1. Copyright © 2008 Lippincott Williams & Wilkins. Introductory Clinical Pharmacology Chapter 11 Miscellaneous Anti-Infectives

2. Copyright © 2008 Lippincott Williams & Wilkins. Vancomycin: Actions and Uses Inhibits bacterial cell wall synthesis and increases cell wall permeability – acts against susceptible gram-positive bacteria Used in the treatment of: –Serious gram-positive infections that do not respond to treatment with other anti- infectives –Anti-infective–associated pseudomembranous colitis caused by Clostridium difficile

3. Copyright © 2008 Lippincott Williams & Wilkins. Vancomycin: Adverse Reactions Common adverse reactions –Nephrotoxicity –Ototoxicity Other adverse reactions –Nausea; chills; fever; urticaria; sudden fall in blood pressure with parenteral administration; skin rashes

4. Copyright © 2008 Lippincott Williams & Wilkins. Vancomycin: Contraindications, Precautions, and Interactions Contraindicated in patients with known hypersensitivity to the drug Used cautiously in patients with renal or hearing impairment; during pregnancy and lactation Interaction –Other ototoxic and nephrotoxic drugs: Additive effects may occur

5. Copyright © 2008 Lippincott Williams & Wilkins. Quinupristin/Dalfopristin: Action, Uses, and Adverse Reactions Bacteriostatic agent Used in the treatment of vancomycin- resistant Enterococcus faecium (VREF) Adverse reactions –Irritation in the vein; incompatibility with saline or heparin flush solutions; nausea, vomiting, and diarrhea

6. Copyright © 2008 Lippincott Williams & Wilkins. Quinupristin/Dalfopristin: Contraindications, Precautions, and Interactions Contraindicated in patients with known hypersensitivity to the drug; during pregnancy and lactation Interaction –Serum levels of the following drugs may increase: Antiretrovirals; antineoplastic and immunosuppressants; calcium channel blockers; benzodiazepines; cisapride

7. Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Assessment Preadministration assessment –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

8. Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Assessment (cont’d) Ongoing assessment –Monitor patient’s vital signs and for any adverse reactions during the first 48 hours Notify primary health care provider of any adverse reaction before the next dose of the drug is due

9. Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process: Evaluation The therapeutic effect is achieved; infection is controlled Adverse reactions are identified, reported, and managed successfully Pain or discomfort following IM or IV administration is relieved or eliminated The patient and family demonstrate understanding of the drug regimen

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