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Nursing 10001 Antimicrobial Therapy

Terms in this set (35)

Are beta lactam ring structure

They interfere w/ bacterial cell wall synthesis by stopping the bacterial enzyme that's necessary for cell division

When exposed to penicillin, the bacteria will die and will cause cell to break down

Both bacteriostatic and bactericidal; depends on dose and duration of therapy

Mainly referred to as beta lactam antibiotics

However, bacteria has become stronger and smarter over the years

When broad spectrum antibiotics such as amoxiciilins are combined w/ other beta-lactamase enzyme inhibitors such as tazobactam

Zosyn is piperacillin and tazobactam (Penicillin and beta-
lactamase enzyme inhibitor together); they work a lot better to
get rid of these really severe infections. They inhibit the bacteria
beta- lactamase cascade and makes it harder for the bacteria to
continue to grow

Important to teach pt. about any side effects of ANY type of antibiotic that you're going to give

Penicillins- teach pt. about hypersensitivity and anaphylaxis, possible allergic reactions (skin reaction, difficulty swallowing); STOP the med, Call 911, and don't give same med again to pt.

Teach pt. about Superinfection (tell pt. to look out for yeast infections, diarrhea for C-diff, mouth sores, tongue discoloration, ulcers in the mouth,GI distress, CDAD)

Before giving penicillin, you need to collect a C&S test

Make sure pt. doesn't have any allergies to penicillin

Refer pt.'s to get allergy testing to make sure that they are really allergic to penicillin

Assess any lab results especially liver enzymes b/c this med is metabolized by liver

Nursing Interventions:
Obtain any cultures or swabs
Assess for any issues w/ bleeding b/c penicillin has been known to decrease the platelet clotting time which means you will bleed longer
Teach pt.s to take the ENTIRE course of antibiotic

Drug interactions: Potassium supplements can increase serum potassium levels when taken with potassium penicillin G or V. When penicillin is mixed with an aminoglycoside in IV solution, the actions of both drugs are inactivated.

10% of ppl who have allergies to penicillin can Actually also have an allergy to cephalosporins
Class of Med: Anti-Infective (Beta lactam), Broad spectrum

Look out for 'cefa'
cefadroxil, cefazolin, cephalexin

Intended action: inhibition of cell wall synthesis in bacteria, leading to cell death (bactericidal)

Uses:
pharyngitis, tonsilitis, otitis, pneumonia, UTI's, skin infections, endocarditis, septicemia, bone and joint infections, billiary infections, respiratory infections, otitis media, cellulitis, impetigo, surgical prophylaxis, MSSA, mild diabetic foot ulcers, genital infections,

Side, adverse or life threatening effects :
anaphylaxis, angioedema, fever, rash, chills, arthralgia (pain in joint), GI distress (nausea, diarrhea, vomiting, abdominal pain, flatulence), CDAD, C-diff colitis, anorexia, elevated hepatic enzymes, increased bilirubin, increased LDH, increased BUN, nephritis, superinfection (C-diff or yeast infection (candidiasis), vaginitis,), Steven- Johnson Syndrome , seizures (high doses), injection site reaction, eosinophilia, headache, dizziness, paresthesias (pins and needles sensation), lethargy, Nephrotoxicity in pt.'s w/ predisposing renal impairment, phlebitis and local abscess at site of injection, heartburn, hypersensitivity, aplastic anemia, toxic epidermal necrolysis, glossitis, leukopenia, thrombocytopenia, proteinuria, renal failure, agranulocytosis, neutropenia, lymphocytosis, pancytopenia, urticaria, dermatitis, arthritis, dyspnea, serum sickness.


Drug Interactions:
Aminoglycosides: increased risk for nephrotoxicity
Oral anticoagulants: increased bleeding
Alcohol: avoided for 72 hours after discontinuation of the drug to prevent disulfiram-like reaction (e.g. flushing, throbbing headache, nausea and vomiting, chest pain, palpitations, dyspnea, syncope, vertigo, convulsions, etc.)


Nursing Assessment:
Assess for allergy to cephalosporins or penicillins. If a patient is allergic to one type or class of cephalosporin, that patient should not receive any other type of cephalosporin or penicillin. •

Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp, earache,

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Monitor electrolytes: K+, Na+, Cl- monthly id on long term therapy

Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess


Nursing Plan:
The patient's infection will be controlled and ultimately eliminated.


Nursing Interventions:
Culture the infected area before cephalosporin therapy is started. The organism causing the infection can be determined by culture, and the antibiotics the organism is sensitive to are determined by sensitivity. If antibiotic therapy is started before culture result is reported, the antibiotic may need to be changed after C&S test results are received.
Class of Med: Anti-Infective (Beta Lactam), Broad spectrum

Look for fix or t; also ends in -ime

cefdinir, cefditoren,

Intended action: inhibition of cell wall synthesis in bacteria, leading to cell death (bactericidal)


Uses:
pharyngitis, tonsilitis, otitis, otitis media, pneumonia, community acquired pneumonia, UTI's, skin infections, acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, viridans strepticocci, bone and joint infections, respiratory infections, febrile neutropenia, intrabdominal infections, acute bronchitis, gonorrhea, gonococcal infections, bacteremia, septicemia, meningitis, CNS infections, peri-operative prophylaxis, PID, ventriculitis (inflammation of ventricles in brain), STD's, gynecologic infections

Contraindicated in infants < 1 month, hypersensitivity of cephalosporins and penicillins

Side, adverse or life threatening effects :
Dizziness, headache, weakness, paresthesia (pins and needles), fever, chills,SEIZURES, dyskinesia (uncontrolled, involuntary muscle movement), NEUROTOXICITY (CEFDINIR), HF, SYNCOPE (CEFDINIR), oral candidiasis, diarrhea, nausea, vomiting, anorexia, pain, glossitis, bleeding, increased AST, ALT, bilirubin, LDH, ALP, abdominal pain, C-DIFF COLITIS (superinfection), CHOLECTASIS { reduction or stoppage of bile flow} (CEFOTAXIME), PROTEINURIA, vaginitis (superinfection), pruritus (itching), candidiasis (superinfection), increased BUN, NEPHROTOXICITY, RENAL FAILURE, LEUKOPENIA, THROMBOCYTOPENIA, AGRANULOCYTOSIS, anemia, NEUTROPENIA, LYMPHOCYTOSIS, EOSINOPHILIA, PANCYTOPENIA, HEMOLYTIC ANEMIA, rash, urticaria (hives), dermatitis, ARTHRALGIA (CEFDITOREN), STEVEN-JOHNSON SYNDROME, dyspnea, ANAPHYLAXIS, SERUM SICKNESS, TOXIC EPIDERMAL NECROLYSIS.

Drug/ Food Interactions:

MANY PRODUCTS SHOULD NOT BE USED W/ CALCIUM SALTS (MIXED OR ADMINISTERED) OR H2 BLOCKERS ANTACIDS (PO)
Cyclosporine: increased cyclosporine levels
Furosemide, probenecid: increased effect/toxicity
Iron: decreased absorption of cefdinir
Plicamycin, valproic acid: increased bleeding
Aminoglycosides: increased effect/toxicity
Anticoagulants, antiplatelets, NSAIDS, thrombolytics: increased bleeding
Food: Iron-rich cereal, infant's formula: decreased absorption

Nursing Assessment:
Assess for allergy to cephalosporins or penicillins. If a patient is allergic to one type or class of cephalosporin, that patient should not receive any other type of cephalosporin or penicillin. •

Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp.

