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Exam 2 Nursing 115 > Exam 2 FlashCards > Flashcards

Exam 2 FlashCards

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1
Q

What is the prototype aminoglycoside?

A

Gentamicin

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2
Q

What does Gentamicin treat?

A 
Intra-abdominal infections
UTIs 
Respiratory tract infections
Septicemia 
Osteomyelitis
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3
Q

What type of bacteria is gentamicin affective against?

A

Gram negative bacteria, aerobic bactera.

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4
Q

How does Gentamicin work?

A

Penetrates cell walls of susceptible bacteria and binds irreversibly to 30S and 50S ribosomal subunits, intracellular structures that synthesize proteins. As a result the bacteria cell membrane becomes defective and cannot synthesize the proteins needed for their function and replication.

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5
Q

What does the nurse assess for in the patient taking Gentamicin?

A
  • Renal function (Nephrotoxic)
  • Patients with vertigo or tinnutis may demonstrate signs of vestibular injury and require evaluation for ototoxicitiy.
  • BBW Nephrotoxic, Ototoxic
  • Serum level should be 5 - 8 mcg/dL
  • Peak serum concentration 30 - 60 minutes after administering it.
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6
Q

What is the prototype fluroquinolones?

A

Ciproflaxcin (Cipro)

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7
Q

What is Ciproflaxcin used to treat?

A 
Acute sinitus
Lower respiratory infections 
Pneumonia 
Skin and soft tissue infections
Prostatis 
UTI
Treatment of anthrax
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8
Q

What type of bacteria is ciproflaxcin effective against?

A

Mainly gram negative, some gram positive

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9
Q

How does ciproflaxcin work?

A

Bactercidal agents that cause cell death. Interferes with enzymes that are required for synthesis of bacterial DNA and therefore are necessary for growth and replication.

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10
Q

What does the nurse assess the patient taking Ciproflaxcin for?

A 
Abdominal pain 
Headache 
Photosensitivity 
Dizziness
Increased liver enzymes 
Injection site reactions 
Serum creatnine 
BUN
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11
Q

What is the prototype macrolide?

A

Erythromycin

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12
Q

What does Erythromycin treat?

A

Effective against gram positive cocci
Can be used as a penicillin substitute
Upper respiratory infections
Prophylatically erythromycin is administered to prevent alpha hemolytic strepococcal endocarditis before dental or other procedures in patients who have valvular heart disease and are allergic to penicillin.

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13
Q

How does erythromycin work?

A

Enters the microbial cells and reversibly binds to the 50S subunits of ribosomes, thereby inhibiting microbial protein synthesis leading to cell death.
Has bacteriostatic and bacteriacidal activity against susceptible bacteria.

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14
Q

How is erythromycin administered?

A

Drink 6 to 8 ounces of water with this medication.
Empty stomach
NO antacids with this medication - it decreases absorption.
Oral contraceptives are decreased.

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15
Q

What does the nurse assess for in the patient taking erythromycin?

A

Hearing
Nausea and vomitting
Super infection: Pseudomembranous colitis
Psychosocial responses: Crying, laughing and altered thought processes

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16
Q

What is the prototype phenothiazines?

A

Promethazine

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17
Q

What does promethazine treat?

A

Nausea and vomiting associated with surgery, anesthia, migraines, chemotherapy, motion sickness.

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18
Q

How does promethazine work?

A

Therapeutic effects in Nausea and Vomiting are attributed to their ability to block dopamine from receptor sites in the brain and CTZ. Act primarily by antagonizing D2 receptors in the area postrema of the midbrain, thereby decreasing the effect of dopamine in the brain. They also possess M1 (Musacarinic) and H1 (Histamine) blocking effects.

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19
Q

Why does promethazine have a BBW

A
  1. Contraindicated in children <2 because of the risk of potentially fatal respiratory depression.
  2. Alerting nurses that promethazine is contraindicated for subcutaneous injections. Preferred parenteral route IM, avoid IV if possible.
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20
Q

What are the side effects of promethazine?

A

Blurred vision, urinary retention, dry mouth, photosensitivity, confusion, extrapyramidial symptoms (Spasms, rigidity, tremors)

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21
Q

What does the nurse teach the patient taking promethazine?

A

Use lowest dosage possible do not take drugs with other drugs that are respiratory depressors.

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22
Q

What does the nurse assess for in the patient taking promethazine?

