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Pharmacology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Bactericidal

A

Kill bacteria

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2
Q

Bacteriostatic

A

Inhibits bacterial growth

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3
Q

Culture and sensitivity

A

Causative microorganism and vulerabikity to specific antibiotics;Obtained first before start antibiotics, separate stick and chlorahexidine cleaner for cultures

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4
Q

Resistance

A

Difficult to treat, overuse and or not taking full course

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5
Q

Superinfection

A

Undergo tx with antibiotic and get another infection, i.e. candidiasis - oral or vaginal thrush

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6
Q

Pt teaching for antibiotics

A

Report diarrhea, s/s of rxn, call 911 if throat swells, take with food to decrease GI upset, take FULL regimen, increase fluid intake , wear medic alert ID for cephalosporin or penicillin allergies , barrier method for birth control, antacids 2 hr before or 1 hr after abx

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7
Q

General nursing interventions for antibiotics

A

Monitor for rxns, diarrhea, C&S before any abx, RFT and LFT, superinfection , check compatibility, renal toxicity and ototoxicity

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8
Q

How do you recognize penicillins?

A

-cillin

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9
Q

Pt teaching for penicillins

A

Increase your fluid intake, take with Food to decrease GI upset, allergic rxn s/s, take the FULL regiment, wear medic alert ID if penicilllin or cephalosporin allergy, use alternative birth control methods

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10
Q

Drug interactions with penicillins

A

Aminoglycosides-NONCOMPATIBLE
Oral contraceptives are less effective
Antacids decrease absorption of penicillins

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11
Q

Mechanism of action for penicillins

A

Inhibit the synthesis of bacterial cell walls

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12
Q

Nursing interventions for penicillins

A

-Aware of allergies to penicillins AND Cephalosporin
-Monitor for allergic rxn (15-30 min minimum)after 1st dose
-C&S before any abx
-RFT and LFT (BUN, creatinine, ALT ,AST)
-Monitor for bleeding
-Monitor for superinfections
-Check compatibility
-Report abnormal labs

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13
Q

How to recognize cephalosporins

A

Cef- or ceph-

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14
Q

Nursing interventions for cephalosporins

A

Allergies to penicillins?
C&S
RFT and LFT
Superinfection
Bleeding
Large muscles for IM injection (pain)- ventrogluteal
Report abnormal
Some can cause disulfiram rxns- hang over like s/s
Infused over at least 30 min

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15
Q

Pt teaching for cephalosporins

A

Avoid alcohol (disulfiram- like rxn)
Oral contraceptives-less effective
Take a probiotic
Take with food
Increase fluids
Report diarrhea

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16
Q

Contraindications for cephalosporins

A

Calcium containing products, penicillin,cephalosporin allergy, decrease LF or RF

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17
Q

Vancomycin nursing interventions

A

Monitor peak and trough levels, C&S first, administer IV over 60 min minimum
Monitor for hearing changes
Monitor for Red Man syndrome
Monitor infusion site
RFT
Monitor for superinfection

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18
Q

Indications for vancomycin

A

Only effective against gram positive organisms; tx for MRSA and C. Diff (orally tx, not absorbed in GI tract)

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19
Q

Adverse effects for vancomycin

A

Red-Man syndrome (pushed too fast IV), ototoxicity(dose related), nephrotoxicity, Steven-Johnson syndrome(painful pink/red spots that may blister- eyes mouth genitals) , IV site pain, thrombophlebitis, drug interactions with ototoxic meds

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20
Q

How to recognize macrolides

A

-omycin or thromycin ;
Macrolides= “throw mice”

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21
Q

Pt teaching for macrolides

A

Report diarrhea, take a probiotic (prevent C.Diff), full regimen!! Antacids 2 hr before 1 hr after, food 1 hr b4 2 hr after, report and monitor for hearing losses and superinfection, avoid sun, birth control barrier methods, allergic rxn s/s

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22
Q

Adverse effects to report- Clindamycin

A

Diarrhea, fatal colitis=black box warning!