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), pruritus (itching), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Monitor electrolytes: K+, Na+, Cl- monthly id on long term therapy

CDAD: Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection (overgrowth of infection): perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

Monitor HR during direct IV infusion (cefotaxime)

Nursing Plan:
The patient's infection will be controlled and ultimately eliminated.


Nursing Interventions:
Culture the infected area before cephalosporin therapy is started. The organism causing the infection can be determined by culture, and the antibiotics the organism is sensitive to are determined by sensitivity. If antibiotic therapy is started before culture result is reported, the antibiotic may need to be changed after C&S test results are received.

Check to see if pt. is allergic to penicillin or cephalosporins

Administer around the clock to maintain blood levels

Administer at least 1 hour before or 2 hours after meals

If patient experiences GI upset: take w/ food

Obtain a sample for C&S before giving med

Monitor for S&S of superinfection (C-diff, yeast infections); especially in pt.'s taking higher doses
To prevent superinfection, give pt.'s cultured dairy (yogurts, probiotics) to eat or take.

Assess pt. for bleeding (monitor PT, INR); increases bleeding times

Monitor body temp and infected area for any changes
Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp, earache,

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Monitor electrolytes: K+, Na+, Cl- monthly id on long term therapy

Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

Monitor HR during direct IV infusion (cefotaxime)


Pt/family teaching:
Report sore throat, bruising, bleeding, joint pain (may indicate blood dycrasias {rare})

Contact provider if vaginal itching, loose-foul smelling stool, furry tongue occurs (superinfection)

Take Entire course of meds until bottle is empty

Don't take a DOUBLE DOSE

NOTIFY PROVIDER OF DIARRHEA W/BLOOD, PUS, MUCUS (C-DIFF COLITIS)

Keep drugs out of reach of children.

• Tell patients to report signs of superinfection, such as mouth ulcers or discharge from the anal or genital area. •

Advise patients to ingest buttermilk, yogurt, or an acidophilus supplement to prevent superinfection of the intestinal flora.

Infuse all IV cephalosporins over 30 minutes or as ordered to prevent pain and irritation. •

Observe for hypersensitivity reactions.

Warn patients to report any side effects from use of oral cephalosporin drugs; these may include anorexia, nausea, vomiting, headache, dizziness, itching, and rash.

Diet • Advise patients to take medication with food if gastric
irritation occurs. •

Encourage patients to take an adequate amount of fluids to avoid dehydration from diarrhea.





Evaluation •
Evaluate the effectiveness of the cephalosporin by determining
whether the infection has ceased and that no side effects,
including superinfection, have occurred.
Class of Med: Anti-Infective (Beta Lactam), Broad spectrum

Look for Quino or Pi

Cefepime, cefditoren, ceftaroline

Intended action: inhibition of cell wall synthesis in bacteria, leading to cell death (bactericidal)

Uses:
pharyngitis, tonsilitis, otitis, pneumonia, UTI's, skin infections, septicemia, bone and joint infections, respiratory infections, otitis media, cellulitis, impetigo, genital infections, gynecologic infections, gonococcal infections, intrabdominal infections, peritonitis, secondary bacterial infection of acute bronchitis, acute bacterial exacerbation of chronic bronchitis, acute sinusitis, meningitis, PID, Lyme disease, gonorrhea.

Contraindicated in seizures, hypersensitivity of cephalosporins and penicillins

Side, adverse or life threatening effects :
Dizziness, headache, fatigue, paresthesia (pins and needles), fever, chills, confusion, diarrhea, nausea, vomiting, anorexia, dysgeusia (altered taste), glossitis, bleeding, increased AST, ALT, bilirubin, LDH, ALP, abdominal pain, loose stools, flatulence, heartburn, stomach cramps, colitis, jaundice, C-DIFF COLITIS (superinfection), vaginitis (superinfection), pruritus (itching), candidiasis (superinfection), increased BUN, NEPHROTOXICITY, RENAL FAILURE, pyuria (pus in urine), dysuria (pain when urinating), reversible interstitial nephritis, LEUKOPENIA, THROMBOCYTOPENIA, AGRANULOCYTOSIS, anemia, NEUTROPENIA, LYMPHOCYTOSIS, EOSINOPHILIA, PANCYTOPENIA, HEMOLYTIC ANEMIA, LEUKOCYTOSIS, GRANULOCYTOPENIA, rash, urticaria (hives), dermatitis, STEVEN-JOHNSON SYNDROME, dyspnea, ANAPHYLAXIS, SERUM SICKNESS.

Drug Interactions:
Antacids: decrease absorption of cephalosporins
Furosemide: increased effect/toxicity
Plicamycin, valproic acid: increased bleeding
Probenecid: decreased excretion of product and increased blood levels/toxicity
Aminoglycosides: increased effect/toxicity
Anticoagulants, antiplatelets, NSAIDS, thrombolytics: increased bleeding


Nursing Assessment:
Assess for allergy to cephalosporins or penicillins. If a patient is allergic to one type or class of cephalosporin, that patient should not receive any other type of cephalosporin or penicillin. •

Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp.

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), pruritus (itching), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Monitor electrolytes: K+, Na+, Cl- monthly id on long term therapy

CDAD: Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection (overgrowth of infection): perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum


Nursing Plan:
The patient's infection will be controlled and ultimately eliminated.


Nursing Interventions:
Culture the infected area before cephalosporin therapy is started. The organism causing the infection can be determined by culture, and the antibiotics the organism is sensitive to are determined by sensitivity. If antibiotic therapy is started before culture result is reported, the antibiotic may need to be changed after C&S test results are received.

Check to see if pt. is allergic to penicillin or cephalosporins

Administer around the clock to maintain blood levels

Administer at least 1 hour before or 2 hours after meals

If patient experiences GI upset: take w/ food

Obtain a sample for C&S before giving med

Monitor for S&S of superinfection (C-diff, yeast infections); especially in pt.'s taking higher doses
To prevent superinfection, give pt.'s cultured dairy (yogurts, probiotics) to eat or take.

Assess pt. for bleeding (monitor PT, INR); increases bleeding times

Monitor body temp and infected area for any changes
Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp, earache,

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Monitor electrolytes: K+, Na+, Cl- monthly id on long term therapy

Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum


Pt/family teaching:
Report sore throat, bruising, bleeding, joint pain (may indicate blood dycrasias {rare}); SYMPTOMS OF HYPERSENSITIVITY

Contact provider if vaginal itching, loose-foul smelling stool, furry tongue occurs (superinfection)

Take Entire course of meds until bottle is empty

Don't take a DOUBLE DOSE

NOTIFY PROVIDER OF DIARRHEA W/BLOOD, PUS, MUCUS (C-DIFF COLITIS)

Keep drugs out of reach of children.

• Tell patients to report signs of superinfection, such as mouth ulcers or discharge from the anal or genital area. •

Advise patients to ingest buttermilk, yogurt, or an acidophilus supplement to prevent superinfection of the intestinal flora.

Infuse all IV cephalosporins over 30 minutes or as ordered to prevent pain and irritation. •

Observe for hypersensitivity reactions.

Warn patients to report any side effects from use of oral cephalosporin drugs; these may include anorexia, nausea, vomiting, headache, dizziness, itching, and rash.

