| Penicillin (antibacterial) | Penicillin G: Class |
| Inhibition of cell wall synthesis, Bactericidal | Penicillin G and Cephazolin: Mechanism of Action |
| Narrow spectrum, more effective for gram(+) | Penicillin G: Spectrum |
| Used for syphilis, meningitis, endocarditis, pneumonia | Penicillin G: Indication |
| Hypersensitivity includes rash and anaphylaxis; Minor GI disturbances and diarrhea | Penicillin G and Cefazolin: Side Effects |
| Most common drug allergy; renal impairment | Penicillin G: C/C |
| Check patient history for allergy; Unstable in stomach acid - parenteral route; Resistance continues to grow | Penicillin G: Nursing Implications |
| Cephalosporin (antibacterial) | Cefazolin: Class |
| Used for infections of respiratory, urinary biliary, bones and joints, gonorrhea, septicemia; 1st line for surgery prophylaxis | Cefazolin: Indication |
| Do not give to patients w/ life-threatening penicillin allergy; caution with renal impairment | Cefazolin: C/C |
| Surgery prophylaxis - should be given within 60 minutes of "cut" time | Cefazolin: Nursing Implications |
| Vancomycin (antibacterial) | Vancomycin: Class |
| Inhibition of cell wall synthesis - binds to the cell wall, Bactericidal | Vancomycin: Mechanism of Action |
| Severe infections resistant to safer antibiotics (e.g. MRSA infections resistant to fluoroquinolones, C. Diff, meningitis) | Vancomycin: Indication |
| Ototoxicity - can be irreversible; Renal toxicity; Red man syndrome (flushing, tachycardia, hypotension); Thrombophlebitis at IV injection site | Vancomycin: Side Effects |
| Hypersensitivity to drug; impaired renal function; history of hearing loss; doesn't mix with other IV drugs | Vancomycin: C/C |
| Own IV line if possible; monitor infusion site for extravasation | Vancomycin: Nursing Implications |
| Tetracycline (antibacterial) | Tetracycline: Class |
| Inhibition of protein synthesis, Bacteriostatic | Tetracycline: Mechanism of Action |
| Drugs of choice for typhus, cholera, Rocky Mountain spotted fever, Lyme disease, H. pylori ulcers, and chlamydia | Tetracycline: Indication |
| Superinfections, nausea, vomiting, epigastric burning, diarrhea, discoloration of teeth, photosensitivity, can worsen renal impairment | Tetracycline: Side Effects |
| Pregnancy or nursing; Children < age 8; allergy to any drug in class; impaired hepatic or renal function | Tetracycline: C/C |
| Widespread resistance; food can reduce absorption - no diary, no antacids, administer with 8 oz water on empty stomach | Tetracycline: Nursing Implications |
| Macrolide (antibacterial) | Erythromycin: Class |
| Inhibition of protein synthesis - binds to 50S ribosomal subunit, Bacteriostatic | Erythromycin: Mechanism of Action |
| Alternative to penicillin - minor ear, throat infections; eye prophylaxis for newborns | Erythromycin: Indication |
| Nausea, vomiting, abdominal cramping; phlebitis and pain at IV site; small but serious risk of cardiac death from QT prolongation | Erythromycin: Side Effects |
| Decrease hepatic metabolism of other drugs - interactions possible; decrease liver function | Erythromycin: C/C |
| Enteric coated given anytime; non-enteric coated oral must give w/ 8 oz water on empty stomach 1 hr before or 3 hrs after eating | Erythromycin: Nursing Implications |
| Aminoglycoside (antibacterial) | Gentamicin: Class |
| Inhibition of protein synthesis - binds to 30S ribosomal subunit, Bactericidal | Gentamicin: Mechanism of Action |
| Broad spectrum | Gentamicin: Spectrum |
| Used for serious gram(-) infections | Gentamicin: Indication |
| Nephrotoxicity and ototoxicity are black box; Neuromuscular blockade is possible; Toxicity is associated with high trough | Gentamicin: Side Effects |