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23
Q

Black box warning for clindamycin

A

Severe and possibly fatal colitis

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24
Q

When do you obtain peak and trough levels for aminoglycosides

A

Thirty min before next dose (results before next dose) and 30 min after administration

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25
Q

Adverse effects for aminoglycosides

A

Nephrotoxicity, ototoxicity, neurotoxicity, photosensitivity, muscle cramps, pruritus, hypersensitivity rxns, tremors, N/V, seizures and encephalopathy

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26
Q

Nursing interventions for aminoglycosides

A

C&S first, renal function baseline and monitor, if altered=decrease dose; monitor for ototoxicity; superinfection monitor, peak and trough monitor

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27
Q

Pt teaching for aminoglycosides

A

Report hearing changes, keep track of amt and appearance of urine, report diarrhea, avoid sun(phototoxicity) allergic rxns-report s/s monitor peak and trough levels

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28
Q

How do you recognize tetracyclines

A

-cycline

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29
Q

Drug-food interactions with tetracyclines

A

Food-impairs absorption (except doxy and mino)- 2 hrs after meals and 1 hr before
Dairy-avoid! 1 hr before dairy
Antacids, Magnesium, iron, calcium(tetracycline=less effective)
Oral contraceptives= less effective

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30
Q

Side effects/adverse effects tetracyclines

A

Photosensitivity, teeth staining(preg ppl=baby stained teeth), GI distress, superinfection, hepatotoxicity, nephorotoxicity

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31
Q

How do you recognize fluoroquinolones

A

-oxacin

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32
Q

Nursing interventions for fluoroquinolones

A

C&S, infuse at least over 60 min (if not 90)-never less, take with food, increase fluids to 2 L/day, avoid caffeine, superinfection monitor, take probiotic, avoid sun, monitor kidney function, tendon pain (swelling, redness, decrease strenuous exercise), backup birth control needed

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33
Q

Adverse effects of fluoroquinolones

A

Photosensitivity, N/V/D, Achilles tendon rupture, superinfection, crystalluria, hypersensitivity rxns, arthropathy, dizziness, headache, peripheral neuropathy, arrhythmia, seizure

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34
Q

Sulfonamides

A

oral, IV, topical, ophthalmic; i.e. trimethoprim-sulfamethoxazole (TMP-SMZ); pregnancy category D

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35
Q

Nursing interventions for sulfonamides

A

Fluids- 2L Q day, output and KF, CBC, crystalluria monitor, S/S infection, bleeding, anemia, avoid sun, superinfection, food 1 hr before/2hr after, Rash/flu-like symptoms-report
Barrier birth C needed

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36
Q

Pt teaching for sulfonamides

A

Barrier method needed
Avoid sun
Report rash/flu-like s/s
Food- 1 hr before 2 hr after

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37
Q

Anaphylaxis

A

Call 911, rapid response team

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38
Q

Prophylaxis

A

Prevent infection

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39
Q

Host factors for bacteria

A

Immune system, site of infection, age, pregnancy , allergies, combination therapy

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40
Q

T/F abx are effective for a cold/virus

A

False

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41
Q

What should you monitor for when a pt is on an abx

A

Diarrhea- Clostridium Difficile (C-Diff!), abx kills good gut bacteria and bad bacteria takes over causing C Diff

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42
Q

S/S of hepatotoxicity

A

Abd pain, jaundice, flank pain, N/V, dark urine, anorexia

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43
Q

What type of drugs are penicillins, cephalosporins, carbapenems, and monobactams (aztreonam)?

A

Beta lactams

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44
Q

What type of drug is vancomycin?

A

Glycopeptide

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45
Q

Mild allergic reaction

A

Itching, hives, rash; stop the medication and call the provider

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46
Q

Anaphylactic shock s/s

A

Laryngeal edema, dyspnea, bronchospasms, cardiac arrest

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47
Q

Tx for anaphylactic shock

A

Epinephrine and albuterol

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48
Q

Tx for mild reactions

A

Antihistamine

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49
Q

What do Beta lactams do to bacteria?