Diet • Advise patients to take medication with food if gastric
irritation occurs. •

Encourage patients to take an adequate amount of fluids to avoid dehydration from diarrhea.

Evaluation •
Evaluate the effectiveness of the cephalosporin by determining
whether the infection has ceased and that no side effects,
including superinfection, have occurred.
Class of Med: Anti-Infective (Beta Lactam), Broad spectrum

Look for ceft+ol

only cephalosporins effective against methicillin-resistant Staphylococcus aureus (MRSA)


Intended action: inhibition of cell wall synthesis in bacteria, leading to cell death (bactericidal)


Uses:
pharyngitis, tonsilitis, otitis, pneumonia, UTI's, skin infections, septicemia, bone and joint infections, respiratory infections, otitis media, cellulitis, impetigo, genital infections, gynecologic infections, gonococcal infections, intrabdominal infections, peritonitis, secondary bacterial infection of acute bronchitis, acute bacterial exacerbation of chronic bronchitis, acute sinusitis, meningitis, PID, Lyme disease, gonorrhea.

Contraindicated in seizures, hypersensitivity of cephalosporins and penicillins

Side, adverse or life threatening effects :
Dizziness, headache, fatigue, paresthesia (pins and needles), fever, chills, confusion, diarrhea, nausea, vomiting, anorexia, dysgeusia (altered taste), glossitis, bleeding, increased AST, ALT, bilirubin, LDH, ALP, abdominal pain, loose stools, flatulence, heartburn, stomach cramps, colitis, jaundice, C-DIFF COLITIS (superinfection), vaginitis (superinfection), pruritus (itching), candidiasis (superinfection), increased BUN, NEPHROTOXICITY, RENAL FAILURE, pyuria (pus in urine), dysuria (pain when urinating), reversible interstitial nephritis, LEUKOPENIA, THROMBOCYTOPENIA, AGRANULOCYTOSIS, anemia, NEUTROPENIA, LYMPHOCYTOSIS, EOSINOPHILIA, PANCYTOPENIA, HEMOLYTIC ANEMIA, LEUKOCYTOSIS, GRANULOCYTOPENIA, rash, urticaria (hives), dermatitis, STEVEN-JOHNSON SYNDROME, dyspnea, ANAPHYLAXIS, SERUM SICKNESS.

Drug Interactions:
Antacids: decrease absorption of cephalosporins
Furosemide: increased effect/toxicity
Plicamycin, valproic acid: increased bleeding
Probenecid: decreased excretion of product and increased blood levels/toxicity
Aminoglycosides: increased effect/toxicity
Anticoagulants, antiplatelets, NSAIDS, thrombolytics: increased bleeding


Nursing Assessment:
Assess for allergy to cephalosporins or penicillins. If a patient is allergic to one type or class of cephalosporin, that patient should not receive any other type of cephalosporin or penicillin. •

Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp.

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), pruritus (itching), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Monitor electrolytes: K+, Na+, Cl- monthly id on long term therapy

CDAD: Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection (overgrowth of infection): perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum


Nursing Plan:
The patient's infection will be controlled and ultimately eliminated.


Nursing Interventions:
Culture the infected area before cephalosporin therapy is started. The organism causing the infection can be determined by culture, and the antibiotics the organism is sensitive to are determined by sensitivity. If antibiotic therapy is started before culture result is reported, the antibiotic may need to be changed after C&S test results are received.

Check to see if pt. is allergic to penicillin or cephalosporins

Administer around the clock to maintain blood levels

Administer at least 1 hour before or 2 hours after meals

If patient experiences GI upset: take w/ food

Obtain a sample for C&S before giving med

Monitor for S&S of superinfection (C-diff, yeast infections); especially in pt.'s taking higher doses
To prevent superinfection, give pt.'s cultured dairy (yogurts, probiotics) to eat or take.

Assess pt. for bleeding (monitor PT, INR); increases bleeding times

Monitor body temp and infected area for any changes
Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp, earache,

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Monitor electrolytes: K+, Na+, Cl- monthly id on long term therapy

Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum


Pt/family teaching:
Report sore throat, bruising, bleeding, joint pain (may indicate blood dycrasias {rare}); SYMPTOMS OF HYPERSENSITIVITY

Contact provider if vaginal itching, loose-foul smelling stool, furry tongue occurs (superinfection)

Take Entire course of meds until bottle is empty

Don't take a DOUBLE DOSE

NOTIFY PROVIDER OF DIARRHEA W/BLOOD, PUS, MUCUS (C-DIFF COLITIS)

Keep drugs out of reach of children.

• Tell patients to report signs of superinfection, such as mouth ulcers or discharge from the anal or genital area. •

Advise patients to ingest buttermilk, yogurt, or an acidophilus supplement to prevent superinfection of the intestinal flora.

Infuse all IV cephalosporins over 30 minutes or as ordered to prevent pain and irritation. •

Observe for hypersensitivity reactions.

Warn patients to report any side effects from use of oral cephalosporin drugs; these may include anorexia, nausea, vomiting, headache, dizziness, itching, and rash.

Diet • Advise patients to take medication with food if gastric
irritation occurs. •

Encourage patients to take an adequate amount of fluids to avoid dehydration from diarrhea.


Evaluation •
Evaluate the effectiveness of the cephalosporin by determining
whether the infection has ceased and that no side effects,
including superinfection, have occurred.
Class of Med: Anti-Infective, Broad spectrum

Ex: azithromycin, clindamycin, clarithromycin, erythromycin, spiramycin, telithromycin, fidaxomycin

At low to moderate drug doses, macrolides have a bacteriostatic effect
At high drug doses, their effect is bactericidal.

Can be administered IV or orally, BUT NEVER IM B/C ITS PAINFUL

IV macrolides SHOULD BE INFUSED SLOWLY TO AVOID UNNECESSARY PAIN (PHLEBITIS)

Intended action: inhibit bacterial growth and reproduction by interfering w/ their ability to make protein (INHIBIT PROTEIN SYNTHESIS)


Uses:
bacterial conjunctivitis, otitis media, tonsillitis, sinusitis, PID, STIs, and skin and respiratory infections. For patients who are allergic to penicillin, duodenal ulcer due to H. pylori, soft-tissue infections, acne, impetigo, urethritis, Legionnaires' disease, diphtheria, CDAD, systemic infections, prevents whooping cough, prevents endocarditis in dentistry (surgery), pharyngitis, sore throat, pneumonia, MAC, Anthrax, chancroid disease in men, chlamydia, gonorrhea, syphilis, conjunctivitis in newborns.


Side, adverse or life threatening effects :
Nausea, vomiting, diarrhea, abdominal pain (cramps), liver toxicity, ANAPHYLAXIS, headache, insomnia, rash, dysgeusia, TOOTH DISCOLORATION, GI distress, CDAD, CANDIDIASIS, superinfection, myasthenia (weakness in muscles), SEIZURES, STEVEN-JOHNSON SYNDROME, RENAL FAILURE, skin irritation, reversible hearing loss, DYSRHYTHMIAS, C-DIFF COLITIS, elevated hepatic enzymes (AST, ALT, ALP), blurred vision, ocular irritation, PHOTOSENSITIVITY, tinnitus (ringing in ears), drowsiness, dizziness, fever, fatigue, TONGUE DISCOLORATION, OTOTOXICITY, anorexia, pruritus, rash, injection site reaction, weakness, ANGIOEDEMA, HYPERBILIRUBINEMIA, HEPATOTOXICITY, BRONCHOSPASM, LEUKOPENIA, ANEMIA.


