Pharm Exam 4 Flashcards
1
Q
Speed Shock
A
When a client receives an IV medication too rapidly, causing dizziness, chest tightness, and flushed face.
2
Q
Extravasation
A
Causes pallor, swelling, and pain at IV site, which can extend tissue damage over time.
3
Q
Anaphylactic shock
A
Causes bronchospasm, wheezing, SOB, severe hypotension, tachycardia, and respiratory or cardiac arrest.
The nurse should call the rapid response team and start oxygen if suspected.
4
Q
Fluid overload
A
SOB, increased blood pressure, increases heart rate, increases respiratory rate, crackles in the lungs, neck vein distention, and edema
The nurse should prepare to administer a diuretic if suspected.
5
Q
Phlebitis
A
the nurse should use a catheter with the smallest gauge possible to prevent irritation of the vein and phlebitis
the nurse should use a warm compress to treat phlebitis
6
Q
0.9 % NaCl
A
Normal saline uses:
Increases intracellular fluid volume
Administration of blood transfusions
Replace fluid losses
Contraindications:
heart failure
pulmonary edema
renal failure
hypernatremia
7
Q
Lactated Ringers (LR)
A
Contains electrolytes, sodium, chloride, potassium, calcium and lactate.
Uses:
provide fluid resuscitation
correct metabolic acidosis
Contraindications:
Heart failure
Renal failure,
head injury
liver disease
respiratory alkalosis
8
Q
Infiltration
A
manifestations: pallor, swelling, and pain at the IV site
9
Q
Extravasation
A
manifestations: blistering, tissue necrosis, ulceration
10
Q
0.45% NaCl
A
Half normal saline
11
Q
Isotonic
A
0.9 % Normal saline
Lactated ringers
Remains in the intravascular space
12
Q
Hypertonic
A
3% saline
Pulls fluid out of the cells and into the veins
13
Q
Hypotonic
A
0.45% half saline
0.18% saline
D5W - after metabolized
Moves fluid from the veins to the cells and interstitial spaces
Hemolysis can occur due to fluid moving from veins into cells.
14
Q
Electron infusion devices (IV pumps)
A
deliver an accurate rate of fluid infusion
Pumps have a variety of safety features that protect the patient from an unwanted bolus, running dry, or running at an infusion rate inconsistent with the usual administration of the medication or fluid.
15
Q
IV Pump Alarm detections
A
air in the tubing
volume is low
infusion is complete
low battery
occlusion
16
Q
Using the piggyback method, where should the nurse place the secondary bag?
A
Higher than the primary bag
17
Q
Bolus
A
Fluids or concentrated medication solution given by IV route over a relatively brief period of time. Equipment used to deliver varies, depending on existing IV lines, volume, and time to be infused.
18
Q
Continuous IV Infusion
A
IV solution that flows continuously (until further notice) - typically seen in NPO and surgical patients
19
Q
Drop Factor
A
Number of drops per milliliter (mL) delivered through various sizes of IV tubing. The tubing diameter affects the size of the drop. The DF is used to calculate flow rates on gravity administration sets.
20
Q
Flow Rate
A
Rate at which fluid is delivered by IV infusion devices, in milliliters per hour (mL/hr).
21
Q
Administration Set
A
another term for IV tubing;
may be used by gravity or IV pump
22
Q
Infusion Line, Primary
A
Main IV line or lines connected to the patient.
The first one is usually “dedicated” to fluid delivery and maintenance. Additional primary and secondary lines are usually reserved for medications or medicated solutions that are incompatible with other fluids.
23
Q
Infusion Line, Secondary
A
Tubing that connects to ports on the primary line and permits an additional medication or fluid to be added without disruption of the primary line.
24
Q
IV Injection Ports
A
accessible port located on the IV line or IV solution container that permits access for injection of additional fluids or medications.
25
Intermittent Infusions
Usually small-volume infusions (up to 250 mL) of IV solutions with medication added delivered at intervals.
piggyback equipment, syringe pumps, and calibrated volume-control burette chambers.
26
IV Piggyback (IVPB)
Small-volume infusions, usually 50 to 250 mL, infused through a short secondary tubing line that is “piggybacked” to a port on a primary line.
