75483683 chemotherapeutic agents[1]

8/10/2019 75483683 Chemotherapeutic Agents[1]

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CHEMOTHERAPEUTIC AGENTSANTIBIOTICS

1. AMINOGLYCOSIDES Kill bacteria primarily by inhibitin pr!tein "ynthe"i"

USES: U"e# primarily aain"t ram $%& micr!!rani"m" that ca'"e UTI( meniniti"( )!'n# in*ecti!n"( +

li*e threatenin "epticaemia", They are the main"tay" in the treatment !* n!"!c!mial ram $%& in*ecti!n" U"e# al"! be*!re "'rery t! re#'ce the n!rmal *l!ra c!ntent !* the inte"tinal tract,

Therapeutic outcome: Primary therape'tic !'tc!me e-pecte# i" the eliminati!n !* bacterial in*ecti!n,

Nursin responsi!i"ities A""e"" *!r any allerie" an# "ympt!m" !* hearin l!"" !r renal #i"ea"e I* pt ha" ha# ane"the"ia )ithin the pa"t ./%01 h!'r"( chec2 t! "ee i* "2eletal m'"cle rela-ant )a"

a#mini"tere#, I* '"e#( )ithh!l# the me#icati!n 3! n!t mi- !ther #r'" in the "ame "yrine !r in*'"e t!ether )ith !ther #r'",

SIDE E##ECTS TO $E%O$T

Ot!t!-icity 4 #'e t! /thcranial ner5e #amae Nephr!t!-icity 4 m!nit!r 'rinaly"i" an# 2i#ney *'ncti!n te"t" *!r abn!rmal re"'lt"6 rep!rt an

increa"in BUN an# creatinine le5el( #ecrea"in 'rine !'tp't !r #ecrea"in "peci*ic ra5ityD$UG INTE$ACTIONS

Nephr!t!-ic p!tential Ot!t-ic p!tential Ne'r!m'"c'lar bl!c2a#e Heparin an# entamicin are phy"ically inc!mpatible, 3O NOT mi- t!ether be*!re in*'"i!n, Ampicillin( Piperacillin( Ticarcillin rapi#ly inacti5ate amin!lyc!"i#e", 3O NOT mi- t!ether !r

a#mini"ter t!ether at the "ame I7 "ite,

&. CE%'ALOS%O$INS

Are chemically relate# t! the penicillin" an# ha5e a "imilar mechani"m !* acti5ity,

Act by inhibitin cell )all "ynthe"i" in bacteria,

May be #i5i#e# int! r!'p"( !r enerati!n"( ba"e# primarily !n antimicr!bial acti5ity,#I$ST GENE$ATION Ha5e e**ecti5e acti5ity aain"t ram $8& micr!!rani"m" + relati5ely mil# acti5ity aain"t ram $%&

micr!!rani"m",SECOND GENE$ATION

Ha5e "!me)hat increa"e# acti5ity aain"t ram $%& bacteria b't are m'ch le"" acti5e than the 9r#

enerati!n aent",T'I$D GENE$ATION Acti5e aain"t P, aer'in!"a( a p!tent ram $%& micr!!rani"m,#OU$T' GENE$ATION Are br!a# "pectr'm( )ith b!th ram $%& an# ram $8& c!5erae,USES U"e# a" alternati5e t! pt" )ith allery t! penicillin( 'nle"" they are al"! alleric t! cephal!"p!rin"

U"e# *!r certain 'rinary + re"pirat!ry tract in*ecti!n"( ab#!minal in*ecti!n"( bacterimia( meniniti"an# !"te!myeliti"

Therapeutic outcome Eliminati!n !* bacterial in*ecti!nNursin responsi!i"ities A""e"" *!r any allerie"( "ympt!m" !* renal #i"ea"e !r blee#in #i"!r#er" Obtain ba"eline lab!rat!ry "t'#ie"SIDE E##ECTS TO $E%O$T 3iarrhea


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Sec!n#ary in*ecti!n" Abn!rmal li5er an# renal *'ncti!n te"t" Hyp!pr!thr!mbinemia 4 )ith !r )ith!'t blee#in Thr!mb!phlebiti" Electr!lyte imbalanceD$UG INTE$ACTIONS Nephr!t!-ic p!tential Anatci#" H1 anta!ni"t" Ir!n "'pplement" Pr!beneci# Alc!h!l Other c!ntracepti5e"

(. #LUO$O)UINOLONES

Act by inhibitin the acti5ity !* 3NA yra"e( an en:yme that i" e""ential *!r the replicati!n !*bacterial 3NA,

USES Cipr!*l!-acin i" the *ir"t )ell t!lerate#( br!a#% "pectr'm !ral antibi!tic in the ;'in!l!ne "erie", It

#em!n"trate" rapi# bacterial acti5ity aain"t the path!en" that ca'"e n!"!c!mial an#c!mm'nity ac;'ire# UTI

Gemi*l!-acin i" "imilar in "pectr'm !* acti5ity an# '"e t! le5!*l!-acin an# m!-i*l!-acin, It al"! ha"an a#5antae !* !nce%#aily !ral #!"in

