penicillin G (benzylpenicllin); comes in sodium, potassium,
Narrow spectrum, penicillinase sensitive
penicillin
Why is pt receiving this? Bactericidal for gram + and some gram –bacteria incl. pneumonia, meningitis,
rheumatic fever, syphilis; prophylaxis for invasive procedures/dental work to prevent endocarditis;
weakens cell wall by disrupting cell wall synthesis/autolysing cell wall causing cell rupture (effective against
procaine, and bezanthine forms
gram + because gram + only have two layers while gram – have 3)
Dosage penicillin G: IM/IV 1-5 million units q 4-6 hrs (most infections)
penicillin V PO 125-500 mg q 6-8 hr (Rheumatic fever: 125-250 q 12 hrs)
procaine IM (moderate or severe inf)600k to 1.2mil units/day
bezanthine IM (strep): 1.2 mil units single dose
(primary, secondary, and early latent syphilis): 2.4 mil “”
(tertiary and late [not neurosyphillis]) 2.4 mil/wk for 3 wk
SE ALLERGIC RXN (potential cross reactivity w/ cephalosporins), seizures, pseudomembranous
colitis, diarrhea, epigastric distress, n/v, rash, eosinophilia, hemolytic anemia, pain at IM site,
phlebitis superinfections
Data used to indicate med is effective/goal assess infection (v/s, cultures, lab work), obtain hx to
determine previous use of penicillins and any rxns GOAL: resolution of s/sx of infection
Med administration concerns observe for signs of allergic rxn (anaphylaxis, rash, difficulty breathing),
monitor bowel function for s/sx of pseudomembranous colitis, administer PO meds around the clock
(Penicillin V may be given w/out concern for food), may increase effects of warfarin, probenecid
decreases excretion, NEVER GIVE PENICLLIN G BENZATHINE OR PROCAINE IV: EMBOLISM OR TOXIC
Pt/caregiver education take as directed, report signs of suprainfection, notify abnormal s/sx (fever,
bloody stool) or if symptoms don’t improve, pt w/ penicillin allergy should ALWAYS carry card w/ info
dicloxacillin (Nallpen)
Narrow spectrum penicillinase resistant
penicillin
Why is pt receiving this? treatment of resp., skin/skin structure, and sinus infection due to
penicillinase-producing staphylococci (staph infections), also indicated in osteomyelitis. Binds
to bacterial cell wall, leading to death.
Dosage PO 125-250 mg q 6hr (up to 2g/day)
SE Seizures (high doses), pseudomembranous colitis, diarrhea, n/v, drug induced hepatitis,
rashes, allergic reactions incl Anaphylaxis and serum sickness superinfections
Data used to assess effectiveness/goal Assess infection, obtain hx of penicillin use/rxn, liver
function tests as indicated GOAL: resolution of s/sx of infection
Medication administration concernsobserve for s/sx of anaphylaxis, s/sx of pseudomembranous
colitis and jaundice, administer medication around the clock, take with full glass of water
(Penicillins are weak/easily destroyed in acid and fruit juices may decrease absorption), may
increase effects of warfarin, probenecid decreases excretion
Pt/caregiver education report s/sx of suprainfection (fuzzy tongue, vaginal itching or discharge,
loose or foul smelling stools), abnormal s/sx (fever, diarrhea, blood in stool), notify if symptoms
do not improve
amoxicillin
Broad spectrum penicillins (aminopenicillins)
Why is pt receiving this? treatment of skin and skin structure infections, otitis media, sinusitis,
resp infections, gu infection, endocarditis prophylaxis, post exposure of anthrax inhalation and
mgmt. of PUD caused by H pylori
Dosage most infections: 250-500 mg PO q 8 hr or 500-875 mg q 12 hr (not to exceed 2-3 g/day)
SE Seizures (high doses), pseudomembranous colitis, n/v, diarrhea, increased lvier enzymes,
rash, ALLERGIC RXNS, superinfections
Data used to assess effectiveness/goal Assess for infection before and throughout therapy,
obtain hx of previous use/rxn to penicillin GOAL: resolution of s/sx of infection
Med administration concerns Administer PO med around the clock, can be given w/out regard
to meals (can be given w/ meals to decrease GI side effects), monitor for s/sx of anaphylaxis,
pseudomembranous colitis ; decreases effectiveness of oral contraceptives, increases effects of
warfarin, probenecid decreases excretion
Pt/caregiver education report s/sx of suprainfection (fuzzy tongue, vaginal itching or discharge,
loose or foul smelling stools), abnormal s/sx (fever, diarrhea, blood in stool), notify if symptoms
do not improve, advise female pts using oral contraceptives to consult other b/c methods
piperacillin (Zosyn when combined w/
Extended spectrum penicillins (spectrum is extended
tazobactam)
compared to other penicillins, incl gram negitve aerobes such as
pseudomonas aeruginosa, active against anaerobic bact.)
