Exam 2- Endocrine (diabetes, steroids, thyroid) + antibiotics Flashcards
1
Q
feedback loop hypoglycemia (low bg)
A
dec bg, inc glucagon metab, act gluconeogenesis, transform glycogen to glucose, inc bg
2
Q
feedback loop hyperglycemia (high bg)
A
inc bg, insulin released, glucose reuptake by skel/musc cells, dec bg
3
Q
pancreas hormones
A
insulin- lowers bg, response to high bg, reuptake glucose by cells
glucagon- inc bg, reponse to low bg, releases stored glucose in form of glycogen
4
Q
ways to lower bg-physiologically
A
secretion insulin by pancreas
inhib gluconeogenesis
store glucose in liver as glycogen
5
Q
insulin response to meals
A
responds to inc carb lvls
converts excess glucose to fat if liver stores are full (released into blood) inc risk CAD
6
Q
diabetes mellitus def
A
dis where body cannot produce insulin or ability to respond to the hormone insulin is impaired
= abnorm metab of carbs, inc lvl glucose in blood/urine
7
Q
dm manifestations- macro and micro
A
hyperglycemia (polyuria, polydipsia (thirst), polyphagia (hunger)
chronic- damages endothlium of vessels
macrovascular abnorm- inc risk CAD (heart), Stroke (Brain)
microvasc abnorm- neuropathy, kidney injury, vision changes (retinopathy)
8
Q
type 1 diab
A
only respond to insulin
autoimm
pancr doesnt produce insulin
genetic
9
Q
type 2 diab
A
most common
cells insulin resistant
need inc insulin to transpor glucose to cells and dec bg
10
Q
insulin routes/sites
A
Iv- ONLY rapid/ shortacting
subq, injections or pumps
abdomin (fastest absorb), back arms, thighs, butt
11
Q
insulin shelf life when opened
A
1 month max at room temp
12
Q
rapid acting insulin
A
fast onset, take right b4 eating, can be mixed
for carb coverage/correction
humalong/ lispro
closest to natural response
13
Q
short acting insulin
A
fast onset, take right b4 eating, can be mixed
for carb coverage/correction
“regular”
14
Q
intermediate insulin
A
NPH cloudy (roll before drawing up) long peak 6-14h scheduled used for basal release can mix w/ short/rapid acting use btw meals
15
Q
long acting insulin
A
no mixing 1x per day basal release scheuled no peak dec risk hypoglycemia "lantus"
16
Q
pre mixed insulin
A
70/30
70% NPH (interm)
30% reg (short)
17
Q
goals antidiabetic therapy
A
bg normal lvl finger stick- 70-130 a1c 4-5 but <7 acceptable promote norm metabolism fats prevent complications prevent hypoglycemic episodes
18
Q
type 2 treatment
A
exercise, diet, oral meds
19
Q
basal insulin replacement
A
use interm or long acting
set order
doses can vary from person to person
20
Q
high bg correction
A
rapid/ short acting
1unit/50 bg
formula- (acutal bg- target bg)/ correction factor
21
Q
carbohydrate coverage
A
rapid/short acting
1 unit/ 15g carbs
formula- total g carbs in meal/ grams/ 1 unit
ex. 45/15= 3 units
22
Q
insulin considerations- most serious side effect
A
hypoglycemia most common/serious effect
know bg prior to admin
clear before cloudy
23
Q
concious/ unconcious insulin admin
A
concisous- OJ (120mL), glucose tabs/gel
goal- 15g carb replacement
unconscious- no oral (risk aspiration), 50% dextrose IV
reassess bg 10-20min, repeat until w/in norm limits
if no iv** glucagon subq/im (20 min onset)
glycogen converted to glucose, stimulate gluconeogensis
24
Q
increased insulin requirements
A
risk for hyperglycemia
weight gain, preg, dec activity, acute infections, hypokalemia, meds
25
decreased insulin requirements
risk hypoglycemia
| weight loss, dec cal intake, inc physical act, dev of renal insuff. (insulin accum bc not excreted as fast)
26
antidiabetic meds- biguanides- action, indication
Metformin (glucophage)