Drug Interactions:
OLDER pt.'s taking CALCIUM CHANNEL BLOCKERS MAY BECOME HYPOTENSIVE OR GO INTO SHOCK WHEN TAKING THESE MEDS (AZITHROMYCIN IS BEST CHOICE IN THIS SITUATION)

Decreases blood levels of chloramphenicol and clindamycin antibiotics

Increases blood levels of multiple drugs, including digoxin, warfarin, and theophylline, carbamazepine (anticonvulsant)

Drinking grapefruit juice may increase adverse effects

Drugs that inhibit the enzyme CYP3A4 increase erythromycin levels (verapamil, azole antifungals, protease inhibitors for HIV and diltiazem)

Macrolides may decrease the HEPATIC METABOLISM of other drugs

Nursing Assessment:
Assess for allergy or hypersensitivity to macrolides

Assess vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Check laboratory tests (liver enzyme values) to determine liver function. Order liver enzyme tests periodically for patients taking large doses of azithromycin for a continuous period. •

Obtain a history of drugs the patient currently takes. The peak level of azithromycin may be decreased by antacids.

monitor liver function (AST, ALT, ALP, bilirubin) tests if therapy lasts longer than 2 weeks

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp.

Assess for Anaphylaxis: rash, urticaria (hives), pruritus (itching), chills, fever, joint pain, angioedema.

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily

Assess for superinfection (overgrowth of infection): perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

Monitor bleeding times (PT,INR) for pt.'s on Warfarin

When giving IV macrolides, assess for thrombophlebitis (clot formation and inflammation)

Monitor for skin rash

Monitor LFTs

Monitor chest pain, cardiac problems



Nursing Plan:
The patient's infection will be controlled and ultimately eliminated.


Nursing Interventions:
Administer on an empty stomach

NEVER ADMINISTER W/ GASTRIC ACIDS OR ACIDIC FRUIT JUICES; AVOID USE W/ MILK

Obtain a sample for C&S before giving med

Monitor for S&S of superinfection (C-diff, yeast infections)
To prevent superinfection, give pt.'s cultured dairy (yogurts, probiotics) to eat or take.

Assess pt. for bleeding (monitor PT, INR); increases bleeding times

Monitor body temp and infected area for any changes

Record vital signs, urine output

LOOK AT LIVER ENZYMES (AST,ALT, ALP. BILIRUBIN)

Report abnormal findings •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp, earache,

Assess for Anaphylaxis: rash, urticaria (hives), chills, fever, joint pain, angioedema.

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH


Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

Monitor for and report gastrointestinal reactions (a decrease in the dose may stop symptoms).

Evaluate all drugs the patient is taking; concurrent use of other drugs can increase erythromycin blood levels.

Monitor for and report signs of ototoxicity.

Question patient about history of a prolong in QT intervals.

Monitor for skin rash

Monitor LFTs

Monitor chest pain, cardiac problems

Monitor for liver damage resulting from prolonged use and high dosage of macrolides such as azithromycin.
Signs of liver dysfunction include elevated liver enzyme levels and jaundice.

Administer oral azithromycin 1 hour before or 2 hours after meals.

Give with a full glass of water, not fruit juice.

Give the drug with food if GI upset occurs.

Chewable tablets should be chewed, not swallowed whole.

Administer antacids either 2 hours before or 2 hours after azithromycin.


Pt/family teaching:
Erythromycin; take on empty stomach, no grapefruit, Dont take with dairy, increase fluid intake, 8oz of water with each dose, oral contraceptives decrease effectiveness with erythromycin, no antacids or St. johns wort

Take with food if gastrointestinal symptoms occur.

Report continuing symptoms to provider.

Report palpitations, fainting spells, or history of QT prolongation on ECG to provider.

Report hearing loss, vertigo, or tinnitus to provider.

Report bloody or watery diarrhea.

Report mouth pain or vaginal discomfort or discharge.

instruct client to complete full coarse of prescription/antibiotics-

Teach about skin protection from sun (photosensitivity)

Instruct patients to take the full course of the antibacterial agent as prescribed.
Drug compliance is most important for all antibacterials (antibiotics).

Side Effects • Encourage patients to report side effects, including adverse reactions (nausea, vomiting, diarrhea, abdominal cramps, itching). •
Teach patients to report any evidence of superinfection, secondary infection resulting from drug therapy; for some patients, stomatitis or vaginitis may occur. •
Tell patients to report the onset of loose stools or diarrhea.
CDAD should be ruled out.


Evaluation •
Evaluate the effectiveness of azithromycin by determining whether the infection has been controlled or has ceased and that no side effects, including superinfection, have occurred.
Is bactericidal (glycopeptide antibiotic)

Vancomycin is used against drug-resistant S. aureus and in cardiac surgical prophylaxis for individuals with penicillin allergies.

Serum vancomycin levels should be monitored.

Used against gram (+) bacteria

Action: Works by inhibiting the cell wall synthesis and causes bactericidal effects

Use: respiratory infections, osteomyelitis (bone infections), skin infections, people w/ bloodstream infections

Can be given orally or rectally (rectally when people have C-diff)

Usually given 125 mg q6hrs PO

Pt's typically DON'T LIKE THE WAY IT TASTES; ALWAYS HAVE A CHASER (GINGER ALE, CRANBERRY OR GRAPE JUICE) FOR PT.'S

WHY IS IT GIVEN ORALLY? IT WORKS BEST WHEN IT PENETRATES THE MUCOSA (WHEN YOU GIVE IT ENEMA, IT ALSO WORKS ON THE LOWER GI TRACT

CAN CAUSE NEPHROTOXICITY AND OTOTOXICITY (TOXICITY OF THE EAR- CRANIAL NERVE 8), PERMANENT HEARING LOSS

IF IT IS GIVEN TOO RAPIDLY, IT CAN CAUSE A SYNDROME CALLED RED NECK SYNDROME (BLOTCHY NECK, FACE, CHEST) AND IS A TOXIC EFFECT RATHER THAN AN ALLERGIC REACTION
TOO MUCH MED IN THE BLOODSTREAM TOO FAST
SLOW THE INFUSION DOWN A BIT SO PT. IS GETTING THE
MED SLOWER

Side effects may include chills, dizziness, fever, rashes, nausea, vomiting, and thrombophlebitis at the injection site.

The risk of nephrotoxicity and ototoxicity may be potentiated when vancomycin is taken with furosemide, aminoglycosides, amphotericin B, colistin, cisplatin, and cyclosporine.

Vancomycin may inhibit methotrexate excretion and can increase methotrexate toxicity.
Class of Med: Anti-Infective, Broad spectrum



Intended action: INHIBITING BACTERIAL PROTEIN SYNTHESIS AND HAS A BACTERIOSTATIC + BACTERICIDAL EFFECT

OFTEN PRESCRIBED FOR ORAL USE, BUT SOMETIMES IN HOSPITAL GIVE IT IV


Uses:
SEVERE INFECTIONS, H.PYLORI THAT CAUSES ULCERS IN THE STOMACH, MRSA, GIVEN AS SMALL DOSES FOR KIDS WHO HAVE SEVERE ACNE, STI'S, SKIN INFECTIONS, SOMETIMES URINARY OR RESPIRATORY TRACT INFECTIONS

2 OF MOST POPULAR: DOXYCYCLINE AND MINOCYCLINE






Tetracyclines should not be taken with magnesium and aluminum antacid preparations, milk products containing calcium, or iron-containing drugs because these substances bind with tetracycline and prevent absorption of the drug.