Why is pt receiving this? appendicitis, peritonitis, skin/skin structure infections, gyenecologic
infections, community acquired and nosocomial pneumonia; binds to bacterial cell wall
membrane causing death
Dosage given IV, depending on infection, renal impairment adjustments as appropriate
SE Seizures (higher doses), confusion, dizziness, HA, insomnia, pseudomembranous colitis,
diarrhea, constipation, drug induced hepatitis, n/v, interstitial nephritis, SJS, TENS, rash,
bleeding, leukopenia, pain/phlebitis @ IV site, ALLERGIC RXNS
Assessment data to determine effective/goal assess infection, obtain hx of PCN use and rxn
GOAL: resolution of s/sx of infection
Med administration concerns probenecid decreases excretion, may alter lithium, potassium
losing diuretics/corticosteroids/amphotericin B may increase risk of hypokalemia, may
increase risk of heptatoxicity w/ other hepatotoxic agents, may decreases levels of
aminoglycosides; assess for s/sx of anaphylaxis, SJS/TENS, pseudoemembranous colitis
Pt/caregiver education: report s/sx of suprainfection (fuzzy tongue, vaginal itching or discharge, loose or foul smelling
stools), abnormal s/sx (fever, diarrhea, blood in stool), notify if symptoms do not improve, advise female pts using oral
contraceptives to consult other b/c methods
amoxicillin + clavulanate (Augmentin) Just like
Aminopenicillins/betalactamase inhibitors
Unasym (ampicillin + sulbactam)
Why is pt receiving this? Treatment of variety of infections; penicillin binds to cell wall to inhibit
synthesis (bact. cell lysis) and betalactamase inhibitor resists bacterial defense mechanisms beta
lactamase destroys penicillin
Dosage most infections PO 250 mg q 8 hrs or 500 mg q 12 hrs;
serious infections and resp. infections PO 875 mg q 12 hr or 500 mg q 8 hr
SE seizures (high doses), pseudomembranous colitis, diarrhea, hepatic dysfunction, n/v, vaginal
candidiasis, ALLERGIC rxns
Data used to assess effectiveness/goal Assess for infection before and throughout therapy,
obtain hx of previous use/rxn to penicillin GOAL: resolution of s/sx of infection
Med administration concerns Administer PO med around the clock, can be given w/out regard
to meals (can be given w/ meals to decrease GI side effects), AVOID HIGH FAT MEALS
(decreases absorption of clavulanate) monitor for s/sx of anaphylaxis, pseudomembranous
colitis ; decreases effectiveness of oral contraceptives, increases effects of warfarin,
probenecid decreases excretion
Pt/caregiver education report s/sx of suprainfection (fuzzy tongue, vaginal itching or discharge,
loose or foul smelling stools), abnormal s/sx (fever, diarrhea, blood in stool), notify if symptoms
do not improve, advise female pts using oral contraceptives to consult other b/c methods
cefazolin (Ancef)
First generation cephalosporin (narrow
spectrum)
Why is pt receiving this? perioperative prophylaxis, treatment of skin/skin structure,
pneumonia, UTIs, bone and join infections and septicemia Produce lysis like PCN’s, binds to
penicillin binding proteins which disrupts cell wall synthesis (causes cell lysis); used with many
gram + and some gram Dosage IM, IV moderate to severe infections: 500 mg-2g q 6-8 hrs; mild infections w/ gram positive cocci: 250-500
mg q 8 hr
perioperative prophylaxis: 1 g given 30-60 min prior to surgery (additional 500 mg-1g given for surgeries > 2 hr)
SE seizures (high doses), pseudomembranous colitis, diarrhea, n/v, Stevens Johnson syndrome,
rashes, agranulocytosis, eosinophilla, hemolytic anemia, neutropenia, thrombocytopenia, pain
at IM site, phlebitis at IV site ALLERGIC RXN incl anaphylaxis and serum sickness (if pt has PCN
allergy, 5-10% chance of cross rxn with cephalosporins) superinfection
Data used to assess effectiveness/goal Assess for infection before and throughout therapy,
obtain hx of previous use/rxn to penicillin GOAL: resolution of s/sx of infection, decreased
incidence of infection when used prophylactically
Med administration concerns: probenecid decreases excretion, concurrent use of loop diuretics
or aminoglycosides can result in nephrotoxicity, assess for s/sx of anaphylaxis,
pseudomembranous colitis, SJS
Pt/caregiver education report unusal s/sx including changes in breathing,bowel habits (bloody,
diarrheal stools), fever, and rash, report signs of superinfection
cefuroxime (Ceftin)
Second generation cephalosporin (increased
activity to more gram negative than first generation (e.g.
