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Antibiotics - Oxazolidinones: Nursing Pharmacology

Notes

Notes

ANTIBIOTICS: OXAZOLIDINONES
DRUG NAME
linezolid (Zyvox), tedizolid (Sivextro)
CLASS
Oxazolidinones
MECHANISM OF ACTION
Bind to bacterial 50S ribosomal subunit → stop protein synthesis and bacterial growth
INDICATIONS
Infections caused by:
  • Streptococci
  • Staphylococci, including MRSA
  • Enterococci, including VRE
  • Mycobacteria
  • Anaerobes (Fusobacterium, Prevotella, Porphyromonas, Bacteroides, Peptostreptococcus)
ROUTE(S) OF ADMINISTRATION
  • PO
  • IV
SIDE EFFECTS
  • Headaches, dizziness, insomnia
  • Gastrointestinal discomfort (nausea, vomiting, diarrhea)
  • Clostridioides difficile infection (CDI)
  • Reversible bone marrow suppression → anemia, leukopenia, thrombocytopenia
  • Reversible optic neuropathy
  • Irreversible peripheral neuropathy
  • Serotonin syndrome
  • Hypertensive crisis
  • Hypoglycemia
CONTRAINDICATIONS AND CAUTIONS
  • Uncontrolled hypertension
  • Pheochromocytoma
  • Thyrotoxicosis
  • Bone marrow suppression, thrombocytopenia
  • Seizures
  • Gastrointestinal or renal disease
  • Pregnancy and breastfeeding
  • Children
  • Interactions:
    • Sympathomimetic medications (pseudoephedrine)
    • Vasopressors (epinephrine, norepinephrine)
    • Dopaminergic medications (dopamine, dobutamine)
    • Serotonergic medications (MAOIs, TCAs, SSRIs)
NURSING CONSIDERATIONS for ANTIBIOTICS: OXAZOLIDINONES
ASSESSMENT AND MONITORING
Assessment
  • Affected area: drainage, odor, redness, warmth, swelling, pain
  • Vital signs
  • Laboratory test results: CBC, blood glucose, renal and hepatic function, wound culture and sensitivity

Monitoring
  • Side effects
  • Therapeutic response: resolution of the infection
  • Vital signs and CBC
CLIENT EDUCATION
  • Purpose of medication: resolve the infection
  • Take this medication twice daily with or without food, and with plenty of fluids
  • Oral suspension: invert the bottle gently 3–4 times; do not shake; use measuring cup or oral syringe to ensure accurate dosing
  • Complete the entire course of medication
  • Avoid foods that have been pickled, smoked, or fermented during therapy
  • Report side effects
    • CDI
    • Peripheral neuropathy
    • Visual changes
    • Lactic acidosis
    • Allergic reaction
    • Serotonin syndrome
    • Bone marrow suppression
    • Hypoglycemia
Transcript

Oxazolidinones are a class of antibiotics used to treat a wide range of infections caused by gram positive bacteria, such as Streptococcus spp, Staphylococcus spp, including methicillin-resistant Staphylococcus aureus or MRSA for short, and Enterococci spp, including vancomycin-resistant Enterococci or VRE, and other strains resistant to other classes of antibiotics.

Additionally, oxazolidinones can be effective against mycobacteria and certain anaerobic bacteria, such as Fusobacterium spp, Prevotella spp, Porphyromonas spp, Bacteroides spp, and Peptostreptococcus spp.

Alright, the most commonly used oxazolidinones include linezolid and tedizolid. These medications can be administered orally or intravenously.

Once administered, oxazolidinones target the bacterial 50S ribosomal subunit, which inhibits protein synthesis. As a result, these medications have a bacteriostatic effect, meaning they stop bacterial growth.

Side effects of oxazolidinones include headaches, dizziness, and insomnia; as well as optic neuropathy, which can lead to vision loss, but is usually reversible; and peripheral neuropathy, which can manifest as numbness, tingling, or weakness in the arms and legs, and is typically irreversible.

Some clients may also experience changes in tongue color and taste, as well as gastrointestinal disturbances like nausea, vomiting, and diarrhea.

In addition, oxazolidinones may disrupt the normal intestinal flora, which can allow certain bacteria like Clostridioides difficile to survive and overgrow within the gastrointestinal tract, rarely but potentially leading to Clostridioides difficile infection or CDI for short.

A very serious side effect of oxazolidinones is reversible bone marrow suppression, which can result in anemia, leukopenia, and thrombocytopenia.

Clients taking oxazolidinones may also develop lactic acidosis, as well as hypersensitivity reactions, such as Stevens Johnson syndrome or anaphylaxis.

In addition, one of the most serious side effects of oxazolidinones is serotonin syndrome. That’s because these medications partially inhibit enzymes called monoamine oxidases or MAOs for short, which are responsible for the breakdown of neurotransmitters like serotonin.

This typically occurs when oxazolidinones are combined with serotonergic medications that also increase the level of serotonin in the brain, including tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors.

So, clients that develop serotonin syndrome usually present with skin flushing, hyperthermia, agitation, muscle rigidity, seizures, and altered mental status, or even coma.

Finally, another dangerous side effect of oxazolidinones is a hypertensive crisis, which is most commonly seen when combined with tyramine-rich food and drinks, such as aged cheese, red wine, and beer; as well as foods containing phenylalanine such as chocolate and caffeine.

Clients that develop hypertensive crisis typically present with hypertension, tachycardia, and arrhythmias, as well as hyperthermia, and agitation.

As far as contraindications go, oxazolidinones should be avoided in clients with uncontrolled hypertension, or other conditions that cause hypertension, such as pheochromocytoma, or thyrotoxicosis, unless their blood pressure and heart rate are closely monitored.

Regarding interactions, oxazolidinones shouldn’t be combined with sympathomimetic medications, such as pseudoephedrine, vasopressors like epinephrine and norepinephrine, and dopaminergic medications, such as dopamine and dobutamine, which also raise blood pressure.

Also, oxazolidinones should not be administered within 14 days of other serotonergic medications like MAO inhibitors.