Therapeutic outcome: Eliminati!n !* bacterial in*ecti!n,

Nursin responsi!i"ities A""e"" *!r an# rec!r# any a"tric "ympt!m" be*!re initiati!n !* the therapy A""e"" *!r any allerie"

ENSURE THAT THE PT IS NOT PREGNANT =arn pt" !* p!""ible ph!t!t!-icity t! l!me*l!-acin Pe#iatric therapy i" n!t rec!mmen#e# beca'"e !* the p!tential *!r permanent cartilae #amae,

SIDE E##ECTS TO E*%ECT Na'"ea( 5!mitin( #iarrhea( #i"c!m*!rt 3i::ine""( liht hea#e#ne"" Ph!t!t!-icity Ra"h Abn!rmal lab re"'lt" Ne'r!l!ic e**ect"

D$UG INTE$ACTIONS Ir!n( antaci#"( "'cral*ate Pr!beneci# NSAI3" 3i#an!"ine The!phylline T!-icity in#'ce# by "par*l!-acin T!-icity in#'ce# by m!-i*l!-acin

+. MAC$OLIDES


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The macr!li#e" are e**ecti5e aain"t a )i#e 5ariety !* path!enic !rani"m"( partic'larlyin*ecti!n" !* the re"pirat!ry an# enital tract,

ACTIONS The macr!li#e" are bacteri!"tatic !r bacterici#al in "'"ceptible bacteria, The #r'" act by bin#in t! cell membrane" an# ca'"in chane" in pr!tein *'ncti!n,

USES The"e antibi!tic" are e**ecti5e in the treatment !* in*ecti!n" ca'"e# by a )i#e rane !* ram%neati5e an# ramp!"iti5e micr!!rani"m",

In a##iti!n( the #r'" are '"e# t! treat acne 5'lari" an# "2in in*ecti!n"(

in c!n>'ncti!n )ith "'l*!nami#e" t! treat 'pper re"pirat!ry in*ecti!n" ca'"e# by Hemophilusinfluenzae,

and as prophylaxis be*!re #ental !r !ther pr!ce#'re" in patient" alleric t! penicillin,AD,E$SE $EACTIONS Relate# t! the a"tr!inte"tinal tract an# incl'#e na'"ea( 5!mitin( #iarrhea( an# ab#!minal pain,

Ab#!minal crampin( na'"ea( 5!mitin( #iarrhea, Alleric reacti!n" ha5e been rep!rte# )ith the a#mini"trati!n !* erythr!mycin, A" )ith alm!"t all antibacterial #r'"( p"e'#!membran!'" c!liti" may !cc'r ranin in "e5erity

*r!m mil# t! li*e threatenin,CONT$AINDICATIONS The"e #r'" are c!ntrain#icate# in patient" )ith a hyper"en"iti5ity t! the macr!li#e" an# patient"

)ith pre%e-i"tin li5er #i"ea"e,NU$SING $ES%ONSI-ILITIES It i" imp!rtant t! '"e the"e #r'" ca'ti!'"ly #'rin prenancy an# lactati!n, Beca'"e a:ithr!mycin( erythr!mycin( an# tr!lean#!mycin are primarily eliminate# *r!m the b!#y

by the li5er( the"e #r'" "h!'l# be '"e# )ith reat ca'ti!n in patient" )ith li5er #y"*'ncti!n, There i" a #ecrea"e# a"tr!inte"tinal ab"!rpti!n !* the macr!li#e" )hen a#mini"tere# )ith 2a!lin(

al'min'm "alt"( !r maal#rate,

INTE$ACTIONS U"e !* the macr!li#e" increa"e" "er'm le5el" !* #i!-in

an# increa"e" the e**ect" !* antic!a'lant", U"e !* antaci#" #ecrea"e" the ab"!rpti!n !* m!"t macr!li#e",

The macr!li#e" "h!'l# n!t be a#mini"tere# )ith clin#amycin( linc!mycin( !r chl!ramphenic!l6 a#ecrea"e in the therape'tic acti5ity !* the macr!li#e" can !cc'r,

C!nc'rrent a#mini"trati!n !* the macr!li#e" )ith the!phylline may increa"e "er'm the!phyllinele5el",

. LINCOSAMIDES

Are e**ecti5e aain"t many ram%p!"iti5e !rani"m"( "'ch a" "trept!c!cci an# "taphyl!c!cci,

Beca'"e !* their hih p!tential *!r t!-icity( the linc!"ami#e" are '"'ally '"e# !nly *!r thetreatment !* "eri!'" in*ecti!n" in )hich penicillin !r erythr!mycin $a macr!li#e& i" n!t e**ecti5e,

ACTIONS The linc!"ami#e" act by inhibitin pr!tein "ynthe"i" in "'"ceptible bacteria( ca'"in #eath,

