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.