It is suggested that tetracyclines, except for doxycycline and minocycline, be taken on an empty stomach 1 hour before or 2 hours after mealtime

the absorption of doxycycline and minocycline is improved with food ingestion


Side Effects and Adverse Reactions
GI disturbances such as nausea, vomiting, and diarrhea are side effects of tetracyclines.

Photosensitivity (sunburn reaction) may occur in persons taking tetracyclines, especially demeclocycline.

Pregnant patients should not take tetracycline during the first trimester of pregnancy because of possible teratogenic effects.

Women in the last trimester of pregnancy and children younger than 8 years of age should also not take tetracycline because it irreversibly discolors the permanent teeth (FLUORESCENT YELLOW COLOR- IRREVERSIBLE TEETH DISCOLORATION)

Minocycline can cause damage to the vestibular part of the inner ear, which may result in difficulty maintaining balance.

Outdated tetracyclines should always be discarded, because the drug breaks down into a toxic by-product.

Nephrotoxicity (kidney toxicity) results when tetracycline is given in high doses with other nephrotoxic drugs.

Because tetracycline can disrupt the microbial flora of the body, superinfection (secondary infection resulting from drug therapy) is another adverse reaction that might result.

ISSUES W/ORAL CONTRACEPTIVES: USE BACK UP BIRTH CONTROL

SIDE EFFECTS: Abdominal pain, glossitis, dry mouth, tooth/nail discoloration, nausea, vomiting, diarrhea, headache, vision changes, diplopia, photosensitivity, rash, pruritus, injection site reaction

ADVERSE EFFECTS: Superinfection, angioedema, hypertension, renal dysfunction

Life threatening: Anaphylaxis, anemia, eosinophilia, thrombocytopenia, hepatotoxicity, increased intracranial pressure, CDAD, Stevens-Johnson syndrome


Drug Interactions Antacids and iron-containing drugs can prevent absorption of tetracycline from the GI tract.

Milk and foods high in calcium can inhibit tetracycline absorption. To avoid drug interaction, these should be taken at least 2 hours apart from tetracycline.

Be aware that lipid-soluble tetracyclines, such as doxycycline and minocycline, are actually better absorbed from the GI tract when taken with milk products and food.

The desired action of oral contraceptives can be lessened when taken with tetracyclines.

The activity of penicillins given with a tetracycline can be decreased because the tetracyclines could cause a bacterial resistance to the action of penicillin.

Administering tetracycline with an aminoglycoside may increase the risk of nephrotoxicity.



Nursing Assessment:
Assess for allergy to TETRACYCLINES.

ASSESS SERUM CREATININE, BUN, I&O RATIOS, S&S OF DEHYDRATION

Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp.

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), pruritus (itching), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Monitor electrolytes: K+, Na+, Cl- monthly id on long term therapy

CDAD: Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection (overgrowth of infection): perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

• Check laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, bilirubin). •

Obtain a history of dietary intake and drugs the patient currently takes.

Dairy products, antacids, iron, calcium, and magnesium decrease drug absorption.

Digoxin absorption is increased, which may lead to digitalis toxicity.


Nursing Plan:
The patient's infection will be controlled and ultimately eliminated.


Nursing Interventions:
Culture the infected area before cephalosporin therapy is started. The organism causing the infection can be determined by culture, and the antibiotics the organism is sensitive to are determined by sensitivity. If antibiotic therapy is started before culture result is reported, the antibiotic may need to be changed after C&S test results are received.

Check to see if pt. is allergic to TETRACYCLINES

Administer tetracycline 1 hour before or 2 hours after meals for optimum absorption

Obtain a sample for C&S before giving med

Monitor for S&S of superinfection (C-diff, yeast infections); especially in pt.'s taking higher doses
To prevent superinfection, give pt.'s cultured dairy (yogurts, probiotics) to eat or take.

Assess pt. for bleeding (monitor PT, INR); increases bleeding times

Monitor body temp and infected area for any changes

Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.


Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp, earache,

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum



Pt/family teaching:
Report sore throat, bruising, bleeding, joint pain (may indicate blood dycrasias {rare}); SYMPTOMS OF HYPERSENSITIVITY

Contact provider if vaginal itching, loose-foul smelling stool, furry tongue occurs (superinfection)

Take Entire course of meds until bottle is empty

Don't take a DOUBLE DOSE

NOTIFY PROVIDER OF DIARRHEA W/BLOOD, PUS, MUCUS (C-DIFF COLITIS)

Keep drugs out of reach of children.

• Tell patients to report signs of superinfection, such as mouth ulcers or discharge from the anal or genital area. •

Advise patients to ingest buttermilk, yogurt, or an acidophilus supplement to prevent superinfection of the intestinal flora.

Observe for hypersensitivity reactions.

Instruct patients to store tetracycline away from light and extreme heat. Tetracycline decomposes in light and heat and causes the drug to become toxic. •

Advise patients to check expiration dates on bottles of tetracycline; out-of-date tetracycline can be toxic.

• Inform female patients who are contemplating pregnancy to avoid taking tetracycline because of possible teratogenic effects.

• Warn parents that children younger than 8 years of age should not take tetracycline because it can cause discoloration of permanent teeth.

• Encourage patients to take the complete course of tetracycline as prescribed.

Side Effects • Advise patients to use a sun block and protective clothing during sun exposure. Photosensitivity is associated with tetracycline.

• Encourage patients to report signs of a superinfection (mouth ulcers, anal or genital discharge).

• Advise patients to use additional contraceptive techniques and not to rely on oral contraceptives when taking the drug because contraceptive effectiveness may decrease.

• Teach patients to use effective oral hygiene several times a day to prevent or alleviate mouth ulcers (stomatitis).

• Educate patients to avoid milk products, iron, and antacids. Tetracycline should be taken 1 hour before or 2 hours after meals with a full glass of water. If GI upset occurs, the drug can be taken with nondairy foods.


Evaluation •
Evaluate the effectiveness of tetracycline by determining whether
the infection has been controlled or has ceased and that there are
no side effects.
Class of Med: Anti-Infective, Broad spectrum, BACTERICIDAL

EX: TOBRAMYCIN, AMIKACIN, GENTAMICIN, STREPTOMYCIN,

Intended action: INHIBIT BACTERIAL PROTEIN SYNTHESIS

WORK AGAINST GRAM (-) BACTERIA, SUCH AS E.COLI

CAN'T BE ABSORBED THROUGH GI TRACT AND CAN'T CROSS CEREBROSPINAL FLUID (CSF), BUT CAN CROSS THE BLOOD BRAIN BARRIER (BBB) IN CHILDREN, BUT NOT ADULTS

ARE GIVEN IM OR IV EXCEPT FOR NEOMYCIN (ORAL PREPARATION FOR THIS MED)

USE NEOMYCIN FOR SOMEONE WHO IS GOING TO HAVE A BOWEL SURGERY + NEED TO PREP THE BOWEL BEFORE THEY GO TO SURGERY

GIVE INHALED TOBRAMYCIN FOR PT.'S WHO HAVE CYSTIC FIBROSIS B/C THEY HAVE COLONIZED INFECTIONS IN THEIR LUNGS

ALWAYS MONITOR THE PEAK AND TROUGH LEVELS OF THESE MEDS B/C THEY CAN BECOME TOXIC

THEY INTERACT W/ COUMADIN- INCREASING SIDE EFFECTS OF COUMADIN




Uses:
RESERVED FOR SERIOUS INFECTIONS, SERIOUS RESPIRATORY TRACT INFECTIONS, SERIOUS SKIN INFECTIONS, BONE + JOINT INFECTIONS, MENINGITIS.


