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NSG 318 - Pharm > Exam 3: Topics 8, 9, & 10 > Flashcards

Exam 3: Topics 8, 9, & 10 Flashcards

1
Q

acute heart failure

A

Heart muscle weakens and enlarges.
Loses ability to pump blood adequately
Compensatory mechanisms fail.
Lungs and periphery become congested.

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2
Q

right sided heart failure

A

blood backs up to the periphery (extremities)

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3
Q

Left sided heart failure

A

blood backs up into the lungs (pulmonary edema)
left ventricle doesn’t contract and can’t get blood into the periphery so it stays in the Lungs

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4
Q

nonpharm treatment for heart failure

A

limit salt and saturated fat intake
limit or avoid alcohol intake
stop smoking (it causes vasoconstriction)
perform MILD exercise

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5
Q

what is the therapeutic serum level of digoxin fro heart failure?

A

0.5-1ng/mL

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6
Q

what effects does digoxin have on the heart muscle

A

increase myocardial contractility
decrease heart rate
decrease conduction
increase CO

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7
Q

What are common signs of digoxin toxicity

A

anorexia, vomitting, diarrhea,
blurred vision, green or yellow halos
bray cardia, abnormal heart rhythms

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8
Q

what is given for digitalis toxicity

A

digoxin immune fab

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9
Q

what is angina

A

acute cardiac chest pain caused by INADEQUATE BLOOD FLOW to the myocardium (decreased o2 to the heart)

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10
Q

what are some things that can cause angina

A

plaque occlusion
coronary artery spasms
sometimes stress and exertion can cause it

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11
Q

what referred pain is associated with angina

A

pain will radiate down the left arm

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12
Q

what are the types of antianginal drugs

A

nitrates
beta blockers
calcium channel blockers

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13
Q

prior to starting antibiotics, what must happen?

A

blood cultures must be drawn

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14
Q

what is the process of taking a blood culture?

A

draw when temperature is rising
collect before takin antibiotics
clean skin per protocol
DO NOT DRAW SPECIMEN FROM IV LINE
draw 2 specimens from 2 different sites
draw 10-15 ml of blood
sed specimen to lab immediately

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15
Q

bactericidal

A

kills bacteria
kills fast

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16
Q

bacteriostatic

A

inhibits bacterial growth
slows growth of bacteria
killing slowly

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17
Q

What are antibiotics mechanism of action

A

inhibition of bacterial cell wall synthesis
alteration of membrane permeability
inhibition of protein synthesis
inhibition of synthesis of bacterial RNA and DNA
interfere w metabolism within the cell

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18
Q

what are some factors that influence the body’s ability to fight infection

A

age
nutrition
immunoglobulins
circulation
WBCs
organ function

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19
Q

inherent resistance

A

occurs without previous exposure to antibacterial drug

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20
Q

acquired resistance

A

caused by prior exposure to an antibiotic. This can cause an antibiotic to not be effective as it once was for a certain bacteria.

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21
Q

what are some health care acquired infections

A

MRSA
VREF
VRSA

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22
Q

what are examples of antibiotic misuse

A

antibiotics taken unnecessarily (for viral infxn, when no bacterial infxn is present, and taking antibiotics incorrectly like skipping doses)

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23
Q

what happens with antibiotic misuse

A

it increases antibiotic resistance

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24
Q

cross resistance

A

resistance to one antimicrobial agent because of its similarity to another antimicrobial agent (may be in the same class)

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25
Q

what are the general antibacterial adverse reactions

A

allergic reaction
superinfection
organ toxicity

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26
Q

allergic reaction

A

hypersensitivity, rash, pruritus, hives, anaphylactic shock

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27
Q

superinfection

A

secondary infection when normal flora is killed

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28
Q

what are the usual sites for super infection

A

mouth, skin , respiratory tract, GU tract, intestines

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29
Q

organ toxicity

A

ear (ototoxicity), liver (hepatotoxicity), kidney (nephrotoxicity)

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30
Q

narrow spectrum

A

Primarily effective against one bacteria type
Examples: penicillin, erythromycin

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31
Q

broad spectrum

A

ability of a drug to be effective against a wide range of microorganisms (gram positive and gram negative)
ex: amoxicillin

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32
Q

When is broad-spectrum useful?

