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Ppt chapter 40
- 1. Chapter 40
Antibiotics Affecting Protein
Synthesis
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 2. Physiology
• In all cells, the process of protein synthesis is divided
into two sections: transcription and translation.
• Initially, transcription occurs within the nucleus,
producing messenger ribonucleic acid (mRNA).
• This mRNA migrates from the nucleus to the cytoplasm.
During this step, mRNA goes through different types of
maturation, including one called splicing, during which
the noncoding sequences are eliminated.
• Translation occurs in the cytoplasm.
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- 4. Aminoglycosides
• The aminoglycosides have been in use since 1944.
• They are extremely effective antibiotics for treating
severe infections.
• However, their general use is limited because of the
potential for serious adverse effects.
• Prototype drug: gentamicin
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 5. Gentamicin: Core Drug Knowledge
• Pharmacotherapeutics
– Serious infections
• Pharmacokinetics
– Distribution: throughout the body except CS; higher
concentration in kidneys than serum
• Pharmacodynamics
– Entering the bacterial cell and binding to the 30S
ribosomal subunit
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 6. Gentamicin: Core Drug Knowledge (cont.)
• Contraindications and precautions
– Hypersensitivity, pregnancy and lactation
• Adverse effects
– Neurotoxicity, nephrotoxicity, ototoxicity, and
neuromuscular blockade
• Drug interactions
– Acyclovir, amphotericin B, cephalothin, cisplatin,
cyclosporine, loop diuretics, prostaglandin synthetase
inhibitors, and vancomycin
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 7. Gentamicin: Core Patient Variables
• Health status
– Past medical and any kidney problems
• Life span and gender
– Ototoxic to the fetus, assess pregnancy status.
• Lifestyle, diet, and habits
– Assess the nutritional status of the patient.
• Environment
– Assess the environment where the drug will be
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
given.
- 8. Gentamicin: Nursing Diagnoses and
Outcomes
• Risk for Injury related to potential drug-related allergic
reactions or neuromuscular blockade or suppression of
bone marrow function
– Desired outcome: The patient will remain free of
injury and will contact the prescriber if unusual
adverse effects occur.
• Diarrhea related to drug effects
– Desired outcome: The patient will avoid
dehydration, maintain fluid intake, and contact the
prescriber if diarrhea persists.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 9. Gentamicin: Nursing Diagnoses and
Outcomes (cont.)
• Imbalanced Nutrition: Less than Body Requirements,
related to drug-induced GI effects or superinfection
– Desired outcome: The patient will maintain body
weight and report any persistent adverse effect.
• Risk for Injury related to CNS effects
– Desired outcome: The patient will remain free of
injury and contact the provider if confusion,
disorientation, or depression occurs.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 10. Gentamicin: Nursing Diagnoses and
Outcomes (cont.)
• Disturbed Sensory Perception related to potential
ototoxicity
– Desired outcome: The patient will report sensory or
perceptual changes to the prescriber.
• Excess Fluid Volume related to potential nephrotoxicity
– Desired outcome: The patient will report any
weight gain exceeding 3 lb to the health care
prescriber.
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- 11. Gentamicin: Planning and Interventions
• Maximizing therapeutic effects
– Make sure that patients receive the full course as
prescribed at around-the-clock intervals.
– Do not give at the same time as extended penicillin.
• Minimizing adverse effects
– Maintain blood levels of gentamicin within a
therapeutic margin that is very narrow.
– Monitor for signs of ototoxicity and nephrotoxicity.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 12. Gentamicin: Teaching, Assessment, and
Evaluations
• Patient and family education
– Patients should not take the drug if pregnant or
breast-feeding.
– Teach patients how to identify, report, and manage
signs and symptoms of allergic reaction and adverse
effects.
• Ongoing assessment and evaluation
– Coordinate the care of the patient to ensure that
other potentially nephrotoxic or ototoxic drugs are
not added to the treatment plan.
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- 13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Gentamicin is effective against which of the following
organism(s)?
– A. Pseudomonas aeruginosa
– B. Proteus mirabilis
– C. Klebsiella
– D. Enterobacter
– E. All of the above
- 14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• E. All of the above
• Rationale: Gentamicin is effective in managing
infections caused by gram-negative bacilli.
• Susceptible organisms include Pseudomonas
aeruginosa, Proteus mirabilis, Escherichia coli;
Klebsiella, Enterobacter, Serratia, and Citrobacter
species; and staphylococci.
