Antipyretics MEDICATION-NURSING Flashcards
Dose:
Antipyretic/Analgesic: 325-650mg po every 4 hours
Cardiac: may use 325mg po initially in acute event, then 81 mg/day.
Enteric coating may not prevent GI bleeding.
Administer with food
Avoid alcohol ingestion with medication
Drug-drug interactions/contraindications
Do not administer to children or adolescents due to risk of Reyes Syndrome
Aspirin
Many drug-drug interactions/contraindications
Administer with food
Avoid alcohol ingestion with medication
Cautious with renal impairment by way of decreasing blood flow to the kidneys
Ibuprofen (Motrin, Advil)
Fever
Analgesic Decreases prostaglandin synthesis in the CNS
(NO anti-inflammatory effect peripherally) Few
Liver toxicity in high, regular doses • Inform patients about the risk of liver injury.
• 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.
• Advise patients who are undernourished (e.g., owing to fasting or illness) to consume no more than 3000 mg of acetaminophen a day.
• 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.
• Advise patients with liver disease to ask the prescriber if acetaminophen is safe.
Acetaminophen
Advise patients with penicillin allergy to wear some form of identification (e.g., Medic Alert bracelet) to alert emergency healthcare personnel.
Instruct outpatients to report any signs of an allergic response (e.g., skin rash, itching, hives).
Overdose can cause neurologic problems, including seizures.
Synergistic with aminoglycoside antibiotics but can’t be administered in the same IV line.
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.
Measure I & O’s
Watch for cross-sensitivity with cephalosporins and carbapenems
ampicillin
Cephalosporins are contraindicated for patients with a history cephalosporin allergy or if history of severe allergic reactions to penicillins.
Monitor 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).
Several can trigger a disulfiram-like reaction if used with alcohol.
cefazolin
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.
Measure peak and trough levels!
Trough-just before dose
Peak–30-60 min after infusion complete.
Watch renal function – BUN/creatinine. Doses may be titrated for renal function
Ototoxicity – assess for dizziness, tinnitus, vertigo and loss of hearing
Gentamicin
Fluoroquinolones are contraindicated in patients with a history of myasthenia gravis.
Use all fluoroquinolones with caution in patients with renal impairment, and in patients age 60 and older
Shouldn’t be taken with aluminum, iron, calcium, iron or zinc supplements.
Advise patients to avoid sunlamps, and exposure to sun; sunscreen does not protect from photosensitivity reactions
Ciprofloxacin (Cipro)
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.
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.
Bind to calcium in developing teeth and form a discolored area > don’t give to pregnant women (will only affect baby teeth) or children below 8 years.
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.
Advise patients to avoid prolonged exposure to sunlight, wear protective clothing and sunscreen
tetracycline
Patient should remain well-hydrated
First dose – observe closely for rash. Instruct patients to discontinue drug use at the first sign of hypersensitivity (e.g., rash).
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.
Exercise caution in patients with renal impairment.
Advise outpatients to consume 8 to 10 glasses of water per day.
Advise patients to avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin.
Observe patients for signs of hemolysis (fever, pallor, jaundice). When sulfonamide therapy is prolonged, periodic blood cell counts should be made.
Trimethroprim- Sulfamethoxazole (TMP-SMZ) (Bactrim)
Erythromycin and clarithromycin are strong inhibitors of cytochrome P450
Drug-drug interactions
Alternative to penicillin in those with PCN allergy
Dilute in large quantities of fluid and infused slowly into a large vein.
Erythromycin and clarithromycin are strong inhibitors of cytochrome P450 – 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.
Erythromycin
Measure peak and trough levels:
Peak- 2 hours after admin
Trough- 30 min. before next dose
Watch renal labs!
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 time provided by pharmacist
Vancomycin
Drug-drug interactions
PO and IV
Metronidazole (Flagyl)
