Quiz 3 Flashcards

Question

Acetaminophen

Answer 1

- Primarily inhibits COX-2 activity in CNS - Reduces production of prostaglandins - UNLIKE NSAIDS, has minimal peripheral COX-1 and COX-2 inhibition = has analgesic and anti-pyretic effects but NO ANTI-INFLAMMATORY properties - Reduced risk of GI and platelet-related side effects - Can cause hepatotoxicity at high doses (<4g/day, monitor liver lab results, Avoid ETOH) Antidote for OD = Acetylcysteine DO NOT TAKE TYLENOL FOR A HANGOVER, USE IBUPROFEN**

Answer 2

Occurs when muscles of the head and neck become very tight due to stress, causing steady and lingering pain - Mild to moderate pain which can be utilized in one area of the head and generalized - Can be effectively treated w/ OTC non-opioid analgesia

Answer 3

- Headache w/ severe, recurrent pain - Characterized by throbbing or pulsating pain on one side (but can be both sides) - Often accompanied by nausea, vomiting, and sensitivity to light and sound - May or may not be preceded by Aura Aura = sensory cue that tells one a migraine is coming (eg flashing lights, special smell, taste etc) Acute Migraine Treatment = OTC Non-opioid = Triptans (eg. Sumatriptan) which cause vasoconstriction (serotonin agonists) Migraine Prophylaxis = Beta-Blockers (eg. Propranolol), Anti-epileptics, anti-depressants etc

Answer 4

Reflection of the balance between heat gain and heat loss by the body (36.0-37.5 degree C) - Metabolic processes speed up or slow down depending on body temp

Answer 5

Rectal = most accurate Esophagus Pulmonary Artery Urinary Cath

Answer 6

Oral = (0.2 lower than core) Temporal Axillary Tympanic

Answer 7

Hypothalamus is the thermal control centre for the body Receives info from the peripheral and central thermoreceptors, in the skin and other organs, and compares info w/ its temp set point (37 = ideal core temp) - When temp falls under set point, hypothalamus signals for heat conservation (vasoconstriction and shivering = increase core temp) - When core temp is higher than set point, hypothalamus signals for heat dissipation = vasodilation and sweating decreasing core temp

Answer 8

Heat Production Heat Loss

Answer 9

VASOCONSTRICTION = confines blood to inner core of body SHIVERING = increases heat production by the muscles PILOERECTIONS = contraction of pilomotor muscles of the skin raises skin hairs (goosebumps), reducing heat loss surface INCREASED EPINEPHRINE PRODUCTION = shift body metabolism to heat production instead of energy production (might explain weakness/fatigue in fever) INCREASE IN THYROID HORMONE = long-term mechanism to increase metabolism and heat production

Answer 10

Most of the body's heat losses occur at the skin surface as heat from the blood moves through the skin, then into the surrounding environment VASODILATION = delivers blood to the periphery where heat is dissipated through radiation, conduction and convection SWEATING = increases heat loss through evaporation (evaporation uses body heat to convert water on the skin to water vapor in cooling)

Answer 11

Fever Hyperthermia

Answer 12

*Change in Set point* Results from a cytokine induced increase in the temp set point in hypothalamus - Phagocytotic cells digest bacteria, release cytokines (these induce prostaglandin production) PGE-2 binds to receptors in the hypothalamus to induce increases in the thermostatic set point Clinical manifestation: Prodromal period = fatigue, malaise, aches & pains Chills = result from body temp trying to catch up to the new set point. Causes shivering to generate heat and raise temp Flush = vasodilation causing skin to become warm & flushed Defervescence = reduction in temp, marked by sweating TREATMENT: -Increasing heat transfer from internal to external environment Eg) sponge bath w/ cool water, cold cloth - Supporting hypermetabolic state that accompanies fever = adequate fluids and sufficient amount of simple carbs - Protections of vulnerable organs & systems = treatment w/ anti-pyretic (re-set set point by blocking PGE-2 production) - Treatment of original causes of fever (eg. infection)

Answer 13

More intense chills that cause the muscles to shake uncontrollably when the body's temp rises rapidly to a new set point (eg during a serious infection)