A

Hallucinations
Convulsions
Sudden death (Excessive doses)
Tissue integrity - Drug may cause severe tissue injury
Burning and pain at the IV site justify immediate discontinuation of the drug

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23
Q

What is the prototype antihistamine?

A

Hydroxyzine (Vistaril)

IM!

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24
Q

What does Hydroxyzine treat?

A

Nausea and vomiting.
Preventing & treating motion sickness.
Also used as a sedative to treat anxiety.

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25
Q

What are the adverse effects of hydroxyzine?

A

Anticholinergic - drowziness, confusion, dry mouth, thickened respiratory secretions, blurred vision, urinary retention, and tachycardia.

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26
Q

What does the nurse teach the patient taking Hydroxyyzine?

A

Adverse effects may impair thinking or reactions so operating a motor vehicle should be avoided.

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27
Q

How does hydroxyzine work?

A

Thought to relieve nausea and vomiting by blocking the action of acetylcholine in the brain.

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28
Q

What does the nurse need to remember about administered hydroxyzine?

A

Oral administration is usually unsuccessful; Give IM in large muscle, IV possible development of abscess with damage to tissue.

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29
Q

What is the prototype of 5 HT3 Receptor Antagonist?

A

Ondansteron (Zofran)

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30
Q

What does Ondansteron treat?

A

FIRST choice for postoperative nausea and vomiting

Associated cancer chemotherapy, radiation therapy, and postoperative status.

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31
Q

How does ondansteron work?

A

Antagonizes serotonin receptors preventing their activation by the effects of emetogenic drugs and toxins/

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32
Q

What does the nurse assess for in the patient taking Ondansteron?

A

Headache
Diarrhea
Stamina and balance.
Use of ondansteron may mask a progressive illeus and gastric distention following abdominal surgery, or in patients with chemotherapy induced nausea and vomiting.

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33
Q

What is the prototype opiate related antidiarrheal agent?

A

Diphenoxylate with Atropine (Lomotil)

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34
Q

How does diphenoxylate with atropine (Lomotil) work?

A

Works by slowing perstalsis by acting on the smooth muscle in the intestine.

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35
Q

What are the contraindications to the use of diphenoxylate with atropine (Lomotil)?

A 
Diarrhea caused by toxic materials
Micro-organisms that penetrate intestinal mucosa 
Pathogenic E. Coli
Shigella 
Antibiotic associated colitis
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36
Q

What does diphenoxylate with atropine treat?

A

Diarrhea

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37
Q

What does the nurse assess the patient taking diphenoxylate with atropine for?

A

Hypotension and respiratory depression due to the effects of diphenoxylate.
He or she assesses for the effects of atropine: Tachycardia, thirst, flushing, urinary retention, and dry skin and mucous membranes.

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38
Q

What is the prototype penicillin?

A

Ampicillin (Principen)

39
Q

What does ampicillin treat?

A

Usually more effective in treating bacteria that are gram positive but can also be used for gram negative.

40
Q

How does ampicillin work?

A

Inhibits bacterial cell wall synthesis by binding to one or more penicillin proteins.

41
Q

What are the uses of ampicillin?

A

Bacterial infections caused by susceptible micro-organisms.
Culture and susceptibility studies should be done prior to administration, be aware of local patterns of strepococcal susceptibility and resistance.

42
Q

Why does penicillin G have a bbw?

A

To alert healthcare providers that inadvertent IV administration of penicillin G benzathine may result in cardiopulmonary arrest and death.

43
Q

What are the contraindications to the use of Ampicillin?

A

Hypersensitivity or allergic reactions to any penicillin formation.
An allergic reaction to one penicillin means the patient is allergic to ALL penicillins

44
Q

How is ampicillin administered?

A

Given IV, IM, PO
On an empty stomach with a full glass of water.
IM penicillins: Necessary to inject them into large muscle mass to decrease tissue irritation.
IV penicillins: Diluted reconstituted penicillin in 50 to 100 mL of 5% dextrose or 0.9% sodium chloride and infused over 30 to 60 minutes to minimize vascular irritation and phlebitis.

45
Q

What is the prototype cephalosporin?

A

Cefazolin (Kefzol, Ancef)

46
Q

How does cefazolin work?

A

Cefazolin inhibits the third and last step of bacterial cell wall synthesis by binding to one or more penicillin binding proteins.

47
Q

What are the indications for use of cefazolin?

A

Surgical prophylaxis and treatment of infections of the respiratory tract, skin and soft tissue, bones and joints, UTI, brain, spinal cord, blood stream.

