DONE: Immune PHARMACOLOGY Flashcards
What are these drugs classified as? Penicillins Cephalosporins Aminoglycosides Tetracyclines Fluoroquinolones Macrolides
A: antibacterial drugs/anti-infectives
It is important that your pt is receiving the right antibiotic and that it’s effective against whatever type of infection that they have going on or that it will prevent whatever we want it to prevent because some of these are given ________
A prophylactically
It’s important to know if your pt has _____ if they have ____ to a certain class of anti-infectives sometimes there are cross ____ with other classes that are closely related
A: allergies
Note: same answers for all blanks
You ___ get the cultural and sensitivity so collect the specimen before you begin the antibiotic or it can alter your result; you don’t have to ___to get the results but you do have to collect the specimen
A: MUST
Wait
Note: IMPORTANT
It kills the bacteria and it does that by inhibiting cell wall synthesis
A: bactericidal
Most effective against fast growing bacteria they are more susceptible to this
Partially metabolized in the liver
Mostly excreted in the urine
A: penicillins
If you have somebody with liver and kidney issues you are going to have to use caution with?
A: penicillins
Abbreviation: PCN and is commonly used for what medication?
A: penicillins
What are the 4 types of penicillins?
A: Aminopenicillins, Extended-spectrum, Natural, and Penicillinase-resistant
These are very common, old drugs so it’s really cheap
A: Aminopenicillins: amoxicillin (Amoxil), amoxicillin/clavulanate (Augmentin, Augmentin XR)
This type of anti-infective is effective against more bacteria
A: Extended-spectrum
An enzyme that is located on the penicillin and some bacteria is resistant to that enzyme so they would be resistant to the other penicillins
A: Penicillinase-resistant
Medication we would use if a patient is Penicillinase resistant
A: dicloxacillin (Dynapen), nafcillin, and oxacillin
Penicillins are effective against what types of bacteria?
A: Gram-positive cocci and bacilli Some gram-negative cocci, some anaerobes Aminopenicillins are used for enterococcal infection Gonorrhea Staphylococci
Up to 10% cross sensitivity so ppl who have an allergy to ____ might also have an allergy to _____; no one is ever allergic to a medication the first time they have it; an allergy is an immune system response and for your immune system to react to something it has to be exposed to it first and identify it as an invader and mount a defense against it so first dose is not going to get an allergic reaction any dose after that can.
A: cephalosporin
Penicillin
End in “cillin”
Nausea, vomiting, diarrhea, epigastric distress
Rash and it’s an allergic reaction and we will talk about that in a couple of seconds
Pain at IM site, thrombophlebitis at IV site it’s an irritating medication
Resistant bacterial and fungal super infections
Anaphylaxis
These adverse reactions are for what type of medication?
A: penicillin
If you receive penicillin then they should watch you for about ____ afterwards to see if you are going to have an anaphylactic reaction
A: 15-20 mins
If giving penicillin at the same time as an aminoglycoside it May decrease effectiveness of aminoglycosides
May diminish effectiveness of oral contraceptives, so you get strep throat, take penicillin and 9 months later have a baby
Extended spectrum penicillins with other PCNs may inhibit platelet aggregation so there you are having a risk for bleeding
A: Penicillin interactions
Probenecid (anti-gout medication) decreases renal excretion of PCN so again we would have to be cautious
Used with clavulanate or sulbactam enhances resistance against those bacteria that are resistant to Penicillinase; produces beta lactamase (which inactivates PCN)
Tetracyclines may decrease effectiveness so here you’ve got 3 antibiotic classifications on this 1 slide penicillin, amino glycosides, and tetracyclines and if you are giving those together you are not going to get the full effect so it’s really important to know and watch for that
A: Penicillin interactions
Directions for taking: include drug name, dosage, frequency, duration, possible adverse reactions; Take complete course of antibiotics; Advise patients on oral contraceptives to use another method; Precautions re: food, other meds; Signs of superinfection
A: general nursing responsibilities: Patient Education
Note: General nursing responsibilities apply to all classes of antibiotics
Watch for s/sx of allergic reaction; Anaphylaxis: rash, pruritus, laryngeal edema, wheezing and this will happen within the first 15 mins after taking it; Keep epinephrine, anti-histamine, and resuscitation equipment close by; Instruct the pt to avoid acidic or carbonated beverages if taking it orally because that can decrease drug absorption; general nursing responsibilities
