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29.07 Anti-Infective – Tetracyclines

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Overview

Overview

A.    Bacteriostatic agents

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

 

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Video Transcript

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


Tetracyclines are a bactericidal 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!

 
  • Question 1 of 6

A client is being prescribed doxycyline and the nurse knows that which of the following would be a contraindication for this client?

  • Question 2 of 6

A nurse is giving a client education on tetracycline use and asks about other medications that the client takes. The nurse would be concerned by which of the following other medications being used with tetracyclines? Select all that apply.

  • Question 3 of 6

A nurse is caring for a client that is being ordered tetracycline for a tick bite. The nurse knows that which of the following tick bite illnesses are treated with tetracyclines? Select all that apply.

  • Question 4 of 6

A client is being prescribed a tetracycline and asks the nurse about names of tetracycline medications. The nurse knows that which of the following medications is not a tetracycline?

  • Question 5 of 6

A client comes to the office because of side effects of their prescription for tetracycline. The nurse would expect to see which of the following on assessment?

  • Question 6 of 6

A nurse is preparing to administer tetracycline to a client with a urinary tract infection. Which of the following is a contraindication to using this drug? Select all that apply.

Module 0 – Pharmacology Course Introduction
Module 3 – Disease Specific Medications

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