MAINTENANCE OF HOMEOSTASIS

FLUIDS maintain fluid balance and replace and

Intracellular fluid – contained within the body’s exchange ions to maintain neutrality.
cells 2. Fluid compartments remain in osmotic
Extracellular fluid – fluid outside the cells equilibrium except for transient changes.
 Interstitial – bathes and surrounds the tissue
cells MOVEMENT OF FLUID AND PARTICLES
 Intravascular – plasma and blood vessels Osmosis
 Transcellular – third component; mucus and  movement of water across a semipermeable
GI, cerebrospinal, pericardial, synovial, and membrane from areas of low solute
ocular fluids concentration to those of high solute
concentration
Fluid compartment Percentage Diffusion
Intracellular 40%  movement of molecules from an area of
Extracellular 20 high concentration to one of low
Interstitial 15 concentration Hydrostatic pressure – the
Intravascular 5 force within a fluid compartment
Transcellular Approximately 1-2 Osmolality
L total (general not  concentration of particles in a solution
included in Active transport
calculations)  requires metabolic activity and expenditure
Total body fluid 60 of energy to move a substance across a cell
membrane
Cations and Anions Osmole
Cations Anions  number of solutes in a solution
Potassium Chloride
OSMOLALITY
Sodium Bicarbonate
 Number of particles dissolved in the serum
Calcium Phosphate
(e.g. sodium, urea, glucose)
Magnesium Sulfate
 Measure of the concentration of solutes per
kilogram in urine
Electrolytre Concentration In Body Fluids  Normal serum osmolality: 275 to 295
Intracellular Fluids Extracellular Fluids mOsm/kg
Major Cations Major Cations  As the number of particles increases, the
Potassium Sodium concentration of solution also increases
Magnesium Potassium  Sodium – primary electrolyte in the ECF
Sodium Calcium
Magnesium Three types of fluid concentration based on
Major Anions Major Anions osmolality of body fluids:
Phosphorus Chloride 1. Iso-osmolar – same proportion of particles
Phosphorus and water
2. Hypo-osmolar – fewer particles than water
HOMEOSTASIS 3. Hyper-osmolar – more particles than wate
Maintenance of constant internal balance within
the body despite the effects of a constantly FLUID REPLACEMENT
changing external environment GENERAL CONSIDERATIONS
Recommended water intake: 2,300 to 2,900 mL/day
1. Anions and cations must be balanced  Oral intake: 1200 to 1500 mL
within each compartment and remain  Solid food: 800 to 1100 mL
electrically neutral. The amount of fluid  Oxidative metabolism: 300 mL
within each compartment remains constant,
and compartments work continuously to
Water loss: kidneys, skin, lungs, GI tract remaining solution is isotonic because of its
 Kidneys: 1200 to 1500 mL quick metabolism into carbon dioxide and water
 Lungs/respiration: 500 mL/day  10% or more solutions should be given via a
 Skin/perspiration: 500-600 mL/day central vein; exception is 50% dextrose which
 GI tract: 200 mL/day may be given via peripheral vein to treat
 Urinary output: 0.5 to 1 mL/kg/h or 35 to hypoglycemia
70 mL/h for a 70-kg patient  May be irritating to veins because of the pH of
the solution
CRYSTALLOIDS
 Contain fluids and electrolytes and freely
cross capillary walls
 No proteins COLLOIDS
 Short-term maintenance fluids  Contain protein or other large molecular
 Treatment for dehydration and electrolyte substances that increase osmolarity without
imbalances dissolving in the solution
 Cause early plasma expansion but have a  Unable to pass through the semipermeable
shorter duration of action than colloids membranes of the capillary walls and stay
within the intravascular compartment
THREE MAJOR CLASSIFICATIONS OF  Plasma expanders
CRYSTALLOIDS  Increase the colloidal oncotic pressure and pull
Isotonic Hypotonic Hypertonic fluids from the interstitial space into the plasma
Same Less osmotic Greater
approximate pressure than osmotic BLOOD AND BLOOD PRODUCTS
osmolality with ECF pressure than  Whole blood, PRBC, plasma, platelet,
ECF or plasma ECF cryoprecipitate
No effect on Increased Higher solute  1 unit of whole blood: increases hemoglobin by
RBCs solute concentration 0.5 o 1 g/dL
concentration than serum  1 unit of PRBC: elevates hematocrit by three
in points
intravascular
space - fluid ELECTROLYTES
move into POTASSIUM
intracellular  Primary intracellular cation
and interstitial  3.5 to 5.0 mEq/L
spaces  Acidotic: pulls out potassium from cells::
Used for Excessive Pull water from Alkaline: puts potassium back into cells
hydration and infusion - interstitial  Kidneys – primary route for potassium loss
expansion of hemolysis, space to the Inverse relationship between sodium and
ECF volume decreased BP, cellECF via potassium reabsorption in the kidneys
decreased IVF osmosis  Daily dietary intake: 40 to 80 mEq/day in 1 or 2
volume shrinkage divided doses within 24 hours contraction of
Monitor for skeletal, cardiac,
circulatory  Transmission and conduction of nerve impulses
overload and smooth muscles

SPECIAL CONSIDERATIONS HYPOKALEMIA

Dextrose solution
 Provide hydration and some calories and
increased glucose levels in the blood
 5% solutions are hypertonic when added to
normal saline or lactated Ringer’s, but the
 Serum potassium < 3.5 mEq/L
 Causes: trauma, injury, surgery, or shock;
vomiting, diarrhea, suctioning, diuretic therapy,
increased aldosterone levels, and decreased
magnesium levels
 Hypokalemia may not be symptomatic until  Symptoms due to water shifting :neuromuscular
potassium levels fall below 3.0 mEq/L. Muscle and GI
weakness (quadriceps weakness) usually occurs  Symptoms associated with hypovolemia:
with potassium levels < 2.5 mEq/L. tachycardia, weak pulse, decreased BP
 Serum potassium level increase by 1 mEq: 100  125-135 mEq/L: IV normal saline
to 200 mEq of IV potassium  ¿ 120 mEq /L : hypertonic 3% or 5% saline
solution
Potassium Deficit
 Alkalosis SIGNS AND SYMPTOMS
 Shallow Respirations SALTLOSS
 Irritability Stupor/coma
 Confusion, Drowsiness Anorexia
 Weakness, Fatigue Lethargy
 Arrhythmias – Tachycardia Irregular Rhythm Tendon Reflexes
and/or Bradycardia Limp muscle
 Lethargy Orthostatic hypotension
 Thready pulse Seizures