Answer 14

Increase in body temp WITHOUT A CHANGE IN HYPOTHALAMIC SET POINT - Thermoregulatory centre struggles to control temp - Related to overproduction of heat, excessive environmental heat or impaired heat dissipation

Answer 15

Heat Exhaustion Heat Stroke Malignant Hyperthermia

Answer 16

-Related to loss of salt and water after prolonged exertion in hot environment - Temp >37.8 >40, tachy, thirst, fatigue, nausea, oliguria (low urine output), delirium

Answer 17

Core Temp >40 Severe, life-threatening** Symptoms: - Hot & dry skin - Tachy - Hyperventilation - Weakness - Delirium - Blurred vision - Convulsions - Collapse - Coma

Answer 18

- A genetic disorder where heat is generated from uncontrolled skeletal muscle contraction, resulting in severe and potentially fatal hyperthermia - Typically triggered by GA agents and muscle relaxant used in surgery - Mechanism r/t abnormally high release of calcium - Treated w/ Dantrolene (muscle relaxant that blocks calcium release)

Answer 19

Occurs when the body temp drops below 35 degrees, impairing normal physiological function - Typically due to exposure to cold environments or immersion in cold water Considerations: - Malnutrition decreases fuel available for heat generation - Loss of body fat decreases tissue insulation - Alcohol and sedative drugs dull mental awareness to cold temps - Certain diseases predispose pts to hypothermia (Eg diabetes, hypothyroidism, spinal cord injury)

Answer 20

AKA induced or controlled hypothermia - Medical treatment in which a pts body temp is deliberately lowered to around 32-34 degrees to help protect the brain and other organs after a cardiac arrest or severe brain injury - Uses cooling blankets, ice packs, or circulation of cool fluids - Slows down body's metabolism, reducing demand for O2

Answer 21

Mild Moderate Severe

Answer 22

32-35 degrees -Shivering - Cold, pale skin - Slurred speech or mild confusion - Numbness in extremities - Increased HR and RR

Answer 23

28-32 degrees - Shivering may stop - Stumbling or difficulty walking - Inability to think clearly or respond to questions - Drowsiness or lethargy - Slower HR, weak pulse - Reduced or absent urine output

Answer 24

<28 degrees - No shivering (body can't produce heat anymore) - Loss of consciousness - Very slow, irregular or absent pulse - Slow, irregular breath or apnea - Fixed dilated pupils - Risk of cardiac arrhythmias

Answer 25

Rapid rewarming can cause hypotension, arrhythmias or cardiovascular collapse **gradual rewarming is crucial**

Answer 26

Designed to provide the CNS w/ info on: Touch, temp, body position and pain

Answer 27

1st Order Neuron: - Transmit sensory info from PERIPHERY to CNS 2nd Order Neuron: - Communicate w/ reflex networks and sensory pathways in the SPINAL CORD and transmit to THALAMUS 3rd Order Neuron: - Relay info from THALAMUS to CEREBRAL CORTEX

Answer 28

Sensory Units Ascending Pathways Central Processing Unit

Answer 29

Made up of sensory receptors and the neurons that carry signals from those receptors

Answer 30

Type A: FAST - Myelinated = helps send messages quickly - Carry info about SHARP PAIN, touch and pressure - Help us react quickly to things like touching something hot (triggers reflexes) Type B : REGULAR SPEED -Myelinated - Transmit signals related to sensations from internal organs and autonomic functions (like HR) Type C: SLOW - Unmyelinated - Carry dull, aching, burning pain and sensations like warmth - Responsible for longer-lasting, more diffuse pain after the initial sharp pain

Answer 31

Cluster of nerve cell bodies located near the dorsal (back) of spinal cord containing the cell bodies of sensory neurons - When you feel something, the sensory nerve endings in the skin send that signal to the DRG, where the axon continues into the spinal cord to connect w/ second-order neurons

Answer 32

Neural pathways that carry sensory information from the spinal cord up to the brain - 2 Pathways Discriminative Pathway Anterolateral pathway Both pathways work together to provide a complete picture of sensory experiences Eg) if you touch something hot, the discriminative pathway helps you identify the exact spot and texture. The anterolateral pathway alerts you to the pain and temp

