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antiinfectives Flashcards

1
Q

actually kills the bacteria

A

bactericidal

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2
Q

stops bacteria from reproducing

A

bacteriostatic

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3
Q

Key Actions Prior to Administration

A

Culture
Susceptibility
Location of administration of medication

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4
Q

how many blood cultures do you obtain?

A

two, an aerobic and anaerobic set

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5
Q

best to get blood cultures ____ and to get them from ______ different locations

A

X2, two

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6
Q

this bottle is the burgundy/red cap

A

anaerobic

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7
Q

this bottle has the blue cap

A

aerobic

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8
Q

What are four problems with antiinfectives?

A

overuse
non-compliance
cost of meds
allergies

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9
Q

____________ leads to antibiotic resistant bacteria

A

non compliance

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10
Q

For all anti-infectives, what do you need to assess, obtain, and know before and after administering them? (x6)

A

baseline vitals
assess allergies
infection history (include s/s) (repeated pneumonia that doesn’t work with certain medications for ex.)
culture and sensitivity
assess for adverse reactions
assess knowledge of medication

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11
Q

What do you need to teach/educate your patients about?

A

Take as prescribed and complete entire regimen
Report unusual reactions such as rash, fever or chills
Check expiration date prior to taking it
Store it correctly
**If using hormonal contraceptives, use additional form of contraceptive during therapy
Don’t stop taking the drug even if symptoms are relieved
Don’t take left over medications or someone else’s medicine
Don’t take any other medications with them without checking with prescriber
Take on an empty stomach
Take with full glass of water
Signs of superinfection
Notify prescriber if s/s don’t improve
Drink plenty of fluids to prevent crystalluria

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12
Q

S/S: black furry growth on tongue, vaginal itching or discharge, loose or foul-smelling stools, mouth ulcers, fever, malaise, muscle aches

A

superinfection s/s

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13
Q
A

crystalluria

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14
Q

_____ often looks like ____

A

crystalluria often looks like wheat

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15
Q

Reddish-purple rash that causes upper layers of skin to die off

A

Stevens-Johnson syndrome

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16
Q

What are the effects of Stevens-Johnson syndrome?

A

Swelling of tongue, face, pain, sloughing of skin, blisters in mouth, nose, eyes

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17
Q

Prior to rash in stevens johnson syndrome, a patient may have?

A

Prior to rash, may have fever, sore throat, cough, pain in eyes

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18
Q
A

Stevens Johnson Syndrome

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19
Q

if someone comes in with a rash or anything that is a s/s of steven Johnson Syndrome, what should you do?

A

stop the antibiotic immediately

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20
Q

What meds are most often associated with SJS?

A

NSAIDS
Penicillins, sulfonamides
Anticonvulsants

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21
Q

what is the risk with reoccurrence with SJS?

A

recurrence is often more severe

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22
Q
A

superinfection

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23
Q

can be due to microbes that have becomes resistant to antibiotics

A

superinfection

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24
Q

which three groups are at an even higher risk for superinfection?

A

individuals with HIV/AIDS
individuals with TB
immunocompromised persons

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25
Q

The second infection (superinfection) is often due to a different microbial, what does this mean?

A

the antibiotic that they were originally on is not likely going to work

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26
Q

t/f: fungal infections can be a part of a a superinfection?

A

true

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27
Q

often end in -cillin

A

penicillins

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28
Q

Natural penecillins G & V are ?

A

penecillins

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29
Q

what are?:
zosyn
timentin
augmentin
unasyn

A

penicillins

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30
Q

penicillin absorption depends on pH of stomach and intestine presence of food in gi tract, and penicillin used (if given orally)
Most given on empty stomach- _____ hr before or _____ hrs after meal

A

1, 2

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31
Q

Large IV doses can prolong bleeding time when taken with anticoagulants with this drug?

A

penicillins

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32
Q

this type of penicillin is safe during pregnancy

A

natural penicillins, G &V

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33
Q

what are the most common side effects of natural penicillins and ampicillin?

