Question

1. What organs are susceptible to toxicity with antimicrobials? What signs and symptoms would alert the nurse to toxicity with each?
2. What is a peak and trough?
3. With IV administration of some antimicrobials, what should be assessed for at the administration site?
4. Sulfa antimicrobials cause crystalluria and blood dyscrasias. What are these?
5. Why would the nurse question the administration of an antimicrobial that is a pregnancy category D?
6. Why use back-up oral contraceptives with some antimicrobials?

Answer 1

What organs are susceptible to toxicity with antimicrobials?
Ans: Antimicrobial drugs can have unintended side effects, including being toxic to organs. The liver and kidney are particularly susceptible to organ toxicity as they are the sites of toxin filtration and toxin metabolic breakdown. Almost any organ or tissue in the human body can be affected by antimicrobial toxicity.

What signs and symptoms would alert the nurse to toxicity with each?
Ans:
Hepato toxicity: Symptoms of hepatotoxicity can include rash, stomach pain, nausea and vomiting, fatigue, dark-colored urine, light-colored bowel movements, jaundice (yellow skin and eyes), loss of appetite, and fever ,eleveted enzyme levels.
Nephrotoxicity: signs and symptoms may include
Decreased urine output, although occasionally urine output remains normal.
Fluid retention, causing swelling in your legs, ankles or feet.
Shortness of breath.
Fatigue.
Confusion.
Nausea.
Weakness.
Irregular heartbeat.
altered measurements of blood urea nitrogen (BUN), concentration of serum creatinine, glomerular filtration rate and creatinine clearance. However, these assessments of nephrotoxicity are only possible when a majority of kidney function is damaged.

What is a peak and trough?
The trough level is the lowest concentration in the patient's bloodstream, therefore, the specimen should be collected just prior to administration of the drug. The peak level is the highest concentration of a drug in the patient's bloodstream.

With IV administration of some antimicrobials, what should be assessed for at the administration site?
Check for extravasation and thrombophlebitis.
Inspect the IV catheter insertion site for redness, swelling, or bruising. Redness can indicate irritation, inflammation, infection, or thrombus formation. Bruising may indicate that a hematoma has developed and may cause damage to surrounding tissues.
Assess the condition of the transparent catheter dressing. The dressing should be clean, dry, and adhere securely to the skin around the IV catheter insertion site. Loose, wet, or soiled dressings should be changed using aseptic technique.
Assess for tenderness and swelling: Gently palpate the area around the IV catheter insertion site and ask the patient if the area is tender or painful. Tenderness may indicate that the insertion site has become inflamed or infected.

Sulfa antimicrobials cause crystalluria and blood dyscrasias. What are these?
Crystalluria :Crystalluria refers to cloudy urine when the cause of cloudiness is due to crystals found in the urine when performing a urine test. Crystalluria is considered often as a benign condition and as one of the side effects of sulfonamides and penicillins.Crystalluria is identified by microscopic examination of urine sediment. sulfonamides are known to be little solubles in acidic urine may be the cause.
Blood dyscrasias:Dyscrasia is a nonspecific term that refers to a disease or disorder, especially of the blood. The latter is called a blood dyscrasia. Sulfonamides may cause blood dyscrasias such as low white blood cell count (leucopenia), low platelet count (thrombocytopenia), and anemia.

Why would the nurse question the administration of an antimicrobial that is a pregnancy category D?
Category D drugs have positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.since it must be clarified.

Why use back-up oral contraceptives with some antimicrobials?
Many antibiotics are believed to decrease oral contraceptive efficacy in this manner, including penicillins, cephalosporins, tetracyclines, macrolides, antifungals, metronidazole, sulphonamides and antituberculosis agents.since it is better to use back up contraceptive.