PHARMACOLOGY

By:
Nerissa Cabaero
Laiza Pineda

Introduction

Pharmacology is the study of the

effect of drugs on living organisms
Medication is a substance
administered for diagnosis, cure,
treatment, or relief of a symptom or
for prevention of disease.
Drug- illicitly obtained substance

Prescription a written direction for the

preparation and administration of a drug
Pharmacy is the art of preparing,
compounding, and dispensing drugs
Pharmacist a person licensed to prepare and
dispense drugs and to make up prescriptions
Pharmacopoeia is a book containing a list of
products used in medicine, with descriptions of
the product, chemical tests for determining
identity and purity, and formulas and
prescriptions

1. Generic name is given before a drug

becomes officially an approved medication
- generally used throughout the drugs use
2. Trade name is the name given by the drug
manufacturer
- sometimes called the brand name
3. Official name is the name under which it is
listed in one of the official publications
4. Chemical name is the name by which a
chemist knows it; this name describes the
constituents of
the drug

PHARMACEUTIC PHASE

>first phase of drug action

>disintegration is the breakdown of a
tablet into smaller pieces
>dissolution is the dissolving of the
smaller pieces in the GI fluid before
absorption.
>rate limiting is the time it takes the
drug to disintegrate and dissolve to
become available for the body to absorb it.

PHARMACOKINETIC
PHASE

>is the process of drug movement

to achieve drug action
-Absorption
-Distribution
-Excretion
-Metabolism or Biotransformation

is the process by which a drug

passes into the bloodstream

- is the movement of drug

particles from the GI tract to body
fluids by passive absorption,
active absorption, or pinocytosis

>passive absorption occurs mostly by

diffusion (movement from higher concentration
to lower concentration). With the process of
diffusion, the drug does not require energy to
move across the membrane.
>active absorption requires a carrier such
as an enzyme or protein to move the drug
against a concentration gradient. Energy is
required for active absorption.
>pinocytosis is a process by which cells
carry drug across their membrane by engulfing
the drug particles.

- factors that affect the rate absorption (blood

flow, pain, stress, hunger, fasting, food,and pH)
>first pass effect in which oral drugs first pass
through the liver and are partially metabolized
prior to reaching the target organ.
>bioavailability is a sub category of absorption.
It is the percentage of the administered drug dose
that reaches the systemic circulation.
- factors that alter bioavailability (the drug
form, route of administration, GI mucosa and
motility, food and other drugs, changes in liver
metabolism)

is the process by which the drug

becomes available to body fluids and
body tissues.

is the transportation of a drug from its site of

absorption to its site of action.
Influenced by blood flow, its affinity to the tissue,
and protein-binding effect
When a drug enters the blood stream, it is carried
to the most vascular organs liver, kidneys, and
brain. Body areas with lower blood supply skin,
muscles receives the drug later.

is a process by which a drug is

converted to a less active form.

Liver is the primary site of

metabolism

Most drugs are inactivated by liver

enzymes and are then converted or
transformed by hepatic enzymes to
inactive metabolites or watersoluble substances for excretion.

- is the process by which metabolites and drugs

are eliminated from the body.
- the main route of drug elimination is through
the kidneys (urine)
- other routes include hepatic metabolism, bile,
feces, lungs, saliva, sweat and breast milk.
- influences drug excretion (pH, kidney disease)
>creatinine clearance most accurate test to
determine renal function
- 12 or 24 our urine collection and a blood
sample
- normal value: 85 to 135 ml/min

PHARMACODYNAMIC
PHASE
is the study of drug
concentration and its effects
on the body

is the process by which a drug

changes the body (alters cell
physiology)

>half-life symbolized as t1/2, of a

drug is the time it takes for one-half of
the drug concentration to be eliminated.
Initially: 100%
After 8 hrs: 50%
After 16 hrs: 25%
After 24 hrs: 12.5%
After 32 hours: 6.25%

>Onset of action the time after administration when

the body initially responds to the drug
- is the time it takes to reach a minimum
effective concentration
>Peak Plasma level the highest plasma level
achieved by a single dose when the elimination rate of a
drug equals the absorption rate
- occurs when the drug reaches its highest blood
or
plasma concentration
>Duration of action is the length of time the drug
has pharmacologic effect
>Drug half-life (elimination half-life) the time
required for the elimination process to reduce the
concentration of the drug to one-half what it was at
initial administration

*Such changes require that the drug interact with specific

molecules and chemicals normally found in the body
> receptor usually a protein, is located on the surface
of a cell membrane or within the cell. A cell membrane
contains receptors for physiologic or endogenous
substances such as hormones and neurotransmitters.
>Agonist a drug that produces the same type of
response as the physiologic or endogenous substance
- drugs that produce a response
>Antagonist inhibits cell function by occupying
receptor sites
- drugs that block a response
- prevents natural body substances or other drugs from
activating the functions of the cell by occupying the
receptor sites.

