ATI Pharmacology Made Easy 4.0 Infection

Azithromycin/Erythromycin. Rationale: Azithromycin, a macrolide, is an acceptable alternative to penicillin for patients who have bacterial infections and are allergic to penicillin. The medication is effective against many gram-positive and gram-negative bacteria and is used for streptococcal pharyngitis. - Nafcillin and amoxicillin/clavulanic acid are penicillins and are contraindicated for those w/a penicillin allergy. Vancomuycin and clindamycin are safer alternatives. - A small percentage of clients who are allergic to penicillin have a cross sensitivity to cephalosporins. Cephalexin is a cephalosporin and is an inappropriate choice for the client.

Stop the cefotetan infusion. Rationale: The nurse should stop the infusion, remove the IV catheter, assess for tissue damage, and treat the client accordingly. The nurse should then initiate IV access via another site, continuing cefotetan therapy according to prescribed parameters. - Because the client could have thrombophlebitis, slowing the infusion will not alleviate the potential tissue damage or risk of embolus, and the IV site should be changed. To prevent thrombophlebitis, the nurse should dilute cefotetan, a second-generation cephalosporin, and infuse it slowly over 20 to 30 min. - The edematous, painful, and warm IV insertion site does not indicate an allergic reaction. The nurse should administer an antihistamine, such as diphenhydramine, if the client has hives, a rash, or other indications of an allergy to cephalosporins. - Switching the client to another antibiotic is essential when the current drug is ineffective or the client has an intolerable reaction to it.

Renal impairment. Rationale: Aztreonam, a monobactam, requires cautious use with clients who have renal dysfunction because it is excreted in the urine. Renal impairment could affect the excretion of aztreonam, allowing the level of the drug to accumulate. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug. - Contraindicated in those with a viral infection, used cautiously in older adults. - Metronidazole is an antimicrobial drug that req's cautious use in those with HF.

Use additional/non-hormonal form of contraception, as the drug can increase the metabolism of oral contraceptives.

Cefotetan + Metronidazole Rationale: Cefotetan, a second-generation cephalosporin, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Metronidazole, an antiparasitic drug, can cause a reaction similar to what disulfiram causes when clients consume alcohol. This reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension. Does not: - Nitrofurantoin (urinary tract antiseptic) can cause diarrhea, N/V. - Amoxicillin (penicillin) can cause diarrhea, N/V. - Aztreonam (a monobactum) can cause a superinfection with Candida albicans

Dehydration Rationale: Acyclovir, an antiviral drug, can cause renal toxicity, especially in clients who are dehydrated. Hydration during and after IV infusion of the drug can help prevent crystalluria. Drugs to use cautiously for other options: - HF: metronidazole (antiparasitic) - Asthma: amoxicillin - Tinnitus: vancomycin (antimicrobial)

Superinfection. Rationale: Imipenem, a carbapenem, can cause the superinfection Candida albicans in the mouth, throat, or vagina. It can also cause glossitis, an inflammation or infection of the tongue. Clients taking the drug should report any mouth pain or vaginal discharge and itching because they might require treatment with an antifungal drug. - Unlikely to cause malabsorption, but can cause gastroenteritis, abdominal pain, and vomiting; unlikely to cause anorexia or dental caries.

Ethacrynic acid or furosemide (Lasix), as they are loop diuretics and ototoxic drugs. Concurrent use increases the client's risk for hearing loss. Others: - Amphotericin B (antifungal) increases risk for nephrotoxicity. - NSAIDs (ex: ibuprofen) inc risk of nephrotoxicity. - Vancomycin (antimicrobial) increases risk of ototoxicity. Drugs that do not specifically interact w/gentamicin: - Diphenhydramine - Acetaminophen - Levothyroxine

Cardiac dysrhythmias, as the drug can cause ECG changes, such as a prolonged QT interval. Report palpitations, fainting, and dizziness. Other effects include fever, hearing loss, and diarrhea.

Bleeding. Rationale: Trimethoprim/sulfamethoxazole, a sulfonamide combination, can increase the effects of warfarin and increase the client's risk for bleeding. The nurse should request another prescription to treat the infection, or, if the client decides to take the drug, ask the provider to prescribe a lower warfarin dose and monitor prothrombin time carefully. The client should report any sign of bleeding, such as easy or unexplained bruising. Other options and rationales: - Thrombosis: rifampin decreases warfarin levels and inc risk of thrombosis - ECG changes: erythromycin - Ototoxicity: erythromycin + gentamicin

Vancomycin

Jaundice, numbness of the hands, and dizziness. Rationale: Isoniazid, an antimycobacterial drug, can cause liver toxicity, especially in clients who abuse alcohol. The nurse should monitor liver enzymes during therapy and instruct the client to report indications of liver damage, such as jaundice, abdominal pain, and fatigue. The nurse should instruct the client to report numbness, pain, or tingling in the hands or feet. Administering pyridoxine (vitamin B6) can help minimize these effects. Isoniazid can cause dizziness, ataxia, and seizures. The nurse should instruct the client to report these CNS effects. - Also: visual disturbances and dry mouth.