 I Intestinal motility Stomach cramping
Nausea
Vomiting HYPERNATREMIA
Ilues  Serum potassium >145 mEq/L
 Causes: excessive oral sodium intake, deficient
HYPERKALEMIA water intake, hypertonic tube feedings,
 Serum potassium > 5.0 mEq/L hyperaldosteronism, Cushing syndrome,
 Causes: Excessive intake, impaired renal corticosteroid use, acute kidney failure
excretion, shift from intracellular to  Treatment: IVF and diuretics
extracellular spaced
SIGNS AND SYMPTOMS
SIGNS AND SYMPTOMS FRIEDSALT
MURDER Fever (low), Flushed Skin
Muscle weakness Restless (irritable)
Urine, oliguria or anuria Increased fluid retention, Increased blood pressure
Respiratory distress Edema (peripheral and pitting)
Decreased cardiac contractility Decreased urinary output, Dry mouth
EKG changes (peaked T waves) Skin flushed
Reflexes, hyper or hypo Agitated
Low-grade fever
SODIUM Thirst
 Major cation in the ECF
 135 to 145 mEq/L CALCIUM
 Dietary requirement: 2000 to 4000 mg daily  Most abundant mineral in the body
 Plays a major role in fluid balance and is the  50% of calcium in blood is bound to albumin;
primary determinant of plasma osmolality other 50% not bound is free (ionized form)
 Neuromuscular irritability and conduction of o Albumin – 3.4 to 5.4 g/dL
nerve impulses  Transmission of nerve impulses and normal
contraction of skeletal and heart muscles,
HYPONATREMIA regulation of heart and blood pressure, hormone
 Serum potassium < 135 mEq/L secretion, maintenance of muscle tone, and
 Causes: loss of sodium-containing fluids, formation of blood clots
deficient intake, or water gain  8.6 to 10.2 g/dL
 Occurs with hypovolemia and hypervolemia  Parathyroid hormone and thyrocalcitonin –
 Thirst: first symptom of sodium deficit maintain the balance of serum calcium
 Phosphorus and calcium have an inverse Arrhythmias / cardiac arrest
relationship Excessive urination

HYPOCALCEMIA DRUGS ACTING ON THE CENTRAL

 Causes: hyperphosphatemia, acute pancreatitis, NERVOUS SYSTEM
widespread bony metastasis, CNS Depressants
hypoparathyroidism, alkalosis, diarrhea, BARBITURATES
alcoholism, malnutrition, use of loop diuretics,  Phenobarbital – sedative and
vitamin D deficiency, and multiple blood anticonvulsant
transfusion  Mephobarbital, pentobarbital, primidone
Treatment:  Primidone – treatment of choice for chronic
 Calcium carbonate – 40% elemental calcium epilepsy
 Calcium citrate – 21% elemental calcium  Produce sedation and drowsiness by altering
 Calcium chloride – 13.6 mEq/gram cerebellar function and depressing the
 Calcium gluconate – 4. 65 mEq/gram actions of the brain and sensory cortex
 Indicated for sedation and seizures
SIGNS AND SYMPTOMS  Induces anesthesia in high doses
CATS  Adverse reactions: dizziness, drowsiness,
Convulsions lethargy, confusion, ataxia, lupus-like
Arrhythmias syndrome; acute psychosis, hair loss,
Tetany impotence, and osteomalacia (primidone);
Stridor and spasms laryngospasm, respiratory depression, and
hypotension (I.V. administration)
MANAGEMENT
 Renal functioning must be assessed before Nursing Considerations:
administering IV calcium chloride  Avoided in children less than 1 month of age
 Administer cautiously in patients who take and in geriatric patients
digitalis because of increased risk of digitalis  Assess patient’s respiratory status before
toxicity. and during drug therapy
 Calcium chloride 10% should be administered  Discourage use of alcohol and other CNS
slowly via infusion-control pump depressants which may produce additive
 Care should be taken to prevent extravasation CNS depressant effects
 Assess hypocalcemic patients for  Monitor blood levels closely to maintain
hypomagnesemia, hypokalemia, and acid-base therapeutic drug levels
imbalances. Hypomagnesemia should be  Administer with food to minimize GI upset
corrected first; low magnesium levels may  Administer IV phenobarbital in emergency
hinder response to treatment. situations only and have emergency
 Vitamin D promotes calcium absorption from resuscitation equipment available
the GI tract  Drug may be habit forming; tolerance and
 Phosphorus inhibits calcium absorption psychological and physical dependence may
occur
HYPERCALCEMIA  Advise patient to take prescribed medication
 Causes: hyperparathyroidism, malignancy, as directed
hypophosphatemia, excessive calcium  Instruct patient who underwent prolonged
intake, prolonged immobilization, multiple therapy not to discontinue drug abruptly as
immobilization, drugs (e.g. thiazide this may cause seizures
diuretics), and steroids  Monitor patient for withdrawal symptoms
SIGNS AND SYMPTOMS
Confusion
Muscle weakness Withdrawal Symptoms
Bone pain Minor Severe
Kidney stone Anxiety Seizures
 Muscle twitching
Hand and finger tremors
Weakness
Delirium
Dizziness
Nausea
Vomiting
Within 16 hours of last
8 to 12 hours dose after abrupt
after last dose cessation of drug and
may last up to 5 days
BENZODIAZEPINES
 Lorazepam
o treatment of acute status epilepticus (IV)
o pre-anesthetic medication used to produce
sedation, relieve anxiety, and reduce the
ability to recall events related to the day of
surgery
o treat anxiety disorders (oral)
 Clonazepam, clorazepate, diazepam
 Act as sedation, antianxiety, and anticonvulsant
by binding to specific GABA receptors to
potentiate the effects of GABA
 Adverse reactions: respiratory depression,
sedation, hypotension, unsteadiness, physical
and psychological dependence, withdrawal
symptoms with abrupt termination
Nursing Considerations:
 Children & elderly are more likely to experience
paradoxical reactions (e.g. tremors, agitation, or
visual hallucinations
 Elderly or debilitated patients are more
susceptible to sedative and respiratory
depressive effects –monitored frequently and
initial dosage must not exceed 2 mg
 Assess patient’s respiratory status before and
during drug therapy – secure a patent airway
and ventilatory support should be given as
required
 Advise patients to that driving a motor vehicle,
operating machinery, or engaging in hazardous
or other activities requiring attention and
coordination should be delayed for 24 to 28
hours following administration or until effects