A

GI effects

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34
Q

Up to 10% of population is allergic

A

Natural penicillins

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35
Q

store liquid suspensions in the fridge and ____ after 14 days

A

discard

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36
Q

Adverse effects of penicillins? (x4)

A

GI: N/V, diarrhea, tongue inflammation
Hypersensitivity: rash, anaphylaxis, serum sickness
CNS: lethargy, hallucinations, confusion, anxiety/depression
sensitivity to other beta lactams

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37
Q

s/s include: fever, general feeling of illness, hives and itching, joint pain, rash, swollen lymph nodes

A

serum sickness

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38
Q

what are the other beta lactam antibiotics?

A

Cephalosporins, carbapenems, monobactams

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39
Q

what is this?

A

rash due to penicillins

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40
Q

vitals
electrolytes
renal function
LOC and Neuro status -bilateral strength test
prothrombin time
international normalized ration
platelet count

A

penicillin assessments

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41
Q

give penicillins 1 hr before other _____________ such as _______ and ________

A

bacteriostatic antibiotics, tetracycliens and erythromycins

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42
Q

what are considerations for giving a IM injection for penicillins?

A

give deep into muscle
dont inject more than 2 grams into muscle
rotate sites

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43
Q

t/f: penicillins can be mixed with other IV meds

A

false

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44
Q

always start with “Cef-“ or “Ceph-“

A

cephalosporins

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45
Q

what is the usual dose for cephalosporins?

A

1-4 grams in divided doses

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46
Q

Common infections that are treated with this drug include infections of the middle ear, throat, tonsils, bronchitis, pneumonia, and UTIs

A

cephalexin

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47
Q

t/f: there are few interactions with other meds with cephalosporins?

A

true

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48
Q

t/f: some cephalosporins are not well absorbed from the GI tract?

A

true

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49
Q

what is the method of action of cephalosporins?

A

Inhibit cell-wall synthesis (bacteriocidal)
1st generation- mainly gram +
2nd and 3rd generation: gram – bacteria
4th generation- gram neg and pos bacteria

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50
Q

Assessment for Cephalosporins

A

liver function
alcohol use within 72 hours
glucose levels
RENAL FUNCTION -BUN AND CREATININE
PT
platelet counts
superinfection
bleeding superinfection

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51
Q

Take oral form WITH food to decrease GI irritation
Eat yogurt or drink buttermilk to replace intestinal flora
May interfere with clients blood sugar monitoring

A

cephalosporins

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52
Q

what are the adverse effects of cephalosporins? (x7)

A

GI: N/V, diarrhea
Neuro: confusion
BLEEDING
hypersensitivity
Serum sickness -fever, edema, hives
thrombophlebitis
altered gluscose levels

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53
Q

azreonam is what type of antibiotic?

A

monobactam

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54
Q

what are adverse effects associated with monobactams? (x2)

A

thrombophlebitis
superinfection

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55
Q

_______ are bad about causing superinfections: candida albicans (thrush, vaginal infection), very opportunistic

A

monobactams

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56
Q

t/f: monobactams are effective against pseudomonas?

A

true

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57
Q

Prescribe miconazole for _______ Candida infections

A

vaginal

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58
Q

Prescribe nystatin for ______ Candida infections

A

oral

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59
Q

monobactams are contraindicated in? (3)

A

patients who already have a VIRAL infection
LACTATING mothers
Be very careful in patients with a history of penicillin or cephalosporin allergy, with decreased liver or renal function or in older patients

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60
Q

Have patients report pain, redness, or swelling at IV site immediately
Have patients report pain and inability to eat
Have patients report vaginal burning, itching, discharge

A

instructions for patients concerning monobactams

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61
Q

What should you assess for when giving a monobactam?

A

IV stie pain redness, swelling
inability to eat (sign of superinfection)

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62
Q

Incompatible with most other IV meds
Probenecid may increase blood levels of _______
Some other antibiotics such as imipenem and cefoxitin may decrease the effectiveness of ________

A

aztreoman

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63
Q

do not give with aminoglycodes because it can cause severe nephrotoxicity!

