antiinfectives Flashcards
1
Q
actually kills the bacteria
A
bactericidal
2
Q
stops bacteria from reproducing
A
bacteriostatic
3
Q
Key Actions Prior to Administration for antibiotics
A
Culture
Susceptibility
Location of administration of medication
4
Q
how many blood cultures do you obtain?
A
two, an aerobic and anaerobic set
5
Q
best to get blood cultures ____ and to get them from ______ different locations
A
X2, two
6
Q
this bottle is the burgundy/red cap
A
anaerobic
7
Q
this bottle has the blue cap
A
aerobic
8
Q
What are four problems with antiinfectives?
A
overuse
non-compliance
cost of meds
allergies
9
Q
____________ leads to antibiotic resistant bacteria
A
non compliance
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
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
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
13
Q
A
crystalluria
14
Q
_____ often looks like ____
A
crystalluria often looks like wheat
15
Q
Reddish-purple rash that causes upper layers of skin to die off
A
Stevens-Johnson syndrome
16
Q
What are the effects of Stevens-Johnson syndrome?
A
Swelling of tongue, face, pain, sloughing of skin, blisters in mouth, nose, eyes
17
Q
Prior to rash in stevens johnson syndrome, a patient may have?
A
may have fever, sore throat, cough, pain in eyes
18
Q
A
Stevens Johnson Syndrome
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
20
Q
What meds are most often associated with SJS?
A
NSAIDS
Penicillins, sulfonamides
Anticonvulsants
21
Q
what is the risk with reoccurrence with SJS?
A
recurrence is often more severe
22
Q
A
superinfection
23
Q
can be due to microbes that have becomes resistant to antibiotics
A
superinfection
24
Q
which three groups are at an even higher risk for superinfection?
A
individuals with HIV/AIDS
individuals with TB
immunocompromised persons
25
The second infection (superinfection) is often due to a different microbial, what does this mean?
the antibiotic that they were originally on is not likely going to work
26
t/f: fungal infections can be a part of a a superinfection?
true
27
often end in -cillin
penicillins
28
Natural penecillins G & V are ?
penecillins
29
what are?:
zosyn
timentin
augmentin
unasyn
penicillins
30
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
1, 2
31
what is the method of action of most penecillins?
bactericidal -prevent cell wall synthesis
32
Widest antimicrobial activity- attack gram negative and positive, and anaerobic organisms
penicillins
33
Large IV doses can prolong bleeding time when taken with anticoagulants with this antibiotic?
penicillins
34
this type of penicillin is safe during pregnancy
natural penicillins, G &V
35
what are the most common side effects of natural penicillins and ampicillin?
GI effects
36
Up to 10% of population is allergic
Natural penicillins
37
Unlike natural penicillins, very effective against many gram negatives
Ampicillin
38
store liquid suspensions in the fridge and ____ after 14 days
discard
39
Adverse effects of penicillins? (x4)
GI: N/V, diarrhea, tongue inflammation
Hypersensitivity: rash, anaphylaxis, serum sickness
CNS: lethargy, hallucinations, confusion, anxiety/depression
sensitivity to other beta lactams
40
s/s include: fever, general feeling of illness, hives and itching, joint pain, rash, swollen lymph nodes
serum sickness
41
what are the other beta lactam antibiotics?
Cephalosporins, carbapenems, monobactams
42
what is this?
rash due to penicillins
43
what do you need to assess with penicillins?
vitals
electrolytes
renal function
LOC and Neuro status -bilateral strength test
prothrombin time
international normalized ration
platelet count
44
vitals
electrolytes
renal function
LOC and Neuro status -bilateral strength test
prothrombin time
international normalized ration
platelet count
penicillin assessments
45
give penicillins 1 hr before other _____________ such as _______ and ________
bacteriostatic antibiotics, tetracycliens and erythromycins
46
what are considerations for giving a IM injection for penicillins?
give deep into muscle
dont inject more than 2 grams into muscle
rotate sites
47
t/f: penicillins can be mixed with other IV meds
false
48
always start with "Cef-" or "Ceph-"
cephalosporins
49
what is the usual dose for cephalosporins?
1-4 grams in divided doses
50
Common infections that are treated with this drug include infections of the middle ear, throat, tonsils, bronchitis, pneumonia, and UTIs
cephalexin
51
t/f: there are few interactions with other meds with cephalosporins?
true
52
3 to 16% cross-sensitivity for those who are allergic to penicillin
cephalosporins
53
t/f: some cephalosporins are not well absorbed from the GI tract?
true
54
where does most excretion happen with cephalosporins?
kidneys
55
what is the method of action of cephalosporins?