action- dec intestinal absorp glucose, dec glucose production in liver, inc insulin sensitivity
indication- trt hyperglycemia assoc w/ type 2
27
antidiabetic meds- biguanides- Metformin- route, contraindicated, pharmacokinetics
route- Po, taken w/ meals
pharmacokin- elim unchanged by kidneys- do not take if GFR < 30, drug can accum + become toxic
contraindicated- metabolic acidosis, radiographic studies requiring IV contrast (iodine hard enough on kid), conditions assoc w/ dec tissue perfusion (sepsis, CHF), excessive alcohol
28
antidiabetic meds- biguanides- Metformin- ae, considerations
ae- lactic acidosis (inc lactate lvl and dec bicarb lvl if septic- aerobic to anaerobic cellular transition creates more lactic acid)
gi distrubances, bloating, diarrh, n/v, hypoglycemia
considerations- monitor bg, renal function (cr, BUN- drug can accum), s/s lactic acidosis (chills, diarr, dizzin, hypotension, bradycardia, musc pain, dypnea, weakness)
hold med if surgery (inc risk for dec tissue perfusion= inc lactic acid) or Iv contrast
best for pregnancy
29
antidiabetic meds- sulfonylureas- glucotrol or DiaBeta- action, indication and route
action- stim pancreatic beta cells to produce more insulin ****inc risk hypoglycemia
indication- treat hypergly assoc w/ type 2
route- Po, 1x/day
30
antidiabetic meds- sulfonylureas- glucotrol or DiaBeta- pharmacokin, contraindicated, ae, interactions
pharmacokin- well absorbed/metab by liver
contraindicated- pat w/ sulfa allergy
ae- hypoglycemia, photosen, dizziness, weight gain
interactions- alcohol (disuifram (antabuse) rxn), NSAIDS, sulfa antibiotics, cimetidine (all inc action sulfonyl)
31
antidiabetic meds- sulfonylureas- glucotrol or DiaBeta-avoid, considerations
avoid- use during preg/lactation
| considerationos- s/s hypoglyc, assesss bg (hold if <70), sulfa allergy
32
antidiabetic meds- thiazolidinediones (TZDs)- Pioglitazone (actos)- action and indication, route
action- reduce insulin resis
indication- trt hypergly assoc w/ type2
*add on drug (not as aggressive at lowering bg)
route- Po 1x day
33
antidiabetic meds- thiazolidinediones (TZDs)- Pioglitazone (actos)- pharmacokin, contraindicated
pharmacokin- absob/ metab by liver
contradindicated- active liver dis, active or hx bladder cancer (inc ca if taken 1+ yrs- s/s hematuria/ dysuria), CHF (inc fluid retention)
34
antidiabetic meds- thiazolidinediones (TZDs)- Pioglitazone (actos)- ae, considerations
ae- chf, liver failure, bladder ca, hypoglycemia, fractures
considerations- monitor liver function (ast/alt)
s/s hypervol (crackles, edema, I&Os)
s/s bladder Ca
35
antidiabetic meds- meglitinides (prandin) or Repaglinide: action, indication, route and pharmacokin
action- stim panc to increase secretion of insulin (same as sulfonylureas), not as likely for hypoglycemia bc has short half life
indication- hyperglycemia trtment w/ type 2
route- po, 30 min before e/ meal
pharmacokin- metab in liver, short half life 1-1.5 hrs, drug-drug interaction w/ antifungals and antibiotics
36
antidiabetic meds- meglitinides (prandin) or Repaglinide: contraindicated, ae, considerations
contraindicated- hprsen, impaired liver fun (longer dose intervals), severe renal impairment (dec dose)
ae- hypoglycemia
considerations- monitor bg, s/s hypoglycemia, check drug interactions, assess kidney function (cr, gfr, bun)
37
antidiabetic meds- alpha-glucosidase inhibitors- Acarbose (Precose): action, route, pharmacokin
action- delays digestion CHO (complex, sucrose, fructose) when drug and food are present in GI tract @ same time
prevents bg from increasing futher
route- po, give TID w/ 1st bite of meals
pharmacokin- metab in GI tract, some metabolites can be absorbed systemically and excreted in urine
