EXAM STUDY GUIDE Flashcards
Signs and symptoms of c-Diff
a. Signs + Symptoms:
1- watery diarrhea + than 3 times a day /antibiotic-associated diarrhea (if present, pt needs to be tested for c-Diff)
2- abdominal pain and gas
3- ever (greater than 38.0C or 100.4F)
4- colitis (inflammation of the colon)
Vincomycin is the medication
cause of C dificille
Superinfection: when pt taking abx (d/t already existing infection) reduce or completely eliminate the normal bacterial flora, which are certain bacteria and fungi needed to maintain normal function in various organs, results in infection on top of already existing infection
⎻ c-Diff is when superinfection progresses to serious superinfection d/t abx disrupting the normal gut flora and cause an overgrowth of Clostridium difficile bacteria
Vaginitis, definition ?
Vaginitis is an inflammation of the vagina that can result in discharge, and itching.
Vaginitis can be caused by tetracyclines, sexually transmitted diseases, certain creams or any irritants to the vaginal area.
Taking bubble baths and Anything that messes up the PH
Viginatis treatment ?
metronidazole (Flagyl®)
- Used for anaerobic organisms
- Intraabdominal and gynecologic infections
- Protozoal Infections
- Several drug interactions
-5 Bacteriocidal
Crystalluria definition and how to prevent it?
Sulfonamides.
The simplest is IV Fluids if they can’t drink
It is the presence of crystals in urine. To prevent crystalluria, patients should be well hydrated. Increase in fluids (2000 to 3000mL/day) preferably water to prevent drug-related crystalluria from sulfonamides
- Asses for PB, breathsounds and check for edema. Remember that you can’t give someone with heart problems and edema too much H2O.
Check for uric levels, creatinine etc
Who is responsible for a Med error?
Nurses are the Sharp end of the tool in giving meds, however the MD, Pharmacologist, are also part of the process. But we are the last to protect our patients. However, if a RN doesn’t complete the 9 Rights, then it would be an RN med error
Review allergic reaction to “cillin’s” meaning
Amoxicillins
- 0.7-4%
- Mild: hives, rash, itching
- Severe: anaphylaxis (A severe, potentially life-threatening allergic reaction.)
Swelling underneath the skin. Ronny nose and fever. - Always have : a suction canister and an ambu bag (Artificial manual breathing unit)
IM injection of epinephrine if you are at the hospital and they have Anaphylaxis and IV if they are at the hospital and they have a cardiac problem.
Epinephrine at clinic
Review Cephalosporins cross-sensitivity drug list
- Patients with throat swelling or anaphylaxis due to cillin (Amoxicillin, penicillin) allergies are contraindicated from taking cephalosporins.
- Patients with allergies to any generation of Cephalosporins are contraindicated from taking cephalosporins of any kind.
Do not mix with alcohol
S/E’s of Tetracycline
Strong affinity for Calcium:
○ discoloration of permanent teeth and tooth enamel in fetuses and children, or nursing infants if taken by the mother
○ 2may retard fetal skeletal development if taken during pregnancy
Do not mix with milk. only water
Use sunscreen when on a bike
Alteration in intestinal flora may result in:
○ Superinfection (overgrowth of nonsusceptible organisms such as Candida: Yeast infection)
○ Diarrhea
○ Pseudomembranous colitis (usually C. difficile)
May also cause:
○ Vaginal candidiasis
○ gastric upset
○ enterocolitis
○ 7 maculopapular rash
S/E’s of Aminoglycoside
○ Ototoxicity (ringing/tenitus)and nephrotoxicity are the most significant
○ Headache
○ Paresthesia (tingling)
○ Fever
○ Superinfections
○ Vertigo
○ Skin rash
8 Dizziness
Review Flu Shot information. Rimantadine (Flumadine®)
1- influenza A
2- Same spectrum of activity, mechanism of action, & indications as amantadine
3 Fewer CNS adverse effects compared to amantadine
4 Causes GI upset
Review Flu Shot information. Amantadine (Symmetrel®)
○ Narrow antiviral spectrum; active only influenza A
○ Current CDC guidelines do not recommend use for treatment or prevention of flu but is still approved for other uses
○ CNS effects: insomnia, nervousness, lightheadedness
○ GI effects: anorexia, nausea, others
Review Flu Shot information. Oseltamivir (Tamiflu®) and Zanamivir (Relenza®)
○ Active against influenza types A and B
○ Reduce duration of illness
○ Oseltamivir: causes nausea and vomiting- 75 mg BID 5Days
○ Zanamivir: causes diarrhea, nausea, sinusitis- Inhalation
○5 Treatment should begin within 2 days* of influenza symptom onset
Review Flu Shot information. Xofluza (baloxavirmarboxil) 2018
newest antiviral approved for influnza
Influenzas A & B
● Action: Inhibits the cap-dependent endonuclease protein within the flu virus, which is essential for viral replication
● Single dose, oral drug
● Shown in clinical trials to decrease the duration of symptoms with one dose & demonstrated a significant reduction in viral shedding in just one day.