Inhibit cell-wall synthesis (bacteriocidal)
1st generation- mainly gram +
2nd and 3rd generation: gram – bacteria
4th generation- gram neg and pos bacteria
56
Assessment for Cephalosporins
liver function
alcohol use within 72 hours
glucose levels
RENAL FUNCTION -BUN AND CREATININE
PT
platelet counts
superinfection
bleeding superinfection
57
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
cephalosporins
58
can you mix cephalosporins with other IV meds?
usually not
59
what are the adverse effects of cephalosporins? (x7)
GI: N/V, diarrhea
Neuro: confusion
BLEEDING
hypersensitivity
Serum sickness -fever, edema, hives
thrombophlebitis
altered gluscose levels
60
GI: N/V, diarrhea
Neuro: confusion
BLEEDING
hypersensitivity
Serum sickness -fever, edema, hives
thrombophlebitis
altered gluscose levels
adverse effects of cephalosporins
61
azreonam is what type of antibiotic?
monobactam
62
what is the method of action for monobactams?
bactericidal, weakens or destroys cell wall
63
what type of bacteria are monobactams effective against?
aerobic gram negative organisms ONLY
64
what are adverse effects associated with monobactams? (x2)
thrombophlebitis
superinfection
65
_______ are bad about causing superinfections: candida albicans (thrush, vaginal infection), very opportunistic
monobactams
66
monobactams are bad about causing ________: candida albicans (thrush, vaginal infection), very opportunistic
superinfections
67
monobactams are only administered ?
IV and IM
68
t/f: monobactams are effective against pseudomonas?
true
69
Prescribe miconazole for _______ Candida infections
vaginal
70
Prescribe nystatin for ______ Candida infections
oral
71
monobactams are contraindicated in? (3)
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
72
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
instructions for patients concerning monobactams
73
What should you assess for when giving a monobactam?
IV stie pain redness, swelling
inability to eat (sign of superinfection)
74
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 ________
aztreoman
75
do not give with aminoglycodes because it can cause severe nephrotoxicity!
aztreonam
76
End in –penem
carbapenems
77
MOA of carbapenems?
very broad spectrum
78
indications for Carbapenems
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
79
given for very complicated skin or skin structure infections,
given for intraabdominal infection
BACTERIAL MENENGITIS
complicated body cavity issues
carbapenems
80
adverse effects of carbapenems
5
GI
respiratory distress
seizures
low bp
hyperkalemia
81
MOA of vancomycin
bactericidal, weakens and destroys cell walls of bacteria
82
indications for Vancomycin
gram positive
MRSA
Clostridium difficile
83
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.
red person syndrome
84
what are the adverse effects of vancomycin?
red person syndrome
ototoxicity
nephrotoxicity
THROMBOPHLEBITIS
85
peaks and troughs are needed to be obtained with this drug
vancomycin
86
there is usually a test dose first and you also need to obtain baseline hearing level with this drug
vancomycin
87
More effective if given orally for colitis
IV is best for all other conditions
Give slowly
Not compatible with much when given IV
vancomycin
88
Tell patients…
Report facial flushing, feelings of faintness, hearing loss, swelling or redness at IV site with this drug
vancomycin
89
contraindications with vancomycin
corn allergy
vancomycin allergy
caution w/renal insufficiency
90
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
vancomycin
91
metformin given with vancomycin increases the risk for which condition?
lactic acidosis
92
end in "-cycline"
tetracyclines
93
MOA of tetracyclines
bacteriostatic
94
indications with tetracyclines
Broad-spectrum activity against many organisms (gram positive and negative, anaerobes, and many other organisms)
95
Interact with milk products, antacids and iron salts (prevent absorption)- give 1 hr before or 2 hrs after drinking milk
tetracyclines
96
Adverse effects: GI, photosensitivity, hepatic and renal toxicity, superinfection
tetracyclines
97
________ interact with milk products, antacids, and iron slats which prevent absorption
tetracyclines
98
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)
tetracyclines
99
Check expiration date (if outdated, can lead to nephrotoxicity)
tetracycline
100
Keep away from light
Avoid sun and use sunblock
tetracyclines
Fluoroquinolones
101
Do not give to those less than 8 years old as permanent teeth will be discolored (Passes through breast milk)
tetracyclines
102
Oral hygiene is key to prevent mouth sores with this drug
tetracyclines
103
what does this depict?
tetracycline stained teeth
104
Erythromycin, Azithromycin, and clarithromycin are all?
macrolides
105
this medication is given with an enteric coating so it will not be destroyed by stomach acid
macrolides
106
MOA of macrolides?