Answer 33

Helps you detect where and what kind of sensation is felt - responsible for transmitting detail sensation (eg fine touch, 2-point discrimination, pressure, vibration and proprioception (aware of body position) - Signals travel from the sensory receptors in skin though 1st order neurons to the spinal cord and then up to the brain without crossing over until they reach the brainstem

Answer 34

Mainly carry info about pain, temp and crude (less precise) touch. - Signals CROSS over the opposite side and thenascend to the brain

Answer 35

Neuron crossover - Helps in coordinating complex movement allowing for smoother and more integrated actions between both sides of the body - Also affects how info is processed Eg) Signals crossing over at brainstem (discriminative) allow brain to pinpoint locations and signal crossing over spinal cord (antero.) enable quicker response

Answer 36

Specific areas of the brain that process and interpret sensory information coming from the ascending pathway - Thalamus and somatosensory cortex - Helps recognize what is being felt and where it's coming from - Afferent pathway relays sensory info from PNS to CNS - Sensory impulse must be strong enough to reach threshold and general action potential **NO MESSAGE SENT IF STIMULI NOT STRONG ENOUGH**

Answer 37

Detect changes in environment caused by mechanical forces (Eg pressure on the skin, stretching muscles and feelings vibrations) Tactile Receptors: - Found in skin - Help us feel light touch, pressure and texture - Free nerve endings, Meissner corpuscles, Merkel disks, Pacinian corpuscles, hair follicles and Ruffini end organs Proprioceptors: - Located in muscles and joints - Sense body position and movement Baroreceptors: - Found in blood vessels - Detect changes in BP

Answer 38

Detect changes in temp - Respond rapidly to sudden changes in temp and then adapt to over the next few min although they do not adapt completely

Answer 39

Free nerve endings that are activated in response to actual or impending tissue injury - Respond to mechanical, thermal and chemical stimuli Mechanical: - Intense pressure applied to skin from extreme stretch or contraction of muscles Thermal: - Extreme hot or cold Chemical: - Tissue trauma, ischemia, and inflammation that cause release of chemical mediators from injured or inflamed tissue - Bradykinin, Histamine, serotonin, and potassium activate and also sensitize nociceptors Prostaglandins sensitizes nociceptors by lowering mechanical and thermal activation thresholds in nociceptive nerve endings thus reducing stimulus intensity required to elicit action potential

Answer 40

A or C fibres (1st order) of the PNS contracts 2nd order pain-transmission neurons (interneuron) in the spinal cord - 2nd order neurons ascend the spinal cord to the thalamus (relay centre) - 2nd order neurons synapse w/ 3rd order neurons leading to the somatosensory cortex where perception and localization of pain takes place = awareness

Answer 41

Body part map in cortx

Answer 42

Chemical neurotransmitters released from nociceptive neurons Glutamate = main excitatory neurotransmitter for pain (binds NMDA receptor) Substance P = elicit slow, excitatory action potentials. Prolongs and enhances the action of glutamate (mostly C-fibres) Endorphins = Inhibitory neurotransmitters aka "neuromodulators"

Answer 43

Neospinothalamic Tract: - FAST-conducting fibres (sharp, fast pain) transmit info to thalamus which relays to somatosensory area to provide precise location of pain Paleospinothalamic Tract: - SLOW-conducting fibres terminate in several thalamic regions including parts that project to the limbic system - Assoc. w/ emotional motivational aspects of pain - Projects into the reticular nuclei, contributing to alertness which indirectly influences hypothalamus to increase BP, HR etc

Answer 44

AKA Withdrawal Reflex No cerebral control -Activation of sensory neuron (afferent) = interneuron = automatic activation of motor neuron (efferent) = response by the effector

Answer 45

Postulates the presence of neural gating mechanisms at the segmental spinal cord level to account for interaction between pain and other sensory modalities - Nociceptors inhibit inhibitory neurons but when other receptors are activated they block this - Simultaneous firing of large diameter touch fibres (A-beta) can block transmission of impulses from small diameter myelinated and unmyelinated pain fibres - Pain intensity can be reduced during active tactile stimulation

