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Cholinergic-Blocking Drugs Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antibiotics For the GU system Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antibiotics: Classes Sulfonamides Penicillins Quinolones Aminoglycosides Tetracyclines glycopepetides Cephalosporins Macrolides Antibiotic Therapy: Mechanism of Action Interference with cell wall synthesis Interference with protein synthesis Interference with DNA replication Acting as a metabolite to disrupt critical metabolic reactions inside the bacterial cell Actions of Antibiotics Bactericidal: kill bacteria Bacteriostatic: inhibit growth of susceptible bacteria, rather than killing them immediately; will eventually lead to bacterial death Antibiotics: Sulfonamides One of the first groups of antibiotics Sulfadiazine Sulfamethoxazole Sulfisoxazole Often combined with another antibiotic Sulfamethoxazole combined with trimethoprim (a nonsulfonamide antibiotic), known as Bactrim, Septra, or co-trimoxazole (SMX-TMP) This combination is used commonly Sulfonamides: Mechanism of Action Bacteriostatic action Prevent synthesis of folic acid required for synthesis of purines and nucleic acid Do not affect human cells or certain bacteria— they can use preformed folic acid Only affect organisms that synthesize their own folic acid Sulfonamides: Indications Effective against both gram-positive and gram-negative bacteria Pneumocystis jirovecii pneumonia (PJP) Co-trimoxazole Upper respiratory tract infections Treatment of UTIs caused by susceptible strains of: Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Proteus vulgaris, Staphylococcus aureus Sulfonamides: Adverse Effects Body System Blood Integumentary Adverse Effects Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia exfoliative dermatitis, Stevens- Johnson syndrome, epidermal necrolysis GI Nausea, vomiting, diarrhea, pancreatitis Other Convulsions, crystalluria, toxic nephrosis, headache, peripheral, neuritis, urticaria Nursing Implications Assess: Before beginning therapy, assess drug allergies; renal, liver, and cardiac function; and other lab studies Be sure to obtain thorough patient health history, including immune status Assess for conditions that may be contraindications to antibiotic use or that may indicate cautious use Assess for potential drug interactions Nursing Implications Treat: It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water For safety reasons, check the name of the medication carefully because there are many drugs that sound alike or have similar spellings Nursing Implications Teach: Patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge Quinolones ciprofloxacin (Cipro) norfloxacin (Noroxin) levofloxacin (Levaquin) moxifloxacin (Avelox) Quinolones: Mechanism of Action Bactericidal Alter DNA of bacteria, causing death Do not affect human DNA Quinolones: Indications Gram-negative bacteria such as pseudomonas Respiratory infections Bone and joint infections GI, GU infections Skin infections Sexually transmitted diseases Anthrax Fluoroquinolones: Adverse Effects Body System CNS Adverse Effects Headache, dizziness, fatigue, depression, restlessness, insomnia GI Nausea, vomiting, diarrhea, constipation, thrush, increased liver function studies, Cardiac Prolonged QT interval Integumentary Rash, pruritus, urticaria, flushing, photosensitivity (with lomefloxacin) Other Fever, chills, blurred vision, tinnitus Black box warning: increased risk of tendonitis and tendon rupture Other Antibiotics nitrofurantoin (Macrodantin) Primarily used for UTIs (E. coli, S. aureus, Klebsiella spp., Enterobacter spp.) Use carefully if renal function is impaired Drug concentrates in the urine May cause fatal hepatotoxicity Usually well-tolerated if patient is kept wellhydrated Bladder analgesics Phenazopyridine Reduces bladder pain and dysuria 3 x a day Nursing Implications Monitor for therapeutic effects Improvement of signs and symptoms of infection Return to normal vital signs Negative culture and sensitivity tests Disappearance of fever, lethargy, drainage, and redness Monitor for adverse reactions 38 5-Alpha-Reductase Inhibitors Finasteride (Proscar) and dutasteride (Avodart) Block the effects of endogenous androgens Used to treat benign prostatic hyperplasia (BPH) Results in alleviation of symptoms of BPH Easier passage of urine May also be used for treatment of malepattern baldness (minoxidil) Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 39 Alpha1-Adrenergic Blockers Used for symptomatic relief of obstruction caused by BPH doxazosin (Cardura) tamsulosin (Flomax) terazosin (Hytrin) alfuzosin (Uroxatral) silodosin (Rapaflo) Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 40 Nursing Implications Assessment should include complete history, including medication history, urinary elimination problems, potential contraindications Obtain baseline vital signs, weight, height, serum electrolyte levels Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 41 Nursing Implications (cont’d) Assess renal and liver function Assess PSA level and perform digital rectal examination (DRE) before beginning any drugs for treatment of prostate disease Assess current medications for potential interactions Copyright © 2014 by Mosby, an imprint of Elsevier Inc.