>Therapeutic effect

-desired effect
-is the primary effect intended,
that is, the reason the drug is
prescribed

>Side effect

-secondary effect
-is one that is unintended; are
physiologic effects not related to
desired drug effects
-even with a correct dosage, side
effects occur and are predicted

>Adverse reaction

-are more severe than side effects

>Drug toxicity
-deleterious effects of a drug on an organism or
tissue
-results from overdosage, ingestion of a drug
intended for external use, and build up of the
drug in the blood because of impaired
metabolism or excretion
-can be identified by monitoring the plasma
(serum) therapeutic range of the drug

>Drug Allergy

-is an immunologic reaction to a drug

-when a client is first exposed to a
foreign substance (antigen), the body
may react by producing antibodies. A
client can react to a drug as to an
antigen and thus develop symptoms
of an allergic reaction.

>Anaphylactic reaction

-a severe allergic reaction usually

occurs immediately after the
administration of the drug
-earliest symptoms: subjective
feeling of swelling in the mouth
and tongue, acute shortness of
breath, acute hypotension, and
tachycardia.

>Drug Tolerance

-exists in a person who has

unusually low physiologic response
to a drug and who requires
increases in the dosage to
maintain a given therapeutic effect

>Drug interaction

-occurs when the administration of

one drug before, at the same time
as, or after another drug alters the
effect of one or both drugs

>Synergestic
-is when two different drugs increase
the action of one or another drug.
>Iatrogenic disease
- (disease caused unintentionally by
medical therapy) can be due to drug
therapy

Assess a clients status and obtain a

medication history prior to giving any
medication to obtain baseline data by
which to evaluate the effectiveness of the
medication
Question any order that is illegible or that
you consider incorrect. Call the person who
prescribed the medication for clarification
Be knowledgeable about the medications
you administer

Use only medications that are in a

clearly labeled container
Do not pour drugs from one
container to another
Do not pour drugs into the hand
Do not recap needles.
Do not use liquid medications that
are cloudy or have changed color

Calculate drug doses accurately. If you are

uncertain, ask another nurse to double-check
your calculations
Administer only medications personally
prepared
Before administering a medication, identify the
client correctly
Do not leave the medications at bedside, with
certain exceptions
If a client vomits after taking an oral
medication, report it to the nurse in charge

When a medication is omitted for any

reason, record the fact together with the
reason
When a medication error is made, report
it immediately to the nurse in charge,
the primary health care provider.
Check the drug label three times before
administration of the medication

Three Times Check for

Safe Medication
Administration
-at the time of
contact with the
drug bottle or
container

-before pouring
the drug

-after pouring
the drug

Types of Medication
Orders

stat order indicates that the medication is to

be given immediately and only once
single order or one-time order is for
medication to be given once at a specified time
standing order may or may not have a
termination date. A standing order may be
carried out indefinitely until an order is written to
cancel it, or it may be carried out for a specified
number of days
prn order or as-needed order, permits the
nurse to give medication when, in the nurses
judgment, the client requires it.

Essential Parts of a
Drug Order

-full name of the client

-date and time the order is written
-name of the drug to be administered
-dosage of the drug
-frequency of administration
-route of administration
-signature of the person writing the
order

*Process of
Administering
Medications*

1. Identify the client

2. Inform the client
3. Administer the drug
4. Provide adjunctive
interventions as indicated
5. Record the drug administered
6. Evaluate the clients response
to the drug

Right Medication/Drug

-the medication given was the

medication ordered

Right Dose

-the dose is appropriate for the

client
-double-check calculations
-know the usual dosage range of
the medication
-question a dose outside of the
usual dosage range

Right Time

-give the medication at the right frequency and at

the time ordered
-medications should be given within 30 minutes
before or after the scheduled time
-administer drugs that are affected by foods, such
as tetracycline, before meals
-administer drugs that can irritate stomach, such
as potassium and aspirin, with food
-it is a nurses responsibility to check whether the
client is scheduled for any diagnostic procedures
that would contraindicate the administration of
medication