27
IV Push
IV medication intermittent bolus dose of 1 to 50 mL, usually administered by manual direct injection with a syringe, sometimes via an infusion pump.
28
“Keep vein open” or “To keep open”;
flow rate order that may be given for a minimum rate that will keep the IV line patent and prevent coagulation.
29
Macrodrip
Gravity IV infusion tubing set that has a wide diameter to deliver large drops
common 10 drops per mL
30
Microdrip (pediatric tubing)
Gravity IV infusion tubing set that has a narrow diameter to deliver small drops and slower flow rates.
common 60 drops per mL
31
Osmolartiy, Tonicity
Solute concentration in solution.
The milliosmol (mOs) is the unit of measurement in plasma and is used as a basis for comparison with the contents of IV solutions.
32
Parenteral Fluids
Fluids administered outside of the digestive tract (e.g., IM, IV, subcutaneous).
33
Patency
State of being open and unblocked, such as a “patent IV site” or “patent airway.”
34
PCA Pump
Patient-controlled analgesia pump
An electronic IV pump with a syringe or IV bag programmed to dispense prescribed amounts of analgesic narcotics at prescribed intermittent intervals with lockout intervals.
35
Saline Lock
Resealable access device that permits additional IV lines or medications to be added into or on primary (main) IV tubing without initiating another injection site or disrupting the main IV line.
36
Volume-Control Burette Device
Transparent, calibrated small-volume container, with a capacity of 100 to 150 mL, that is manually connected to an IV line just below the main IV solution container.
protects at risk patients of overload by limiting the total amount of solution available in case of equipment or a rate failure incident.
37
Antibiotic
Having the ability to destroy or interfere with the development of a living organism. (antibacterial drugs)
38
Antiseptic
One of two types of topical antimicrobial agents; a chemical that inhibits the growth and reproduction of microorganisms without necessarily killing them. (static agents)
39
Bactericidal antibiotics
Antibiotics that kill bacteria.
40
Bacteriostatic antibiotics
Antibiotics that do not actually kill bacteria but rather inhibit their growth
41
Cross-reactivity
the potential to be allergic to a drug with a similar structure (for example, penicillins and cephalosporins
42
Disinfectant
One of two types of topical antimicrobial agents; a chemical applied to nonliving objects to kill microorganisms.
43
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
An inherited disorder in which the red blood cells are partially or completely deficient in glucose-6-phosphate dehydrogenase, a critical enzyme in the metabolism of glucose. Certain medications can cause hemolytic anemia in patients with this disorder. This is an example of a host factor related to drug therapy.
44
Empiric therapy
treatment before culture results - it involves the presumptive treatment of an infection to avoid treatment delay before specific culture information has been obtained
45
Definitive therapy
antibiotic therapy after organism identified by cultures -
The administration of antibiotics based on known results of culture and sensitivity testing identifying the pathogen causing infection
46
Host factors
Factors that are unique to a particular patient that affect the patient’s susceptibility to infection and response to various antibiotic drugs. Examples include a low neutrophil count or a lack of immunoglobulins in the blood that carry antibodies
47
Prophylactic antibiotic therapy
Treatment to prevent an infection -Antibiotics taken before anticipated exposure to an infectious organism in an effort to prevent the development of infection.
48
Slow acetylation
A common genetic host factor in which the rate of metabolism of certain drugs is reduced.
49
sulfamethoxazole-trimethoprim (co-trimoxazole) - DOSAGE
It is available in both oral and injectable dosage forms.
50
Subgroups of penicillin
natural penicillins - penicillin G, penicillin V
penicillinase-resistant penicillins - cloxacillin, dicloxacillin, nafcillin, oxacillin
aminopenicillins- amoxicillin, ampicillin
extended-spectrum penicillins - piperacillin, ticarcillin, carbenicillin, piperacillin/tazobactam
51
Beta-lactamase
Any of a group of enzymes produced by bacteria that catalyze the chemical opening of the crucial beta-lactam ring structures in beta-lactam antibiotics.
