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Penicillin
TX of infections Most common AE=anaphalaxis (s/s=rash, fever, wheezing, death)
Procaine penicillin
-Given IM (small dot on hub of needle should be up) -thick fluids
Extended Spectrum Penicillin
-used in serious infections -direct toxicity issues-muscle twitching, seizures, decreased function of platelets (bleeding)- dose related toxicity!! -avail as NA salt only> monitor pts with high NA diet!> as result pt can dev hypernatremia b/c its given via NA salt
CEPHALOSPORINS
-if allergic to penicillin pt isn’t necessarily allergic to cephalosporins -wide variety of uses include respiratory, urinary, bone, skin, and ear infections -drug interaction with ETOH (disulfiram=red flushing face) -nursing management similar to penicillin (culture and sensitive report sts susceptibility, admin around clock NOT prn, give full course of therapy, assess pts s/s of infection resolving by pt subjectively stating they feel better”, treat GI probs> give ice chips mouth care, small frequent meals for stomatitis, assess for allergic rxns)
VANCOMYCIN
-one of most prevalent infection meds -used for eterococcous infections -VRE can be developed (vancomyocin resistant enterococcous) -AE 1) ototoxicity (monitor for it) 2) nephrotoxicity (monitor I &O)3) red mans syndrome (give it slowly 1/2-1 hr, caused by nursing mgmt, pt turns red, BP decreases, tachycardia) -assess pt renal fxn -narrow TI so monitor peaks (just b4 admin) and troughs (just after admin)
AMINOGLYCOSIDES
Gentamycin, tobramycin, neomycin, streptomycin
AMINOGLYCOSIDES
-Gentamycin, tobramycin, neomycin, streptomycin -used in severe infections -most effective when given w/ penicillin -not absorbed orally -excreted changed via kidneys -many strands of bacteria don’t allow aminoglycocides to enter cell, so give with penicillin -assess pt renal fxn (esp neonates and elderly) -AE major toxicities 1) neurotoxicity 2) nephrotoxicity 3) ototoxicity (including fetus! Cat C) -narrow TI (check peaks and troughs) -minimize AE= monitor serum creatinine, creatinine clearance, BUN, urinalysis (to assess nephrotoxicity) -monitor I and O, hydration status (to assess nephrotoxicity) -monitor hearing, balance (to asses ototoxicity) -monitor muscle weakness, ataxia (to assess for neurotoxicity) -monitor pt baseline status prior to giving these drugs
ERYTHROMYCIN
-similar to penicillin in action -used w/pts allergic to penicillin -AE GI stomach probs -give with food (but not juice or milk!) -give IV slwoy (like vancomycin) -metabolized via p450 system
TETRACYCLINES
-absorption in stomach, upper intestine, is decreased with presence of iron products -distribution concentrates in bones, liver, tumors, and spleen -preg FDA cat D, contra with <8yo -AE – teeth damage, GI upset, severe photosensitivity, superinfections, no preg women! -give 1 hr b4 or 2 hrs post meal -avoid admin with dairy, antacids, dairy
STREPTOGRAMINS
-expensive $ -serious/life threatending infections from VRE or MRSA -local inflammation at IV insertion site (40% of pts) -reconstitute with 5% dextrose or sterile water for injections INCOMPATIBLE WITH SALINE! -add reconstituted sol to at leaset 250 cc of D5W for peripheral admin. 100 cc for central line -may need to diluate d5w if peripheral vein irritation develops -if infusion site irritation, consider new site, central line or pic line
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