Right Route

-give the medication by the ordered route

-make certain that the route is safe and
appropriate for the client
-assess the clients ability to swallow before
administration of oral medications
-do not crush or mix medications in other
substances
-use aseptic technique when administering
drugs
-stay with the client until oral drugs have been
swallowed

Right Client

-medication is given to the

intended client
-check clients identification band
with each administration of
medication

Right Client Education

-explain information about the medication to

the client
-Client teaching also includes therapeutic
purpose, possible side effects of the drug,
any dietary restrictions or requirements, skill
of administration, and laboratory monitoring
-this right is a principle of informed consent,
which is based on the individual having the
knowledge necessary to make decisions

Right Documentation

-document medication
administration after giving it, not
before, this includes: name of the
drug, the dose, route, time and
date, nurses initials or signature

Right to Refuse

-adult clients have the right to

refuse any medication
-the nurses role is to ensure that
the client is fully informed of the
potential consequences of refusal
and to communicate the clients
refusal to the health care provider

Right Assessment

-Some medications require specific

assessments prior to
administration
-Medication orders may include
specific parameters for
administration

Right Evaluation

-conduct appropriate follow-up

Basic Formula
D
H

Where D is the desired dose (drug

dose ordered by the health care
provider)
H is the one-hand dose (drug
dose on label of container [vial,
bottle]
V is the vehicle (drug form in
which the drug comes [tablet,
capsule, liquid]
A is the amount calculated to

Body weight

convert the pounds to kilograms if

necessary (lb / 2.2=kg)
determine drug dose per BW by multiplying
as follows:

-drug dose X body weight = clients

dose per day

follow the basic formula, ratio and

proportion method to calculate the drug
dosage

* Calculating
Intravenous
Fluid*
Method I: three-step
1. amount of solution =
Hours to administer

milliliters/hour (ml/hr)

2. Milliliters per hour = milliliters/ minute

(ml/min)
60 minutes
3. milliliters per minute X drops per milliliter of IV
set =
drops/minute (gtt/min)

Method II: two-step

1. Amount of fluid
= milliliters/hour (ml/hr)
Hours to administer
2. milliliters per hour X drops per milliliter
= drops
per minute (gtt/min)
60 minutes

If the milliliters per hour is known, then use step 2

to determine the drops per minute

Method III: one-step

Amount of fluid X drops per milliliter (IV set)

= drops/ minute
(gtt/min)

hours to administer X minutes per hour (60)

Antibacterial and antimicrobials are

substances that inhibit the growth of
or kill bacteria and other
microorganisms (microscopic
organisms including viruses, fungi,
protozoa, and rickettsiae). Technically,
the term antibiotic refers to chemicals
produced by one kind of
microorganism that inhibits the growth
of or kills another.

>Bacteriostatic drugs inhibit the

growth of bacteria (tetracycline
and sulfonamides)
>Bactericidal drugs kill the
bacteria (penicillins and
cephalosporins)

Penicillin

-a natural antibacterial agent obtained from the

mold genus Penicillium, was introduced to the
military during World War II and is considered to
have saved many soldiers lives. It became widely
used in 1945 and was labeled a miracle drug.
With the advent of penicillin, many clients
survived who would have normally died from
wound and severe respiratory infections.
-foods may decrease the absorption of many
penicillins that are taken orally, therefore those
penicillins should be taken with a full glass of
water 1 hour before food intake or 2 hours after
meal time. Amoxicillins and bacampicillin are
penicillins that are unaffected by food.

General Adverse Effects

to Antibacterial Drugs

-allergy or hypersensivity
-superinfection
-organ toxicity

Basic Penicillins

>penicillin G procaine
(Crysticillin, Wycillin) for
moderately serious infections. Slow
IM absorption with prolonged action.
>penicillin G benzathine (Bicillin)
Long-acting penicillin when given
by injection. Used as prophylaxis for
rheumatic fever.

>penicillin G sodium/potassium
(Pentids, Pfizerpen) Poorly absorbed
orally because of gastric acidity and food.
Take before or after meals. Penicillin G is
available in salts (potassium [K] and
sodium [Na]). With high doses, electrolyte
levels should be monitored.
>penicillin V potassium (V-Cillin K,
Veetids, Betapen VK) - Acid-stable and less
active than penicillin G against some
bacteria. Not recommended in renal
failure. Take drug after meals.