Inhibit RNA and protein synthesis (bacteriostatic, but can be bactericidal if in enough concentration)
107
what are the indications for macrolides?
Gram + and – activity
108
Can increase theophylline levels, increasing risk of toxicity
macrolides
109
Adverse effects: increase in eosinophils, GI distress
marcolides
110
Don’t drink fruit juice with these meds
marcolides
111
what do you need to assess for with macrolides?
2
hepatic function
hydration
112
Often end in –mycin or –micin
aminoglycosides
113
gentamicin is a ?
aminoglycoside
114
What is the MOA of aminoglycosides?
bactericidal by interrupting protein synthesis
115
what is the indications for aminoglycosides ?
Effective against gram-negative bacilli, mycobacteria, some protozoa
116
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
Uses for aminoglycosides
117
how are aminoglycosides usually given?
Usually IM or IV bc they are poorly absorbed from the GI
118
these antibiotic drugs cross the placenta but NOT the blood/brain barrier
aminoglycosides
119
Cautious use with NMBAs- can increase neuromuscular blockade with increased respiratory distress and muscle relaxation
aminoglycosides
120
Toxicity to kidneys and neurologic system can result in renal failure and peripheral neuropathy
aminoglycosides
121
Ototoxicity- can be masked by ______; _______ increase risk when giving aminoglycosides. Hearing loss may be irreversible
antiemetics, Loop diuretics
122
aminoglycosides can cause ______ ______ (lack of feeling in distal extremities, tingling, often in diabetics)
peripheral neuropathy
123
Allergy history
Culture and sensitivity prior to first dose
Vital signs
Electrolytes
Hearing ability
Renal function
Adverse reactions
Patient’s knowledge level
assessment before giving aminoglycosides
124
Keep well hydrated
Don’t mix other drugs with IV
Monitor key assessments
Administer IM dose deep into large muscle mass
aminoglycoside implementation
125
Must administer IV form over 30-60 minutes for adults and 1-2 hours for infants to prevent neuromuscular blockage
aminoglycosides
126
Peak- draw blood __ minutes to __ hour after IV injection of gentamicin
30 min, 1 hour
127
when should the trough draw be obtained?
just before giving the next dose
128
Peak above __ mcg/mL and trough above __ mcg/mL can increase risk of toxicity with gentamicin
12, 2
129
what tube needs to be avoided as it interferes with the peak and trough results for gentamicin?
a heparinized tube
130
What are the adverse effects of aminoglycosides?
4
Renal toxicity
ototoxicity
neuromuscular blockage
neuropathy
131
IV gentamicin needs to be administered over what time from for infants? for adults?
1-2 hours for infants, 30-60 minutes for adults
132
ciprofloxacin and levofloxacin are?
fluoroquinolones
133
MOA of fluoroquinolones?
bactericidal, interrupt DNA synthesis during cell replication
134
often used for UTIs and URIs
fluoroquinolones
135
end in "-floxacin"
fluorquinolones
136
indications for fluoroquinolones?
gram negative bacteria
UTIs
URIs
respiratory infection
GI infection
skin
bone joint infections
137
Adverse effects of fluoroquinolones? (3)
GI
dizziness
phototoxic reactions
138
t/f: milk needs to be avoided with fluroquinolones?
true
139
changes in cell signaling proteins and causes toxic effects on muscles, tendons, cartilage, bones, and muscles
fluoroquinolone toxicity
140
typically seen in older people who are on steroids, also seen in athletes a lot. limit high intensity activity while on med,
fluoroquinolone toxicity
141
contraindications for fluoroquinolones?
myasthenia gravis
breastfeeding
pregnancy
142
while taking a fluoroquinolones you need to increase fluids to prevent?
crystalluria
143
a patient needs to avoid driving while taking fluoroquinolones because the drugs?
may alter alertness
144
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)
teaching for fluoroquinolones
145
class IA or class 3 dysrhythmics, specifically amiodarone, what happens is that when you take these with fluoroquinolones will cause torsos something??????
