Antipyretic & Antimicrobial Medications Flashcards
1
Q
NSAID
A
Non steroidal anti inflammatory inhibitors
2
Q
Aspirin Classification
A
NSAID
3
Q
Aspirin indication
A
pain, fever, inflammation
reduction of platelet aggregration
reduction of cancer risk
4
Q
Aspirin MOA
A
inhibits Cyclooxygenase enzyme - both COX 1 and COX 2
to reduce fever, pain and inflammation, Aspirin inhibits COX 2
to to protect against MI and ischemic stroke, Aspirin inhibits COX 1
5
Q
Aspirin is a __________ _________ of cyclooxygenase.
A
Non selective inhibitor
6
Q
Side effects of Aspirin
A
GI effects- gastritis, dyspepsia, ulcers
renal impairment
bleeding
7
Q
Side effects of Aspirin result from its inhibition of
A
COX 1 enzyme
8
Q
What is unique about Aspirin’s inhibition of cyclooxygenase as compared to other NSAIDS?
A
it is irreversible, meaning that its duration of action depends on how quickly tissues can synthesize new molecules of COX-1 and COX-2
all other NSAIDS are reversible inhibitors and their effects decline as soon as blood levels fall
9
Q
Nursing Considerations: Aspirin: Antipyretic Dosage
A
*Antipyretic: 325-650mg po every 4 hours
10
Q
Nursing Considerations: Aspirin: Cardiac Dosage
A
Cardiac: may use 325mg po initially in acute event, then 81 mg/day.
11
Q
Nursing Considerations: Aspirin
Should it be administered to children ?
A
NO.
*Do not administer to children or adolescents younger than 18 years due to risk of Reyes Syndrome
12
Q
Nursing Considerations: Aspirin
Will enteric coating prevent GI bleeds?
should it be administered with food? what should be avoided with ingestion?
Some drug to drug interactions to be aware of
A
- Enteric coating may not prevent GI bleeding.
- Administer with food
- Avoid alcohol ingestion with medication as it can increase risk of gastric bleeding
*Drug-drug interactions/contraindications -
can intensify effects of anticoagulants so must be used with caution in combination
- use with caution with ACE inhibitors
-
13
Q
Ibuprofen classification
A
NSAID
14
Q
Ibuprofen indication
A
fever
analgesic - pain
anti-inflammation
15
Q
Ibuprofen MOA
A
- Non-selective inhibitor of COX (1 and 2)
- Anti-inflammatory
- Antipyretic
16
Q
Side effects of Ibuprofen
A
gastric bleeding (although risk is lower than that of Aspirin’s)
*GI – gastritis, dyspepsia, ulcers
*Bleeding
(Selective COX 2 inhibitors are known to cause an increased risk of thrombotic events; celecoxib (Celebrex))
17
Q
Nursing Considerations: Ibuprofen
A
- Many drug-drug interactions/contraindications
- Administer with food
- Avoid alcohol ingestion with medication
18
Q
Acetaminophen Classification
A
Acetaminophen is a Cyclooxygenase inhibitor that lacks any anti inflammatory properties.
It is an antipyretic and analgesic
19
Q
Acetaminophen Indications
A
Fever
Analgesic
20
Q
Acetaminophen MOA
A
inhibits cyclooxygenase (and thereby prostaglandin synthesis) within the CNS system, thus reducing fever and pain
No anti-inflammatory effects peripherally because it can’t inhibit prostaglandin synthesis outside the CNS
21
Q
Acetaminophen Side Effects
A
Few and extremely rare at therapeutic doses.
does not cause gastric ulceration or renal impairment and does not inhibit platelet aggregation
Overdose can cause severe liver injury
22
Q
How is Acetaminophen different from Aspirin ?
A
Acetaminophen does not have any anti inflammatory effects.