●5 Designed to target the flu virus, including oseltamivir- resistant strains & avian strains (H7N9, H5N1)
Review RSV for infants/children medication
Respiratory syncytial virus (RSV) is a major cause of respiratory illness in children. The virus usually causes a common cold. But sometimes it infects the lungs and breathing passages and can cause breathing problems in infants and young children.
Ribavirin for inhalation is used to treat severe pneumonia in infants and young children that is caused by the respiratory syncytial virus (RSV).
- Ribavirin (Virazole®):
- Synthetic nucleoside analog: block DNA %
- Given orally or nasal inhalation
- Teratogenic- Black Box- it should not be used in women who are pregnant or in men whose partners may become pregnant. if inhaled PPE must be worn mask.
- Inhalation form Ribavirin (Virazole®) used for hospitalized infants with RSVinfections. Adjunct inHepC treatment
Vaginitis cause?
Vaginitis can be caused by tetracyclines, sexually transmitted diseases, certain creams or any irritants to the vaginal area. Anything that ducks with the PH
What is - Cytomegalovirus (CMV)?
- Cytomegalovirus (CMV) retinitis is a viral infection of the retina of the eye resulting in inflammation. It belongs to the family of herpes. Usually people get it when they are immuno compromised due to HIV. The medication for it is Ganciclovir as an ocular implant. It also exist and oral and paraternal forms
Where does Cytomegalovirus (CMV) occur? Meaning which people?
- Serious CMV infections can occur in people who have weakened immune systems as a result of: HIV, Bone marrow transplant, Chemotherapy, or Drugs that suppress the immune system.
Does everyone with CMV have symptoms?
- Some people with CMV retinitis have no symptoms. If there are symptoms, they may include: Blind spots, blurred vision, or floaters.
How is CMV diagnosed?
- CMV retinitis is diagnosed through an ophthalmologic exam. Dilation of the pupils and ophthalmoscopy will show signs of CMV retinitis.
- CMV infection may be diagnosed with blood or urine tests that look for substances specific to the infection.
medication for CMV ?
- Ganciclovir: IV antiviral, inhibits viral dna polymerase
What is student RN actions for suspected allergic medication reaction?
- stop the medication and alert the doctor
- Alert RN/charge nurse
- Provide oxygen
- Monitor respiration
- Be ready to perform CPR
- Monitor vital signs
- 6 Prepare Epinephrine as indicated. Coz it opens the airways.
How long does it take to infuse Vancomycin?
- Slowly infused, at least over 60 minutes (longer for higher doses) about 1:30 min
Peek of vancomycin? C diff
1h after administration.
What happens when you infuse vancomycin fast?
- Rapid infusion may cause hypotension or red man syndrome (flushing & itching of head, face, neck, upper trunk area), extravasation at IV site → Assess skin at IV, in upper body and take BP.
What is Vancomycin used for?
1- treatment of MRSA
2- gram-positive bacteria
3- when given orally of antibiotic-induced colitis (C.Diff)
4- staphylococcal enterocolitis (Inflammation of colon)
What precautions should you take with vancomycin?
- Must monitor blood levels to ensure therapeutic levels and prevent toxicity (nephro- & oto-toxicity)
Rationale why you obtain culture of infection before administering antibiotic? & what is the order of operation?