more broad spectrum than first generation)
Why is pt receiving this? treatment of resp., skin/skin structure, bone and joint, UTI, infections
caused by susceptible organisms, as well as meningitis, gynecologic infections and lyme disease
Dosage oral tablets and oral suspension ARE NOT substitutable (not bioequivalent)
PO varies based on infection, gonorrhea- 1 g single dose
IM, IV: varies based on infection
SE seizures (high doses), pseudomembranous colitis, diarrhea, cramps, n/v, rashes,
agranulocytosis, bleeding, eosinophilia, hemolytic anemia, neutropenia, thrombocytopenia, pain
at IM site, phlebitis at IV site, Allergic rxns
Data used to assess effectiveness/goal Assess for infection before and throughout therapy,
obtain hx of previous use/rxn to penicillin GOAL: resolution of s/sx of infection
Med administration concerns Tablets should be swallowed whole and not broken to avoid
lasting bitter aftertaste, may be taken w/out regard to food, probenecid decreases excretion,
concurrent use of loop diuretics or aminoglycosides can result in nephrotoxicity, assess for s/sx
of anaphylaxis, pseudomembranous colitis
Pt education report unusal s/sx including changes in breathing,bowel habits (bloody, diarrheal
stools), fever, and rash, report signs of superinfection
ceftriaxone (Rocephin)
Third generation cephalosporin (less effective
than previous generations in treating staphylococci,
whereas activity against gram negative pathogens is
greater)
Why is pt receiving this? treatment of skin/skin structure, urinary and gynecologic, resp.,
bone/joint infections, meningitis, intra-abdominal infections and septicemia, otitis media,
perioperative prophylaxis, and lyme disease
Dosage IM, IV Most infections: 1-2 g q 12-24 hr, Gonorrhea 250 mg IM (single dose)
meningitis: 2 g q 12 hr. perioperative prophylaxis: 1 g 30 min-2hr before surgery
SE seizures (high doses), pseudomembranous colitis, diarrhea, cramps, n/v, rashes,
agranulocytosis, bleeding, SJS, eosinophilia, hemolytic anemia, neutropenia, thrombocytopenia,
pain at IM site, phlebitis at IV site, Allergic rxns
Data used to assess effectiveness/goal Assess for infection before and throughout therapy,
obtain hx of previous use/rxn to penicillin GOAL: resolution of s/sx of infection, decreased
incidence of infection when used preoperatively
Med administration concerns: probenecid decreases excretion, concurrent use of loop diuretics
or aminoglycosides can result in nephrotoxicity, should not be given with calcium containing
solutions, assess for s/sx of anaphylaxis, pseudomembranous colitis, SJS
Pt/caregiver education report unusal s/sx including changes in breathing,bowel habits (bloody,
diarrheal stools), fever, and rash, report signs of superinfection
cefepime (Maxipime)
Fourth generation cephalosporin (less effective than previous generations in
treating staphylococci, whereas activity against gram negative pathogens is greater)
Why is pt receiving this? treatment of following infections: uncomplicated skin and skin skin
structure infections, bone and joint infections, uncomplicated/complicated UTI’s, respiratory
tract infections, complicated intra-abdominal infections, septicemia
DosageIM: mild/moderate (un)complicated UTI due to E.coli: .5-1 g every 12 hr
IV: varies based on infection; see manufacturer’s recommendations for impaired renal
adjustment
SE Seizures (increased risk in renal impairment), encephalopathy, HA, pseudomembranous
coltis, diarrhea, n/v, rahes, bleeding, eosinophila, hemolytic anemia, neutropenia,
thrombocytopenia, pain @ IM site, phlebitis @ IV, allergic rxns , superinfection
Data used to assess effectiveness/goal Assess for infection before and throughout therapy,
obtain hx of previous use/rxn to penicillin GOAL: resolution of s/sx of infection
Med administration concerns: probenecid decreases excretion, concurrent use of loop diuretics
or aminoglycosides can result in nephrotoxicity, should not be given with calcium containing
solutions, assess for s/sx of anaphylaxis, pseudomembranous colitis
Pt/caregiver education report unusal s/sx including changes in breathing,bowel habits (bloody,
diarrheal stools), fever, and rash, report signs of superinfection
imipenem (Primaxim) (imipenem/cilastatin
Carbapenems broad spectrum betalactam
[cilastatin prevents renal inactivation])