USES The"e antibi!tic" are e**ecti5e in the treatment !* in*ecti!n" ca'"e# by a )i#e rane !* ram%

neati5e an# ramp!"iti5e micr!!rani"m", The linc!"ami#e" are '"e# *!r the m!re "eri!'" in*ecti!n", In "eri!'" in*ecti!n" they may be '"e# in c!n>'ncti!n )ith !ther antibi!tic",

AD,E$SE $EACTIONS Ab#!minal pain( e"!phaiti"( na'"ea( 5!mitin( #iarrhea( "2in ra"h( an# bl!!# #y"cra"ia",


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The"e #r'" al"! can ca'"e p"e'#!membran!'" c!liti"( )hich may rane *r!m mil# t! 5ery"e5ere,

3i"c!ntin'in the #r' may relie5e mil# "ympt!m" !* p"e'#!membran!'" c!liti",

CONT$AINDICATIONS The linc!"ami#e" are c!ntrain#icate# in patient" )ith hyper"en"iti5ity t! the linc!"ami#e"( th!"e

)ith min!r bacterial !r 5iral in*ecti!n"( an# #'rin lactati!n an# in*ancy,

NU$SING $ES%ONSI-ILITIES It i" imp!rtant t! '"e the"e #r'" )ith ca'ti!n in patient" )ith a hi"t!ry !* a"tr!inte"tinal

#i"!r#er"( renal #i"ea"e( !r li5er impairment,

The ne'r!m'"c'lar bl!c2in acti!n !* the linc!"ami#e" p!"e" a #aner t! patient" )ithm/asthenia ra0is an autoimmune 2isease mani3este2 !/ e-treme )ea2ne"" an#e-ha'"ti!n !* the m'"cle"&,

INTE$ACTIONS =hen 2a!lin !r al'min'm i" a#mini"tere# )ith the linc!"ami#e"( the ab"!rpti!n !* the

linc!"ami#e i" #ecrea"e#, =hen the linc!"ami#e" are a#mini"tere# )ith the ne'r!m'"c'lar bl!c2in #r'" $#r'" that are

'"e# a" a#>'nct" t! ane"thetic #r'" that ca'"e paraly"i" !* the re"pirat!ry "y"tem& the acti!n !*the ne'r!m'"c'lar bl!c2in #r' i" enhance#( p!""ibly lea#in t! "e5ere an# pr!*!'n#re"pirat!ry #epre""i!n,

NU$SING %$OCESS #O$ %TS. $ecei0in a Tetrac/c"ine4 Macro"i2e4 or Lincosami2ePreadministration Assessment It i" imp!rtant t! e"tabli"h an acc'rate #ataba"e be*!re the a#mini"trati!n !* any antibi!tic, The n'r"e "h!'l# i#enti*y an# rec!r# "in" an# "ympt!m" !* the in*ecti!n, E-ample" !* "!me !* the "in" an# "ympt!m" !* an in*ecti!n in 5ari!'" area" !* the b!#y are

pain( #rainae( re#ne""( chane" in the appearance !* "p't'm( eneral malai"e( chill" an# *e5er(c!'h( an# ")ellin,

The n'r"e !btain" a th!r!'h allery hi"t!ry( e"pecially a hi"t!ry !* #r' allerie", I* the patient ha" a hi"t!ry !* allerie" an# ha" n!t t!l# the primary health care pr!5i#er( the n'r"e

"h!'l# n!t a#mini"ter the *ir"t #!"e !* the #r' 'ntil thi" pr!blem i" #i"c'""e# )ith the primaryhealth care pr!5i#er,

Other lab!rat!ry te"t" "'ch a" renal an# hepatic *'ncti!n te"t"( c!mplete bl!!# c!'nt( an#'rinaly"i" may al"! be !r#ere#,

5. %ENICILLINS The antibacterial pr!pertie" !* nat'ral penicillin" )ere #i"c!5ere# in ?@1/ by Sir Arth'r lemin

)hile he )a" per*!rmin re"earch !n in*l'en:a, Ten year" later( Briti"h "cienti"t" "t'#ie# the e**ect" !* nat'ral penicillin" !n #i"ea"e%ca'"in

micr!!rani"m", H!)e5er( it )a" n!t 'ntil ?@.? that nat'ral penicillin" )ere '"e# clinically *!r the treatment !*

in*ecti!n", Alth!'h '"e# *!r m!re than year"( the penicillin" are "till an imp!rtant an# e**ecti5e r!'p !*

antibi!tic" *!r the treatment !* "'"ceptible path!en" $#i"ea"e%ca'"in micr!!rani"m"&,

There are 3our roups o3 penici""ins: nat'ral penicillin"( penicillina"e%re"i"tant penicillin"( amin!penicillin"( e-ten#e#%"pectr'm penicillin",

E6amp"es o3 penici""ins Nat'ral penicillin"Dpenicillin G an# penicillin 7 Penicillina"e%re"i"tant penicillinDcl!-acillin( #icl!-acillin( na*cillin Amin!penicillin"Dampicillin( am!-icillin( bacampicillin


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E-ten#e#%"pectr'm penicillin"Dme:l!cillin( piperacillin( ticarcillin

