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final Flashcards

1
Q

antimicrobial

A

drug used to prevent or treat infections caused by pathogenic microorganisms

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2
Q

antibiotic

A

drug that can kill or inhibit bacterial growth and replication

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3
Q

bactericidal

A

agent that kills bacteria

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4
Q

bacteriostatic

A

agent that inhibits bacterial growth and replicaiton

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5
Q

drug selection depends on

A

organism causing infection
severity of infection
other factors

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6
Q

gram +

A

staph
strep
enterococci

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7
Q

gram -

A

e. coli
klebsiella
proteus
pesudomonas
serratia
salmonella
shigella

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8
Q

beta lactam antibacterial

A
  • derive from beta-lactam ring which is part of chemical structure
  • ring is necessary for antibacterial activity
  • some bacteria produce beta-lactamase that can disrupt ring and inactive mechanism of action
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9
Q

beta-lactam antibacterials example

A
  • pencillins
  • cephalosporins
  • carbpenems
  • monobactams
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10
Q

mechanism of action of beta-lactams

A

inhibit synthesis of bacterial cell wall
binds with proteins and produces defective cell wall which destroys microorganism

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11
Q

penicillins

A
  • safe, effective, widely used
  • effective at killing gram +
  • first antibiotic developed
  • destroyed by gastric acid
  • injections are given
  • extensive use produced drug resistant strains of stpahylococci
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12
Q

ampicillin (principen)

A
  • inhibits bacterial wall synthesis by binding to penicillin binding proteins
  • broad spectrum
  • uses: infective endocarditis, skin, soft tissue, respiratory , GI, and GU infections
  • PO, IV, and IM
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13
Q

contraindications for penicillins

A
  • hypersensitivity to any cillins
  • cross-allergenicity
  • neonates (immature renal function)
  • renal impairment (check BUN and creatinine first)
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14
Q

adverse effects of pencillins

A
  • rash
  • anaphylaxis
  • abdominal discomfort
  • diarrhea
  • n/v
  • nephropathy
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15
Q

monitoring and administration for penicillins

A
  • BUN/creatinine
  • rash
  • IM - deep into large muscle
  • IV - dilute and infused over 30-60min
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16
Q

patient education for pencillins

A
  • shake suspension
  • take on empty stomach with full glass of water
  • complete prescription
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17
Q

pencillin G

A

black box warning for IV admin as it can cause cardiac arrest and death
ONLY give IM
common in syphillis and rheumatic fever

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18
Q

penicillins + beta lactamase inhibitors examples

A
  • piperacillin-taxobactam (Zosyn) popular for sepsis
  • ampicillin-sulbactam (Unasyn)
  • amoxicillin-clavulanate (augmentin) take with meals to avoid GI upset, contains same amount of clavulanate
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19
Q

cephalosporins (cefazolin)

A
  • broad spectrtum againast + and -
  • good against step and staph
  • classified into 5 subgroups
  • all start w/ cef
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20
Q

1st gen cefazolin

A
  • stronger protection against gram + (strep and staph)
  • surgical prophylaxis
  • drug of choice for MSSA
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21
Q

cefazolin contraindications

A
  • neonates
  • renal impairment
  • pcn or ceph allergy
  • caution when combined with vancomycin, aminoglycosides, and furosemide
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22
Q

adverse effects of cefazolin

A
  • hypersensitivity rash
  • nonallergic rash
  • abdominal pain
  • diarrhea
  • gastritis
  • n/v
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23
Q

monitoring for cefazolin

A
  • s/s of infection resolving
  • rash
  • BUN/creatinine
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24
Q

patient education for cefazolin

A
  • complete prescription
  • take with food or milk
  • interactions
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25
Q

2nd gen cephalosporin

A
  • cefaclor
  • stronger with gram -
  • klebsiella, e. coli
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26
Q

3rd gen cephalosporin

A
  • ceftriaxone
  • gram -
  • coverage for resistance to 1st and 2nd gen
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27
Q

4th gen cephalosporin

A
  • cefepime
  • stable against beta-lactamase
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28
Q