A: Penicillin: Nursing Responsibilities
Begins with “cef” or “ceph”
Bactericidal; Does NOT kill fungi or viruses
Metabolism varies by drug but they are excreted primarily in the urine and you have to be sure that you have good renal function
A: cephalosporins
There are 4 generations of cephalosporins: 4th generation cephalosporins are more effective against ____and 1st generation is more effective against ___; least effective ____ at 4 and getting more and more until they are most effective at generation 1 and with ____ they are least effective with the 1st generation and more effective with the 4th generation
A: gram negative (4 to 1) gram positive (1 to 4) gram positive gram negative Note: other than that gram negative, gram positive there is really no reason that you have to be aware of which generation it is;
I want to point out in the 1st generation ___ is the medication that you see given prophylactically in the peri-operative period to prevent infection
A: Ancef
Gram-positive and gram-negative bacterial infections and that would be a reason a physician would order one or another generation
Gram-positive and gram-negative cocci infections
Some gram-negative bacilli infections
A: Cephalosporins: Contraindications
Nausea, vomiting, diarrhea (not allergic reactions) so you will see how that might not be a good thing with someone with colitis
Rash – allergic reaction
Anaphylaxis and remember that is an exaggerated allergic reaction
Pain at IM site, phlebitis at IV site-there can be irritation at the site
Pseudomembranous colitis can develop as a result of being on this medication and this is something that you know as C-diff
if somebody develops a rash or hives do not give them this medication; you need to stop it and notify the physician
A: Cephalosporins: Adverse Reactions
If also on aminoglycosides they are not compatible you have to use separate IV site and that is very important because we don’t want them mixing in the IV tubing and you can find that information in your drug guide under the compatibility chart
A: Cephalosporins: Interactions
____ is medication given to alcoholics that want to quit drinking so they take this medication and they get really sick if they drink so _____ will have a similar reaction
A: Disulfiram
Cephalosporins
End in “cin” Bactericidal Poor oral absorption, most given IV Not metabolized Excreted unchanged in urine What type of drug class is this?
A. aminoglycosides
_____ is NOT an aminoglycoside; ___ is in a category all by itself DO NOT GET THIS CONFUSED
A: Vancomycin
Vancomycin
Note: VERY IMPORTANT TO KNOW
Aerobic gram-negative bacilli and some gram-positive bacteria (some gram-positive are resistant)
Septicemia, postoperative pulmonary, intra-abdominal, and serious recurrent UTIs so we will use other medications for UTI’s unless they are serious and reoccurring, infections of bone, skin, soft tissue, and joints
Ammonia forming bacteria in gut of pt with hepatic encephalopathy
In conjunction with others: serious staph, serious pseudomonas aeruginosa infections, nosocomial pneumonia, TB, pelvic inflammatory disease, serious Klebsiella infections
This is used for serious infections and if they can use something else they will because the side effects of these drugs can be bad
What type of medication has these indications?
A: Aminoglycosides
Hypersensitivity as with any drug
Severe renal disease because it’s cleared there or excreted there
Pregnancy
Breast feeding
What medication has these contraindications?
A: Aminoglycosides
Must Use with caution for the following reasons for what medication?
Renal disease that is just renal disease not severe renal disease
Neuromuscular disorders such as Parkinson’s and myasthenia gravis
Heart failure
Elderly
Infants
A: Aminoglycosides
Note: We have to do that again because of the side effects
Vestibular and cochlear ototoxicity, nephrotoxicity, and neurotoxicity it can destroy someone’s ears and kidneys…very important to be aware of that
Oto- and Nephro- toxicity: reversible ONLY if caught early and then discontinued the medication IMMEDIATELY; I can’t emphasize this enough; I have seen somebody go into renal failure totally lose all kidney function and die because they were on ______?
What medication classification has this serious adverse reaction?
A: Aminoglycosides
Note: VERY, VERY, VERY IMPORTANT FOR YOU TO KNOW THIS FOR YOUR CAREER AS A NURSE; REMEMBER THAT I AM NOT JUST FOCUSING ON A TEST I AM ALSO THINKING ABOUT WHEN YOU ARE A NURSE
MOST SERIOUS:
What are the most common adverse reactions for Aminoglycosides?