| Preexisting hearing loss, renal problems; Increased risk of nephrotoxicity with other drugs affecting kidney | Gentamicin: C/C |
| Measure creatinine clearance and serum drug concentrations at specific intervals; Measure peak and trough to find therapeutic dose (Peak – highest concentration – 30-60 min after administration; Trough – lowest concentration – before administration of drug); Watch urine and hearing | Gentamicin: Nursing Implications |
| Fluoroquinolone (antibacterial) | Ciprofloxacin: Class |
| Inhibition of DNA synthesis – inhibit enzyme essential to function, Bactericidal | Ciprofloxacin: Mechanism of Action |
| Oral medication for serious infections used for wide variety of urinary, soft tissue, bone, and respiratory (drug of choice for Anthrax) | Ciprofloxacin: Indication |
| GI disturbance; photosensitivity; joint pain; confusion in older adults; toxic psychosis; seizures; cardiotoxicity; hepatotoxicity; tendon rupture (black box) | Ciprofloxacin: Side Effects |
| Pregnancy; children <18; serious drug interactions; renal impairment; neurotoxic at high doses; seizures possible with rapid infusion | Ciprofloxacin: C/C |
| Watch for serious adverse effects | Ciprofloxacin: Nursing Implications |
| Sulfonamides (antibacterial) | Trimethoprim-Sulfamethoxazole: Class |
| Inhibition of metabolic pathways (folic acid metabolism), Bacteriostatic | Trimethoprim-Sulfamethoxazole: Mechanism of Action |
| UTI | Trimethoprim-Sulfamethoxazole: Indication |
| Rash; allergy; blood disorders; renal tubule damage | Trimethoprim-Sulfamethoxazole: Side Effects |
| Folate deficiency; sulfa allergy; pregnancy or nursing; renal or liver impairment | Trimethoprim-Sulfamethoxazole: C/C |
| Antiviral | Acyclovir: Class |
| Slow viral reproduction by stopping viral DNA production | Acyclovir: Mechanism of Action |
| Drug of choice for herpes simplex virus and varicella-zoster virus infections | Acyclovir: Indication |
| Nausea, vomiting, anorexia; elevated hepatic enzymes; minor skin irritation, rash, itching; neurotoxicity at high doses; nephrotoxicity possible when given IV | Acyclovir: Side Effects |
| Caution with renal impairment and other drugs affecting renal | Acyclovir: C/C |
| Infuse slowly (at least 1 hour) with adequate hydration and frequent labs to monitor renal function | Acyclovir: Nursing Implications |
| Antiviral | Oseltamivir: Class |
| Stop spreading flu virus in resp tract by inhibiting neuraminidase | Oseltamivir: Mechanism of Action |
| Reduce duration of or prevent influenza A or B | Oseltamivir: Indication |
| Teaching – works best within 12 hours of symptom; no longer helpful after 48 hours of symptom | Oseltamivir: Nursing Implications |
| Nucleoside reverse transcriptase inhibitor (NRTI) | Zidovudine: Class |
| Replaces thymidine in RT enzyme to create defective DNA strand | Zidovudine: Mechanism of Action |
| HIV infection – symptomatic or asymptomatic, post exposure prophylaxis, and to reduce perinatal transmission from mother to baby in utero | Zidovudine: Indication |
| Anemia, neutropenia, anorexia, nausea, diarrhea, fatigue, weakness, myalgia, headache; Serious – bone marrow toxicity, serious CNS effects, fatal acidosis | Zidovudine: Side Effects |
| Preexisting anemia, neutropenia, significant renal/hepatic impairment; avoid drugs that depress bone marrow; other similar agents may contribute to acidosis and hepatomegaly; caution with herbal supplements | Zidovudine: C/C |
| Monitor labs and adverse reactions; Watch for opportunistic infections; Teach adherence | Zidovudine: Nursing Implications |
| Polyene antifungal | Amphotericin B: Class |
| Binds to sterols in fungal cell membrane, allowing cellular contents to leak out | Amphotericin B: Mechanism of Action |