- 15. Lincosamides
• They are very toxic drugs.
• Their use must be monitored and limited to situations
with infections by bacteria with known sensitivity.
• Prototype drug: clindamycin (Cleocin)
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- 16. Clindamycin: Core Drug Knowledge
• Pharmacotherapeutics
– Aerobic gram-positive cocci and several anaerobic
gram-negative and gram-positive organisms
• Pharmacokinetics
– Varies with route of administration. Metabolized:
liver. Excreted: bile and urine.
• Pharmacodynamics
– Enters the bacterial cell and binds to bacterial
ribosomes, suppressing protein synthesis
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 17. Clindamycin: Core Drug Knowledge
(cont.)
• Contraindications and precautions
– Hypersensitivity, pregnancy, and lactation
• Adverse effects
– Pseudomembranous colitis, maculopapular rash,
erythema, and pruritus
• Drug interactions
– Neuromuscular blockers, aluminum salts,
cyclosporine, benzoyl peroxide, tretinoin, and
salicylic acid
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 18. Clindamycin: Core Patient Variables
• Health status
– Assess for allergy to medication.
• Life span and gender
– Assess the growth and developmental level of the
child or infant.
• Lifestyle, diet, and habits
– Assess lifestyle to ensure that the drug will be given
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
properly.
• Environment
– Assess the environment where the drug will be given.
- 19. Clindamycin: Nursing Diagnoses and
Outcomes
• Risk for Injury related to allergic reactions
– Desired outcome: The patient will stop drug
therapy and immediately report symptoms of allergic
reaction to the prescriber.
• Diarrhea related to drug effects
– Desired outcome: The patient will avoid
dehydration and report persistent diarrhea to the
provider.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 20. Clindamycin: Nursing Diagnoses and
Outcomes (cont.)
• Imbalanced nutrition: Less than Body Requirements,
related to drug-related GI effects, alteration in taste,
superinfections
– Desired outcome: The patient will maintain body
weight and report persistent symptoms affecting
nutritional status.
• Risk for Injury related to possible blood dyscrasias
– Desired outcome: The patient will remain injury-free
throughout drug therapy.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 21. Clindamycin: Planning and Interventions
• Maximizing therapeutic effects
– Make sure that the patient receives the full course of
clindamycin as prescribed.
– Coordinate the administration of drugs to decrease
potential undesired interactions.
• Minimizing adverse effects
– Clindamycin should be administered on an empty
stomach with a full glass of water.
– Report diarrhea to the provider immediately.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 22. Clindamycin: Teaching, Assessment, and
Evaluations
• Patient and family education
– Advise patients to contact the prescriber immediately
if they experience diarrhea.
– Teach patients to recognize and report symptoms of
allergic reaction and superinfection.
• Ongoing assessment and evaluation
– Monitor the patient for the onset of diarrhea.
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- 23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• What is the most serious adverse reaction of clindamycin
administration?
– A. Respiratory arrest
– B. Pseudomembranous colitis
– C. Ventricular tachycardia
– D. Ototoxicity
- 24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• B. Pseudomembranous colitis
• Rationale: Pseudomembranous colitis is the most
serious side effect of clindamycin and carries a Black
Box warning because of this side effect.
- 25. Macrolide Antibiotics
• The macrolide antibiotics have been in use since 1952.
• They are characterized by molecules made up of large-ring
lactones.
• Macrolides are bacteriostatic or bactericidal in susceptible
bacteria.
• Prototype drug: erythromycin
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 26. Erythromycin: Core Drug Knowledge
• Pharmacotherapeutics
– Treating Legionnaire disease, Mycoplasma
pneumoniae pneumonia, diphtheria, chlamydial
infections, and chancroid
• Pharmacokinetics
– The drug is easily inactivated by gastric acid. Peak 1
to 4 hours. Metabolized: liver. Excreted: urine and
bile.
• Pharmacodynamics
– Inhibiting RNA-dependent protein synthesis at the
chain elongation step
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 27. Erythromycin: Core Drug Knowledge
(cont.)
• Contraindications and precautions
– Allergy to medication
• Adverse effects
– GI symptoms, urticaria, maculopapular rash,
erythema, and interstitial nephritis
• Drug interactions
– Astemizole and terfenadine
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 28. Erythromycin: Core Patient Variables
• Health status
– Assess medical history and allergies.
• Life span and gender
– Assess pregnancy and lactation status.