Side, adverse or life threatening effects :
Serious adverse reactions to aminoglycosides include ototoxicity and nephrotoxicity.

Renal function, drug dose, and age are all factors that determine whether a patient will develop nephrotoxicity from aminoglycoside therapy.

Careful drug dosing is especially important with younger and older patients.

The nurse must assess changes in patients' hearing, balance, and urinary output.

Prolonged use of aminoglycosides could result in a superinfection, and specific serum aminoglycoside levels should be closely monitored to avoid adverse reactions.

SIDE EFFECTS: Anorexia, stomatitis, nausea, vomiting, alopecia, rash, pruritus, skin/ocular irritation, visual disturbances, photosensitivity, headache, dizziness, confusion, depression, tinnitus, weakness, arthralgia

ADVERSE EFFECTS: Superinfection, peripheral neuropathy, laryngeal edema, hearing loss, hypokalemia, hypomagnesemia, hyponatremia

Life threatening: Anaphylaxis, nephrotoxicity, thrombocytopenia, anemia, agranulocytosis, hepatic dysfunction, increased intracranial pressure

Drug Interactions:

Anticoagulants: increased bleeding


Nursing Assessment:
Assess for allergy to AMINOGLYCOSIDES

Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp.

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), pruritus (itching), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH


CDAD: Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection (overgrowth of infection): perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

Nephrotoxicity is an adverse reaction to most aminoglycosides. • Assess laboratory results to determine renal and liver function, including BUN, serum creatinine, ALP, ALT, AST, and bilirubin.

Serum electrolytes should also be checked.

Aminoglycosides may decrease serum potassium and magnesium levels.

• Obtain a medical history related to renal or hearing disorders. Large doses of aminoglycosides could cause nephrotoxicity or ototoxicity.


Nursing Plan:
The patient's infection will be controlled and ultimately eliminated.


Nursing Interventions:
Culture the infected area before cephalosporin therapy is started. The organism causing the infection can be determined by culture, and the antibiotics the organism is sensitive to are determined by sensitivity. If antibiotic therapy is started before culture result is reported, the antibiotic may need to be changed after C&S test results are received.

Check to see if pt. is allergic to AMINOGLYCOSIDES


Obtain a sample for C&S before giving med

Monitor for S&S of superinfection (C-diff, yeast infections); especially in pt.'s taking higher doses
To prevent superinfection, give pt.'s cultured dairy (yogurts, probiotics) to eat or take.

Assess pt. for bleeding (monitor PT, INR); increases bleeding times

Monitor body temp and infected area for any changes
Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp, earache,

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Monitor electrolytes: K+, Na+, Cl- monthly id on long term therapy

Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum


Monitor intake and output. Urine output should be at least 600 mL/day. Immediately report any decrease in urine output. Urinalysis may be ordered daily, and results should be checked for proteinuria, casts, blood cells, and appearance.

• Check for hearing loss. Aminoglycosides can cause ototoxicity.

Note whether body temperature has decreased.

• Dilute gentamicin in 50 to 200 mL of NS or D5W solution and administer IV over 30 to 60 minutes.

• Check that therapeutic drug monitoring (TDM) has been ordered for peak and trough drug levels. Blood should be drawn 45 to 60 minutes after drug has been administered for peak levels and minutes before next drug dosing for trough levels. Gentamicin peak values should be 5 to 8 mcg/mL, and trough values should be less than 1 to 2 mcg/mL.


Pt/family teaching:
Report sore throat, bruising, bleeding, joint pain (may indicate blood dycrasias {rare})

Contact provider if vaginal itching, loose-foul smelling stool, furry tongue occurs (superinfection)

Take Entire course of meds until bottle is empty

Don't take a DOUBLE DOSE

NOTIFY PROVIDER OF DIARRHEA W/BLOOD, PUS, MUCUS (C-DIFF COLITIS)

Keep drugs out of reach of children.

• Tell patients to report signs of superinfection, such as mouth ulcers or discharge from the anal or genital area. •

Advise patients to ingest buttermilk, yogurt, or an acidophilus supplement to prevent superinfection of the intestinal flora.

Observe for hypersensitivity reactions.•

Encourage patients to take an adequate amount of fluids to avoid dehydration from diarrhea.

Encourage patients to increase fluid intake unless fluids are restricted.

Advise patients to report aminoglycoside side effects that include nausea, vomiting, tremors, tinnitus, pruritus, and muscle cramps. •

Direct patients to use a sun block and protective clothing during sun exposure because aminoglycosides can cause photosensitivity.


Evaluation •
Evaluate the effectiveness of the aminoglycoside by determining whether the infection has ceased and whether any side effects have occurred.
Class of Med: Anti-Infective, Broad spectrum

EX: CIPROFLOXACIN, LEVOFLOXACIN, MOXIFLOXACIN, OFLOXACIN


CIPROFLOXACIN- TREAT UTI'S
LEVOFLOXACIN (LEVAQUIN)- COMMUNITY ACQUIRED PNEUMONIA OR RESPIRATORY INFECTIONS

THESE MEDS CAN BE GIVEN ORALLY OR IV

Intended action: INTERFERE W/ THE ENZYME DNA GYRASE, WHICH IS NEEDED TO SYNTHESIZE BACTERIAL DNA


Uses:
INTRA-ABDOMINAL INFECTIONS, ABSCESSES, SOFT TISSUE INFECTION, BONE/JOINT INFECTIONS, UTI'S, RESPIRATORY INFECTIONS



Side, adverse or life threatening effects :
anaphylaxis, dizziness, irritability, headache, retinal detachment, corneal deposits, ocular pruritus, tendon rupture, injection site reaction, dysgeusia, GI distress, CDAD, superinfection, and Stevens-Johnson syndrome, visual impairment, ocular irritation/bleeding, conjunctivitis, keratitis, hyperemia, nephrotoxicity, pruritis, photosensitivity.


Patient Safety:
Fluoroquinolones, especially levaquin, should be reserved for patients who have no other alternative treatment options for uncomplicated UTI, acute bacterial exacerbation of chronic bronchitis, or acute bacterial sinusitis due to disabling and potentially irreversible serious adverse reactions. These adverse reactions include tendon rupture, tendinitis, peripheral neuropathy, CNS effects, and exacerbation of myasthenia gravis. (Black Box Warning.)



Drug Interactions:
Anticoagulants, antiplatelets, NSAIDS, thrombolytics: increased bleeding


Nursing Assessment:
Assess for allergy to FLUOROQUINOLONES•

Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp.