A

Inhibit the synthesis of the bacterial cell wall

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50
Q

Naturally occurring penicillins are made by ______.

A

Mold

51
Q

Natural and penicillinase are __________ ___________, which are gram ____________.

A

Narrow spectrum; positive

52
Q

Aminopenicillins are ______________ (some gram-________ activity and penicillinase sensitive)

A

Broad spectrum; negative

53
Q

Extended spectrum abx are active against :

A

Pseudomonas

54
Q

Extended spectrum abx are relatively ineffective against:

A

Gram-positive organisms

55
Q

How are penicillins exerted?

A

Active tubular secretion

56
Q

Side/adverse effects of penicillins

A

Hypersensitivity, superinfection, N/V/D, nephropathy, CNS toxicity, Hepatic injury

57
Q

What are the types of hypersensitivities with penicillins?

A

Immediate- 2-30 min, accelerated 1-72 hrs, late days-weeks

58
Q

How many generations are there with cephalosporins

A

Four

59
Q

First generation cephalosporins are _____ spectrum, similar to ______ - spectrum ______ and sensitive to B lactamases

A

Narrow, broad

60
Q

Drug interactions for cephalosporins

A

Calcium-containing products-non compatible
Alcohol causes disulfiram rxn
Antacids decrease absorption
Oral contraceptives are less effective
Probenecid decreases excretion of cephalosporins
Nephrotoxic drugs (aminoglycosides) can cause nephrotoxicity

61
Q

What cephalosporin must be given ventrogluteal IM?

A

Ceftriaxone or Rocephin

62
Q

What is required monitoring for vancomycin?

A

Peak and trough

63
Q

How long must vancomycin be given over?

A

60 min minimum

64
Q

Red-Man syndrome

A

When vancomycin is given too quickly; redness in face, neck, chest, tacycardia, hypotension ; not allergic rxn- stop infusion, give diphenhydramine, and when s/s resolve, start infusion at a slower rate

65
Q

Stevens-Johnson syndrome

A

Fever, flu-like symptoms, rash=blue/purple (face first), dysphagia, dysuria

66
Q

What cephalosporins have anti-vitamin K effects? What can they cause?

A

Ceftriaxone(Rocephin) cefotetan(Cefotan)

67
Q

What is pseudomonas membranous colitis

A

C. Diff/ clostridium difficile

68
Q

Second generation cephalosporins have an increased activity towards ________ __________ organisms

A

Gram negative

69
Q

Third generation cephalosporins are even ________ in spectrum and are more ______ to B-lactamase

A

Broader, resistant

70
Q

Fourth generation cephalosporins work for _________________ and ______________ activity

A

Gram-postive and gram-negative

71
Q

What routes can cephalosporins be given?

A

PO, IM, IV

72
Q

Cephalosporins have a cross allergy with:

A

Penicillins

73
Q

Side/adverse effects of cephalosporins

A

GI distress (N/V/D), hypersensitivity reactions, bleeding, superinfections, pain with IM injection

74
Q

How do you recognize aminoglycosides?

A

-micin, -mycin except for amikacin

75
Q

What are aminoglycosides?

A

Broad spectrum abx that are poorly absorbed orally; non compatible with penicillin, but typically given together in separate tubing.

76
Q

What do aminoglycosides require for administration?

A

Peak and trough levels and monitoring- small margin of safety with a narrow therapeutic index

77
Q

What type of drug is an aminoglycoside?

A

Protein synthesis inhibitor, requires binding to intracellular protein (ribosomal subunit) and needs to gain entry into the cell

78
Q

Gentamicin

A

Aminoglycoside

79
Q

Drug interactions with gentamicin

A

Penicillin, ototoxic meds (i.e. loop diuretics), nephrotoxic meds (ampoteracin B and vancomycin), oral contraceptives- less effective
Antacids= decrease effect

80
Q

S/S of ototoxicity?