38
antidiabetic meds- alpha-glucosidase inhibitors- Acarbose (Precose): contraindicated, ae, considerations
contraindicated- pt w/ hypersen, certain GI disorders (crohns), severe renal impair
ae- hypoglycemia, Gi disturbances, abd pain, diarrhea, toots
considerations- glucose trtment not effective w/ candy or juice- drug delays absorption
need use glucose gel, tabs or IV dextrose
39
antidiabetic meds- incretin mimetic (GLP-1-Agonist)- Exenatide (Byetta) action, route and pharmacokin
incretin- naturally occuring horm that stim pancreas to produce enough insulin for amnt of food consumed
action- pauses glucose production by the liver, slows gastric emptying
route- subq bid w/ 60 min before meals
keep refrigerated, good for 30 days
pharmacokin- excreted by kidneys (check cr, bun and gfr)
** scheduled can cause weight loss (makes ppl feel full quicker)
dec absorb cards, dec gluconeogenesis (glycogen to glucose)
40
antidiabetic meds- incretin mimetic (GLP-1-Agonist)- Exenatide (Byetta) contraindicated, ae, and considerations
contraindicated- end stage renal dis, hypersen, severe Gi dis, on dialysis
ae- pancreatitis, diarrh, n/v, hypoglycemia, thrombocytopenia (dec platelet count, inc risk bleeding)
considerations- dec absorp of po meds if given at same time- (give o/ meds 1hr before)
watch for s/s hypoglycemia if used w/ sulfonyurea
monitor bg, monitor for s/s pancreatitis (unexplained, persistent, severe abd pain and inc amylase)
amylase released when pancreas is inflamm
41
antidiabetic meds- DPP-4 inhib- Sitagliptin (Januvia): action, route, pharmacokin
action- inhib DPP-4 results in inc lvls of incretin hormones
(Dpp-4 enzyme breaks dwn incretin)
indirectly inc incretin lvls (preventing incretin breakdown)
route- po daily in am (w/ or w/o food)
pharmacokin- excreted in urine unchanged
42
antidiabetic meds- DPP-4 inhib- Sitagliptin (Januvia): contraindicated, ae, and considerations
contraindicated- renal impairment (reduce dose)
| ae- hyprsen, hypoglycemia (rare if not used w/ sulfonyrea), uppr respir infection, sore throat, headache, pancreatitis
43
antidiabetic meds- patient ed
diet, exercise and weight control!
s/s hypolycemia and trtment
1 unit / 15g CHO
use only glucose gel/ tabs for alpha glucosidase inhib (acarbose)
s/s hyperglycemia
factors effect bg- exercise, alcohol, food
44
corticosteroid hormone- production
adrenal cortex (located above kid)
45
corticosteroid horm- function- cho, inflamm
maintain homeostasis, affect body systemically
metab of CHO, protein and lipids
inflamm and immune responses
inc corticosteroid lvls= inc gluconeogenesis (glycogen to glucose) inc bg
protein- long term use high lvls= musc wasting, thin skin
lipids- fat redistribution, buffalo hump and moon face
46
corticosteroid horm- function- body systems
CV- maintain bp, encourages vasoconstriction, if prolonged = htn
CNS- adeq glucose for brain
MS- dec bone formation, inc brkdwn, osteoporosis
Respir- bronchodilator and lung expansion (MDI)
GI- risk peptic ulcers, causes GI tract ischemia
47
corticosteroids- secretion and stimuli
controlled by HPA axis (hypothal, pituitary and adrenal cortex)
stimulated- low blood vol, stress responses (pain, anxiety, trauma, illness, infection) inc synthesis
hypothal- Corticotropin releasing horm
pituitary-adrenocortiocotropic horm
adrenal cortex- cortisol
48
Corticosteroid secretion negative feedback loop
cortisone not stopped being produced if medicated from CNS stimulation or administration of external hormones
49
glucocorticoids
fun- metab, inflamm, immune processes
inc- cortiosl, corticosterone, cortisone
secreted cyclically