Answer 46

Endogenous Opioid Peptides - Inhibitory neurotransmitters aka Neuromodulators: endorphins, enkephalins, dynorphins Act on mu, delta and kappa receptors Release from hypothalamus, limbic, reticular formation DESCENDING pathway Inhibit Substance P Induced secretion of Serotonin and Norepinephrine

Answer 47

Disease-producing potential of a microorganism High Virulence = causes diseases even when present in small numbers

Answer 48

Bacteria Fungi Virus Parasites Prions

Answer 49

Precautions with pts at all times to protect us and the pt Hand Hygiene**

Answer 50

Transmitted from direct or indirect contact from pt or their environment Medication resistant diseases (MRSA, C. diff) PPE: Gloves, Gown, and standard

Answer 51

Transmitted by talking, sneezing, coughing etc - Can travel 3-6ft from the source before falling to the ground due to gravity Eg) flu, pneumonia, Pertussis PPE: Simple mask, eye protection, and standard precautions

Answer 52

Transmitted by cough, sneezes etc - Pathogens can remain suspended in the air and travel far Eg) Varicella, Shingles, Measles, Tuberculosis PPE: N95, goggles, standard precautions. *Negative pressureroom*

Answer 53

- Ability of a pathogen to grow extremely rapidly and damage surrounding tissues - Might take a week or more to mount an immune response against the organism, so this exponential growth can rapidly overwhelm body defenses and disrupt cellular function

Answer 54

Pathogens production of toxins Exotoxin = proteins released by bacteria into surrounding tissues, that inactivate or kill host cells Eg) Staphylococcus aureus produces a toxin that leads to food poisoning Endotoxin = harmful non-protein chemicals released from the cell wall of GRAM NEGATIVE bacteria, elicit immune response - Released when the bacteria dies, causing macrophages to release cytokines - Initial dose of antibiotic may worsen symptoms by lysing bacteria and releasing larger amounts of endotoxins

Answer 55

Capsules can prevent phagocytosis - Antigenic shift of drift to avoid detections by immune system - Inducing endocytosis to hide certain bacteria in host cells

Answer 56

Pathogens can modify drug target site - Pathogens can modify uptake of a drug by altering its capsule, cell wall membrane - Pathogen can directly inactivate the drug

Answer 57

- Single-celled organisms that lack a nucleus

Answer 58

Shape: - Bacilli = rod shape - Cocci = spherical - Spirilla = spiral Organization: - Di = pairs - Strep = chains - Staphy = clusters Oxygen: Aerobic Anaerobic Gram Positive: - Contain thick cell wall made of peptidoclycan (helps retain VIOLET colour after staining) Eg) Staphylococcus, streptococcus, enterococcus Gram Negative: - Have thinner cell walls causing them to lose gram stain Eg) Escherichia, Klebsiella, Pseudomonas, Salmonella

Answer 59

Drug that is effective against pathogens Bactericidal = kills bacteria Bacteriostatic = Prevents growth and reproduction

Answer 60

Susceptible Organsim = antibiotic, antiviral, anti-fungal, antiprotozoal Chemical Structure of the Drug = group of drugs w/ similar properties and adverse effects Eg) aminoglycosides, sulfonamides Mechanism of Action = Inhibition of cell wall synthesis vs disruption of plasma membrane etc

Answer 61

1) Inhibition of Cell Wall Synthesis: - All bacteria have cell walls, so some antibiotics bind to specific proteins (penicilin-binding protein- PBP) that are essential to building that wall Eg) Beta-lactam antibiotics inhibit cell wall synthesis and tend to be bactericidal 2) Inhibitions of protein Synthesis: - Some antibiotics impede the synthesis of proteins at the ribosome (bacteriostatic) 3) Disruption of the Plasma Cell Membrane: - Anti-bacterial and anti-fungal medications interfere w/ pathogens plasma membrane, affecting permeability 4) Inhibition of Nucleic Acid Synthesis: - Antibiotics can disrupt the synthesis of DNA/RNA and bacterial cell division 5) Inhibition of Metabolic Pathways: - Bacteria often need a steady supply of nutrients and metabolites as they divide very rapidly - Some drugs are made to structurally resemble these building blocks so they can "fool" the cell into using them for growth - When used, these drugs block growth and synthesis

