00:01
Now, the next group of
medications are the macrolides.
00:03
An example is erythromycin,
also clarithromycin
or azithromycin.
00:09
Now, if you've received a
prescription, you have likely either
been a recipient of Z-Pack,
or know somebody who got one,
but when we call a Z-Pack
is usually azithromycin,
one of the macrolides, okay?
So, we've got erythromycin,
clarithromycin, and azithromycin,
which is also known as the Z-Pack.
00:31
These guys are also broad spectrum,
which is why they're prescribed
often when a culture isn't done
because they're so broad spectrum.
00:38
They hit most gram-positive bacteria,
some of them are gram-negative,
like whooping cough and
chlamydia infections.
00:45
But basically, it hits most
of the gram-positive bacteria.
00:49
Now, someone's allergic
to penicillin G,
we can also use a macrolide like
erythromycin to fix that too.
00:57
Now, this is a very
unusual side effect,
and so we want to point it out.
01:01
We're not asking you
to read cardiac rhythm strips.
Although, that's a really important skill,
that's not part of what
we're doing in pharmacology.
01:09
Well, GI distress is the
most common side effect,
and I know we say that
with a lot of medications,
but if you've ever
taken macrolides,
they are really,
really hard on your gut.
01:21
But this one is a rare risk,
but it's a life-threatening risk.
01:26
What it does is prolong part of the
natural electricity of the heart.
01:31
So the QT interval
becomes prolonged.
01:34
And that can lead to
sudden cardiac death
from a heart rhythm called
Torsades de pointes.
01:38
Now, you'll see a picture
of what that looks like.
01:41
All you want to remember is
that this medication
has a rare side effect.
01:47
It extends the QT
interval on their 12-lead,
and the longer that makes that,
that puts the heart at risk to go into this
life-threatening rhythm
called Torsades de pointes.
01:58
So, if I already know that the patient
has a known history of QT prolongation,
like they've had an ECG,
we know that their QT interval is
already too long or longer than normal,
and they're on particular
anti-disrhythmic drugs,
erythromycin is not
a safe drug for them.
02:17
The next drug in this
family is clindamycin.
02:20
Clindamycin is a derivarive of Lincomycin,
which inhibits protein synthesis like Erithromycin does.
02:25
Now, it really has
some cool activity.
02:28
It's active against most
anaerobic organisms.
02:32
I mean,
gram-positive and gram-negative.
02:35
And it's also active against
most gram-positive aerobes,
so that's a pretty
impressive drug.
02:41
It's a great option if your
patient can't take penicillin.
02:45
It's widely used as an
alternative to penicillin.
02:47
We also use it for
2 other categories.
02:50
So, we can use clindamycin for
serious anaerobic infections
that are outside of the
central nervous system,
and severe group
A streptococcus.
03:00
Now, the adverse effects are
similar to some of the other drugs
we talked about in this family.
03:05
There's a high rate of C.
diff associated diarrhea.
03:09
Yuck.
03:10
And superinfections
that may start up
to 4 to 6 weeks after
we've stopped the
medication for the patient.
03:18
Okay, that is worth pausing and
reflecting on for just a minute.
03:20
So, not only can it develop C.
diff
for your patient from a
superinfection, it can develop
up to 4 to 6 weeks after you've
already stopped the medication.
03:31
So you want to educate your
patient to be aware of that
and to notify their health care provider
if they have any of those symptoms.
03:37
And this is another one of those medications
that can cause erosive esophagitis.
03:42
Same thing as the rest of
the members of their family.
03:44
So the erosive esophagitis --
I want you to take a minute,
pause, and write in your notes,
what are the things that we
need to educate your patient on
to prevent the possibility of
them getting erosive esophagitis?
Okay, remember, erosive esophagitis
is that excruciating sore throat,
so we want to
educate the patient
that they cannot lay down
after they take the medication.
04:11
So recommend that they do not
take the medication at night,
and they stay upright after
they take a dose of clindamycin.