{"id":110,"date":"2019-09-22T17:53:09","date_gmt":"2019-09-22T21:53:09","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/3-12-macrolides\/"},"modified":"2022-12-12T15:29:35","modified_gmt":"2022-12-12T20:29:35","slug":"3-12-macrolides","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/3-12-macrolides\/","title":{"raw":"3.12 Macrolides","rendered":"3.12 Macrolides"},"content":{"raw":"Macrolides are complex antibacterial broad-spectrum medications that are effective against both gram-positive and gram-negative bacteria.\r\n\r\n<strong>Mechanism of Action:<\/strong> Macrolides inhibit RNA protein synthesis and suppress reproduction of the bacteria. Macrolides are bacteriostatic as they do not actually kill bacteria, but inhibit additional growth and allow the body's immune system to kill the offending bacteria.[footnote]This work is a derivative of <a href=\"https:\/\/cnx.org\/contents\/5CvTdmJL@7.1:rFziotaH@5\/Introduction\"  rel=\"noopener noreferrer\">Microbiology<\/a> by <a href=\"https:\/\/openstax.org\/\"  rel=\"noopener noreferrer\">OpenStax<\/a> licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\"  rel=\"noopener noreferrer\">CC BY 4.0<\/a>. Access for free at <a class=\"internal\" href=\"https:\/\/openstax.org\/books\/microbiology\/pages\/1-introduction\"  rel=\"noopener noreferrer\">https:\/\/openstax.org\/books\/microbiology\/pages\/1-introduction<\/a>[\/footnote]\r\n\r\n<strong>Indications for Use:<\/strong> Macrolides are often used for respiratory infections, otitis media, pelvic inflammatory infections, and Chlamydia.\r\n\r\n<strong>Nursing Considerations Across the Lifespan:<\/strong> Macrolides are safe for use across the lifespan, including in pregnancy and with pediatric clients.\r\n\r\n<strong>Specific Administration Considerations:<\/strong> Macrolides can have significant impact on liver function and should be used cautiously in clients with liver disease or impairment.\r\n\r\n<strong>Patient Teaching &amp; Education:<\/strong> GI upset is common and clients can be advised to take medication with food. Clients should also be advised to avoid excessive sunlight and to wear protective clothing and use sunscreen when outside, as well as to report any adverse reactions immediately.\u00a0 Advise clients to report symptoms of chest pain, palpitations, or yellowing of eyes or skin.\u00a0 Additionally, clients should be advised that these medications can cause drowsiness.[footnote]uCentral from Unbound Medicine. <a href=\"https:\/\/www.unboundmedicine.com\/ucentral\"  rel=\"noopener noreferrer\">https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\r\n<h1>Macrolides Medication Card<\/h1>\r\nNow let's take a closer look at the medication card for erythromycin and azithromycin.[footnote]Daily Med, <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm\"  rel=\"noopener noreferrer\">https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 28, 2019.[\/footnote][footnote]UpToDate (2021). Erythromycin. <a href=\"https:\/\/www.uptodate.com\/contents\/search\">https:\/\/www.uptodate.com\/contents\/search<\/a>[\/footnote] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">Medication Card 3.12.1: <strong>Macrolides<\/strong> (<a class=\"rId49\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=16e754a6-f8e0-4ecf-8300-c55aebe73e33&amp;audience=consumer\"  rel=\"noopener noreferrer\">erythromycin,\u00a0<\/a><a class=\"rId50\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=8acce3c1-f4be-4968-a71f-3ffd9fbaa4a4&amp;audience=consumer\"  rel=\"noopener noreferrer\">azithromycin<\/a>)<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<strong>Class:<\/strong> Macrolides\r\n\r\n<strong>Prototypes:<\/strong> erythromycin, azithromycin\r\n\r\n<strong>Mechanism:<\/strong>\u00a0 Bacteriostatic \u2013 work by inhibiting RNA protein synthesis and suppressing reproduction of the bacteria.\r\n<h3>Therapeutic Effects<\/h3>\r\n<ul>\r\n \t<li>Monitor for systemic signs of infection:\r\n<ul>\r\n \t<li>WBC<\/li>\r\n \t<li>Temperature<\/li>\r\n \t<li>Culture results<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Monitor site of infection for improvement<\/li>\r\n<\/ul>\r\n<h3>Administration<\/h3>\r\n<ul>\r\n \t<li>alternative to B-lactam if pt allergic<\/li>\r\n \t<li>inhibits translocation of proteins (binding to ribosome 50S = cell death)<\/li>\r\n \t<li>*effective against species that reproduce inside host cells (listeria, Neisseria, campylobacter) instead of just ones in bloodstream\/interstitial spaces<\/li>\r\n \t<li>PO: Reconstitute suspension with water. Can be given with or without food. Take with food if GI upset occurs<\/li>\r\n \t<li>IV: Reconstitute and shake until well dissolved. Dilute as instructed. Infuse a 500-mg dose of azithromycin IV over 1 hour or longer. Never give as a bolus or IM injection<\/li>\r\n \t<li>May prolong QT interval segment. Monitor for dysrhythmias<\/li>\r\n<\/ul>\r\n<h3>Indications<\/h3>\r\n<ul>\r\n \t<li>upper, lower respiratory tract infections<\/li>\r\n \t<li>skin infections<\/li>\r\n \t<li>soft tissue infections<\/li>\r\n \t<li>STIs: syphilis, gonorrhea, chlamydia<\/li>\r\n \t<li>lyme disease<\/li>\r\n \t<li>strep<\/li>\r\n<\/ul>\r\n<h3>Contraindications<\/h3>\r\n<ul>\r\n \t<li>competes with other drugs for liver metabolism bc *highly protein bound<\/li>\r\n \t<li>decreased efficiency of oral birth control<\/li>\r\n \t<li>pregnancy<\/li>\r\n \t<li>geriatric<\/li>\r\n<\/ul>\r\n<h3>Side Effects<\/h3>\r\n<ul>\r\n \t<li>Erythromycin: GI irritation = increase motility<\/li>\r\n \t<li>*GI<\/li>\r\n \t<li>GI disturbances<\/li>\r\n \t<li>Hypersensitivity<\/li>\r\n \t<li>Skin rashes<\/li>\r\n<\/ul>\r\n<h3>Nursing Considerations<\/h3>\r\n<ul>\r\n \t<li>monitor skin<\/li>\r\n \t<li>monitor bowels<\/li>\r\n \t<li>monitor labs, esp liver enzymes<\/li>\r\n \t<li>good category if pt allergic to penicillin<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">Clincal Reasoning and Decsion-Making Activity 3.11a<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<strong>Using the above information, consider the following clinical scenario question:<\/strong>\r\n\r\nA nurse is administering azithromycin to a client with an acute bacterial worsening of COPD. Today the client's sclera appear yellow, which is a new finding. What is the nurse's next best response?\r\n\r\nNote: Answers to the\u00a0 activities can be found in the \"<a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/chapter-3\/\">Answer Key<\/a>\" sections at the end of the book.\r\n\r\n<\/div>\r\n<\/div>","rendered":"<p>Macrolides are complex antibacterial broad-spectrum medications that are effective against both gram-positive and gram-negative bacteria.<\/p>\n<p><strong>Mechanism of Action:<\/strong> Macrolides inhibit RNA protein synthesis and suppress reproduction of the bacteria. Macrolides are bacteriostatic as they do not actually kill bacteria, but inhibit additional growth and allow the body&#8217;s immune system to kill the offending bacteria.<a class=\"footnote\" title=\"This work is a derivative of Microbiology by OpenStax licensed under CC BY 4.0. Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/1-introduction\" id=\"return-footnote-110-1\" href=\"#footnote-110-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<p><strong>Indications for Use:<\/strong> Macrolides are often used for respiratory infections, otitis media, pelvic inflammatory infections, and Chlamydia.<\/p>\n<p><strong>Nursing Considerations Across the Lifespan:<\/strong> Macrolides are safe for use across the lifespan, including in pregnancy and with pediatric clients.<\/p>\n<p><strong>Specific Administration Considerations:<\/strong> Macrolides can have significant impact on liver function and should be used cautiously in clients with liver disease or impairment.<\/p>\n<p><strong>Patient Teaching &amp; Education:<\/strong> GI upset is common and clients can be advised to take medication with food. Clients should also be advised to avoid excessive sunlight and to wear protective clothing and use sunscreen when outside, as well as to report any adverse reactions immediately.\u00a0 Advise clients to report symptoms of chest pain, palpitations, or yellowing of eyes or skin.\u00a0 Additionally, clients should be advised that these medications can cause drowsiness.<a class=\"footnote\" title=\"uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral\" id=\"return-footnote-110-2\" href=\"#footnote-110-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<h1>Macrolides Medication Card<\/h1>\n<p>Now let&#8217;s take a closer look at the medication card for erythromycin and azithromycin.<a class=\"footnote\" title=\"Daily Med, https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm, used for hyperlinked medications in this module. Retrieved June 28, 2019.\" id=\"return-footnote-110-3\" href=\"#footnote-110-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><a class=\"footnote\" title=\"UpToDate (2021). Erythromycin. https:\/\/www.uptodate.com\/contents\/search\" id=\"return-footnote-110-4\" href=\"#footnote-110-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a> Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.<\/p>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\">Medication Card 3.12.1: <strong>Macrolides<\/strong> (<a class=\"rId49\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=16e754a6-f8e0-4ecf-8300-c55aebe73e33&amp;audience=consumer\" rel=\"noopener noreferrer\">erythromycin,\u00a0<\/a><a class=\"rId50\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=8acce3c1-f4be-4968-a71f-3ffd9fbaa4a4&amp;audience=consumer\" rel=\"noopener noreferrer\">azithromycin<\/a>)<\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p><strong>Class:<\/strong> Macrolides<\/p>\n<p><strong>Prototypes:<\/strong> erythromycin, azithromycin<\/p>\n<p><strong>Mechanism:<\/strong>\u00a0 Bacteriostatic \u2013 work by inhibiting RNA protein synthesis and suppressing reproduction of the bacteria.