Answer 62

1) RNA Synthesis inhibitors: - Rifampin 2) Protein Synthesis inhibitors - Aminoglycosides - Ketolides - Macroslides - Streptogamins - Tatracyclines 3) Anti-metabolites: - Sulfonamides 4) DNA Synthesis Inhibitors: - Fluoroquinolones 5) Cell wall synthesis Inhibitors: - Carbapenems - Cephalosporins - Ioniazid - Penicilins - Vanco

Answer 63

Ability of organism to become unresponsive to the effects of an anti-infective over time Resistance is a major clinical problem, worsened by improper use of anti-infectives: -Mechanisms = pathogen destroys drug, pathogen prevents drug entry or pumps drug out of itself, pathogen alters target site of drug or undergoes mutation or adapts to drug Bacteria can change physiology to become resistant by: - Replicating rapidly - Mutating spontaneously and randomly - Acquiring resistance and promoting resistance to other bacteria via CONJUGATION = Transfer of small pieces of DNA called PLASMIDS that contain resistance promoting gene

Answer 64

Aka Nosocomial infections Main sources: Patient flora Invasive devices Medical personnel Medical Equipment

Answer 65

- Usually occurs in pts with weakened immune systems - Resistant to certain antibiotics - 60% or so of MRSA resistant to Penicilin

Answer 66

Found in wounds and pressure ulcers in hospitals and nursing homes - pts w/ weakened immune systems most at risk

Answer 67

"secondary Infections" - Develop when host flora is damaged by antibiotic, leaving nutrients and space for pathogens to grow -Broad spectrum antibiotics can cause these Eg) C. diff associated Colitis (caused by alteration of the normal bowel flora, which allows multiplication of C. diff) = Symptoms include abdominal pain, diarrhea containing blood and mucus = D/C antibiotics and consider fluid and electrolyte replacement, no anti-diarrheal Candidiasis = Candida albicans is naturally occurring fungus that lives on the body - Antibiotics can cause thrush or vaginal yeast infections when they disrupt the balance of healthy bacteria and candida

Answer 68

Use Culture and Sensitivity (C&S) testing to identify the organism and then the appropriate antibiotic - If not, begin w/ broad spectrum antibiotic then use a narrow-spectrum antibiotic - Antibiotics should NOT be used for viral infections or for coughs - If infection caused by one microbe, treatment w/ single drug is usually best (combining antibiotics can decrease their effectiveness and promote resistant strains Antibiotics are sometimes given: - To prevent secondary infections - Prophylactically for surgeries

Answer 69

1) Host defenses and Immune System Status 2) Local tissue conditions 3) Allergy history and drug hypersensitivity 4) Pregnancy, age, genetics

Answer 70

1) Inhibition of Cell Wall Synthesis: - Penicillin, Cephalosporin, Carbapenems, Vanco 2) Inhibitions of DNA Synthesis: - Fluoroquinolones, Sulfonamide 3) Inhibition of Protein Synthesis: - Tetracyclines, Macrolides, Aminoglycosides 4) Disruption of Call Membrane: - Polymyxins

Answer 71

Bacterial cell walls are made of peptidoglycan molecules that form a set of chains called Penicillin-binding proteins (PBPs) Penicillin (Beta-lactam): - Beta lactum rings structure of penicillin binds to PBPs causing lysis of growing bacteria by damaging walls *Mainly active against gram+ bacteria** Resistance to Penicillin = secreting an enzyme that splits penicillin's beta lactam riing Developed B-Lactamase Inhibitors = Clavulanate, Tazobactum Narrow Spectrum (Penicillin V&G) = Broad Spectrum (amoxicillin, Ampicillin) = Extended Spectrum (Piperacillin - one of the broadest)

Answer 72

- Mainly active against gram+ bacteria - Most have narrow spectrum - Widely distributed to tissues - Nearly all are rapidly excreted by kidneys (mindful w/ dosage could = renal impairment) - Short Half-lives (monitor 30min after infusion) - C. diff or other superinfections