A

aztreonam

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64
Q

End in –penem

A

carbapenems

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65
Q

indications for Carbapenems

A

Used for life-threatening infections that haven’t responded to other medications
given for very complicated skin or skin structure infections,
given for intraabdominal infection
bacterial meningitis
complicated body cavity issues

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66
Q

given for very complicated skin or skin structure infections,
given for intraabdominal infection
BACTERIAL MENENGITIS
complicated body cavity issues

A

carbapenems

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67
Q

adverse effects of carbapenems
5

A

GI
respiratory distress
seizures
low bp
hyperkalemia

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68
Q

indications for Vancomycin

A

MRSA
Clostridium difficile

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69
Q

s/s: hypotension, flushing of the face and trunk. rapid release of histamines cause this to happen, start the med slow and then give accordingly.

A

red person syndrome

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70
Q

what are the adverse effects of vancomycin?

A

red person syndrome
ototoxicity
nephrotoxicity
THROMBOPHLEBITIS

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71
Q

peaks and troughs are needed to be obtained with this drug

A

vancomycin

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72
Q

there is usually a test dose first and you also need to obtain baseline hearing level with this drug

A

vancomycin

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73
Q

More effective if given orally for colitis
IV is best for all other conditions
Give slowly
Not compatible with much when given IV

A

vancomycin

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74
Q

Tell patients…
Report facial flushing, feelings of faintness, hearing loss, swelling or redness at IV site with this drug

A

vancomycin

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75
Q

contraindications with vancomycin

A

corn allergy
vancomycin allergy
caution w/renal insufficiency

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76
Q

Interactions:
Metformin may increase risk for lactic acidosis
Drugs that are toxic to hearing or the kidneys increase risk for ototoxicity or nephrotoxicity with this drug

A

vancomycin

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77
Q

metformin given with vancomycin increases the risk for which condition?

A

lactic acidosis

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78
Q

end in “-cycline”

A

tetracyclines

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79
Q

Interact with milk products, antacids and iron salts (prevent absorption)- give 1 hr before or 2 hrs after drinking milk

A

tetracyclines

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80
Q

Adverse effects: GI, photosensitivity, hepatic and renal toxicity, superinfection

A

tetracyclines

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81
Q

________ interact with milk products, antacids, and iron slats which prevent absorption

A

tetracyclines

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82
Q

Give on empty stomach
Give water (a lot) with administration or risk severe esophageal irritation
Don’t give within 1 hour of bedtime (esophageal reflux)

A

tetracyclines

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83
Q

Check expiration date (if outdated, can lead to nephrotoxicity)

A

tetracycline

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84
Q

Keep away from light
Avoid sun and use sunblock

A

tetracyclines
Fluoroquinolones
sulfamides

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85
Q

Do not give to those less than 8 years old as permanent teeth will be discolored (Passes through breast milk)

A

tetracyclines

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86
Q

Oral hygiene is key to prevent mouth sores with this drug

A

tetracyclines

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87
Q

what does this depict?

A

tetracycline stained teeth

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88
Q

Erythromycin, Azithromycin, and clarithromycin are all?

A

macrolides

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89
Q

this medication is given with an enteric coating so it will not be destroyed by stomach acid

A

macrolides

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90
Q

Can increase theophylline levels, increasing risk of toxicity

A

macrolides

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91
Q

Adverse effects: increase in eosinophils, GI distress

A

marcolides

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92
Q

Don’t drink fruit juice with these meds

A

marcolides

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93
Q

what do you need to assess for with macrolides?
2

A

hepatic function
hydration

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94
Q

Often end in –mycin or –micin

A

aminoglycosides

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95
Q

gentamicin is a ?

A

aminoglycoside

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96
Q

what is the indications for aminoglycosides ?

A

Effective against gram-negative bacilli, mycobacteria, some protozoa

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97
Q

Serious nosocomial infections, UTIs, CNS infections
Used in combination with penicillins to treat gram-positive organisms
Can be used to prevent endocarditis during GI and GU surgery or procedures

A

Uses for aminoglycosides

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98
Q

these drugs cross the placenta but NOT the blood/brain barrier

A

aminoglycosides

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99
Q

Cautious use with NMBAs- can increase neuromuscular blockade with increased respiratory distress and muscle relaxation

A

aminoglycosides

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100
Q

Toxicity to kidneys and neurologic system can result in renal failure and peripheral neuropathy

A

aminoglycosides

101
Q

Ototoxicity- can be masked by ______; _______ increase risk when giving aminoglycosides. Hearing loss may be irreversible