D$UG $ESISTANCE Beca'"e the nat'ral penicillin" ha5e been '"e# *!r many year"( #r'%re"i"tant "train" !*

micr!!rani"m" ha5e #e5el!pe#( ma2in the nat'ral penicillin" le"" e**ecti5e than "!me !* thene)er antibi!tic" in treatin a br!a# rane !* in*ecti!n",

Bacterial re"i"tance ha" !cc'rre# )ithin the penicillin",

-acteria" resistance is the a!i"it/ !* bacteria t! pr!#'ce "'b"tance" that inacti5ate !r #e"tr!ythe penicillin,

One e-ample !* bacterial re"i"tance i" the ability !* certain bacteria t! pr!#'ce penici""inase4 anen:yme that inacti5ate" penicillin,

The penicillina"e%re"i"tant penicillin" )ere #e5el!pe# t! c!mbat thi" pr!blem,

Action o3 penici""in

Bacteria )ithin the b!#y ca'"e" in*ecti!nA#mini"trati!n !* penicillinCa'"e" bacteriat! ")ell( r'pt're( !r a""'me 'n'"'al "hape"Bacteria e5ent'ally #e"tr!ye#,

The penicillin" may beF !acterici2a" 2estro/ !acteria7

!acteriostatic s"o8 or retar2 the mu"tip"ication !* bacteria&,

I2enti3/in the Appropriate %enici""in

T! #etermine i* a "peci*ic type !* bacteria i" "en"iti5e t! penicillin( cu"ture an2 sensiti0it/ testsare per3orme2.

A c'lt're i" per*!rme# by placin in*ecti!'" material !btaine# *r!m area" "'ch a" the "2in(re"pirat!ry tract( an# bl!!# !n a c'lt're plate that c!ntain" a "pecial r!)in me#i'm,

Thi" r!)in me#i'm i" *!!# *!r the bacteria,

USES1. In3ectious Disease

The nat'ral an# "emi"ynthetic penicillin" are '"e# in the treatment !* bacterial in*ecti!n" #'e t!"'"ceptible micr!!rani"m",

Penicillin" may be '"e# t! treat in*ecti!n" "'ch a" 'rinary tract in*ecti!n"( "epticemia( meniniti"(intra%ab#!minal in*ecti!n( !n!rrhea( "yphili"( pne'm!nia( an# !ther re"pirat!ry in*ecti!n",

E-ample" !* in*ecti!'" micr!!rani"m" $bacteria& that may re"p!n# t! penicillin therapy incl'#e!n!c!cci( "taphyl!c!cci( "trept!c!cci( an# pne'm!c!cci,

&. %roph/"a6is Penicillin i" !* n! 5al'e in the treatment !* 5iral !r *'nal in*ecti!n",

H!)e5er( the primary health care pr!5i#er !cca"i!nally )ill pre"cribe penicillin a" proph/"a6is$pre5enti!n& aain"t a p!tential "ec!n#ary bacterial in*ecti!n that can !cc'r in a patient )ith a5iral in*ecti!n,

In the"e "it'ati!n" the 5iral in*ecti!n ha" )ea2ene# the b!#y" #e*en"e" an# the per"!n i""'"ceptible t! !ther in*ecti!n"( partic'larly a bacterial in*ecti!n,

Penicillin al"! may be pre"cribe# a" pr!phyla-i" *!r a p!tential in*ecti!n in hih%ri"2 in#i5i#'al"(

"'ch a" th!"e )ith a hi"t!ry !* rhe'matic *e5er,

AD,E$SE $EACTIONS mil# na'"ea( 5!mitin( #iarrhea( "!re t!n'e !r m!'th( *e5er( an# pain at in>ecti!n "ite,

Penicillin can "tim'late a h/persensiti0it/ An!ther a#5er"e reacti!n that may be "een )ith penicillin( a" )ell a" )ith alm!"t all antibi!tic"( i"

a superin3ection $a "ec!n#ary in*ecti!n that !cc'r" #'rin antibi!tic treatment&

'/persensiti0it/ reactions to penici""in


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S2in ra"h Urticaria $hi5e"& Snee:in =hee:in Pr'rit'" $itchin& Br!nch!"pa"m $"pa"m !* the br!nchi& ecti!n "ite,

Irritati!n !* the 5ein an# phlebiti" $in*lammati!n !* a 5ein& may !cc'r )ith intra5en!'" $I7&a#mini"trati!n,

CONT$AINDICATIONS Penicillin" are c!ntrain#icate# in patient" )ith a hi"t!ry !* hyper"en"iti5ity t! penicillin !r the

cephal!"p!rin",%$ECAUTIONS

Penicillin" "h!'l# be '"e# ca'ti!'"ly in patient" )ith renal #i"ea"e( prenancy $PrenancyCate!ry C&( lactati!n $may ca'"e #iarrhea !r can#i#ia"i" in the in*ant&( an# in th!"e )ith ahi"t!ry !* allerie",