52
Beta-lactam
The designation for a broad class of antibiotics that includes four subclasses penicillins, cephalosporins, carbapenems, and monobactams
53
beta-lactamase inhibitors
clavulanic acid (also called clavulanate), tazobactam, sulbactam, and avibactam
54
Penicillin - mechanism of action
Penicillins bind to specific proteins called penicillin-binding proteins and inhibit peptidoglycan, which interfere with normal cell wall synthesis - eventually leading to lysis
55
Penicillins - indications
Streptococcal infections (e.g. tonsillitis, pharyngitis, scarlet fever, endocarditis)
Sinus infections (often Augmentin)
56
3rd Generation Cephalosporins - indications
weak against gram-positive bacteria but potent gram-negative antibiotics.
57
Tetracyclines - indications
Wide spectrum gram negative and gram positive organism
Skin infections
Dental infections
Atypical infections (Rickettsia spp, Borrelia spp., Chlamydia spp., Mycoplasma pneumonia)
Lyme disease
acne
Adjunct treatment for protozoan infections
58
Sulfonamides - indications
gram postive and gram negative
C. trachomatis
Nocardia
H. influenzae
UTIs (e.g. E. coli)
upper respiratory tract infection
staphylococcus infections because of the high rate of community- acquired MRSA infections
59
Penicillins - adverse effects
Hypersensitivity: Anaphylaxis, rash, fever, wheezing
GI upset: Nausea, vomiting, diarrhea
Superinfections
60
Penicillin - contraindications
Requires dosage reductions in renal impairment (piperacillin, ampicillin)
61
Penicillin - nursing interventions
Screen clients with claimed allergies for true hypersensitivity reactions (e.g. rash, wheezing, anaphylaxis) ensuring the client did not just have an adverse effect (e.g. diarrhea, nausea, vomiting). Adverse effects do not result in a contraindication to this class of medications.
Monitor pulmonary function and for signs of allergic reaction.
Clients should be instructed to complete the full antibiotic regimen to encourage eradication of infection and discourage resistance.
Most penicillins can be taken with food to mitigate GI symptoms.
62
Cephalosporins - Mechanism of action
Similar mechanism compared to penicillins – cephalosporins fall under the beta-lactam classification.
63
Cephalosporins - Adverse effects
Hypersensitivity: Clients with true penicillin allergies develop reactions with cephalosporin usage. As cephalosporin generations increase the risk of allergic reactions to people with penicillin allergies decreases.
GI upset: Nausea, vomiting, diarrhea
CNS: Headache, dizziness
Nephrotoxicity
Superinfections
64
Super infection
c.diff
secondary infection: candidiasis
when a patient doesn't finish the full prescription, the infection comes back stronger
65
Cephalosporins - interactions
Ceftriaxone should not be reconstituted or mixed with a calcium-containing product (e.g. Ringer’s or Hartmann’s solution) due to risk of precipitation in the lungs or kidneys
66
Cephalosporins- nursing interventions
Screen for true penicillin allergies – ensuring a real hypersensitivity reaction.
Monitor pulmonary function and for signs of allergic reaction.
Generally safe in pregnancy.
Monitor renal function
Potential interaction with anticoagulants → bleed risk
IV and IM route only - ceftriaxone because of gi upset
once a day dosing
elimination is primarily in liver NOT kidneys
easily crosses the blood brain barrier so it can treat
give orally with food to decrease GI upset
Avoid use in clients taking anticoagulants
ANTABUSE - alcohol
Dont give with calcium - LR
67
Tetracyclines - mechanism of action
Inhibit protein synthesis → inhibition of bacterial cell growth.
68
Tetracyclines - adverse effects
Not pregnancy safe
Teeth discoloration
Sun sensitivity
Weakening of skeletal bone structure
Hepatotoxicity
Should not be given to kids <8 yrs old
Tooth discoloration
Fetal skeletal deformities if taken
during pregnancy
enterocolitis
gastric upset
vaginal candidiasis
Alteration in intestinal flora may
cause:
Superinfection (overgrowth of non-
susceptible organisms - Candida)
C. Diff infection
Maculopapular rash
69
Tetracyclines - contraindications
Tetracyclines given to children under the age of 8 can cause permanent tooth discoloration if given for prolonged courses.