Broad-Spectrum
Penicillins
(Aminopenicillins)

-are used to treat both grampositive and gram-negative

bacteria.
>amoxicillin (Amoxil)
Amoxicillin-clavunalate
(Augmentin) treatment of lower
respiratory infections, otitis media,
sinusitis, skin infections, UTIs

>ampicillin (Polycillin, Omnipen) first

broad-spectrum penicillin. 50% of the drug is
absorbed by GI tract. Effective gram-negative
and gram-positive bacteria. Individuals with
penicillin allergies may also be allergic to
ampicillin.
>ampicillin-sulbactam (Unasyn) same as
ampicillin.
>bacampicillin HCl (Spetrobid) same as
ampicillin. 90% is absorbed. It is hydrolyzed to
ampicillin during absorption from the GI tract.

Penicillinase-Resistant
Penicillins (Antistaphylococcal
Penicillins)

-are used to treat penicillinaseproducing S.aureus.

>Cloxacillin (Tegopen) for most
gram-positive bacterial infections
>Dicloxacillin sodium (Dynapen)
Methicillin (Staphcillin) first
penicillinase- resistant penicillin.
Used to treat staphylococcal
infection.

>Nafcillin (nafcin, Unipen) Highly

effective against penicillin G-resistant
staphylococcus aureus. Not
recommended for oral use because of
its instability in gastric juices.
>Oxacillin sodium (Prostaphlin,
Bactocil) for penicillin-resistant
staphylococci. As effective as
methicillin.

Extended-Spectrum
Penicillins (Antipseudomonal
Penicillins)

-are group of broad-spectrum penicillins. This

group of drug is effective against
Pseudomonas aeruginosa, a gram-negative
bacillus that is difficult to eradicate. These
drugs are also useful againstmany gramnegative organisms such as Proteus spp.,
Serratia spp., Klebsiella pneumoniae,
Enterobacter spp., and Acinobacter spp. The
antipseudomonal penicillins are not
penicillinase-resistant. Their pharmacologic
action is similar to that of aminoglycosides,
but they are less toxic than aminoglycosides.

>Carbenicillin indanyl (Geocillin, Geopen)

the first penicillin-like drug developed to treat
infections caused by Pseudomonas aeruginosa
and Proteus spp. It contains large amounts of
sodium. Use with caution when administering
to clients with hypertension or congestive heart
failure.
>Mezlocillin sodium (Mezlin) for serious
infections, especially because of Pseudomonas
aeruginosa. It can be given in combination
with aminoglycosides and cephalosporins to
obtain synergestic effects.

>Piperacillin sodium (Pipracil) For

serious infections. Can be given before
and after surgery. Primarily used for
gram-negative organisms. Treatment
for septicemia; bone; joint; respiratory;
and urinary tract infections.
>Piperacillin-tazobactam (Zosyn)
to treat appendicitis, skin infections,
pneumonia

>Ticarcillin disodium (Ticar) effective

against gram-positive and gram-negative
bacilli. Used to treat respiratory, urinary,
reproductive, skin, and soft tissue
infections. It can be given in combination
with aminoglycosides for synergistic effect.
>Ticacillin-clavulanate (Timentin)
effective for treating septicemia and lower
respiratory tract, urinary tract, skin, bone,
joint infections.

-asses for allergy to penicillin or

cephalosporins
-check laboratory results,
especially liver enzymes
-record urine output

-send a sample of material from the infected

area to laboratory for culture to determine
antibiotic susceptibility (also known as C&S)
before antibiotic therapy is started.
-check signs and symptoms of superinfection,
s/sx are stomatitis (mouth ulcers), genital
discharge (vaginitis), and anal or henital itching.
-examine client for allergic reaction to the
penicillin product
-have epinephrine available to counteract a
severe allergic reaction

-check client for bleeding, a decrease in

platelet aggregation may result.
-monitor body temperature and
infectious area
-dilute the antibiotic for IV use in an
appropriate amount of solution
-advise client to take medication with
food if gastric irritation occurs and to
take oral penicillin 1 hour before or 2
hours after meals to avoid delay in drug
absorption.

Cephalosporins

In 1948 a fungus called Cephalosporin

acremonium was discovered in seawater at
a sewer outlet off the coast of Sardinia.
This fungus was found to be active against
gram-positive and gram-negative bacteria
and resistant to beta-lactamase (an
enzyme that cats against beta-lactam
structure of penicillin). In the early 1960s
caphalosporins were used with clinical
effectiveness.