| Serious systemic fungal infections | Amphotericin B: Indication |
| “Shake and bake” reaction – fever, chills, rigors, nausea, headache; Serious – cardiac arrest, ototoxicity, nephrotoxicity | Amphotericin B: Side Effects |
| Highly toxic, causes renal injury – infuse 1 L saline on the same day; avoid administering with other drugs with renal toxicity or renal involvement | Amphotericin B: C/C |
| Pre-treat with Benadryl + acetaminophen to reduce “shake and bake” symptoms; Administer IV slowly (2-6 hrs); Monitor cardiovascular and respiratory status during IV therapy; Reduce or discontinue if BUN over 40mg/dL or creatinine over 3 mg/dL; Check vitals every 30 min for 4 hours after test dose | Amphotericin B: Nursing Implications |
| Antifungal | Fluconazole: Class |
| Inhibits synthesis of ergosterol in fungal cell membrane | Fluconazole: Mechanism of Action |
| Treatment of candidiasis, fungal meningitis | Fluconazole: Indication |
| Nausea, vomiting, diarrhea; Serious – Stevens-Johnson syndrome in immunosuppressed patients | Fluconazole: Side Effects |
| Hepatic impairment, hypokalemia, preexisting renal impairment, many drug interactions (CYP450 involvement) | Fluconazole: C/C |
| Monitor BUN, serum creatinine, and liver function laboratory tests | Fluconazole: Nursing Implications |
| Mycolic acid inhibitor | Isoniazid: Class |
| Inhibits synthesis of mycolic acid – bactericidal for rapidly dividing organisms and bacteriostatic for dormant mycobacteria | Isoniazid: Mechanism of Action |
| TB prophylaxis and treatment | Isoniazid: Indication |
| Rash, fever; Serious – neurotoxicity, hepatotoxicity, blood dyscrasias | Isoniazid: Side Effects |
| History of hepatic disease; seizure disorder; Do not take with antacids and may interfere with drugs involved with CYP450; Do not take with alcohol | Isoniazid: C/C |
| Penicillin G: Class | Penicillin (antibacterial) |
| Penicillin G and Cephazolin: Mechanism of Action | Inhibition of cell wall synthesis, Bactericidal |
| Penicillin G: Spectrum | Narrow spectrum, more effective for gram(+) |
| Penicillin G: Indication | Used for syphilis, meningitis, endocarditis, pneumonia |
| Penicillin G and Cefazolin: Side Effects | Hypersensitivity includes rash and anaphylaxis; Minor GI disturbances and diarrhea |
| Penicillin G: C/C | Most common drug allergy; renal impairment |
| Penicillin G: Nursing Implications | Check patient history for allergy; Unstable in stomach acid - parenteral route; Resistance continues to grow |
| Cefazolin: Class | Cephalosporin (antibacterial) |
| Cefazolin: Indication | Used for infections of respiratory, urinary biliary, bones and joints, gonorrhea, septicemia; 1st line for surgery prophylaxis |
| Cefazolin: C/C | Do not give to patients w/ life-threatening penicillin allergy; caution with renal impairment |
| Cefazolin: Nursing Implications | Surgery prophylaxis - should be given within 60 minutes of "cut" time |
| Vancomycin: Class | Vancomycin (antibacterial) |
| Vancomycin: Mechanism of Action | Inhibition of cell wall synthesis - binds to the cell wall, Bactericidal |
| Vancomycin: Indication | Severe infections resistant to safer antibiotics (e.g. MRSA infections resistant to fluoroquinolones, C. Diff, meningitis) |
| Vancomycin: Side Effects | Ototoxicity - can be irreversible; Renal toxicity; Red man syndrome (flushing, tachycardia, hypotension); Thrombophlebitis at IV injection site |
| Vancomycin: C/C | Hypersensitivity to drug; impaired renal function; history of hearing loss; doesn't mix with other IV drugs |
| Vancomycin: Nursing Implications | Own IV line if possible; monitor infusion site for extravasation |
| Tetracycline: Class | Tetracycline (antibacterial) |