A

antiemetics, Loop diuretics

102
Q

aminoglycosides can cause ______ ______ (lack of feeling in distal extremities, tingling, often in diabetics)

A

peripheral neuropathy

103
Q

Allergy history
Culture and sensitivity prior to first dose
Vital signs
Electrolytes
Hearing ability
Renal function
Adverse reactions
Patient’s knowledge level

A

assessment before giving aminoglycosides

104
Q

Keep well hydrated
Don’t mix other drugs with IV
Monitor key assessments
Administer IM dose deep into large muscle mass

A

aminoglycoside implementation

105
Q

Must administer IV form over 30-60 minutes for adults and 1-2 hours for infants to prevent neuromuscular blockage

A

aminoglycosides

106
Q

Peak- draw blood __ minutes to __ hour after IV injection of gentamicin

A

30 min, 1 hour

107
Q

when should the trough draw be obtained?

A

just before giving the next dose

108
Q

Peak above __ mcg/mL and trough above __ mcg/mL can increase risk of toxicity with gentamicin

A

12, 2

109
Q

what tube needs to be avoided as it interferes with the peak and trough results for gentamicin?

A

a heparinized tube

110
Q

What are the adverse effects o aminoglycosides?
4

A

Rental toxicity
ototoxicity
neuromuscular blockage
neuropathy

111
Q

IV gentamicin needs to be administered over what time from for infants? for adults?

A

1-2 hours for infants, 30-60 minutes for adults

112
Q

ciprofloxacin and levofloxacin are?

A

fluoroquinolones

113
Q

often used for UTIs and URIs

A

fluoroquinolones

114
Q

end in “-floxacin”

A

fluorquinolones

115
Q

indications for fluoroquinolones?

A

gram negative bacteria
UTIs
URIs
respiratory infection
GI infection
skin
bone joint infections

116
Q

Adverse effects of fluoroquinolones? (3)

A

GI
dizziness
phototoxic reactions

117
Q

t/f: milk needs to be avoided with fluroquinolones?

A

true

118
Q

changes in cell signaling proteins and causes toxic effects on muscles, tendons, cartilage, bones, and muscles

A

fluoroquinolone toxicity

119
Q

typically seen in older people who are on steroids, also seen in athletes a lot. limit high intensity activity while on med,

A

fluoroquinolone toxicity

120
Q

contraindications for fluoroquinolones?

A

myasthenia gravis
breastfeeding
pregnancy

121
Q

while taking a fluoroquinolones you need to increase fluuids to prevent?

A

crystalluria

122
Q

a patient needs to avoid driving while taking fluoroquinolones because the drugs?

A

may alter alertness

123
Q

Drink plenty of fluids
Avoid caffeinated products
Avoid operating machinery and driving as the medication can cause dizziness
Use sunblock and avoid the sun
Report side effects such as dizziness, GI effects, and rash (elders more likely to develop side effects)

A

teaching for fluoroquinolones

124
Q

Don’t confuse with meds use to treat GI system like proton-pump inhibitors (some end in –azole and –azine, such as co-trimaxazole)

A

sulfonamides

125
Q

trimethoprim/sulfamethoxazole (bactrim) is?

A

sulfonamides

126
Q

prevent folic acid synthesis and are bacteriostatic

A

sulfonamides

127
Q

this drug class can Increase hypoglycemic effects of sulfonylureas (can drop blood sugar)

A

sulfonamides

128
Q

Reaction similar to serum sickness is possible (fever, joint pain, hives, bronchospasm, leukopenia) ca be associated with this drug class

A

sulfonamides

129
Q

Less commonly used now as resistance is increasing; more often seen when patient allergic to penicillin
Used to have low solubility leading to crystallization of the urine, but newer ones are more soluble

A

sulfonamides

130
Q

if you give ______ or ______ with sulfonamides, it can cause a hemorrage

A

phenytoin, warfarin

131
Q

what is the largest use for sulfonamides?