responsible for majority of corticosteroid effects
50
mineralcorticoids
ex. aldosterone
maintan. flud-electrolyte balance
influences Na and H2O
51
adrenal sex hormones
corticosteroids
androgens
estrogens and progesterone
52
corticosteroid meds- glucocorticoids- actions
prednisone- po
methlyprenisolone- iv
dexmethasone (decadron) iv / po
fluticasone (Flonase) nasal
actions- inhib inflamm, inhib lymphocytes (immune system), strengthen/ stabilize biologic mem
53
corticosteroid meds- glucocorticoids- indications for admin (use)
```
dis of adrenal cortex (addisons)(no cortisol production)
allergic/hypersen reactions
higher doses
autoimmue dis (lupus, asthma, RA)
organ/ tissue graft or transplant
neurologic conditions (cerebral edema)
respir dis (COPD)
*trtment palliative not curative
```
54
corticosteroid meds- glucocorticoids- contraindicated and ae
contraindicated- systemic fungal infections, pt w/ risk of infection, Dm (spike glucose lvls), PUD (wall destruction and vasoconstriction), HTn, CHF, renal insuff
ae- depression, euphoria, HTN, dec wound healing, fragile skin, peptic ulceration, adrenal supp, hyperglycemia, thromboembolism, osteoporosis, nausea, fluid retention, hypokalemia
55
glucocortiocids- considerations
assess for fluid vol overload (edema, crackles, weight gain, SOB)
monitor Glucose (inc), K (dec), and WBC (dec)
assess for s/s GI bleed (dec Hbg and Hct), blood in emesis/ stool)
meds must be tapered to give HPA axis time to restart
(if not secondary adrenal insuff can happen w/ hypoten, dyspnea and weakn)
56
glucocorticoids- pt ed
tapper off med
avoid exposure to infection
weigh frequently, monitor for fluid retention
report- sore throat, fever, s of infection, weight gain >5lb in 1 wk
dec Na intake, eat K rich foods, get adequate Ca and vitamin D for MS ae
rinse mouth w MDI
if diabetic could require extra insulin
57
thyroid hormones- def and types disorders
t3- triiododthyroinine
t4- thyroxine
released from thyroid when gland is stim by TSH
hypo/hyperthyroidism
58
thyroid horm- function
inc basal metab rate
inc heart rate and contractility
promote grwth/dev of children
inc lvls= tachyc
59
thryoid horm flow sheet
hypothal- TRH, Anterior pit TSH, thryoid T3 and T4
60
hypothyroidism- cause/manif
cause- dis destruction of thryoid gland, inadque production thryoid horm
manif- dec bp/hr, weakness, dry/thinned hair, weight gain
61
hypothyroidism- types
```
thyroiditis (can dec or inc lvls)
trtmnt w/ anithyroid drugs/ radiation therapy
secondary hypothyroidism- dec tsh or trh
congenital
adult hypothyroidism (myxedema)
```
62
goiter cause
thyroid overstim by TSH- hypertrophy of thyroid gland
63
thyroid horm replacement levothyroxine (synthroid)- action, indication and route
action- replaces/ supplem endogenous thyroid horm to normalize metab rates in tissues
indication- hypothyroidism
route- po @ breakfast 30-60 min before food (empty stomach)
64
thyroid horm replacement levothyroxine (synthroid)- contraindicated, ae, considerations
contraindicated- hyprsen, recent MI (inc o2 demands of heart= exacerbate myocardial ischemia)
ae- iatrogenic hyperthyrodism
considerations-
food dec absorp- give 1h before breakfast
assess for s/s hyperthyroidism (tachydcardia, inc bp, chest pain, dysrhythmias)
monitor T3-4 and TSH
65
relationship btw tsh and T3 and T4
tsh high= not enough Thyroid hormones (inc dose)
| tsh low= thyroid hormones are active (dec dose)
66
hyperthyroidism- cause and s/s
cause- graves dis (excessive t3-4)
overtrtment w/ thyroid drugs
manif- tachyca, dysrthy, exophthal, sweating
67
antithyroid drugs- Propylthiouracil (PTU)- action, indication and route
palliative!
