- Precautions should be continued for 24 hours after the initiation of antibiotic therapy.
- Assess for allergies. Encourage fluid intake unless contraindicated. Teach the client about the importance of completing the full prescribed course. 모든 항생제의 peak는 1/2 hour after the end of infusion, through time은 just before or 1/2 hour before next dose.
1-1. ① cephalosporins
- ex) cefepime (Maxipime), ceftriaxone (Rocephin), loracerbef (Lorabid)
- side/adverse effect: headache, dizziness, paresthesia, nephrotoxicity, hepatotoxicity, GI disturbances, pseudomembranous colitis
1-2. ② vancomycin
- side/adverse effect: nephrotoxicity, GI distress, ototoxicity, photosensitivity, bone marrow depression, hypokalemia, red man syndrome
- Administer over 1 hour. The therapeutic range is 10 ∼20mg/L. Check cranial nerve 8. Apply sunscreen.
1-3. ③ penicillin
- ex) amoxicillin (Amoxil), ampicillin (Principen), penicillin G
- side/adverse effect: nephrotoxicity, hepatotoxicity, GI distress, bone marrow depression
- Administer on an empty stomach. cepha계열과 penicillin과 cross-react 함
1-4. ④ aminoglycosides
- ex) amikacin (Amikin), gentamicin, neomycin (Neo-Fradin), streptomycin
- side/adverse effect: nephrotoxicity, confusion 등 neurotoxicity, ototoxicity, GI irritation, palpitations
1-5. ⑤ macrolide
- ex) azithromycin (Zithromax), erythromycin
- side/adverse effect: nephrotoxicity, hepatotoxicity, GI distress, pseudomembranous colitis, ototoxicity, photosensitivity, anosmia, headache, confusion 등 neurotoxicity, bone marrow depression
- Administer on an empty stomach. 500mg 후 250mg. 제산제와는 2시간 간격을 두고 줌, macrolide계열과 penicillin과 cross-react 하지 않음
1-6. ⑥ fluoroquinolones
- ex) ciprofloxacin (Cipro), levofloxacin (Levaquin)
- side/adverse effect: headache, dizziness, insomnia, depression, GI distress, bone marrow depression, rash, photosensitivity
1-7. ⑦ sulfonamides
- ex) sulfadiazine, sulfisoxazole
- side/adverse effect: nephrotoxicity, hepatotoxicity, GI distress, bone marrow depression, photosensitivity, headache, dizziness, seizure
1-8. ⑧ tetracyclines
- ex) doxycycline (Vibramycin), tetracycline (Sumycin)
- side/adverse effect: hepatotoxicity, teeth staining, bone damage
2. antiviral medications
3. antifungal medications
- ex) amphotericin B, ketoconazole, fluconazole (Diflucan)
- side/adverse effect: nephrotoxicity (most serious), hepatotoxicity, GI distress, headache, hearing loss, peripheral neuritis, rash, K↓, anemia
4. acetaminophen (Tylenol)
- Acetaminophen inhibits prostaglandin synthesis. Acetaminophen is used to decrease pain and fever, not used to decrease inflammation.
- Acetaminophen is contraindicated in clients with hepatic or renal disease, alcoholism, and/or hypersensitivity.
- side/adverse effect: anorexia, nausea, vomiting, hepatotoxicity, hypoglycemia, oliguria, rash
- Monitor liver enzyme test results. Instruct the client that self-medication should not be used longer than 10 days for an adult and 5 days for a child.
- maximum 4g/day
- Note that the antidote for acetaminophen is acetylcysteine (Mucomyst).
- Non-Steroidal Anti-Inflammatory drugs are aspirin and aspirin-like medications that inhibit the synthesis of prostaglandins. The medications act as an analgesic to relieve pain, an antipyretic to reduce body temperature, and an anticoagulant to inhibit platelet aggregation.
ex) ibuprofen (Motrin IB, Advil), ketorolac (Toradol), indomethacin (Indocin)
- NSAIDs are contraindicated in clients with hypersensitivity or liver or renal disease.
- side/adverse effect: hepatotoxicity, gastric irritation, decreased renal function, tinnitus, blurred vision, dysrhythmias, blood dyscrasias, cardiovascular thrombotic events, dizziness, headache
- Monitor for signs of bleeding such as tarry stools, bleeding gums, petechiae, ecchymosis, and purpura. Instruct the client to take the medication with water, milk, or food. An enteric-coated or buffered form of aspirin can be taken to decrease gastric distress. Clients taking aspirin should sit upright for 20 to 30 minutes after taking the dose. Note that aspirin should be discontinued 3 to 7 days before surgery to reduce the risk of bleeding. Clients taking anticoagulants should not take aspirin or NSAIDs. Aspirin and NSAIDs should not be taken together because aspirin decreases the blood level and the effectiveness of the NSAIDs and can increase the risk of bleeding. Instruct the client to avoid alcoholic beverages.