A

UTIs
patients allergic to penicillins

132
Q

Prolonged use can lead to blood disorders such as anemia and low WBC and platelet count

A

sulfonamides

133
Q

are not given topically bc of hypersensitivity

A

sulfonamides

134
Q

adverse effects include:
decreased blood glucose
serum sickness
kidney stones/crystaluria
possible hemorrhage
skin rash/itching
blood issues with prolonged use
Gi issues
photosensitivity

A

sulfonamides

135
Q

Avoid sun
Take with full glass of water and drink plenty of fluids
Report s/s of hypersensitivity

A

sulfonamides

136
Q

Monitor blood sugar if diabetic, especially if taking oral hypoglycemic

A

sulfonamides

137
Q

may turn urine yellow and permanently stain contact lenses

A

Sulfasalazine

138
Q

what are the two types of antiparasitic drugs?

A

metronidazole
chloroquine

139
Q

is used to treat protozoan infections

A

metronidazole

140
Q

is used to treat malaria

A

chloroquine

141
Q

what are the antiparasitics?

A

metronidazole
Iodoquinol
Tinidazole

142
Q

indications for metronidazole

A

bactericidal against anaerobic gram negative bacteria
protozoa

143
Q

What are the side effects of metronidazole?

A

GI: n/v, diarrhea
CNS: headache, vertigo, ataxia,seizures, neuropathy
darkening urine 9harmless)
superinfection w/candidia (mouth and vagina)
metallic taste in mouth

144
Q

what should you do if Severe CNS symptoms = Seizures, peripheral neuropathy occur when givin metronidazole?

A

STOP MEDICATION

145
Q

contraindications of metronidazole (2)

A

Active CNS diseases
Severe Blood disorders

146
Q

precautions with metronidazole (x4)

A

Existing Candida infection
CHF
Liver or renal failure
Seizure disorder

147
Q

Citalopram (Celexa), ritonavir (Norvir), or IV nitroglycerin, sulfamethoxazole or trimethoprim may also cause disulfiram-type reactions

A

metronidazole

148
Q

what occurs when metronidazole is given with phenobarbital?

A

it decreases levels of metronidazole

149
Q

what occurs when lithium and metronidazole are given together?

A

decreased lithium levels

150
Q

is metronidazole compatible with anything IV?

A

not really

151
Q

if you use alcohol while on metronidazole, you can have the _____ reaction

A

antabuse

152
Q

What are the antiparasitics?

A

chloroquine
primaquine
quinine

153
Q

this drug kills the erythrocytic form of protozoan responsible for malaria

A

chloroquine

154
Q

MOA of chloroquine

A

kills the erythrocytic form of the protozoan responsible for malarial infections

155
Q

where can malaria remain in the body during treatment which may cause a reoccurrence?

A

the liver

156
Q

side effects of chloroquine?
2

A

Visual Symptoms: blurred vision, photophobia, (retinopathy)
Nausea/Diarrhea

157
Q

give chloroquine at least ___ hours before or after antacids or laxatives

A

4

158
Q

t/f: child doses of chloroquine are based on weight

A

true

159
Q

take 500 mg tablet once a week,
1 to 2 weeks before traveling, while you are where you are, and then for four weeks after you’re back
1 g for acute

A

prophalaxis treatment for malaria

160
Q

for acute attacks of chloroquine, give ___ gram orally and taper the dose off

A

1 gram

161
Q

contraindications of chloroquine?

A

Allergy to drugs with connection to chloroquine
Drugs with a connection to chloroquine that have a history of causing visual changes
Prophyria (a disorder in production of hemoglobin

162
Q

precautions with chloroquine?

A

Liver disease
Alcoholism
Young children with G6PD deficiency may lead to hemolytic anemia

163
Q

interactions with chloroquine?

A

Antacids and laxatives with magnesium or aluminum decrease absorption of chloroquine
Lemon juice reduces the effectiveness of chloroquine

164
Q

what are the two classes of antifungal medications?

A

azoles
polyenes

165
Q

What are the azoles?

A

ketoconazole
itraconazole
micronazole
clotrimazole

166
Q

What are the polyenes?

A

amphotericin B (severe fungal infections)
nystatin

167
Q

antifungals are also called?

A

antimycotic

168
Q

antimycotic medications are use for superficial or systemic ______ infections

A

fungal

169
Q

antimycotic medications treat opportunistic infections that arise when the body’s _______ ______ is compromised

A

immune system

170
Q

MOA of amphotericin B?

A

interrupts integrity of the cell walls of fungi
fungistatic and fungicidal (depends on dose and sensitivity)

171
Q

common adverse reactions to amphotericin B?