Ideally, before beginning abx therapy, the suspected areas of infection should be cultured to identify the causative organism and potential abx susceptibilities. Remember order of operations. First we collect colture through, sputum, blood or urine then we administer medication
Inquire with patients regarding their vague statement of “allergic reaction to a Medication that is not clear”.
- Ask patients to clarify the symptoms of their allergic reaction. Some allergic reactions are not true allergic reactions, some patients may label common side effects as an allergic reaction.
Clarify with the doctor and the patient before giving the medication.
Peak and trough vancomycin?
Peak= At the end of commonly 1h administration if it’s a kidney problem.
Peak= 15 to 50 mcg ml
Trough= Before the next dose 15 to 30 min. Time to draw is right before the next dose. taken prior to 3rd or 4th dose. Situational.
Trough 10/20- mcg/mL ideally 15/20
What does Vancomycin treat?
When taken in an IV, It treats MRSA and gram + bacteria.
When taken as a pill it is used to kill C-Dif. and staphylococcal enterocolitis.
Bactericidal. Kills bacteria by binding to their cell wall, leading to breakdown and cell death.
Bone and joint infections as well
Best antibiotic for pneumonia gram + infections?
1 GEN CEPHALOSPORINS
Penicillin d/t it’s ability to inhibit peptidoglycan production.
Gram - harder to treat.
Best antibiotic for pneumonia gram + infections who is allergic to Penicillin ?
Pt allergic to penicillin with gram positive pneumonia: Tetracycline
Patients taking cephalosporins should avoid?
Alcohol
Patients taking cephalosporins are at risk for bleeding.
Because it interferes with our blood clotting factors. Don’t give it with SNAD’s meaning blood thinners.
cephalosporin generations: increases
level of gram-negative coverage increases w/ each successive generation.
The first-generation have the most gram-positive coverage
The later generations have the most gram-negative coverage
Cephalosporin cross sensitivity?
With penicillin because they have the same structure.
Can someone with a penicillin allergy take Cephalosporins?
No, and they can’t take any other cephalosporins of any generation either.
First generation Cephalosporins are active more against gram + or - negative bacteria?
First-generation cephalosporins are active against gram + organisms and have limited activity against gram - bacteria.
BEST TREATMENT FOR PNEUMONIA.
Are first-generation cephalosporins available both in Iv and oral forms?
Yes, they are.
Name the 4 drugs of first-generation Cephalosporins.
⎻ cefadroxil
⎻ cefazolin (Ancef) - preoperative + postoperative surgical prophylaxis
⎻ cephalexin (Keflex)
⎻ cephradine
Second-generation cephalosporins are active more against gram + or - negative bacteria?
Coverage against gram-positive organisms is similar to first-generation. It has enhanced coverage against gram-negative bacteria
Are second-generation cephalosporins available both in Iv and oral forms?
Yes
Name the 5 second-generation Cephalosporins.
⎻ cefaclor
⎻ cefoxitin - abdominal surgery prophylaxis
⎻ cefuroxime
⎻ cefotetan
⎻ cefprozil
Third-generation cephalosporins Cephalosporins are active more against gram + or - negative bacteria?
a. most potent out of first 3 generations against gram-negative organisms, but less against gram-positive organisms
b. resistance is beginning to limit its usefulness
c. avail in both parenteral + oral forms
Third-generation cephalosporins available in both IV and oral?
Oui
Name the 7 third-generation cephalosporin drugs.
⎻ cefotaxime
⎻ cefpodoxime
⎻ ceftazidime - difficult-to-treat infections/intra-abdominal infections/complicated UTIs
○ Third-generation drug of choice d/t to excellent spectrum of activity + safety profile
⎻ ceftibuten
⎻ cefdinir
⎻ ceftizoxime
⎻ ceftriaxone (Rocephin) - pass easily through blood-brain barrier; one of only few tx for meningitis
Fouth generation cephalosporins more effective aganist gram + or harm - ?
Broad spectrum
Fourt-generation cephalosporins available in both IV and oral?
Only IV
Name the fourth-generation cephalosporin drugs.
⎻ cefepime (Maxipime) - tx for uncomplicated + complicated UTIs/uncomplicated skin + skin structure infections/pneumonia
Fifth-generation cephalosporins Cephalosporins are active more against gram + or - negative bacteria?
Broader spectrum than current cephalosporins.