5th gen cephalosporin

A
  • cefaroline
  • common acquired pneumonia, skin infections, MRSA, VRSA
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29
Q

carbapenems

A
  • imipenem-cilastatin (Primaxin)
  • broad-spectum: gram - and gram + aerobes and anaerobes
  • uses: tx of infections caused by organisms resistant to other drugs
  • lower respiratory tract, urinary tract, intra-abdominal infections, bone and joint, skin, polymicrobial infection, bacterial septicemia, and endocarditis
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30
Q

contraindications of carbapenems

A
  • kids with CNS infections (increase risk of seizures)
  • hypersensitvity to carbapenems or pcn
  • shock and AV blocks shouldn’t get IM
  • neonates
  • decreased kidney fxn (increases risk for seizures)
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31
Q

adverse effects of carbapenems

A
  • hypersensitivity
  • GI upset
  • elevated LFTs
  • seizures!
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32
Q

monitoring for carbapenems/ impenium-cilastatin

A

eval s/s of infection improvment

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33
Q

monobactams

A
  • aztreonam (azactam)
  • only drug in class
  • gram - and many drug resistant strains
  • used for UTI, skin, lower respiratory tract infections, intra-abdominal and gyn infetions, meningitis, and gram - speticemia
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34
Q

contraindications of monobactams/aztreonam

A
  • hypersensitivity
  • renal impairment
  • used in combo w/ aminoglycosides
  • no cross allergenicity
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35
Q

adverse effects of monobactams/aztreonam

A
  • elevated LFTs
  • hypersensitivity reactions
  • rash
  • diarrhea
  • n/v
  • extended use (super infections, c. diff)
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36
Q

monitoring for monobactams/aztreonam

A
  • s/s of improving infection
  • WBC count
  • BUN/creatinine/LFTs
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37
Q

aminoglycosides

A
  • gentamicin
  • penetrates bacterial cell walls preventing bacterial synthesis of protein needed for replication
  • used in combination for serious systemic infections (septicemia, resp infections, abdominal infections, osteomyelitis)
  • used for gram - oragnisms
  • UTIs alone
  • poorly absorbed orally
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38
Q

aminoglycoside (gentamicin) peak and trough

A
  • narrow therapuetic index
  • maintenance dose based on serum drug conc.
  • peak 5-8
  • peak >10-12 and trough levels >2 for prolonged time can lead to nephrotoxicity
  • multiple daily doses vs once daily show better bactericidal effects and post-antibiotic effects
  • monitor random 12hr serum conc instead of peak and trough
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39
Q

contraindications of aminoglycoside (gentamicin)

A
  • neonates/children/older adults (narrow therapuetic index)
  • renal impairment
  • myasthenia gravis or neuromuscular conditions (can damage 8th CN increasing muscle weakness)
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40
Q

adverse effects of aminoglycosides (gentamicin)

A
  • nephrotoxicity
  • ototoxicity
  • peripheral neuropathy
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41
Q

monitoring for aminoglycosides/ gentamicin

A
  • resolving infection
  • dizziness/vertigo/tinnitus/hearing loss
  • serum concentration
  • BUN/creatinine
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42
Q

black box on gentamicin/aminoglycosides

A
  • ototoxicity and nephrotoxicity
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43
Q

patient education for aminoglycosides (gentamicin)

A
  • adverse effects (hearing loss, balance, anuria, tinnitus)
  • stay well hydrated
  • interactions w/ cephalosporins (increased nephrotoxicity), furoseide due to increased risk of nephro and ototoxicity, vancomycin due to increased risk of nephrotoxicity, and penicillin can inactivate gentamicin
  • don’t give >10 days
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44
Q

fluoroquinolones

A
  • ciprofloxacin (cipro)
  • synthetic bactericidal active against gram - and gram + (some)
  • interferes with DNA synthesis required for abcterial growth and development
  • give PO well
  • mainly excreted and metabolized in kidney
  • uses for resp, GU, GI, bone, joint, and skin infections
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45
Q

contraindications of fluroquinolones/ciprofloxacin

A
  • older adults
  • renal impairment
  • hypersensitivity
  • concurrent use with tizanidine
  • hx or risk of aortic anuerysm
  • myasthenia gravis
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46
Q

adverse effects of fluroquinolones/ciprofloxacin

A
  • n/v
  • abdominal discomfort
  • dizziness
  • headache
  • photosensitivity
  • tendon rupture/tendonitis
  • aortic aneurysm
  • hypersensitvity
  • prolonged QT waves causing torsades de pointe and cardiac death
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47
Q

black box warning on fluroquinolones/ciprofloxacin

A

tendonitis and tendon rupture
peripheral neuropathy
cns, cardiac, derm, and hypersensitivity rxns

