Pharm, part 48: Immune Medications - Antibiotics - Others

Hi, I am Cathy, with Level Up RN. In this video, I'm going to continue my coverage of antibiotics. In our last two videos, we talked about antibiotics that affect protein synthesis and cell wall synthesis. In this video, we are going to talk about antibiotics that affect the bacterial cell in other ways. At the end of the video, I'm going to provide you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video. So definitely stay tuned for that. And if you have our pharmacology flashcard, definitely pull those out so you can follow along because we won't go through every single detail that's on these cards, but I'll try to hit the highlights.

First up, we have our fluoroquinolones, which include ciprofloxacin and levofloxacin.

These antibiotics are used to treat a number of bacterial infections, including UTIs, bone and joint infections, respiratory infections, as well as anthrax.

They work by inhibiting DNA synthesis in the bacteria.

Side effects include diarrhea, superinfection such as C. diff, photosensitivity, and increase in liver enzymes, and this medication also carries a black box warning due to the risk for tendon rupture, which is definitely unique to this medication class.

Our little cool chicken hint for helping you to remember this drug class and one of the key side effects of this drug class is if you look at the words ciprofloxacin and levofloxacin, they both have that flox, which reminds me of fox. So if you remember that that fox likes to eat tendons, then I'll help you remember that these medications can result in tendon rupture.

Next up, we have trimethoprim sulfamethoxazole, which is an antibiotic that is used to treat a number of bacterial infections such as UTIs, respiratory infections, and middle ear infections.

The mode of action of this medication class is that it inhibits folic acid synthesis in the bacteria.

Side effects include GI upset, blood dyscrasias, which can cause anemia, thrombocytopenia, and leukopenia. Other side effects include photosensitivity, crystalluria, as well as Stevens-Johnson syndrome, which is a very severe rash.

In terms of nursing care, we're going to want to assess the patient for sulfa allergies prior to administration of this medication, and if you look at the drug name, it includes sulfa in there, so that will help you remember that you need to do that. Other nursing care items include monitoring the patient's CBC levels because of the risk of blood dyscrasias.

We also want to encourage the patient to increase their fluid intake in order to prevent that crystalluria side effect.

Next up, we have nitrofurantoin, which is an antibiotic that is used to treat UTIs.

It works by inhibiting bacterial enzymes that are needed for DNA, RNA, and cell wall synthesis.

Side effects include GI upset, pulmonary toxicity, peripheral neuropathy, and brown discoloration of the urine. So you definitely want to give your patient a heads up about that discoloration so they're not alarmed and also advised them to take this medication with food.

All right. Next, we have metronidazole, which is another common antibiotic that we administer in the hospital setting. Metronidazole can be used for bacterial infections, as well as protozoan infections.

So it inhibits DNA and protein synthesis, and it is also effective against anaerobic bacteria.

Side effects include GI upset, metallic taste, dark urine, dizziness, and headache.

In terms of patient teaching, you want to advise your patient to not drink alcohol when they are taking metronidazole.

Our little cool chicken hint here on the card to help you remember at least one of the side effects of metronidazole, if you look at the word metronidazole, it starts with M-E-T, and metallic taste also starts with M-E-T. So hopefully that's helpful.

All right, time for quiz. I have three questions for you. First question, patients taking trimethoprim sulfamethoxazole should be advised to increase their fluid intake due to the risk of blank. The answer is crystalluria. Question number two, what antibiotic carries a black box warning due to the risk of tendon rupture? The answer is ciprofloxacin or levofloxacin. Question number three, metallic taste is an expected side effect with metronidazole. True or false? The answer is true.

Okay. I hope this video has been helpful. Can I get a thumbs up for saying all these drug names? [laughter] It took a few takes to get them right. So take care and good luck with studying.