1. Copyright © 2008 Lippincott Williams & Wilkins. Introductory Clinical Pharmacology Chapter 9 Tetracyclines, Macrolides, and Lincosamides

2. Copyright © 2008 Lippincott Williams & Wilkins. Anti-infectives composed of natural and semisynthetic compounds Actions: Inhibit bacterial protein synthesis Used as broad spectrum antibiotic when penicillin is contraindicated Treats infections –caused by rickettsiae –skin and soft tissue –uncomplicated urethral, rectal infections –Helicobacter pylori Tetracyclines (TCN)

3. Copyright © 2008 Lippincott Williams & Wilkins. Gastrointestinal/other body system reactions –Nausea and or vomiting –Diarrhea –Epigastric distress –Stomatitis –Sore throat –Skin rashes –Photosensitivity reaction Tetracyclines: Adverse reactions

4. Copyright © 2008 Lippincott Williams & Wilkins. EXAMPLES OF TCNs Sumycin / tetracycline Vibramycin / doxycycline Minocin / minocycline

5. Copyright © 2008 Lippincott Williams & Wilkins. Contraindicated in patients with hypersensitivity or during pregnancy, lactation (Category D) Nursing alert –Not given to children younger than 9 years of age (may cause yellow/gray/brown discoloration on developing teeth) Tetracyclines: Contraindications

6. Copyright © 2008 Lippincott Williams & Wilkins. Used cautiously in patients with: –Impaired renal function –Liver impairment Chronic care alert –May increase the risk of digitalis toxicity in patients who take digitalis drugs for heart disease Tetracyclines: Precautions

7. Copyright © 2008 Lippincott Williams & Wilkins. Tetracyclines: Interactions Interactant drugEffect of interaction Antacids containing aluminum, zinc, magnesium, or bismuth salts Decreases effectiveness of tetracyclines Oral anticoagulantsIncreases risk for bleeding Oral contraceptivesDecreases effectiveness of contraceptive agent

8. Copyright © 2008 Lippincott Williams & Wilkins. Tetracyclines: Interactions (cont’d) Interactant drugEffect of interaction DigoxinIncreases the risk for digitalis toxicity Calcium-rich foodsCauses potentially impaired absorption of tetracycline

9. Copyright © 2008 Lippincott Williams & Wilkins. Effective against a wide variety of pathogenic organisms, particularly infections of the respiratory and genitourinary tracts Act by causing changes in protein function and synthesis Macrolides

10. Copyright © 2008 Lippincott Williams & Wilkins. Examples of Macrolides Zithromax/azithromycin Biaxin / clarithromycin E-mycin, E.E.S / erythromycin

11. Copyright © 2008 Lippincott Williams & Wilkins. Used as prophylaxis before dental or other procedures in patients allergic to penicillin and in the treatment of: –A wide range of gram-negative and gram-positive infections –Acne vulgaris and skin infections –Upper respiratory infections caused by Hemophilus influenza Macrolides: Uses

12. Copyright © 2008 Lippincott Williams & Wilkins. Gastrointestinal (GI) –Nausea –Vomiting –Diarrhea –Abdominal pain or cramping Adverse Reactions of Macrolides

13. Copyright © 2008 Lippincott Williams & Wilkins. Contraindicated in patients with hypersensitivity to the macrolides; preexisting liver disease Used cautiously in patients with liver dysfunction; during pregnancy or lactation (pregnancy categories B and C) Macrolides: Contraindications and Precautions

14. Copyright © 2008 Lippincott Williams & Wilkins. Macrolides: Interactions Interactant drugEffect of interaction Antacids (kaolin, aluminum salts, or magaldrate) Decreases absorption and effectiveness of macrolide DigoxinIncreases serum levels of digoxin AnticoagulantsIncreases risk of bleeding

15. Copyright © 2008 Lippincott Williams & Wilkins. Macrolides: Interactions (cont’d) Interactant drugEffect of interaction Clindamycin, lincomycin, or chloramphenicol Decreases therapeutic activity of the macrolide TheophyllineIncreases serum theophylline level

16. Copyright © 2008 Lippincott Williams & Wilkins. Used for treating serious infections in which penicillin or erythromycin is not effective Used for the more serious infections Used in conjunction with other antibiotics Actions: By inhibiting protein synthesis in susceptible bacteria, causes cell death Lincosamides

17. Copyright © 2008 Lippincott Williams & Wilkins. Examples of Lincosamides Cleocin / clindamycin Lincocin / lincomycin

18. Copyright © 2008 Lippincott Williams & Wilkins. Gastrointestinal/other body reactions –Abdominal pain –Nausea –Vomiting –Diarrhea –Skin rash Lincosamides: Adverse Reactions

19. Copyright © 2008 Lippincott Williams & Wilkins. Lincosamides: Interactions Interactant drugEffect of interaction Kaolin or aluminum-based antacids Decreases absorption of the lincosamide Neuromuscular blocking drugs Increases action of neuromuscular blocking drug, possibly leading to severe and profound respiratory depression

20. Copyright © 2008 Lippincott Williams & Wilkins. Preadministration assessment –Establish an accurate database before the administration of any antibiotic –Obtain general health history –Record vital signs and obtain description of signs and symptoms –Note patient’s general appearance –Obtain culture and sensitivity test results Nursing Process: Assessment

21. Copyright © 2008 Lippincott Williams & Wilkins. Ongoing assessment –Take vital signs every 4 hours or as ordered –Notify the primary health care provider if there are changes in the vital signs or if signs and symptoms worsen –Compare current signs and symptoms of infection and record any specific findings Nursing Process: Assessment (cont’d)

22. Copyright © 2008 Lippincott Williams & Wilkins. The therapeutic effect is achieved; infection is controlled; normal vision unaffected; no diarrhea Adverse reactions: Identified, reported, and managed Patient and family demonstrate understanding of drug regimen Patient verbalizes the importance of complying with prescribed therapeutic regimen Nursing Process: Evaluation

23. Copyright © 2008 Lippincott Williams & Wilkins. End of Presentation