Anti-Infective – Tetracyclines

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Outline

Overview

      I.         Overview

A.    Bacteriostatic agents (note that in the video she says bacteriocidal but bacteriostatic is correct)

B.    Gram + / – organisms, protozoa

C.     Mechanism of Action

1.     Inhibit protein synthesis

D.    Types

1.     Demeclocycline

2.     Oxytetracycline

3.     Tetracycline

4.     Doxycycline

5.     Minocycline

     II.         Indications

A.    Chlamydia

B.    Gonorrhea

C.     Chancroid

D.    Syphilis

E.     Mycoplasma pneumonia

F.     Rocky Mountain spotted fever

G.    Acne

H.    Cholera

I.      Lyme disease

J.      H. pylori infections

K.     Balantidiasis

   III.         Contraindications

A.    Drug allergy

B.    Pregnant women

C.     Nursing women

D.    Children under the age of 8

   IV.         Interactions

A.    Antacids

B.    Antidiarrheal drugs

C.     Dairy products

D.    Iron preparations

E.     Oral anticoagulants

F.     Oral contraceptives

    V.         Side Effects

A.    Discoloration of permanent teeth

B.    Tooth enamel hypoplasia

1.     Fetuses

2.     Children

C.     Abnormal fetal skeletal development

D.    Bulging fontanelles (neonates)

E.     Hematologic dysfunction

1.     Coagulation irregularities

2.     Thrombocytopenia

3.     Hemolytic anemia

F.     Photosensitivity

G.    Alternation of vaginal flora

1.     Vaginal candidiasis

H.    Alternation of intestinal flora

1.     Gastric upset

2.     Super infections

3.     Diarrhea

4.     Enterocolitis

 

Patient Education

When patients take antacids, antidiarrheal drugs, dairy or iron supplements – tetracycline absorption is reduced, thereby decreasing its baseline efficiency. With oral anticoagulants, tetracyclines increase the effects of the anticoagulants = increase bleeding. Lastly, oral contraceptives are less effective. So a back-up method is recommended while patients are taking this medication class.

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Transcript

Hey there, today we are going to discuss tetracyclines, which are a certain type of antibiotic class.


Tetracyclines are a bacteriostatic agent, which means they kill bacteria. They kill gram +/- and protozoans. They accomplish this by inhibiting protein synthesis.


As you can see, tetracyclines all have the same ending ,-CYCLINE. It’s an easy way to remember this type of antibiotic. 


Indications for tetracyclines are plentiful but I wanted to focus on two sections here. STI (sexually transmitted infections) – chlamydia, gonorrhea, and syphilis. And another population two are RMSF (Rocky mountain spotted fever) and lyme disease – tick based illnesses.


Contraindications for tetracycline include  allergies and tetracyclines are generally avoided in  pregnant / nursing women and children under 8 – as they can potentially cause development defects in newborns and in younger children. An easy way to remember the contraindications is PNC.


Now this is where tetracyclines really get interesting, their interactions with other drugs. When patients take antacids, antidiarrheal drugs, dairy or iron supplements – tetracycline absorption is reduced, thereby decreasing its baseline efficiency. With oral anticoagulants, tetracyclines increase the effects of the anticoagulants = increase bleeding. Lastly, oral contraceptives are less effective. An easy way to remember the interactions is AO AO DI.


The side effects of tetracyclines can be divided into four groups. Let’s discuss the first group: Dental – discoloration of permanent teeth (yellow or gray) due to drug calcification under in the gum line – and tooth enamel hypoplasia can occur. The hypoplasia will make children’s teeth vulnerable to tooth decay so oral care is important. These are the main reason why tetracyclines are avoided in children under 8. If the provider does prescribe this type of antibiotic due to prior drug resistance with other antibiotics the following side effect must be monitored.


The next set of side effects are children focused and include abnormal fetal skeletal development and bulging fontanelles. Research has linked this to tetracyclines and their inability to inhibit bone growth. Bulging fontanelles has been linked to tetracyclines ability to cause increased ICP in young children also. So remember this is why we aren’t regularly giving this to pregnant moms and newborns and  is contraindicated.


Hematology side effects of tetracycline used include general hematology dysfunction (anemia, thrombocytopenia, leukopenia), and coagulation irregularities.


Lastly, we have the other category and include photosensitivity, vaginal and intestinal flora alteration. The flora is altered due to broad spectrum of activity and their ability to kill the natural colonization in the body.


Priority nursing concepts for tetracyclines include pharmacology and infection control.