48
Q

What are the contraindications to the use of cefazolin?

A

Previous anaphylatic reaction to penicillins
Cross sensitivity low in those with delayed reactions to PCN
Skin Rash
Cephalosporin allergy.

49
Q

What is the prototype Carbapenem?

A

Impenem-Cilastin (Primaxin)

50
Q

how does impenem-cilastin work?

A

Inhibits bacterial cell wall synthesis by binding with penicillin proteins. Broad spectrum

51
Q

What is the max dose of impenem-cilastin?

A

IV/IM 4 g/day

52
Q

What does impenem-cilastin treat?

A 
Lower respiratory infections 
UTI 
Intra-abdominal 
Skin and skin structures
Polymicrobial infections 
Bacterial Septicemia 
Endocarditis
53
Q

What is the prototype monobactam?

A

Aztreonam (Azactam)

54
Q

How does Aztreonam work?

A

Aztreonam inhibits bacterial cell wall synthesis by binding with penicillin-binding proteins.
*Because of its monobactam structure it has limited cross allergenicity between itself and other beta-lactam antibiotics. Generally considered safe to administer to patients with a known penicillin allergy.

55
Q

What does Aztreonam treat?

A 
UTI 
Skin/Skin structure infection
Lower respiratory infection 
Intrabdominal infection
Gynecologic infections 
Gram negative septicemia infections
56
Q

What is the prototype Sulfonamide?

A

Trimethoprim-sulfamethoxazole

57
Q

How does Trimethoprim-Sulfamethoxazole work?

A

Acts as antimetabolite of PABA which microorganisms require to produce folic acid. Folic acid is necessary for the production of bacterial intracellular proteins. Sulfonamides enter into the reaction instead of PABA, competing for the enzyme involved and cause formation of nonfunctional derivatives of folic acid. Thus sulfonamides halt the multiplication of new bacteria but do not kill mature fully formed bacteria.

58
Q

What does TMP-SMZ treat?

A

UTI caused by E.Coli, Proteus, Klebsiella Organisms
In combination to treat chronic bronchitis.
Ulcerative colitis, other uncommon infections
Topically: Prevention of burn wound infections
Ocular and soft tissue infections

59
Q

What are the contraindications to the use of TMP-SMZ?

A

Patients with Renal Failure
Infants <2 months
Known hypersensitivity to the drugs, sulfonamides, salicylates, megaloblastic anemia related to folate deficiency.

60
Q

How is TMP-SMZ administered

A

Full glass of water
Cannot be taken with other drugs.
IV lines should be flushed prior to administration and after.

61
Q

What does the nurse assess the patient taking TMP-SMZ for

A

Intake and output. If intake is greater then output, renal assessment is necessary.
Assess for hyperkalemia, anemia, and changes in the CBC that are indicative of blood dyscrasias.
Signs & symptoms of superinfection or hypersensitivity reactions.

62
Q

What is the prototype urinary antiseptic?

A

Nitrofurantoin

63
Q

What does nitrofurantoin treat?

A

Urinary Tract Infections

64
Q

What are the contraindications to the use of Nitrofurantoin?

A

Renal insufficiency
Pregnancy
Fetal malformations
Hemolytic anemia

65
Q

What are the adverse effects of nitrofurantoin?

A

Nonspecific ST and T wave changes and bundle block branch
CNS changes fever, malaise, depression, headache, lethargy and vertigo
Inform patient that the drug may cause urine to turn Brown

66
Q

What is important for the nurse to remember about nitrofurantoin?

A

May be bactericidal because of local effects produced by high concentration level in renal tubules and urine.
Not used for systemic infections

67
Q

What is the prototype tetracycline?

A

Tetracycline Gram Positive and Gram negative

68
Q

How does tetracycline work?

A

Penetrates microbial cells by passive diffusion and an active transport system. It binds to the 30S ribosomes and inhibits microbial protein synthesis. In patients with acne it supresses the growth of propionbacterium acnes with sebaceous follicles reducing the free fatty acid content in the sebum.

69
Q

What is tetracycline used for?

A

Drug of choice in specific infections:
- Cholera, rocky mountain spotted fever, syphillis, typhus, h.pylori, etc
Useful in animal bites (Lyme disease)
Chronic bronchitis, gonorrhea and syphyllis in patients with a known PCN allergy
Chlamydia infections, adjunct STD treatment
Prophylaxis and treatment of anthrax
Long term acne treatment
substitute of PCN in hypersensitivity

70
Q

What are the contrainidcations to the use of tetracycline?

