exam 1 Flashcards
______-given orally to decontaminate the GI tract before surgical procedures
neomycin
most common Health care–associated infections
MRSA
The elderly patient will experience polypharmacy, but not much can be done about it.
1. True 2. False
false
When completing an admission assessment, the patient states that she is allergic to sulfa drugs. What will the nurse do next?
Mark the allergy on her medical record.
Place an “allergy” armband on the patient.
Ask the patient for more information about the allergic reaction she had.
Notify the physician about the patient’s allergy.
Ask the patient for more information about the allergic reaction she had.
. A patient with a new diagnosis of tuberculosis (TB) will be taking isoniazid (INH) as part of the anti-TB therapy. However, he is also known to be a slow acetylator. This means that:
- the dosage of INH may need to be lower to prevent INH accumulation.
- the dosage of INH may need to be higher due to the slow acetylation process.
- no adjustment of INH will be needed.
- he will need to take a combination of anti-TB drugs for successful therapy.
- the dosage of INH may need to be lower to prevent INH accumulation.
interactions for this Beta-Lactam antibiotic
Oral contraceptives, warfarin, NSAIDs, others
Penicillins
A patient has a prescription for a sulfa drug as treatment for a urinary tract infection. She is also taking an oral contraceptive, an oral sulfonylurea antidiabetic drug, and phenytoin for a history of seizures. Which drug may pose a potential serious interaction with the sulfa drug?’
The oral contraceptive
The oral antidiabetic drug
The phenytoin
All of these
All of these
—use of herbal products and other nontraditional remedies
Alternative medicine
margin of safety between toxic and effective dose (ratio)
The ratio between the toxic and therapeutic concentrations of a drug
Therapeutic index
Ongoing monitoring of plasma drug concentrations and dosage adjustment based on these values as well as other laboratory indicators such as kidney and liver function test results; it is often carried out by a pharmacist in collaboration with medical, nursing, and laboratory staff
Therapeutic drug monitoring
Adverse Effects
Increased liver enzymes
Use with caution in patients with renal and liver dysfunction
azoles
antibiotic that Adverse Effects
Strong affinity for calcium:
-Discoloration of permanent teeth and tooth enamel in fetuses and children, or nursing infants
-May retard fetal skeletal development if taken during pregnancy
Alteration in intestinal flora may result in:
-Superinfection,diarrhea,pseudomembranous colitis, Vaginal candidiasis, gastric upset, enterocolitis, maculopapular rash, other effects
Tetracyclines “cycline”
The study of how various drug forms influence the way in which the drug affects the body
Pharmaceutics
Most medications have been extensively studied in a variety of different populations and age groups.
1. True 2. False
false
The majority of drug studies have focused on people between the ages of 13 and 65
An 82-year-old woman is unable to take the influenza vaccine due to allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. Which option would be best for her?
She should receive the flu vaccine as soon as possible
.
She should receive zanamivir (Relenza) in the inhalation form
.
She should begin oral oseltamivir (Tamiflu) therapy when symptoms begin.
She should begin oral oseltamivir (Tamiflu) therapy as soon as possible.
She should begin oral oseltamivir (Tamiflu) therapy as soon as possible.
dosage is calculated for peds. by
weight in kg
______soluble- higher blood concentrations
Water
The transport of a drug by the bloodstream to its site of action
Distribution
Cephalosporins (cef, ceph) __________ generation
Good gram-positive and poor gram-negative coverage
Used for surgical prophylaxis
first
black box warning nephro & oto toxicity
gentamicin
neomycin
amikacin
aminoglycosides
Medications used to treat bacterial infections
Antibiotics
antibiotic where
Treatment of choice for MRSA (IV)
treatment for C. difficile and for staphylococcal enterocolitis (P.O)
Vancomycin (Vancocin)
Adverse Effects:
Pulmonary fibrosis and pneumonitis (bleomycin)
Heart failure—cardiomyopathy (daunorubicin)
Cytotoxic Antibiotics
Most drugs considered to be effectively removed after about ____ half-lives
5
A patient is prescribed ibuprofen 200 mg PO every 4 hours as needed for pain. The pharmacy sends up enteric-coated tablets, but the patient refuses the tablets, stating that she cannot swallow pills. What will the nurse do?