A: nausea, vomiting, diarrhea
Hypersensitivity
Transient neutropenia, leukopenia, thrombocytopenia aka transient pancytopenia
Elevated liver enzymes
Phlebitis if given IV, sterile abscess if given IM
Name the Aminoglycosides Interactions
A: Interact with other aminoglycosides or loop diuretics: additive ototoxicity and added together they can be more ototoxic
Inactivated when given with PCNs
Given at same site with cephalosporins inactivates and needs to be given in 2 separate sites when you are giving both same as with cephalosporins
Used with some inhalation anesthetics or neuromuscular blockers may cause respiratory paralysis and that kind of makes sense why we want to be careful if we are giving it to somebody who already has some neuromuscular disorder we don’t want to cause respiratory distress
Assess for vertigo and hearing loss before starting the medication and if there is any change during therapy then the medication needs to be stopped and of course you will notify the physician, but you know, educate the pt, how is your hearing now? Maybe do a hearing test, and then monitor during tx to make sure that we don’t have any hearing loss
Monitor renal function VERY important
Make sure patient well hydrated; Encourage fluids 1500-2000 mL a day
MONITOR PEAK AND TROUGH
See General Nursing Responsibilities
What medication do these nursing responsibilities refer to?
A: Aminoglycosides
Drawn to determine if SAFE level of antibiotic is being administered
A: peak and trough
peak and trough note: please read
Note: Peak level is drawn after target dose (e.g. 3rd dose) most often seen the 3rd dose being used, the physician will write an order for gentamycin because Gentamycin is actually an aminoglycoside; the Dr. will write dosing per pharmacy so pharmacy will start at what is a reasonable dose based on their assessment of the pt and they’ll say do a peak and trough with the 3rd dose; so when the 3rd dose is due to be hung, they will go ahead and hang it and it has to be hung exactly on time, it has to run over exactly the amt of time that it’s supposed to so here comes your math skills, say it’s supposed to run over an hour and it was due at 9 o’clock so you hang it at 9 o’clock it runs until 10 it has to do that for this to be accurate and then after the medication has been infused then 45-60 mins after like 10:45 to 11 we will draw the peak because the target dose is the 3rd dose so we are drawing it when the medication is at its highest concentration in the blood; then say it is every 12 hours at 9 pm we need to do another dose so we draw the trough right before we give that next dose; this is before the target dose and different hospitals will do it different ways so you will have to do that; just know that the trough is lowest level of medication in the blood and for Gentamycin the trough should be between 0.5-1.5 and the peak should be between 6-10
Peak levels questioned with Vancomycin (non-classified anti-infective) they just do troughs so that’s FYI and they don’t really do peaks anymore with Vancomycin; but something very important for you to know; I would like you to know the Gentamycin though
Trough level is drawn before ___ dose
A: target
Nursing usually draws ___ to ensure done on time
A: P & T=peak and trough
Tetracyclines are:
A: Bacteriostatic they might actually kill some bacteria’s and Inhibits bacterial protein synthesis
Tetracyclines are _____ in urine or feces
A: Excreted
Note: So it’s important for your pt to be moving your bowels right or they are not going to be excreting this drug; these drugs
Tetracyclines are metabolized in?
A: kidneys
End in “cline” Demeclocycline hydrochloride (Declomycin), doxycycline hyclate (Vibramycin), minocycline hydrochloride (Minocin), oxytetracycline hydrochloride (Terramycin), tetracycline hydrochloride (Sumycin) These are examples of what type of medication classification?
A: tetracycline
This is a very commonly used tetracycline:
A: tetracycline hydrochloride (Sumycin)
Gram-positive and gram-negative infections
Lyme disease
Gonorrhea
Syphilis
Mycoplasma, chlamydia, Rickettsia
Acne
These are indications for what type of medication?
A: tetracyclines
____ this is an atypical use but if someone has _____ tetracycline can actually inhibit the action of ADH so it might be used
Note: same answer for both blanks
A: SIADH
Demeclocycline hydrochloride (Declomycin) is the medication that’s used and it actually works as a diuretic in someone that has ____
A: SIADH
Pregnancy and breast feeding
Hypersensitivity again if they have a hypersensitivity to this med we don’t give it and that’s any tetracycline so they can’t say they are allergic to one and take others because it works across the whole class
Children under 8 unless no alternative; it’s not good for the formation of teeth and to the enamel in kids
Causes permanent tooth discoloration
Use cautiously in elderly
These are contraindications for what medication?