• Lifestyle, diet, and habits
– Instruct how to take the medication to avoid toxicity.
• Environment
– Assess the environment where the drug will be given.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 29. Erythromycin: Nursing Diagnoses and
Outcomes
• Risk for Injury related to possible allergic reactions
– Desired outcome: The patient will stop drug therapy and
report any signs of allergic reaction immediately to the
prescriber.
• Diarrhea related to drug-induced GI upset
– Desired outcome: The patient will avoid dehydration,
maintain fluid intake, and contact the prescriber if
diarrhea persists.
• Risk for Infection related to potential for superinfection
following drug therapy
– Desired outcome: The patient will contact the provider if
any signs of superinfection occur, for example, sore throat
or fever.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 30. Erythromycin: Planning and Interventions
• Maximizing therapeutic effects
– Reconstitute erythromycin with sterile water only.
– Prepared infusion solutions that are stored at room
temperature must be used within 8 hours.
• Minimizing adverse effects
– Because erythromycin can be very irritating to veins,
it is important to administer IV infusions over 30 to
60 minutes.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 31. Erythromycin: Teaching, Assessment, and
Evaluations
• Patient and family education
– Encourage patients to take the complete course of
antibiotics.
– Advise patients to take erythromycin on an empty
stomach, unless GI distress is unbearable.
• Ongoing assessment and evaluation
– Monitor for signs of allergic reactions, resolution of
presenting signs and symptoms of infection, and
signs of superinfection.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 32. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Grapefruit juice will decrease the serum concentration of
erythromycin.
– A. True
– B. False
- 33. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• B. False
• Rationale: Instruct the patient to avoid grapefruit or
grapefruit juice because it increases the serum
concentration of erythromycin and may cause adverse
effects or toxicity.
- 34. Oxazolidinones
• Oxazolidinones are the first new class of antibiotics
developed specifically for treating methicillin-resistant
Staphylococcus aureus (MRSA) infections.
• Prototype drug: linezolid (Zyvox)
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- 35. Linezolid: Core Drug Knowledge
• Pharmacotherapeutics
– Treatment of VRE and MRSA
• Pharmacokinetics
– Administered: oral or IV. Metabolism: liver. Excreted:
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
kidneys.
• Pharmacodynamics
– Blocking the early stages of the process bacteria use
to make proteins
- 36. Linezolid: Core Drug Knowledge (cont.)
• Contraindications and precautions
– Hypersensitivity
• Adverse effects
– Diarrhea, headache, nausea, and vomiting
• Drug interactions
– Adrenergic and serotonergic agents
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 37. Linezolid: Core Patient Variables
• Health status
– Assess medical history.
• Life span and gender
– Pregnancy Category C drug
• Lifestyle, diet, and habits
– Evaluate diet and alcohol use.
• Environment
– Assess the environment where the drug will be given.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 38. Linezolid: Nursing Diagnoses and
Outcomes
• Deficient Fluid Volume related to nausea, vomiting, and
diarrhea from linezolid therapy
– Desired outcome: The patient will remain well
hydrated throughout therapy.
• Risk for Injury related to thrombocytopenia and
pseudomembranous colitis
– Desired outcome: The patient will remain free
from injury and contact the health care provider
immediately if any signs of bleeding or abdominal
pain occur.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 39. Linezolid: Nursing Diagnoses and
Outcomes (cont.)
• Risk for Injury related to hypertensive crisis
– Desired outcome: The patient will remain
normotensive by adhering to antihypertensive
therapy and limiting foods or beverages with
tyramine, caffeine, or alcohol.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 40. Linezolid: Planning and Interventions
• Maximizing therapeutic effects
– Administer at evenly spaced intervals.
• Minimizing adverse effects
– To avoid hypertensive crisis, monitor the patient’s
intake of food or beverages containing tyramine,
caffeine, or alcohol.
– Serial blood pressure readings should be obtained
throughout therapy.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 41. Linezolid: Teaching, Assessment, and
Evaluations
• Patient and family education
– Explain dietary restrictions, focusing on food or
beverages containing tyramine, caffeine, or alcohol.
– Teach patients the signs and symptoms of
thrombocytopenia and pseudomembranous colitis.
• Ongoing assessment and evaluation
– Monitor for efficacy of treatment and resolution of
the presenting infection.
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- 42. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Linezolid is classified as a Pregnancy Category ___ drug.
– A. A
– B. B
– C. C
– D. D
– E. X
- 43. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• C. C
• Rationale: Linezolid is classified as a pregnancy category
C drug.