Crush the tablets and mix them with applesauce or pudding.
Call the pharmacy and ask for the liquid form of the medication.
Call the pharmacy and ask for the IV form of the medication.
Encourage the patient to try to swallow the tablets
Call the pharmacy and ask for the liquid form of the medication.
Adverse Effects
Hair loss, nausea and vomiting, myelosuppression
Neurologic, cardiovascular, pulmonary, hepatobiliary, GI, genitourinary, dermatologic, ocular, otic, and metabolic toxicity
Tumor lysis syndrome
Antimetabolites
Assess baseline blood counts before administering ___________ drugs
antineoplastic
The study of what the drug does to the body
The study of the biochemical and physiologic interactions of drugs at their sites of activity. It examines the physicochemical properties of drugs and their pharmacologic interactions with body receptors.
Pharmacodynamics
A patient is diagnosed with onychomycosis. The nurse anticipates use of which medication for the treatment of this condition?
terbinafine (Lamisil)
voriconazole (Vfend)
fluconazole (Diflucan)
amphotericin B (Amphocin, Fungizone)
terbinafine (Lamisil)
During intravenous quinolone therapy in an 88-year-old patient, which potential problem is of most concern when assessing for adverse effects?
Hepatotoxicity
Rhabdomyolysis
Tendon rupture
Nephrotoxicity
Tendon rupture
_______soluble;- Higher concentration in fat, larger volume of distribution
fat-
this Beta-Lactam antibiotic has Adverse Effects
Serious: Allergic
Commons: Nausea, vomiting, diarrhea, abdominal pain
Penicillins
treatment of an infection before specific culture information has been reported or obtained
Empiric therapy
A nurse is administering gentamicin by IV infusion at 0900. The gentamicin will take 1 hr to infuse. When should the nurse plan for a peak serum level of gentamicin to be drawn?
A. 1000
B. 1030
C. 1100
D. 1130
B. 1030
Beta-Lactam antibiotic that
Reserved for complicated body cavity and connective tissue infections in acutely ill hospitalized patients
May cause drug-induced seizure activity
Used for treatment of bone, joint, skin, and soft-tissue infections; many other uses
Cilastatin inhibits an enzyme that breaks down imipenem
Carbapenems
treatment of serious systemic infections
Poor oral absorption; no PO forms (exception neomycin
Gentamicin
Amikacin
Aminoglycosides
determines the rate of drug dissolution (dissolving of solid dosage forms and their absorption from the GI tract).
Dosage form
Generally only inhibits the growth of microorganisms but does not necessarily kill them
Applied exclusively to living tissue
Antiseptics
to maintain health and wellness and “boost” one’s immune system
Proactive agents
The use of many different drugs concurrently in treating a patient, who often has several health problems.
Polypharmacy
antibiotic where
Primarily used for urinary tract infections (UTIs)
drug concentrates in the urine, use carefully if renal function is impaired
May cause fatal hepatotoxicity
nitrofurantoin (Macrodantin)
The study of what the body does to the drug
Pharmacokinetics
given as an oral lozenge or troche should be slowly and completely dissolved in the mouth (not chewed or swallowed whole)
suspension should be swished thoroughly in the mouth as long as possible before swallowing
Nystatin
major concern for thromycin
ototoxicity
Decrease in specific signs and symptoms of infection are noted (fever, elevated WBC, redness, inflammation, drainage, pain)
Therapeutic response
Pregnancy Safety Categorie where
Adverse effects reported in the animal fetus; information for humans is not available.
C
A laboratory measure of the lowest concentration of a drug needed to kill a certain standardized amount of bacteria
Minimum inhibitory concentration (MIC)
for treatment and cure of diseases
Therapeutic agents
The drug has a registered trademark; use of the name is restricted by the drug’s patent owner (usually the manufacturer)
Trade name (proprietary name)
A pregnant woman with liver disease is taking a pregnancy category B medication for her illness. Which statement is true in this situation?
- The mother’s liver disease will expose the fetus to less of the medication.
- The mother’s liver disease will expose the fetus to more of the medication.
