Antibiotics
抗生物質の選択、用途についてはあまり細かい問題には出会わなかったように思う（診断領域になるためそれはそうかという感じではある）どちらかと言うと、処方された場合の注意点についての設問が多かった。ただ現行(2023~)のスタイルの試験問題ではケースに沿って問題に答える中で処方された抗生剤を選択するものがあったので大まかな種類と薬品名、用途は把握しておくべき。何れにせよどのような血液検査が必要か？や副作用、日常生活で内服中の注意点に関する問題が中心となる。
1. Macrolides
Erythromycin
Clarithromycin
Uses: Upper and lower respiratory infections
Otitis media (with sulfonamides)
Alterations for persons with penicillin allergy,
when penicillin is the most appropriate drug
Adverse Effects: Nausea, Vomiting, Diarrhea, abdominal pain, Hepatotoxicity
Ototoxicity, Phlebitis at IV site, Rash
Nursing Implications:
⚪︎ Administer IV slowly to avoid phlebitis
⚪︎ Do not crush coated tablets
⚪︎ Non-coated tablets best absorption on empty stomach
⚪︎ Give IM deeply in large muscle
Cefazolin
Rashes, Superinfections, Anaphylaxis, Phlebitis at IV site
Pseudomembranous colitis
Nursing Implications:
⚪︎ Rotate IV sites
⚪︎ Assess for penicillin allergy, potential cross sensitivity.
⚪︎ Probenecid will decrease excretion and increase blood levels
⚪︎ May potentiate effects of anticoagulants
3. Vancomycin
Vancomycin
Uses: Life-threatening infectionswhen less toxic antiinfective is contraindicated
Staphylococcal infections, Pseudomembranous colitis
Adverse Effects: Mainly associated with IV administration:
Nausea, Vomiting, unpleasant taste, Ototoxicity, Nephrotoxicity
Phlebitis, Hypotension, Back and neck pain
⭐︎Red Man syndrome：Flushing of face, neck, chest, Upper extremities
Maculopapular rash
Nursing Implications:
⚪︎ Monitor IV site very closely
⚪︎ Monitor I&O; cloudy or pink urine may be a sign of nephrotoxicity
⚪︎ Monitor bowel status throughout therapy
⚪︎ Monitor BP throughout therapy
4. Penicillins
Ampicillin
Poxicillin
Oxacillin
Uses: Treatment of wide variety of infections:
Pneumococcal pneumonia / Streptococcal pharyngitis / Syphilis / Gonorrhea
Also, enterococcal infections (with aminoglycoside); and prevention.
Adverse Effects: Epigastric distress, diarrhea, Nausea, Vomiting, Rashes, Urticaria
Pain at IM site, Phlebitis at IV site, Super-infection, Anaphylaxis, Anemia
Nursing Implications:
⚪︎Assess for previous reactions to penicillins and cephalosporins.
⚪︎Oral med given on empty stomach.
⚪︎Monitor CBC, BUN, creatinine.
5. Aminoglycosides
Gentamycin
Streptomycin
Tobramycin
Uses: Gram-negative bacterial infections
Adverse Effects: Ototoxicity, Nephrotoxicity, Super-infection, Photosensitivity with topical use
Nursing Implications:
⚪︎Monitor renal function tests and I&O.
⚪︎Assess for hearing loss and balance.
⚪︎Monitor therapeutic levels (peak & trough).
⚪︎Maintain adequate hydration.
⚪︎Avoid sunlight.
6. Sulfonamides
Cotrimoxazole
Sulfisoxazole
Uses: UTI, Otitis media, Pneumocystis carinii pneumonia
Adverse Effects: Steven Johnson Syndrome (fever, bullae on skin, ulcers of lips, eyes,
mouth and genitalia)
Nausea, Vomiting, Diarrhea, Stomatitis, Photosensitivity, Agranulocytosis
Aplastic anemia, Bleeding, Crystalluria, Superinfection
Nursing Implications:
⚪︎Assess IV site frequently, phlebitis is common.
⚪︎Monitor I&O; fluid intake should be sufficient to maintain a urine output of
at least 1200–1500 ml daily to prevent crystalluria and stone formation.
⚪︎Caution patient to use sunscreen and protective clothing.
⚪︎Caution that sulfonamides decrease effectiveness of contraceptives.
⚪︎Monitor renal and hepatic function.
7. Tetracyclines
Doxycycline
Tetracycline
Minocycline
Uses: Chlamydia, Mycoplasma, Acne, Rickettsia
Doxycycline — treatment of lyme disease
Adverse Effects: Nausea, Vomiting, Diarrhea, Rashes, Photosensitivity
Super-infection, Hepatotoxicity, Chelating to teeth and new bone
Nursing Implications:
⚪︎Contraindicated in pregnant, lactating women,
and in children <8 years as drug binds to calcium in teeth and new bone growth.
⚪︎Caution patient to use sunscreen and protective clothing.
⚪︎Patient should avoid taking antacids with dairy products
as calcium decreases absorption.
⚪︎Administer 1 hr. before or 2 hr. after meals.
8. Chloramphenicol
Chloromycetin
Uses: Management of the following serious infections when
less toxic agents cannot be used:
Skin, Soft tissue infections
CNS infections(including meningitis)
Bacteremia
Ophth: local infections
Adverse Effects: Bone marrow depression, Peripheral neuritis, Confusion
Depression, Gray syndrome in newborns (abd. distention, vomiting,
pallor, and cyanosis), Death due to baby's immature liver function,
Bitter taste after IV administration
Nursing Implications:
⚪︎Assess for signs of bone marrow depression
(petechiae, sore throat, fatigue, unusual bleeding, and bruising).
⚪︎Patients with impaired liver or renal function, infants, children, and elderly
are at greatestrisk of developing adverse effects.