of the drugs have subsided
 Advise patients that getting out of bed
unassisted may result in falling and potential
injury if undertaken within 8 hours of receiving
lorazepam
 Discourage use of alcohol and other CNS
depressants which may produce additive CNS
depressant effects
 Discourage use of alcohol for at least 24 to 48
hours and other CNS depressants which may
produce additive CNS depressant effects
 Administer IV diazepam via direct IV push no
faster than 5 mg/minute in adults and over at
least 3 mins in children using large veins
 Drug may be habit forming; tolerance and
psychological and physical dependence may
occur
 Instruct patient who underwent prolonged
therapy not to discontinue drug abruptly as this
may cause or worsen seizures
 Monitor patient for withdrawal and overdosage
symptoms – Flumazenil: benzodiazepine
antagonist
CNS Stimulants
 Methylphenidate
o treatment of ADHD and narcolepsy
o acts by blocking the reuptake of
norepinephrine and dopamine into the
presynaptic neuron
 Amphetamine-dextroamphetamine,
dexmethylphenidate, dextroamphetamine,
doxapram, modafinil, pemoline
 Increase neurotransmitter levels in the CNS by
increasing neuronal discharge or by blocking an
inhibitory neurotransmitter
 Increase mental alertness and respiratory rate o
Treat ADHD and narcolepsy
 Treat respiratory stimulation after anesthesia –
doxapram
 Adverse reactions: headache, restlessness, upper
abdominal pain, decreased appetite, tremor,
irritability, insomnia, priaprism, hypertension,
arrhythmias, angina, CV collapse (acute);
marked weight loss, fatigue, depression, and
growth restriction (chronic)
Nursing Considerations:
 Methylphenidate may be given to children over
the age of 6
 Avoided in patients with known structural
cardiac abnormalities, cardiomyopathy, serious
heart rhythm arrhythmias, or coronary disease;
glaucoma
 Monitor blood pressure and heart rate closely
Assess respiratory status and arterial blood gas
 measurements for changes when administering
doxapram
 Caution for the risk of peripheral vasculopathy –
monitor for the fingers and toes feeling numb,
cool, painful, and/or changing colors from pale,
to blue, to red
 Avoid concomitant use of monoamine oxidase
inhibitor within the preceding 14 days
 Methylphenidate hydrochloride extended-
release capsule is administered orally once daily
in the morning and should not be crushed,
chewed, or divided.
 Instruct to avoid intake of alcohol and caffeine-
containing beverages
 Instruct to take at least 6 hours before bed to
prevent insomnia
 Monitor patient for signs of abuse and
dependence
 Advise patient not to share drug to anyone else
and to take drug as prescribed
 Instruct patient to report for the development of
adverse reactions
Antidepressants
 Used to treat depression and other mental health
disorders (e.g. migraine headache, chronic pain,
and premenstrual syndrome)
 Increase neurotransmitters in the CNS,
including serotonin, dopamine, and
norepinephrine
 Tricyclic Antidepressants (TCAs), Selective
Serotonin Reuptake Inhibitors (SSRIs),
Serotonin Norepinephrine Reuptake
Inhibitors (SNRIs), and Monoamine Oxidase
Inhibitors (MAOIs)
Tricyclic Antidepressants
 One of the first-generation antidepressants
 Used to treat neuropathic pain and insomnia
 Amitriptyline – antidepressant with sedative
effect; inhibits the membrane pump mechanism
responsible for the uptake of norepinephrine and
serotonin in adrenergic and serotonergic
neurons
 Clomipramine, doxepin, imipramine,
trimipramine, amoxapine, desipramine,
nortiptyline, protriptyline
 Adverse effects: anticholinergic – constipation,
urinary retention, drowsiness; adrenergic and
dopaminergic blockage – cardiac conduction
disturbances and hypotension; histaminergic
blockage – sedation; serotonergic blockage –
alter seizure threshold and cause sexual
dysfunction
Nursing Considerations:
 Administer at bedtime due to sedating effect
 Contraindicated with concomitant MAOI use
 Caution with use in geriatric patients due to
their increased sensitivity to anticholinergic side
effect (e.g. tachycardia, urinary retention,
constipation, dry mouth, blurred vision, and
exacerbation of narrow-angle glaucoma;
cognitive impairment, psychomotor slowing,
confusion, sedation, delirium)
 Watch out for orthostatic hypotension and risk
of falls
 Instruct patient not to abruptly stop drug as this
may produce nausea, headache, and malaise
 Monitor patient for increased risk of suicidality
and instruct patient and family members or
caregivers to immediately report any sudden
changes in mood, behaviors, thoughts, or
feelings
Selective Serotonin Reuptake Inhibitor
 Second-generation antidepressants
 Used to treat depression, obsessive compulsive
disorder, bulimia, panic disorder, PTSD,
anxiety, premenstrual syndrome, and migraines
 Inhibit the reuptake of serotonin
 Fluoxetine, citalopram, escitalopram,
fluvoxamine, paroxetine, sertraline, dapoxetine
 Onset of effect develops slowly for up to 12
weeks
Adverse effects:
 Serotonin Syndrome – mental status changes
(e.g. agitation, hallucinations, coma); autonomic
instability (e.g. tachycardia, labile blood
pressure, hyperthermia); neuromuscular
aberrations (e.g. hyperreflexia, incoordination);
gastrointestinal symptoms (e.g. nausea,
vomiting, diarrhea)
 Neuroleptic Malignant Syndrome –
hyperthermia, muscle rigidity, autonomic
instability with possible rapid fluctuation of
vital signs, and mental status changes
Others side effects: rash, mania, seizures,
decreased appetite and weight; increased
bleeding associated with concomitant use of
NSAIDs, aspirin, warfarin, and other drugs that
affect coagulation; hyponatremia; anxiety; and
insomnia

Nursing Considerations:
 Educate patient that drug’s effect may not arise
until 3 months or 12 weeks of therapy
 Caution in patients taking other CNS
medications who have liver dysfunction
 Avoid concomitant use with MAOIs
 Instruct to avoid grapefruit juice while on
therapy due to its effect in the CYP3A4 enzyme
that affects the bioavailability of enzyme
 Instruct patient to avoid abrupt cessation of drug
as this may cause anxiety, insomnia, and
increased nervousness