First

Effective against gram-positive bacteria,

such as streptococci and most
staphylococci. Effective against most
gram-negative bacteria, such as
Escherichia coli and species of Klebshiella,
Proteus, Salmonella, and Shigella.
-Cefadroxil, cefazolin sodium,
cephalexin, cephalothin, cephapirin
sodium, cephradine

Second

Same effectiveness as the first

generation. These antibiotics possess a
broader spectrum against other gramnegative bacteria, such as Haemophilus
influenzae, Neisseria gonnorhea.
Neisseria meningitides, Enterobacter
spp., and several anaerobic organisms.
-cefaclor, cefamandole, cefmetazole
sodium, cefonicid sodium, ceforanide,
cefotetan, cefoxitin sodium, cefprozil
monohydrate, cefuroxime

Third

Same effectiveness as the first and second

generations. Also effective against gramnegative bacteria, such as Pseudomonas
aeruginosa, Serratia spp., and Acinobacter
spp. Less effective against gram-positive
bacteria.
-cefdinir, cefixime, cefoperazone,
cefotaxime, cefpodoxime, ceftazidime,
ceftriaxone, ceftizoxime sodium, ceftibuten,
moxalactam disodium, cefditoren pivoxil

Fourth

Similar to the third generation.

Resistant to most beta-lactamase
bacteria. Has a broader gram-positive
coverage than the third generations.
Effective against E.coli, Klebshiella,
Proteus, strepcocci, certain
staphylococci, and P. aeruginosa.
-cefepime

-assess for allergy to cephalosporins.

-record vital signs and urine output. Report
abnormal findings, which may include an
elevated temperature or decrease in urine
output.
-cheack laboratory results, especially those that
indicate renal and liver function, such as blood
urea nitrogen, serum creatinine, aspartate
aminotransferase, alanine a
minotransferase, alkaline phosphatase, and
bilirubin. Report abnormal findings. Use these
laboratory results for baseline values.

-culture the infected area before cephalosporin

therapy is started. The organism causing the
infection can be determined by culture, and the
antibiotics sensitive to the organism are
determined by culture and sensitivity (C&S)
-check for signs and symptoms of
superinfection, especially if client takes high
doses of a cephalosporin product for a
prolonged period. Superinfection is usually
caused by the fungal organism Candida in the
mouth (mouth ulcers) or in the genital area,
such as the vagina (vaginitis)

-refrigerate oral suspensions, for IV

cephalosporins, dilute in an
appropriate amount of fluids (50100ml)
-Administer IV cephalosporins over
30-45 minutes 2 to 4 times a day
-monitor vital signs, urine output,
and laboratory results. Report
abnormal findings.

Client teaching

-keep drugs out of reach of small children

-instruct client to report signs of
superinfection
-advise client to ingest buttermilk or
yogurt to prevent superinfection of the
intestinal flora with long-term therapy of a
cephalosporin.
-instruct client to take complete course of
medication even when symptoms of
infection have ceased.
-observe for hypersensitivity reactions.

Side Effects
-anorexia, nausea, vomiting,
headache, dizziness, itching, and
rash.
Diet
-advise client to take medication with
food if gastric irritation occurs.

Macrolides

-including azithromycin, clarithromycin,

dirithromycin, erythromycin. At low to moderate
doses, macrolides have Bacteriostatic effect, and
with high drug doses, the effect is bactericidal.
Macrolides can be administered orally or
intravenously (IV) but not intramuscularly (IM)
because its too painful.
-macrolides are active against most gram-positive
bacteria and moderately active against some
gram-negative bacteria. Resistant organisms may
emerge during treatment. Macrolides are used to
treat mild to moderate infections of the respiratory
tract, sinuses, GI, skin, and soft tissue, as well as
diphtheria, impetigo contagiosa, and STDs.

-assess vital signs and urine output

-check laboratory tests for liver
enzyme values to determine liver
function.
-obtain a history of drugs client
currently takes.

-obtain a sample from the infected area and send to the

laboratory for (C&S) test before starting azithromycin therapy.
-monitor VS, urine output, and laboratory values, especially
liver enzymes
-monitor client for liver damage resulting from prolonged use
and high dosage of Macrolides, such as azithromycin. Signs of
liver dysfunction include elevated liver enzyme levels and
jaundice.
-administer oral azithromycin 1 hour before meals or 2 hours
after meals. Give with a full glass of water and not fruit juice.
Give the drug with food GI upset occurs. Chewable tablets
should be chewed and not swallowed whole.
-for IV azithromycin, dilute in an appropriate amount of
solution
-administer antacids either 2 hours before or 2 hours after
azithromycin

Client Teaching
-instruct client to take full course of
antibacterial agent as prescribed. Drug
compliance is most important for all
antibacterials.
Side Effects
-nausea, vomiting, diarrhea, abdominal
cramps, and itching.
-instruct client to report onset of loose
stools or diarrhea

Lincosamides

-inhibit bacterial protein synthesis and have both

bacteriostatic and bactericidal actions,
depending on drug dosage
>Ex. Clindamycin and lincomycin
>Clindamycin- is more widely prescribed than
lincomycin because it is active against most
gram-positive organisms, including
Staphylococcus aureus and anaerobic organisms.
-is absorbed better than lincomycin
through the GI tract and maintains high serum
drug concentration.