146
Don’t confuse with meds use to treat GI system like proton-pump inhibitors (some end in –azole and –azine, such as co-trimaxazole)
sulfonamides
147
trimethoprim and bactrim are?
sulfonamides
148
prevent folic acid synthesis and are bacteriostatic
sulfonamides
149
this drug class can Increase hypoglycemic effects of sulfonylureas (can drop blood sugar)
sulfonamides
150
Reaction similar to serum sickness is possible (fever, joint pain, hives, bronchospasm, leukopenia) ca be associated with this drug class
sulfonamides
151
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
sulfonamides
152
if you give ______ or ______ with sulfonamides, it can cause a hemorrage
phenytoin, warfarin
153
what is the largest use for sulfonamides?
UTIs
154
Prolonged use can lead to blood disorders such as anemia and low WBC and platelet count
sulfonamides
155
are not given topically bc of hypersensitivity
sulfonamides
156
can turn urine yellow and permanently stain contact lenses
sulfonamides (sulfasalazine)
157
adverse effects include:
decreased blood glucose
serum sickness
kidney stones/crystaluria
possible hemorrhage
skin rash/itching
blood issues with prolonged use
Gi issues
photosensitivity
sulfonamides
158
Avoid sun
Take with full glass of water and drink plenty of fluids
Report s/s of hypersensitivity
sulfonamides
159
Monitor blood sugar if diabetic, especially if taking oral hypoglycemic with this antibiotic
sulfonamides
160
may turn urine yellow and permanently stain contact lenses
Sulfasalazine
161
what are the two types of antiparasitic drugs?
metronidazole
chloroquine
162
is used to treat protozoan infections
metronidazole
163
is used to treat malaria
chloroquine
164
what are the antiparasitics?
metronidazole
Iodoquinol
Tinidazole
165
MOA of metronidazole?
damages DNA but not until inside the anaerobic orangisms
166
indications for metronidazole
bactericidal against anaerobic gram negative bacteria
protozoa
167
What are the side effects of metronidazole?
GI: n/v, diarrhea
CNS: headache, vertigo, ataxia,seizures, neuropathy
darkening urine 9harmless)
superinfection w/candidia (mouth and vagina)
metallic taste in mouth
168
what should you do if Severe CNS symptoms = Seizures, peripheral neuropathy occur when givin metronidazole?
STOP MEDICATION
169
Comes in tablets, capsules, sustained release capsules, topical cream, vaginal gel, IV infusion
metronidazole
170
contraindications of metronidazole (2)
Active CNS diseases
Severe Blood disorders
171
precautions with metronidazole (x4)
Existing Candida infection
CHF
Liver or renal failure
Seizure disorder
172
Citalopram (Celexa), ritonavir (Norvir), or IV nitroglycerin, sulfamethoxazole or trimethoprim may also cause disulfiram-type reactions
metronidazole
173
what occurs when metronidazole is given with phenobarbital?
it decreases levels of metronidazole
174
what occurs when lithium and metronidazole are given together?
decreased lithium levels
175
is metronidazole compatible with anything IV?
not really
176
if you use alcohol while on metronidazole, you can have the _____ reaction
antabuse
177
What are the antiparasitics?
chloroquine
primaquine
quinine
178
this drug kills the erythrocytic form of protozoan responsible for malaria
chloroquine
179
MOA of chloroquine
kills the erythrocytic form of the protozoan responsible for malarial infections
180
where can malaria remain in the body during treatment which may cause a reoccurrence?
the liver
181
side effects of chloroquine?
2
Visual Symptoms: blurred vision, photophobia, (retinopathy)
Nausea/Diarrhea
182
give chloroquine at least ___ hours before or after antacids or laxatives
4
183
t/f: child doses of chloroquine are based on weight
true
184
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
prophalaxis treatment for malaria
185
for acute attacks of chloroquine, give ___ gram orally and taper the dose off
1 gram
186
contraindications of chloroquine?
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
187
precautions with chloroquine?
Liver disease
Alcoholism
Young children with G6PD deficiency may lead to hemolytic anemia
188
interactions with chloroquine?
Antacids and laxatives with magnesium or aluminum decrease absorption of chloroquine
Lemon juice reduces the effectiveness of chloroquine
189
what are the two classes of antifungal medications?
azoles
polyenes
190
What are the azoles?
ketoconazole
itraconazole
micronazole
clotrimazole
191
What are the polyenes?
amphotericin B (severe fungal infections)
nystatin
192
antifungals are also called/
antimycotic
193
antimycotic medications are use for superficial or systemic ______ infections
fungal
194
antimycotic medications treat opportunistic infections that arise when the boy's _______ ______ is compromised
immune system
195
MOA of amphotericin B?
interrupts integrity of the cell walls of fungi
fungistatic and fungicidal (depends on dose and sensitivity)
196
common adverse reactions to amphotericin B?