A. tetracyclines
GI – anorexia, GI upset, flatulence, nausea, vomiting, bulky and loose stools, epigastric burning
Hypersensitivity
Pancreatitis, hepatotoxicity
Photosensitivity
Rash Pain at IM site, phlebitis at IV site
Mild BUN increase
These adverse reactions are for what medication?
A. tetracyclines
Antacids, calcium supplements, iron, magnesium containing laxatives, milk and dairy decrease absorption so if you are going to be giving these at the same time you really need to be careful
May increase effects of oral anti-coagulants so we have an issue there with bleeding
Decrease effectiveness of oral contraceptives so we have an issue there with having a baby
Decrease effectiveness of PCNs
These interactions describe what medication?
A. tetracyclines
ONLY doxycycline and minocycline are given IV all the others are either given PO or IM
Patient Education
Avoidance of milk products and drugs containing calcium, magnesium, aluminum or iron because it’s going to effect the absorption of the medication and if they do have to use some of those medications then they need to be taken 2-3 hours before or after the tetracycline
Take on an empty stomach
Avoid direct sunlight because of that photosensitivity
See General Nursing Responsibilities
Use these nursing responsibilities for what medication?
A. tetracyclines
______ are used as a Broad spectrum which means that they are effective against a wide variety of bacteria
A: Fluoroquinolones
_____ Inhibit intracellular enzymes
A: Fluoroquinolones
_____ Excreted, mostly unchanged, in urine and mostly unmetabolized
A: Fluoroquinolones
This med Ends in “floxacin”
A: Fluoroquinolones
Ciprofloxacin (Cipro), gatifloxacin (Tequin) is one that I haven’t seen too much, gemifloxacin (Factive), levofloxacin (Levaquin) is very common, lomefloxacin hydrochloride (Maxaquin), moxifloxacin hydrochloride (Avelox) norfloxacin (Noroxin), ofloxacin (Floxin), sparfloxacin (Zagam)
Ciprofloxacin (Cipro) and levofloxacin (Levaquin) are the ones that you will see the most often
Name the classification for these medications?
A: Fluoroquinolones
What classification of drug has this long list of indications? Aerobic gram-positive and gram-negative infections Bone and joint infections Skin and soft tissue infections Intra-abdominal infections Urinary tract infections Pyelonephritis Acute sinusitis Chronic bronchitis Gonorrhea Endocervical and urethral chlamydial infections Pelvic inflammatory disease
A: Fluoroquinolones
______ was in the news because that’s the medication that was given post anthrax exposure to prevent cutaneous anthrax
A: ciprofloxacin
Children
Cautiously: CV disorders, CNS disorders, seizures (it can cause seizures), renal insufficiency, cerebral ischemia, severe hepatic dysfunction
What classification of drugs has these contraindications?
A: Fluoroquinolones
Nausea Crystalluria Phototoxicity Diarrhea Rash Can cause C-diff What classification of drugs has these adverse reactions?
A: Fluoroquinolones
May increase serum levels of methylxanthines which are a respiratory medication, a bronchodilator, aminophylline, theophylline is a methyl xanthine
A: Antacids; Fluoroquinolones: Interactions
Note: Can cause toxicity and this is something that you don’t want to see; it can be very unpleasant and harmful
______ may reduce effectives
A: Antacids; Fluoroquinolones: Interactions
________ may decrease renal excretion
A: Probenecid (anti-gout med); Fluoroquinolones: Interactions
Give 2 hours apart from: antacids, calcium, and iron
Monitor renal function
A: Fluoroquinolones: Nursing Responsibilities
Note: See General Nursing Responsibilities
Take with 8 ounces of water
Wear sunscreen due to photo sensitivity, if there is a C & S ordered you need to do that before giving the medication although you do NOT have to wait for the results
A: Patient education; Fluoroquinolones: Nursing Responsibilities
Broad spectrum Block protein synthesis High doses- bacteriocidal Low doses – bacteriostatic Given IV or po What drug classification is this?
A: Macrolides
Note: Not given IM – too painful
Give IV slowly to avoid pain
Absorbed from GI tract
Poorly metabolized or not metabolized
Excreted in either urine or feces (depending on which drug it is)
What drug classification is this?