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), pruritus (itching), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH


CDAD: Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection (overgrowth of infection): perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

Obtain a drug and diet history. Antacids and iron preparations decrease absorption of fluoroquinolones such as levofloxacin, and levofloxacin can increase the effects of theophylline and caffeine and can also increase the effects of oral hypoglycemics. When levofloxacin is taken with nonsteroidal antiinflammatory drugs (NSAIDs), central nervous system (CNS) reactions may occur, which includes seizures.


Nursing Plan:
The patient's infection will be controlled and ultimately eliminated.


Nursing Interventions:
Culture the infected area before cephalosporin therapy is started. The organism causing the infection can be determined by culture, and the antibiotics the organism is sensitive to are determined by sensitivity. If antibiotic therapy is started before culture result is reported, the antibiotic may need to be changed after C&S test results are received.

Check to see if pt. is allergic to FLUOROQUINOLONES

Administer levofloxacin 2 hours before or after antacids and iron products for best absorption. Give with a full glass of water. If GI distress occurs, the drug may be taken with food.

• Dilute IV levofloxacin in an appropriate amount of solution (250 mg in 50 mL, 500 mg in 100 mL, 750 mg in 150 mL. NS, D5W, D5NS, D5LR). Infuse over 60 minutes.

Monitor serum theophylline levels when taken concurrently with levofloxacin, which can increase theophylline levels. Check for symptoms of CNS stimulation such as nervousness, insomnia, anxiety, and tachycardia.

• Monitor blood glucose. Levofloxacin can increase the effects of oral hypoglycemics.Obtain a sample for C&S before giving med

Monitor for S&S of superinfection (C-diff, yeast infections); especially in pt.'s taking higher doses
To prevent superinfection, give pt.'s cultured dairy (yogurts, probiotics) to eat or take.

Assess pt. for bleeding (monitor PT, INR); increases bleeding times

Monitor body temp and infected area for any changes
Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp, earache,

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum


Pt/family teaching:
Report sore throat, bruising, bleeding, joint pain (may indicate blood dycrasias {rare}); SYMPTOMS OF HYPERSENSITIVITY

Contact provider if vaginal itching, loose-foul smelling stool, furry tongue occurs (superinfection)

Take Entire course of meds until bottle is empty

Don't take a DOUBLE DOSE

NOTIFY PROVIDER OF DIARRHEA W/BLOOD, PUS, MUCUS (C-DIFF COLITIS)

Keep drugs out of reach of children.

• Tell patients to report signs of superinfection, such as mouth ulcers or discharge from the anal or genital area. •

Advise patients to ingest buttermilk, yogurt, or an acidophilus supplement to prevent superinfection of the intestinal flora.

Observe for hypersensitivity reactions.

Diet • Advise patients to take medication with food if gastric
irritation occurs. •

Encourage patients to take an adequate amount of fluids to avoid dehydration from diarrhea.

Teach patients to drink at least 6 to 8 glasses (8 oz) of fluid daily. •

Encourage patients to avoid caffeinated products.

Direct patients to avoid operating motor vehicles or hazardous machinery while taking the drug, at least until drug stability has occurred, because of possible drug-related dizziness.

• Inform patients that photosensitivity is a side effect of most fluoroquinolones. Patients should wear sunglasses, sun block, and protective clothing when in the sun.

• Encourage patients to report side effects such as dizziness, nausea, vomiting, diarrhea, flatulence, abdominal cramps, tinnitus, rash, and tendon rupture (very rare). Older adults are more likely to develop side effects.


Evaluation •
Evaluate the effectiveness of the fluoroquinolone by determining whether the infection has ceased and the body temperature has returned within normal range.
Class of Med: Anti-Infective, Broad spectrum, bacteriostatic

Intended action: inhibit bacterial synthesis of folic acid, WHICH IS ESSENTIAL FOR BACTERIAL GROWTH

EX: Sulfadiazine, Sulfasalazine, Trimethoprim-sulfamethoxazole (BACTRIM)-USED TO TREAT PJP (PPL WHO ARE IMMUNOSUPPRESSED, HIV/AIDS)

READILY ORAL ADMINISTERED

Uses:
AS AN ALTERNATIVE DRUG FOR PPL WHO ARE ALLERGIC TO PENICILLINS, UTI'S, EAR INFECTIONS, EYES OF NEWBORNS FOR PROPHYLAXIS, OTITIS MEDIA, IN SOLUTION AND OINTMENTS FOR BURNS,

GIVEN TO PT.'S WHO HAVE HAD TRANSPLANTS

Side, adverse or life threatening effects :
ALLERGIC REACTION, PRURITIS, ANAPHYLAXIS (NOT COMMON), BLOOD DISORDERS (HEMOLYTIC ANEMIA, AND LOW WBC COUNTS) CAN OCCUR FROM PROLONGED USE OF THESE MEDS, PHOTOSENSITIVITY.


AVOID DURING PREGNANCY B/C OF CONGENITAL MALFORMATIONS OF NEURAL TUBE DEFECTS


Side effects of sulfonamides may include an allergic response such as skin rash and itching. Anaphylaxis is uncommon.

Blood disorders such as hemolytic anemia, aplastic anemia, and low WBC and platelet counts could result from prolonged use and high dosages.

GI disturbances such as anorexia, nausea, and vomiting may also occur.
The early sulfonamides were insoluble in acid urine, and crystalluria (crystals in the urine) and hematuria (blood in the urine) were common problems. Increasing fluid intake dilutes the drug, which helps prevent crystalluria.

Photosensitivity, an excessive reaction to direct sunlight or ultraviolet (UV) light that leads to redness and burning of the skin, can also occur; therefore the patient should avoid sunbathing and excess ultraviolet light.

Cross-sensitivity, a sensitivity or allergy to one sulfonamide that leads to sensitivity to another sulfonamide, might occur with the different sulfonamides but does not occur with other antibacterial drugs.

Sulfonamides should be avoided during pregnancy to avoid congenital malformations, neural tube defects, and kernicterus.


Drug Interactions:
Anticoagulants, antiplatelets, NSAIDS, thrombolytics: increased bleeding


Nursing Assessment:
Assess for allergy to SULFONAMIDES•

Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp.

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), pruritus (itching), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

CDAD: Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection (overgrowth of infection): perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

Assess the patient's renal function by checking urinary output (>600 mL/day), BUN (normal, 8 to 25 mg/dL), and serum creatinine (normal, 0.5 to 1.5 mg/dL).

• Obtain a medical history from the patient. Sulfonamides such as TMP-SMZ are contraindicated for patients with severe renal or liver disease.

• Determine whether the patient is hypersensitive to sulfonamides. An allergic reaction can include rash, skin eruptions, and itching. A severe hypersensitivity reaction includes erythema multiforme—an erythematous macular, papular, or vesicular eruption that can cover the entire body—or exfoliative dermatitis, characterized by desquamation, scaling, and itching of the skin.

• Obtain a history of drugs the patient currently takes. Oral antidiabetic drugs (sulfonylureas) given with sulfonamides increase the hypoglycemic effect; use of warfarin with sulfonamides increases the anticoagulant effect.

• Assess baseline laboratory results, especially complete blood count (CBC). Blood dyscrasias may occur as a result of high doses of sulfonamides over a continuous period, causing life-threatening conditions.

Nursing Plan:
The patient's infection will be controlled and ultimately eliminated.


