Antibiotics/Anti-infectives
Sulfonamides
Sulfamethoxazole is prototype
A bacteriostatic antibiotic, often combined
with another antibiotic (trimethoprim)
Indications: Treatment of urinary tract infections,
outpatient Staphylococcus infections, upper
respiratory tract infections, pneumocystis jiroveci
pneumonia
Side Effects: Hemolytic and aplastic anemia,
agranulocytosis, thrombocytopenia, photosensitivity,
exfoliative dermatitis, Stevens-Johnson syndrome,
epidermal necrolysis, nausea + vomiting, diarrhea,
pancreatitis, hepatotoxicity, convulsions, crystalluria,
toxic nephrosis, headache, peripheral neuritis,
urticaria, cough
Nursing Implications
Vancomycin
Bactericidal, IV only through central line
Indications: Drug of choice for MRSA
Side Effects: Leukopenia, nephrotoxicity, and
hypotension can occur if given too quickly, phlebitis
Nursing Implications
Give over 60-90 minutes, has a high risk of phlebitis and can cause necrosis if extravasation occurs.
Tetracyclines
Doxycycline is prototype
Protein synthesis inhibitor
Indications: …
Side Effects: Nausea, vomiting, diarrhea, sore tongue,
photosensitivity, increased intracranial pressure, can
promote yeast infections
Nursing Implications
Foods, antacids, and especially dairy products decrease absorption. If patient is taking warfarin,
observe carefully for bleeding. Avoid sun exposure. Take 1 hour before or 2 hours after meals and do
not take with milk! Binds to calcium, causing a slow bone growth rate in children. Take medications
with 6-8 ounces of fluid, preferably water. Avoid sunlight and tanning beds due to photosensitivity.
Aminoglycosides
Gentamycin is prototype
Protein synthesis inhibitor, bacteriocidal
Indications: Systemic infections, kills gut bacteria that
produces ammonia, sterilizes bowel prior to surgery
Side Effects: Ototoxicity and candidiasis
Nursing Implications
IV route is preferred, there is no oral route. Toxic to the kidneys, so there is a contraindication with
preexisting kidney disease. Peak and trough are especially important with this drug.
Macrolides
Erythromycin is prototype
Protein synthesis inhibitor, bacteriostatic
Indications: H. pylori
Side Effects: Nausea, vomiting, diarrhea, loss of
appetite, photosensitivity
Nursing Implications
Has serious drug reactions. If taking other medications, give IV erythromycin within 8 hours of
dilution. Take with food to decrease GI side effects and avoid sun exposure. Assess heart rate and
rhythm every 4 hours after administration. Drugs are highly protein bound and will cause severe
interactions with other protein bound drugs. Absorption of the drug is enhanced when taken on an
empty stomach, but due to high incidence of GI upset, many drugs are taken after a meal or snack.
Quinolones
Ciprofloxacin is prototype
DNA synthesis inhibitor, also known as
fluoroquinolones. Broad spectrum
antibacterial drugs
Indications: Used against gram negative organisms
and some gram positive organisms to inhibit the
production of DNA, preventing bacterial
reproduction
Side Effects: Ototoxicity and candidiasis, tendon
rupture, headache, dizziness, insomnia, depression,
restlessness, convulsions, nausea + vomiting,
diarrhea, constipation, thrush, increased liver
function study results, prolonged QT interval, rash,
pruritus, urticaria, flushing, tendonitis, fever, chills,
blurred vision, tinnitus
Nursing Implications
Has an excellent oral absorption, but absorption is reduced by antacids. Before administration, assess
the patient for any medications taken such as iron, vitamins and antacids. After administration, check
heart rate and rhythm every 4 hours. Patient should stop the drug and notify the prescriber of any
tendon or joint pain/swelling. Ensure to take the drug with a full glass of water and increase fluids
throughout the day. Check pulse daily, and if diabetic, check blood glucose levels more often. Tendon
rupture is more common in older adults.
Seizures/Antiepileptic Drugs
Barbiturates
Phenobarbital and Primidone is prototype
Therapeutic effects are seen at serum drug
levels of 10-40 ug/mL.
Diazepam is drug of choice for status
epilepticus
Indications: Prevention or control of seizure activity,
long term maintenance therapy for chronic, recurring
seizures, acute treatment of convulsions
Side Effects: Sedation,
cardiovascular/CNS/GI/dermatologic reactions
Contraindications: Known drug allergy, porphyria,
liver or kidney impairment, respiratory illness
Nursing Implications
Phenobarbital is addictive and sedating. Primidone is metabolized in the liver to phenobarbital. Avoid
in pregnant women as can cause birth defects and congenital abnormalities. Therapy is long term and
possibly lifelong.
Hydantoins
Phenytoin is prototype
First line drug, highly protein bound
Fosphenytoin
Injectable prodrug of phenytoin, can be given
via IM or IV (IV push or continuous infusion
w/o burning on injection)
Indications: Prevention or control of seizure activity,
long term maintenance therapy for chronic, recurring
seizures, acute treatment of convulsions
Side Effects: Gingival hyperplasia, acne, hirsutism,
Dilantin facies, osteoporosis
Indications: Prevention or control of seizure activity,
long term maintenance therapy for chronic, recurring
seizures, acute treatment of convulsions
Nursing Implications
IV administration that is very irritating to the veins, a filter and saline flush must be utilized. Diluted in
normal saline for IV infusion. Administered through a slow IV push directly into a large vein through a
large gauge (should be 20 gauge or larger) venous catheter. Avoid in pregnant women as can cause
birth defects and congenital abnormalities. Therapy is long term and possibly lifelong. Blood
dyscrasias may occur with administration.
