Exam 3 blueprint Flashcards by Kelli Greer

how do we diagnose TB

acid fast sputum test

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general patient teaching for tuberculosis treatment

avoid alcohol, take meds as prescribed to prevent resistance

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general adverse effects of tuberculosis drugs

hepatotoxicity

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What does INH (isoniazid) treat

tuberculosis

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Drug-food interactions of INH?

tyramine foods, oral contraceptives, antacids decrease absorption

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examples of tyramine foods

soups, soy sauce, aged cheese, aged meats, fermented foods (wine and some beers), kimchi, figs, avocado

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Patient teaching for isoniazid?

take B6/pyridoxine to decrease neuropathy, avoid tyramine, avoid alcohol, report symptoms of hepatitis (jaundice, anorexia, abdominal pain, fatigue, nausea), use condoms, take on empty stomach

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What does rifampin treat?

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Side effects of rifampin?

will turn body fluids orange-red, hepatotoxicity

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What is the polyene anti-fungal drug we discussed? (treats disseminated yeast)

amphotericin B (systemic and very toxic drug)

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Adverse effects of amphotericin B?

nephrotoxicity, thrombophlebitis, bone marrow suppression, hypokalemia, infusion reactions

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If a patient on amphoterecin B experiences an infusion reaction, what will their symptoms be? What do we do as a nurse?

fever, chills, tachypnea; IV drip very slowly, give test dose and pretreat with acetaminophen and diphenhydramine

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How can we prevent nephrotoxicity in our patients taking amphotericin B?

keep very hydrated with 1 L NS on day of IV

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Can we give amphotericin B with ahminoglycosides?

NO ; both produce nephrotoxicity

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How to recognize azole anti-fungals?

end in azole

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Adverse effects of azole anti-fungals?

hepatotoxicity, burning with topical administration, nausea, vomiting

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Patient teaching for azole anti-fungals?

monitor S/S of hepatotoxicity (dark urine and tarry stools), monitor S/S of liver failure (abdominal pain, nausea, anorexia, fatigue, jaundice), fluconazole is a pregnancy category D (use barrier method)

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How to recognize anti-virals

end in -vir

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The antiviral used to treat shingles/herpes?

acyclovir

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Nursing interventions for acyclovir?

rotate IV site and give over 60 minutes, monitor for phlebitis, increase hydration to decrease risk of nephrotoxicity, monitor kidney function and I&O

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what does bactericidal mean?

kills bacteria

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what does bacteriostatic mean

inhibits bacterial growth

what is culture and sensitivity (C&S)

causative microorganism ; vulnerability to specific ABX (what kills it)

What causes antibacterial resistance?

overuse of antibiotics, not taking full dose regimen

What is a superinfection?

patient taking antibiotics gets a different infection

What are the three general adverse reactions for antibiotics?

hypersensitivity/anaphylaxis, superinfection, organ toxicity

What are the symptoms of mild and severe hypersensitivity reactions?

mild: pruritus, rash, hives severe: anaphylaxis, SOB, bronchospasms

What are the 3 most common superinfections we get from antibiotics?

candidiasis as vaginal yeast/ oral thrush, C-Diff/pseudomembraneous colitis, and stomatitis

What organs do we primarily see toxicity in when administering antibiotics

ototoxicity (ears ringing, loss of balance) , hepatotoxicity (dark urine, abdominal pain, anorexia, fatigue, nausea, vomiting) nephrotoxicity (low output, increased RFTs, differences in urine)

General patient teaching for antibiotics?

take to completion, use barrier method of birth control, report diarrhea, report allergic reactions, take probiotic, superinfections

General nursing interventions for antibiotics?

monitor RFTs and LFTs, increase fluids, monitor for superinfections

What antibiotic classes inhibit synthesis of bacterial cell wall (contain betalactam ring)

penicillins, cephalosporins, vancomycin

How to recognize penicillins?

end in -cillin

Mechanism of action for penicillins?

beta lactam ring inhibits synthesis of bacterial cell wall and division from enzymes

What drug interactions do we see with penicillins?

aminoglycosides are incompatible (require second tubing), oral contraceptives decrease effectiveness, antacids decrease absorption

Patient teaching for penicillins?

wear medic alert bracelet if allergic, take with food, take full regimen, increase fluids, use backup birth control, monitor s/s of allergic reactions

Nursing interventions of penicillins

monitor diligently for allergic reaction, get C&S before administering, monitor for superinfection, RFT, LFT, bleeding tests, check compatibility of other meds (ahminoglycosides), report abnormals, dosage calculations

What are abnormal lab results we should report to the provider if taking penicillin?

allergic reactions, BUN, creatinine, PT, INR, aPTT, platelets, hyperkalemia, hypernatremia

How can we recognize cephalosporin antibiotics?

begin with ceph- or cef-

contraindications of cephalosporins?

allergic to penicillin / cephalosporins

Adverse reactions of cephalosporins?

superinfection, bleeding, hypersensitivity reactions

Patient teaching for cephalosporins

avoid alcohol (produces disulfiram like reaction), take with food, take probiotic, increase fluids, notify diarrhea, extra birth control

Nursing interventions of cephalosporins?

monitor for hypersensitivity reactions, use ventrogluteal for IM injections, infuse IV over 30 minutes, get C&S before therapy, RFT, LFT, report diarrhea, report abnormals, report bleeding s/s

If someone is allergic to penicillin but not cephalosporins, this is called?

true penicillin allergy

If someone is allergic to cephalosporins and penicillin, this can mean?

allergy to beta-lactam ring

What type of antibiotic is vancomycin?

glycopeptide

Indications for vancomycin?

IV is MRSA (can be given oral for pseudomembranous colitis)

Adverse effects of vancomycin?

red man syndrome, ototoxicity, nephrotoxicity, Steven-johnson syndrome, thrombophlebitis

Symptoms of red man syndrome? What causes this?

flushing, hypotension, tachycardia ; IV infused too quickly

What should we do if our patient has red man syndrome?

give diphenhydramine, restart infusion at slower rate

Aminoglycosides should be used with caution alongside vancomycin because of what reactions?

ototoxicity and nephrotoxicity

Nursing interventions for vancomycin?

obtain peak and trough levels, infuse over 60 minutes, monitor red man syndrome, monitor hearing changes, monitor infusion site, RFTs, monitor superinfection, obtain C&S first