Tetracyclines (Nursing)

00:01 Hi. Welcome to our video on bacteriostatic inhibitors of protein synthesis.

00:06 So, in other words, we're talking about antibiotics.

00:09 But want to start with a question.

00:11 What is the difference between bacteriostatic and bactericidal? Pause the video, take a minute, and write some notes in the margin.

00:25 Welcome back. The difference between bacteriostatic and bactericidal is bactericidal, the antibiotic actually kills the bacteria.

00:35 With bacteriostatic, it just does something that stops the replication of the bacteria, but it doesn't actually kill the bacteria.

00:43 But think of static as kind of even, but cidal definitely means killer.

00:49 Let's take a look at tetracyclines. Here's 4 examples of tetracyclines: tetracycline -- of course -- demeclocycline, doxycyxline, and minocycline.

01:00 Okay, those are just 4 examples that fall into the same drug category known as the tetracyclines.

01:07 Now, I recommend when you are studying pharmacology, that you think about the side effects by families or categories.

01:14 So, in this case, the family or category name would be tetracycline.

01:19 For examples are individual drugs that represent that family or category.

01:24 So what you do not want to do is try to memorize each drug individually by itself.

01:29 You want to look for the common side effects and adverse effects and cautions that we're looking for, for the group as a family.

01:37 Now, in the upper right hand corner, you'll see that there's a different icon.

01:40 That's to help you remember this mechanism of action.

01:43 This tetracycline family is a bacteriostatic inhibitor of protein synthesis.

01:49 Now they've created a special icon for each one of the mechanisms of action.

01:53 And that is so cool, because if you keep looking at that icon and reminding your brain, it'll make it much easier for you to remember the mechanism of action.

02:03 Now, tetracyclines are very broad spectrum.

02:06 They're bacteriostatic, and they are broad spectrum.

02:10 Now, we've used less and less of these over the years because we have more selective drugs.

02:15 Remember, broad spectrum means it knocks out plenty or more than one type of bug or bacteria, and so that puts us at an increased risk for things like superinfections or resistance.

02:27 So we've used these tetracyclines less and less over the years because we have drugs that are better, they're more selective, and they have fewer of the nasty toxicities that tetracyclines can have.

02:39 Now we use tetracyclines to treat acne, peptic ulcer disease, or periodontal disease.

02:45 So those are 3 categories that we still use this drug for.

02:49 But we use it with caution with patients who have known renal disease, because someone who has kidneys that are struggling and not really effective at doing what kidneys are supposed to do, filter and excrete things, they have an increased risk for tetracycline toxicity.

03:05 So keep that in mind with these patients. They're broad spectrum, bacteriostatic antibiotics, but the same time, I want to be really careful in using with patients who have known renal disease.

03:17 Now, one of the nastiest possible side effects of tetracycline is we know that they have a risk of the patient developing C. difficile-associated diarrhea.

03:28 Whew. Remember we talked about that? That has a phenomenal odor, one you will never forget.

03:35 The other risk is thrush, Candida albicans.

03:39 It's like a yeast infection in your mouth.

03:42 You can also have it in very personal places, as you see listed there.

03:46 So a yeast infection is particularly uncomfortable for your patient no matter what orifice it involves.

03:53 So remember, we talked about it because tetracyclines are broad spectrum, they go after lots of different types of bacteria, that's why we have a risk for these other superinfection kind of things like C. diff and thrush.

04:07 If you've ever been a patient who's had thrush, especially oral thrush, it's extremely painful for the patient.

04:13 So you want to watch and see if your patient is developing any of those signs and symptoms that we immediately intervene.

04:20 Now, here's one of the really weird ones about tetracycline.

04:24 It can involve your teeth, because tetracyclines bind to the calcium in developing teeth in kids 4 months to 8 years.

04:33 So, we rarely would give a tetracycline to a pediatric patient.

04:37 That's because we know what it does to their teeth and how it damages their teeth.

04:42 It's also got the regular things like the GI irritation and the esophageal erosion if they lay down.

04:48 Now, we talked about that in the Adverse Drug Effects video, but want to hit it again here, that all of these drugs can cause severe esophageal erosion, or erosive esophagitis is another term that we use to describe it.

05:03 It is an excruciating sore throat if the patient takes this medication and then lays down.

05:11 That's why you want to educate your patient to not take the medication and then lay down, or take it at night time because we usually lay down at nighttime.

05:21 And again, we already talked about the C. diff and thrush.

05:24 We brought that back a couple times just to remind you that the tetracyclines are really known for causing those.

05:31 It will also suppress long bone growth in premature infants, which is another reason we don't give it to pediatric patients.

05:37 When it comes to toxicity, tetracyclines have an increased risk for hepatotoxicity if you're having to give it IV route in higher doses.

05:47 So, the higher the dose, the longer the period of time the patient is on a tetracycline, the bigger the risk is for them to develop hepatotoxicity.

05:56 Remember that's the toxicity of the liver. Hepat means liver.

06:01 Also, there's a risk for nephrotoxicity, or renal damage.

06:07 The last one is photo sensitivity.

06:09 That means if you're taking a tetracycline, if you go out in the sun, you're really at an increased risk to get sunburn.

06:15 So you want to educate your patients to wear a hat when they go out, wear lots of sunblock, because this particular medication will make them photosensitive. Really at an increased risk to be sunburned, even if they're someone who's not usually at risk for sunburn.