Nursing Interventions:
Culture the infected area before cephalosporin therapy is started. The organism causing the infection can be determined by culture, and the antibiotics the organism is sensitive to are determined by sensitivity. If antibiotic therapy is started before culture result is reported, the antibiotic may need to be changed after C&S test results are received.

Check to see if pt. is allergic to SULFONAMIDES

Administer sulfonamides with a full glass of water. Extra fluid intake can prevent crystalluria and kidney stone formation.

• Record intake and output. To decrease the risk of crystalluria, fluid intake should be at least 2000 mL/day, and urine output should be at least 1200 mL/day. The sulfonamide sulfadiazine is more likely to cause crystalluria than combination drugs.

• Monitor vital signs. Note whether the patient's temperature has gone down. • Observe the patient for hematologic reactions that may lead to life-threatening anemias. Early signs are sore throat, purpura, and decreasing WBC and platelet counts. Check CBC, and compare values with baseline findings.

Obtain a sample for C&S before giving med

Monitor for S&S of superinfection (C-diff, yeast infections); especially in pt.'s taking higher doses
To prevent superinfection, give pt.'s cultured dairy (yogurts, probiotics) to eat or take.

Assess pt. for bleeding (monitor PT, INR); increases bleeding times

Monitor body temp and infected area for any changes
Record vital signs and urine output.

Report abnormal findings, which may include elevated temperature or decreased urine output. •

Evaluate laboratory results, especially those that indicate renal and liver function (BUN, serum creatinine, AST, ALT, ALP, and bilirubin). Use these laboratory results for baseline values, and report any abnormal findings.

Collect C&S before giving these meds

Check for S&S of infection: temp, characteristics of sputum, wounds, urine, stool, WBC baseline, take temp, earache,

Check stools during, after tx.

Do an I&O ratio

Assess for Anaphylaxis: rash, urticaria (hives), chills, fever, joint pain, angioedema.

Identify urine output. If decreased or decreasing, NOTIFY PROVIDER (MAY INDICATE NEPHROTOXICITY)

Check for increased BUN, creatinine

Monitor blood studies: AST, ALT, ALP, CBC, WBC, Hct, bilirubin, LDH

Assess bowel patterns daily; if severe diarrhea occurs, product should be discontinued (may indicate C-diff colitis)

Monitor for bleeding, ecchymosis (bruising), bleeding gums, hematuria, stool guaiac (bloody stool test) daily if on long term therapy

Assess for superinfection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum


Pt/family teaching:
Report sore throat, bruising, bleeding, joint pain (may indicate blood dycrasias {rare}); SYMPTOMS OF HYPERSENSITIVITY

Contact provider if vaginal itching, loose-foul smelling stool, furry tongue occurs (superinfection)

Take Entire course of meds until bottle is empty

Don't take a DOUBLE DOSE

NOTIFY PROVIDER OF DIARRHEA W/BLOOD, PUS, MUCUS (C-DIFF COLITIS)

Keep drugs out of reach of children.

• Tell patients to report signs of superinfection, such as mouth ulcers or discharge from the anal or genital area. •

Advise patients to ingest buttermilk, yogurt, or an acidophilus supplement to prevent superinfection of the intestinal flora.

Observe for hypersensitivity reactions.

Encourage patients to take an adequate amount of fluids to avoid dehydration from diarrhea.

Encourage patients to drink several quarts of fluid daily while taking sulfonamides to avoid crystalluria.

• Advise pregnant patients to avoid sulfonamides during the last 3 months of pregnancy.

• Counsel patients not to take antacids with sulfonamides because antacids decrease the absorption rate of sulfonamide drugs.

• Warn patients with an allergy to one sulfonamide that all sulfonamide preparations should be avoided, with health care provider's approval, because of the possibility of cross-sensitivity.

Observe the patient for rash or any skin eruptions.

Teach patients to take sulfonamides 1 hour before or 2 hours after meals with a full glass of water.

Direct patients to report bruising or bleeding that could be a result of a drug-induced blood disorder. Advise patients to have their blood cell count monitored on a regular basis.

• Warn patients to wear sunglasses, avoid direct sunlight, and use sun block and protective clothing to decrease the risk of photosensitive reactions

Evaluation •
Evaluate the effectiveness of sulfonamide therapy by determining whether the infection has been alleviated and the blood cell count is within normal range.
fungal infections- infections caused by a fungus (mycosis)
like candidiasis or tinia

may be local or systemic (in the lungs, in bloodstream)

classified as opportunistic or primary infections

opportunistic- typically occur in ppl who are immunosuppressed or debilitated, cancer pt.'s, ppl who are taking antibiotics or chemotherapies.

primary infection- foot fungus, ringworm.

antifungal drugs- anti-mycotic drugs (used to treat fungal infections)
work similarly to antibacterial meds

nystatin- used orally or topically to treat fungal infections; can be used in the mouth (spit and swish-thrush)

-AZOLE anti-fungals- vaginal yeast infections, systemic infections, comes in creams and ointments, powders, shampoos, GOOD FOR TINIA INFECTIONS (TINIA CAPTITUS- FUNGAL INFECTION ON SCALP)

ASSESS HEPATIC FUNCTION, LIVER ENZYMES,Obtain a medical history that includes any serious renal or hepatic disorders. Antifungal agents such as amphotericin B, fluconazole, flucytosine, and ketoconazole are contraindicated if the patient has a serious renal or liver disease. • Check laboratory tests for liver function (alkaline phosphatase [ALP], ALT, AST, gamma-glutamyl transferase [GGT]), BUN, bilirubin, and serum creatinine because elevated levels can indicate liver or renal dysfunction. Use these test results for future comparisons. • Assess any prior use of antifungals. • Record baseline vital signs for future comparisons.




INTERVENTIONS:Obtain a culture to determine the fungus type (e.g., Candida). • Monitor the patient's urinary output; many antifungal drugs can cause nephrotoxicity. • Check laboratory results for BUN, serum creatinine, ALP, ALT, AST, bilirubin, and electrolytes and compare these with baseline findings. Certain antifungals can cause hepatotoxicity and nephrotoxicity when high doses are taken for an extended period. • Record vital signs and compare these with baseline findings. • Observe for side effects and adverse reactions to antifungal drugs, which may include nausea, vomiting, headache, phlebitis, and signs and symptoms of electrolyte imbalance.

Patient Teaching • Advise patients to take drugs as prescribed. Compliance is of the utmost importance because discontinuing a drug too soon may result in relapse. • Instruct patients to keep appointments to monitor laboratory testing of serum liver enzymes, BUN, creatinine, and electrolytes. • Advise patients not to consume alcohol. • Educate patients on proper administration of topical preparations. • Teach patients to avoid operating hazardous equipment or motor vehicles when taking antifungals that may cause visual changes, sleepiness, dizziness, or lethargy (e.g., amphotericin B, ketoconazole, or flucytosine). • Encourage patients to report side effects such as nausea, vomiting, diarrhea, dermatitis, rash, dizziness, tinnitus, edema, and flatulence. These symptoms may occur when taking certain antifungal drugs. • Respect the patient's apprehension and fear concerning the use of topical antifungal drugs and the desire to use alternative methods. Evaluate the patient's method of topical administration in regard to safe practice. If the method is considered unsafe, explain why and suggest modifications. If appropriate, involve other persons for clarification.

DON'T TAKE THESE MEDS W/ ALCOHOL