action- inhib production thyroid horm and conversion of t3 to active t4
indication- trtment hyperthyroidism
route- po, depends on severity
68
antithyroid drugs- Propylthiouracil (PTU)- pharmacokin, ae, considerations
ae- agranulocytosis (dec bone marrow= dec wbc= inc risk infection)
considerations- s/s hyperthyroidism, dev of s/s hypothyroidism, WBC, thyroid function
69
antithyroid drugs- sodium iodide- action, indication and route
action- radioactive, beta/gamma rays destroy thyroid tissue
indication- hyperthyroid
route- po, dosing specific to pt
70
antithyroid drugs- sodium iodide- contraindicated, ae, considerations/ education
contraindicated- pregn
ae- depression hematopoietic system (blood) w/ lrg doses, n/v, tendern/ swelling in neck, sore throat, cough
ed- for 1 wk after trtment- double flush toilet, don't touch kids, wash hands, avoid contact w/ others, stay 3 ft away and only talk for a few min, don't share silverware, plates, cups etc
71
antibiotic function
trt infections, not commonly used as prophylaxis (in risk resistance)
72
broad spectrum v narrow spectrum
broad- covers gram - and +
73
bactericidal
kill bac at therapetuic conc
74
bacteriostatic
slowly kills bac (dec conc), allows own body's immune system to eradicate
*not recomm for immunocomp pt
75
host defense mech
```
intact skin, muc mem
mech movements (coughing and swallowing)
immune processes (wbc and macrophages)
```
76
opportunistic infections- complications
inc prevalence w/ impaired host defense
caused by outbreak norm flora
ex. c-diff, canida albicans (yeast)
complications- thrush (white tongue coating and ulcers), bacteremia
77
current antibiotic trends
resurgence infectious dis in general
resistant strains (mrsa, vancomyacin, carpopenum)
bc over use broad spectrum and inapp prescribing (educate patient on difference btw virus and bacterial infection)
78
current infectious disease trends
inc immunocomp pt (mre co-morbid and invasive procedures)
longer survival rates
inc pt misuse (need to take all meds as perscribed to avoid spreading resistant bac to others)
79
comm aquired v nosocomial infections
comm- less severe, easier to trt
hospital- mre severe, difficult to trt, mostly resistant to drugs
(considered avoidable)
80
causes nosocomial infections
mrsa (methacillin-resis staphlococcus aureus)- treated w/ penacillin originally then vancomyacin
vancomyacin resistant enterococcus- e aecalis
carbapenem resistant enterobacter
clostridium difficle
s/s distinct clor and smell, highly contageous via spores (have to wash hands w soap)
antib wipes out o/ norm flora keeping c-diff in check
high mortality rate in elderly
81
prevent resistant and nosocomial infections
vaccinate, take cath out (urinary and central lines- jugular or subclavian)
target path (culture), treat infection not contamination (take blood cul from 2 separate sites), treat infection not colonization (>100,000= infection)
stop trtmnt when infection cured or unlikely (monitor daily)
wash hands!
82
CFU
colony forming units
test to detect infection
<100,000= do not treat for infection
gold standard
83
suspetabiliy w/ culture
```
smaller the #= better the antib will work
bc when antib is at low does it is still effectively killing bac
x R (resistant) will not work
```
84
penicillins-categories
action- bactericidal (weaken cell wall)
"bet-lactams"- antib is encapsulated in beta-lactam ring
enzymes have resist by destroying ring
85
beta lactamses or penacilinases
enzymes secreted by bac to destroy beta lactam ring of antib
86
Penacillinase sensitive- narrow spectrum
```
PCNase sensitive ( not resistant to penicillinase bac)
gram + (incl staph a)
PCN- G- postassium pcn G (im, iv)
procaine pcn G (im)
cause dysrhyth if admin into blood s
benzathine pcn G (IM)
```
PCN V
stable in stomach acid
87
PCN G and V- ae
min metab
excreted unchanged by kid (inc ae in pt dec renal fun)
ae- allergic rxn (monitor 1 and 2nd time when admin, verify allergy w/ pt)
nephrotoxicity (bun, cr, gfr), potassium pcn g via IV route (cause hyperkal- ventricular tachy- check renal function especially!!)