- Because the medication is pregnancy category B, the medication is generally considered safe for the fetus.
- The liver of the fetus will protect the fetus from the effects of the medication.
- The mother’s liver disease will expose the fetus to more of the medication.
Impairment in maternal kidney or liver function may result in higher drug levels in the mother, which in turn may result in increased drug exposure to the fetus.
A period of continued bacterial suppression that occurs after brief exposure to certain antibiotic drug classes, especially aminoglycosides
continues to kill bacteria days after drug is given
Postantibiotic effect
Describes the drug’s chemical composition and molecular structure
Chemical name
A drug that binds to and stimulates the activity of one or more receptors in the body
Agonist
antibiotic that Nursing implications:
highly protein-bound: severe interactions with other protein-bound drugs
high incidence of GI upset, many drugs are taken after a meal or snack
Macrolides “thromycin”
Cephalosporins (cef, ceph) _________ generation
Most potent against gram-negative bacteria, Less active against gram-positive bacteria
third
Beta-Lactam antibiotic that Nursing implications:
Assess for penicillin allergy; may have cross allergy
Give orally administered forms with food to decrease GI upset, even though this will delay absorption
Some of these drugs may cause a disulfiram (Antabuse)-like reaction when taken with alcohol
Cephalosporins (cef, ceph)
Antibiotics that kill bacteria
Bactericidal antibiotics
Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone. For example, 1 + 1 is greater than 2
Synergistic effects
bind to calcium so have patient avoid dairy
cyclines
Adverse Effects
Nephrotoxicity
Extravasation causes tissue damage and necrosis
myelosuppression and alopecia
(phosphamide , platin)
Alkylating Drugs
The nurse identifies which of the following as the most significant neurotoxin of the cytotoxic drug class?
paclitaxel (Taxol)
docetaxel (Taxotere)
vincristine (Vincasar PFS)
etoposide (Toposar)
vincristine (Vincasar PFS)
Kills organisms
Used only on nonliving objects
Disinfectants
Antiemetics often work better if given__________minutes before chemotherapy is started
30 to 60
A drug that binds to and inhibits the activity of one or more receptors in the body
Antagonist
The clinical use of drugs to prevent and treat diseases
Pharmacotherapeutics
Antiretroviral Drug that
HIV treatment
Given to HIV-infected pregnant women and new born babies to prevent maternal transmission
Dose limited adverse effect: bone marrow suppression
zidovudine (Retrovir)
antibiotics with adverse effects
Increased risk of tendonitis and tendon rupture
Prolonged QT interval
Quinolones (Floxacin)
Lowest point in any fluctuating value over time; for example, the lowest white blood cell count measured after the count has been depressed by chemotherapy
10-28 days after first dose
Nadir
Mechanism of Action
Interference with cell wall synthesis
Bactericidal
Beta-Lactam Antibiotics
Bacteria that are resistant to one or more classes of antimicrobial drugs.
Multidrug-resistant organisms
Cephalosporins (cef, ceph) _________ generation
Broader spectrum of antibacterial activity than third generation, especially against gram-positive bacteria
fourth
Drugs used to treat cancer. Also called cancer drugs, anticancer drugs, cancer chemotherapy, and chemotherapy.
