1. Introduction to Clinical Pharmacology Chapter 9 Antibacterial Drugs That Interfere With DNA/RNA Synthesis

2. Fluoroquinolones Ciprofloxacin (Cipro) Gemifloxacin (Factive)
Levofloxacin (Levaquin)
Moxifloxacin (Avelox)
Ofloxacin (Floxin)

3. Fluoroquinolones: Actions
Bactericidal effect:
Interfere with the synthesis of bacterial DNA
Prevents cell reproduction, leading to death of the bacteria

4. Fluoroquinolones: Uses
Used to treat infections caused by gram-positive and gram-negative microorganisms
Used for the treatment of:
Lower respiratory infections
Bone and joint infections
Urinary tract infections and infections of the skin
Sexually transmitted diseases

5. Fluoroquinolones: Adverse Reactions
Common adverse effects:
Nausea; diarrhea; headache; abdominal pain or discomfort; dizziness
What should the nurse do?
Serious adverse effects:
Photosensitivity and hypersensitivity
Bacterial or fungal superinfections
Explain to patient why superinfections happen
Pseudomembranous colitisPPT
Bacterial superinfection that is potentially life-threatening problem because of an overgrowth of the microorganism Clostridium difficile (C. diff) in the bowel.

6. Fluoroquinolones: Superinfections
Can develop rapidly and can be potentially serious and life threatening
Antiinfectives disrupt the normal flora
It is “superimposed” on the original infection
Altered chemical environment allows uncontrolled bacteria or fungal micoorganisms to multiply
Especially can happen when on antiinfective therapy for a long time or on repeated courses of therapy

7. Fluoroquinolones: Contraindications and Precautions
Contraindicated:
In patients with a history of hypersensitivity; in children younger than 18 years; during pregnancy; in patients who cannot follow precautions regarding photosensitivity
Used cautiously in:
Patients with diabetes; renal impairment; patients with history of seizures; geriatric patients; patients on dialysis
Risk of severe cardiac arrhythmias with patients that take moxifloxican along with any of these: quinidine, procainamide, amiodarone, or sotalol
Can cause pain, inflammation, or rupture of a tendon; patients over 60 have a greater risk if taking a corticosteroid also

8. Fluoroquinolones: Interactions
Interactant drug
Effect of interaction
Theophylline
Increased serum level
Cimetidine (Tagamet)
Hampers elimination of antibiotic
Oral anticoagulants
Increased risk of bleeding
Antacids, iron salts, or zinc
Decreased antibiotic absorption-administer at least 2 hours apart
NSAIDs
Risk of seizure

9. Nursing Process: Assessment #1
Preadministration assessment:
Signs and symptoms of infection
Take and record vital signs and identify symptoms and history of drug allergies
Primary health care provider may order:
Culture and sensitivity: to be done before first dose of the drug is given
Renal and hepatic function tests; CBC; urinalysis

10. Nursing Process: Assessment #2
Ongoing assessment:
Monitor patient’s vital signs and for any adverse reactions during the first 48 hours
Notify primary health care provider is significant drop in blood pressure, increase in pulse or respirations, or spike in temperature
Notify the primary health care provider of any adverse reaction before the next dose of the drug is due

11. Nursing Process: Nursing Diagnosis
Risk for Impaired Comfort related to fever
Risk for Impaired Skin Integrity related to photosensitivity
Acute Pain related to tissue injury during drug therapy
Diarrhea related to superinfection secondary to antibiotic therapy adverse drug reaction
Anxiety due to being sick

12. Nursing Process: Planning
The expected outcome includes an optimal response to therapy based on the reason for administration of the anti-infective:
Management of adverse drug reactions
Decrease in anxiety
Understanding of and compliance with the prescribed treatment regimen

13. Nursing Process: Implementation #1
Promoting an optimal response therapy:
Observe patients for adverse reactions: Notify primary health care provider
Intramuscular administration: monitor, record, and develop a plan for rotating injection sites
Intravenous administration: monitor needle site; check rate of infusion; inspect the vein

14. Nursing Process: Implementation #2
Monitoring and managing patient needs:
Diarrhea
Check and record the color and consistency of each stool
Acute pain at injection site
Inform the patient about discomfort
Use proper flush solution

15. Nursing Process: Implementation #3
Educating the patient and family:
Explain the importance of taking the drug at prescribed time intervals and as directed
Advise about the importance of completing the entire course of treatment
Explain the necessity of contacting the primary health care provider immediately if symptoms occur

16. Nursing Process: Implementation #4
Monitoring and managing patient needs:
Acute pain: tissue injury
Inspect needle site, rate of infusion, and vein for signs of tenderness, pain, and redness
Rate of infusion should be checked every 15 minutes

17. Nursing Process: Implementation #5
Monitoring and managing patient needs (cont.)
Diarrhea
Check the patient’s stools and report any incidence of diarrhea or the presence of blood and mucus immediately
Any report on stool such as C. difficile test, occult blood test (guaiac testing/hemoccult testing)

18. Nursing Process: Implementation #6
Educating the patient and family:
Explain the adverse reactions of specific prescribed antibiotics
Explain where superinfections can occur and signs and symptoms
A fungal superinfection commonly occurs in the mouth, vagina, and anogenital areas, commonly manifested by creamy, white, lace-like patches on the tongue, mouth, or throat; white or yellow vaginal discharge; anal or vaginal itching or redness; and inflammation or excoriation of the mouth or the skin folds of the anogenital area.
Use sunscreen but also use long sleeves, hats with wide brims
Advise about the signs and symptoms of potentially serious adverse effects

19. Nursing Process: Implementation #7
Educating the patient and family (cont.)
Explain the necessity of contacting the primary health care provider immediately if symptoms occur
Develop a teaching plan to include the information that appears in the Home Care Checklist
Explain that extended release forms need to be swallowed whold

20. Nursing Process: Evaluation #1
The therapeutic effect is achieved; infection is controlled; bowel is cleansed sufficiently if surgery is to occur
Fluid intake and output is appropriate
Norfloxacin should be taken n empty stomach

21. Nursing Process: Evaluation #2
Adverse reactions are identified, reported, and managed
Patient and family demonstrate understanding of the drug regimen
Patient verbalizes the importance of complying with the prescribed therapeutic regimen

22. Question #1 Is the following statement true or false?
Fluoroquinolones are the primary class of bactericidal drugs affecting the bacterial cell by interfering with the synthesis of RNA.

23. Answer to Question #1 False
Fluoroquinolones are the primary class of bactericidal drugs affecting the bacterial cell by interfering with the synthesis of DNA. These drugs are used to treat a wide range of both gram- negative and gram-positive microorganisms.

24. Question #2 Is the following statement true or false?
Frequent liquid stools may be an indication of a superinfection or pseudomembranous colitis.

25. Answer to Question #2 True
Frequent liquid stools may be an indication of a superinfection or pseudomembranous colitis. If pseudomembranous colitis occurs, it is usually seen 4 to 10 days after treatment is started.

26. Question #3 Is the following statement true or false?
When medications are given IV, the vein needs to be monitored frequently because the medications can be irritating to the tissue.

27. Answer to Question #3 True
When medications are given IV, the vein needs to be monitored frequently because the medications can be irritating to the tissue.