Acetaminophen does not suppress platelet aggregation, does not cause gastric ulceration and does not decrease renal blood flow or cause renal impairment
23
Q
Nursing Considerations: acetaminophen and liver effects
A
Inform patient of potential for severe liver injury if there is an overdose
also advise patients with liver disease to ask their provider if acetaminophen is safe to take
24
Q
Nursing considerations: Acetaminophen maximum total dosage a day
A
Advise patients to consume no more than 4000 mg (MAX) of acetaminophen a day, including the amount in combination prescription products (eg, Vicodin, Percocet) as well as OTC products.
25
Nursing Considerations: Acetaminophen and undernourished patients
Advise patients who are undernourished (eg, owing to fasting or illness) to consume no more than 3000 mg of acetaminophen a day.
26
Nursing Considerations: Acetaminophen and Alcohol
Advise patients not to drink alcohol while taking acetaminophen.
• Advise patients who won't stop drinking alcohol (more than 3 drinks a day) to take no more than 2000 mg of acetaminophen a day.
27
What is unique about Acetaminophen as a Cyclooxygenase inhibitor?
It has no anti inflammatory effects.
28
What are the names of antibiotics affecting cell wall synthesis ?
Beta-lactam antibiotics
29
When instructing a patient in taking antibiotics, make sure to tell them what regarding taking treatment course?
Instruct the patient to complete the prescribed course of treatment, even though symptoms may abate before the full course is over.
30
Indications of antimicrobial effects
reduction in fever, pain, or inflammation; improved appetite or sense of well-being
31
What is selective toxicity ?
The ability of a drug to injure invading microbes without injuring cells of the host
32
What is a bactericidal drug ?
Kills bacteria
33
What is a bacteriostatic drug ?
Suppresses microbe growth
34
Penicillins Drug class
Beta-lactam
35
beta-lactamases - what are they-
also how does it relate to penicillins ?
chemicals manufactured by bacteria that make them resistant to all or most beta-lactam antibiotics, such as penicillin
There are drugs that combine a penicillin and a beta lactamase inhibitor to counteract these defenses
36
Penicillin Indication
both therapeutically and prophylactically
*Therapeutic: used for gram-positive bacteria ex. Strep and Staph & a few gram-negatives such as Neisseria, and syphilis (Treponema).
Some will cover anaerobes such as Enterobacter & also Pseudomonas, and Klebsiella
*Prophylactic: used to prevent bacteremia in selected populations at risk for endocarditis, such as people with artificial or damaged heart valves
37
Penicillin MOA
Affects cell wall synthesis
38
Penicillin Side Effects
Allergy
GI – diarrhea, dyspepsia
Renal impairment can cause penicillins to accumulate to toxic levels
Suprainfections possible
39
What should patients with a penicillin allergy do ?
Advise patients with penicillin allergy to wear some form of identification (eg, Medic Alert bracelet) to alert emergency healthcare personnel
Instruct outpatients to report any signs of an allergic response (eg, skin rash, itching, hives).
40
Penicillin overdose can cause .......
neurologic problems, including seizures
41
Penicillin is synergistic with aminoglycoside antibiotics, but they cannot be administered in ......
the same IV line.
42
Patients taking penicillin - instructions for taking them
Instruct the patient to take oral penicillins with a full glass of water 1 hour before meals or 2 hours after. Penicillin V, amoxicillin, and amoxicillin/clavulanate may be taken with meals.
43
Amoxicillin + clavulanic acid (these drugs combine a penicillin and a beta-lactamase inhibitor)
Augmentin
44
Ampicillin + sulbactam=
= Unasyn
45
Ticarcillin + clavulanic acid =
Timentin
46
Piperacillin + tazobactam =
Zosyn
47
Cephalosporin Drug Class
Beta-lactam antibiotics
48
Four generations:
*First generation
(eg, cephalexin)
*Second generation
(eg, cefoxitin)
*Third generation
(eg, cefotaxime)
*Fourth generation
(cefepime)
*Fifth generation
(ceftaroline)
With each generation of cephalosporins, what is there?
increased activity against gram-negative organisms and increased effectiveness against organisms that produce beta-lactamases
49
To avoid the development of resistant populations of bacteria, ______ and _______generations of cephalosporins should be reserved for serious infections!
third and fourth
50
Cephalosporins MOA
affects cell wall synthesis
51
Cephalosporins Side Effects
* Risk of increased bleeding with warfarin because of interference with Vitamin K metabolism
* Allergy
GI upset: diarrhea and pseudomembranous colitis
immune-mediated hemolytic anemia
*can promote clostridium difficile suprainfection
52
Cephalosporins are contraindicated for those with
a history of allergic reactions to cephalosporins or of severe allergic reactions to penicillins.