Narrow therapeutic index
Drug resistance
Combination of drugs
Harmful to all rapidly growing cells
Antineoplastic drugs
Inhibit fungal cell cytochrome P-450 enzymes, resulting in cell membrane leaking
Result: altered cellular metabolism and fungal cell death
Triazoles
antibiotic that Adverse Effects
GI effects, primarily with erythromycin
Nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia
Azithromycin and clarithromycin: fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration
Macrolides “thromycin”
coadministration of two drugs that are metabolized by this system may result in competition for these enzymes, and thus higher levels of one of the drugs
Drug interaction
- binds to protein, limited amount that can go to bloodstream,
Bound drug
Adverse Effects
- Hemolytic and aplastic anemia
- Photosensitivity
- crystalluria
- agranulocytosis
- thrombocytopenia
- exfoliative dermatitis
- convulsions
- peripheral neuritis
Sulfonamides
treat all forms of Mycobacterium
TB is most commonly characterized by granulomas in the lungs
Antitubercular drugs
Drug interactions in which the effect of a combination of two or more drugs with similar actions is equivalent to the sum of the individual effects of the same drugs given alone. For example, 1 + 1 = 2
Additive effects
routes of Absorption
Enteral (GI tract):
- orally vs Sublingual and Buccal routes, G tube
- first pass effect, variable absorption
Parenteral: -Intravenous (IV) Rapid onset; Avoid first pass effect Nursing considerations: monitor drug, compatibilities, iv site -Intramuscular (IM); subcutaneously
Topical: Avoid first pass effect, except rectal administration Transdermal: deliver constant amount slower onset, prolong duration nursing consideration: Topical Delivers meds directly to affected area, decease systemic absorption, Nursing consideration Inhaled
- extent of drug percentage that is left after it goes through liver (all P.O, NG,rectal)
First pass effect
A patient tells the nurse that he wants to stop taking his antilipemic drugs and start taking garlic to lower his cholesterol. The nurse’s best reply would be:
“That decision is up to you.”
“You have every right to switch to herbal remedies.”
“You should not go against what the doctor has prescribed for you.”
“Let’s explore the evidence that supports the use of garlic to lower your cholesterol.”
“Let’s explore the evidence that supports the use of garlic to lower your cholesterol.”
Four weeks after beginning antitubercular drug therapy on an outpatient basis, the patient reports that he still experiences night sweats, and his productive cough has not stopped. What is the main concern at this time?
- He is not taking his medication properly.
- More time is needed to see a therapeutic response.
- His infection may be resistant to the drug therapy ordered.
- He may have contracted a different strain of
tuberculosis (TB).
- His infection may be resistant to the drug therapy ordered.
Beta-Lactam antibiotic that
Structurally and pharmacologically related to penicillins
Bactericidal action
Broad spectrum
Have five generation
Cephalosporins (cef, ceph)
The lowest concentration of drug reached in the body after it falls from its peak level, usually measured in a blood sample for therapeutic drug
Trough level
4 Areas of rapid distribution:
heart, liver, kidneys, brain
______ trimester fetus is at greatest risk for birth defects from drugs
First
A patient with active HIV has been taking zidovudine (Retrovir). Which potential adverse effect may limit the length of time this medication can be taken?
Lactic acidosis
Bone marrow suppression
Hepatomegaly
Fatigue
Bone marrow suppression
Therapy may last for up to 24 months
Take medications exactly as ordered, at the same time every day
treatment for TB
The nurse is caring for a patient who received chemotherapy 24 hours ago. The patient’s white blood cell count is 4,400 mcL. Which symptom, if experienced by the patient, should the nurse report to the prescriber immediately?
Fatigue
Diarrhea
Fever
Nausea and vomiting
Fever
Ideally, before beginning antibiotic therapy, the suspected areas of infection should be ______ to identify the causative organism and potential antibiotic susceptibilities
cultured
A property of some antibiotics, especially aminoglycosides, whereby achieving high plasma drug concentrations, even if briefly, results in the most effective bacterial kill
once a day
Concentration-dependent killing
Natural products obtained from the plant Vinca alkaloids (periwinkle)
Vincristine—IV only
Taxanes
paclitaxel (western yew tree: bark)
Mitotic Inhibitors
With TB,
Perform__________ on the first Mycobacterium spp. that is isolated from a patient specimen
Begin a regimen with multiple _______ drugs (to reduce chances of development of resistance) Adjust drug regimen once the results of susceptibility testing are known
Monitor patient ________ closely during therapy
drug-susceptibility testing
antitubercular
compliance
Name given by the United States Adopted Names Council
nonproprietary
Generic name (nonproprietary name)
major concern for penecillin
allergy - monitor 30 mins after 1st dose
—simultaneous use of both traditional and alternative medicine
Complementary medicine
When working with a patient who is neutropenic, the nurse identifies which as the most effective measure to prevent the patient from developing an infection?
