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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.