Isoniazid (INH). Rationale: Isoniazid is used to treat tuberculosis and reduces the possibility of resistance to rifampin when combined with the drug. Drug resistance can develop quickly if the client only takes rifampin. - Gentamicin, vancomycin, and metronidazole are not used to treat TB.

Seizure disorder. Rationale: Metronidazole, an antiparasitic drug, can cause ataxia, vertigo, and seizures. It requires cautious use with clients who have a history of seizure activity, liver or renal failure, or heart failure. - Hearing loss: vancomycin - Asthma: amoxicillin - Anemia: Amphotericin B

Urine output. Rationale: Gentamicin, an aminoglycoside, can cause nephrotoxicity. The nurse should monitor the client's BUN and creatinine levels and for an increased output of diluted urine. It is also essential to monitor serum gentamicin levels and maintain a therapeutic range. - Can also cause N/V, hypotension, hypertension, vertigo, and skeletal muscle weakness.

Cough. Rationale: Nitrofurantoin, a urinary tract antiseptic, can cause cough, shortness of breath, chest pain, and fever. These adverse effects can indicate an acute allergic reaction and require immediate discontinuation of drug therapy. - Can also cause diarrhea and peripheral neuropathy. - Dark colored urine is harmless effect.

C. diff-associated diarrhea. Rationale: Severe diarrhea, often containing mucus and blood, can indicate Clostridium difficile-associated diarrhea. Treatment includes stopping drug therapy and replacing fluids and electrolytes. Clients should immediately report severe diarrhea and blood in the stools.

Take an antacid at least 2 hr after taking the drug. Rationale: The nurse should recommend that the client take an antacid to relieve the dyspepsia at least 2 hr after taking ciprofloxacin, a fluoroquinolone. This is because antacids decrease the absorption of the drug. - Avoid caffeine b/c it can increase CNS effects. - Avoid taking supplemental iron b/c iron dec absorption of drug. - Avoid taking drug w/milk or other dairy products b/c calcium decreases absorption.

Acetaminophen + diphenhydramine. Rationale: Infusion reactions to amphotericin B IV, such as fever, chills, nausea, and headache, start 1 to 2 hr after the infusion begins and subside within 4 hr. The nurse can help prevent these effects by administering acetaminophen prior to the infusion. The nurse can help prevent adverse reactions by administering diphenhydramine prior to the infusion. - Aspirin inc risk of renal injury. - Hydrocortisone decreases client's resistance to infection. - Ibuprofen inc risk of renal injury.

Tendon pain. Rationale: Ciprofloxacin, a fluoroquinolone, can cause tendon rupture, most often of the Achilles tendon. This adverse effect is especially common for older adults or clients who take glucocorticoids, such as prednisolone. The nurse should tell the client to report tendon pain and stop taking the drug. - Can also cause photosensitivity and vertigo, malaise.

"Bring in a stool sample for testing." - The nurse cannot make changes to client's prescription, the client should not self-treat diarrhea, and blood work is not indicated for these symptoms.

Call emergency services immediately. Rationale: Amoxicillin can cause a severe anaphylactic reaction. A client who has difficulty breathing should call emergency services and seek immediate care. The client will need to be treated with epinephrine and an antihistamine, such as diphenhydramine, to treat an anaphylactic reaction.

Swelling of hands or feet, or gynecomastia. Rationale: Itraconazole, an azole antifungal drug, can cause edema, which can also indicate heart dysfunction, and should be monitored closely. It can also cause a temporary decrease in sexual hormone synthesis, resulting in gynecomastia, reduced libido, low sperm counts, and menstrual irregularities. + skin rashes, photosensitivity, dry mouth, headaches, tingling in hands and feet.

Third gen cephalosporins. Rationale: Later generation cephalosporins are used to treat infections that cross the blood-brain barrier, and third-generation are specifically prescribed to treat bacterial meningitis. - First gen: treat infections of skin, bone, and joints. - Monobactams: used to treat infections of abdomen, respiratory system, female reproductive tract. - Macrolides: treat severe infections, such as whooping cough, diphtheria, and chlamydia.

BUN. Rationale: Acyclovir, an antiviral drug, can cause renal toxicity due to drug accumulation in renal tubules. The nurse should monitor the client's urine output, BUN, and creatinine levels, and increase fluid intake to hydrate and flush the kidneys. Others: - Cefotetan (2nd gen cephalosporin) for PTT - Amphotericin B for Hct - Ketoconazole for AST