Administer prophylactic antibiotics
Stop administration of the chemotherapeutic drug
Perform hand hygiene
Vaccinate the patient to prevent bacterial infection
Perform hand hygiene
A 58-year-old man is receiving vancomycin as part of the treatment for a severe bone infection. After the infusion, he begins to experience some itching and flushing of the neck, face, and upper body. He reports no chills or difficulty breathing. The nurse should suspect:
an allergic reaction has occurred.
an anaphylactic reaction is about to occur.
the medication will not be effective for the bone infection
.
the IV dose may have infused too quickly.
the IV dose may have infused too quickly.
A measure of the extent of drug absorption for a given drug and route (from 0% to 100%)
Bioavailability
Which cytotoxic antibiotic does the nurse identify as most likely to cause pulmonary fibrosis?’
plicamycin
mitoxantrone
mitomycin
bleomycin
bleomycin
Fifteen minutes after an infusion of amphotericin B was started, the patient begins to complain of fever, chills, muscle pain, and nausea. His heart rate has increased slightly, but his blood pressure is down to 100/68. What is the nurse’s priority?
Notify the prescriber immediately.
Recognize an impending anaphylactic reaction and stop the infusion.
Assess for other symptoms of this expected infusion- related reaction.
Slow the infusion to reduce these adverse effects.
Assess for other symptoms of this expected infusion- related reaction.
used to treat Many severe systemic fungal infections
Amphotericin B:
: The time a drug concentration is sufficient to elicit a therapeutic response
Duration
Beta-Lactam Antibiotics 4 groups
Penicillins
Cephalosporins
Carbapenems
Monobactams
Antibiotics that do not actually kill bacteria but rather inhibit their growth
Bacteriostatic antibiotics
Which condition does the nurse anticipate when assessing a patient with tumor lysis syndrome? Hyperuricemia Hypophosphatemia Hypokalemia Hypercalcemia
Hyperuricemia
The maximum concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring.
Peak level
Pregnancy Safety Categorie where
Possible fetal risk in humans has been reported; however, in selected cases consideration of the potential benefit versus risk may warrant use of these drugs in pregnant women.
D
Adverse Effect:
Peripheral neuropathy—Pyridoxine
Hepatotoxicity
Isoniazid (INH)
Drug interaction in which the bacterial killing effect of two antibiotics given together is greater than the sum of the individual effects of the same drugs given alone
Synergistic effect
Pregnancy Safety Categorie where
Studies indicate no risk to the human fetus.
A
A common genetic host factor in which the rate of metabolism of certain drugs is reduced.
Slow acetylation
When handling and administering vesicant drugs the nurse will:
double-flush the patient’s bodily secretions in the commode.
use sterile towels to clean up after chemotherapy spills
.
mix chemotherapeutic drugs in the patient’s room
.
teach the patient how to administer parenteral chemotherapeutic drugs.
double-flush the patient’s bodily secretions in the commode.
– does not dissolve until hits the small intestine (aspirin is a common one)
Enteric coated
Pregnancy Safety Categorie where
Studies indicate no risk to the animal fetus; information for humans is not available.
B
A mother calls the clinic to ask about giving acetaminophen to her infant. She says she has used the liquid form for her 5-year-old child, and she wants to know how much to give to her infant, who has a fever. The nurse should:
1. instruct the mother to give the infant the same dose as the child. 2. instruct the mother to give the infant half the dose that she would normally give the child. 3. assist the mother in calculating the dose for the infant. 4. consult with a physician before instructing the mother on giving the medication.
consult with a physician before instructing the mother on giving the medication.
The physician should be consulted before acetaminophen is used in children under the age of 2.
The cellular processes involved in the drug and cell interaction
Drug actions
physiologic reaction of the body to the drug
Drug effect:
causes perm. discoloration of teeth
do not give to pregenant women or children under 8
cyclines
indications for this Beta-Lactam antibiotic include
Prevention and treatment of infections caused by susceptible bacteria
Gram-positive bacteria, including Streptococcus spp., Enterococcus spp., Staphylococcus spp.