Any in#icati!n !* "en"iti5ity i" rea"!n *!r ca'ti!n, The #r' i" al"! '"e# )ith ca'ti!n in patient" )ith a"thma( renal #i"ea"e( blee#in #i"!r#er"( an#

a"tr!inte"tinal #i"ea"e,INTE$ACTIONS

S!me penicillin" $ampicillin( bacampicillin( penicillin 7& may inter*ere )ith the e**ecti5ene"" !* birthc!ntr!l pill" that c!ntain e"tr!en,

There i" a #ecrea"e# e**ecti5ene"" !* the penicillin )hen it i" a#mini"tere# )ith the tetracycline",


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The "'l*!nami#e" are primarily !acteriostatic4 8hich mean" they "l!) !r retar# them'ltiplicati!n !* bacteria,

Thi" bacteri!"tatic acti5ity i" #'e t! "'l*!nami#e anta!ni"m t! para%amin!ben:!ic aci# $PABA&(a "'b"tance that "!me( b't n!t all( bacteria nee# t! m'ltiply,

Once the rate !* bacterial m'ltiplicati!n i" "l!)e#( the b!#y" !)n #e*en"e mechani"m" $)hitebl!!# cell"& are able t! ri# the b!#y !* the in5a#in micr!!rani"m" an# there*!re c!ntr!l the

in*ecti!n,USES

The "'l*!nami#e" are !*ten '"e# t! c!ntr!l 'rinary tract in*ecti!n" ca'"e# by certain bacteria"'ch a" Escherichia coli, Staphylococcus aureus, and Klebsiella-Enterobacter.

Ma*eni#e $S'l*amyl!n& an# "il5er "'l*a#ia:ine $Sil5a#ene& are t!pical "'l*!nami#e" '"e# in thetreatment !* "ec!n#% an# thir#%#eree b'rn",

AD,E$SE $EACTIONS The "'l*!nami#e" are capable !* ca'"in a 5ariety !* a#5er"e reacti!n", S!me !* the"e are

"eri!'" !r p!tentially "eri!'"6 !ther" are mil#,

The *!ll!)in hemat!l!ic chane" may !cc'r #'rin "'l*!nami#e therapyF Aranu"oc/tosis;2ecrease in or "ac< o3 ranu"oc/tes4a type !* )hite bl!!# cell Throm!oc/topenia;2ecrease in the num!er o3platelet" Ap"astic anemia;anemia 2ue to 2e3icient re2bl!!# cell pr!#'cti!n in the b!ne marr!) Leu


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=hen a "'l*!nami#e i" a#mini"tere# )ith an !ral antic!a'lant( the acti!n !* the antic!a'lantmay be enhance#,

The ri"2 !* b!ne marr!) "'ppre""i!n may be increa"e# )hen a "'l*!nami#e i" a#mini"tere# )ithmeth!tre-ate,

=hen a "'l*!nami#e i" a#mini"tere# )ith a hy#ant!in( the "er'm hy#ant!in le5el may beincrea"e#,

S'l*!nami#e" may inhibit the $hepatic& metab!li"m !* the !ral hyp!lycemic #r'" t!lb'tami#e$Orina"e& an# chl!rpr!pami#e $3iabine"e&, Thi" )!'l# increa"e the p!""ibility !* a hyp!lycemicreacti!n,

>. TET$ACYCLINES A r!'p !* anti%in*ecti5e" c!mp!"e# !* nat'ral an# "emi"ynthetic c!mp!'n#",

They are '"e*'l in "elect in*ecti!n" )hen the !rani"m "h!)" "en"iti5ity t! the tetracycline"( "'cha" in ch!lera( R!c2y M!'ntain "p!tte# *e5er( an# typh'",ACTIONS

The tetracycline" e-ert their e**ect by inhibitin bacterial pr!tein "ynthe"i"( )hich i" a pr!ce""nece""ary *!r repr!#'cti!n !* the micr!!rani"m,

The 'ltimate e**ect !* thi" acti!n i" that the bacteria are either #e"tr!ye# !r their m'ltiplicati!n ratei" "l!)e#,

The tetracycline" are !acteriostatic capa!"e o3 s"o8in or retar2in the m'ltiplicati!n !*bacteria&( )herea" the macr!li#e" an# linc!"ami#e" may be bacteri!"tatic !r !acterici2a"$capable !* #e"tr!yin bacteria&,

USES e**ecti5e in the treatment !* in*ecti!n" ca'"e# by a )i#e rane !* ram%neati5e an# ramp!"iti5e

micr!!rani"m", '"e# in in*ecti!n" ca'"e# by Ric2ett"iae $R!c2y M!'ntain "p!tte# *e5er( typh'" *e5er( an# tic2

*e5er"&, '"e# in "it'ati!n" in )hich penicillin i" c!ntrain#icate#( in the treatment !* inte"tinal amebia"i"(

an# in "!me "2in an# "!*t ti""'e in*ecti!n",

'"e# in the treatment !* 'nc!mplicate# 'rethral( en#!cer5ical( !r rectal in*ecti!n" ca'"e# byChlamydia trachomatis and as adjunctive treatment in "e5ere acne,