Why is pt receiving this? Bacterostatic but can be bactericidal; treatment of pseudomans
aeruginosa, lower RTIs, UTI’s, abd infections, skin/skin structure infection, gyenecologic
infections, bone and joint, bacteremia, endocarditis, polymicrobic infections
Dosage IV mild: 250-500 mg q 6 hrs/moderate: 500 mg q 6-8 or 1 g q 8 hrs/ serious: 500 mg q 6
hrs to 1 g q 6-8 hrs; [250 mg/mL w/ 250-mg vial; 5 mg/mL w/ 500 mg vial], Rate: doses under 500 mg inf
over 20-30 min; > or equal to 750 over 40-60 min
IM: 500-750 mg q 12 hr
Renal impairment adjustments
SE: Hypersensitivity, GI effects, suprainfections, seizures, dizziness, somulence, hypotension,
pseudomembranous colitis, diarrhea, n/v, rash, phlebitis
Data used to assess effectiveness: Assess for infection before and throughout therapy, obtain
hx of previous use/rxn to penicillin GOAL: resolution of s/sx of infection
Med administration concerns observe for anaphylaxis, suprainfections, probenecid decreases
renal excretion, may be inactivated if used w/ aminoglycosides
Pt/caregiver education pts
Notify for signs of rxn, signs of suprainfection, and bloody/diarrheal stool, fever
vancomycin (Lyphocin)
anti-infectives
Why is pt receiving this? Bactericidial treatment of potentially life threatening infections when less toxic
anti-infectives are contraindicated. Particularly useful in staphylococcal infections incl endocarditis (can
be used prophylactically IV), MRSA, Cdiff (PO); binds to cell wall
Dosage Renal impairment adjustments Serious systemic infections: IV 500 mg q 6 hr or 1 g q 12 hr (up to 4
g/day)
Endocarditis prophylaxis: IV: 1 g signle dose 1 hr pre-procedure
Diarrhea due to C. diff PO: 125 mg q 6 hr for 10 days
Staph. Enterocolitis: PO 500-2000 mg/day in 3-4 divided doses for 7-10 days
SE N/V, altered taste, otoxicity (reversible, but not always), hypotension, nephrotoxicity, eosinophilia,
leukopenia, phlebitis, HYPERSENSITIVITY rxns RED MAN/RED NECK SYNDROME (occurs if given too fast,
not a genuine allergic rxn, pt can still receive if diluted over 60 min)
Data used to assess effectiveness signs of infection, severity of diarrhea, bowel status
Med administration concerns additive ototoxic and nephrotoxic effects w/ other agents, monitor IV site
closely for signs of vein irritation, monitor Is and OS and daily weight (cloudy/pink urine may be sign of
nephrotoxicity), assess for signs of superinfection, anaphylaxis; orally administered only for C diff and
Staph,
Pt/caregiver education take as directed, do not double dose, instruct pt to reporst signs of
hypersensitivity, tinnitus, vertigo, hearing loss, notify if no improvement seen,
tetracycline (Sumycin)
Tetracycines (bacteriostatic inhibitors of prn
synthesis)
Why is pt receiving this? various infections caused by unusal organisms, incl. rickettsial disease,
chlamydia trachomatis, brucellosis, cholera, mycoplasma pneumonia, lyme disease, anthrax;
inhibits bacterial synthesis at level of 30s bacterial ribosome Tetracycline also indicated in acne
Dosage PO 250-500 mg q 6 hr or 500 mg-1 g q 12 hr
SE: benign intracranial hypertension, Hepatoxicity, pseudomembranous colitis, diarrhea, n/v,
esophagitis, pancreatitis, SJS, TENS, photosensitivity, thrombophlebitis, hepatotoxicity, renal
toxicity, vestibular toxicity
Data used to assess effectiveness assess s/sx of infection,
Medication administration concern risk of permanent staining of teeth in infant if used during
last half of pregnancy, contraindicated in children under 8; food slows fast/intermediate acting
forms (minocycline) administer w/ full glass of water 1 hs to prevent esophageal upset; chelating
agent will bind to calcium supplements, milk products, iron supplements, magnesium
laxatives, and antacids GIVE 1 HR BEFORE MEALS OR 2 HR AFTER MEALmay increase effect of
warfarin and decrease effect of estrogen contraceptives, monitor bowel function, signs of rash
Pt/caregiver education take exactly as directed and finish regiment even if feeling better, advise pt to
avoid taking milk or dairy w/ oral tetracylines as well as antacids, zinc, calcium, mg, or al containing
medications, sodium bicarb and iron supplements; notify immediately s/sx of SJS/TENS,
pseudomembranous colitis, hepatotoxicity occur, advise females to use non hormonal b/c methods, use
sunscreen and protective clothing to prevent photosensitivy rxns, report suprainfection, discard outdated