A

Renal Failure
Younger then 8: Can discolor tooth enamel and depress bone growth.
Pregnancy: Fatal hepatic necrosis in the mother.

71
Q

What medication should not be taken with tetracycline?

A

Don’t take with anticoagulants because it enhances the effects of Vitamin K. Digoxin combined with tetracyclines leads to increased digoxin absorption resulting in digoxin toxicity.

72
Q

What should the nurse assess the patient taking tetracycline for?

A

GI irritation, nausea, epigastric distress, diarrhea, vomiting
Rash, anaphylaxis, serum sickness
Necessary to assess for photosensitivity, sunburn
CBC for anemia and signs and symptoms of a super infection

73
Q

What is the prototype loop diuretic?

A

Furosemide (Lasix)

74
Q

How does furosemide work?

A

Inhibits sodium and chloride reabsorption in the ascending loop of henle, where absorption of most filtered drugs takes place.

75
Q

Which diuretic is preferred when rapid effects are required?

A

When rapid effects are required furosemide is the drug of choice. Hypertensive crisis, pulmonary edema.

76
Q

What are the contraindications to the use of furosemide?

A

Known sensitivity to the drug
Anuria
Patients who are allergic to sulfonamide may also be allergic to furosemide

77
Q

How does the nurse administer furosemide?

A

IV injections: Over 1 to 2 minutes
Continous IV infusion: Rate of 4 mg/min or less
Furosemide must be mixed with normal saline or lactated ringers solution because 5% dextrose in water or D5W may accelerate degradation of furosemide.

78
Q

What does the nurse assess the patient taking furosemide for?

A

Volume depletion
Electrolyte imbalances
Digitalis therapy may exagerate hypokalemia particularly cardiovascular effects.
Diminished hearing = sign of ototoxicity.

79
Q

What does the nurse teach the patient taking furosemide?

A

Furosemide is potassium wasting, thus potassium rich low sodium diet is recommended. This helps diuretic drugs to be more effective and allows smaller doses to be taken.
Potassium imbalances can damage heart function.

80
Q

What is the prototype thiazide diuretic?

A

Hydrocholorthiazide (Microzide)

81
Q

How does HCTZ work?

A

Acts to decrease absorption of water, sodium chloride, and bicarbonate in the distal convulted tubule.

82
Q

What are the contrainidcations to the use of HCTZ?

A

Known senstivity to thiazides or sulfonamide derived agents or renal decompensation or anuria. (No urine output)

83
Q

What does HCTZ treat?

A

Drug of choice for most patients who require long term management of heart failure, hypertension and nephrotic syndrome.

84
Q

What does the nurse assess the patient taking HCTZ for?

A

Monitoring for transient or irreversible hearing impairment, tinnitus or dizziness is important. Ototoxicity is more likely to occur with high serum drug levels.

85
Q

What is the prototype potassium sparing diuretic?

A

Spirinolactone

86
Q

How does spirinolactone work?

A

Competitively inhibits mineral corticosteriod receptors and blocks the effects of aldosterone, hormone secreted by the adrenal cortex, in the renal tubules. Spirinolactone then blocks the sodium retaining effects of aldosterone and aldosterone must be present for spirinolactone to be effective.

87
Q

What are the indications for use of spirinolactone?

A 
Treatment of heart failure
Ascites in patients with liver disease
Hypokalemia
Hypertension
Primary and secondary hyperaldosteronism
88
Q

Why does spironolactone have a bbw?

A

Investigation has shown that the drug is tumorgenic with chronic toxicity in rats. Unneccessary use should be avoided.

89
Q

What are the contraindications to the use of spirinolactone?

A

Known hypersensitivity

Renal insufficiency

90
Q

How is spirinolactone administered?

A

Same time each day, preferably in the morning. Take with food. Decreases GI irritation.

91
Q

What should the nurse assess the patient taking spirinolactone for?

A

Evidence of fluid/electrolyte imbalances: Hyperkalemia, hyponatremia, hypomagnesemia, hypochloremic alkalosis

92
Q

What should the nurse teach the patient taking spirinolactone?

A

BP readings are necessary drug may cause drowsiness and dizziness

93
Q

What are the adverse effects of spirinolactone?

A

Dizziness, headaches, abdominal cramping, diarrhea.

Effects on androgen receptors: Deepening of voice, gynecomastia, menstrual irregularities, testicular atrophy

Exam 2 Nursing 115 (4 decks)

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