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Introductory Clinical
Pharmacology
Chapter 11
Miscellaneous Anti-Infectives
Copyright © 2008 Lippincott Williams & Wilkins.
Vancomycin: Actions and Uses
• Inhibits bacterial cell wall synthesis and
increases cell wall permeability – acts
against susceptible gram-positive bacteria
• Used in the treatment of:
– Serious gram-positive infections that do
not respond to treatment with other antiinfectives
– Anti-infective–associated
pseudomembranous colitis caused by
Clostridium difficile
Copyright © 2008 Lippincott Williams & Wilkins.
Vancomycin: Adverse Reactions
• Common adverse reactions
– Nephrotoxicity
– Ototoxicity
• Other adverse reactions
– Nausea; chills; fever; urticaria; sudden
fall in blood pressure with parenteral
administration; skin rashes
Copyright © 2008 Lippincott Williams & Wilkins.
Vancomycin: Contraindications,
Precautions, and Interactions
• Contraindicated in patients with known
hypersensitivity to the drug
• Used cautiously in patients with renal or
hearing impairment; during pregnancy and
lactation
• Interaction
– Other ototoxic and nephrotoxic drugs:
Additive effects may occur
Copyright © 2008 Lippincott Williams & Wilkins.
Quinupristin/Dalfopristin: Action, Uses,
and Adverse Reactions
• Bacteriostatic agent
• Used in the treatment of vancomycinresistant Enterococcus faecium (VREF)
• Adverse reactions
– Irritation in the vein; incompatibility with
saline or heparin flush solutions; nausea,
vomiting, and diarrhea
Copyright © 2008 Lippincott Williams & Wilkins.
Quinupristin/Dalfopristin: Contraindications,
Precautions, and Interactions
• Contraindicated in patients with known
hypersensitivity to the drug; during
pregnancy and lactation
• Interaction
– Serum levels of the following drugs may
increase: Antiretrovirals; antineoplastic
and immunosuppressants; calcium
channel blockers; benzodiazepines;
cisapride
Copyright © 2008 Lippincott Williams & Wilkins.
Nursing Process: Assessment
• Preadministration assessment
– Take and record vital signs and identify
symptoms and history of drug allergies
– Primary health care provider may order:
•Culture and sensitivity – To be done
before first dose of the drug is given
•Renal and hepatic function tests; CBC;
urinalysis
Copyright © 2008 Lippincott Williams & Wilkins.
Nursing Process: Assessment (cont’d)
• Ongoing assessment
– Monitor patient’s vital signs and for any
adverse reactions during the first 48
hours
•Notify primary health care provider of
any adverse reaction before the next
dose of the drug is due
Copyright © 2008 Lippincott Williams & Wilkins.
Nursing Process: Evaluation
• The therapeutic effect is
achieved; infection is
controlled
• Adverse reactions are
identified, reported, and
managed successfully
• Pain or discomfort following
IM or IV administration is
relieved or eliminated
• The patient and family
demonstrate understanding
of the drug regimen
Copyright © 2008 Lippincott Williams & Wilkins.
End of Presentation
Copyright © 2008 Lippincott Williams & Wilkins.