88
pcnase-resistant penacillins
```
narrow spectrum
ex. nafcillin, oxacillin, dicloxacillin
dev to preserve beta-lactam ring
popular for staph infections
inc resistance by MRSA
therefore if pt gains resistance to pcnase-resistant it means the bac is also resistant to pcn G (and K), and pcn V
```
89
broad spectrum penacillins- aminopcn
ampicillin, amoxicillin
good gram + coverage
inc gram - coverage compared to o/ narrow pcn
susceptible to penicillinases
90
ampicillin v amoxicillin
amniopenacillins
ampicillin- po or iv
ae- rash, diarrh and pseudomembranous colitis (c-diff)
amoxicillin- po
less diarrh, rash and c-diff
b/ excreted unchanged by kidneys
91
extended spectrum pcn- antipseudomonal penacillincs
ticarillin, piperacillin
futher inc gram neg coverage
popular- infection caused by pseudomonas aeruginosa
used in immunosupp patients
92
penacillin and beta-lactamase inhib combos
penacillin and enzyme destroying inhibitor chem combo
amoxicillin + clavulanic acid= agumentin
ampicillin and sulbactam= Unasyn
ticarcillin and clavulanic acid= timentin
piperacillin and tazobactam = zosyn
prescribed based on pcn dose- second compound mg not vary
ex. cant use 2 500mg for 1g bc clavulanic acid dose will be x2 concentrated
93
penacillins- nursing considerations
collect culture and blood before therapy
educate pt about completing full course
monitor wbc (effectiveness) and renal studies (toxicity, especially pcn G potassium, can be nephrotoxic)
take w/ full glass of water 1h before meal or 2h after
iv compatability- pcn not mix w/ aminoglycosides ex. gentamicin will be inactivated
94
cephalosporins- diff btw generations
first-fourth
inc effectiveness for gram neg coverage
inc ability to cross BBB
inc penacillinase resistance (can fight ring-destroying enzyme better)
95
cephalosporin- action, route, distribution and elim
action- bactericidal
im or iv due to poor gi absorption
distrib- 3 and 4th only reach significant conc in CSF
elim- excreted primarily unchanged in kid (except ceftriaxone or rocephin)
1/2 is by kid and 1/2 metab inactived by liver
96
cephalosporin- ae
common- allergic rxn, mild diarrh, abd cramping, rash, pruritis (itching)
potential corss-sen w/ pcn (if pt rxn to pcn, likely will have same rxn to cephalo)
bleeding (cefoperazone, cefotetan, ceftriaxone)
hemolytic anemia (lysis rbc)
super or opportunistic infection
thrombophlebitis (diluted to dec irritation to veins)
97
most common opportunistic infection
yeast candida of vagina or mouth
| c-diff
98
cephalo interactions
```
avoid alcohol (cefazolin, cefmetazole, cefoperazone, cefotetan)
probenecid (anti gout, inc conc cephalo= inc ae)
anticoag prolong bleeding time
nephrotoxicity
```
99
cephalosp- nursing considertions
may take w/ food or milk if gi irritated
monitor pt/inr, bleeding gums or easy bruising
renal (bun, cr, gfr)
liver (ast, alt) w/ certrixone
100
vancomycin-action, coverage, distribution and elimination
bacteriocidal
gram + coverage
not beta-lactam! (no ring)= very effective against staph incl mrsa
popular for cdiff or trtmnt serious infection in pt w/ pcn allergy
poor gi absorb- admin by iv (oral if treating cdiff)- not inject IM ever
not best for treating meningitis (csf)
excreted unchanged kid- NEPHROTOX.
101
vanco- ae
nephro
red man syndrome (act cytokines if admin too fast= rash and hypotension from vasodilation)
thrombophlebitis (dilute to dec)
thrombocytopenia (inc lysis and bleeding)
102
vanco- nursing considerations
```
monitor renal labs and TROUGH lvls
avoid nephrotoxic drugs
infuse slowly (> 60 min)
dilute solution, change infusion site often
monitor platelet count and s/s bleeding
```
103
trough and peak lvls
trough- take before admin of 3rd dose
if high= inc risk nephrotoxicity
peak- take w/in 10 min of 3rd dose completion
assessed to ensure drug not accum and damaging renal cells
104
tetracycline- types
short acting- tetracycline (8h half life)
intermediate acting- demeclocyline (12h half life)
long acting- doxycyline and minocycline (16-18h)
105
tetracycline- function and use
broad spectrum
bacteriostatic
uses- not favored due to high resistance
chlamydia, lyme dis, h pylori (peptic ulcer) and acne
106
tetracycline- pharmacokin
dec absorption due to food, dairy and antacids (inc affinity to Ca and Mg)
(drug binds to mol and is unabsorbable)
distribution- poor csf distrib, readily crosses placenta
elim- short/intermediate acting- kidneys
long active- liver via bile
107
