Pharm, part 46: Immune Medications - Antibiotics - Protein Synthesis Inhibitors

by Cathy Parkes September 24, 2021 Updated: April 14, 2022 7 min read

In this article, we begin to cover systemic anti-infectives. And, in particular, antibiotics that inhibit protein synthesis.

The Nursing Pharmacology video series follows along with our Pharmacology Second Edition Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Cool Chicken When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

Macrolides: azithromycin (Zithromax), erythromycin (E-Mycin)

Cool Chicken Azithromycin, Erythromycin (Macrolides): used for respiratory infections. If you “throw the mice” they slide because of phlegm.

Macrolides include medications such as azithromycin and erythromycin. These medications are used to treat a variety of bacterial infections, but they are not effective against MRSA (methicillin-resistant staphylococcus aureus).

Mode of action of macrolides

Macrolides work by inhibiting protein synthesis, which slows bacterial growth. This is known as bacteriostatic.

Side effects of macrolides

Side effects include GI upset. Other side effects include dysrhythmias (irregular beating of the heart, including Torsades de Pointes), as well as ototoxicity (balance or hearing issues) and rash.

Note: Take this medication on an empty stomach with a full glass of water.

Lincosamides: clindamycin (Cleocin)

Lincosamides, including clindamycin, are antibiotics used for serious bacterial infections.

Mode of action of clindamycin

Clindamycin works by inhibiting protein synthesis. And it can be either bactericidal (it kills the bacteria) or bacteriostatic, depending on the concentration.

Side effects of clindamycin

Clindamycin's side effects include GI upset, diarrhea, and the possibility for a superinfection, for example, the contact infection clostridium difficile, also known as Clostridioides difficile or C. diff. C. diff is a germ (bacterium) that causes severe diarrhea and colitis (an inflammatory reaction in the colon).

This medication carries a black box warning because of the risk of CDAD (C. difficile-associated disease).

Note: It is important for a patient on this medication to monitor their bowel movements for frequent, watery diarrhea, which could indicate the presence of C. diff.

Aminoglycoside: gentamicin (Garamycin)

Cool Chicken Gentamicin is the OPPOSITE of gentle. It causes ototoxicity and nephrotoxicity.

Of the aminoglycosides to know, gentamicin is probably most important. Gentamicin is used to treat very serious bacterial infections.

Mode of action of gentamicin

Gentamicin works by inhibiting protein synthesis. It is bactericidal (kills bacteria).

Side effects of gentamicin

Gentamicin has some serious side effects, including ototoxicity, as well as nephrotoxicity (rapid deterioration of the liver and kidney functions caused by medicine, a chemical, or an herbal or dietary supplement, respectively). Other side effects include vertigo (a spinning sensation) and ataxia (impaired balance and coordination).

Gentamicin has a black box warning because of the risk of ototoxicity.

Nursing care for a patient on gentamicin

Monitor the patient for symptoms such as tinnitus or hearing loss.

In addition, monitor the patient's kidney function (creatinine, BUN, urinalysis) throughout therapy because of the risk of nephrotoxicity.

You can learn about these diagnostics and more with our Lab Values Study Guide & Flashcard Index, a list of lab values covered in our Lab Values Flashcards for nursing students, an easy reference guide.

This medication is administered through the intramuscular route or IV route.

Gentamicin has a narrow therapeutic range, which will require frequent blood draws.

Finally, it is important to monitor the patient’s peak and trough levels of gentamicin.

Tetracyclines: doxycycline (Vibramycin), tetracycline (Sumycin)

Cool Chicken Tetris: LOTS of little blocks (that look like square teeth) — helps to remind you that Tetracycline treats LOTS of things and causes discolored teeth in fetus/children.

Among the medications that fall within this class are tetracycline and doxycycline.

These medications are used to treat a wide variety of bacterial infections, including acne, Lyme disease, STDs, and Rocky Mountain spotted fever (a bacterial disease spread through the bite of an infected tick).

Mode of action of tetracyclines

Tetracyclines work by preventing protein synthesis, which inhibits bacterial growth. That means tetracyclines are bacteriostatic.

Side effects of tetracyclines

Tetracyclines have side effects that include GI upset, tooth discoloration in children (and in fetuses), as well as hepatotoxicity (liver damage caused by exposure to drugs), photosensitivity, and possibility of superinfection, such as C. diff.

Patient teaching for tetracyclines

Never give this medication to children under eight or to pregnant women because of the side effect of tooth discoloration.

Advise the patient to wear sunscreen due to photosensitivity.