53
With cephalosporins, it is especially important to monitor ...... and exercise caution in patients with a history of .......
the prothrombin time, bleeding time, or both. Parenteral vitamin K can correct abnormal prothrombin time. Observe patients for signs of bleeding and, if bleeding develops, discontinue the drug. Exercise caution in patients with a history of bleeding disorders and in patients receiving drugs that can interfere with hemostasis (anticoagulants; thrombolytics; antiplatelet drugs, including aspirin and other NSAIDs).
54
Alcohol and cephalosporins: good idea or not ?
NOT A GOOD IDEA. Several can trigger a disulfiram-like reaction if used with alcohol.
Advise patients about alcohol intolerance and warn them not to drink alcoholic beverages.
55
Patient instructions for Cephalosporins
Don't intake with alcohol
make sure to refrigerate an oral suspension
Advise patients to take oral cephalosporins with food if gastric upset occurs.
report any diarrhea
56
Vancomycin Drug Class
Non beta-lactam
57
Vancomycin indications
A potentially toxic antibiotic only used to treat serious infections.
Can be used in treating gram+ infections (in those with PCN allergy)
Oral preparation can be used for bowel infections, particularly Clostridium difficile (a suprainfection) – topical to GI system, not absorbed by the bloodstream
58
For those allergic to penicillins and having a serious infection, this can be used .....
Vancomycins
59
Vancomycins MOA
affects call wall synthesis
60
Major toxicity of Vancomycins
renal failure
61
Side effects - Vancomycins
Ototoxicity and
dose-related nephrotoxicity
Multiple drug interactions with hyperlipidemic drugs, muscle relaxants, and ototoxic drugs
Irritating to the vein, causing thrombophlebitis (use large vein and change site often
Rapid infusion can cause “red man syndrome”
62
What is "red man syndrome ?"
an infusion-related reaction peculiar to vancomycin - It typically consists of pruritus, an erythematous rash that involves the face, neck, and upper torso, flushing, urticaria, tachycardia, hypotension
63
Nursing Considerations of Vancomycin
*Measure peak and trough levels
Rapid infusion can cause “red man syndrome,” characterized by flushing, rash, pruritus, urticaria, tachycardia, and hypotension. To minimize risk, infuse vancomycin slowly, over 60 minutes or longer.
64
To minimize risk of "red man syndrome," what can be done?
To minimize risk, infuse vancomycin slowly, over 60 minutes or longer.
65
Tetracyclines are what kind of drug ?
bacteriostatic inhibitors of protein synthesis
66
Tetracycline, Demeclocycline, Doxycycline, Minocycline - these are the four __________ available for systematic therapy
tetracyclines
67
Tetracycline Indications
Agents of choice for Chlamydia and rickettsial diseases (Rocky Mountain spotted fever)
Used in acne, periodontal disease.
68
Tetracycline MOA
Bind to the 30S ribosomal subunit, which inhibits the binding of transfer RNA to the messenger RNA-ribosome complex. The addition of amino acids to the growing peptide chain is prevented
Broad spectrum but resistance has developed
69
Tetracycline Side Effects
* Discoloration of developing teeth
* GI distress (epigastric burning, cramps, nausea, vomiting, diarrhea)
* Photosensitivity
70
All tetracyclines can increase the __________ of the skin to ultraviolet light
sensitivity. This can lead to exaggerated sunburn
71
Tetracycline Nursing Considerations : directions for taking
Advise patients to take most oral tetracyclines on an empty stomach (1 hour before meals or 2 hours after) and with a full glass of water. Minocycline may be taken with food
72
This type of Tetracycline medication may be taken with food.
