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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