Chills, fever, tachycardia, hypotension, headache, nausea
Blood marrow suppression
Thrombophlebitis
Renal Toxicity
hypotension
hypomagnesemia
hypokalemia
197
What two medications should be given with amphotericin B and why?
diphenhydramine and acetaminophen to minimize uncomfortable reactions
198
What should you monitor while administering amphotericin B? (4)
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
199
what needs to be done before amphotericin B is given and what needs to be done following?
give a test dose, DOCUMENT
200
what are the pros and cons of the lipid based form of amphotericin B ?
less adverse effects
more expensive
201
what is thrush?
oral candida infection
202
how is nystatin used to treat oral candida infections?
the swish and swallow method is used
203
why are labs important for amphotericin B?
early detection of kidney damage or anemia
204
amphotericin B is contraindicated in?
allergy to drug
breastfeeding
205
preexisting bone marrow depression,
anemia
renal insufficiency
are all conditions that which drug would be used cautiously in?
amphotericin B
206
nephrotoxicity increases when amphotericin B is given with which drugs?
Nephrotoxic chemotherapy meds
Aminoglycosides
Cyclosporine
Furosemide
Vancomycin
207
________ when given with amphotericin B increases the risk for hypokalemia
corticosteroids
208
digitalis toxicity increases in the presence of _______ which is a side effect of amphotericin B administration
hypokalemia
209
Adverse effects:
(common) chills, fever, n/v, anorexia, muscle and joint pain, indigestion, anemias
(decreased hematocrit); also hypotension, flushing, paresthesias
Hypomagnesemia and hypokalemia
adverse effects of amphotericin B
210
t/f: hypotension and tachpnea are also side effects of amphotericin B?
true
211
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
amphotericin B
212
MOA of Ketoconazole
interupts cell wall integrity of fungi
213
what are the side effects of ketonazole?
liver toxicity
n/v, constipation, diarrhea
drowsiness/dizziness
decrease in sexual hormone synthesis which causes decreased libido, low sperm count, gynecomastia, menstural irregularities
214
ketoconzaole has to be given with what medium?
coffee, tea, water, juice, or HCl, IT NEEDS AN ACID MEDIUM
215
what liver tests do you need to monitor for with ketonazole?
ALT, AST tests
216
what are the different ways ketoconazole can be administered?
tablet or topical shampoo
217
Oral form requires an acid medium for absorption in the stomach
ketoconazole
218
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
patient instructions for ketoconazole
219
Allergy to drug
Meningitis caused by fungi
Onychomycosis (fungal infection of the nails)
Ocular fungal infections
contraindications for ketoconazole
220
History of allergy to other drug in its class
Existing liver disease
Alcoholism
HIV infection
Older adults
Children less than 2 years
precautions for ketoconazole
221
Rifampin decreases blood levels of _______
Herbal Echinacea increases the risk for liver toxicity
Antacid and proton pump inhibitors and H2 Antagonists greatly decrease absorption – need acidic environment so take _________ at least 2 hours before taking any of these meds
Ketoconazole
222
how are -azoles administered?
PO or IV
223
these meds are often used to treat candidiasis
-azole
224
what -azole medication is the most common?
fluconazole
225
ONE notable exception to “azole” is _______________ which is used for ____fungal infections of fingernails and toenails
terbinafine
226
What are assessments that need to be done with antifungals?
renal or hepatic disorders
lab work -liver enzymes, BUN, serum creatinine
baseline vital signs
227
Interventions for –azole antifungals
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
228
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
Patient teaching for azole antifungals
229
treats herpes simplex and herpes zoster
Acyclovir
230
treats cytomegalovirus
Ganciclovir
231
treats hepatitis B and C
Interferon alfa – 2b
232
treats influenza
Oseltamiver
233
treats respiratory syncytial virus (RSV)
Ribavirin
234
Symptoms of infection include headache, low-grade fever, nausea, vomiting, diarrhea, muscle pain, fatigue and cough
symptoms of viral infection
235
if youre 18 and older and allergic to eggs you can take which flu vaccine?
flublok quadrivalent
236
if youre 4 or older and allergic to eggs you can now take which flu vaccine?
flucelvax quadrivalent
237
What medications are used to treat herpetic viruses?