Side Effects and Adverse Reactions

-GI irritation, such as nausea,
vomiting, and stomatitis. Rash
may also occur. Severe adverse
reactions include colitis and
anaphylactic shock

Vancomycin

-Its use was almost abandoned because of many

reports of nephrotoxicity and ototoxicity.
Ototoxicity results in damage to the auditory or
vestibular branch of cranial nerve III. Such damage
can result in permanent hearing loss (auditory
branch) or temporary or permanent loss of balance
(vestibular branch). Vancomycin is still used against
drug-resistant S. aureus and in cardiac surgical
prophylaxis for individuals with penicillin allergies.
Serum vancomycin levels should be monitored.
-has become resistant for treating enterococci.
Quinupristin/dalfopristin are two combined resistant
enterococci (VRE) infections. Antibiotic-resistant
enterococci can cause endocarditis.

Ketolides

-are new classification of antibiotics, which

are structurally related to Macrolides. The
first drug in this class is telithromycin
(Ketek) used for adults of 18 years and
older to treat acute chronic bronchitis,
acute bacterial sinusitis, and community
acquired pneumonia. These disorders are
usually caused by Streptococcus
pneumoniae and Haemophilus influenza.

Side Effects and Adverse Reactions

-visual disturbances, stomatitis,
glossitis, gastritis, nausea, vomiting,
abdominal distention, flatulence,
oral and vaginal candidiasis,
constipation, and watery stool.
-may also lead to an exacerbation
of myasthenia gravis

Tetracycline

-is isolated from Streptomyces aureofaciens in

1948, were the first broad-spectrum antibiotics
effective against gram-positive and gramnegative bacteria and many other organisms,
such as mycobacteria, rickettsiae, spirochetes,
and chlamydiae.
-act by inhibiting bacterial protein synthesis
and have a Bacteriostatic effect.
-are frequently prescribed for oral use,
although they are also available for IM and IV
use. Because IM administration of tetracycline
causes pain on injection and tissue irritation,
this route of administration is seldom used.

-assess vital signs and urine output

-check laboratory results, especially those that
indicate renal and liver function, such as BUN,
serum creatinine, aspartate aminotransferase,
alanine aminotransferase, and bilirubin
-obtain history of dietary intake and drugs
client currently takes. Dairy products,
antacids, iron, calcium, and magnesium
decrease drug absorption. Digoxin absorption
is increased, which may lead to digitalis
toxicity

-obtain a sample for culture from the

infected area and send to the laboratory for
a culture and sensitivity test. Antibiotic
therapy can be started after the culture
sample has been taken.
-administer tetracycline 1 hour before
meals or 2 hours after meals for absorption.
-monitor laboratory values for liver and
kidney functions; these include liver
enzymes, BUN, and serum creatinine.
-record VS and UO.

Client Teaching

-instruct client to store tetracycline out of the light and

extreme heat. Tetracycline decomposes in light and
heat, causing the drug to become toxic.
-advise client to check the expiration date on the bottle
of tetracycline; out-of-date tetracycline can be toxic.
-inform woman who is contemplating pregnancy who
has an infection to tell her health care provider and to
avoid taking tetracycline because of possible
teratogenic effect.
-warn parents that children less than 8 years old
should not take tetracycline because it can cause
discoloration of permanent teeth.
-direct client to take the complete course of
tetracycline as prescribed.

Side Effects

-encourage client to use sun block and

protective clothing during sun exposure.
Photosensitivity is associated with
tetracycline.
-instruct client to report signs of a
superinfection (mouth ulcers, anal, or
genital discharge)
-teach client to use effective oral
hygiene several times a day to prevent
to alleviate mouth ulcers (stomatitis).

Diet

-educate client to avoid milk

products, iron, and antacids.
Tetracycline should be taken 1
hour before meals or 2 hours after
meals with a full glass of water. If
gastrointestinal upset occurs, the
drug can be taken with nondairy
foods.