A

when the pathogen is unknown and has not been identified by culture and sensitivity test

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33
Q

structure of penicillin

A

Beta-lactam ring structure

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34
Q

types of penicillins

A

basic penicillins
broad spectrum penicillins
penicillinase resistant penicillins
extended spectrum penicillins

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35
Q

penicillin action

A

inhibits cell wall synthesis
bacteriostatic and bactericidal

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36
Q

cephalosporin structure

A

beta lactam structure

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37
Q

often if you are allergic to ____ you are also allergic to _____

A

penicillin
cephalosporin

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38
Q

action of cephalosporins

A

inhibit bacterial cell wall synthesis
bactericidal

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39
Q

what does cephalosporin treat

A

respiratory, urinary, skin, bone, joint, genital infection

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40
Q

How many generations of cephalosporins are there?

A

5 generations

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41
Q

action of macrolides

A

inhibit protein synthesis
broad spectrum

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42
Q

what is often given if a patient has a penicillin allergy

A

azithromycin (Zithromax)

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43
Q

action of tetracyclines

A

inhibit protein synthesis
broad spectrum

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44
Q

what do tetracyclines treat

A

acne, antrax, plague, gingivitis, cholera, STI, skin urinary and respiratory infection

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45
Q

most antibiotics cause…

A

ototoxicity (hearing loss)

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46
Q

action of aminoglycosides

A

inhibit protein synthesis
bactericidal

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47
Q

What do aminoglycosides treat?

A

serious infections of the blood, such as meningitis, infective endocarditis, septicemia,etc

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48
Q

Action of Fluoroquinolones

A

interfere with enzyme DNA gyrase needed to synthesize bacterial DNA
bactericidal

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49
Q

What are fluroquinolones used to treat?

A

anthrax, skin, soft tissue, bone/joint, gynecologic, intrabdominal, urinary and respiratory tract infection

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50
Q

action of sulfonamides

A

inhibit bacterial synthesis of folic acid
bacteriostatic

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51
Q

use of sulfonamides

A

OM, meningitis, malaria, respiratory infxn, UTI

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52
Q

Tuberculosis Etiology

A

Mycobacterium tuberculosis (acid-fast bacillus)

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53
Q

Tuberculosis transmission

A

Person to person via droplets; coughing, sneezing

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54
Q

patients at risk for tuberculosis

A

immunocompromised
living or working in high risk residential setting
injection of illegal drugs
healthcare workers with high risk patient

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55
Q

symptoms of tuberculosis

A

cough, fever, night sweats
gi distress weight loss
positive acid fast bacilli in sputum or bloody sputum

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56
Q

when is prophylaxis TB recommended

A

close/active contact is TB pt
HIV + or immunocompromised
conversion from - to + TB
latent TB infection
injection drug users
recent immigration from high prevalence country

57
Q

Antitubercular drug therapy

A

single drug therapy (ineffective)
multi drug therapy (decrease bacterial resistance, tx duration decrease)

58
Q

special population for TB

A

pregnancy, HIV, peds

59
Q

fungal infection

A

Candidiasis

60
Q

Local fungal infections

A

mucous membrane, hair, skin, nails, moist skin areas

61
Q

mild fungal infection

A

oral candidiasis, thrush, vaginal candiaisas

62
Q

system fungal infection

A

sever can affect organs, abdomen , CNS

63
Q

transmission method for viruses

A

droplets: coughing, sneezing, talking

64
Q

common viral infections

A

Influenza, common cold, chickenpox (varicella), Hep B(hepatitis), HIV

65
Q

helminths

A

parasitic worms

66
Q

4 groups of helminths

A

cestodes (tapeworms)
Trematodes (flukes)
intestinal nematodes (round worms)
tissue invading nematodes (tissue round worms)

67
Q

transmission method for helminths

A

from infected soil to human via contaminated food, bites of carrier insects, direct penetration of skin

68
Q

helminths often affect what sites

A

intestines
lymphatic system, blood vessels, liver

69
Q

peptide action

A

interferes with bacterial cell wall causing cell death

70
Q

peptide classification

A

antiviral, antibacterial ,Antifungals, anti-parasitic

71
Q

patient safety to avoid antibiotic resistance

A

ask HCP if they can be treated w/o antibiotics
take antibiotics as prescribed
NEVER skip doses and complete all of the antibiotic even if they feel better
never take someoneelses antibiotic

72
Q

An antiviral drug used for the treatment of herpes simplex virus

A

Acyclovir (Zovirax)

73
Q

A penicillin that is commonly used for otitis media, tonsillitis, and urinary tract infections that is a broad spectrum antibiotic

A

amoxicillin

74
Q

A reaction to a drug that many time starts with shortness of breath and can lead to vascular collapse, laryngeal edema, bronchospasms, and cardiac arrest.