Parkinson’s Drugs
Carbidopa Levodopa
Dopamine replacement drug, increases “on”
time and decreases “off” time
Indications: Parkinson’s disease
Side Effects: Cardiac dysthymias, hypotension,
chorea, muscle cramps, suicidal tendencies, GI
distress
Nursing Implications
Best taken on empty stomach to minimize GI side effects, use cautiously in patients with glaucoma.
Interacts with pyridoxine (Vitamin B6) and dietary protein. Large doses of levodopa are needed to get
dopamine to the brain but also causes adverse effects. Do not double dose drugs, used to control
symptoms and is not a cure. Patient should avoid large amounts of chocolate and caffeine. Avoid
overheating in hot weather.
Older adults are more sensitive to effects and should change positions slowly. Confusion,
hallucinations, and uncontrolled body movements are possible, use hand rails on stairs. Changes to
the home should be implemented.
Antidiabetic Drugs
Glucagon
Breaks down glycogen into glucose, raises
blood glucose levels back to normal
Indications: Hypoglycemia, not enough glucose to
make enough ATP
Side Effects:
Nursing Implications
Has opposite actions from insulin.
Insulin
Rapid acting insulin
Insulin lispro (Humalog): similar to
endogenous insulin
Insulin aspart (NovoLog)
Insulin glulisine (Apidra)
Rapid acting insulin
Afreeza
Inhaled
Long Acting
Insulin glargine (Lantus)
Onset of Action: 5 to 15 minutes, has most rapid
onset
Peak: 1 to 2 hours
Duration: 3 to 5 hours
Patient must eat a meal after injection.
Peak: 12 to 15 minutes
Duration: 2 to 3 hours
Administered within 20 minutes before each meal.
Must be given in conjunction with long-acting
insulins or oral diabetic agents
Side Effects: Hypoglycemia, cough and throat pain,
risk of acute bronchospasms
Contraindications: Smokers, those with chronic lung
diseases
Onset: 1 to 2 hours
Peak: None
Clear, colorless solution that is usually dosed
once daily, providing a constant level of
insulin in the body
Intermediate Acting
NPH/Insulin Isophane Suspension
Cloudy appearance, often combined with
regular insulin
Short acting insulin
Humulin R/Regular Insulin
Administered via IV bolus, IV infusion,
intramuscular, or SQ
Nursing Implications
Duration: 24 hours
Onset: 1 to 2 hours
Peak: 4 to 8 hours
Duration: 10 to 18 hours
Onset: 30 to 60 minutes
Peak: 2.5 hours
Duration: 6 to 10 hours
Has opposite actions from insulin. SQ Rapid acting (lispro/aspart) or short acting (regular) insulin are
adjusted according to blood glucose test results.
Basal-Bolus insulin dosing occurs with long acting insulin (glargine) or insulin lispo/aspart.
Oral Antidiabetic Drugs
Biguanide (Metformin)
First line drug, most commonly used oral drug
for type 2 diabetes.
Sulfonylureas (Glipizide)
Stimulates insulin secretion from beta cells of
pancreas, lowering blood glucose levels
Thiazolidinediones (Pioglitazone)
Indications: Type 2 Diabetes
Side Effects: GI distress, abdominal bloating, nausea,
cramping, diarrhea, feeling of fullness, metallic taste,
reduced vitamin B12 levels, lactic acidosis
Take with food. Causes liver to decrease stores of
glucose, be careful Is patient is scheduled for surgery
or procedure
Side Effects: Hypoglycemia, hematologic effects,
nausea, epigastric fullness, heartburn
Indication: Type 2 Diabetes
Reduce glucose production in the liver
Nursing Implications
Make sure patient’s meal is on the unit before giving drugs, check vital signs and daily urine output.
Check weight and indications of edema formation. Administered when exercise and diet doesn’t work
to control blood glucose.
Thyroid Drugs
Thyroid Drugs
Methimazole
First line therapy
Propylthiouracil (PTU)
Levothyroxine
Indications: Hyperthyroidism
Action: Slows down the formation of thyroid
hormone
Adverse Effects: Bone marrow suppression, drugs
can be hepatotoxic, enhance action of drugs that
reduce blood clotting
Indications: Hyperthyroidism
Action: Slows down the formation of thyroid
hormone
Adverse Effects: Bone marrow suppression, drugs
can be hepatotoxic, enhance action of drugs that
reduce blood clotting
Indications: Hypothyroidism
Action: Binds to receptors on DNA and activates
genes for metabolism
Side Effects: Overdose of drugs results in
hyperthyroidism, increased activity of cardiac and
nervous systems, enhanced action of drugs that
reduce blood clotting
Interactions: Enhance anticoagulants, antiseizure and
antidepressants lower levo levels, binding agents,
antiulcer medications, calcium and iron supplements
reduce absorption of the medication (allow 4 hours
between medication)
Dose starts low and is slowly increased until patient
has normal levels, may take up to 6-8 weeks for full
effect. Do not take OTC meds without consulting
provider
Nursing Implications
Check color of the roof of mouth and eyes daily. Avoid crowds and people who are ill. Therapeutic
effect may take 1-2 weeks, and full benefit will take effect in 3-12 weeks. Do not consume seafood or
things with iodide. Monitor for leukopenia and thrombocytopenia.