or decomposed tetracylines (may be toxic)
gentamicin (“-micin”, “-mycin”)
Aminoglycoside (bactericidal inhibitor of prn synthesis)
(Gramycin/G-mycin)
Why is pt receiving this? Treatment of infection cause by AEROBIC GRAM NEGATIVE BACILLI
when penicillin contraindicated; can be used in tandem w/ other antibiotics for mgmt. of serious
enterococcal infections, prevention of endocarditis (IV), treatment of localized infections
(topical); inhibits bact synthesis by acting at 30 s subunit
Dosage IM/IV 1-2 mg/kg q 8 hr (up to 6 mg/kg/day in 3 divided doses)
SE IRREVERSIBLE OTOTOXICITY,NEPHROTOXICITY, hypersensitivity, neuromuscular blockade,
hypomagnemesia,
Med administration concerns VERY IMPORTANT MED TO DETERMINE SERUM LEVELS VIA
PEAK/TROUGH (draw peak 30 min after IV administration and trough 1 hr before next dose),
Inactivated by cephalosporins and penecillins, increase risk of ototoxicity w/ loop diuretics,
Assess 8th cranial nerve function constantly throughout therapy, s/sx of infection and
superinfection , monitor Is and Os for assessment of renal function
Pt caregiver education Importance of encouraging fluids
erythromycin (-ycin)
macrolides
Why is pt receiving this? Infections normally treated with penicillin where pt has penicillin
infection (for example: legionella pneumophilia, bordatella pertussis, corynebacterium
diphtheria, chlamidia) , broad spectrum(gram + and some gram -) bacteriostatic antibiotic that
inhibits prn synthesis at 50s bacterial ribosome
Dosage (depends on form)most infections PO: 250 mg q 6 hr or 333 mg q 8 hr or 500 mg q 12 hr
IV: 250-500 mg (up to 1 g) q 6 hr
SE seizures (rare), otoxicity, TORSADES DE POINTES, VENTRICULAR ARRYTHMIA (QT Interval
elongation) pseudomembranous colitis, n/v, abd pain, cramping, CHOLESTATIC HEPATITIS
interstitial nephritis, phlebitis @ IV site, ALLERGIC RXNS, superinfection
Med Administration Concerns use w/ diltiazem, verapamil, and protease inhibitors can increase
risk of cardiac arrhythmias; may increase levels of ergotamine and dihydroergotamine and risk
for acute ergot toxicity, concurrent use with amioderone increases risk of torsades, INTERACTS
W/ DIGOXIN, WARFARIN, STATINS, CCBS, monitor bowel status/function, better absorption if
given 1 hr before meals and 2 hrs after
Pt/caregiver education BAD METALLIC TASTE, notify s/sx of fever/diarrhea, adverse signs,
superinfection
clindamycin (Cleocin)
Anti-infective
Why is pt receiving this? indicated for anaerobic infections located outside of CNS
Dosage PO: most infections 150-450 mg q 6 hrs; IM/IV: 300-600 mg q 6-8 hrs or 900 mg q 8 hrs
IV: dilute 300/600 mg in 50 mL D5W, NS, D5NS, D51/2NS, LR; 900/1200 in 100 mL
[] not to exceed 1800 mg/mL and not to exceed rate of 30 mg/min (can cause cardiopulmonary
arrest)
SE PSEUDOMEMBRANOUS COLITIS , arrhythmias, hypotension, dizziness, confusion,
diarrhea, n/v, phlebitis @ IV site
Med administration concern Monitor s/sx of infection and for pseudomembranous colitis,
assess for hypersensitivity; administer PO w/ full glass of water, do not administer >600 mg in
single IM injection,
Pt/caregiver teaching pts report abnormal s/sx, signs of suprainfection, bitter taste occurs with
IV,
sulfamethoxone-trimethoprim (Bactrim)
SULFA drug (BROAD SPECTRUM)
Why is pt receiving this? Bronchitis, shigella, otitis media, UTI’s pneumocystic pneumonia (PCP),
prevention of PCP in HIV+ patients; burn (unlabeled use) Inhibits folic acid production by
bacteria
Dosage PO/IV depends on infection
SE HYPERSENSITIVITY , Red man syndrome, SJS, fatigue, hypotension, kernicterus in
neonates, hyperkalemia, hyponatremia, crystaluria, photosensitivity, hypoglycemia,
agranulocytosis, aplastic anemia, phlebitis
Med Administration Concerns can increase effects of digoxin and warfarin, increase risk of
thrombocytopenia from thiazide diruetics (esp in geriatrics), risk of hyperkalemia w/ concurrent
use of ACE inhibitors, monitor for phlebitis, hypersensitivity rxns, monitor Is and Os and bowel
function
Pt/caregiver education Encourage fluids to prevent crystaluria, monitor for allergy, notify for
adverse s/sx
nitrofurantonin (Fuadantin)
Anti-infective
Why is pt receiving this? prevention/treatment of UTI’s; BACTERIOSTATIC: [low];
BACTERICIDAL [high]
Dosage Active infection: 50-100 mg q 6-8 hr or 100 mg q 12 hr (extended release)
Chronic suppression: 50-100 mg single evening dose
