Final

Question 1

1. Why are cephalosporins effective against bacteria? Can they be given to those with PCN allergy, and if yes why, if no why?

Answer 1

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%)

Question 2

2. What teaching for administering tetracycline is important for patients at home?10

Answer 2

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

Question 3

3. Name some of the ways we can reduce microbial resistance.

Answer 3

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

Question 4

4. 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?

Answer 4

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

Question 5

5. 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.

Answer 5

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

Question 6

6. If a patient has decreased renal function how would that affect the dosing of gentamicin?

Answer 6

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

Question 7

7. What is the reason for the combination amoxicillin/clavulanate?

Answer 7

a. Clavulanate is a beta lactamase inhibitor => allows the amoxicillin to break down the cell wall and get into the pathogen

Question 8

8. What medication works by blocking estrogen receptors on breast tissues?

Answer 8

a. Tamoxifen => palliative treatment of advanced breast cancer in postmenopausal women

Question 9

9. What do you do if your patient has erythema and pain at the IV site during vincristine infusion?

Answer 9

a. 1st stop the infusion! => then place a warm compress over site

Question 10

10. How does interferon alfa-2 work against cancer?

Answer 10

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

Question 11

11. How does methotrexate kill cancer cells?

Answer 11

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

Question 12

12. What have MRSA bacteria done to become resistant?

Answer 12

a. MRSA alters the penicillin binding proteins => penicillin is no longer able to attach to the cell wall

Question 13

13. What medication is used to shorten the duration of shingles rash?

Answer 13

a. Acyclovir
i. Shortens duration of rash, decreases severity and duration
ii. Used prophylactically => may reduce 6 yearly outbreaks to 2

Question 14

14. What medication used for HIV patients has CNS effects (sleep disorder/dizziness) when started?

Answer 14

a. Efavirenz
i. Dizziness, nightmares, difficulty concentrating, sleep issues
ii. Resolves after first few weeks

Question 15

15. Explain to a patient why antimicrobials are not ordered for a patient hospitalized with a virus? Remember what the definition of antimicrobial is?

Answer 15

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

Question 16

16. What medication is used for latent TB? What else is given to counteract a side effect of this medication?

Answer 16

a. Isoniazid (6-9 mo)

b. Vitamin B-6 is given to counteract peripheral neuropathy

Question 17

17. 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?

Answer 17

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

Question 18

18. What is the most important thing to watch for when giving benzodiazepines?

Answer 18

a. CNS depression (LOC, respiratory depression, sedation) Priority ABCs or CAB

Question 19

19. Why do we not just give dopamine by itself as a replacement for treating Parkinson disease?

Answer 19

a. Dopamine cannot cross the BBB => not effective for treating CNS disease

Question 20

20. Review steroids that you learned about. Why is there tapering and what side effects?

Answer 20

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

Question 21

21. What is the most important thing to teach breastfeeding mothers regarding taking any medications?

Answer 21

a. Check with your HCP before starting any medications, especially OTC.

Question 22

22. What are some causes of errors that you should be aware of? Think about safety issues from beginning of the class.

Answer 22

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

Question 23

23. What are the signs of rhabdomyolysis and which medications can cause this?

Answer 23

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

Question 24

24. What lab test monitors for therapeutic effect of heparin?

Answer 24

a. aPTT => activated partial thromboplastin time

i. Evaluates the persons ability to form clots

Question 25

25. How does atenolol work to help with angina?

Answer 25

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

Question 26

26. What are the first line blood pressure medications for newly diagnosed hypertension?

Answer 26

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

Question 27

27. What are some signs of electrolyte imbalance you assess for with spironolactone?

Answer 27

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

Question 28

28. What treatment is given for poisoning to prevent absorption of the ingested poison?

Answer 28

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

Question 29

sls of redman

Answer 29

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.