Penicillins
this Beta-Lactam antibiotic has Nursing implications:
Take oral doses with water (not juices) as acidic fluids may nullify drug’s antibacterial action
Monitor patients taking penicillin for an allergic reaction for at least 30 minutes after administration
Penicillins
The 3 most common adverse effects of antibiotics are ________________________________
nausea, vomiting, and diarrhea
Active in all phases of the cell cycle, blockade of DNA
Natural substances produced by the mold Streptomyces
Cytotoxic Antibiotics
type of antibiotic where Indications
Both gram-positive and gram-negative bacteria
Treatment of
UTI
Pneumocystis jirovecii pneumonia (PJP)
Upper respiratory tract infections
Staphylococcus infections due to the high rate of community-acquired MRSA infections
Sulfonamides (Sulf)
Metabolized in the liver through acetylation—watch for “slow acetylators”
Used alone or in combination with other drugs
Contraindicated with liver disease
Used for the prophylaxis and treatment of TB
Isoniazid (INH)
A general term for drugs that destroy viruses, either directly or indirectly by suppressing their replication
caused by viruses other than HIV
Influenza viruses
HSV, VZV
CMV
Hepatitis A, B, C (HAV, HBV, HCV)
Antiviral drugs
Cephalosporins (cef, ceph) ___________ generation
Good gram-positive coverage, better gram-negative coverage than first generation
Use prophylactically
second
nursing implications:
Monitor vital signs of patients receiving IV infusions every 15 to 30 minutes
During IV infusions, monitor I&O to identify adverse effects
Use IV infusion pumps and the most distal veins possible
Antifungal Drugs
antibiotic with
Used for chronic bone infections, GU infections, etc,
FDA black box warning: C diff associated diarrhea
clindamycin (Cleocin)
The desired or intended effect of a particular medication
Therapeutic effect
Contracted in a hospital or institutional setting
Were not present or incubating in the patient on admission to the facility
Health care–associated infections
Signs and symptoms of infection do not improve
sometimes wrong antibiotic, drug resistance
Subtherapeutic response
A significant side effect of _________ is a red-orange discoloration of urine, saliva, tears, and sweat.
rifampin
Factors that ________ metabolism
Fast acetylator, Barbiturate therapy, Rifampin therapy, Phenytoin therapy
increase
3 Areas of slow distribution:
muscle, skin, fat
A pregnant woman has been diagnosed with cancer and is meeting with her oncologist to plan treatment. Which statement about chemotherapy and pregnancy is true?
She will have to wait until the baby is born before starting chemotherapy.
The greatest risk of fetal harm from chemotherapy is during the third trimester.
Chemotherapy treatment during the second or third trimester poses less risk to the fetus.
Chemotherapy is unsafe during pregnancy, but radiation therapy is safe in low doses.
Chemotherapy treatment during the second or third trimester poses less risk to the fetus.
antibiotic that: nursing implications:
Avoid milk products
Take all medications with 6 to 8 ounces of fluid,
photosensitivity, avoid sunlight and tanning beds
Tetracyclines “cycline”
antibiotic where
Used for anaerobic organisms, protozoal infections, etc
Contraindications: alcohol use w/in 3 days, pregnancy 1st trimester
Avoid alcohol 24 hours before first dose and 36 hours after last dose
metronidazole (Flagyl)
– percentage of drug absorbed into bloodsteam
Bioavailability
A patient is complaining of severe pain and has orders for morphine sulfate. The nurse knows that the route that would give the slowest pain relief would be which route?
IV
IM
Subcut
PO
PO
Movement of a drug from its site of administration into the bloodstream for distribution to the tissues
Absorption
Alter the chemical structure of the cells’ DNA
Alkylating Drugs
Monitor for expected effects of bone marrow suppression
Expect nausea, vomiting, diarrhea, stomatitis
Hydration–nephrotoxicity
Report ringing/roaring in the ears—possible ototoxicity
Report tingling, numbness, or pain in extremities— peripheral neuropathies may occur
Alkylating drugs
Adverse effects:
Extravasation
Hair loss, nausea and vomiting, myelosuppression
Convulsions
Mitotic Inhibitors
The time it takes for a drug to reach its maximum therapeutic response
Peak:
in pediatrics ________&_________ are immature, impairing drug metabolism and excretion
Liver and kidneys
A patient is taking nystatin (Mycostatin) in an oral troche form for oral candidiasis. Which instruction is correct?
Allow the troche to dissolve slowly in the mouth.
