Pharm Test #3 Flashcards
indications for use of adrenal agents
- widely used to suppress the immune system
- short-term use to relieve inflammation during acute stages of illness
do adrenal agents cure inflammatory disorders
NO
where are the adrenal glands located
flattened bodies that sit on top of each kidney
what two hormones do adrenal glands secrete
- cortisol
- aldosterone
this increases glucose and controls blood pressure
cortisol
causes kidneys to absorb sodium. CV is impacted if not working
aldosterone
3 types of corticosteroids
androgens, glucocorticoids, mineralocorticoids
what causes greatly reduced cortisol and aldosterone secretion
adrenal gland hypotension
what are the actions of the adrenocortical hormones
cause the release of glucose for energy
signs/symptoms of adrenal gland hypofunction
- hypoglycemia
- muscle weakness
- hypotension
- fatigue
- hyperkalcemia
signs of adrenal crisis
physiological exhaustion
hypotension
fluid shift
shock and even death
treatment of adrenal crisis
massive infusion of replacement steroids
constant monitoring and life support procedures
medications for glucocorticoids
dexamethasone
hydrocortisone - IV
methylprednisolone - IV
prednisone - oral ***know
what do glucocorticoids impact
the sugar
monitor blood glucose level
why be concerned if pt is on glucocorticoids long term
-make bones brittle
-monitor pt for fractures
-suppresses immune system- makes wounds hard to heal
-need to protect pt from infections
what are the actions of glucocortioids
initiate many complex reactions responsible for anti-inflammatory and immunosuppressive effects
why use glucocorticoids
- short term treatment of many inflammatory disorders
- to relieve discomfort
- give body a chance to heal from effects of inflammation
contraindications for glucocorticoids
- acute infection
-irritating to GI and can cause issues
cautions for glucocorticoid
acute peptic ulcer
indications for prednisone
replacement therapy in adrenal cortical insufficiency;
short term management of various inflammatory and allergic disorders,
hypercalcemia associated with cancer,
hematological disorders,
ulcerative colitis,
acute exacerbations of multple sclerosis
actions of prednisone
enters target cells and binds intracellular corticosteroid receptors, initiating many complex reactions responsible for anti-inflammatory and immunosuppressive effects
medication for mineralocorticoid
fludrocortisone
3 things to know about mineralocorticoid
- fludrocortisone
- take same time every day
- weigh daily bc pt gains a lot of weight and record
drug to drug interaction for mineralocorticoid
decrease effectiveness with salicylates, rifampin
adrenal gland hyperfunction
- cortisol is excessively secreted or
- aldosterone is excessively secreted
- can result in an adrenal gland problem, like a tumor
medication for adrenal gland hyperfunction
mifepristone — this can cause abortions
what is the actions of fludrocortisone
- increases sodium reabsorption in renal tubules and increases potassium and hydrogen excretion, leading to water and sodium retention
intended response or side effects about adrenocortical agents
-intended-reduce blood levels of glucocorticoids and aldosterone
-normal BG and BP
side effects: can lead to adrenal insufficiency
what do you teach patients about adrenocortical agents
-signs of adrenal insufficiency
-keep all blood work appointments
2 types of antibiotics
bacteriostatic
bactericidal
what do bacteriostatic antibiotics do
those substances that prevent growth of bacteria
what does bactericidal antibiotics do
kill bacteria directly
how do you select treatment of antibiotic
id the causative organism
-antibiotic is chosen that has been nown to be effective at treating invading organism
signs of infection
-fever
-lethargy
-increased wbc
-classic signs of inflammation
-look at cultures
how do bacteria become resistant to antibiotics
-adapt to environment
-longer antibiotic has been in use, greater the chance bacteria will develop into resistant strain
this is a group of powerful antibiotics used to treat serious infections caused by gram negative aerobic bacilli
aminoglycosides
common medication for aminoglycosides
gentamicin **know
what to know about gentamicin
ototoxic - hearing impairment or loss
harsh med - very toxic to kidneys
what type of antibioitic is aminoglycosides
bactericidal
pharmacokinetics of aminoglycosides
depend on kidney for excretion and are toxic to the kidneys
adverse effects of aminoglycosides
ototoxicity and nephrotoxicity *****
know
this new class of broad spectrum antibiotics effective against gram positive and gram negative bacteria
carbapenems
carbapenems medication to know
imipenem-cilastatin (Primaxin)
true or false
because of adverse effects of aminoglycosides, it is important to teach pt to restrict fluids and eat 6 small meals daily
false
try to drink lots of fluids to maintain nutrition even though nausea, vomiting and diarrhea may occur
indications of carbapenems
-treatment of serious infections caused by suseptible bacteria
what type of antibiotic is carbapenems
bactericidal
actions of carbapenems
inhibit cell membrane synthesis in susceptible bacteria leading to cell death
pharmacokinetics of carbapenems
excreted unchanged in urine - have an average half life of 1-4 hours
-this doesn’t get broken down in body
-okay to use for liver disease
adverse effects of carbapenems
pseydomembranous colitis, cdiff diarrhea, and nausea and vomiting can lead to serious dehydration and electrolyte imbalance
this is similar to penicillin in structure and activity
cephalosporins
common meds for cephalosporins
cephalexin (keflex)
ceftriaxone (rocephin)
what type of antibiotic is cephalosporins
bactericidal and bacteriostatic
what are the indications of cephalosporins
treatment of infections caused by susceptible bacteria
actions of cephalosporins
interfere with cell wall building ability of bacteria when they divide
pharmacokinetics of cephalosporins
-well absorbed from GI tract
-metabolized in liver, excreted in urine
contraindications of cephalosporins
-allergies to cephalosporins or penicillin ****
know
adverse side effects of cephalosporins
GI tract irritations
you are writing plan of care for patient receiving Cefaclor. What would be apporpriate nursing diagnosis for pt?