Fifth-generation cephalosporins available in both IV and oral?
only IV
Fifth generation cephalosporin is the only generation that treats Marsa.
oui
Name the 2 fifth-generation cephalosporin drugs that you know.
⎻ ceftaroline - acute skin + skin structure infections/community-associated pneumonia
⎻ ceftolozane/tazobactam
Review CDC’s levels for CD4-Tcells for HIV and AIDS patients
CD4 count:
○ 500-1600: Normal
○ 200-500: Beginning of HIV Illness
○ <200: AIDS
- Review the website https://hivinfo.nih.gov/home-page
a. Nevirapine
i. Classification - (NNRTI)
ii. s/e - rash-fever-n/HA- abn liver function
b. Fuzeon
i. MOA - prevents vial cell attaching to cells
ii. s/e - since SQ check injection site can get irritated
c. NNRIT s/e for Efavirenz
CD4 cells are a type of white blood cell?
OUI.
They’re also called CD4 T lymphocytes or “helper T cells.” That’s because they help fight infection by triggering your immune system to destroy viruses, bacteria, and other germs that may make you sick
Medication taken as prescribed in HIV helps keep viral load low?
Yes
Low HIV in the blood ensures that the immune system in doing good and prevents illness?
yes
When CD4 is high meaning that the WBC is high in the blood the HIV virus is not detectable and therefore it can not be transmitted to a sexual partner, fetus, or through breastfeeding.
OUI
What are the complexities of the regimen when someone has HIV/AIDS?
pill burden, size, dosing schedule, food requirements, polypharmacy
Skipping doses can cause HIV to
Become resistant to medication and weaken the immune system.
Treatment regimens change during course of illness with HIV
oui
Is HIV chronic ?
yes
What to teach and asses a patient with HIV/ AIDS ?
- Assess educational level, reading level, best learning strategies, familiarity with social resources, mental/emotional status due to impacts on pt, family, significant others.
- Evaluate value systems, social patterns, hobbies, spiritual beliefs, support systems.
- Assess financial status and services due to lack of HC insurance, financial resources. May need social services to support, since drugs may be taken for the duration of their life.
Can antiviral drugs kill both healthy and cancer cells?
OUI. Because same are cell specific and others are not.
What are antiretroviral drugs used for ?
Antiretroviral drugs (“ARV’s” or “ART’s”) 🞑 Used to treat infections caused byHIV, the virus that causes AIDS. Antiretroviral drugs A specific term for antiviral drugs that work against retroviruses such as HIV.
Antiretroviral therapy goals ?
1- Get to a viral load of less than 50 copies/mL is considered to be an undetectable viral load and is a primary goal of antiretroviral therapy
2- When effective, treatment leads to a significant reduction in mortality and incidence of opportunistic infections, improves patient’s physical performance, and significantly increases T-cell counts
Are combinations of drugs to treat HIV/AIDS common?
YES
Most common treatment for HIV /AIDS ?
The most effective treatment to date is referred to as HAART. HAART usually includes at least three medications. Commonly 2001 recommended drug combinations include two or three NRTIs (Nucleoside reverse transcriptase inhibitors); two NRTIs plus one or two protease inhibitors; or a NRTI plus a NNRTI with one or two protease inhibitors
Because most Antineoplastic meds cause N/V/D, what nursing education material is vital to this patient population?
Use Benedryl 30 min before
- Educate pt. on non-pharmacological measures to prevent N/V:
- Stagger intake of small meals throughout day
- Eat light, bland meal a few hours prior to treatment
- Avoid fried, fatty or sweet foods
- Cold beverages
- Avoid unpleasant smells
- Meditation & deep breathing exercises
- Ginger tea or non carbonated ginger ale (nausea reducer)
- IV fluids if V/D severe, for rehydration
- Antiemetics: (Combination antiemetic may be more effective)
- 30-60 min prior to treatment, to promote comfort, reduce N/V and prevent dehydration and malnutrition
- Education & Nurse Interventions for Diarrhea:
- Avoid oral intake of irritating, spicy, gas-producing foods; caffeine; high-fiber foods; alcohol; very hot or cold beverages; lactose food or bev.