Minocycline
73
Tetracycline Nursing Considerations: what kind of foods and supplements should patients allow at least 2 hours between ingestion of tetracycline .......
Instruct patients to allow at least 2 hours between ingestion of tetracyclines and these chelators: milk products, calcium supplements, iron supplements, magnesium-containing laxatives, and most antacids.
74
Why should Tetracyclines not be given to pregnant women or children below 8 years ?
Tetracyclines bind to calcium in developing teeth and form a discolored area. However use during pregnancy will only affect baby teeth.
Discoloration of permanent teeth occurs when tetracyclines are taken by patients 4 months to 8 years
75
Why is it important for patients to know the symptoms of Candidiasis when taking tetracyclines ?
Tetracyclines are a broad spectrum antibiotic and so the risk of suprainfection is greater than with antibiotics that have a more narrow spectrum. Candidiasis is one of the diseases that may occur through overgrowth of fungi (in this case, Candida Albicans)
76
Symptoms of Candidiasis -
Candidiasis -Inform patients about symptoms of fungal infection (vaginal or anal itching; inflammatory lesions of the anogenital region; black, furry appearance of the tongue), and advise them to notify the prescriber if these occur.
77
Nursing Considerations: Tetracyclines and Sunlight
Advise patients to avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin.
78
Macrolides Drug Class
Broad spectrum antibiotics that inhibit protein synthesis
79
Why are macrolides called "Macrolides"?
Because they are big
80
Azithromycin (Zithromax)
Erythromycin
Clarithromycin (Biaxin)
These are all ......
Macrolides
81
Name at least 2 types of Macrolides
Azithromycin (Zithromax)
Erythromycin
Clarithromycin (Biaxin)
82
Macrolides Indications
Gram-positive and some gram-negative bacteria.
Legionella and Chlamydia
83
In patients with an allergy to penicillin G, this drug class can be used as an alternative of first choice for several infections ?
Macrolides
84
Macrolides MOA
Prevents protein synthesis
Inhibit addition of new amino acids to the growing peptide chain by binding to the 50S ribosomal subunit
85
Macrolides Side Effects
GI disturbances - epigastric pain, nausea, vomiting, diarrhea
QT prolongation and sudden cardiac death - possibility when combined with drugs that can raise its plasma level
86
Erythromycin and clarithromycin (macrolides) are strong inhibitors of __________________________and hence these should be administered with caution in patients taking these drugs .....
cytochrome p450 hepatic drug metabolizing enzymes
administer with caution in patients taking drugs metabolized by these enzymes (statins and warfarin, among others).
Azithromycin is a weaker inhibitor of P450 enzymes, but caution is still advised.
87
When giving Erythromycin via IV, make sure to
Dilute in large quantities of fluid and infused slowly into a large vein.
88
Clindamycin Drug Class
bacteriostatic inhibitor of protein synthesis
89
Clindamycin Indications
Anaerobes and gram-positive aerobes
Reserve for serious infections
Poor penetration of the brain.
90
Like macrolides, Clindamycin has a similar MOA:
Inhibits 50S ribosomal subunit
91
Clindamycin Side Effects
Suprainfection with Clostridium difficile
92
Clindamycin Nursing Considerations
IV infusion must be SLOW (fatalities have occurred from too rapid infusion).
93
Aminoglycosides Drug Class
Bactericidal Inhibitor of Protein Synthesis
- Narrow Spectrum Antibiotics
94
Name most commonly employed aminoglycosides
Gentamicin
Tobramycin
Amakacin
95
Aminoglycoside Indications
Aerobic gram negative bacilli: Pseudomonas, Klebsiella, and Serratia
no activity against anaerobes
96
Aminoglycoside MOA
Bind to the 30S ribosomal subunit
thereby causing
1) Inhibition of protein synthesis
2) premature termination of protein synthesis
3) Production of abnormal proteins (secondary to misreading of the genetic code)
97
Aminoglycosides are bactericidal. Cell kill is _____________
concentration dependent: the higher the concentration, the more rapidly the infection will clear
98
Aminoglycosides Side Effects
Ototoxic and nephrotoxic— adjust for renal impairment
Aminoglycosides can inhibit neuromuscular transmission, causing potentially fatal respiratory depression.