SE: dizziness, drowsiness, HA, nystagmus, pneumonitis, pulmonary fibrosis, pseudomembranous
colitis, anorexia, n/v, hepatotoxicity, photosensitivity, peripheral neuropathy, HYPERSENSITIVITY
Med admin concerns antacid can decrease absorption, additive hepatotoxic effects; administer
with food or mild to minimize GI irritation, dealy/increase absorption, increase peak
concentration; DO NOT CRUSH;
Pt/caregiver education wear sunscreen/protective clothing after d/c (photosensitivity), report
adverse s/sx, rust colored discoloration of urine normal, may cause dizziness/drowsiness
phenazopyridine (Pyridium)
Urinary tract analgesics (nonopioid)
Why is pt receiving this? Provides relief from UT symptoms: pain, itching, burning, urgency,
frequency
DosagePO 200 mg 3 times daily for 2 days
SE: BRIGHT ORANGE URINE , may make skin looked jaundice, HA, vertigo, hepatotoxicity,
nausea, rash
Data used to determine med’s effectiveness Assess pain, GOAL: decrease in pain and burning
on urination
Med administration concerns Med should be discontinued after pain relieved, administer with
or following meals to decrease GI irritation, DO NOT CRUSH,
Pt/caregiver education Educate that although this may be discontinued after relief, very
important to continue antibiotic regimen, orange discoloration of urine normal, may cause
staining of soft contact lenses
ciprofloxacin (Cipro)
Fluoroquinolones
Why is pt receiving this? urinary tract infections incl cystitis and prostatis, gonorrhea (not first line due
to increasing resistance) gynecologic infections, respiratory tract infections including sinustitis, acute
exacer. chronic bronchitis, skin and skin structure infections, bone/joint infections, infectious
diarrhea, postexposure treatment of inhalational anthrax; inhibits bacterial DNA gyrase enzyme
BROAD SPECTRUM
Dosage PO (most infections): 500-750 mg q 12 hr; IV (most infections): 400 mg q 12 hr; [1-2
mg/mL], administer over 60 min into large vein
Renal impairment adjustment
SE Elevated intracranial pressure, seizures, HA, CNS symtpoms, Hepatotoxicity,
Pseudomembranous colitis, diarrhea, nausea, Candida suprainfection of pharynx and vagina,
tendon rupture (especially in children <1 and elderly) HYPERSENSITIVITY, SJS
Med Administration Concerns concurrent use of amioderone, erythromycin, quinide, and some
antipsychotics increases risk of torsades, CHELATION agent, may increase effects of warfarin,
cimetidine may impair elimination, probenecid decreases renal excretion, use w/ corticosteroids
increases risk of tendon rupture, suspension should not be administered in feeding tube
Pt/caregiver education Notify for signs of hypersensitivity, pseudomembranous colitis, may
cause dizziness/ drowsiness, partners of pt being treated for gonorrhea must be tested
metronidazole (Flagyl)
Anti-infectives/antiprotozoals
Why is pt receiving this: PO/IV: Tretment of protozal infections (may be used w/ a
cephalosporin), obiglate anaerobes, and H. Pylori , PO: amebacide, IV: perioperative
prophylactic ; prohibits prn and DNA synthesis
Dosage: Dosage varies based on infection
IV: [5 mg/mL] over 30-60 min
SE: Neurotoxicity, ALLERGY, superinfections, Disulfiram (antabuse like) rxn w/ alcohol,
Seizures, dizziness, HA, asceptic meningitis/encephalopathy (IV), optic neuropothy, abd
pain, anorexia, nausea, SJS, rash, urticarial; Phlebitis @ IV site
Med Administration Concerns Cimetidine may decrease absorption, phenobarbitol and rifampin
may increase metab (decrease effectiveness), increases effects of phenytoin, lithium, and
warfarin; Disulfiram rxn can be so bad as to affect a person using mouthwash. Assess for rash.
Pt caregiver education: Take as directed, finish regimen; when used for trichiminosis, sexual
partners may be asymptomatic sources of reinfection (get tested); avoid use of alcohol until at
least 3 days after last part of treatment; unpleasant medical taste; medication may turn urine
dark
Amphotericin B (Fungizone) (referred to as “amphoterrible”)
Antifungal HIGH ALERT
Why is pt receiving this? Treatment of progressive, potentially fatal fungal infections .Binds to
fungal cell membrane, allowing leakage of cellular contents. Selective for ergosterol (fungal)
more than cholesterol. May be fungistatic or fungicidal.
Dosage IV/IT. IV: give test dose of 1 mg. If test dose tolerated, initate therapy w/ .25 mg/kg/day.