Swish the medication in the mouth and then swallow it.
Chew the troche thoroughly to activate the medication.
Swallow the troche whole without chewing.
Allow the troche to dissolve slowly in the mouth.
Factors that _________ metabolism
Cardiovascular dysfunction, renal insufficiency, starvation, obstructive jaundice, slow acetylator, ketoconazole therapy
decrease
____ trimester fetus is more likely to have side effects from drugs
Last
A specific term for antiviral drugs that work against retroviruses such as HIV
Used to treat infections caused by HIV, the virus that causes AIDS
Antiretroviral drugs
antibiotic that
Bacteriostatic
Bind (chelate) to Ca+++ and Mg++ and Al+++ ions to form insoluble complexes
Dairy products, antacids, and iron salts reduce oral absorption
Should not be used in children under age 8 or in pregnant/lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth
Tetracyclines “cycline”
Before any antibiotics monitor what 7 things
Allergies Kidney and liver function Labs- cbc- wbc- bmp Culture & sensitivity Contraindications Drug interactions Signs and symptoms of super infection
treatment with antibiotics to prevent an infection, as in intraabdominal surgery or after trauma
Prophylactic therapy:
Adverse Effects:
Cardiac dysrhythmias
Neurotoxicity
Renal toxicity,
Pulmonary infiltrates
Amphotericin B:
what is the major concern for beta lactams
pcn cross sensitivity
A property of most antibiotic classes whereby prolonged high plasma drug concentrations are required for effective bacterial kill
penicillin, beta lactams
give multiple times a day
Time-dependent killing
Pregnancy Safety Categorie where
Fetal abnormalities have been reported, and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs are not to be used in pregnant women.
X
antibiotic where
Toxic level: >20 mcg/ml (Trough) right b4 3rd dose
Red man syndrome may occur (rapid infusion)
Should be infused over 60 minutes
Serious: Rapid infusions may cause hypotension
May cause ototoxicity and nephrotoxicity
Vancomycin (Vancocin)
Contraindications:
Liver failure
Renal failure
Drug allergy
Antifungal Drugs
The time it takes for one half of the original amount of a drug to be removed from the body
A measure of the rate at which a drug is removed from the body
Half-life
major concerns:
crystaluria
photosensitivity
decreased kidney function
sulfonamides
Used to suppress replication of HSV-1, HSV-2, VZV
Drug of choice for treatment of initial and recurrent episodes of these infections
Oral, topical, parenteral forms
acyclovir (Zovirax)
The leakage of any intravenously or intraarterially administered medication into the tissue space surrounding the vein or artery; can cause serious tissue injury
Extravasation
antibiotics where adverse effect
Nephrotoxicity and Ototoxicity (auditory impairment and vestibular impairment [eighth cranial nerve])
Others: Headache, paresthesia, fever,superinfections, vertigo, skin rash,dizziness
Aminoglycosides
Beta-Lactam antibiotic that Adverse Effects
Similar to penicillins
Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema
Potential cross-sensitivity with penicillins
Cephalosporins (cef, ceph)
anything with ase means
enzyme
Occur when antibiotics reduce or completely eliminated the normal bacterial flora
Pseudomembranous colitis—Antibiotic associated infection
Superinfection
The biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite, or a less active metabolite
Metabolism/Biotransformation
patient who is receiving high-dose chemotherapy with methotrexate is also receiving leucovorin. The purpose of the leucovorin is to:
produce an additive effect with the methotrexate by increasing its potency against the cancer cells.
reduce the incidence of cardiomyopathy caused by the methotrexate.
add its antiinflammatory effects to the treatment regimen.
reduce the bone marrow suppression caused by the methotrexate.
reduce the bone marrow suppression caused by the methotrexate.