- 44. Streptogramins
• Streptogramins are the newest class of antibiotics.
• Designed to eradicate “superbugs” resistant to other
antibiotics.
• Prototype drug: quinupristin/dalfopristin (Synercid)
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 45. Quinupristin/Dalfopristin: Core Drug
Knowledge
• Pharmacotherapeutics
– Serious or life-threatening infections associated with
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VRE
• Pharmacokinetics
– Administered: IV. T½: 1 hour.
• Pharmacodynamics
– Inhibits bacterial protein synthesis by irreversibly
blocking ribosome functioning
- 46. Quinupristin/Dalfopristin: Core Drug
Knowledge (cont.)
• Contraindications and precautions
– Hypersensitivity
• Adverse effects
– Pseudomembranous colitis, superinfection, and
hepatotoxicity
• Drug interactions
– Drugs that are metabolized by CYP3A4, a cytochrome
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
of P-450
- 47. Quinupristin/Dalfopristin: Core Patient
Variables
• Health status
– Assess health history and contraindications to
medication use.
• Life span and gender
– Pregnancy Category B drug
• Environment
– Assess the environment where the drug will be given.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 48. Quinupristin/Dalfopristin: Nursing
Diagnoses and Outcomes
• Pain related to IV administration
– Desired outcome: The patient will inform you
immediately should pain at the injection site occur.
• Diarrhea related to potential pseudomembranous colitis
– Desired outcome: The patient will remain well
hydrated throughout therapy and report any diarrhea
immediately.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 49. Quinupristin/Dalfopristin: Nursing
Diagnoses and Outcomes (cont.)
• Risk for Injury related to potential superinfection or
hepatotoxicity
– Desired outcome: The patient will remain free of
injury throughout therapy.
• Risk for Impaired Skin Integrity related to rash or
pruritus.
– Desired outcome: The patient will report itching or
rash immediately to minimize potential for infection.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 50. Quinupristin/Dalfopristin: Planning and
Interventions
• Maximizing therapeutic effects
– The medication should not be administered with any
other medications through a Y-site infusion.
– Flush the line before and after administration with
5% dextrose and water.
• Minimizing adverse effects
– Administer these drugs in a peripherally inserted
central catheter (PICC) or a central line whenever
possible.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 51. Quinupristin/Dalfopristin: Teaching,
Assessment, and Evaluations
• Patient and family education
– Teach patients the potential adverse effects.
– Advise patients to report any diarrhea immediately.
• Ongoing assessment and evaluation
– During infusion, monitor the IV site for signs of
infiltration, edema, or phlebitis.
– Question the patient regarding pain at the injection
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
site.
- 52. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Quinupristin/dalfopristin is best administrated via
– A. Oral route
– B. PICC line
– C. Peripheral IV
– D. Z-track IM
- 53. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• B. PICC line
• Rationale: Because injection site problems are very
common with the administration of
quinupristin/dalfopristin, administer these drugs in a
peripherally inserted central catheter (PICC) line
whenever possible.
- 54. Tetracyclines
• The tetracyclines were developed as semisynthetic
antibiotics based on the structure of a common soil mold.
• They are broad-spectrum antibiotics that affect both
gram-positive and gram-negative bacteria.
• Over the years, major resistance has developed to
tetracyclines.
• Prototype drug: tetracycline
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 55. Tetracycline: Core Drug Knowledge
• Pharmacotherapeutics
– Rickettsia species, Mycoplasma pneumoniae, and
Chlamydia trachomatis
• Pharmacokinetics
– Administered: oral. Excreted: kidneys.
• Pharmacodynamics
– Inhibits or retards the growth of bacteria but does
not kill them
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 56. Tetracycline: Core Drug Knowledge
(cont.)
• Contraindications and precautions
– Allergy, pregnancy, or lactation
• Adverse effects
– GI upset, photosensitivity, and rash
• Drug interactions
– Penicillin G, aluminum, bismuth, calcium, iron,
magnesium, and zinc salts
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 57. Tetracycline: Core Patient Variables
• Health status
– Assess medical status.
• Life span and gender
– Pregnancy Category D drug
• Lifestyle, diet, and habits
– Assess dietary intake.
• Environment
– Assess for exposure to sun.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 58. Tetracycline: Nursing Diagnoses and
Outcomes
• Risk for Injury related to potential superinfection or
allergic drug reaction
– Desired outcome: The patient will experience no
new infection and no preventable allergic reaction
related to tetracycline.