 Watch out for orthostatic hypotension and risk
of falls
 Monitor patient for increased risk of suicidality
and instruct patient and family members or
caregivers to immediately report any sudden
changes in mood, behaviors, thoughts, or
feelings
Serotonin Norepinephrine Reuptake Inhibitor
 Venlafaxine, desvenlafaxine, duloxetine,
levomilnacipran, milnacipran
 Inhibits reuptake of serotonin and
norepinephrine, with weak inhibition of
dopamine reuptake
 Indicated for treatment of a major depressive
disorder
 May take up to 8 weeks before therapeutic
effect is recognized
 Adverse effects: sustained increase in blood
pressure; serotonin syndrome, insomnia,
anxiety, decreased appetite, weight loss, mania,
hyponatremia, increased bleeding, elevated
serum cholesterol, somnolence, and nausea
Nursing Considerations:
 Educate patient that drug’s effect may not arise
until 2 months or 8 weeks of therapy
 Caution in patients taking other CNS
medications who have and renal dysfunction
 Avoid concomitant use with MAOIs or within
14 days of use of an MAOI
 Elderly patients are at greater risk for
developing hyponatremia
 Use with caution with other serotonin
medications
 Instruct patient to avoid abrupt cessation of drug
Watch out for orthostatic hypotension and risk
of falls
 Monitor patient for increased risk of suicidality
and instruct patient and family members or
caregivers to immediately report any sudden
changes in mood, behaviors, thoughts, or
feelings
Monoamine Oxidase Inhibitors
 First-generation antidepressant
 Tranylcypromine, selegiline, phenelzine,
isocarboxazid
 Potentiation of monoamine neurotransmitter
activity in the CNS due to the irreversible
inhibition of monoamine oxidase; MAO inhibits
norepinephrine, dopamine, epinephrine, and
serotonin
 Indicated for major depressive disorder;
Parkinson’s disease
 Adverse effects: HYPERTENSIVE CRISIS
(BP greater than 180/120 mmHg) with evidence
of organ dysfunction – occipital headache,
palpitations, neck stiffness or soreness, nausea
or vomiting, sweating, dilated pupils,
photophobia, shortness of breath, or confusion;
tachycardia or bradycardia associated with
constricting chest pain; seizures; intracranial
bleeding; serotonin syndrome
Other side effects: mania, orthostatic hypotension,
hepatotoxicity, seizures, hypoglycemia in diabetic
patients, decreased appetite and weight loss,
dizziness, headache, drowsiness, and restlessness
Nursing Considerations:
 Caution in elderly – increased risk for postural
hypotension and serious adverse effects
 Instruct patient to avoid abrupt cessation of drug
to prevent withdrawal symptoms
 Instruct patient to avoid intake of tyramine-
containing food and beverages during therapy
and after 2 weeks after therapy is discontinued
 Patients should avoid alcohol and other CNS
depressants during therapy and after 2 weeks
after therapy is discontinued
 Advise patient the signs of hypertensive crisis
and instruct to immediately report headache,
chest or throat tightness, and palpitations
 Monitor patient for increased risk of suicidality
and instruct patient and family members or
caregivers to immediately report any sudden
changes in mood, behaviors, thoughts, or
feelings
Foods To Avoid That Contain Tyramine
Avocados Overripe fruits Antipsychotics
Bananas Papaya pickled  Used to treat drug-induced psychosis,
Beef or chicken liver herring schizophrenia, extreme mania, depression that is
Brewers’ yeast Raisins resistant to other therapy, and other CNS
Broads beans Red wine, beer, conditions
Caffeine, such as in coffee, sherry  Referred to as tranquilizers because they
tea, or chocolate Sausage. Bologna, produce a state of tranquility
Cheese, especially aged, pepperoni, salami  First-generation (Conventional) –
except cottage cheese Sour cream Haloperidol (schizophrenia and Tourette’s
Meat extracts and Soy sauce disorder)
tenderizers Yogurt  Second-generation (Atypical) – Risperidone
(schizophrenia, acute mania, irritability caused
Antimania by autism)
Mood Stabilizers  Block dopamine receptors in the brain:
 Used to treat bipolar affective disorder First-generation block dopamine receptors in the
 Lithium – alters sodium transport in nerve and limbic system and basal ganglia (associated with
muscle cells and effects a shift toward emotions, cognitive function, motor function)
intraneural metabolism of catecholamines; Second-generation block specific dopamine 2
indicated for treatment of manic episodes of receptors and specific serotonin 2 receptors
bipolar disorder and as maintenance for
individuals with bipolar disorder  Adverse effects: increased risk of death due to
 Carbamazepine, Divalproex sodium, cardiovascular or infection-related causes in
Lamotrigine, Valproic acid elderly patients with dementia-related psychosis
 Adverse effects: Adverse
Definition
Early lithium toxicity: diarrhea, vomiting, Effect
drowsiness, muscular weakness, and lack of Involuntary contraction of the oral
coordination; giddiness, ataxia, blurred vision, Tardive and facial muscles (such as tongue
tinnitus, and large output of diluted urine Dyskinesia thrusting) and wave like
Other effects: fine hand tremors, polyuria, mild movement of the extremities.
thirst may persist throughout treatment Neuroleptic Potentially life-threatening
malignant adverse effect that includes high
Nursing Considerations: syndrome fever, unstable blood pressure, and
 Lithium has a narrow therapeutic range of 0.8 to (NMS) myoglobinemia.
1.2 mEq/L Involuntary motor symptoms
 Watch out for symptoms of lithium toxicity similar to those associated with
 Monitor serum lithium levels before initiating Parkinson’s disease. Includes
and during duration of therapy symptoms such as akathisia
 Closely monitor serum sodium levels Extraparamyd (distressing motor restlessness)
 Contraindicated in renal or cardiovascular al Symptoms and acute dystonia (painful
disease, severe dehydration or sodium depletion, muscle spasms.) often treated with
and patients receiving diuretics because of high anticholinergic medications such
risk of lithium toxicity as benztrophine and
 Avoid use in children less than 12 years old trihexyphenidyl.