It is ESSENTIAL to obtain _______ from appropriate sites BEFORE beginning antibiotic therapy
cultures
treatment of systemic infection
synergistic effect with pcn
aminoglycosides
Inhibit viral replication
adverse effects:
-Healthy cells are often killed also, resulting in serious toxicities
Antiviral Drugs
application of hot or cold packs and/or sterile occlusive dressings, and elevation and rest of the affected limb
leave the intravenous catheter in place
aspirate any residual drug and/or blood from the catheter
these are all steps in case _____ occurs
Extravasation
The elimination of drugs from the body
Kidneys (main organ)
Others: liver, bowel
Excretion
antibiotic that has Indications of
Strep infections
Mild to moderate URI and LRI (respiratory infection)
Clarithromycin combination with omeprazole: active ulcer disease associated with Helicobacter pylori infection
Syphilis and Lyme disease, Gonorrhea, Chlamydia, Mycoplasma
Macrolides “thromycin”
avoid alcohol
c.diff / collitis - black box warning
flagyl
for long-term prevention of disease
Prophylactic agents
The nurse is giving a medication that has a high first-pass effect. The health care provider has changed the route from IV to PO. The nurse expects the oral dose to be
higher because of the first-pass effect.
lower because of the first-pass effect.
the same as the IV dose.
unchanged.
higher because of the first-pass effect.
An infection that is acquired by a person who has not been hospitalized or had a medical procedure (such as dialysis, surgery, catheterization) within the past year
Community-associated infections
is the metabolism of a drug before it becomes systemically available, and it reduces the bioavailability of the drug.
: The first-pass effect
highly protein bound antibiotic
thromycin
antibiotic with Indications
Pseudomonas Complicated urinary tract respiratory bone and joint GI skin sexually transmitted infections)
Quinolones (Floxacin)
type of antibiotic where
combined with trimethoprim (Bactrim, Septra)
Bacteriostatic action
Take with 2000 to 3000 mL of fluid/24 hr
Assess RBCs prior to beginning therapy
Take oral doses with food
Sulfonamides
Folate (folic acid) antagonists:
Antimetabolites
main organ or metabolism
liver
Drugs are organized into pharmacologic classes
7 Types of Therapies
- Acute therapy
- Maintenance therapy
- Supplemental/replacement therapy
- Palliative therapy
- Supportive therapy
- Prophylactic therapy
- Empiric therapy
Block activity of the enzyme reverse transcriptase, preventing production of new viral DNA
Reverse transcriptase
Factors that are unique to a particular patient that affect the patient’s susceptibility to infection and response to various antibiotic drugs. Examples include a low neutrophil count or a lack of immunoglobulins in the blood that carry antibodies.
Host factors
May postpone effective treatment of more chronic disease states
May delay treatment of serious and/or life-threatening disorders
May relieve symptoms of a disorder but not the cause
over the counter drugs
Substances that can interfere with normal prenatal development and cause one or more developmental abnormalities in the fetus.
Teratogens
A 56-year-old man is taking over-the-counter antacids for relief of indigestion. He tells the nurse that he consumes at least one bottle a week and has done so for over a month because “it works for me.” The nurse’s main concern is that
this self-treatment is expensive.
this self-treatment may be delaying treatment of a more serious problem.
this self-treatment may be the best treatment of his indigestion.
the long-term use of antacids may make the indigestion worse.
this self-treatment may be delaying treatment of a more serious problem.
antibiotic therapy tailored to treat organism identified with cultures
Definitive therapy:
antibiotic that
Prevent protein synthesis within bacterial cells
Considered bacteriostatic, in high enough
concentrations, may also be bactericidal
Macrolides “thromycin”
Active against influenza types A and B
Treatment should begin within 2 days of influenza symptom onset
oseltamivir (Tamiflu) and zanamivir (Relenza)
: The time it takes for the drug to elicit a therapeutic response
Onset
Medications combined with certain penicillin drugs to block the effect of beta-lactamase enzymes
Beta-lactamase inhibitors
A patient is receiving amphotericin B lipid complex. The nurse knows that an advantage of the lipid formulations of this drug is that they
have a lower cost.
can be administered quickly.
take longer to be absorbed.
cause fewer adverse effects.
cause fewer adverse effects.
Bone marrow suppression (BMS)
Bone marrow depression (BMD)
Myelosuppression
Used to treat infection with cytomegalovirus (CMV) & CMV retinitis
Oral, parenteral forms
Ophthalmic form surgically implanted (Vitrasert)
watch out for Bone marrow toxicity
ganciclovir (Cytovene)
