symptoms are dose related
77. -do not give with acids
78. -IV must be diluted sufficiently and administered slowly to avoid venous irritation and thrombophlebitis.
79. Related drugs:
1.) Erythromycin estolate (Ilosone)
82.
3.) Clarithromycin (Biaxin)
2.) Azithromycin (Zithromax)
83.
4.) Dirithromycin (Dynabac)
84. E. TETRACYCLINES
85. Prototype: Tetracycline hydrochloride (Acromycin V)
86. Action: broad-spectrum with bateriostatic action and, at higher doses, bactericidal action; inhibits bacterial
wall synthesis, reduces free fatty acids from triglycerides thus reducing acne lesions
87. Use: Chlamydia, mycoplasma, rickettsia, acne vulgaris, gonorrhea, spirochetes
88. Adverse Effect: hypersensitivity, superinfection chelating to teeth and new bome, N/V, diarrhea, colitis,

80.
81.

headache, dizziness, abdominal cramping, photosensitivity.

89. Nursing Implications:
90.
a.) Avoid use during pregnancy, in nursing women, and in children under age 8 as drug binds to calcium
in teeth and new bone growth, which results in tooth discoloration of permanent teeth and retarded bone growth
91.
b.) Give deep IM
92. Discharge Teaching:
93.
a.) Take 1hr. before or 2 hrs. After meals and avoid taking with dairy products, antacids, vitamins and
minerals.
94.
b.) Avoid the sun while taking drug and for a few days after therapy is terminated
95.
c.) Use meticulous hygiene to reduce super infections.
96. Related Drugs:
1.
Doxycycline (Vibramycin) can be administered with food.

2.

Minocycline (Minocin) can be taken with food. Dizziness and fatigue may occur.

3.

Demeclocycline (Declomycin) administer on an empty stomach; foods high in calcium and iron interfere

with absorption.

97. F. CHLORAMPHENICOL
98. Prototype: Chloramphenicol (Chloramycetin)
99. Action: a synthetic broad-spectrum agent primarily bacteriostatic but is bactericidal in higher dose; inhibits
protein synthesis
100.
Use: Haemophilus influenzae meningitis, rickettsia, salmonella typhi, mycoplasma, bactereoides,
typoid fever.
101.
*Chloramphenicol is used only in severe infections when other antibiotics can not be used due to
its severe adverse effect of aplastic anemia.
102.
*Gray baby syndrome: abdominal distention, vomiting, pallor, irregular respiration; circulatory
collapse.
103.
Adverse Effect: Aplastic Anemia; neurotoxicity; gray baby syndrome (seen in premature infants,
newborn and children less than 2yrs old), hypersensitivity, N&V, enterocolitis, superinfections, bitter taste
especially after IV injection.
104.
Nursing Implications: Do not give by IM injection
105.
Discharge Teaching: 1.) inform physician immediately of fever, fatigue, sore throat, or bruising.

106.
107.
108.
109.

2.) Take drug on empty stomach unless upset.

G. SULFONAMIDES
Prototype: Sulfisoxazole (Gantrisin)
Action: prevents conversion of para-amino benzoic acid (PABA) to folic acid, which is required for
bacterial growth; bacteriostatic, can be bactericidal in high urinary concentrations
110.
Use: UTI, Otitis media, nocardiosis, vaginitis
111.
Adverse effects: hypersensitivity, Sterens-Johnson syndrome (acute onset of fever,bullae on skin

114.
115.
116.
118.

and ulcers in mucous membranes of lips, eyes, mouth, nasal passages, and genetalia, pneumonia, joint
pain ad prostratin are also seen fever 7 to 10 days after starting therapy may indicate sensitization or
hemolytic anemia; renal dysfunction hematologic reaction, G.I reaction; photosensitivity
112.
Nursing Implications: Give oral form on empty stomach with full glass of water.
113.
Discharge Teaching:
a.) avoid direct sunlight
b.) increased hypoglycemic reactions for patients taking OHA
c.) Oral contraceptives may be unreliable while client is receiving sulfonamides.
117.
Related drugs:
1.) Sulfasalazine (Azulfidine)-used in treatment of ulceratives colitis, constains aspirin, so it is

contraindicated in clients allergic to salicylates.

119.
2.) Sulfamethoxazole-can be given in combination with trimethoprim. (bactrim)-used in treatment of UTI,
bronchitis, pneumocystis pneumonia.
120.
H. URINARY ANTI-INFECTIVES
121.
1. Methenamine (mandelamine)
122.
-converted to formaldehyde (which is bactericidal) in the presence of acidic urine
123.
Adverse Effect: N&V, diarrhea
124.
Nursing Implications: -give with food
125.
-avoid foods, fluids, and medications that alkalinize urine
126.
2. Nalidixic Acid (Neg Gram)
127.
-bactericidal effect in gram-negative bacteria by preventing transmission of genetic
informations.
128.
Adverse Effect: Photosensitivity, headache, dizziness
129.
Nursing Implication: give with food.
130.
3. Nitrofurantoin (Macrodantin)
131.
-interferes with carbohydrates metabolism of bacteria; bacteriostatic in low concentration, and
bactericidal in high concentrations.
132.
I. VANCOMYCIN
133.
Prototype: Vancomycin hydrochloride (Vancocin)
134.
Action: interferes with cell membrane synthesis and exhibits a bactericidal and bacteriostatic
effect.

135.

Use: staphylococcus infections, pseudomembranous colitis, grain positive organism s, penicillin

and methicillin resistant bacteria

136.
Adverse Effect: Ototoxicity, nephrotoxicity, hypersensitivity, thrombophlebitis, red-neck syndrome:
(flushing and hypotension from rapid infusion), superifection.
137.
J. FLUOROQUINOLONES
138.
Prototype: Ciprofloxacin (Cipro)
139.
Actions: Inhibits DNA-syrase (an enzymes needed for replication of bacterial DNA) bactericidal
140.
Use: pseudomonas infections, gram-negative urinary tract infections or gram-negative systemic
infections

141.
142.

Adverse Effect: N&V, diarrhea, headache, tremors

Nursing Implications:
143.
a.) administer with a large glass of water to prevent crystalluria
144.
b.) Do not give with antacids.
145.
c.) Give 2hrs after meals.
146.
Related drugs:
1.
Norfloxacin
3.
Leofloxacin

2.

Gatifloxacin (Tequin)

4.

Sparfloxacin (Zagam)

5. K. ANTITUBERCULAR DRUGS
6. Prototype: Isoniazid (INH)
7. Action: Bacteriostatic and in high concentration becomes bactericidal
8. Use: initial treatment of tuberculosis; prophylactic treatment of tuberculosis in high risks group.
9. Adverse Effect: peripheral neuritis, jaundice, nausea, blood dyscrasis
10. Nursing Implications: give vit B6; on empty stomach, tyramine rich foods should be avoided; avoid
histamine-containing foods as they may cause an exaggerated drug response; avoid alcohol
11. Related drugs:
12. 1.) Ethambutol
13. Adverse Effect: optic neuritis, a loss of red green color discrimination, and decreased visual acuity can
occur with dosages of 250mg
14. 2.) Rifampicin body fluids may turn orange.
15. 3.) Streptomycin damage to cranial nerve VIII
16.
-renal toxicity
17. 4.) Pyrazinamide excess uric acid levels, w/c can cause gout or hepatic