A

anaphylactic reaction

75
Q

OTC drugs that should not be taken at the same time as azithromycin (Zithromax) or levofloxacin (Levaquin)

A

antacids

76
Q

Antibiotic that inhibits the steps of protein synthesis and is used for bacterial conjunctivitis, STIs, and skin infections. This drug works well for those who are allergic to penicillin/cephalosporin.

A

Azithromycin (Zithromax)

77
Q

Antibiotics that are effective against gram-positive and gram-negative bacteria are known as this type of antibiotic

A

broad spectrum antibiotics

78
Q

Labs needed before giving antibiotics to determine the ability to metabolize and excrete the drug.

A

BUN, creatinine, liver enzymes

79
Q

A broad spectrum antibiotic that is used for otitis media, meningitis, and surgical infection prophylaxis that have a disulfiram-like reaction

A

Cephalosporins

80
Q

If a client is allergic to penicillin they can also be allergic to this classification of drugs

A

Cephalosporins

81
Q

The signs/symptoms of this superinfection include multiple episodes of watery, diarrhea that may be bloody, abdominal cramping, and a possible increased temperature

A

Clostridium difficile

82
Q

A reaction a client may have if metronidazide (Flagyl) or ceftriaxone and drinking alcohol

A

Disulfiram-like reaction

83
Q

Antibiotic that is used to treat acne, E. coli, MRSA and anthrax that should not be taken with milk

A

Doxycycline

84
Q

An azole antifungal that is used for candida infections and prophylactically for those undergoing bone marrow transplant. Drinks with caffeine are contraindicated when taking this drug.

A

Fluconazole (Diflucan)

85
Q

An antibiotic that is administer via IM or IV and used for endocarditis, septicemia, bone/joint infection, and meningitis and may cause alopecia or photosensitivity

A

Gentamicin Sulfate

86
Q

An anthelmintic medication used to treat clients with parasitic worms such as roundworm.

A

Ivermectin (Stromectol)

87
Q

An expected side effect of isoniazid and ceftriaxone that the nurse should monitor but does not require discontinuation of the medication

A

Injection site redness

88
Q

Antibiotic that interferes with the enzyme DNA gyrase and is used to treat cellulitis, impetigo and skin infections. May cause abdominal cramps, restlessness, depression and injection site reaction.

A

Levofloxacin (Levaquin)

89
Q

A peptide medication that is used for anaerobic infections including rosacea.

A

Metronidazide ((Flagyl)

90
Q

Antibiotics that are effective against only one bacterial type are known as this type of antibiotic

A

Narrow spectrum antibiotic

91
Q

Medication that may have reduced effects when taken with doxycycline

A

Oral Contraceptives

92
Q

An adverse reaction to many antibiotics that starts with ringing of the ears

A

Ototoxicity

93
Q

A disease-producing microorganism

A

Pathogen

94
Q

A lab test that is drawn 30 - 60 minutes after administration of a medication to determine the amount of medication in the system

A

Peak Level

95
Q

A broad spectrum classification of antibiotics that inhibits bacterial cell wall synthesis and has a beta-lactam ring structure

A

Penicillin

96
Q

A potential side effect of IV administration of acyclovir that requires that the nurse assess the IV site prior to administration, frequently throughout the administration of the drug, and after administration.

A

Phlebitis

97
Q

Medication that may be required when taking an anti-TB drug

A

Pyridoxine (Vitamin B6)

98
Q

First step for the nurse when a client presents with possible anaphylactic reaction to IV antibiotics

A

Stop infusion

99
Q

Classification of antibiotic that inhibits bacterial synthesis of folic acid

A

Sulfonamides

100
Q

A secondary infection caused when the normal flora is killed when taking an antibiotic

A

Superinfection

101
Q

Two antibiotics that are combined that causes bacterial resistance to develop more slowly than if one of the drugs were used alone

A

TMP-SMX

102
Q

The first test a person should receive if they have come in contact with an individual with TB

A

TB Skin Test

103
Q

Another name of oral candidiasis that is typically treated with the antifungal drug Nystatin

A

Thrush

104
Q

A side effect of doxycycline that can affect women in the last trimester of pregnancy and children younger than 8 years old

A

Tooth discoloration

105
Q

Lab test that is drawn right before the time of the scheduled administration of the next dose of antibiotic to determine the amount of medication in the sytem

A

Trough Level

106
Q

The length of time TB meds such as isoniazid need to be taken

A

Up to 2 Years

107
Q

Blood test that is used to detect infection and determine if an antibiotic has been effective in eliminating the infection

A

White Blood Cells Count

108
Q

What does the nurse need to educate a patient taking an anti-hypertensive drug?