99
Aminoglycosides Nursing Considerations
For many patients, once daily infusion is as good as divided doses because it produces very high levels that kill bacteria even after the blood level declines.
Low levels in between the daily dose allows washout from body cells in between doses and lowers the risk of toxicity. (measure peak and trough levels)
Can be used topically to sterilize the gut or on the skin (neomycin) or eye.
100
```
Sulfamethoxazole-
and Trimethroprim (Bactrim) Drug Class
```
Bactericidal Broad Spectrum Antimicrobials : they disrupt the synthesis of tetrahydrofolic acid
these drugs are marketed together in a fixed-dose combination product
101
```
Sulfamethoxazole-
and Trimethroprim (Bactrim) Indications
```
Broad spectrum, including many gram negative and gram positive
Used extensively for UTI, Pneumocystis jerovici pneumonia
102
```
Sulfamethoxazole-
and Trimethroprim (Bactrim) MOA
```
Blocks bacterial enzymes that are important for the synthesis of the building blocks of DNA, RNA and proteins.
Combination of a sulfa drug (sulfamethoxazole) and an inhibitor of a bacterial enzyme called dihydrofolate reductase (trimethoprim) - are synergistic in their activity.
103
```
Sulfamethoxazole-
and Trimethroprim (Bactrim) Side Effects
```
Hypersensitivity reactions are most concerning:
Rash, including rare Stevens-Johnson syndrome.
Heme: hemolytic anemia and other blood dyscrasias (agranulocytosis, leukopenia, thrombocytopenia, aplastic anemia).
Crystalluria (kidney/bladder stones)
CNS: headache, psychosis
104
```
When taking Sulfamethoxazole-
and Trimethroprim (Bactrim) or other Sulfonamides, the patient should remain well _________________ and consume 8-10 _____________ per day
```
hydrated; glasses of water
105
```
Sulfamethoxazole-
and Trimethroprim (Bactrim) or other Sulfonamides - Nursing Considerations at the first dose
```
First dose – observe closely for rash. Instruct patients to discontinue drug use at the first sign of hypersensitivity (eg, rash).
106
Sulfanamides Contraindications
Sulfonamides are contraindicated for patients with a history of severe hypersensitivity to sulfonamides and chemically related drugs, including thiazide diuretics, loop diuretics, and sulfonylurea-type oral hypoglycemics
107
Sulfanamides Nursing Considerations: Exercise caution in those with
renal impairment
108
Sulfanamides Nursing Considerations: signs of hemolysis and blood count
Observe patients for signs of hemolysis (fever, pallor, jaundice). When sulfonamide therapy is prolonged, periodic blood cell counts should be made.
109
Sulfanamides Nursikng Considerations: Sun exposure
Advise patients to avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin.
110
Fluoroquinolones Drug Class
Broad Spectrum antibiotic
111
What types of drugs are these ?
Ciprofloxacin (Cipro)
Levofloxacin
Oxofloxacin
Fluoroquinolones
112
Fluoroquinolones Indications
Active against aerobic organisms, most gram negative and some gram positive
113
Fluoroquinolones MOA
Inhibit an enzyme (DNA gyrase) important in bacterial DNA replication
114
Fluoroquinolones Side Effects
Can cause irreversible joint disease in children <18
Rarely, tendon rupture in adults
Photosensitivity
Candida suprainfections, especially of the oropharynx
Infrequent but serious CNS effects.
115
Fluoroquinolones Contraindications
contraindicated in patients with a history of myasthenia gravis.
116
Use all fluoroquinolones with caution in patients with ........................................
Use all fluoroquinolones with caution in patients with renal impairment, and in patients age 60 and older, patients taking glucocorticoids, and patients who have undergone a heart, liver, or kidney transplantation.
117
fluoroquinolones shouldn't be taken with what kind of supplements ?