Take this medication on an empty stomach with a full glass of water. However, note that there are certain food products and medications that the patient must avoid because they will decrease the absorption of tetracycline. These foods include dairy products, and foods that are high in calcium or iron. Patients should also avoid antacids — all of these will decrease absorption of this medication.

Finally, tetracyclines decrease the effectiveness of oral contraceptives.


Full Transcript

Okay. In this video, we are going to start going over systemic anti-infectives. And in particular, during this video, we will be focusing on antibiotics that inhibit protein synthesis. If you are following along with cards, I am on card 153.

All right. Let's first talk about macrolides. Macrolides include medications such as azithromycin and erythromycin.

These medications are used to treat a variety of bacterial infections, but they are not effective against MRSA.

They work by inhibiting protein synthesis, which slows bacterial growth. So they are bacteriostatic.

Side effects include GI upset, which I can attest to because erythromycin makes me super sick. Other side effects include dysrhythmias, as well as auto toxicity, and rash. You're supposed to take this medication on an empty stomach with a full glass of water and then try not the barf.

And then in terms of a hint for how you can remember these medications, this hint comes from a Level Up RN crew member. So azithromycin and erythromycin are used for respiratory infections. And if you look at the drug names, it looks like they have throw the mice, right? Throw mice. So if you throw the mice, they will slide because of phlegm due to respiratory infections, so. Well, hopefully help you remember that these medications are used for infections such as respiratory infections.

All right. Now, let's talk about Lincosamides, which is clindamycin.

Clindamycin is used for serious bacterial infections.

It works by inhibiting protein synthesis. And it can be either bactericidal or bacteriostatic, depending on the concentration.

Key side effects include GI upset, as well as diarrhea, and the possibility for a super infection. For example, clostridium difficile.

This medication actually carries a black box warning because of the risk of CDAD.

So it's going to be really important when your patient is on this medication to really monitor their bowel movements for frequent, watery diarrhea, which could indicate the presence of C. diff.

All right. Let's now talk about an important aminoglycosides to know, which is gentamicin.

Gentamicin is used for very serious bacterial infections.

It works by inhibiting protein synthesis. And it is bactericidal, so it kills the bacteria.

It does come with some very serious side effects, including autotoxicity, as well as nephrotoxicity. And then other side effects include vertigo, as well as ataxia.

It does have a black box warning because of that risk of autotoxicity.

So you're definitely going to want to monitor your patient and ask them about any symptoms such as tinnitus or hearing loss. In addition, we're going to want to monitor our patient's kidney function throughout therapy because of the risk of nephrotoxicity. Also, we administer this medication through the intramuscular route or IV route. And it does have a narrow therapeutic range. So we're going to want to do frequent blood draws, and monitor the patient's peak and trough levels of gentamicin.

So my tip for remembering this is that Gentamicin is the opposite of gentle. It causes autotoxicity as well as nephrotoxicity. So it is a very potent antibiotic.

Okay. So last but not the least are tetracyclines. If you're following along with cards, definitely take a look at the back of this card because there's a lot of bold red items that are going to be really important for you to know.

So a couple of medications that fall within this class include tetracycline as well as doxycycline.

These medications are used to treat a wide variety of bacterial infections, including acne, Lyme disease, STDs, and Rocky Mountain spotted fever, just to name a few.

Tetracyclines work by preventing protein synthesis, which inhibits bacterial growth. So it is bacteriostatic.

There are quite a few side effects to know. These include GI upset, tooth discoloration in children and in fetuses, as well as hepatotoxicity, photosensitivity, and a possible super infection such as C. diff.

So there are some important teaching points that you definitely need to provide to your patient. First of all, we would never give this medication to children under eight or pregnant women because of that side effect of tooth discoloration. In addition, we should advise our patient to wear sunscreen because of the side effect of photosensitivity. We take this medication on an empty stomach with a full glass of water. However, there are certain food products and medications that we need the patient to avoid because they decrease the absorption of tetracycline. So patients should avoid dairy products, foods that are high in calcium or iron. And they should also avoid antacids. Again, all of these things will decrease absorption of this medication. And in addition, tetracyclines also decrease the effectiveness of oral contraceptives. So that's another important teaching point.

So the trick or the tip I got for learning about tetracycline and some of the side effects came to me from a Level Up RN crew member, who says that tetracycline reminds her of Tetris. And in Tetris, there's lots of little blocks which look like little square teeth. And that helps to remind you that tetracycline treats lots of little things. Like you have all these little blocks. And it causes discolored teeth in children and fetuses. So I really felt like that tip was helpful.

I hope you find it helpful as well. And stay tuned for more antibiotics in my next video. Thanks so much for watching.


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