A

rise slowly due to HTN
reduce salt intake to 2g/day
DO NOT abruptly stop medication because they can have rebound hypertension
Will most likely need to take their whole life even if they feel better
encourage exercise AFTER getting permission from HCP
If African American patient, most have to combine antihypertensives with diuretics to be effective
Educate makes about erectile dysfunction, but tell them the benefits of this drug

109
Q

If a pt. is on spironolactone, what is it important to educate that patient about?

A

Don’t eat foods high in potassium/potassium supplements because it can increase risk of hyperkalemia

110
Q

What CAMS should you avoid with anti-hypertensives?

A

PARSLEY (makes the drug ineffective)

111
Q

A patient is on nitroglycerine for angina, what is important to educate the patient about?

A

If the first does dosen’t help in the first 5 minutes, CALL 911 then take the second dose
Do not exceed 3 SL doses
Take patch off nightly to avoid tolerance/resistance

112
Q

A patient is places in isoniazid, if a client or a nurse is exposed to a positive patient, what is he first thing they will do?

A

a TB skin test

113
Q

If a patient is places on an isoniazid, what is important to educate the patient about?

A

Treatment bay be up to 2 years (24 months)
Causes photosensitivity

114
Q

What would a nurse teach a patient about tetracyclines?

A

antibiotic is not properly absorbed with any milk products, better to be taken on an EMPTY stomach

115
Q

A female pt. and tetracycline is ordered, what is important to find out/educate on?

A

TELL HCP PT IS PREGNANT so that a different antibiotic can be ordered as PERMANENT TOOTH DISCOLORATION and fetal anomalies can happen
Tell pt. to use additional contraceptive to prevent pregnancy

116
Q

Long term antibiotics can result in…

A

superinfection (secondary infection)
especially in females (vaginitis)

117
Q

What should a nurse remember before antibiotics are administered?

A

Do a CBC and blood culture
Check WBC (decreased WBC mean drug is working)

118
Q

What is Nystatin used for and how is it taken

A

Candidiasis (oral thrush)
Taken as prescribed, even if they feel better

119
Q

If the patient is on aspirin daily, what would they be taking it for?

A

It is used as an anti-platelet to prevent clots

120
Q

What is the use of a thrombolytic?

A

clot buster, dissolve clots

121
Q

How does rosuvastatin work?

A

Inhibits HMG COa enzyme to decrease LDL levels

122
Q

What is the antidote for Warfarin?

A

Vitamin K

123
Q

Why is Warfarin used if a patient has to be on it for a long time, compared to heparin?

A

It has a longer half life
so the patient doesn’t have to take warfarin as much as they would have to take heparin

124
Q

What is the antidote for heparin?

A

protamine sulfate

125
Q

What lab is drawn fro warfarin and heparin to check serum level

A

Heparin: PTT/aPTT
Warfarin: INR

126
Q

A patient is on digoxin, what is important to do prior to administration?

A

check BPM and DO NOT administer if BPM <60
if less than 60 hold medication and contact HCP

127
Q

What is the therapeutic serum level for digoxin?

A

0.5-1 ng/mL

128
Q

If a serum drug level id 5ng/mL for digoxin, what do you do?

A

Hold med, contact HCP

129
Q

If you have an antibiotic ordered through IV, what is important to do prior to administration?

A

Check IV site for infiltration, especially when giving antibiotics because it can cause necrosis

130
Q

Why would you not be able to give Alteplase (tPA)?

A

if a patient has a head injury, hemorrhagic stroke, surgery
can cause further bleeding

131
Q

If a patient is taking metronidazole (Flagyl), what is important to educate them about?

A

DO Not consume alcohol (it may cause them to feel flushed, palpitations)

132
Q

What is fluconazole (diflucan) used for?

A

candidiasis

133
Q

Which two labs are important to review before admin medication?

A

renal and hepatic labs

134
Q

If a patient is on clopidogrel (plavix) and they are taking it with an anti-platelet, it is important for them to do what?

A

stop taking it 7 days prior to surgery
can cause increased bleeding

135
Q

If you have two antibiotics given together, why would you give them together?

A

Helps to kill bacteria
decrease bacterial resistance

136
Q

If your patient is on rosuvastatin (Crestor), what is it important to educate them about?

A

Take with water
DO NOT stop taking abruptly
if they have weakness or muscle spasms contact HCP

137
Q

When a pt. is on an anticoagulant which CAM is important to avoid?

A

gingko

138
Q

When furosemide (Lasix) is being taken with any amino glycoside, it can cause what?

A

OTOTOXICITY!
one sign of this is tinnitus

NSG 318 - Pharm (11 decks)

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