Question

complete each Following Medications: Tetracycline, Gentamycin

1. Summary of the Unit/Classification
2. Typical routes of administration
3. Common side effects and adverse effects
4. Special considerations
5. Common Nursing interventions

Answer 1

1.Tetracycline:

Tetracycline is a Broad spectrum antibiotic.

*Action: Inhibit protein synthesis

inhibit (30S ribosome) translation

It is used as a Bacteriostatic and Broad Spectrum

*Available forms :

Capsules: 100 mg, 250 mg, 500 mg
Suspension: 125 mg/5 ml
Tablets: 250 mg, 500 mg
Topical ointment: 3%

*Typical routes of administration:

-Good oral availability(food and/or milk reduce GI absorption of oral preparations of tetracycline by 50% or more)

-Absorption is 60-80% orally (fasting adults)

-Bioavailability is 100% intravenously

-Bioavailability is less than 40% when administered via intramuscular injection,

*Tetracycline common side effects and adverse effects

-Suprainfection: C. difficile, Candida
-Interferes with calcification & bone growth
-Stains teeth
-Photosensitivity
-GI disturbances
-Hepatotoxicity
-Renal toxicity (tetracycline & demeclocycline)
-Vestibular toxicity - minocycline
Tetracyclines were taken after expiration date may lead to breakdown products can damage kidneys

Special considerations:
-Tetracycline causes false-negative results in urine tests using glucose oxidase reagent (Diastix, Chemstrip uG, or glucose enzymatic test strip) and false elevations in fluorometric tests for urinary catecholamines.
-ALERT Check the expiration date. Outdated or deteriorated tetracyclines have been linked to reversible nephrotoxicity (Fanconi’s syndrome).
- During topical use, avoid contact with eyes, nose, and mouth.
-Monitor patient for hypersensitivity reactions.
- Monitor patient for resolution of symptoms.
- Discontinue drug if condition persists or worsens.

*Nursing implications and patient teaching :

- Used for Gram-positive and Gram-negative. Chlamydiae, mycoplasmas, rickettsiae and certain protozoa; also used for acne.
- Contraindicated in severe renal or hepatic impairment, common bile duct obstruction, UV exposure and pregnancy/lactation (Preg. Cat. D)
- Given orally with glass of water. Milk and milk products can reduce absorption; if GI symptoms, give with food
- Don't give right before bed
- Report GI symptoms
- Check signs of superinfection; check tongue and mouth for thrush (redness/rash type)
- Withhold if superinfection occurs
- Drug Interactions (Antacids, Minerals, Oral Anticoagulants, Antidiarrheal Agents with kaolin, Methoxyflurane can cause fatal nephrotoxicity)

Patient education:

-Report onset of diarrhea
- Reduce the incidence of superinfection
- Avoid direct exposure to sunlight
- Report immediately if the sudden onset of painful or difficult swallowing

2.Gentamycin

*It is an antibacterial: aminoglycoside

The mode of action is: inhibition of bacterial protein synthesis; bactericidal effect

It is a drug of Pregnancy category C

*Typical routes of administration :

Injection: 40 mg/ml (adult), 10 mg/ml (pediatric), 2 mg/ml (intrathecal)
Ophthalmic ointment: 3 mg/g
Ophthalmic solution: 3 mg/ml
Topical cream or ointment: 0.1%

*Common side effects and adverse reactions:

side effects: anorexia, nausea, vomiting, rash, numbness, visual disturbances, tremors, tinnitus, pruritus, muscle cramps or weakness, photosensitivity

Adverse reactions: oliguria, urticaria, palpitations, superinfection
life-threatening: ototoxicity, nephrotoxicity, thrombocytopenia, agranulocytosis, neuromuscular blockade, liver damage

*Special considerations :

Use the preservative-free form for the intrathecal route.
- Systemic absorption from excessive use may cause systemic toxicities.
-Monitor serum drug levels. Prolonged peak serum level above 10 mcg/ml and trough serum level above 2 mcg/ml increases the risk of toxicity.

*Common nursing interventions:

Assessment

- Assess for infection (vital signs, wound appearance, sputum, urine, stool, WBC) at beginning of and throughout therapy.

-Obtain specimens for culture and sensitivity before initiating therapy. The first dose may be given before receiving results.

-Evaluate eighth cranial nerve function by audiometry before and throughout therapy. Hearing loss is usually in the high-frequency range. Prompt recognition and intervention are essential in preventing permanent damage. Also monitor for vestibular dysfunction (vertigo, ataxia, nausea, vomiting). Eighth cranial nerve dysfunction is associated with persistently elevated peak aminoglycoside levels. Aminoglycosides should be discontinued if tinnitus or subjective hearing loss occurs.

-Monitor intake and output and daily weight to assess hydration status and renal function.

-Assess for signs of superinfection (fever, upper respiratory infection, vaginal itching or discharge, increasing malaise, diarrhea).

-Lab Test Considerations: Monitor renal function by urinalysis, specific gravity, BUN, creatinine, and CCr before and throughout therapy.

-May cause increased BUN, AST, ALT, serum alkaline phosphatase, bilirubin, creatinine, and LDH concentrations.

-Toxicity and Overdose: Monitor blood levels periodically during therapy. The timing of blood levels is important in interpreting results. Draw blood for peak levels 1 hr after IM injection and 30 min after a 30-min IV infusion is completed. Trough levels should be drawn just before the next dose. Peak level range 4– 12 mcg/ mL; trough level range 0.5– 2 mcg/mL. Once daily peaks are 2– 3 times greater than multiple dosing.

Patient or family teaching:

- Instruct patient to report signs of hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating.

-Advise patient of the importance of drinking plenty of liquids.

- Teach patients with a history of rheumatic heart disease or valve replacement the importance of using antimicrobial prophylaxis before invasive medical or dental procedures.

-Topical: Instruct patient to wash affected skin gently and pat dry. Apply a thin film of ointment. Apply occlusive dressing only if ordered by a health care professional. The patient should assess skin and inform health care professional if skin irritation develops or infection worsens.