A

Tinnitus, balance issues,hearing loss, (baseline hearing needed)

81
Q

S/S of renal toxicity?

A

Hematuria, proteinuria, decreased output, cloudy urine; baseline I&O needed

82
Q

How do you measure a baby’s I&O?

A

Log intake and weigh diapers for output

83
Q

Tetracyclines

A

Similar to amingoglycosides, broad-spectrum abx, useful in tx for rickettsial disease, chlamydial disease, cholera, Lyme disease, mycoplasma pneumonia

84
Q

Routes for tetracyclines

A

oral, IM (painful and rarely used), IV

85
Q

Pregnancy category for Tetracyclines

A

D- contraindicated

86
Q

Interventions/pt teaching tetracyclines

A

C&S, food 1 hr before 2 hr after, Kidney and Liver, avoid sun, superinfection monitor, probiotic (take), avoid milk, iron, magnesium, antacids, calcium
Expiration dates= CNS toxicity

87
Q

Empiric therapy

A

Abx started before C&S results

88
Q

Selective toxicity

A

Kill only microbe and not host cells

89
Q

Beta lactamase

A

Enzyme in bacteria that eats through beta lactation rings in abx

90
Q

What do macrolides treat?

A

Mycoplasma infections, pneumonia, legionnaires disease, chlamydial infections, diphtheria, pertussis, COPD pt with pneumonia

91
Q

Side/adverse effects of macrolides

A

GI effects (N/V/D, cramping, anorexia), hypersensitivity rxn, phototoxicity, superinfection, ototoxicity(high doses)

92
Q

When should macrolides be cautiously used?

A

In pt with liver disease or dysfunction

93
Q

Drug interactions for macrolides

A

Antacids=inhibit absorption
Oral contraceptives=less effective
Digoxin(HR), cyclosporine(immunosuppressive), and warfarin(bleeding)= increase effects of macrolides
Penicillins and clindamycin decrease effect of macrolides

94
Q

Lincosamides

A

Only used if known sensitivity , activity against anaerobes- can penetrate bone; C.Diff =resistant, allergy to PCN? Black box warning: severe and possible fatal colitis!!!

95
Q

Clindamycin routes

A

IV, PO, IM

96
Q

Side effects/adverse reactions Clindamycin

A

Rash, N/V/D, phototoxicity, C. Diff (d/c at first sign of diarrhea)

97
Q

Nursing interventions for Clindamycin

A

C&S first, full regimen unless diarrhea develops, take with food, take probiotic, report diarrhea, antacids inhibit absorption

98
Q

Quinolones

A

Inhibit DNA replication, limited to tx for complicated infections, broad spectrum ; routes=PO and IV

99
Q

Contraindications for fluoroquinolones

A

Less than 18 yo

100
Q

Sulfonamides s/e and a/e

A

GI distress, superinfection(a), photosensitivity, crystalluria (a), blood dyscrasias(low RBC,WBC, and PLT= s/s anemia, infection, bleeding), Stevens-Johnson syndrome(a), hypersensitivity rxns(a)

101
Q

Sulfonamides drug interactions

A

Oral contraceptives=less effective
Antacids=inhibit absorption
Oral hypoglycemics increase risk of hypoglycemia
ACE inhibitors and Potassium-sparing diuretics increase K+(hyperkalemia)
Warfarin (increases effect)
Diogoxin and sulfonylurea (increases drug effects- K+ level, bleeding, Digoxin toxicity)

102
Q

S/S of digoxin toxicity

A

Yellow/green halos, bradycardia, anorexia, N/V

103
Q

Metronidazole drug type

A

Antiprotozoal, tx for vaginal trichomoniasis, giardiasis, and all forms of amebiasis, also tx for C.Diff and H. Pylori, PO and IV(C.Diff) route