tetracycline- ae and considerations
ae-gi irritation (give w/ food), photsenitivity (sunburn easier), effects bone of infants/children (discoloration perm teeth, dec enamel dev, disruption perm teeth formation) and can alter fetal skel dev if taken during preg
prone to suprainfections
nephrotoxic
hepatoxic (long acting) monitor liver enzyme periodically
108
macrolides- types
erthromycin
telithromycin (ketek)
azithomycin (zithromax)
clarithromycin (biaxin)
109
macrolides- erythromycin- action, fun and use
bacteriostatic (can be bacteriocidal against highly susep organisms or in high conc)
broad spectrum (mostly gram pos. some gram neg)
enteric coated
use- respir infections (strep), skin, soft tissue, pertussis, diptheria, PID, urethritis, syphillis, rheumatic fever
110
macrolides- erythromycin- pharmacokin
absorbp- broke dwn by gastric acid (why has enteric coating)
can be dec by food
distribution- poor csf penetration
metab- liver (cyp3a4 enzymes)- common to have d-d interactions (antib can dec absorb of o/ drug or vise versa= inc drug accum)
excretion- bile, sm amnt excreted unchanged by kidneys
111
macrolides- erythromycin- ae and considerations
ae- gi (n/v, diarrh, epigastric pain)
CARDIOTOXIC (high conc can prolong QT interval leading to ventr tachy (torsades) and death
suprainfection
thrmbophleb w/ iv admin (dilute)
considerations- enteric-coated take w or w/o food
take w/ full glass h20
assess GI, monitor liver function tests
avoid concurrent admin of drugs that inhibit cyp3a4 enzymes (can inc effects of cardiac arrhythmias)
112
Aminoglycosides- gentamicin (garamycin)
```
ex. neomycin, kanamycin, streptomycin
very potent!
serious toxicities
bactericidal
aerobic gram neg pathogens only (need air)
```
113
Aminoglycosides- pharmacokin
absorp- not absorbed in Gi (give IV only)
distributiono- poor csf pentration
crosses placenta, may be toxic to fetus
elimination- excreted unchanged in kid
(inc half life w/ dec renal function) (inc risk nephrotoxicity- check trough and peaks)
114
Aminoglycosides- ae
ototoxicity (loss of hearing or ringing)
nephrotoxicity
neuromuscualar blockade (paralysis and musc weakness if admin fast)- trt w/ Ca infusion
115
Aminoglycosides-nursing considerations
peak and trough
encourage fluid intake (help kid function)
monitor bun, cr, gfr, protein and urine specific gravity, I+O's
monitor for tinnitis and muscle weakness
116
sulfonamides- use, action, types
trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim)
sulfadiazine (microsulfon)
sulfamethoxazole
bacteriostatic, broad spectrum
use- limited (resistance, less toxic options)
UTI's especially e-coli
117
sulfonamides- pharmacokin
absorp- well absorbed Po
distribution- good systemically, crosses placenta
metab- liver
excreted- kidneys
118
sulfonamides- ae and considerations
ae- allergic rxn (incl stevens-johnson syndrome)= flu like s/s/ and then skin peels off (inc risk infection)
hemolytic anemia
crystalluria
photosensitivity (like tetracyclines)
assess for allergies, monitor kid fun (drug can form crystals in renal tubules bc not h20 sol)
monitor UA, CBC
pt ed- 1500-2400 (8-10) glasses water day
stop drug and call dr at first sign of rash
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Fluoroquinolones- use, func, action
ciprofloxacin (cipro)
levofloxacin (levaquin), enoxacin (penetrex), Lomefloxacin (maxaquin), norfloxacin (noroxin), ofloxacin (floxin)
bactericidal, broad spectrum
use- infections respir, GI, urinary, bones/joints, skin/soft tissue
120
Fluoroquinolones- pharmako and ae
absorp- well absorbed po
distribu- low penet csf, crosses placenta
metab- liver
excretion- kidneys
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black box- cartilage toxicity (rupture tendons)
worsening s of myasthenia gravis (overactive thyroid gland, musc weakness and cardiac a)
hypoglycemia coma (esp if combines w/ sulfonyrea)
psychiatric affects (inc risk depression, anxiety, confusion and hallucinations)
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Gi- n/v, diarrh, abd pain
cns- dizziness
opportunitstic infections
photosen
crystalluria, acute kidney injury
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Fluoroquinolones- considerations
separate drug from oral antacids by 2hh
avoid use pediactric pt dt risk tendonitis/ tendon rupture
monitor for tendon pain and swelling
mon. s of bleeding if on anticoag (warfarin prolongs bleeding time)
encourage fluid intake and UV protection