Tetracycline in c!mbinati!n )ith metr!ni#a:!le an# bi"m'th "'b"alicylate i" '"e*'l in treatinHelicobacter pylori a bacteria in the stomach that can ca'"e peptic 'lcer&,

AD,E$SE $EACTIONS Ga"tr!inte"tinal reacti!n" incl'#e na'"ea( 5!mitin( #iarrhea( epia"tric #i"tre""( "t!matiti"( an#

"!re thr!at, S2in ra"he" al"! may be "een,

A photosensiti0it/ $ph!t!t!-ic& reaction ma/ !e seen 8ith this roup !* #r'"( mani*e"te# byan e-aerate# "'nb'rn reacti!n )hen the "2in i" e-p!"e# t! "'nliht e5en *!r brie* peri!#",

The tetracycline" are n!t i5en t! chil#ren y!'ner than @ year" !* ae 'nle"" their '"e i"ab"!l'tely nece""ary beca'"e the"e #r'" may ca'"e permanent yell!) ray% br!)n#i"c!l!rati!n !* the teeth,

The '"e !* the tetracycline"( e"pecially pr!l!ne# !r repeate# therapy( may re"'lt in bacterial !r*'nal !5err!)th !* n!n"'"ceptible !rani"m",

CONT$AINDICATIONS i* the patient i" 2n!)n t! be hyper"en"iti5e t! any !* the tetracycline", #'rin prenancy beca'"e !* the p!""ibility !* t!-ic e**ect" t! the #e5el!pin *et'", The

tetracycline" are cla""i*ie# Prenancy Cate!ry 3 #r'", The"e #r'" al"! are c!ntrain#icate# #'rin lactati!n an# in chil#ren y!'ner than @ year" $may

ca'"e permanent #i"c!l!rati!n !* the teeth&,%$ECAUTIONS?NU$SING $ES%ONSI-ILITIES It i" imp!rtant t! '"e the tetracycline" ca'ti!'"ly in patient" )ith renal *'ncti!n impairment, 3!"e" reater that 1 # can be e-tremely #amain t! the li5er, The n'r"e "h!'l# care*'lly chec2 the e-pirati!n #ate" !* the tetracycline" be*!re a#mini"trati!n

beca'"e #era#ati!n !* the tetracycline" can !cc'r6 a*ter #era#ati!n( the aent" are hihly t!-ict! the 2i#ney",


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INTE$ACTIONS Antaci#" !r *!!#" hih in calci'm impair ab"!rpti!n !* the tetracycline", =hen the tetracycline" are a#mini"tere# )ith !ral antic!a'lant"( an increa"e in the e**ect" !* the

antic!a'lant may !cc'r, =hen tetracycline" are a#mini"tere# t! )!men '"in !ral c!ntracepti5e"( a #ecrea"e in the e**ect

!* the !ral c!ntracepti5e may be "een, Thi" may re"'lt in brea2thr!'h blee#in !r prenancy, =hen #i!-in i" a#mini"tere# )ith the tetracycline" there i" an increa"e# ri"2 *!r #iitali" t!-icity Tetracycline" may re#'ce in"'lin re;'irement", Bl!!# l'c!"e le5el" "h!'l# be m!nit!re#

*re;'ently #'rin tetracycline therapy,Nursin A"ert !he nurse should not "ive tetracyclines alon" #ith dairy products mil$ or cheese%, antacids,

laxatives, or products containin" iron. &hen these dru"s are prescribed, the nurse ma$es sure they are "iven ' hours before or after

the administration of a tetracycline.

@. ANTITU-E$CULOSIS D$UGS

ACTIONS

M!"t antit'berc'lar #r'" are !acteriostatic s"o8 or retar# the r!)th !* bacteria& aain"t the(. tuberculosis bacill'",

The"e #r'" '"'ally act t! inhibit bacterial cell )all "ynthe"i"( )hich "l!)" the m'ltiplicati!n rate!* the bacteria,

Only i"!nia:i# i" bacterici#al( )ith ri*ampin an# "trept!mycin ha5in "!me bacterici#al acti5ity,

USES Antit'berc'lar #r'" are '"e# in c!mbinati!n )ith !ther antit'berc'lar #r'" t! treat acti5e

t'berc'l!"i", I"!nia:i# $INH& i" the !nly antit'berc'lar #r' '"e# al!ne, =hile i"!nia:i# i" '"e# in c!mbinati!n )ith !ther #r'" *!r the treatment !* primary t'berc'l!"i"(

a primary '"e i" in pre5enti5e therapy $pr!phyla-i"& aain"t t'berc'l!"i", !r e-ample( )hen a #ian!"i" !* t'berc'l!"i" i" pre"ent( *amily member" !* the in*ecte#

in#i5i#'al m'"t be i5en pr!phylactic treatment )ith i"!nia:i# *!r L m!nth" t! ? year,

STANDA$D T$EATMENT Stan#ar# treatment *!r t'berc'l!"i" i" #i5i#e# int! t)! pha"e"F the initial pha"e *!ll!)e# by a

c!ntin'in pha"e,

3'rin the initial pha"e( #r'" are '"e# t! 2ill the rapi#ly m'ltiplyin (. tuberculosis and toprevent dru" resistance.