 Therapeutic effects do not appear until 1 to 3 These adverse effects are due to the blockage of
weeks of therapy alpha-adrenergic, dopamine, endocrine, histamine,
 May cause dizziness or drowsiness – caution and muscarinic receptors.
with risk for falls and injury  Other adverse effects: hyperglycemia,
 Advise patient to report and seek immediate hyperlipidemia, weight gain
emergency assistance if they experience
fainting, lightheadedness, abnormal heart beats, Nursing Considerations:
or shortness of breath
 Haloperidol is contraindicated with Parkinson’s Drug Reaction with Eosinophilia and Systemic
disease or dementia with lewy bodies Symptoms (DRESS) - fever, rash,
 Patients who are concurrently taking lithium and lymphadenopathy, and/or facial swelling, in
antipsychotics should be monitored closely for association with other organ system involvement
neurotoxicity (weakness, lethargy, fever,
tremulousness, confusion, and extrapyramidal Other effects: hepatoxocity; thrombocytopenia,
symptoms) and symptoms should be leukopenia, granulocytopenia, agranulocytosis, and
immediately reported pancytopenia with or without bone marrow
 Medication doses should be evenly spaced suppression; nervous system reactions: nystagmus,
throughout the day ataxia, slurred speech, decreased coordination,
 May require several weeks to obtain desired somnolence, and mental confusion
effects
 Patients should be advised regarding the Dress SJS/TEN
possibility of extrapyramidal symptoms and that Latency 2-8 weeks 4-28 days
abrupt withdrawal may cause dizziness, nausea Rash Morbilliform Painful
and vomiting, uncontrolled movements of erythematous
mouth, tongue, or jaw. macules with
 Advise patient to avoid alcohol or other CNS purpuric
depressants while using the medication centers –
vesicles/bullae
Anticonvulsants - sloughting
Antipsychotics Mucosal 50% have mild ¿90% have
 Drugs used for seizures involvement mucosal severe mucosal
 Stabilize cell membranes and suppress the involvement, involvement
abnormal electric impulses in the cerebral cortex rarely with with bleeding
 CNS depressants erosions at 2 or more
Three main pharmacologic effects: sites
1. Increase the threshold activity in the motor CBC Eosinophilia Lympopenia
cortex and atypical
2. Limit the spread of a seizure discharge from its leukocytes
origin by suppressing the transmission of Hepatitis 50% or more ¿10%
impulses from one nerve to the next Kidney Tubulointerstiti Prerenal
3. Decrease the speed of the nerve impulse al nephritis azotemia
conduction within a given neuron o Some drugs Skin biopsy Dermal edema Full-thickness
work by enhancing the effects of the inhibitory with infiltration epidermal
neurotransmitter gammaaminobutyric acid by lymphocytes necrosis
(GABA) and oes
Phenytoin Nursing Considerations:
 First anti-seizure medication reduction of  Rate of administration should not exceed 50
sustained highfrequency neuronal discharges mg/minute in adults and 1 to 3 mg/kg/min in
 Acts by interfering with sodium channels in the pediatric patients because of the risk of severe
brain hypotension and cardiac arrhythmias. Careful
 Indicated for treatment of tonic-clonic (grand cardiac monitoring is needed during and after
mal) and psychomotor (temporal lobe) seizures administering intravenous phenytoin.
and for the prevention and treatment of seizures  Phenytoin has a narrow therapeutic drug level
occurring during or following neurosurgery (10-20 mcg/ml); so, serum drug monitoring is
 Adverse effects: dermatologic reactions (e.g. required. Monitor for signs and symptoms of
toxic epidermal necrolysis (TEN) and Stevens- confusion that may indicate delirium, psychosis,
Johnson syndrome (SJS) that occur usually or encephalopathy.
within 28 days
 Advise patient not to abruptly discontinue  Levetiracetam should not be stopped abruptly,
medications as this can cause status epilepticus or withdrawal seizures may occur.
 Phenytoin is extensively bound to plasma  Use with caution in patients with renal
proteins and is prone to competitive impairment.
displacement  Advise patients not to drive or operate
 Phenytoin is metabolized by hepatic cytochrome machinery until they have gained sufficient
P450 enzymes, so it is susceptible to inhibitory experience on levetiracetam
drug interactions, which may produce  Patients, family, and caregivers should also
significant increases in circulating phenytoin monitor carefully for suicidality during
concentrations and enhance the risk of drug medication therapy
toxicity.  Monitor patients for adverse reactions (e.g.
anaphylaxis, behavioral or mood changes,
CYP 450 Inducers CYP 450 Inhibitors dermatologic reactions
Sodium valproate
Isoniazid Gabapentin
Ethanol (chronic) Cimetidine  Indicated as adjunct treatment for partial
Barbiturates Ketoconazole seizures, but is most used to treat neuropathic
Phenytoin Fluconazole pain
Rifampicin Acute alcohol  Exact mechanism of action is unknown;
Griseofulvin Erythromycin structurally like GABA, but does not act on
Carbamazepine Sulfonamides GABA receptors or influence GABA
St. John’s Ciprofloxacin  Adverse effects: increase the risk of suicidal
Wort/Smoking Omeprazole thoughts or behavior; DRESS; dizziness,
Metronidazole somnolence, and other signs of CNS depression
Grapefruit juice
Nursing Considerations:
Nursing Considerations:  Gabapentin use in pediatric patients with
 It may take several weeks to obtain the desired epilepsy 3 to 12 years of age is associated with
medication effect. the occurrence of central nervous system related
 Patients should avoid alcohol and other CNS adverse events:
depressants while taking anticonvulsant drug 1. emotional lability;
therapy 2. hostility;
 Diabetic patients should monitor their blood 3. hought disorder;
glucose levels carefully. 4. hyperkinesia
 Peripheral edema and ataxia tended to increase
Levetiracetam in incidence with age. Fall precautions should
 Indicated as adjunctive therapy in the treatment be considered.