- Help pt plan meals to meet dietary and bowel elimination needs
- Administer opioids for their antidiarrheal properties
Review if Pregnant women can safely take antiviral drugs. And if yes, which one?
● Zidovudine (AZT): NRTI, first drug that had an increased quality of life impact on HIV and AIDS patients
● Safe to give to HIV infected pregnant women and to newborn babies to prevent maternal transmission of the virus—(bone marrow suppression)
● Ribavirin (Virazole): Black Box warning- pregnancy class X relating to significant teratogenic and/or embryocidal effects (also sexual partners must be careful)
Which is the most commmon antiviral drug for a pregnant woman?
● Zidovudine for aids and HIV
Med for Herpes simplex?
Acyclovir (Zovirax)
What is the main med to treat Herpes Simplex?
Acyclovir (Zovirax)
○ synthetic nucleoside analog; blocks cellular %; used to suppress replication of HSV-1, HSV-2, VZV.
○ Drug of choice for treatment of initial and recurrent episodes of these infections
○ oral, topical, parenteral forms
HSV 1 VS 2
Oral vs genital
Is acyclovir (Herpes simplex) dangerous when you are pregnant?
Not super dangerous
Review term Window Period
Most infectious period.
**from when you get it till it shows on a test.
The time between infection and enough antibodies for a positive HIV test.
Duration: approximately 1.5 to 3 months.
No symptoms or signs of illness. HIV test is negative during window period. Virus is multiplying rapidly and viral load is high. Person is very infectious.
check page 9 study guide.
Review what a PI is? And PI’s s/e
Check page 10
Look up why HSV1 rationale for treatment
Acyclovir.
HSV1( Herpes simplex virus type 1): commonly associated with perioral blisters “oral herpes”
- do not cause serious or life-threatening illness
- highly transmissible through close physical contact
- painful skin lesions occur intermittently, with periods of latency
- Antiviral medications are not curative, but they speed up the process of remission and reduce the duration of painful symptoms.
- medications should start early in a given outbreak.
- Patients may be prescribed an ongoing lower dose of antiviral drug for prophylaxis of outbreaks
What is gancyclovir used for ?
Treat CMV
What medication is used for an Ocular implant and how susceptible of contracting is it?
Ganciclovir (Cytovene)
Synthetic nucleoside analog
Used to treat infection with cytomegalovirus (CMV)
Oral and parenteral forms
CMV retinitis -inflammation of the retina can cause blindness
Ophthalmic form surgically implanted
Other drugs include: fomivirsen (Vitravene), Forscarnet, Cidofovir, and Valganciclovir
Cancer drugs are referred to as Antineoplastic and the patient education would include:
a. Comprehensive Physical assessment
b. Oral care education
c. Dietary education - to avoid spicy-acidic-alcohol & tobacco
d. Use of premedication 30-60 min before chemo if strong reaction to mitigate s/e
e. Risk of infection d/t low Neutrophils
f. To prevent infection, pt/family/staff to protect pt should perform good Hand Hygiene
g. Report fever of 100.5/38.1 immediately
h. Hydration is key to preventing hemorrhagic cystitis
i. Wash fruits/veggies d/t they can have germs to infect pt on them
j. Avoid recently vaccinated people, they are not yet fully covered
Rationale use of Hormone Therapy
- Hormone drugs (antagonists & agonists) → Used to treat a variety of neoplasms in men and women. Oppose effects. testosterone feeds the cancer cells so we give men astrogen. If it’s a female we do the opposite.
- Used commonly as adjuvant and palliative therapy, but may be first choice in some cancers, like breast and prostate.
Rationale use of Hormone Therapy 2
● Hormonal Drug for Female Specific Neoplasms: (used often in breast cancer)
○ Aromatase Inhibitors: Anastrozole, aminoglutethimide
○ Selective estrogen receptor modulators: Tamoxifen, toremifene
○ Progestins: megestrol (Megace), medroxyprogesterone
● Hormonal Drug for Male Specific Neoplasms: (used often in prostate cancer)
○ Antiandrogens: bicalutamide, flutamide, nilutamide
○ Gonadotropin-releasing hormone antagonists: leuprolide, goserelin
○ Antineoplastic hormone: estramustine
Review Targeted Drug Therapy
- Normal cell growth is regulated by communication between pathways of the cell environment. Signal transduction pathways = cell membrane contains protein receptors that transmit info from inside cell to external cell environment
- Cancer cells have deregulated cell signaling pathways, with cell receptors and proteins altered.