The initial pha"e la"t" appr!-imately 1 m!nth" an# the c!ntin'in pha"e appr!-imately . m!nth"()ith the t!tal treatment reimen la"tin *!r L t! @ m!nth"( #epen#in !n the patient" re"p!n"e t!therapy,

The initial pha"e m'"t c!ntain three !r m!re !* the *!ll!)in #r'"F i"!nia:i#( ri*ampin( an#pyra:inami#e( al!n )ith either ethamb't!l !r "trept!mycin,

The C3C rec!mmen#" treatment t! bein a" "!!n a" p!""ible a*ter the #ian!"i" !* t'berc'l!"i", The treatment rec!mmen#ati!n reimen i" *!r the a#mini"trati!n !* ri*ampin( i"!nia:i#( an#

pyra:inami#e *!r a minim'm !* 1 m!nth" $/ )ee2"&( *!ll!)e# by ri*ampin an# i"!nia:i# *!r .m!nth" $?L )ee2"& in area" )ith a l!) inci#ence !* t'berc'l!"i",

In area" !* hih inci#ence !* t'berc'l!"i"( the C3C rec!mmen#" the a##iti!n !* "trept!mycin !rethamb't!l *!r the *ir"t 1 m!nth",

$ET$EATMENT At time" treatment *ail" #'e t! n!nc!mpliance )ith the #r' reimen !r t! ina#e;'ate initial #r'

treatment, =hen treatment *ail"( retreatment i" nece""ary,


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Retreatment enerally incl'#e" the '"e !* *!'r !r m!re antit'berc'lar #r'", Retreatment #r'reimen" m!"t !*ten c!n"i"t !* the "ec!n#ary #r'" ethi!nami#e( amin!"alicylic aci#(cycl!"erine( an# capre!mycin, O*l!-acin an# cipr!*l!-acin may al"! be '"e# in retreatment,

At time" #'rin retreatment( a" many a" "e5en !r m!re #r'" may be '"e#( )ith the ine**ecti5e#r'" #i"c!ntin'e# )hen "'"ceptibility te"t re"'lt" are a5ailable,

NU$SING %$OCESSThe %atient $ecei0in an Antitu!ercu"ar Dru

Preadministration Assessment Once the #ian!"i" !* t'berc'l!"i" i" c!n*irme#( the primary health care pr!5i#er "elect" the #r'

that )ill be"t c!ntr!l the "prea# !* the #i"ea"e an# ma2e the patient n!nin*ecti!'" t! !ther", Many lab!rat!ry an# #ian!"tic te"t" may be nece""ary be*!re "tartin antit'berc'lar therapy(

incl'#in ra#i!raphic "t'#ie"( c'lt're an# "en"iti5ity te"t"( an# 5ari!'" type" !* lab!rat!ry te"t"("'ch a" a c!mplete bl!!# c!'nt,

It al"! i" imp!rtant t! incl'#e a *amily hi"t!ry an# a hi"t!ry !* c!ntact"( i* the patient ha" acti5et'berc'l!"i"( a" part !* the a""e""ment,

3epen#in !n the "e5erity !* the #i"ea"e( patient" may be treate# initially in the h!"pital an# then#i"chare# t! their h!me *!r "'per5i"e# *!ll!)%'p care( !r they may ha5e all treatment in"tit'te#!n an !'tpatient ba"i",

Ongoing Assessment =hen per*!rmin the !n!in a""e""ment( the n'r"e !b"er5e" the patient #aily *!r the

appearance !* a#5er"e reacti!n", The"e !b"er5ati!n" are e"pecially imp!rtant )hen a #r' i" 2n!)n t! be nephr!t!-ic !r !t!t!-ic, It i" imp!rtant t! rep!rt any a#5er"e reacti!n" t! the primary health care pr!5i#er, In a##iti!n( the n'r"e care*'lly m!nit!r" 5ital "in" #aily !r a" *re;'ently a" e5ery . h!'r" )hen

the patient i" h!"pitali:e#,

Geronto"oic A"ert )lder adults are particularly susceptible to a potentially fatal hepatitis #hen ta$in" isoniazid,

especially if they consume alcohol on a re"ular basis. !#o other antitubercular dru"s, rifampin and pyrazinamide, can cause liver dysfunction in the

older adult.

Careful observation and monitorin" for si"ns of liver impairment are necessary e", increasedserum aspartate transaminase, increased serum alanine transferase, increased serum bilirubin,

and jaundice%.