<\/p>\n<h3>Therapeutic Effects<\/h3>\n<ul>\n<li>Monitor for systemic signs of infection:\n<ul>\n<li>WBC<\/li>\n<li>Temperature<\/li>\n<li>Culture results<\/li>\n<\/ul>\n<\/li>\n<li>Monitor site of infection for improvement<\/li>\n<\/ul>\n<h3>Administration<\/h3>\n<ul>\n<li>alternative to B-lactam if pt allergic<\/li>\n<li>inhibits translocation of proteins (binding to ribosome 50S = cell death)<\/li>\n<li>*effective against species that reproduce inside host cells (listeria, Neisseria, campylobacter) instead of just ones in bloodstream\/interstitial spaces<\/li>\n<li>PO: Reconstitute suspension with water. Can be given with or without food. Take with food if GI upset occurs<\/li>\n<li>IV: Reconstitute and shake until well dissolved. Dilute as instructed. Infuse a 500-mg dose of azithromycin IV over 1 hour or longer. Never give as a bolus or IM injection<\/li>\n<li>May prolong QT interval segment. Monitor for dysrhythmias<\/li>\n<\/ul>\n<h3>Indications<\/h3>\n<ul>\n<li>upper, lower respiratory tract infections<\/li>\n<li>skin infections<\/li>\n<li>soft tissue infections<\/li>\n<li>STIs: syphilis, gonorrhea, chlamydia<\/li>\n<li>lyme disease<\/li>\n<li>strep<\/li>\n<\/ul>\n<h3>Contraindications<\/h3>\n<ul>\n<li>competes with other drugs for liver metabolism bc *highly protein bound<\/li>\n<li>decreased efficiency of oral birth control<\/li>\n<li>pregnancy<\/li>\n<li>geriatric<\/li>\n<\/ul>\n<h3>Side Effects<\/h3>\n<ul>\n<li>Erythromycin: GI irritation = increase motility<\/li>\n<li>*GI<\/li>\n<li>GI disturbances<\/li>\n<li>Hypersensitivity<\/li>\n<li>Skin rashes<\/li>\n<\/ul>\n<h3>Nursing Considerations<\/h3>\n<ul>\n<li>monitor skin<\/li>\n<li>monitor bowels<\/li>\n<li>monitor labs, esp liver enzymes<\/li>\n<li>good category if pt allergic to penicillin<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Clincal Reasoning and Decsion-Making Activity 3.11a<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p><strong>Using the above information, consider the following clinical scenario question:<\/strong><\/p>\n<p>A nurse is administering azithromycin to a client with an acute bacterial worsening of COPD. Today the client&#8217;s sclera appear yellow, which is a new finding. What is the nurse&#8217;s next best response?<\/p>\n<p>Note: Answers to the\u00a0 activities can be found in the &#8220;<a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/chapter-3\/\">Answer Key<\/a>&#8221; sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-110-1\">This work is a derivative of <a href=\"https:\/\/cnx.org\/contents\/5CvTdmJL@7.1:rFziotaH@5\/Introduction\" rel=\"noopener noreferrer\">Microbiology<\/a> by <a href=\"https:\/\/openstax.org\/\" rel=\"noopener noreferrer\">OpenStax<\/a> licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\" rel=\"noopener noreferrer\">CC BY 4.0<\/a>. Access for free at <a class=\"internal\" href=\"https:\/\/openstax.org\/books\/microbiology\/pages\/1-introduction\" rel=\"noopener noreferrer\">https:\/\/openstax.org\/books\/microbiology\/pages\/1-introduction<\/a> <a href=\"#return-footnote-110-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-110-2\">uCentral from Unbound Medicine. <a href=\"https:\/\/www.unboundmedicine.com\/ucentral\" rel=\"noopener noreferrer\">https:\/\/www.unboundmedicine.com\/ucentral<\/a> <a href=\"#return-footnote-110-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-110-3\">Daily Med, <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm\" rel=\"noopener noreferrer\">https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 28, 2019. <a href=\"#return-footnote-110-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-110-4\">UpToDate (2021). Erythromycin. <a href=\"https:\/\/www.uptodate.com\/contents\/search\">https:\/\/www.uptodate.com\/contents\/search<\/a> <a href=\"#return-footnote-110-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":90,"menu_order":12,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[50],"contributor":[],"license":[],"class_list":["post-110","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":70,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/110","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/users\/90"}],"version-history":[{"count":5,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/110\/revisions"}],"predecessor-version":[{"id":1418,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/110\/revisions\/1418"}],"part":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/70"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/110\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/media?parent=110"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=110"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/contributor?post=110"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/license?post=110"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}