A

Chills, fever, tachycardia, hypotension, headache, nausea
Blood marrow suppression
Thrombophlebitis
Renal Toxicity
hypotension
hypomagnesemia
hypokalemia

172
Q

What two medications should be given with amphotericin B and why?

A

diphenhydramine and acetaminophen to minimize uncomfortable reactions

173
Q

What should you monitor while administering amphotericin B? (4)

A

Vital signs and symptoms during infusion
Kidney function tests every few days (BUN, Creatinine, Potassium)
Weight, I+O for retention of fluid and urinary output (notify provider if have a decrease in urine output or weight change)
Hct, CBC = watch for signs of bone marrow suppression and anemia

174
Q

what needs to be done before amphotericin B is given and what needs to be done following?

A

give a test dose, DOCUMENT

175
Q

what are the pros and cons of the lipid based form of amphotericin B ?

A

less adverse effects
more expensive

176
Q

what is thrush?

A

oral candida infection

177
Q

how is nystatin used to treat oral candida infections?

A

the swish and swallow method is used

178
Q

why are labs important for amphotericin B?

A

early detection of kidney damage or anemia

179
Q

amphotericin B is contraindicated in?

A

allergy to drug
breastfeeding

180
Q

preexisting bone marrow depression,
anemia
renal insufficiency
are all conditions that which drug would be used cautiously in?

A

amphotericin B

181
Q

nephrotoxicity increases when amphotericin B is given with which drugs?

A

Nephrotoxic chemotherapy meds
Aminoglycosides
Cyclosporine
Furosemide
Vancomycin

182
Q

________ when given with amphotericin B increases the risk for hypokalemia

A

corticosteroids

183
Q

digitalis toxicity increases in the presence of _______ which is a side effect of amphotericin B administration

A

hypokalemia

184
Q

Adverse effects:
(common) chills, fever, n/v, anorexia, muscle and joint pain, indigestion, anemias
(decreased hematocrit); also hypotension, flushing, paresthesias
Hypomagnesemia and hypokalemia

A

adverse effects of amphotericin B

185
Q

t/f: hypotension and tachpnea are also side effects of amphotericin B?

A

true

186
Q

Monitor renal, liver function
Usually test dose administered for 20-30 minutes
Don’t mix with other meds
Monitor baseline vitals and also repeat q30 minutes for at least 4 hours after starting it

A

amphotericin B

187
Q

what are the side effects of ketonazole?

A

liver toxicity
n/v, constipation, diarrhea
drowsiness/dizziness
decrease in sexual hormone synthesis which causes decreased libido, low sperm count, gynecomastia, menstural irregularities

188
Q

ketoconzaole has to be given with what medium?

A

coffee, tea, water, juice, or HCl, IT NEEDS AN ACID MEDIUM

189
Q

what liver tests do you need to monitor for with ketonazole?

A

ALT, AST tests

190
Q

Oral form requires an acid medium for absorption in the stomach

A

ketoconazole

191
Q

Report abdominal pain, jaundice, fatigue and anorexia
Take with food and fluids to reduce GI symptoms
Don’t take with antacids because there needs to be an acidic environment for absorption
Do NOT drive or do hazardous activities if drowsy or dizzy
Report Hormonal symptoms if severe

A

patient instructions for ketoconazole

192
Q

Allergy to drug
Meningitis caused by fungi
Onychomycosis (fungal infection of the nails)
Ocular fungal infections

A

contraindications for ketoconazole

193
Q

History of allergy to other drug in its class
Existing liver disease
Alcoholism
HIV infection
Older adults
Children less than 2 years

A

precautions for ketoconazole

194
Q

these meds are often used to treat candidiasis

A

-azole

195
Q

what -azole medication is the most common?

A

fluconazole

196
Q

ONE notable exception to “azole” is _______________ which is used for ____fungal infections of fingernails and toenails

A

terbinafine

197
Q

What are assessments that need to be done with antifungals?

