Aminoglycoside Monitoring - ansbaseline hearing test, BUN, creatinine irreversible

NCLEX Pharmacology Anti-infectives & Antibiotics Amino glycoside Recommendation During Tx - ansIncrease fluids 1500-2000 ml/day Aminoglycoside ADRs - ansGI, rash, pain or swelling at injection site, dizziness, tinnitus (ototoxic), suprainfections, anaphylaxis Aminoglycoside consideration for administration - ansCannot be given PO. Suitable

routes: IM, IV, topical, irrigation, and inhalation

Aminoglycoside Indication - ansTreat HAI of the respiratory tract such as ESCHERICHIA coli and KLEBIELLA species.Aminoglycoside Indication - ansUsed to treat SEVERE infections: SEPTICEMIA, severe UTIs (remember UTIs are a common cause of SEPTICEMIA) Aminoglycoside Monitoring - ansbaseline hearing test, BUN, creatinine (irreversible ototoxic and nephrotoxic), trough levels to watch for therapeutic levels and toxicity Aminoglycoside special consideration - ansThese anti-infectives are toxic and are used sparingly, hence they are not one of the top 200 RXed. Typically this medication is switched to a less toxic drug when infection has been identified.Aminoglycosides - ansgentamicin, streptomycin, tobramycin, neomycin, kanamycin, amikacin (note no top 200 RXed) (BE CAREFUL WITH THESE mycins. They're not macrolides) Aminoglycosides are gram + or - ? - ansThey are gram - (NEGATIVE) and treat aerobic bacteria such as escherichia coli and klebsiella species Aminoglycosides Mechanism of Action - ansMedications are bactericidal: they inhibit protein synthesis in bacteria and compromise the structure of the cell wall.

Azithromycin (Zpak) administration - ansDay 1: 2 caps

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Ciprofloxacin* Indication - ansTx illnesses associated with germ warfare such as anthrax and plague Clindamycin (Cleocin) - ansBS AB that is often used for oral infections Associated risk of Pseudomembranous colitis limits use 1 / 2

Clindamycin (Cleocin) ADR - ansADR rash pruritis, DIFFICULTY SWALLOWING Common pen infections - ansstreptococcal, syphilis, Lyme Daptomycin (Cubincin) ADR

Class: Cyclic-lipopeptide - ansGI, fever, headache, dizziness, INSOMNIA, rash

Daptomycin (Cubincin) Class: Cyclic-lipopeptide - ansReserved for serious skin

infections and abscess infections Fluoroquinolones - ansCiprofloxacin*, levofloxacin*, gatifloxacin, moxifloxacin, ofloxacin, nolfloxacin Fluoroquinolones ADR - ansGI, dizziness, headache, sleep disturbances, suprainfections, phytotoxicity, cardiotoxicity, tendon/joint injury Fluoroquinolones contraindications - anspregnancy, <18 years of age, with the exception of anthrax exposure Fluoroquinolones gram + or - ? - ansSurprise! it's both + and - Fluoroquinolones indication - ansNot first line treatment, but indicated for infections of the sinuses, skin, lungs, ears, urinary tract, bones and joints **** txs and prevents Anthrax**** Fluoroquinolones Interactions - ansAntacids, mineral supplements and multivitamins interfere with absorption up to 90% when given together Fluoroquinolones Mechanism of Action - ansBactericidal: They are the ONLY class of antimicrobial agents in clinical use that directly inhibit DNA synthesis in bacteria Fluoroquinolones Monitoring - ansBUN, creatinine, I & O <-- watch the kids Fluoroquinolones Special Indications - ansbeta-lactam resistant organisms (macrolides, tertacyclines, or ahminoglycosides) maybe susceptible to ciprofloxacin*

Fluoroquinolones WARNING - ansBlack Box: tendonitis and tendon rupture

GentaMICIN toxicity - ansSx: bilateral vestibulopathy (inner ear damage), imbalance, oscillopsia (transient visual blurring when moving the head - think oscillating) Hydroxychloroqyine (Plaquenil) - ansAntimalarial -- easier to prevent malaria than to treat. Prophylaxis for travel

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