| Tetracycline: Mechanism of Action | Inhibition of protein synthesis, Bacteriostatic |
| Tetracycline: Indication | Drugs of choice for typhus, cholera, Rocky Mountain spotted fever, Lyme disease, H. pylori ulcers, and chlamydia |
| Tetracycline: Side Effects | Superinfections, nausea, vomiting, epigastric burning, diarrhea, discoloration of teeth, photosensitivity, can worsen renal impairment |
| Tetracycline: C/C | Pregnancy or nursing; Children < age 8; allergy to any drug in class; impaired hepatic or renal function |
| Tetracycline: Nursing Implications | Widespread resistance; food can reduce absorption - no diary, no antacids, administer with 8 oz water on empty stomach |
| Erythromycin: Class | Macrolide (antibacterial) |
| Erythromycin: Mechanism of Action | Inhibition of protein synthesis - binds to 50S ribosomal subunit, Bacteriostatic |
| Erythromycin: Indication | Alternative to penicillin - minor ear, throat infections; eye prophylaxis for newborns |
| Erythromycin: Side Effects | Nausea, vomiting, abdominal cramping; phlebitis and pain at IV site; small but serious risk of cardiac death from QT prolongation |
| Erythromycin: C/C | Decrease hepatic metabolism of other drugs - interactions possible; decrease liver function |
| Erythromycin: Nursing Implications | Enteric coated given anytime; non-enteric coated oral must give w/ 8 oz water on empty stomach 1 hr before or 3 hrs after eating |
| Gentamicin: Class | Aminoglycoside (antibacterial) |
| Gentamicin: Mechanism of Action | Inhibition of protein synthesis - binds to 30S ribosomal subunit, Bactericidal |
| Gentamicin: Spectrum | Broad spectrum |
| Gentamicin: Indication | Used for serious gram(-) infections |
| Gentamicin: Side Effects | Nephrotoxicity and ototoxicity are black box; Neuromuscular blockade is possible; Toxicity is associated with high trough |
| Gentamicin: C/C | Preexisting hearing loss, renal problems; Increased risk of nephrotoxicity with other drugs affecting kidney |
| Gentamicin: Nursing Implications | Measure creatinine clearance and serum drug concentrations at specific intervals; Measure peak and trough to find therapeutic dose (Peak – highest concentration – 30-60 min after administration; Trough – lowest concentration – before administration of drug); Watch urine and hearing |
| Ciprofloxacin: Class | Fluoroquinolone (antibacterial) |
| Ciprofloxacin: Mechanism of Action | Inhibition of DNA synthesis – inhibit enzyme essential to function, Bactericidal |
| Ciprofloxacin: Indication | Oral medication for serious infections used for wide variety of urinary, soft tissue, bone, and respiratory (drug of choice for Anthrax) |
| Ciprofloxacin: Side Effects | GI disturbance; photosensitivity; joint pain; confusion in older adults; toxic psychosis; seizures; cardiotoxicity; hepatotoxicity; tendon rupture (black box) |
| Ciprofloxacin: C/C | Pregnancy; children <18; serious drug interactions; renal impairment; neurotoxic at high doses; seizures possible with rapid infusion |
| Ciprofloxacin: Nursing Implications | Watch for serious adverse effects |
| Trimethoprim-Sulfamethoxazole: Class | Sulfonamides (antibacterial) |
| Trimethoprim-Sulfamethoxazole: Mechanism of Action | Inhibition of metabolic pathways (folic acid metabolism), Bacteriostatic |
| Trimethoprim-Sulfamethoxazole: Indication | UTI |
| Trimethoprim-Sulfamethoxazole: Side Effects | Rash; allergy; blood disorders; renal tubule damage |
| Trimethoprim-Sulfamethoxazole: C/C | Folate deficiency; sulfa allergy; pregnancy or nursing; renal or liver impairment |
| Acyclovir: Class | Antiviral |
| Acyclovir: Mechanism of Action | Slow viral reproduction by stopping viral DNA production |