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48
Q

patient education for fluroquinolones/ciprofloxacin

A
  • advesre effects
  • don’t take with milk or Ca2+
  • drink fluids to decrease crystalization in urine
  • interactions with ondansetron, amniodarone, reduces clearance of theophylline, hypoglycemia on glyburide, and hold 1hr before tube feeds
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49
Q

monitoring for fluroquinolones/ciprofloxacin

A
  • admin over 60 minutes
  • take full rx
  • BUN/creatinine monitoring
  • no serum tests
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50
Q

tetracyclines

A
  • older broad spectrum bacteriostatic
  • rarely used for systemic infections due to microbial resistance
  • development of more effective/less toxic meds
  • urinary antiseptic
  • used only in UTIs
  • oral or IV
  • effective against wide range of gram + and - microbes
  • not usually drug of choice
  • widely distributed to body tissues
  • mainly excreted in urine and feces
  • minocycline eliminated by liver
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51
Q

tetracycline examples

A
  • achromycin
  • demeclocycline (declomycin)
  • doxycycline (vibramycin)
  • minocycline (minocin)
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52
Q

pharm of tetracyclines

A
  • bind to 30S subunit of bacterial ribosome to inhibit bacterial protein synthesis
  • food decreases absorption
  • Ca2+, milk products, iron supp., Mg2+ laxatives, antacids
  • do not give to pregnant women, lactating women, or children <8
  • drug interactions: oral (anticoags increase vitamin K), increased absorption w/ dig (increasing toxicity) and makes pcns less effective
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53
Q

major precautions on tetracyclines

A
  • eliminated in urine so can accumulate in kidneys
  • contraindicated in renal impairment and kidney failure
  • can cause hepatotoxicity
  • discoloration of teeth
  • can interfere with bone growth (so drug is a NO for children)
  • diarrhea can indicate for c. diff
  • high dose IV therapy shown w/ liver damage
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54
Q

uses of tetracycline

A
  • doxycycline: chlamydia, mycoplasma pnuemonia, lyme, anthrax
  • doxycycline and minocycline: P. acnes
  • tetracycline for mycoplasma, chlamydia, rickettsia, in combo for h. pylori
  • tetra for second line of chronic bronchitis, gonorrhea, syphillis in pcn allergy
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55
Q

pt education w/ tetracyclines

A
  • admin
  • adverse effects: hypersensitivity, intracranial HTN, GI, superinfections (oral candida), increased pigmentation
  • avoid during pregnancy
  • decreases effectiveness or oral contraceptives
  • sun sensitivity
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56
Q

sulfonamides

A
  • bacteristatic against gram + and -
  • increasing resistance, decreasing efficacy
  • susceptability should be documented by C&S
  • can be used in treatment of systemic infections
  • first drug for systemic tx
  • inhibit synthesis of folic acid which is needed for bacterial multiplication
  • primarily used for UTI
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56
Q

trimethoprim/sulfamethoxazole

A
  • combination that inhibits sequential steps in bacterial folic acid synthesis making it more powerful than each drug alone
  • plasma drug levels
  • therapuetic use: mainly UTIs, otitis media, bronchitis, shigellosis, pneumonia from jiroveci or pneumocystis and GI infection
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56
Q

ex of sulfonamides

A
  • all start with sulf
  • sulfaziazine
  • sulfasalazine
  • sulfisoxazole
  • trimethoprim-sulfamethoazole (prototype)
  • mafenide (sulfamylon)
  • silver sulfadiazine
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56
Q

adverse effects of trimethoprim/sulfamethoxazole

A
  • GI: n/v, diarrhea, abdominal discomfort, pancreatitis, anorexia
  • skin: hives
  • electrolytes: hyperkalemia
  • renal damage (check BUN/cr)
  • bloody dyscriasis: aplastic anemia, agranulocytosis, eosinophilia, thrombocytopenia, leukopenia (check CBC)
  • hypersensitivity: steven’s johnson syndrome
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57
Q

caution with trimethoprim/sulfamethoxazole

A

renal and hepatic impairment
- children <2 months, pregnant, or breastfeeding
- can cause hyperbilirubinemia and kernicterus