Alright, let’s recap. Tetracyclines all end in -CYCLINE, with many indications but 2 main ones are STI / Ticks based – chlamydia, gonorrhea, chancroid and syphilis vs. RMSF (Rocky mountain spotted fever) and lyme disease. Contraindications for tetracycline include allergies, and tetracyclines should be avoided in  pregnant / nursing women and children under 8 – as they can potentially cause development defects in newborns and in younger children. An easy way to remember the contraindications is DPNC.

Interactions – When patients take antacids, antidiarrheal drugs, dairy or iron supplements – tetracycline absorption is reduced, thereby decreasing its baseline efficiency. With oral anticoagulants, tetracyclines increase the effects of the anticoagulants = increase bleeding. Lastly, oral contraceptives are less effective. An easy way to remember the interactions is AO AO DI.

Side effects include: discoloration of permanent teeth (yellow or gray), tooth enamel hypoplasia, abnormal fetal skeletal development and bulging fontanelles, general hematology dysfunction (anemia, thrombocytopenia, leukopenia), and coagulation irregularities. Also, photosensitivity, vaginal and intestinal flora alteration.


You know now the important details regarding tetracyclines. Now, go out and be your best self today and as always, Happy Nursing!

 

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Study Plan Lessons

Digestion & Absorption
Hiatal Hernia
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Bariatric Surgeries
Trauma Survey
Stomach Cancer (Gastric Cancer)
Antidepressants
Nursing Care and Pathophysiology for Cholecystitis
Hyperthermia (Thermoregulation)
Inserting an NG (Nasogastric) Tube
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NG Tube Med Administration (Nasogastric)
Cranial Nerves
Sensory Basics
06.03 Multi-System CCRN Important Points for CCRN Review
Antidepressants
Intake and Output (I&O)
Nutrition (Diet) in Disease
Enteral & Parenteral Nutrition (Diet, TPN)
Digestive System Anatomy
Stomach Video
Addicted Newborn
Anti-Infective – Tetracyclines
Accountability and Assistance for Personal Limitations for Certified Perioperative Nurse (CNOR)
Acute Abdomen for Certified Emergency Nursing (CEN)
Advanced Directive and DNR Status Confirmation for Certified Perioperative Nurse (CNOR)
Anorexia – Signs and Symptoms Nursing Mnemonic (ANOREXIA)
ARDS causes Nursing Mnemonic (GUT PASS)
Bowel Perforation for Certified Emergency Nursing (CEN)
Cholecystitis for Certified Emergency Nursing (CEN)
Cholinergic Crisis – Signs and Symptoms Nursing Mnemonic (SLUDGE)
Cimetidine (Tagamet) Nursing Considerations
Cirrhosis for Certified Emergency Nursing (CEN)
Diabetes Insipidus Case Study (60 min)
DKA Treatment Nursing Mnemonic (KING UFC)
Encephalopathy Case Study (45 min)
Famotidine (Pepcid) Nursing Considerations
Ferrous Sulfate (Iron) Nursing Considerations
Gastrointestinal (GI) Bleed Concept Map
GERD (Gastroesophageal Reflux Disease)
GERD causes Nursing Mnemonic (Reflux Is Probably Mean)
Head to Toe Nursing Assessment (Physical Exam)
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Hyperemesis Gravidarum for Certified Emergency Nursing (CEN)
Inflammatory Bowel Disease Case Study (45 min)
Intussusception
Ischemic Bowel for Progressive Care Certified Nurse (PCCN)
Metoclopramide (Reglan) Nursing Considerations
NG Tube Medication Administration
Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)
Nursing Care and Pathophysiology for Pancreatitis
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Appendicitis
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Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Cholecystitis
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
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Nursing Care Plan (NCP) for Lyme Disease
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Nursing Care Plan (NCP) for Nutrition Imbalance
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Nursing Care Plan (NCP) for Pneumonia
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Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)
Nursing Care Plan for Gastritis
Omeprazole (Prilosec) Nursing Considerations
Pancreatitis for Certified Emergency Nursing (CEN)
Pancreatitis For PCCN for Progressive Care Certified Nurse (PCCN)
Pantoprazole (Protonix) Nursing Considerations
Patient and Family Teaching (Per Procedure) for Certified Perioperative Nurse (CNOR)
Patient Positioning
Peptic Ulcer Disease Case Study (60 min)
Peritonitis for Certified Emergency Nursing (CEN)
Preeclampsia (45 min)
Preeclampsia, Eclampsia, and HELLP Syndrome for Certified Emergency Nursing (CEN)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Ranitidine (Zantac) Nursing Considerations
Sucralfate (Carafate) Nursing Considerations
Toxic Ingestion, Inhalation, Overdose for Progressive Care Certified Nurse (PCCN)
Vitamin B12 Lab Values
Vitamin D Lab Values