• Diarrhea related to drug-induced GI effects
– Desired outcome: The patient will report any
incidence of diarrhea and follow the prescriber’s
recommendation.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 59. Tetracycline: Nursing Diagnoses and
Outcomes (cont.)
• Imbalanced nutrition: Less than Body Requirements,
related to adverse GI effects of nausea, vomiting,
diarrhea, and altered taste
– Desired outcome: The patient will maintain dietary
intake to provide adequate nutrition.
• Risk for Impaired Skin Integrity related to drug-induced
photosensitivity
– Desired outcome: The patient will dress
appropriately and take adequate precautionary
measures while outdoors to avoid unnecessary
sunburn.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 60. Tetracycline: Planning and Interventions
• Maximizing therapeutic effects
– To maximize absorption, oral preparations should be
administered on an empty stomach either 1 hour
before or 2 hours after any meals or other drugs.
• Minimizing adverse effects
– Monitor the patient to ensure that adequate fluids are
given to replace fluid lost with diarrhea.
– Wear protective clothing and sunscreen when
outdoors.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 61. Tetracycline: Teaching, Assessment, and
Evaluations
• Patient and family education
– Advise women of childbearing age that tetracycline
should not be taken during pregnancy or breast-feeding.
– Advise patients to take tetracycline on an empty
stomach.
• Ongoing assessment and evaluation
– Monitor renal status to detect and prevent
hepatotoxicity and to observe for any signs of
superinfection.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 62. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Tetracycline should not be administered with antacids.
– A. True
– B. False
- 63. Answer
• A. True
• Rationale: Tetracycline forms an insoluble chelate with
aluminum, bismuth, calcium, iron, magnesium, and zinc
salts, which are frequently an ingredient in antacids.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 64. Miscellaneous Antibiotics that Affect
Protein Synthesis
• Miscellaneous antibiotics include chloramphenicol and
spectinomycin.
• Used to treat large outbreaks of typhus
• Prototype: chloramphenicol
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- 65. Chloramphenicol: Core Drug Knowledge
• Pharmacotherapeutics
– True broad-spectrum antibiotic
• Pharmacokinetics
– Administered: oral and IV. Peak 1 to 3 hours.
• Pharmacodynamics
– Inhibiting the protein synthesis of bacterial cells
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 66. Chloramphenicol: Core Drug Knowledge
(cont.)
• Contraindications and precautions
– Toxic reaction to the medication
• Adverse effects
– Aplastic anemia, hypoplastic anemia,
thrombocytopenia, pancytopenia, and
granulocytopenia
• Drug interactions
– Many different types of drugs
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 67. Chloramphenicol: Core Patient Variables
• Health status
– Assess medical history.
• Life span and gender
– Assess pregnancy status.
• Environment
– Assess the environment where the drug will be given.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 68. Chloramphenicol: Nursing Diagnoses and
Outcomes
• Risk for Injury related to drug-induced adverse effects,
such as blood dyscrasias, gray baby syndrome, and CNS
effects, including optic or peripheral neuritis, headache,
depression, confusion, or delirium
– Desired outcome: Regular and careful monitoring
will protect the patient from permanent drug-related
adverse effects.
• Risk for Impaired Skin Integrity, rash and pruritus,
related to topical drug use
– Desired outcome: The nurse and patient will
observe for and report signs of unusual skin reaction
and contact the prescriber.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 69. Chloramphenicol: Planning and
Interventions
• Maximizing therapeutic effects
– Oral chloramphenicol should be administered on an
empty stomach 1 hour before or 2 hours after meals.
• Minimizing adverse effects
– Monitor plasma concentrations at least weekly or
more often in patients with hepatic or renal
impairment.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 70. Chloramphenicol: Teaching, Assessment,
and Evaluations
• Patient and family education
– Explain the importance of completing therapy.
– Teach patients the importance of measuring fluid
intake and output accurately.
• Ongoing assessment and evaluation
– For patients receiving systemic therapy, coordinate
serial monitoring of chloramphenicol plasma
concentrations.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
- 71. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• A serious and potentially life-threatening adverse effect
of chloramphenicol is “gray baby” syndrome.
– A. True
– B. False
- 72. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• A. True
• Rationale: “Gray baby” syndrome is most common in
premature infants or newborns receiving
chloramphenicol, whose hepatic systems have
difficulty conjugating or excreting chloramphenicol.