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58
Q

pt education trimethoprim/sulfamethoxazole

A
  • take on empty stomach
  • oral contraceptives will have decreased effect
  • take w/ 8oz of water
  • take drug after or before meals
  • avoid sun and tanning beds
  • wear suncreen
  • don’t take with OTCs
  • changes in labs
  • inform dentist if on med
  • monitor glucose
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59
Q

sulfonamides - silver sulfadiazine

A
  • used to suppress bacterial colonization in pts with 2nd and 3rd degree burns
  • apply after cleaning wound 1-2x/day with sterile gloves
  • application of med i pain free
  • systemic abosrption (dont give if pregnant or to young children)
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60
Q

urinary antiseptics

A
  • trimethoprim (primsol)
  • nitrofurantoin (macrobid)
  • phenazopyridine (pyridium)
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61
Q

nitrofuranotin

A
  • take with food
  • dont give to older adlts, pregnancy, renal insufficiency
  • adverse effects: st/t wave changes, bundle branch blocks, fever, malaise, headache, lethargy, vertigo, dperession
  • can turn urine brown
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62
Q

phenazopyridine

A
  • analgesic for urinary symptoms
  • take with food
  • containdicated in renal insufficiency and hepatitis
  • can turn urine reddish orange
  • black box: can turn skin yellow, REPORT!
  • ae: fever, sore throat, bruising, bleeding REPORT
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63
Q

macrolides use and drug selection

A
  • drug of choice for community-acquired pneumonia
  • chlamydia
  • pertussis
  • h. pylori
  • chronic bronchitis
  • alternative for pcn allergies
  • increasing resistance
  • not appropraite for sinusitis
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64
Q

macrolides caution

A

most are safe in pregnancy and children

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65
Q

adverse effects of macrolides

A
  • n/v
  • abdominal pain
  • cramping
  • diarrhea
  • skin: urticaria, bullous eruptions, exzema, steven-johnson syndrome
  • INHIBITS CYP3A4 meaning it increases other drugs conc.
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66
Q

monitoring for macrolides

A
  • altered response for meds meabolized from CYP450, 3A4, and 2C9
  • hepatic or renal imapirment
  • monitor hearing loss
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67
Q

patient education w/ macrolides

A
  • ADEs
  • drug interactions
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68
Q

macrolide examples

A
  • azithromycin
  • clarithromycin
  • erythromycin (prototype)
  • fidaxomicin
  • broad-spectrum class
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69
Q

erythromcyin (macrolides)

A
  • bind to ribsomones to inhibit protein synthesis (bacteriostatic but can be cidal)
  • pharmacokinetics; well absorbed from duodeum
  • inhibitors of CYP3A4 meaning it increases serum conc. of other drugs (monitor w/ warfarin and digoxin
70
Q

use of erythromycin

A
  • penicillin sub for allergy to pcn
  • prevention for rheumatic fever, gonorrhea, syphillis, pertussis and chlamydia conjunctivits
  • legionnaires disease, GU infections, from chamydia, URIs
71
Q

caution w/ macrolides and erythromycin

A
  • severe liver disease
  • breastfeeding
72
Q

adverse effects of erythromcyin / macrolides

A
  • GI: n/v, diarrhea, hepatotoxicity (monitor LFTs)
  • CNS: hearing loss, confusion, lability of emotions, alteration in thought
  • cardiac: ventricular dysrythmias (IV only)
  • allergic: redness of skin, rash, bronchospasm, anaphylaxis
  • other: hearing loss (reversible)
73
Q

teaching for erythromycin (macrolides)

A
  • take around clock q6hrs
  • empty stomah q1hr before or 2hrs after
  • not grapefruit juice
  • complete full rx
  • don’t take with dairy or antacids
  • take w 8oz of water
  • oral contraceptives have decreased effectiveness
74
Q

lincosamides / clindamycin (cleocin)

A
  • inhibits protein synthesis (same as macrolides)
  • oral dosing completely absorbed not affected by gastric acid
  • adverse effects: n/v, diarrhea
  • no gram-negative activity
  • gram+= strep, staph, bacterioides, b. fragilis
75
Q

monitoring for lincosamides (clindamycin)

A
  • stop med if significant diarrhea occurs
  • do not give as a bolus, can cause cardiac arrest
76
Q

patient education for lincosamides/clindamyin (cleocin)