of partial onset seizures in patients 12 years of  Instruct patient not to abruptly discontinued
age and older with epilepsy drug because of the possibility of increasing
 Exact mechanism of action is unknown; but seizure frequency
may interfere with sodium, calcium, potassium,  Patients should be monitored for the emergence
or GABA transmission or worsening of depression, suicidal thoughts or
 Adverse effects: behavioral abnormalities (e.g. behavior, and/or any unusual changes in mood
psychotic symptoms, suicidal ideation, or behavior
irritability, and aggressive behavior);  Monitor for adverse reactions and report
somnolence and irritability; anaphylaxis or immediately to the provider
angioedema; serious dermatological reactions  Patients should be advised neither to drive a car
(e.g. StevensJohnson syndrome (SJS) and toxic nor to operate other complex machinery until
epidermal necrolysis (TEN)); coordination they have gained sufficient experience on
difficulties and hematologic abnormalities gabapentin
 Patients should not take gabapentin within 2
Nursing Considerations: hours of antacid medications
 cross the blood-brain barrier; incidence of
AntiParkinson’s Agents levodopainduced nausea and vomiting is less
 Imbalance of dopamine and acetylcholine and a when it is combined with carbidopa
deficiency of dopamine in certain areas of the  Adverse reactions: hallucinations and
brain psychotic-like behavior; intense gambling urges,
 Drug therapies are aimed at increasing levels of increased sexual urges, intense urges to spend
dopamine and/or antagonizing the effects of money, binge eating, and/or other intense urges,
acetylcholine and the inability to control these urges;
 Used to slow the progression of symptoms increased risk for melanoma; dark red, brown,
or black color may appear in saliva, urine, or
PARKINSON’S DISEASE sweat; dyskinesia
 Onset usually gradual, after age 50. (slowly
Progressive) Nursing Considerations:
 Mask-like, blank expression  Recommended for use in patients older than age
 Stooped posture 18
 Depression  Drug can take several weeks to see positive
 Possible mental deteriorate effects, and this should be explained to patients
 Pill rolling tremors and their caregivers
 Shuffling, propulsive gait  Drug is contraindicated for use with MAOIs
 Rarely occurs in black population  All patients should be observed carefully for the
development of depression with concomitant
Muscle suicidal tendencies
Bradykinesia Tremor
Rigidity  Patients should be advised to exercise caution
 I resistance  Commonly while driving or operating machines
 Loss of to passive in hands  Neuroleptic malignant syndrome (NMS) have
normal arm movement and arm been reported in association with dose
swing while  Cog wheel,  Pill rolling reductions or withdrawal of certain
walking jerky slow motion with antiparkinsonian agents. Therefore, patients
 I Blinking movement the fingers should be observed carefully when the dosage
of the  Occurs of levodopa is reduced abruptly or discontinued.
eyelids most often  Instruct patients to plan their mealtimes around
 Loss of at rest medication times to improve the ability to use
ability to  May their utensils and to avoid diets high in protein
swallow involve due to decreased absorption of the medication
 Blank diaphragm,
expression tongue, Selegiline
 Difficulty lips, and  Used conjunction with carbidopa-levodopa;
initiating jaw control symptom fluctuations
movement increases  Inhibits MAO-B, blocking the breakdown of
with stress. dopamine
 Side effects are dose dependent, with larger
Carbidopa/Levodopa doses posing a hypertensive crisis risk if there is
 Most common drug used to treat Parkinson’s consumption of food or beverages with tyramine
disease and is usually started as soon as the  Large doses may inhibit MAO-A that promotes
patient becomes functionally impaired metabolism of tyramine in the GI tract -
 Indicated for Parkinson’s disease; treat restless hypertensive crisis!
leg syndrome
 Levodopa – metabolic precursor of dopamine Nursing considerations:
that crosses the blood-brain barrier and is  Advise patient to avoid foods high in tyramine
converted to dopamine in the brain.  May cause drowsiness, dizziness, and
 Carbidopa – combined with levodopa to help orthostatic changes. Watch out for falls and
stop the breakdown of levodopa before it can injuries.
 Advise patient to exercise caution while driving
or operating machines
 Monitor for adverse reactions and report
promptly to healthcare provider
Amantadine
 Used in early stages of Parkinson’s disease but
can be effective in moderate or advanced stages
in reducing tremor and muscle rigidity
 Exact mechanism of action is unknown
 An antiviral drug that acts on dopamine
receptors
 Indicated also medication-induced
extrapyramidal symptoms, and influenza A
 Adverse reactions: suicide ideation, congestive
heart failure, and peripheral edema; intense
gambling urges, increased sexual urges, intense
urges to spend money uncontrollably, and other
intense urges with an inability to control them;
increased risk of melanoma; nausea, dizziness
(lightheadedness), and insomnia; anticholinergic
side effects, impaired thinking, and orthostatic
hypotension
Nursing Considerations:
 Use cautiously in patients with renal
impairment
 Monitor patients for suicidal ideation
 Therapy should not be stopped abruptly
because it can cause Parkinsonian crisis
 Advise patient to take medication as directed
and ensure that no dose is skipped or doubled
 Patients should avoid using this medication
with OTC cold medications or alcoholic
beverages
 Advise patient to exercise caution while
driving or operating machines
 Monitor for adverse reactions and report
promptly to healthcare provider.
Iloilo Doctor’s College College of Nursing
PHARMACOLOGY 
Daryl Faith B. Co, RN, MD 
ANTI-INFECTIVE AGENTS
I. General Information
II. Bacterial Resistance 
III. Antibiotics
IV. Anti-tubercular agents
V. Antifungals  B. Use of Anti-infective Agents
VI. Antivirals
VII. Antimalarials 
VIII. Antiprotozoals 
IX. Anti-helminthics
X. Miscellaneous Antibacterial agents 
I. General Information
A. Therapeutic Actions of Anti-infective
Agents
Goal: interference with the normal function of the
invading organism to prevent it from reproducing
and to cause cell death without affecting host cells
Selective toxicity – ability to affect certain
proteins or enzyme systems
Narrow spectrum: effective against only a
few microorganisms with a very specific
metabolic pathway or enzyme (e.g. gram-
negative or gram positive)
Broad Spectrum: interferes with
biochemical reactions in many different
kinds of microorganisms, useful in treatment
of a wide variety of infections (e.g. both
gram-negative and gram-positive)
Bactericidal – cause death of the cells they
affect
Bacteriostatic – merely interferes with the
ability of the cells to reproduce or divide
used only by the infecting organism but not
by human cells
Mechanism of Therapeutic Actions:
1. Interfere with biosynthesis of pathogen cell
wall
2. Prevent usage of substances essential to
growth and development
3. Interfere with protein synthesis
4. Interfere with DNA synthesis
5. Alter the permeability of the cell membrane
A. Anti-infective Activity Spectrum –
antimicrobials vary their effectiveness
against an invading organism
Treat
Culture How do pathogens acquire resistance?

used for identification of the infecting 1. Produce an enzyme

pathogen 2. Changing cellular permeability or alter
Sensitivity transport systems
3. Alter binding sites on membranes or
evaluate bacteria and determine which drugs ribosomes
can control the microorganism that have 4. Produce an antagonistic chemical to the drug
known resistant strains
Combination Prevention of Bacterial Resistance
Synergistic effect Limit the use of antimicrobials
Infections caused by more than one Drug dosing should be high enough and
organism long enough
Delay the emergence of resistant strains (e.g. Around-the-clock dosing
Tuberculosis) Health teaching:

Prophylaxis (e.g. Malaria, Gastrointestinal or Only use antibiotics when prescribed by a

Genitourinary surgery, Cardiac valve disease, certified health professional.
Dental Procedures) Never demand antibiotics if your health
worker says you don’t need them.