acyclovir
valacyclovir
famiclovir
238
MOA of acyclovir?
inhibits replication of DNA, virostatic against herpes simplex and herpes zoster
239
side effects of topical acyclovir? (2)
burning
itching
240
side effects of oral acyclovir? (4)
N/V
diarrhea
headache
vertigo
241
IV side effects of acyclovir?
renal toxicity
CNS toxicity: restlessness, tremors, psychosis, seizures
thrombophlebitic
242
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
acyclovir assessment and interventions
243
Patient instructions:
Topical: avoid scratching area, avoid eyes, use glove to apply, persistent or extreme skin symptoms,
Oral: take with food if GI symptoms are bad, if you have persisten GI issues then you need to report that
Report CNS changes that are extreme: restlessness, tremors
IV: hydrate them really well, watch for thrombophlebitis
patient instructions for acyclovir
244
acyclovir is contraindicated in? (2)
allergy to acyclovir or valacyclovir
245
precautions with acyclovir?
renal insufficiency
neurologic disorders, dehydration
246
Interactions
Probenecid increases blood levels
Zidovudine increases CNS effects
Nephrotoxic drugs increase risk for renal toxicity
interactions with acyclovir
247
assessment for anti virals
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
248
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
Client Teaching for Anti-Virals
249
Severe systemic allergic reaction
Multisystem involvement
anaphylaxis
250
anaphylaxis includes?
skin
airway
vascular system
GI tract
251
anaphylaxis is life threatening can be generalized or systemic activity, go into circulatory shock, causes overwhelming ____________ AND __________
VASIODILATION, HYPOVALEMIA
252
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?
6 hours
253
How does anaphylaxis happen?
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
254
increased risk and severity of anaphylaxis in?
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
255
common drugs that people are allergic to?
antibiotics
aspirin
NSAID
IV contrast
256
Common environmental allergies?
latex: gloves, urinary catheter, ET tubes
257
Common poison allergens?
ants
bees
wasps
yellow jackets
258
Every system starts shutting down with anaphylaxis bc it causes inadequate ______ ______
tissue profusion
259
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
mast cell triptase
260
diagnostic tools for anaphlaxis?
you can use ABG to tell how well theyre oxegenating
ECG
Chest X-Ray
Urea
Electrolytes
261
allergens cause ___ antibodies to bind to ______ ______ which causes a release of histamines and ______ which causes an increase in permeability of capillaries and venules
IgE, mast cells ,leukotrienes
262
systemic vasodilation, increased capillary permeability, poor tissue profussion, and hypovalemia,
anaphylaxis physiologic reactions
263
s/s of anaphylaxis?
History of exposure (Not always clear)
Hypotension
Bronchospasm
Upper Airway Obstruction
Pulmonary Edema
Angioedema
Generalized Edema
Pruritis
Rash
Vomiting
Diarrhea
Abdominal Pain
264
_______ is likely when: sudden onset, sudden respiratory symptom, sudden decrease in blood pressure,
anaphylaxis
265
Need ______ or more of the following to determine anaphylaxis: sudden skin or mucosal issues, sudden respiratory symptoms, sudden reduced bp, sudden GI symptoms
two
266
if someone has a ______ ______ after exposure to a known allergen, then you need to be worried about anaphylaxis
reduced bp
267
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
anaphylaxis
268
what do you do if you know its anaphylaxis?
secure ABC
remove trigger
get them in a position that promotes ventilation and circulation (head leaning down) NEVER SITTTING OR STANDING
administer epinephrine
269
goal is to restore vessels to normal, stop multi organ failure and restore tissue profusion through?
epinephrine, oxygen administration, fluid recitation, antihistamines (second line of treatment), bronchodilator, steroids (may shorten anaphylattic crisis and decreases inflammation),
270
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
epinephrine
271
isolated reaction, some kind of trigger causes immediate reaction with immediate S/S within 30 minutes
uniphasic
272
an hour up to 72 hours later after you have an initial reaction, you go back into it, it is not common
biphasic
273
servere anaphylactic reaction that keeps occurring despite aggressive treatment 24-36 hours in possible length
protracted
274
what is the dose of epinephrine for anaphalaxis IV?
0.1-0.25 mg every 5-15 min
275
what is the dose of epinephrine for anaphylaxis IM?
0.3 - 0.5 mg
may repeat every 10-15 minutes as needed
276
you always want ______ doses of epi at all times, particularly if you have a biphasic reaction
two
277
patient education for epi administration?
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