A
  • finishing therapy
  • ADRs; diarrhea
77
Q

oxazolidinone

A
  • linezolid (zyvox)
  • used to treat infections, including pneumonia and infections of skin
  • used for treatment of infections caused by multi-resistant bacteria including vancomycin resistant enterococcus faecium
  • avoid dietary tyramine
  • foods and beverages that have been pickled, smoked, and fermented carry tyramine
  • monitor CBC b/c myelosuppression may occur with treatment courses lasting more than 2 wks
  • many perpetuate serotonin syndrome in those taking SSRIs, MAOIs (muscle twitching, sweating, shivering, fever)
  • available in po and IV, infused ALONE
78
Q

black box warning of oxazolidnone (linezolid)

A
  • inhibits action of monoamine oxidase which breaksdown serotonin in brain causing accumulation leading to toxicity
  • more likely on those taking MMOI or SSRI
  • muscle twitching, sweating, fever
79
Q

metronidazole (flagyl)

A
  • treats protoza and bacterial infection
  • active against trihomonas vaginalis, entamoeba, histolytic, h. pylori, clostridium, c. diff
  • pharmacokinetics: well absorbed when taken orally
80
Q

adverse effects of metroniadazole (flagyl)

A
  • rash
  • nausea
  • abomdinal pain
  • dizziness
  • seizuers
  • headache
  • metallic taste
81
Q

contraindication for metronidazole

A
  • avoid in first trimester of pregnancy
  • caution CNS or blood disorders
82
Q

monitoring and education for metronidazole

A
  • resolution of symptoms
  • metallic taste in mouth is normal
  • avoid alcohol due to severe reaction
  • concurrent treatment of partner if STI
83
Q

rifaximin (Xifaxan)

A
  • traveler’s diarrhea caused be e. coli
  • 97% eliminated in feces (not useful for systemic infections)
84
Q

adverse effects f rifazimin

A
  • flatulence
  • headache
  • abdominal pain
  • n/v
  • constipation
  • prolonged use= superinfection
85
Q

lipoglycopeptides

A
  • vancomycin
  • used for severe gram + infections like MRSA, SSNA, endocarditis
  • prophylactic for those at risk for MRSA
  • inhibits cell wall synthesis
  • oral treats c. diff and staph enterocolitis
  • IV
86
Q

adverse effects of lipoglycopeptides (vancomycin)

A
  • ototoxicity (transient or permanent)
  • nephrotoxicity (excreted mainly by kidneys)
  • vancomycin should be infused slowly in a dilute solution no greater than 10mg/min over no less than 60 minutes to avoid rapid reaction
  • stopping of infusion usually results in prompt cessation of reactions
87
Q

if vancomycin is given too fast…

A
  • red man syndrome
  • rash on the face, neck, and upper torso
  • Weakness
  • Angioedema
  • Chest or back pain
  • Itching
  • Burning sensation
  • Generalized discomfort
  • Dizziness
  • Agitation
  • Headaches
88
Q

clinical use and dosing of lipglycopeptides/vancomycin

A
  • serious gram + infections resistent to other meds
89
Q

monitoring and education for lipoglycopeptides/vancomycin

A
  • hearing and renal function
  • peak and trough
  • IV site extravasation and tissue damage
  • adverse effects
90
Q

when should trough level be drawn

A

right before next dose

91
Q

when should peak levels be drawn

A

30-60 mintutes after infusion is done

92
Q

hypersensitivity to vancomycin

A
  • oral ulcerations
  • skin rash
93
Q

gram + coverage

A
  1. penicillins (amp, amoxicillin)
  2. cephalosporins (1st and 2nd gen)
  3. macrolides (eryhromycin, clarithroymcin, azithromycin)
  4. quinolones (gatifloxacin, moxifloxacin)
  5. vancomycin (MRSA)
  6. sulfonamide/trimethoprim
  7. clindamycin
  8. tetracyclines
  9. chloramphenicol
  10. others: linezolid, synercid (VRE)
94
Q