A

renal or hepatic disorders
lab work -liver enzymes, BUN, serum creatinine
baseline vital signs

198
Q

Interventions for –azole antifungals

A

Obtain a culture of the fungal site
Monitor I/O
Monitor labs (BUN, creatinine, and liver enzymes)
Record vitals signs
Monitor for side effects such as nausea, vomiting, headache, phlebitis if given IV, and signs of electrolyte imbalance

199
Q

Do not abruptly dc
Have labs monitored if outpatient
Avoid alcohol with some
Do not drive or operate machinery until you know the effects
Report side effects such as ___nausea, vomiting, diarrhea, dermatitis, rash, dizziness, edema, tinnitus

A

Patient teaching for azole antifungals

200
Q

treats herpes simplex and herpes zoster

A

Acyclovir

201
Q

treats cytomegalovirus

A

Ganciclovir

202
Q

treats hepatitis B and C

A

Interferon alfa – 2b

203
Q

treats influenza

A

Oseltamiver

204
Q

treats respiratory syncytial virus (RSV)

A

Ribavirin

205
Q

Symptoms of infection include headache, low-grade fever, nausea, vomiting, diarrhea, muscle pain, fatigue and cough

A

symptoms of viral infection

206
Q

if youre 18 and older and allergic to eggs you can take which flu vaccine?

A

flublok quadrivalent

207
Q

if youre 4 or older and allergic to eggs you can now take which flu vaccine?

A

flucelvax quadrivalent

208
Q

What medications are used to treat herpetic viruses?

A

acyclovir
valacyclovir
famiclovir

209
Q

MOA of acyclovir?

A

inhibits replication of DNA, virostatic against herpes simplex and herpes zoster

210
Q

side effects of topical acyclovir? (2)

A

burning
itching

211
Q

side effects of oral acyclovir? (4)

A

N/V
diarrhea
headache
vertigo

212
Q

IV side effects of acyclovir?

A

renal toxicity
CNS toxicity: restlessness, tremors, psychosis, seizures
thrombophlebitic

213
Q

When using the topical form, patients should monitor and report severe skin reactions
Oral, monitor and report severe GI symptoms
Watch for renal toxicity by monitoring BUN and creatinine levels
IV, infuse slowly
Hydrate patient during and for 2 hours after infusion
Watch for CNS effects
Check patency of IV

A

acyclovir assessment and interventions

214
Q

acyclovir is contraindicated in? (2)

A

allergy to acyclovir or valacyclovir

215
Q

precautions with acyclovir?

A

renal insufficiency
neurologic disorders, dehydration

216
Q

Interactions
Probenecid increases blood levels
Zidovudine increases CNS effects
Nephrotoxic drugs increase risk for renal toxicity

A

interactions with acyclovir

217
Q

assessment for anti virals

A

Renal or hepatic disease
Baseline vitals and lab work, especially CBC, BUN, serum creatinine, liver enzymes, and electrolytes
I/O
Monitor labs
Record vitals
Monitor for side effects
Monitor for superinfection

218
Q

Maintain adequate fluid intake
Client with genital herpes or HIV should be aware that it can spread even when asymptomatic (condoms can reduce but not totally prevent spread);
Report side effects, especially decreased urine output and CNS changes; also may experience GI side effects or rash
Rise slowly from a sitting position
Have labs monitored
May experience gingival hyperplasia (swollen, red gums) and oral hygiene is key

A

Client Teaching for Anti-Virals

219
Q

Severe systemic allergic reaction
Multisystem involvement

A

anaphylaxis

220
Q

anaphylaxis includes?

A

skin
airway
vascular system
GI tract

221
Q

anaphylaxis is life threatening can be generalized or systemic activity, go into circulatory shock, causes overwhelming ____________ AND __________

A

VASIODILATION, HYPOVALEMIA

222
Q

if you’re going to die from anaphylaxis what is the time from that you typically are going to do so from time of exposure and reaction to allergen?

A

6 hours

223
Q

How does anaphylaxis happen?

A

Prior sensitization to an allergen has occurred
Produces antigen specific immunoglobulin
So, subsequent re-exposure to the allergen causes anaphylactic reaction
Release histamine, leukotrienes, prostaglandins, thromboxanes and bradykinins
Cause increased mucous membrane secretions, increased capillary permeability and fluid leak
Causes decreased tone in vasculature and increased tone in bronchioles

224
Q

increased risk and severity of anaphylaxis in?

