Copyright © 2008 Lippincott Williams & Wilkins. Introductory Clinical Pharmacology Chapter 10 Fluoroquinolones and Aminoglycosides

Copyright © 2008 Lippincott Williams & Wilkins. Introduction Various microorganisms became more resistant to antibiotics –Two broad-spectrum antibiotics were developed Fluoroquinolones Aminoglycosides

Copyright © 2008 Lippincott Williams & Wilkins. Fluoroquinolones Ciprofloxacin (Cipro) Enoxacin (Penetrex) Gatifloxacin (Tequin) Lomefloxacin (Maxaquin) Moxifloxacin (Avelox) Ofloxacin (Floxin) Sparfloxacin (Zagam)

Copyright © 2008 Lippincott Williams & Wilkins. Fluoroquinolones: Actions Bactericidal effect –Interferes with the synthesis of bacterial DNA Prevents cell reproduction leading to death of the bacteria

Copyright © 2008 Lippincott Williams & Wilkins. 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

Copyright © 2008 Lippincott Williams & Wilkins. Fluoroquinolones: Adverse Reactions Common adverse effects –Nausea; diarrhea; headache; abdominal pain or discomfort; dizziness

Copyright © 2008 Lippincott Williams & Wilkins. Fluoroquinolones: Contraindications and Precautions Contraindicated in patients with: –History of hypersensitivity; in children younger than 18 years; during pregnancy (category C); who cannot follow precautions regarding photosensitivity

Copyright © 2008 Lippincott Williams & Wilkins. Fluoroquinolones: Interactions Interactant drugEffect of interaction TheophyllineIncreased serum level Cimetidine (Tagamet)Hampers elimination of antibiotic Oral anticoagulantsIncreased risk of bleeding Antacids, iron salts, or zinc Decreased antibiotic absorption NSAIDsRisk of seizure

Copyright © 2008 Lippincott Williams & Wilkins. Aminoglycosides Amikacin (Amikin) Gentamicin (Garamycin) Kanamycin (Kantrex) Neomycin (Mycifradin) Netilmicin (Netromycin) Streptomycin Tobramycin (Nebcin)

Copyright © 2008 Lippincott Williams & Wilkins. Aminoglycosides: Actions Exert bactericidal effect –Block protein synthesis –Disrupt functional ability of the bacterial cell wall

Copyright © 2008 Lippincott Williams & Wilkins. Aminoglycosides: Uses Primary use: Treatment of infections caused by gram-negative microorganisms Used to reduce bacteria in the bowel: For patients having abdominal surgery Oral aminoglycosides: Useful in suppressing GI bacteria (bowel prep)

Copyright © 2008 Lippincott Williams & Wilkins. Aminoglycosides: Adverse Reactions General system reactions –Vomiting; anorexia; rash; and nausea

Copyright © 2008 Lippincott Williams & Wilkins. Aminoglycosides: Adverse Reactions (cont’d) Signs and symptoms of adverse reactions –Nephrotoxicity: Proteinuria; hematuria; increased BUN level and serum creatinine concentration; decreased urine output –Ototoxicity: Tinnitus; dizziness; roaring in the ears; vertigo –Neurotoxicity: Numbness; skin tingling; circumoral (around the mouth) paresthesia

Copyright © 2008 Lippincott Williams & Wilkins. Aminoglycosides: Interactions Interactant drugEffect of interaction CephalosporinsIncreased risk of nephrotoxicity Loop diuretics (water pills) Increased risk of ototoxicity Pavulon or AnectineIncreased risk of neuromuscular blockage

Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Assessment Preadministration assessment –Identify and record vital signs and symptoms and history of allergies –Primary health care provider may order culture and sensitivity; renal and hepatic function tests; CBC; urinalysis –Evaluate the patient’s level of consciousness and ability to swallow: Kanamycin or neomycin for hepatic coma

Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Assessment (cont’d) Ongoing assessment –Compare initial signs and symptoms of infection to current and record findings –Evaluate and record general condition and changes in mentation daily: Kanamycin or Neomycin for hepatic coma –Monitor patient’s vital signs and notify primary health care provider

Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Evaluation The therapeutic effect is achieved; infection is controlled; bowel is cleansed sufficiently if surgery is to occur No pain or injury with intact hearing Fluid intake and output is appropriate

Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Evaluation (cont’d) 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

Copyright © 2008 Lippincott Williams & Wilkins. End of Presentation