a. deficient fluid volume and imbalanced nutrition: less than body requirements, related to diarrhea
b. chronic pain RT GI, CNS effects of drug
c. monitor renal function test values
d. perform culture and sensitivity tests at the site of infection
a. deficient fluid volume and imbalanced nutrition: less than body requirements, related to diarrhea
this is relatively new synthetic class of antibiotics with broad spectrum of activity
fluoroquinolones
common meds for fluoroquinolones
ciprofloxacin (cipro)
levofloxacin (levaquin)
**know its broad spectrum antibiotic
actions of tetracyclines
inhibits protein synthesis insusceptible bacteria, preventing cell replication
pharmacokinetics of tetracyclines
- adequately absorbed from GI tract
- concentrated in liver, excreted unchanged in urine
adverse side effects of tetracyclines
-most GI but possible damange to teeth and bones
- causes teeth discoloration in children –> yellow/brown and is permanent
drug to drug interactions for tetracyclines
penicillin G, oral contraceptives
do you take tetracyclines with or without food
administer on empty stomach
pyridoxine = ?
B6
antituberculins contains
pathogens causing TB
what are two antituberculosis drugs
rifampin and isoniazid (INH)
if exposed to TB how long will be on isoniazid (INH)
6 months
what antituberculosis drug do you take with vitamin B6
isoniazid (INH)
first antibiotic introduced for clinical use
penicillin
which antibiotics do you use for severe infections caused by sensitive organisms and broad spectrums use
penicillin and penicillinase resisitant antibiotics
what are the actions of penicillin and penicillinase resistant antibiotics
interfere with the ability of susceptible bacteria to build their cell walls
these rapidly absorbed from GI tract, reaching peak levels in 1 hour. excreted unchanged in urine
penicillin and penicillinase resistant antibiotics
what are the contraindications of penicillin and penicillinase resistant antibiotics
allergies to penicillin or cephalosporins, renal disease
drug to drug interactions for penicillin and penicillinase resistant drugs
tetracyclines, parenteral aminoglycosides
these developed as semisynthetic antibiotics based on structure of common soil mold
tetracyclines
true or false
tetracyclines can lead to sun burns
true - pts on these drugs should stay out of the sun
what are the actions of antituberculins
act on DNA of bacteria leading to lack of growth and eventual bacterial death of TB
what are the pharmacokinetics of antituberculins
-absorbed well in GI tract
-metabolized in liver
how do you test for active TB
need gram of sputum of multiple days
true or false
chest xray is not a diagnosis of active TB
true. a chest x ray only shows if you were exposed. does not indicate TB is active or not
what are the adverse effects of TB drugs
hepatotoxicity
what are the drug to drug interactions for antituberculins
rifampin and INH can cause liver toxicity
contraindications of antituberculins
renal or hepatic failure
these vary in their effective ness against invading organisms
anti infectives
this kill the cell
bactericidal
this prevents reproduction of cell
bacteriostatic
effective against only a few microorganisms with a very specific metabolic pathway or enzyme
narrow spectrum of activity
“match the bug to the drug”
narrow spectrum of activity
useful in treating a wide variety of infections
broad spectrum of activity
what are examples of narrow spectrum of activity
PCN and amoxicillin
what are used to determine the type and extent of infection
culture and sensitivity tests
ability over time to adapt to an anti infective drug and produce cells that no longer affected by particular drug
natural or acquired resistance
these act on specific enzyme system or biological process, many microorganisms that do not act on this system are not affected by this particular drug
antiinfectives
how do you prevent resistance to medication
- limit the use of antimicrobial agents to the treatment of specific pathogens sensitive to drug being used
- make sure doses are high enough and duration of drug therapy is long enough
how is the ID of the infecting pathogen done
by culture
this determines which drugs are capable of controlling the particular microorganism
sensitivity test
what is a treatment of systemic infections
combination therapy
- some drugs are synergistic
ex; opioid can affect and tylenol
trying to prevent infection from occurring
give before surgery and then after to prevent infection
prophylaxis
who gets prophylaxis
- ppl traveling to area where malaria is endemic
- pts undergoing GI or genitourinary surgery
- pts with known cardiac valve disease, valve replacements, other invasive procedures
for dental work - how many hours before do CVD pts get the prophylaxis
72 hours
adverse reactions to antiinfective therapy
- kidney damage - highly toxic and renal failure
- GI toxicity
- Neurotoxicity
- Hypersensitivity Reactions - make sure pt isn’t allergic
- Superinfections - yeast & c.diff
- Ototoxcitiy
three antiinfective medications
- vancomycin
- gentamycin
- enoxaparin
what do you do for your pt who is on antiinfective therapy
monitor I & O, monitor any pt changes, get CBC
how long after pt receives new medications via IV will they have an allergic reaction
10 mins