A: Macrolides
This is where is gets a little confusing with the amino glycosides you just might have to do some memorization here
What classification of drugs are these?
A: Macrolides
End in “mycin” remember this is similar to amino glycosides so this isn’t perfect
What drug classification is this?
A: Macrolides
Azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E-mycin)
What classification of drugs are these?
A: Macrolides
Note: I think with this one you will just have to memorize it and I know in the past that I have often thought oh erythromycin is an amino glycoside and then I look it up and go whoops so that is something you will have to memorize because the rules don’t really work well with this one
_____ and _____ upper and lower respiratory, skin and soft tissue infections, helicobacter pylori remember that it causes ____, mycobacterial and gram-positive and –negative organisms so you will see that there is a lot of over lapping here like the things we just read the upper and lower respiratory, skin and soft tissue…hey that’s what Cipro is for also so a lot of times it’s just physician preference or maybe what’s going around in the community right now have you ever gone to the doctor with some type of an infection and they will say well we know that this is going around in the community right now so they will give you an antibiotic because that what whatever in the community is susceptible to and that’s call ____ _____ ___ it’s the use of an educated guess to prescribe a medication
A: Azithromycin and clarithromycin GERD empirical antibiotic use These are Macrolides: Indications Note: If we don’t have cultural and sensitivity results than that’s the best we have at that time is an educated guess of course if the pt doesn’t get better than or we get C & S back that tells us it’s the wrong medication then we can change it but just in case you have some confusion about hey all these medications seem to overlap, they do overlap but they may be more effective, one will be more effective than the other and we find that through C & S and we start out with education first, educated guess to dose them until we get the results back
______ moderate to severe infections (e.g Pneumococcal pneumonia, acute PID, intestinal amebiasis, Legionnaire’s disease, chlamydial infections)
A: Erythromycin: Macrolides: Indications
Hypersensitivity
Use with caution: hepatic dysfunction, lactation, renal dysfunction
A: Macrolides: Contraindications
Nausea, vomiting, diarrhea, abdominal cramps those can be side effects depending on the severity
Hypersensitivity
Hepatotoxicity when in conjunction with other hepatotoxic drugs (e.g. acetaminophen, sulfonamides)
Anytime it causes organ damage it’s an adverse reaction especially in conjunction with other drugs that are hepatotoxic like Acetametaphen which can be really hepatotoxic it can put you in liver failure and sulfonamides
A: Macrolides: Adverse Reactions
Increases serum levels: theophylline (the bronchodilator), carbamazepine, and warfarin; we have to be very cautious so you can see we can cause bleeding if we increase serum levels of Coumadin,
Do not use erythromycin with these types of drugs: risk for toxicity
_______peaks may be reduced when taken with antacids and be less effective
A: Azithromycin
Macrolides: Interactions
Monitor liver functions during therapy-remember that it can cause liver damage
A: Macrolides: Nursing Responsibilities
Note: Labs: liver enzymes: alkaline phosphatase, alanin aminotransferase, aspartate aminotransferase and bilirubin
Assess for jaundice; to assess for jaundice you are going to look at the whites of their eyes to see if they are tinged yellow, urine will get darker, skin will get yellow
Oral _____ given 1 hour ac or 2 hours pc
A: azithromycin; Macrolides: Nursing Responsibilities
Give antacids 2 hours before or after
Assess for superinfection
A: Macrolides: Nursing Responsibilities
BEFORE first dose: allergy history, C&S
Observe for allergic reactions
Monitor relevant labs that we talked about
Assess for superinfection
A: General Nursing Responsibilities
Note: Black furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools and there we are talking about C-diff which is probably the superinfection that you are going to see the most often so these general nursing responsibilities are things that you do for EVERY anti-infective that a pt is on
Directions for taking: include drug name, dosage, frequency, duration, possible adverse reactions
Take complete course of antibiotics
Advise patients on oral contraceptives to use another method
Precautions re: food, other meds
Signs of superinfection
A: Patient Education: General Nursing Responsibilities
Selected Disorders from the following categories: Infections Allergies Autoimmune Diseases (select) Rheumatoid arthritis Systemic lupus erythmatosus (SLE) HIV/AIDS These follow under what type of responsibilities?
A: general nursing responsibilities
