Macrolides: Erythromycin (Nursing)

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.