3.13 Tetracyclines
Tetracyclines are broad-spectrum antibiotics that are bacteriostatic, subsequently inhibiting bacterial growth.
Mechanism of Action: Tetracyclines work by penetrating the bacterial cell wall and binding to the 30S ribosome, inhibiting the protein synthesis required to make the cellular wall.[1]
Indications: Tetracycline medications are useful for the treatment of many gram-positive and gram-negative infectious processes yet are limited due to significant side effects experienced by many clients.
Nursing Considerations: Significant side effects of tetracycline drug therapy include photosensitivity, discoloration of developing teeth and enamel hypoplasia, and renal and liver impairment.[2] Tetracyclines are contraindicated in pregnancy and for children ages 8 and under. Small amounts may be excreted in breast milk.
Side Effects/Adverse Effects: Side effects of tetracycline medications include GI upset and photosensitivity. Adverse effects include candidiasis and C-diff. Tetracyclines may cause permanent teeth discoloration if given to clients less than 8 years old. Significant adverse effects include increased intracranial pressure, and clients should be monitored for new-onset headaches, blurred vision, diplopia, and vision loss. Tetracyclines also decrease the effectiveness of oral contraceptives; therefore, backup contraceptive methods should be used.
Health Teaching & Health Promotion: Clients should be instructed to avoid direct sunlight exposure and wear sunscreen to prevent skin sensitivities. Additionally, it is important for clients to be educated regarding potential impaired absorption of tetracycline with the use of dairy products. Clients who are on oral contraceptives should be educated that tetracyclines may impede the effectiveness of the oral contraceptive, and an alternative measure of birth control should be utilized while on the antibiotic. Female clients must be aware to immediately stop tetracycline if they become pregnant. Expired tetracycline should be immediately disposed of as it can become toxic.[3]
Now let’s take a closer look at the medication grid for tetracycline in Table 3.13.[4]
Table 3.13 Tetracycline Medication Grid
Class/Subclass |
Prototype/Generic |
Nursing Considerations |
Therapeutic Effects |
Side/Adverse Effects |
|---|---|---|---|---|
| Tetracyclines | tetracycline | Check allergies
Alert: Check expiration date. Using outdated or deteriorated drug has been linked to severe reversible nephrotoxicity (Fanconi syndrome) Effectiveness is reduced when drug is given with milk or other dairy products, antacids, or iron products For best drug absorption, give drug with a full glass of water on an empty stomach at least 1 hour before or 2 hours after meals Give drug at least 1 hour before bedtime to prevent esophageal irritation or ulceration Use caution with renal or hepatic impairment Avoid using in children younger than age 8 because drug may cause permanent discoloration of teeth, enamel defec