| Acyclovir: Indication | Drug of choice for herpes simplex virus and varicella-zoster virus infections |
| Acyclovir: Side Effects | Nausea, vomiting, anorexia; elevated hepatic enzymes; minor skin irritation, rash, itching; neurotoxicity at high doses; nephrotoxicity possible when given IV |
| Acyclovir: C/C | Caution with renal impairment and other drugs affecting renal |
| Acyclovir: Nursing Implications | Infuse slowly (at least 1 hour) with adequate hydration and frequent labs to monitor renal function |
| Oseltamivir: Class | Antiviral |
| Oseltamivir: Mechanism of Action | Stop spreading flu virus in resp tract by inhibiting neuraminidase |
| Oseltamivir: Indication | Reduce duration of or prevent influenza A or B |
| Oseltamivir: Nursing Implications | Teaching – works best within 12 hours of symptom; no longer helpful after 48 hours of symptom |
| Zidovudine: Class | Nucleoside reverse transcriptase inhibitor (NRTI) |
| Zidovudine: Mechanism of Action | Replaces thymidine in RT enzyme to create defective DNA strand |
| Zidovudine: Indication | HIV infection – symptomatic or asymptomatic, post exposure prophylaxis, and to reduce perinatal transmission from mother to baby in utero |
| Zidovudine: Side Effects | Anemia, neutropenia, anorexia, nausea, diarrhea, fatigue, weakness, myalgia, headache; Serious – bone marrow toxicity, serious CNS effects, fatal acidosis |
| Zidovudine: C/C | Preexisting anemia, neutropenia, significant renal/hepatic impairment; avoid drugs that depress bone marrow; other similar agents may contribute to acidosis and hepatomegaly; caution with herbal supplements |
| Zidovudine: Nursing Implications | Monitor labs and adverse reactions; Watch for opportunistic infections; Teach adherence |
| Amphotericin B: Class | Polyene antifungal |
| Amphotericin B: Mechanism of Action | Binds to sterols in fungal cell membrane, allowing cellular contents to leak out |
| Amphotericin B: Indication | Serious systemic fungal infections |
| Amphotericin B: Side Effects | “Shake and bake” reaction – fever, chills, rigors, nausea, headache; Serious – cardiac arrest, ototoxicity, nephrotoxicity |
| Amphotericin B: C/C | Highly toxic, causes renal injury – infuse 1 L saline on the same day; avoid administering with other drugs with renal toxicity or renal involvement |
| Amphotericin B: Nursing Implications | Pre-treat with Benadryl + acetaminophen to reduce “shake and bake” symptoms; Administer IV slowly (2-6 hrs); Monitor cardiovascular and respiratory status during IV therapy; Reduce or discontinue if BUN over 40mg/dL or creatinine over 3 mg/dL; Check vitals every 30 min for 4 hours after test dose |
| Fluconazole: Class | Antifungal |
| Fluconazole: Mechanism of Action | Inhibits synthesis of ergosterol in fungal cell membrane |
| Fluconazole: Indication | Treatment of candidiasis, fungal meningitis |
| Fluconazole: Side Effects | Nausea, vomiting, diarrhea; Serious – Stevens-Johnson syndrome in immunosuppressed patients |
| Fluconazole: C/C | Hepatic impairment, hypokalemia, preexisting renal impairment, many drug interactions (CYP450 involvement) |
| Fluconazole: Nursing Implications | Monitor BUN, serum creatinine, and liver function laboratory tests |
| Isoniazid: Class | Mycolic acid inhibitor |
| Isoniazid: Mechanism of Action | Inhibits synthesis of mycolic acid – bactericidal for rapidly dividing organisms and bacteriostatic for dormant mycobacteria |
| Isoniazid: Indication | TB prophylaxis and treatment |
| Isoniazid: Side Effects | Rash, fever; Serious – neurotoxicity, hepatotoxicity, blood dyscrasias |
| Isoniazid: C/C | History of hepatic disease; seizure disorder; Do not take with antacids and may interfere with drugs involved with CYP450; Do not take with alcohol |