The n'r"e incl'#e" the *!ll!)in in*!rmati!n in the teachin plan )hen a "peci*ic antit'berc'lar #r' i"pre"cribe#F

Ethambutol* !a$e this dru" once a day at the same time each #ay, I* a #!"e i" mi""e#( #! n!t#!'ble the #!"e the ne-t #ay, N!ti*y the primary health care pr!5i#er !* any chane" in 5i"i!n !rthe !cc'rrence !* a "2in ra"h,

+soniazid* !a$e this dru" hour before or ' hours a*ter meal", H!)e5er( i* a"tric 'p"et !cc'r"(ta2e i"!nia:i# )ith *!!#, N!ti*y the primary health care pr!5i#er !* )ea2ne""( yell!)in !* the"2in( l!"" !* appetite( #ar2enin !* the 'rine( "2in ra"he"( !r n'mbne"" !r tinlin !* the han#" !r*eet, A5!i# tyramine%c!ntainin *!!#", T! pre5ent pyri#!-ine $5itamin BL& #e*iciency( L t! m!* pyri#!-ine #aily may be pre"cribe#,

yrazinamide* otify the primary health care pr!5i#er i* any !* the *!ll!)in !cc'r"F na'"ea(

5!mitin( l!"" !* appetite( *e5er( malai"e( 5i"'al chane"( yell!) #i"c!l!rati!n !* the "2in( !r"e5ere pain in the 2nee"( *eet( !r )ri"t", $N!teF Pain in the"e area" may be a "in !* acti5e !'t,&

/ifampin* !a$e the dru" once daily on an empty stomach $? h!'r be*!re !r 1 h!'r" a*ter meal"&,A re##i"h br!)n !r re##i"h%!rane #i"c!l!rati!n !* tear"( "p't'm( 'rine( !r ")eat may !cc'r, S!*tc!ntact len"e" may be permanently "taine# i* )!rn )hile the patient i" ta2in the #r', N!ti*y theprimary health care pr!5i#er !* any yell!) #i"c!l!rati!n !* the "2in( *e5er( chill"( 'n'"'al blee#in!r br'i"in( an# "2in ra"h !r itchin, I* ta2in an !ral c!ntracepti5e( chec2 )ith primary health carepr!5i#er beca'"e reliability !* the c!ntracepti5e may be a**ecte#,


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1. LE%$OSTATIC D$UGS

CLO#ABIMINE

ACTIONS AND USES

Cl!*a:imine i" primarily bacterici#al aain"t (. leprae.

The e-act m!#e !* acti!n !* thi" #r' i" 'n2n!)n, Cl!*a:imine i" '"e# t! treat lepr!"y,AD,E$SE $EACTIONS

Cl!*a:imine may ca'"e pimentati!n !* the "2in( ab#!minal pain( #iarrhea( na'"ea( an# 5!mitin,

CONT$AINDICATIONS4 %$ECAUTIONS4 AND INTE$ACTIONS Cl!*a:imine i" '"e# ca'ti!'"ly in patient" )ith a"tr!inte"tinal #i"!r#er"( #iarrhea( an# #'rin

prenancy $Prenancy Cate!ry C& an# lactati!n, I* cl!*a:imine i" '"e# #'rin prenancy( the in*ant may be b!rn )ith pimente# "2in,

DA%SONE

ACTIONS AND USES

3ap"!ne i" bacterici#al an# bacteri!"tatic aain"t (. leprae. !he dru" is used to treat leprosy. 0apsone may al"! be '"e# in the treatment !* #ermatiti" herpeti*!rmi"( A chr!nic( in*lammat!ry "2in #i"ea"e,

AD,E$SE $EACTIONS

A#mini"trati!n !* #ap"!ne may re"'lt in hem!ly"i" $#e"tr'cti!n !* re# bl!!# cell"&( na'"ea(5!mitin( an!re-ia( an# bl'rre# 5i"i!n,

CONT$AINDICATIONS4 %$ECAUTIONS4 AND INTE$ACTIONS 3ap"!ne i" '"e# )ith ca'ti!n in patient" )ith anemia( "e5ere car#i!p'lm!nary #i"ea"e( hepatic

#y"*'ncti!n( an# #'rin prenancy $Prenancy Cate!ry C&, 3ap"!ne i" c!ntrain#icate# #'rin lactati!n, S'b"tantial am!'nt" !* #ap"!ne are e-crete# in brea"t mil2 an# can ca'"e hem!lytic reacti!n" in

ne!nate",The %atient $ecei0in a Leprostatic Dru

readministration 1ssessment It i" imp!rtant t! per*!rm a c!mplete phy"ical e-aminati!n an# hi"t!ry be*!re the in"tit'ti!n !*

therapy, The n'r"e e-amine" the in5!l5e# area" an# #e"cribe" them in #etail !n the patient" rec!r# t!

pr!5i#e a #ataba"e *!r c!mpari"!n #'rin therapy,ONGOING ASSESSMENT

The"e #r'" are !*ten i5en !n an !'tpatient ba"i", Each time the patient i" "een in the clinic !r primary health care pr!5i#er" !**ice( the n'r"e

per*!rm" a eneral phy"ical e-aminati!n( )ith partic'lar attenti!n i5en t! the a**ecte# area",


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75483683 chemotherapeutic agents[1]

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