Final Flashcards
- Why are cephalosporins effective against bacteria? Can they be given to those with PCN allergy, and if yes why, if no why?
a. Cephalosporin’s are bactericidal
i. Inhibition of cell wall synthesis by binding to the PBP’s => growing bacteria are unable to build their cell wall => cell lysis
b. Cephalosporins CAN be given to a pt with PCN allergy
i. Ask pt what the PCN allergy reaction was/is
ii. If the allergy isn’t anaphylactic and does not cause dyspnea => cross allergy percentage is small (~10%)
- What teaching for administering tetracycline is important for patients at home?10
a. Teach the pt that tetracycline can cause esophageal irritation
i. Take with a full glass of water and not QHS
ii. Remain upright for 30-60min after administration
b. Teach the pt about the adverse effect of teeth staining
i. CI => pts < 8yo, and mothers who are breastfeeding or pregnant
c. Teach pt to not take with food, milk, or antacids
i. Tetracycline binds with magnesium, and calcium => interferes with absorption
d. Teach the pt about superinfection
i. Can cause yeast (vaginal or oral) infection, profuse watery diarrhea (C. diff)
ii. Maybe taken with Diflucan or other ABX to prevent superinfection
- Name some of the ways we can reduce microbial resistance.
a. Prevent infection! (best way)
i. Vaccinations
ii. Aseptic techniques
iii. Remove tubes promptly when not needed anymore
iv. It is easier to prevent vs. tx
b. Dx and tx infection properly
i. Obtain blood culture BEFORE administration of ABX
ii. We want to refrain from giving a broad spectrum => give narrow spectrum specific to the bacteria
c. Use antimicrobials correctly
i. Finish prescribed dose even if pt feels “better”
ii. Use as prescribed
- If an infection is not showing signs of clearing up after starting on a sulfa combo antibiotic, what would be the next step for that patient?
a. The pt may have to do another culture to see what bacteria is causing the infection
b. The HCP may change the pt to a different ABX like ciprofloxacin if resistance is occurring
- With any antibiotic including tetracycline if the patient is complaining of profuse diarrhea what would you as a nurse do? Outpatient teaching or in hospital.
a. It is likely that the pt has C. diff
i. If they are an outpatient, they need to be instructed to clean bathroom very well and come see their PCP
ii. If they are in the hospital, they need to be immediately placed on contact precautions and HCP needs to be informed
- If a patient has decreased renal function how would that affect the dosing of gentamicin?
a. To decrease toxicity the dose of gentamicin would be given every other day
b. It is important to monitor kidney function labs (BUN, creatinine) and monitor for acute kidney injury
- What is the reason for the combination amoxicillin/clavulanate?
a. Clavulanate is a beta lactamase inhibitor => allows the amoxicillin to break down the cell wall and get into the pathogen
- What medication works by blocking estrogen receptors on breast tissues?
a. Tamoxifen => palliative treatment of advanced breast cancer in postmenopausal women
- What do you do if your patient has erythema and pain at the IV site during vincristine infusion?
a. 1st stop the infusion! => then place a warm compress over site
- How does interferon alfa-2 work against cancer?
a. Interferon a-2 binds to the receptors on cancer cells => non-specific inhibitor of viral replication
b. It enhances function of the immune system (phagocytosis) suppressing proliferation
c. Stimulates the body’s defense to help remove and neutralize the cancer cell
d. It is naturally release in our bodies
- How does methotrexate kill cancer cells?
a. Methotrexate interferes with cell metabolism and division by tricking the cell into absorbing the fake folic acid
b. It interferes with the conversion to activated folic acid => which is needed for cell growth
c. Inhibits cell metabolism and growth
d. Cell lysis occurs because the cell can no longer replicate
- What have MRSA bacteria done to become resistant?
a. MRSA alters the penicillin binding proteins => penicillin is no longer able to attach to the cell wall
- What medication is used to shorten the duration of shingles rash?
a. Acyclovir
i. Shortens duration of rash, decreases severity and duration
ii. Used prophylactically => may reduce 6 yearly outbreaks to 2
- What medication used for HIV patients has CNS effects (sleep disorder/dizziness) when started?
a. Efavirenz
i. Dizziness, nightmares, difficulty concentrating, sleep issues
ii. Resolves after first few weeks
- Explain to a patient why antimicrobials are not ordered for a patient hospitalized with a virus? Remember what the definition of antimicrobial is?
a. Antimicrobial => antibiotic => used for bacterial infections
b. Using antimicrobials on viruses could increase your risk of resistance
c. If pt has a virus encourage increase in fluid intake, rest, and use acetaminophen for fever
- What medication is used for latent TB? What else is given to counteract a side effect of this medication?