A

infant -cannot communicate s/s
adolescents/young adults -risk taking behavior
surgery/L&D -drug exposure they previously havent had
elderly
Cardio and psychiatric
alcohol, sedatives, antidepressants can put you at higher risk for severity

225
Q

common drugs that people are allergic to?

A

antibiotics
aspirin
NSAID
IV contrast

226
Q

Common environmental allergies?

A

latex: gloves, urinary catheter, ET tubes

227
Q

Common poison allergens?

A

ants
bees
wasps
yellow jackets

228
Q

Every system starts shutting down with anaphylaxis bc it causes inadequate ______ ______

A

tissue profusion

229
Q

this will confirm the diagnosis of anaphylaxis, this is done afterwards if you cant figure out what causing the allergy or if they still have the allergy

A

mast cell triptase

230
Q

diagnostic tools for anaphlaxis?

A

you can use ABG to tell how well theyre oxegenating
ECG
Chest X-Ray
Urea
Electrolytes

231
Q

allergens cause ___ antibodies to bind to ______ ______ which causes a release of histamines and ______ which causes an increase in permeability of capillaries and venules

A

IgE, mast cells ,leukotrienes

232
Q

systemic vasodilation, increased capillary permeability, poor tissue profussion, and hypovalemia,

A

anaphylaxis physiologic reactions

233
Q

s/s of anaphylaxis?

A

History of exposure (Not always clear)
Hypotension
Bronchospasm
Upper Airway Obstruction
Pulmonary Edema
Angioedema
Generalized Edema
Pruritis
Rash
Vomiting
Diarrhea
Abdominal Pain

234
Q

_______ is likely when: sudden onset, sudden respiratory symptom, sudden decrease in blood pressure,

A

anaphylaxis

235
Q

Need ______ or more of the following to determine anaphylaxis: sudden skin or mucosal issues, sudden respiratory symptoms, sudden reduced bp, sudden GI symptoms

A

two

236
Q

if someone has a ______ ______ after exposure to a known allergen, then you need to be worried about anaphylaxis

A

reduced bp

237
Q

can look like: Anxiety or Panic Attack
Asthma
Bronchospasm/Laryngeal Edema due to inhalation of irritant
Foreign Body Airway Obstruction
Hypovolemia
Vasovagal Episode
Cardiogenic Shock

A

anaphylaxis

238
Q

what do you do if you know its anaphylaxis?

A

secure ABC
remove trigger
get them in a position that promotes ventilation and circulation (head leaning down) NEVER SITTTING OR STANDING
administer epinephrine

239
Q

goal is to restore vessels to normal, stop multi organ failure and restore tissue profusion through?

A

epinephrine, oxygen administration, fluid recitation, antihistamines (second line of treatment), bronchodilator, steroids (may shorten anaphylattic crisis and decreases inflammation),

240
Q

increases vasoconstriction, increases peripheral vascular resistance and decreases mucosal edema, increases bronchodilation, increases inotrapy (increase force of muscle contrations, which is good for the heart), affects speed and conduction of the heart

A

epinephrine

241
Q

isolated reaction, some kind of trigger causes immediate reaction with immediate S/S within 30 minutes

A

uniphasic

242
Q

an hour up to 72 hours later after you have an initial reaction, you go back into it, it is not common

A

biphasic

243
Q

servere anaphylactic reaction that keeps occurring despite aggressive treatment 24-36 hours in possible length

A

protracted

244
Q

what is the dose of epinephrine for anaphalaxis IV?

A

0.1-0.25 mg every 5-15 min

245
Q

what is the dose of epinephrine for anaphylaxis IM?

A

0.3 - 0.5 mg
may repeat every 10-15 minutes as needed

246
Q

you always want ______ doses of epi at all times, particularly if you have a biphasic reaction

A

two

247
Q

patient education for epi administration?

A

don’t put your thumb on the end

teach them what their trigger is and teach them how to avoid it

diet issue: how to modify their diet

autoinjector is expensive, or it isn’t around when you need it, don’t know how to use it or inject it properly, sometimes have a reaction that is really bad really quck

248
Q

What is do all these drugs have in common: monobactams, penicillin, vancomycin, cephisorn, amphotericin b (fungazone), and acyclovir (zovirax)?

A

thrombph

Pharm (14 decks)

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