SE: HIGHLY TOXIC Tissue sloughs away w/ infiltration; Infusion RXNS: fever, chills, rigors,
nausea, HA (can be reduced slightly w/ pretreatment w/ diphenhydramine plus acetaminophen. ASA can
help but can cause kidney damage). Nephrotoxicity, Hypokalemia, chest pain, hypotension,
diarrhea, hyperbillirubinemia, n/v, HYPERSENSITIVTY RXNS
Med Administration Concerns Unknown metabolism/elimination, wear gloves when handling,
need to invert/shake solution every ½ hr to keep in suspension, concurrent use w/
corticosteroids increases effects of hypokalemia (remember Cushing’s disease) MONITOR PT FOR
FIRST ½ HR after infusion started, assess IV site frequently, monitor VS every 15 min of
infection and 30 min for 2-4 hrs post infusion ,
Pt/caregiver education: inform pt of potential side effects and discomfort at IV site, Notify HCP
if ANY adverse effects experienced
ketoconazole (Nizoral) (-“azole”)
Systemic anti-infectives
Why is pt receiving this? Treatment of less severe fungal infections, candidiasis, chromomycosis,
coccoidomycosis, histoplasmosis, blastyomycosis, etc. Inhibits synthesis of ergosterol
Dosage PO: 200-400 mg/day single dose; can also be used topically
SE (generally less in topical treatment) Hepatotoxicity, dizziness/drowsiness, TORSADE’s, n/v,
sex hormone changes (decrease in sperm count, decreased male libido, menstral irregularities,
gynecomastia), adrenal insufficiency, ANAPHYLAXIS
Med Administration Concerns significant CYP450 player, can increase levels of quinidine, may
increase levels and risks of statins, may increase levels and risk toxicity with ergotamine and
dihydroergotamine, can increase levels of digoxin, oral hypoglycemic agents, warfarin,
carbamezpine; may alter effectiveness of hormonal contraceptives, H2 blockers and PPI
decrease absorption, risk of hepatoxicty w/ alcohol or other hepatotoxic agents, administer
WITH meals to decrease GI upset
Pt caregiver education: instruct pt to take med as directed at same time each day, avoid
concurrent use of alcohol, may cause dizziness/drowsiness (avoid driving, fall risk precautions),
photophobic precautions, use nonhormonal form of contraception
griseofulvin
Systemic anti-fungal
Why is pt recieivng this? Treatment of superifical (tinea) infections that do not respond to
topical antifungals. Tinea capitis (head), pedis (foot) onychomycosis (nail fungus); Inhibits fungal
mitosis
Dosage PO: microsize Tinea pedis, onychomycosis 500 mg q 12 hr. Tinea capitis, corporis, or
curis: 250 mg q 12 hr or 500 mg once daily
Ultramicrosize Tinea pedis, onychomycosis 375 mg q 12 hr. Tinea capitis, corporis, or curis:
187.5 mg q 12 hr or 375 mg once daily
SE transient HA, rash, GI, insomnia, tiredness, HEPATOTOXICITY, SJS, TENS, HYPERSENSITIVITY
RXNS
Med Administration Concerns taken w/ alcohol can result in tachycardia, flushing, and increased
CNS depression , phenobarbitol may decrease effectiveness, Increased absorption by fatty
foods; assess history of PCN rxns (cross rxn may exist)
Pt Caregiver education Take complete regimen as prescribed (This med therapy is longer
than others lasting weeks to months) , hygine to control sources of infection, dizziness
(driving/fallprecautions), avoid alcohol
nystatin (Mycostatin)
Local (topical) antifungals
Why is pt receiving this? Treatment of oropharyngeal and intestinal candidiasis. Alters
membrane permeability of fungus
Dosage Swish/swallow; losenges
PO: 400,000-600,00 units 4 times daily as oral suspension 200,000-400,000 4-5 times daily as
lozenges
SE: minimal. Diarrhea, nausea, stomach pain, contact dermatitis, SJS
Med administration conerns: no significant drug interactions; shake thoroughly before each
dose, oral hygiene before each dose, swish and swallow
Acyclovir (-cy/ciclovir)
Antiviral ; purine analog
Why is pt receiving this? Herpes Simplex Virus, Varicella Zoster Virus, Suppresses synthesis of
viral DNA
Dosage PO/IV varies based on infection and reccurence ; renal impairment dosage adjustments
SE seizures, dizziness, HA, hallucinations, diarrhea, N/V, reversible nephrotoxicity, cyrstaluria,
SJS, changes in menstruation, pain, phlebitis
Med administration concerns Probenecid increases blood levels, theophylline increases risk of
toxicity, decreases blood levels (may decrease effectiveness) of valporic acid or phenytoin.
Additive nephrotoxic effects. Administered w/out regard to food w/ full glass of water
(crystaluria), shake oral suspension before administration
Pt caregiver education use of OTC creams/topical meds may delay healing and actually spread
infection, acyclovir is no a cure, condoms should be used during sexual contact, women with
herpes should undergo yearly Pap smears, avoid drug contact in eyes,
zidovudine (Retrovir; AZT)
Nucleoside Reverse Transcriptase Inhibitor (NRTI)
Why is pt receiving this? HIV infection as part of “HIV cocktail” known as HAART (Highly
Aggressive Anti-retroviral Therapy); acts as “analog” to nucleotide to bind with and inhibit HIV
enzyme reverse transcriptase. Allows for increasing CD4 count to delay or prevent onset of AIDS.