Always follow your health worker’s advice
C. Adverse Reactions when using antibiotics.
Kidney Damage (e.g. Gentamicin) Never share or use leftover antibiotics.
GI toxicity (e.g. Meropenem) Prevent infections by regularly washing
Hepatotoxic (e.g. Cephalosporins) hands, preparing food hygienically, avoiding
Neurotoxic (e.g. Aminoglycosides, close contact with sick people, practicing
Chloroquine) safer sex, and keeping vaccinations up to
Hypersensitivity Reactions (e.g. Penicillin, date.
Cephalosporins)
Superinfections (e.g. broad spectrum III. Antibiotics
antibiotics) – manifested as vaginal or yeast Antibiotic Class Generic Name
infections, C. difficile infection Penicillin G Benzathine
Penicillin G potassium
Penicillin
Penicillin G procaine
II. Bacterial Resistance Penicillin V
Resistance – natural or acquired; ability over time Extended
Amoxicillin
to adapt to an anti-infective drug and produce cells spectrum
Ampicillin
that are no longer affected by a particular drug penicillin
Cloxacillin
Because anti-infectives act on specific Penicillinase Oxacillin
enzyme systems or biologic processes, many resistant Nafcillin
microorganisms that do not use that system antibiotics Dicloxacillin
or process are not affected by a particular Methicillin
Monobactam Aztreonam
anti infective drug and have natural or
Carbapenem Imipenem
intrinsic resistance
Sulfonamides Cotrimoxazole
(Trimethoprimsulfamethoxazo
 le) Extended spectrum penicillin: less active
Sulfadiazine against gram-positive and anaerobic
Sulfasalazine organisms than penicillin G, but they have
Ciprofloxacin much greater efficacy against gram-
Delafloxacin
negative species
Levofloxacin
Fluoroquinolones Penicillinase-resistant penicillin: resists the
Moxifloxacin
Ofloxacin hydrolysis of the beta-lactam ring by the
Gemifloxacin enzyme, beta-lactamase.
Azithromycin Beta-lactamase facilitates bacterial
Macrolides Clarithromycin resistance to penicillin. It destroys the beta-
Erythromycin lactam ring of penicillin, making it
Aminoglycosides Amikacin
ineffective.
Demeclocycline
Tetracycline Doxycycline Administration considerations:
Minocycline
Hypersensitivity & cross-reactivity
Combination with potassium- sparing
Antibiotic Cell structure affected diuretics
Penicillin Give with food but avoid citrus- based
Cephalospori products
n Watch out for fever or diarrhea
Cell wall
Carbapenems
Monobactam
s 2. Cephalosporins
Lipoglycopep Related to penicillin due to beta-lactam
tide Cell membrane
structure
Aztreonam
Aminoglycos Skin and skin-structure infections, bone
Protein synthesis by binding to infections, GUT infections, otitis media, and
ide
ribosome community-acquired respiratory tract
Tetracycline
Macrolides infections
class of antibiotics work by
Oxazolidinon Bactericidal
inhibiting bacterial RNA protein
es Interfere with cell wall synthesis
Fluoroquinol
DNA enzymes Grouped into generations
ones
Carbapenems Administration considerations:
Ketolides Protein function
Hypersensitivity & cross-reactivity
Lincosamides
Inhibit folic acid synthesis for RNA Disulfiram-like reactions
Sulfonamides Monitor BUN & creatinine
& DNA
Watch out for signs of superinfection

1. Penicillin
“-cillin” 3. Carbapenems
Streptococcal, Pneumococcal, Life-threatening, multi-drug resistant
Staphylococcal infections infections
Oral, IV, IM Broad-spectrum: gram-positive and gram-
Bactericidal negative
Interfere with cell wall synthesis Bactericidal
Interfere with cell wall synthesis
Administration considerations:
Hypersensitivity & cross- reactivity
Watch out for sign of superinfection
4. Monobactams
Beta-lactam ring structure
Narrow-spectrum: gram- negative
(Pseudomonasaeroginosa)
Bactericidal
Interfere with cell wall synthesis
Administration considerations:
Hypersensitivity & cross-reactivity
Watch out for sign of superinfection
GI symptoms, coagulation abnormalities
5. Sulfonamides
“sulfa-“
Competitively inhibit bacterial metabolic
enzymes
UTI, otitis media, acute exacerbations of
chronic bronchitis, and traveler’s diarrhea
Bacteriostatic: gram-negative and gram
positive
Administration considerations:
Hypersensitivity
Increased risk of crystalluria kidney stones
or decreased kidney function - increase fluid
intake
Increased photosensitivity – use sunscreen
and protective clothing
Watch out for signs of superinfection and
bleeding
6. Fluoroquinolones
“-floxacin”
Pneumonia, complicated skin or urinary
tract infections
Inhibit bacterial DNA replication
Bactericidal
Broad-spectrum
Administration considerations:
Hypersensitivity & photosensitivity
Avoid use of antacids and medications
containing iron and zinc
Take with full glass of water two hours
before or after meals
Contraindicated for children – complicated
UTIs, pyelonephritis, plaque, post-Anthrax
exposure
Tendinitis and tendon rupture, peripheral
neuropathy, CNS effects, exacerbation of
muscle weakness in patients with
Myasthenia Gravis
7. Macrolides
“-thromycin”
Respiratory infections, otitis media, pelvic
inflammatory infections, and Chlamydia
Inhibit bacterial RNA protein synthesis –
Bacteriostatic
Broad-spectrum
Administration considerations:
Hypersensitivity & hepatotoxicity
Take with food
Photosensitivity – wear protective clothing
and use sunscreen
Drowsiness, chest pain, palpitations,
jaundice
8. Aminoglycosides
“-mycin”
Streptomycin – streptococcal endocarditis,
second-line anti-TB drug - Neomycin –
hepatic encephalopathy - Inhibit bacterial
ribosome (30S subunit) - inhibit protein
synthesis
Bactericidal
Broad-spectrum
Administration considerations:
Given with beta-lactam medications
Monitor for decreasing urine output,
increasing BUN & creatinine, and
decreasing GFR
Increase fluid intake
 more selective than Imidazoles and have
fewer side effects
9. Tetracyclines examples: fluconazole, itraconazole,
“-cycline” voriconazole, Posaconazole
Inhibit bacterial ribosome (30S subunit)
inhibit protein synthesis
Bacteriostatic 3. Allylamines
Broad-spectrum MOA: inhibit squalene epoxidase, which
Given with beta-lactam medications converts squalene to ergosterol
Administration considerations: topical application
dermatophytic skin infection (e.g. ringworm
Hypersensitivity – tinea pedis/athlete’s foot, tinea cruris –
Photosensitivity, nephrotoxicity, jock itch, tinea corporis)
hepatotoxicity oral treatment: Terbinafine for fingernail
Discoloration of developing teeth and and toenail fungus (watch out for
enamel hypoplasia hepatotoxicity)
Contraindicated in pregnancy and children 8 examples: terbinafine, naftifine, tolnaftate
years old and younger
Avoid consuming dairy products
Impedes effectiveness of OCP 4. Polyenes
naturally produced by actinomycete soil
bacteria
IV. Anti-tubercular Agents structurally related to macrolides
(Please refer to the last page) MOA: binding membrane ergosterol and
forming pores in the plasma membrane
V. Antifungals examples: nystatin, amphotericin B
1. Imidazole infections (e.g. aspergillosis, cryptococcal
synthetic fungicide meningitis, histoplasmosis, blastomycosis,
Nystatin: topical application for yeast candidiasis); nephrotoxic!