104
Q

S/e and a/e of metronidazole

A

Hypersensitivity rxns (a)
GI upset N/V/D(S)
Photosensitivity (S)
Superinfection (a)
Urine discoloration (s)- dark red/brown
Metallic taste (S)
Stevens-Johnson syndrome (a)
Disulfiram-like rxn (a)
Neurotoxicity/CNS toxicity(a)- seizures, ataxyia, dizziness, extremity weakness

105
Q

Indications for metronidazole

A

Vaginal trichomoniasis, giardiasis, all forms of amebiasis, treat H. Pylori and C.Diff (anaerobic bacteria and several protozoan species)

106
Q

Pt teaching for metronidazole

A

Dark brown/red urine=expected
Avoid alcohol (Disulfiram rxn)
Metallic taste=expected
Avoid sun/wear protective clothing and sunscreen

107
Q

Nitrofurantoin

A

Tx for UTI and cystitis only, oral, stays in kidneys

108
Q

Nursing considerations/ pt teaching for nitrofurantoin

A

Increase fluid intake 2L q day prevent crystalluria
Severe GI distress (anorexia, N/V/D, abd pain)
Antacids- avoid
Take with food
Brown urine=expected
Liquid can stain teeth

109
Q

Indications for nitrofurantoin

A

UTI or cystitis

110
Q

TB

A

Mycobacteria= slow growing and require prolonged tx
Dx= acid-fast sputum culture
Important for pt to take abx as prescribed, combination therapy= vital:4-5 drugs
Test every 3-6 months after tx complete
Evaluate with chest radiography, sputum tests, and no s/s of TB

111
Q

Current TB tx

A

6-9 months of RIPE(rifampin, INH, pyrazinamide, ethambutol)

112
Q

Latent TB

A

Positive PPD but no s/s= INH, rifapentine, rifampin for 6-9 months (RRI)

113
Q

MDR TB( multi-drug resistant)

A

Multiple drug therapy for up to 24 months (15-24 months), INH and Rifampin

114
Q

INH

A

First-line drugs- isoniazid; take on empty stomach, oral and IM; contraindicated in liver disease

115
Q

INH pt teaching

A

Take B6 (pirodoxine), s/s hepatitis (abd pain, anorexia, jaundice, fatigue, nausea), regular LFTs
Avoid alcohol and Tyramine, use barrier method for birth control

116
Q

When on INH, what is neuropathy a sign of?

A

Low B6

117
Q

Example of tyramine foods

A

Aged meats (salami, pepporoni), aged cheese, avacado, fig, bananas, fish , soy saucer

118
Q

Rifampin Side effects

A

Orange urine (all fluids and feces), no contacts (stains), adverse=hepatotoxicity

119
Q

What do all TB meds have in common?

A

Can cause hepatotoxicity, LFT must be done, contraindicated in liver disease, avoid alcohol

120
Q

What areas do fungal infections occur?

A

Poorly vascularized areas that increase growth (skin, nails, hair); fungi are slow to grow and harder to kill than bacteria

121
Q

Amphotericin B is a ___________________

A

Polyene Antifungal, drug of choice for systemic fungal infection; highly toxic (only for life threatening systemic infections) for serious disseminated yeast and fungal infections

122
Q

Amphotericin B s/e and a/e

A

-Infusion rxn- test dose first, no rxn=premed w/ diphenhydramine and acetaminophen
-Hypokalemia
-Bone marrow suppression(leukopenia, decrease WBC, PLTs, H&H, baseline CBC monitor)
-Thrombophlebitis
-Nephrotoxicity (inc hydration, 1 L normal saline on day of infusion; I/O, BUN, creatinine, report dec output)

123
Q

Amphotericin B nursing interventions

A

Labs- CBC , H&H
I/O
Infusion rxn
Central line(ideally), filter tubing needed, IV pump(2-4 hours with 1 L fluid same day)

Pharmacology (12 decks)

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