Exam 5 Flashcards
Amoxicillin
Stop and vanco ordered at s/s C. diff
Hives and rash tx w/ antihistamine
Anaphylaxis tx w/ epinephrine and resp support
take at beginning of meals to decrease GI symptoms and increase absorption
tx candida w/ antifungal
amoxicillin decrease effectiveness of BC
Itraconazole
take with food to decrease GI symptoms. requires acid medium for absorption take with cola, coffee, tea or juice. avoid milk and cream bc decreases acid
antacids, PPIs and H2 antagonists greatly decrease absorption bc they decrease acid. take at least 2 hrs before these.
adverse: liver toxicity. LFT monitored during tx. s/s-abdominal pain, jaundice, fatigue and anorexia
vancomycin
adverse: nephrotoxicity-increase BUN and creatinine and decrease or increase in urine output.
adverse: ototoxicity- tinnitus and perceived hearing loss
used for penicillin allergies, MRSA and C diff
adverse: red man syndrome-hypotension, tachycardia, flushing of face and trunk, urticaria and pruritis-due to infusing vanco too fast.
vanco should be diluted properly before admin, dont give with other IV drugs bc incompatiility with many drugs. peak and trough levels should be monitored.
cefotetan
adverse: disulfiram-like reaction (N/V, severe headache, hyptoension) caused by drinking alcohol
may cause hemorrhage, monitor PT and bleeding time
cross-sensitivity to penicillin with cephalosporins.
Adverse: c. diff
imipenem
adverse: N/V if infusion is too rapid (1000 mg over 40-60 mins)
may have cross-sensitivity if allergic to penicillin or cephalosporins. contraind penicillin. precaut ceph
allergy presents as hives, itching or difficulty breathing
monitor LDH, AST, bilirubin, BUN and creatinine. LDH will increase with cellular destruction.
Acute liver- AST and bilirubin
Acute kidney- BUN and creatinine
Aztreonam
adverse: thrombophlebitis or inflammation at IV site, discontinue IV
Tetracycline
give on empty stomach one hr before or 2 hr after meals. if N/V/D occur give with non-dairy foods, calcium decreases absorption.
shake before measuring
adverse: photosensitivity
adverse: hepatoxicity esp pregnant women
adverse: c. diff
Adverse: permanent discoloration of deciduous teeth or fetus if taken after 4 mo pregnant. permanent teeth discolored if taken by children under 8.
contraind: seious liver or kidney failure
1st choice for syphilis in pt with penicillin allergy
Erythromycin
take 1 hr before or 2 hr after meals with 8 oz water for best absorption, if GI symptoms may be taken with food
adverse: cardiac toxicity-vent dysrhythmias, palpitations and fainting spells
adverse: ototoxicity- hearing loss, vertigo and tinnitus
adverse: C. diff and candida
amphotericin B
can cause infusion reaction 1-2 hrs after begins causing chills, fever, tachycardia, hypotension, headache and nausea. subsides within 4 hrs and decreases over course of therapy which is usually several weeks. decrease reaction with diphenhydramine and acetaminophen before infusion.
adverse: renal toxicity, RBC suppression and allergic reaction
Renal toxicity- increased BUN and creatinine and hypokalemia. pt should be kept well hydrated with IV fluids before and during infusion to help prevent renal toxicity.
RBC suppression-anemia-fatigue, decrease RBD count and H&H
gentamicin
increased trough levels can case ototoxicity. early signs-tinnitus, headache and vertigo. late sign-hearing loss. 8th cranial nerve should be evaluated by audiometry
adverse: nephrotoxicity- polyuria, dilute urine, proteins and casts in urine, and increased BUN and creatinine. casts are early indicator of renal tubule damage. peak and trough levels monitored to prevent nephro and ototoxicity
peak levels drawn 30 min after IM or IV completion
Trough levels drawn 1 hr before next dose
ciprofloxacin
antacids, iron, calcium, dairy products and sucralfate should be taken 2 hr after or 6 hr before cipro
pt encouraged to drink 1500-2000 mL (6-8 8oz glasses) of fluids/day
adverse: Achilles tendon rupture-pain in back of ankle
adverse: photosensitivity-may occur despite sunscreen, clothes over body and SPF .30
nitrofurantoin
adverse: resp symptoms
Acute resp: chills, fever and cough lasts 2-4 days after med is discontinued
subacute resp: cough, SOB, dyspnea that lasts weeks to months and may be permanent (pulmonary fibrosis)
adverse: permanent peripheral neuropathy- muscle weakness, numbness, or tingling extremities. more common in pt with renal failure.
Adverse: blood cell dysfunction-anemia, thrombocytopenia, and neutropenia.
timethoprim/sulfamethoxazole
adverse: blood cell deficiencies-thrombocytopenia, anemia, neutropenia
adverse: stevens-johnson syndrome: fever, painful red to purple rash and blisters on skin and mouth
adverse kernicterus-occurs in fetus and infants due to high bilirubin levels which may cause brain damage. drug should be avoided in pregnant and nursing women and children under 2 mos
adverse: c diff and candida
isoniaszid
adverse: peripheral neuropathy esp with alcohol use disorder-reversed with pyridoxine (vit B6)
take with or without food but not within 1 hr of antacids that contain Mg. Mg decreases absorption
adverse: liver damage- monitor liver enzymes
Adverse: DRESS-fever, rash, lymphadenopathy and/or facial swelling in addition to other organ system involvement (hepatitis, nephritis, hematologic disorders, myocarditis, myositis)
give with other drugs (rifampin, ethambutol or pyrazinamide) for active TB. give alone fore latent TB
NO ALCOHOL
Rifampin
adverse: liver damage
adverse: DRESS
Adverse: red-orange discoloration of body fluids harmless. discolored soft contact lenses.
give 1 hr before or 2 hr after meals, unless severe GI symptoms-can take with food or capsule emptied into food
decreases blood levels of oral contraceptives use other BC