infection on skin, mouth, vagina, intestinal
fungal infections
Amphotericin B: systemic fungalMOA: VI. Antivirals
inhibit the biosynthesis of ergosterol, the 1. Anti-herpes
main sterol in membranes of fungi - skin Acyclovir
infections (e.g. ringworm – tinea
pedis/athlete’s foot, tinea cruris – jock itch, used for treatment of herpes and varicella
tinea corporis) virus infections, including genital herpes,
examples: miconazole, ketoconazole, chickenpox, shingles, Epstein-Barr virus
clotrimazole infections, and cytomegalovirus infections
2. Triazoles MOA: termination of the DNA chain during
MOA: inhibit the biosynthesis of ergosterol, viral replication process
the main sterol in membranes of fungi - Administered topically or systematically
administered orally or intravenously - Administration considerations:
systemic yeast infections (e.g. oral thrush, Nephrotoxic
cryptococcal meningitis) Emphasize patient compliance
 May cause significant fatigue, thus patients Tissue schizonticidal drugs: act on primary
should be encouraged to rest tissue forms of plasmodia which initiate the
erythrocytic stage; block further
2. Anti-influenza development of infection Examples:
Oseltamivir primaquine, pyrimethamine
Gametocytocidal drugs: destroy sexual
MOA: inhibits neuraminidase enzyme forms of the parasite thereby preventing
expressed on the viral surface, thereby transmission of infection to mosquitoes
preventing the release of virus from infected Examples: primaquine, artemisinins,
cells. Neuraminidase promotes release of quinine
virus from infected cells
Does NOT CURE influenza, but may
decreased flu symptoms and shorten Antimalaria
Indications
duration of illness l Drug
Given for patients as prophylaxis against Quinine,
infections, known exposure, or lessen course Treat acute attacks Mefloquine,
Chloroquine
of illness
Effect radical cure
Administration consideration: (elimination of dormant liver
Primaquine
stage parasites/hypnozoites
Emphasize patient compliance Tafenoquine
found in Plasmodium
Must be started within 48 hours of symptom vivax and ovale)
onset Chloroquine,
Mefloquine,
Proguanil,
3. Antiretrovirals Prophylaxis Pyrimethami
Used for treatment of HIV ne,
MOA: impede virus replication Dapsone,
Administration consideration: Doxycycline
Primaquine,
Impact renal function – urine output and Proguanil,
Prevent transmission
renal laboratories (e.g. BUN, creatinine) Pyrimethami
must be monitored ne
Administration considerations:
Emphasize importance of compliance
May cause significant fatigue, thus patients Impacts hearing and vision – monitor
should be encouraged to rest closely for adverse effects
GI upset – take medications with food
Photosensitivity – wear protective
VII. Antimalarials
sunglasses to prevent ocular damage
Used for the prevention or treatment of
Encourage strict adherence to full
malaria
prescription regimen – 6 months or more of
MOA: Target specific intracellular
therapy
processes that impact cell development
Minimize additional exposure to mosquitoes
Blood schizonticidal drugs: act on
(e.g. repellents, protective clothing, netting)
erythrocytic stage of the parasite thereby
Avoid alcohol consumption
terminating clinical illness Examples:
quinine, chloroquine, lumefantrine,
atovaquone
Metronidazole gel: treatment for acne rosacea,
bacterial vaginosis, or trichomonas
Metronidazole IV: Giardia and anaerobic bacterial
infection (C. difficile infection)
Administration considerations:
Watch out for seizures, peripheral
neuropathies, dizziness
Avoid alcohol consumption – may have
disulfiram reactions
Educate on importance of medication
compliance and prevention of reinfection
May cause dry mouth – instruct to hydrate
or suck on sugarless candies
May cause darkening of urine
Patients who are being treated for
trichomoniasis should be advised that sexual
partners must also be treated, even if they
are asymptomatic
VIII. Antiprotozoals
Target infectious protozoans (e.g. Giardia)
Orally, parenterally, topically
Oral route for GI infections
IX. Anti-helminthic
Target parasitic helminths – roundworms
(Nematoda) and flatworms
(Platyhelminthes)
MOA: prevent microtubule formation
within parasitic cell, compromising glucose
uptake; block neuronal transmission within
parasite causing starvation, paralysis, and
death of worms; inhibit ATP formation and
impair calcium uptake inducing paralysis
and death
Administration considerations:
May cause liver damage and bone marrow
suppression in prolonged therapy
Instruct patients to ensure rigorous hygienic
precautions to minimize risk of reinfection
(e.g. wash all beddings, linens, towels, and
clothing after treatment)
Oral route is used to treat antibiotic
associated C. difficile infection
Nephrotoxic and ototoxic – patient’s trough
levels must be monitored carefully to avoid
complications
“Red man syndrome” – patients receiving
IV vancomycin experience flushing of the
skin and reddish rash on the upper body
when infusion is administered too rapidly
Educate patient on importance of adhering
to full course of antibacterial therapy
Monitor for hypersensitivity, tinnitus,
hearing loss, vertigo
X. Miscellaneous Antibiotics
Vancomycin
Glycopeptide effective against gram positive
bacteria, used to treat serious orsevere
infections when other antibiotics are
ineffective or contraindicated, such as those
caused by MRSA (Methicillin resistant
Staphylococcus aureus)
MOA: inhibit cell wall synthesis
Administration considerations:
Poorly absorbed from the GI tract, so it must
be given IV to treat systemic infection