Accumulation of antibiotics can occur in fetal bone and teeth in pregnancy
Risk of hepatotoxicity in pregnant women
70
Tetracyclines - nursing interventions
Obtain cutters before beginning antibiotic
Consult on increased sensitivity to light – avoid excessive sun exposure or use sunscreen
Avoid antacids and multivitamins with this medication
Interaction with birth control – caution with oral contraceptives; additional birth control may be needed
dairy products, antacids, and iron salts reduce oral absorption
Increase risk of digoxin toxicity- monitor digoxin levels
71
Sulfonamides - contraindications
3rd trimester pregnancy
<2 YRS OLD
Risk of serious hypersensitivity reactions – screen for sulfa allergies
Blood dyscrasia – fatalities associated with severe reactions including agranulocytosis and aplastic anemia
Hepatic necrosis
Hyperkalemia – caution in clients with heart conditions
Hypoglycemia – caution in diabetics
Risk of thrombocytopenia
72
Sulfonamides - nursing intervention
Screen for true sulfa allergies – monitor for signs and symptoms of hypersensitivity
Can take with food with upset stomach
Not safe for pregnancy
Nephrotoxic monitor for the following:
Scr > 1.3 = Bad for kidney
BUN > 20
Urine output < 30 ml/hr or less = kidney in distress
73
Penicillin - interactions
NSAIDS
Oral contraceptives
Warfarin
74
Sulfonamides - adverse effects
Hypersensitivity: Contraindicated when a known or suspected sulfa allergy is present (including allergies to sulfa containing drugs e.g. sulfonylureas, thiazides)
GI: Nausea, vomiting, diarrhea
Renal: Crystalluria
CNS: Headache, dizziness
Bone marrow depression
Photosensitivity, rash
75
Bacteriostatic - mechanism of action
bind to calcium ions to form insoluble complexes
76
The use of tetracycline is limited in children because of the occurrence of which side effect?
Discoloration of teeth
77
Prophylactic Therapy
Administration of antibiotics prior to an anticipated exposure to infectious pathogens
78
Definitive Therapy
Use of antibiotics based on known results of culture and sensitivity testing
79
Empiric Therapy
Presumptive treatment of infection based on judgement of the pathogen(s) most likely causing an infection
80
The nurse is reviewing the culture results of a patient with an infection, and notes that the culture indicates a gram-positive organism. Which generation of cephalosporin is most appropriate for this type of infection?
First-generation
81
When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin. What possible effect may occur as the result of an interaction between these drugs?
The penicillin will cause an enhanced anticoagulant effect of the warfarin.
82
A patient tells the nurse that he is having nausea and decreased appetite during drug therapy with a tetracycline antibiotic. Which statement is the nurse’s best advice to the patient?
“Drink a full glass of water with each dose.”
-Oral doses should be given with at least 8 ounces of fluids and food to minimize gastrointestinal upset. Antacids and dairy products will bind with the tetracycline and make it inactive.
83
A nurse is caring for a child who is allergic to penicillin. The nurse should verify which of the following prescriptions with the provider?
Piperacillin/tazobactam
84
Which statement accurately reflects the method of action of penicillin?
Inhibition of bacterial cell wall synthesis
85
A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections?
Sulfonamides
86
The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy?
Decreased white blood cell count
87
Metronidazole - indications
Broad spectrum azole antibiotic
Primarily treats protozoal infections
Oral form treats bacterial and protozoal infections
Treats C.diff associated diarrhea which occurs secondary to broad-spectrum antibiotic use and bacterial vaginal infections
IV form helps to prevent anaerobic bacterial infections such as colorectal, abdominal, and vaginal surgeries.
Used in combination with other drugs to treat peptic ulcer disease.
88
Metronidazole - mechanism of action
Bactericidal against anaerobic gram-negative bacteria and various types of Protozoa
Damages the DNA in anaerobic organisms
Unique because it doesn’t produce a pharmacological action until its inside the anaerobic organism
89
Which antibiotics are NOT safe in pregnancy
Sulfonamides
Gentamicin
Tetracycline
90
Vancomycin
PO,IV or rectal use
Ototoxity - especially in combination with gentamycin
Red man syndrome
Caution in renal impairment and hearing loss
91
Aminoglycosides
E. Coli
Ototoxic
Nephrotoxicity
Intense neuromuscular blockade - respiratory depression and muscle weakness
Once a day dosing - trough level
