McKenna's Pharmacology for Nursing, 2e

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P A R T 2  Chemotherapeutic agents

Evaluation

■ ■ Perform culture and sensitivity tests at the site of infection. ■ ■ Conduct assessment of orientation, affect and reflexes to establish a baseline for any CNS effects of the drug. ■ ■ Perform renal function tests, including BUN and creatinine clearance, to evaluate the status of renal functioning and to assess necessary changes in dose. ■ ■ Check culture and sensitivity reports to ensure that this is the drug of choice for this person. ■ ■ Monitor renal function tests before initiating therapy to appropriately arrange for dose reduction if necessary. ■ ■ Ensure that the person receives the full course of the fluoroquinolone as prescribed to eradicate the infection and to help prevent the emergence of resistant strains. ■ ■ Monitor the site of infection and presenting signs and symptoms (e.g. fever, lethargy, urinary tract signs and symptoms) throughout the course of drug therapy. Failure of these signs and symptoms to resolve may indicate the need to reculture the site. Arrange to continue drug therapy for at least 2 days after resolution of all signs and symptoms to help decrease the development of resistant strains. ■ ■ Provide small, frequent meals as tolerated, frequent mouth care and ice chips or sugarless lollies to suck if dry mouth is a problem to relieve discomfort and provide nutrition , and provide adequate fluids to replace those lost with diarrhoea. ■ ■ Implement safety measures, including adequate lighting, use of side rails and assistance with ambulation to protect the person from injury if CNS effects occur. ■ ■ Instruct the person about the appropriate dosage schedule and possible adverse effects to enhance knowledge about drug therapy and to promote compliance. –– Take safety precautions, including changing position slowly and avoiding driving and hazardous tasks, if CNS effects occur. –– Try to drink a lot of fluids and to maintain nutrition (very important), although nausea, vomiting and diarrhoea may occur. –– Avoid ultraviolet light and sun exposure, using protective clothing and sunscreens. –– Report difficulty breathing, severe headache, severe diarrhoea, severe skin rash, fainting spells and heart palpitations. ■ ■ Provide the following teaching: Implementation with rationale

■ ■ Monitor person’s response to the drug (resolution of bacterial infection). ■ ■ Monitor for adverse effects (orientation and affect, GI effects, photosensitivity). ■ ■ Evaluate effectiveness of the teaching plan (person can name drug, dosage, possible adverse effects to expect and specific measures to help avoid adverse effects). ■ ■ Monitor effectiveness of comfort and safety measures and compliance with the therapeutic regimen.

KEY POINTS

KEY POINTS

■■ Fluoroquinolones inhibit the action of DNA enzymes in susceptible gram-negative bacteria. They are used to treat a wide range of infections. ■■ Monitor the person for headache, dizziness, GI upsets and bone marrow depression, and caution the person about the risk of photosensitivity reactions.

PENICILLINS AND PENICILLINASE- RESISTANT ANTIBIOTICS

Penicillin (Table 9.5) was the first antibiotic introduced for clinical use. Sir Alexander Fleming used Penicillium moulds to produce the original penicillin in the 1920s. Subsequent versions of penicillin were developed to decrease the adverse effects of the drug and to modify it to act on resistant bacteria. Penicillins include ben- zylpenicillin ( BenPen ), flucloxacillin ( Flopen ), procaine penicillin ( Cilicaine ), dicloxacillin ( Diclocil ), amoxycil- lin ( Amoxil , Augmentin ), ampicillin ( Amicyn , Ibimicyn ) and ticarcillin ( Timentin ). With the prolonged use of penicillin, more and more bacterial species have synthesised the enzyme penicilli- nase to counteract the effects of penicillin. Researchers have developed a group of drugs with a resistance to penicillinase, which allows them to remain effective against bacteria that are now resistant to the penicillins. The actual drug chosen depends on the sensitivity of the bacteria causing the infection, the desired and available routes and the personal experience of the clinician with the particular agent. Therapeutic actions and indications The penicillins and penicillinase-resistant antibiot- ics produce bactericidal effects by interfering with the ability of susceptible bacteria to build their cell walls when they are dividing (see Figure 9.2). These drugs prevent the bacteria from biosynthesising the framework