a. Isoniazid (6-9 mo)
b. Vitamin B-6 is given to counteract peripheral neuropathy
- What kind of drug regimen is recommended for TB initially and would you change this with positive sputum culture after 2 weeks and no drug resistance noted from the C&S?
a. Initial induction phase (2 mo)
i. IRPE (Isoniazid, rifampin, pyrazinamide, ethambutol)
ii. Active kill of the infection
iii. Monitor liver function labs
b. Continuation phase (4 + mo)
i. IR (isoniazid, rifampin)
c. If the pt has a positive sputum culture after 2 weeks and no drug resistance => continue IRPE regimen
- What is the most important thing to watch for when giving benzodiazepines?
a. CNS depression (LOC, respiratory depression, sedation) Priority ABCs or CAB
- Why do we not just give dopamine by itself as a replacement for treating Parkinson disease?
a. Dopamine cannot cross the BBB => not effective for treating CNS disease
- Review steroids that you learned about. Why is there tapering and what side effects?
a. Tapering is done to give your adrenal glands the chance to resume normal function on their own
i. Adrenal glands shrink when they are not being used
b. Stopping steroid abruptly can cause Addisonian crisis
i. Adrenal insufficiencies
ii. Hypotension r/t shock
iii. Tachycardia
iv. Hyperkalemia, hypoglycemia, hyponatremia
v. N/V/D
vi. Dehydration
c. Adverse effects of steroid use
i. Osteoporosis
ii. Hyperglycemia
iii. Increase infection susceptibility
iv. PUD r/t reduced PG in gastric mucosa
v. Cataracts/Glaucoma
vi. Muscle wasting (myopathy)
vii. Weakness/fatigue
viii. Adrenal insufficiency
ix. F/E imbalances HYPOkalemia
x. Mood changes (nervous, moodiness, hallucination, SI)
xi. Impaired wound healing
xii. Weight gain in the trunk and face
- What is the most important thing to teach breastfeeding mothers regarding taking any medications?
a. Check with your HCP before starting any medications, especially OTC.
- What are some causes of errors that you should be aware of? Think about safety issues from beginning of the class.
a. Administration errors => wrong person, route, time
b. Inaccurate prescribing => wrong drug, dose, overdose
c. Errors in pt assessment => incomplete or inadequate medication hx
d. Not performing 5 rights thoroughly
e. Extravasation of IV
f. IVP given too quickly
g. When there is an error => 1st take care of pt => assess then implement => after that you can call the provider to let them know
- What are the signs of rhabdomyolysis and which medications can cause this?
a. Signs of rhabdomyolysis
i. Elevated creatine kinase
ii. Severe myopathy
iii. Muscle pain and weakness
iv. Dark urine
v. Oliguria
b. Meds that can cause rhabdomyolysis
i. -Statins (Atorvastatin, lovastatin, simvastatin)
ii. Fibric acid drugs (Gemfibrozil, fenofibrate)
1. Increased risk when given with -statins
- What lab test monitors for therapeutic effect of heparin?
a. aPTT => activated partial thromboplastin time
i. Evaluates the persons ability to form clots
- How does atenolol work to help with angina?
a. Atenolol => beta blocker
i. Selectively blocks beta 1 receptors on the heart
ii. Decreases cardiac workload
iii. Reduces HR and contractility
iv. Reduces CO and BP
- What are the first line blood pressure medications for newly diagnosed hypertension?
a. Diuretics (start here if no underlying conditions)
i. Furosemide
b. ACE inhibitors
i. Lisinopril
c. ARB’s
i. Losartan
d. CCB’s
i. Nifedipine, Verapamil
- What are some signs of electrolyte imbalance you assess for with spironolactone?
a. Potassium sparing => monitor for hyperkalemia
i. Dysrhythmias!
1. ECG changes (peaked T, widened QRS)
ii. Muscle cramping
iii. Weakness
iv. Paralysis
v. Oliguria
vi. Respiratory distress
vii. Diarrhea
viii. Decreased cardiac contractility
ix. Hyperreflexia
- What treatment is given for poisoning to prevent absorption of the ingested poison?
a. Activated charcoal => must be with in 1hr of ingestion
i. Binds to toxins, absorbs them and travels through the GI tract without toxins being absorbed
ii. Flavor can be added => mix well to reduce clumping
sls of redman
Typically the first signs and symptoms of red man syndrome will be a rash on the face, neck, and upper torso. The skin can appear flushed and become itchy and burning. This can develop into a fever and chills, and the person may have a headache and become dizzy or agitated. The face, eyes, and lips can also swell.
