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- -the medication is to be taken with plenty of fluids (2000 to 3000 mL/24 hr)
- -taken with food to decrease GI adverse effects.
- -medications are to be taken exactly as prescribed and for the full duration indicated, as with all antibiotics.
- -Doses are to be spaced at regularly scheduled intervals.
- -Instruct the patient to take oral dosage forms with water, avoiding the following beverages: caffeine-containing beverages, citrus fruit, cola beverages, fruit juices, and tomato juice (decrease effectiveness of the antibiotic).
- -If the patient must take a penicillin drug four times a day, encourage the patient to set up a reminder system (with cell phone alarms or a watch) so that blood levels remain steady.
- -advise the patient to report unresolved GI upset
- -such as diarrhea and nausea
- -Alcohol must be avoided.
- -advise patients to avoid exposure to tanning beds and direct sunlight or to use sunscreen and/or wear protective clothing because of drug-related photosensitivity.
- -These photosensitive effects may be noticed within a few minutes to hours after taking the drug and may last up to several days after the drug has been discontinued.
- -instruct the patient to take the drug as directed, and check for interactions with other drugs being taken at the same time, especially interactions between erythromycin and other medications.
- -For some drugs in this class (e.g., azithromycin), newer dosage forms are available in 3-day and 1-day dose packs rather than the 5-day dose pack. Always be sure that the patient knows the proper dosage and instructions for the drug the patient is taking.
- -Educate the patient about the drug, its purpose, and its adverse effects, including the risk of hearing loss, which may occur after completion of therapy. Advise the patient to report to the prescriber any change in hearing.
- -Forcing fluids up to 3000 mL/day, unless contraindicated, is important with any medication but especially with antibiotics to maximize absorption of oral doses, minimize some of the adverse effects, and ensure adequate hydration.
- -Instruct the patient to report to the prescriber any persistent headache, nausea, or vertigo. Educate the patient about the signs and symptoms of superinfection, such as diarrhea; vaginal discharge; stomatitis; loose and foul-smelling stools; and cough.
- Educate about the importance of avoiding exposure to the sun and tanning beds. Recommend the use of sunglasses and sunscreen protection.
- • Advise the patient to report to the prescriber any headache, dizziness, restlessness, diarrhea, vomiting, oral candidiasis, flushing of the face, and/or inflammation of the tendons.
- • Educate about drug interactions that may occur with the following drugs: calcium, magnesium, probenecid, nitrofurantoin, oral anticoagulants, antacids, iron, sucralfate, and zinc preparations. Instruct the patient to take calcium and magnesium supplements at least 1 hour before or after taking the quinolone. Probenecid may reduce the excretion of the antibiotic and cause toxicity. Since quinolones may alter the intestinal flora and thus vitamin K synthesis, oral anticoagulants must be used with caution in patients taking these antibiotics.
- • Instruct the patient to take ciprofloxacin and levofloxacin, both quinolones, exactly as ordered.
- Instruct the patient not to use topical forms near the eyes or near any abraded areas to avoid irritation.
- • When vaginal dosage forms are used, the patient needs to be advised not to engage in sexual intercourse for the duration of therapy. The full course of antibiotics are to be taken as ordered to obtain maximal therapeutic benefit.
- • If cream dosage forms get into the eyes accidentally, instruct the patient to rinse the eyes immediately with copious amounts of cool tap water.
- Instruct the patient to continue therapy for the full prescribed length of treatment (as with all antibiotics).
- • Educate the patient to avoid tyramine-containing foods (e.g., red wine, aged cheeses) while taking the drug.
- • Instruct the patient to report to the prescriber immediately any severe abdominal pain, fever, severe diarrhea, and/or worsening of signs and symptoms of infection.
- Caution the patient to avoid alcohol and any alcohol-containing products (e.g., cough preparations and elixirs) while taking the drug because of the risk for a disulfiram-like reaction (e.g., severe vomiting).
- • Educate the patient about the purpose of the drug, such as its use as either an antibacterial or an antifungal medication, because this knowledge is crucial to achieving therapeutic effects and preventing adverse effects.
Advise the patient to report to the prescriber any abdominal cramping, dizziness, severe skin reactions, or jaundice.
- Instruct the patient to report any changes in hearing such as ringing in the ears or a feeling of fullness in the ears. Any nausea, vomiting, unsteady gait, dizziness, generalized tingling (usually after intravenous dosing), chills, fever, rash, and/or hives must also be reported.
- • Monitor therapeutic serum levels throughout therapy; this monitoring is key to prevention of toxicity. Trough levels are usually monitored throughout therapy. Stress to the patient that follow-up appointments are important for monitoring serum drug levels and identifying possible toxic effects.
Amphotericin B possible adverse reactions
possible adverse effects include tinnitus, blurred vision, burning and itching at the infusion site, headache, rash, fever, chills, hypokalemia, gastrointestinal upset, and various anemias.
Instruct patients taking caspofungin to immediately report to the prescriber any problems with shortness of breath, itching, facial swelling, and/or a rash.
to be taken 1 hour before or 1 hour after meals. Warn the patient about the adverse effect of photophobia with use of this drug.