Aminoglycosides

-acts by inhibiting bacterial protein

synthesis.
-The aminoglycosides antibioics are
used against gram-negative bacteria,
such as E.coli, Proteus spp, and
Pseudomonas spp. Some gram-positive
cocci are resistant to aminoglycosides,
so penicillins or cephalospporins may be
used.

-record vital signs and urine output. Compare

these results with future vital signs and urine
output.
-assess laboratory results to determine renal
and liver functions, including blood urea
nitrogen, serum creatinine, alkaline
phosphatase, alanine aminotransferase,
aspartate aminotransferase, and bilirubin.
Serum electrolytes should also be checked.
Aminoglycosides may decrease the serum
potassium and magnesium levels.
-obtain a medical history related to renal or
hearing disorders.

-send a sample from the infected area to

the laboratory for culture to determine
organism and antibiotic sensitivity before
aminoglycoside is started.
-monitor intake and output. Urine output
should be at least 600 ml/d. immediately
report if urine output is decreased.
Urinalysis may be ordered daily. Check
results for proteinuria, casts blood cells, or
appearance.
-check for hearing loss. Aminoglycosides
can cause ototoxicity.

-evaluate laboratory results and compare with

baseline values. Report abnormal results.
-monitor vital signs. Note if body temperature
has decreased.
-for IV use, dilute the aminoglycoside in 50-200
ml of normal saline solution or dextrose 5% in
water (D5W) solution and administer in 30-60
minutes.
-monitor for signs and symptoms of
superinfection such as stomatitis (mouth ulcers),
genital discharge (vaginitis), and anal or genital
itching.

Client teaching

-unless fluids are restricted, encourage client

to increase fluid intake
-instruct client never to take leftover
antibiotics.

Side Effects
-nausea, vomiting, tremors, tinnitus, pruritus,
and muscle cramps
-direct client to use sun block and protective
clothing during sun exposure. Photosensitivity
can be caused by aminoglycosides.

1.amikacin SO4 (amikin) Synthetic derivative

of kanamycin. Effective against Pseudomonas
spp. Hearing changes should be monitored.
2.gentamicin SO4 (garamycin)
Kanamycin SO4 (kantrex) used orally for
hepatic coma. Effective against gram-negative
bacteria with the exception of Pseudomonas
aeruginosa. Monitor for hearing loss and urinary
output.
3.Neomycin SO4 (Mycifradin) decreases
bacteria in the bowel and is used as a
preoperative bowel antiseptic. It is also available
as a topical antibiotic ointment

4.Netilmicin (netromycin) used in treating

moderate to severe gram-negative infections, such
as those caused by Enterobacter, Escherichia coli,
Klebsiella, Proteus, Pseudomonas, and Serratia.
5.paromomycin (Humatin) used in treating
hepatic coma and parasitic infections. Hearing
changes and urinary output should be monitored.
6.streptomycin SO4 first aminoglycoside. Used
with antituberulosis drugs in treatment of
tuberculosis. Ototoxicity is a major problem.
7.Tobramycin SO4 (Nebcin) very effective
against Pseudomonas aeruginosa. Hearing changes
and urinary output should be monitored. Toxic
effects are less than for other aminoglycosides.

Fluoroquinolones
(Quinolones)

-the mechanism of action of

fluoroquinolones is to interfere with the
enzyme DNA gyrase, which is needed to
synthesize bacterial deoribonucleic acid
(DNA). Their antibacterial spectrum
includes both gram-positive and gramnegative organisms. They are bactericidal.
This group of antibiotics is useful in the
treatment of urinary tract, bone, and joint
infections; bronchitis; pneumonia;
gastroenteritis; and gonorrhea.

>Nalidixic acid (NegGram) and Cinoxacin

(Cinobac) urinary tract infection
> Norfloxacin (Noroxin) for urinary tract
infection
Ciprofloxacin (Cipro) approved use for
urinary tract infections; lower respiratory tract
infections; and skin, soft tissue, bone, and joint
infections.
>LevoFloxacin (levaquin), sparfloxacin
(Zagam), and Trovafloxacin (trovan) are
used primarily to treat respiratory problems,
such as community-acquired pneumonia,
chronic bronchitis, acute sinusitis, UTIs, and
uncomplicated skin infections.