- Current major focus due to severe toxicity of cancer treatments.
- Lock & Key Mechanism → Specific targeting one molecule feature on surface and involved in growth of tumor cells or an enzyme within the cell → Block or disable signals for cell growth and cause apoptosis (cell death).
- Ex. monoclonal antibodies, tyrosine kinase inhibitors (TKI’s)
- TKI’s: Inhibit enzyme tyrosine kinase and block development of tumor growth, new blood vessels, and cellular cancer growth. Used currently to treat lung, breast, thyroid, renal cancers and leukemia and lymphoma.
- Interfere with specific pathways in cancer cells = kill cancer cells directly w/ little-no effect on healthy normal cells
- PO: Daily, start at low dose
- Common Side Effects: Rash, cardiotoxicity, hepatotoxicity, hypertension, metabolic abnormalities (hyperglycemia, hyperlipidemia), and others
Review the danger of giving an Vinca alkaloid (Madagascar plant)drug intrathecally?
● Intrathecal route(never administer/ black box ): several deaths have been reported due to this error. Painful death.
● Practices suggest that vincristine be diluted in 25-50 mL of fluid and never be dispensed via syringe
● For IV use only!
Nadir
Lowest point during chemo of WBC
Know the % of infection rate for a practitioner to contract HIV from a needlestick. How long will they take prophylactic antiretroviral meds?
○ Pooled analysis of prospective studies on healthcare workers with occupational exposures suggests risk is approximately 0.3% (95% Cl, 02%-0.5%)
○ PEP (Post-Exposure Prophylaxis)
○ Within 72 hrs of HIV exposure for 28 days
Review the website https://hivinfo.nih.gov/home-page
a. Nevirapine
i. Classification - (NNRTI)
ii. s/e - rash-fever-n/HA- abn liver function
b. Fuzeon
i. MOA - prevents vial cell attaching to cells
ii. s/e - since SQ check injection site can get irritated
c. NNRIT s/e for Efavirenz
What is the rationale for HIV/AIDS pts to understand and know each med they are taking and why it will not cure them but keep their viral loads manageable?
- Understanding of HIV viral load, CD4 count, side effects and dosing schedule of medications, expected clinical outcomes, consequences of poor adherence and benefits to adequate treatment.
- Medication must be taken exactly as prescribed to keep viral load low (HIV in blood ↓ ensures immune system is intact and prevents illness) and CD4 high (WBC ↑) → undetectable = will not transmit to sexual partners, fetus, or through breastfeeding.
- Regimen complexity: pill burden, size, dosing schedule, food requirements, polypharmacy
- Skipping doses can cause HIV to become resistant to medication and weaken the immune system.
- Treatment regimens change during course of illness → med modifications
- Chronic illness: Important to assess pt knowledge of illness and need for long-term/lifelong treatment.
- Assess educational level, reading level, best learning strategies, familiarity with social resources, mental/emotional status due to impacts on pt, family, significant others.
- Evaluate value systems, social patterns, hobbies, spiritual beliefs, support systems.
- Assess financial status and services due to lack of HC insurance, financial resources. May need social services to support, since drugs may be taken for the duration of their life.
Review all the ways HIV is transmitted?
Most people who get HIV get it through anal or vaginal sex, or sharing needles, syringes, or other drug injection equipment. It can also be transmitted from mother-to-child during pregnancy . brest milk and transplants. View Table
Sharipe moments, (Antibiotics)
1- Beta-lactam antibiotics include penicillins, cephalosporins and related compounds. patients with a history of throat swelling or hives from penicillin should not receive cephalosporins because there could be cross sensitivity because they are both Beta-lactams
2- Cephalosporins: Adverse Effects:
Potential allergy exists with penicillin if a true allergy to penicillin exists.
3- Tetracyclines : They Bind (chelate) to Ca+++ and Mg++ and Al+++ ions. When these electrolytes bind to the antibiotic they become insoluble and complex. The antibiotic doesn’t work anymore.
Should not be used in children under age 8 or in pregnant/lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth.
