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

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

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

4. 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

5. 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

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

7. 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

8. 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

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

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

11. 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)

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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