-record vital signs and intake and

urine output. Fluid intake should
be at least 2000ml/d
-assess laboratory results to
determine renal function: BUN and
serum creatinine
-obtain a drug and diet history

-obtain specimen from the infected site and send to the

laboratory for culture and sensitivity before initiating
antibacterial drug therapy.
-monitor intake and output.
-record vital signs. Report abnormal findings.
-check laboratory results, especially blood urea nitrogen
and serum creatinine. Elevated values may indicate renal
dysfunction
-if gastrointestinal distress occurs, the drug may be taken
with food.
-check signs and symptoms of superinfection such as
stomatitis (mouth ulcers), furry black tongue, anal or
genital discharge,a nd itching
-monitor blood sugar. Levofloxacin can increase the
effects of oral hypoglycemics.

Client Teaching

-teach client to drink at least 6 to 8

glasses of fluid daily
-encourage client to avoid
caffeinated products.

Side Effects

-direct client to avoid operating hazardous

machinery or operating a motor vehicle while
taking the drug or until drug stability has occurred
because of possible drug related dizziness.
-inform client that photosensitivity is a side effect
of most fluoroquinolones. Client should use
sunglasses, sun block, and protective clothing
when in the sun.
-instruct client to report side effects, such as
dizziness, nausea, vomiting, diarrhea, flatulence,
abdominal cramps, tinnitus and rash. Older adults
are more likely to develop side effects.

Unclassified
Antibacterial Drugs

>Chloramphenicol (Chloromycetin) was discovered in

1947 and has a Bacteriostatic action by inhibiting
bacterial protein synthesis
- Effective against gramnegative and gram-positive bacteria and many other
organisms, such as rickettsiae, Mycoplasmas, and
H.influenzae
>Spectinomycin HCl (Trobicin) introduced in 1971, is
used against Neisseria gonorrheae, the microbe that
causes gonorrhea
>Quinupristin/dalfopristin (Synercid) it acts by
disrupting the protein synthesis of the organism. When
administering the drug through a peripheral IV line,
pain, edema, and phlebitis may occur.

Sulfonamides

-are one of the oldest antibacterial

agents
-they are bacteriostatic because they
inhibit bacterial synthesis of folic acid,
which is essential for bacterial growth.
Folic acid (folate) is required by cells for
biosynthesis of ribonucleic acid (RNA),
deoxyribonucleic acid (DNA), and
protein

*Short-Acting

>Sulfadiazine (microsulfon) for treatment

of systemic infections. When taking this
drug, increase the fluid intake
>Sulfamethizole (Sulfasol, Thiosulfil Forte)
for treatment of UTIs. It is highly soluble.
>Sulfisoxazole (Gantrisin) popular drug
for treating UTIs because it is more soluble
in urine. Rapidly absorbed from GI tract.
Used for treatment and prophylaxis for
otitis media.

*Intermediate-Acting

>Sulfamethoxazole (Gantanol) For UTIs, otitis media,

and meningococcal. A strain meningitis prophylaxis.
>Sulfasalazine (Azulfidine, Salazopyrin) for treatment of
ulcerative colitis, Crohns disease, rheumatoid arthritis.
Take after eating. Side effects include nausea, vomiting,
and bloody diarrhea.
>Trimethoprim an antibacterial agent that interferes
with bacterial folic acid synthesis similarly to sulfonamides
- UT antiinfective that may be used alone for
uncomplicated UTIs
- effective against the gram-negative bacteria
Proteus spp., Klebsiella spp.,and E.coli
>Co-trimoxazole to treat UTI, otitis media, bronchitis,
pneumonia, Pneumocystis carinii infection, rheumatic
fever, burns

-assess clients renal function by checking

urinary output, BUN (8-25 mg/dl), serum
creatinine (0.5- 1.5 mg/dl) -determine
whether the client is hypersensitive to
sulfonamides.
Obtain drug history of drugs client currently
takes.
-assess baseline laboratory results,
esp.CBC. blood dyscrasias may occur as a
result of high doses of sulfonamides over a
continuous period, causing life-threatening
conditions.

-administer sulfonamides with a full

glass of water
-record clients intake and output.
-monitor VS
-observe for hematologic reaction that
may lead to life-threatening anemias.
Early signs are sore throat, purpura, and
decreasing WBC and platelet counts.
-Check for signs and symptoms of
superinfection.

Client Teaching

-advise pregnant woman to avoid

sulfonamides during the last 3 months
of pregnancy
-inform the client not to take antacids
with sulfonamides because antacids
decrease the absorption rate.
-teach client to take the sulfonamide 1
hour before or 2 hours after meals with
a full glass of water.

Side Effects

-direct client to report bruising or

bleeding that could be a result of
drug-induced blood disorder.
-advise client to avoid direct
sunlight and to use sun block and
protective clothing to decrease the
risk of photosensitive reactions.