Dosage Mgmt of HIV infection: PO 100 mg q 4 hr while awake or 200 mg 3 times daily or 300 mg
twice daily; IV: 1 mg/kg infused over 1 hr q 4 hr (change to oral therapy ASAP) ----------------------Prevention of Maternal/fetal transmission: Adults >14 weeks pregnant PO 100 mg 5 times daily
until onset of labor, (during labor/delivery): IV: 2 mg/kg over 1 hr then continuous infusion of 1
mg/kg/hr until cord is campled
SE Seizures, HA, weakness, anxiety, confusion, decreased mental acuity, dizziness,
HEPATOMEGALY, PANCREATITIS, abd pain, diarrhea, nausea, LACTIC ACIDOSIS, fat
redistribution, gynecomastia, anemia, granulocytopenia, neutropenia,
Med administration concerns increased bone marrow depression w/ other agents, antineoplastics,
and radiation therapy; increased nephrotoxicity w/ acyclovir; toxicity may be increased with Probenecid
Pt caregiver education Instruct to take as directed, around the clock, even if sleep is disturbed.
Importance of compliance of therapy and routine follow ups. May cause dizziness/fainting
(driving, fall risk), not a cure for HIV, notify abnormal s/sx, redistribution and accumulation of
body fat may occur (body image counseling), do not breast feed during therapy
nevirapine (Viramune)
Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI)
Why is pt receiving this? mgmt. of HIV in combination with NRTI as part of HAART; binds directly
to reverse transcriptase to disrupt its effects ; post exposure prophylaxis (PEP)
Dosage PO: varies based on either Immediate release or extended release; renal impairment
dose adjustment
SE HA, HEPATOTOXICITY, nausea, abd pain, rash (may progress to TENS), granulocytopenia,
myalgia, paresthesia, SJS, fever
Med Administration Concerns significantly decreases ketoconazole levels, decrease level and
effectiveness of hormonal contraceptives, decreased by rifampin, may increase risk of bleeding
w/ warfarin, use of prednisone w/in first two weeks may increase risk of rash, additive risk of
rash w/ other drugs causing rash; DoNOTCrush extended release tabs, may be given w/out
regard to food, if therapy is interrupted for 7 days or more, restart therapy
Pt caregiver education Instruct to take as directed, around the clock, even if sleep is disturbed.
Importance of compliance of therapy and routine follow ups. May cause dizziness/fainting
(driving, fall risk), not a cure for HIV, notify abnormal s/sx, redistribution and accumulation of
body fat may occur (body image counseling)
indinavir (Crixivan) (-avir)
Protease Inhibitor
Why is pt receiving this? Mgmt of HIV infection w/ other antiretrovirals as part of HAART, post
exposure prophylaxis (PEP) ; inhibits HIV protease which prevents cleavage of viral polyproteins
Dosage PO 800 mg q 8 hr
SE dizziness/drowsiness, fatigue, HA, insomnia, abd pain, acid regurg, alterted taste,
asymptomatic hyperbillirubinemia, diarrhea HEPATOTOXICITY, nephrolithiasis,
HYPERGLYCEMIA, HYPERLIPIDEMIA, FAT REDISTROBUTION, KETOACIDOSIS, back/flank pain
increased bleeding in hemopheliacs, reduced bone mineral density, elevation of serum
transaminases
Med Admin Concerns increase risk of toxicity from amioderone, ergot derivatives, rifampin
decreases blood levels, risk of myopathy w/ statins, blood levels increased by ketoconazole;
HIGH FAT OR HIGH PRN MEALS decreases absorption administer w/ water 1 hr before or 2 hr
after a meal.
Pt/caregiver education Take as directed, important to adhere to regimen. If missed dose is
within 2 hrs of next dose, skip dose and take next schedule dose; store in original container
(sensitive to moisture), may cause kidney stones, may cause hyperglycemia, does not cure HIV,
drowsiness/dizziness, body fat redistribution, avoid breastfeeding, importance of regular follow
up
enfuirtide (Fuzeon or T-20)
Fusion inhibitor
Why is pt receiving this? can be used w/ HAART, prevents HIV envelope from fusing w/ cell
membrane of CD4 cell
Dosage Sub Q 90 mg twice daily
SE fatigue, conjunctivitis, cough, pna, sinusitis, diarrhea, nausea, abd pain, injection site
reactions, myalgia, limb pain , HYPERSENSITIVITY,
Med Admin concerns no drug/drug interactions