gram - coverage

A
  1. broad spectrum penicillin (ticarcillin-clavulanate, peperacillin-tazobactam)
  2. cephalosporins (2nd, 3rd, 4th gen)
  3. aminoglycosides (streptomycin, neomycin, monitor for renal and ototoxicity)
  4. macrolides (azithromycin)
  5. quinolones (ciprofloxacin)
  6. monbactams (azetreonam)
  7. sulfonamide/trimethoprim
  8. carbapenems (impenem)
  9. chloramphenicol
95
Q

atypical coverage

A
  1. macrolides (legionella, mycoplasma, chlamydiae)
  2. tetracyclines (rickettsiae, chlamydiae)
  3. quinolones (legionella, mycoplasma, chlamydia)
  4. chloramphenicol (rickettsiae, chlamydiae, mycoplasma)
  5. ampicillin (listeria)
96
Q

candiasis

A

infection containing or caused by candida

97
Q

dermatophytes

A

fungal parasite that grows in or on skin

98
Q

fungi

A

plantlike orangism that lives as parasites on living tissue or as saprophytes on decaying organic matter

99
Q

immunocompromised

A

having impaired or weakned immune system

100
Q

molds

A

fungi widely dispersed in evrionment and either saprophytic or parasitic; multicellular organisms composed of colonies of tangled strands

101
Q

mycoses

A

disease induced by fungus or resembling such disease

102
Q

yeasts

A

unicellular fungi of genus saccaromyces or candida

103
Q

fungal infections

A
  • may be mild or superifical
  • can be life threatening and systemic
  • fungi are larger and more complex than bacteria
  • thick rigid cell wall
  • similar to human cells
104
Q

mild and superficial fungal infections

A

skin
hair
nails

105
Q

life threatening and system fungal infections are commonly in

A

immunocompromised hosts

106
Q

increased risks of severe fungal infections

A
  • HIV
  • use of immunosuppresants like those with cancer or organ transplants
  • use of indwelling urinary cath
  • prosthetic device implant
  • overuse of broad-spectrum antibiotics
107
Q

drug therapy for fungal infections

A
  1. polyenes (for severe infections and oral candida)
  2. azoles (resistant to candida, meningitis)
  3. echinocandins (candida, aspergillosis)
108
Q

polyenes

A

amphotericin B
nystatin

109
Q

azoles

A

fluconazole

110
Q

echinocandins

A

caspofungin

111
Q

pyrimidine analog

A

flucytosine

112
Q

miscellaneous antifungal

A

griseofulvin

113
Q

what is polyenes (amphotericin B) used for

A
  • serious systemic fungal infections, candidiasis
  • cutaneous candidiasis
  • oral candidiasis
114
Q

azoles (fluconazole) use

A
  • oropharyngeal, esophageal, vaginal, and systemic candidiasis
  • prevention of candidiasis after bone marrow transplant
  • cryptococcal meningitis
115
Q

echinocandins (caspofungin) use

A

invasive apergillosis
candidiasis

116
Q

pyrimidine analog (flucytosine) use

A

serious infections from candida or cryptococcus

117
Q

griseofulvin use

A

dermatophytosis (skin, hair, nails)

118
Q

amphotericin B (polyene) action and use

A
  • binds to fungal cell membrane and changes permeability and prevents reproduction
  • used for progressive and potentially fatal infections (cryptococcus, blastomycosis, systemic candidasis, disseminate monolialsis, coccidiomycosis, histoplasmosis)
119
Q

adverse effects of ampotericin B (polyene)

A
  • multiple organ failure
  • respiratory arrest
  • cardiac arrest
  • GI, GU, and heme s/s
  • electrolyte imbalances (hyponatremia, K+ elevated)
120
Q

normal Na+

A

135-145

121
Q

normal K+ levels

A

3.5-6.0

122
Q

mag levels

A

1.3-2.1

123
Q

normal phosphate levels

A

2.5-4.8

124
Q

contraindications for amphotericin B (polyene)

A
  • known allergy to amphotericin B
  • impaired renal function
  • lactating women
125
Q

nursing implications for amphotericin B (polyene)

A
  • may drug to drug interactions
  • given with IV filter in D5W within 8 hours of reconstitution
  • receive testing dose
  • culture done prior to administration
  • monitor electrolytes
  • infused over 2-6hrs
  • monitor KF, LFTs, and lactic acid level
126
Q

black box warning of amphotericin B (polyenes)

A

risk of toxicity when used for progressive or fatal infections

127
Q

nystatin (polyene)