Shouldn’t be taken with aluminum, iron, calcium, iron or zinc supplements.
118
fluoroquinolones Nursing Considerations: Tendon Damage
Inform patients about the risk of tendon damage and instruct them to report early signs of tendon injury (pain, swelling, inflammation), and to refrain from exercise until tendinitis has been ruled out.
119
Fluoroquinolones Nursing Considerations: Sun Exposure
Advise patients to avoid sunlamps, and to use a sunscreen and protective clothing when outdoors.
120
Metronidazole (Flagyl) Indications
Targets anaerobic organisms, including parasites and bacteria:
C. difficile and others
121
Metronidazole (Flagyl) Indications
A prodrug that is activated only in anaerobic cells
122
Metronidazole (Flagyl) Side Effects
Cytochrome P450 interactions
Darkening of the urine
CNS adverse effects
Caution during pregnancy, avoid during lactation
123
Metronidazole (Flagyl) routes
PO and IV
124
Amphotericin B Drug Class
Antifungal
125
Amphotericin B Indications
Used for life-threatening systemic fungal infections
126
Amphotericin B MOA
Binds to sterols in the fungal membrane and increases permeability – the fungal cell swells and bursts
127
Amphotericin B Side Effects
Infusion reactions – phlebitis and systemic symptoms (fever, chills, rigors, nausea and headache)
Nephrotoxic – use with caution with other nephrotoxic drugs (aminoglycosides)
128
This drugs nickname is Amphoterrible .....
Amphotericin B
129
Amphotericin B route
IV only
130
Amphotericin B Nursing Considerations
Can it be used during pregnancy ?
Monitor renal labs, intake and output
NOT teratogenic – can be used in pregnancy. (Minimal data available about use during pregnancy)
131
Fluconazole
Ketoconazole
Iitraconazole
Drug Class ......................
Azole Antifungals
132
Azole Antifungals:
Fluconazole
Ketoconazole
Iitraconazole
Indications ..................................
Oral alternative to amphotericin B for systemic fungal infections
Can be used topically for fungal skin infections
133
Azole Antifungals:
Fluconazole
Ketoconazole
Iitraconazole
MOA ..........
Inhibit the synthesis of a sterol component of the fungal cell membrane
134
Azole Antifungals:
Fluconazole
Ketoconazole
Iitraconazole
Strong inhibitor of cytochrome P450 enzymes – use with extreme caution in hepatically metabolized drugs
Rare hepatic necrosis
Teratogenic!
135
Azole Antifungals:
Fluconazole
Ketoconazole
Iitraconazole
are they safe during pregnancy ?
NO! UNSAFE during pregnancy
136
Acyclovir Drug Class
Antiviral
137
Acyclovir Indications
Active against all herpes viruses: herpes simplex, herpes zoster, and cytomegalovirus (CMV)— although most strains of CMV are resistant
138
Acyclovir MOA
Suppresses synthesis of viral DNA – but must be activated by a viral enzyme, thymidine kinase
139
Acyclovir Side Effects
Nephrotoxic – maintain high hydration to dilute drug in renal tubules
140
Acyclovir Routes
Oral, IV, topical
141
Does Acyclovir eliminate the Herpes Virus ?
No: Inform patients with herpes simplex genitalis that acyclovir only decreases symptoms; it does not eliminate the virus and does not produce cure
Advise patients to cleanse the affected area with soap and water 3 to 4 times a day, drying thoroughly after each wash.
Advise patients to avoid all sexual contact while lesions are present, and to use a condom even when lesions are absent
142
Ganciclovir Drug Class
Antiviral
143
Because Ganciclovir is excreted unchanged in the urine, what should be done in those with renal impairment?
decrease dose for patients with renal impairment.
144
We should monitor blood counts when taking Ganciclovir because of what prominent two adverse effects
Granulocytopenia and thrombocytopenia are prominent adverse effects – monitor blood counts.
145
Can Ganciclovir be used during pregnancy ?
NO! Teratogenic and embryotoxic – birth control should be in place.