A
  • same action as amphotericin
  • used topically, oral, intestinal, and vaginal candidiasis
  • not aborbed systemically
  • oral: swish and swallow
  • topical: apply to skin
  • intravaginnaly: isnert vaginally
128
Q

azoles/fluconazole action

A
  • binds to sterols in fungal cell membrane and changes their permeabiltiy
  • broader spectrum with fewer adverse effects and less drug to drug interactions
129
Q

use of fluconazole (azole)

A
  • systemic and topical drug of choice for UTI and thrush
  • long term use for those with AIDS to suppress meningitis
130
Q

adverse effects of fluconazole (azole)

A
  • n/v
  • diarrhea
  • abdominal pain
  • headache
  • rash
  • impact renal and hepatic fxn
  • prolonged QT interval!
131
Q

contraindications for fluconazole (azole)

A
  • known allergy
  • pregnancy and lactation
  • renal and hepatic impairment
132
Q

nursing implications for fluconazole (azole)

A
  • may drug to drug interactions
  • don’t give concurrently with losartan, warfarin, or phenytoin (increases risk of toxicity)
133
Q

black box warning of fluconazole (azole)

A

other drugs in this class may increase risk for HF

134
Q

echinocandin/caspofungin action and use

A
  • inhibits synthesis of fungal cell wall, interfering with reproduction
  • treats invasive aspergillosis, candida of intrabaomdinal pleura, esophagous, periontinotis, or febrile neutropenic pts
135
Q

adverse effects of caspofungin (echinocandin)

A
  • fever
  • headache
  • n/v
  • skin rash
  • phelibitis at injection site
136
Q

contraindications of caspofungin (echinocandin)

A
  • known allergy
  • contraindicated w/ mannitol
137
Q

nursing implications for caspofungin (echinocandin)

A
  • IV only
  • incompatible with other meds
  • don’t mix w/ desxtrose
  • med must be room temp
  • must be given over 1hr
  • assess liver, kidneys, electrolytes, and blood counts
138
Q

pyrimidine analog/flucytosine action and use

A
  • effects cell membrane of fungus causing cell death
  • adjunctive agent with amphotericin B for systemic infections caused by candida and cryptococcus
139
Q

adverse effects of flucytosine (pyrimidine analog)

A
  • GI upset
  • n/v
  • duodenal ulcer
  • GI bleed
  • bone marrow depression
  • rash
  • pruritus
  • urticaria
  • hepatic and renal toxicity
140
Q

contraindications of flucytosine (pyrimidine analog drugs)

A
  • known allergy
  • pregnancy
  • lactation
141
Q

nursing implications for pyrimide analog/ flucytosine

A

culture and sensitivity b4 treatment
monitor pregnancy

142
Q

black box warning or pyrimidine analog/flucytosine

A

extreme caution w/ renal impaired patients

143
Q

griseofulvin action and use

A
  • disrupts cell division phase, making it resistant to invasion
  • treatment of skin, hair, and nail infection (dermatophytosis)
144
Q

adverse affects of griseofulvin

A
  • CNS responses
  • redness
  • photosensitivity
  • urticaria
  • GI
  • hepatotoxicity
145
Q

contraindications of griseofulvin

A
  • known allergy
  • liver disease
  • prophyria
  • pregnancy
146
Q

nursing implications for griseofulvin

A
  • NO ALCOHOL
  • NO VIT E
  • take with food-
147
Q

black box warning of griseofulvin

A

may increase risk for hepatotoxicity

148
Q

parasites

A
  • living organism surviving at expense of host
  • causes are common human ailments worldwide
  • include; protzooa, helminths, affect GI tract and other tissues
  • scabies and pediculi (lice); affect skin
149
Q

types of parasitic infections

A
  • amebiasis
  • giardiasis
  • malaria
  • trichomoniasis (worm from undercooked meat)
  • heminthiasis (hookworm, pinworm, roundworm, tapeworm)
  • scabies
  • pediculosis
150
Q

amebiasis

A
  • common in africa, asia, and latin america
  • occurs more with anal sex
  • areas with poor sanitation
  • occurs wit ingestion of food or water contaminated with human feces containing amebic cysts
  • if left untreated it can cause ulcerations of colon and abscesses of liver
151
Q

signs of amebiasis

A
  • n/v
  • diarrhea
  • abdominal crampin
152
Q

trichomoniasis

A
  • single cell protozoan
  • spread by men who have no signs of infection and engage in sexual intercourse
  • women more likely to show signs
  • s/s: vaginal burning, urethritis, foul smelling yellow discharge
153
Q

giardiasis

A
  • affect mainly children
  • occurs with limited water treatment and poor sanitary conditions
  • can be community outbreak
  • international travelers
  • person to person
  • raw undercooked food
  • anal-oral sexual contact
  • produces diarrhea and abdominal cramping
154
Q

metronidazole action and use

A
  • diffuses across cell membrane to cause cell death
  • used in intestinal amebiasis, trichomoniasis and bacterial vaginosis
155
Q

adverse effects of metronidazole

A
  • headache
  • dizziness
  • ataxia
  • dark urine
  • diarrhea
  • n/v
  • metallic taste
  • rash
  • bronchospasm
156
Q

contraindcations for metronidazole

A
  • allergy
  • pregnancy
157
Q

nursing implications for metronidazole

A
  • don’t give with barbituates (decreases effect)
  • don’t give with anticoags
  • don’t take with alcohol (can caused tachycardia, redness under skin, n/v)
158
Q

black box warning on metronidazole

A

causes cancer in rats

159
Q

malaria

A
  • caused by 5 protozoan species
  • high in tropics
  • acute febrile illness with headahce, chills, n/v, and copious sweating
  • if not treated in first 24hrs it can lead to death
  • three treatments: 1. prevention/prophylaxis, 2. treatment of acute attack, 3. prevention of relapse
160
Q

antimalarial action and use

A
  • chloroquine phosphate
  • inhibits DNA and RNA which interfers with metabolism of Hgb needed by parasites and raises pH needed for growth
  • prophylactic and treatment of malaria
161
Q

adverse effects of chloroquinolone phosphate (antimalarial)

A
  • visual disturbances
  • cardiac changes
  • hypotension
  • n/v
  • diarrhea
  • rash
  • pruritus
  • muscle weakness
162
Q

contraindications for chloroquine phosphate (antimalarial)

A
  • hypersensitivity
  • retinal disease
  • ETOH
  • pregnancy/lactation
163
Q

nursing implications for chloroquinolone phosphate (antimalarial)

A
  • no alcohol
  • same time each day w/ food
164
Q

black box warning on chloroquinoline phosphate (antimalarial)

A

can trigger neuropsychiatric reactions

165
Q

helminthiasis

A
  • infestation of worms
  • frequently found in tropical areas
  • most often GI tract
166
Q

mebendazole (anthelminitic) action and use

A
  • blocks glucose needed for survival of worms
  • eradicates parasite or decreases infesation
167
Q

adverse effects of mebendazole (anthelminitic)

A
  • dizziness
  • drowsiness
  • headaches
  • seizures
  • diarrhea
  • n/v
  • heme effects
  • hepatic and renal complications
168
Q

contraindications of mebendazole

A
  • hypersensitivity
  • pregnancy and lactation
169
Q

nursing implications for mebendazole (antithelminitic)

A

must chew/crush and mix with food to increase serum levels

170
Q

scabies and pediculosis

A
  • parsitic infection of skin
  • scabies: “itch mite” burrows into skin and lays eggs creating visible skin lesions
  • pediculosis; caused by one of 3 types (head, body, pubic)
  • likely to occur in areas of pverty, overcrowded areas, and poor sanitiation
  • highly communicable and transmitted via contract with person or infected items
171
Q

permetrhin (scabicides and pediculicides) action and use

A
  • absorption results in paralysis of worm and death
  • treatment of active or prophylactic treatment
172
Q

adverse effects of permetrhin (scabicides and pediculicides)

A
  • pruritus
  • rash
  • erythema
  • burning of scalp
173
Q

contraindications permetrhin (scabicides and pediculicides)

A
  • allergy
  • less than 2months old
174
Q

nursing implications for permetrhin (scabicides and pediculicides)

A
  • assess for lice or scabies
  • wear gloves
  • leave on for 10min before rinsing for lice
  • if scabies, apply cream head to toe ad leave for 8-14hrs
175
Q

black box for permetrhin (scabicides and pediculicides)

A

can cause neurologic toxicities, seizures, and death

176
Q
A

path/pharm (4 decks)

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