Answer 73

Strong, repeating network of carbohydrate and protein chains, CONSTRUCTED BY ENZYMES CALLED PENICILLIN_BINDING PROTEINS (PBP)

Answer 74

- Contain beta-lactam rings that interfere w/ cell wall synthesis (like penicillin) - Over 20 cephalosporins in 5 generations - Begin w/ 'cef' or 'ceph' 5%-10% of pts allergic to penicillin are hypersensitive to cephalosporins **Contraindicated for clients who have experienced anaphylaxis following penicillin exposure**

Answer 75

- Effective against GRAM - bacteria (except 1st gen) - Risk of pseudomembranous colitis - Because it eliminates through kidneys, need to monitor intake and output, BUN, and serum creatine - If client is taking NSAIDs, MONITOR BLOOD COAGULATION STUDIES because ceph increases the effect of platelet inhibition

Answer 76

- Contain beta-lactam rings that interfere w/ cell wall synthesis (like penicillin) - Broad-spectrum abx w/ similar properties to other beta-lactams - Slightly different beta-lactam ring making it resistant to beta-lactamase *Better activity against serious Gram Negative and multidrug-resistant infections than ceph and penicillin Sometimes "last resort" for treating multidrug-resistant infections Medications: - Meropenem, Imipenem-cilastatin (cilastatin blocks renal dipeptides, an enzyme responsible for the excretion of imipenem)

Answer 77

- Imipenem-cilastatin - Cefotaxime or ceftriaxone - Penicillin G potassium or Amoxicillin - Gentamicin

Answer 78

DNA = recipe book RNA = chefs assistant (makes proteins by carrying out info/instructions on DNA Protein synthesis in bacterial replication: - Process by which bacteria produce proteins required for their growth and reproduction - Involves 2 main stages: Transcription (copying info from DNA) and Tramslation (decoding info to make protein) in 30S and 50S subunit of ribosome

Answer 79

Fluoroquinolones: - Ciprofloxacin**, Moxifloxacin etc - Act on DNA gyrase and topoisomerase IV, preventing relaxation of supercoil and separation of new strands into daughter cells - Mostly GRAM NEGATIVE bacteria - Used for urinary tract infections, GI, respiratory, and skin infections Many Adverse Effects: - GI toxicity, cardiotoxicity, nerve damage, phototoxicity, cartilage toxicity leading to tendon abnormalities

Answer 80

Sulfonamides: - Suppress DNA replication by inhibiting synthesis of folic acid (folate) - Adverse effects include hypersensitivity reactions, blood abnormalities, nausea, vomiting, anorexia - INCREASE FLUID INTAKE TO 1500-3000mL per day (r/t side effect of crystalluria = dehydration = crystal formation = kidney stones) - Medication = Trimethoprim-Sulfamethoxazole (bactrim)

Answer 81

Tetracyclines: - Inhibit Protein synthesis at the 30S subunit by preventing tRNA from binding mRNA - Active against GRAM + AND Gram - bacteria - PO meds SHOULD BE TAKEN ON EMPTY STOMACH - Bind metal ions so should NOT be taken w/ milk, antacids or iron supplements - Can be hepatotoxic and cause photosensitivity - Women on the Pill may be susceptible to vaginal candidiasis - Tetracycline DECREASES the effectiveness of the pill

Answer 82

Eg) Thromycin - Inhibit bacterial protein synthesis by binding to the 50S ribosomal subunit - Most effective against Gram + bacteria - Alternative drugs for pts allergic to penicillin - Decrease hepatic metabolism of other drugs thus drug interaction are possible - Macrolides are contraindicated in clients w/ hepatic disease - Single dose of azithromycin is EFFECTIVE AGAINST NEISSERIA GONORRHOEAE

Answer 83

Genamicin, Tobramycin, Streptomycin - Bind to 30S causing misreads of mRNA - Has serious adverse effects including nephrotoxicity, ototoxicity (hearing loss and tinnitus), neurotoxicity, neuromuscular blockade - Assoc w/ post-antibiotic effect - Must be given parentally - Effective against Gram - bacteria - May cause muscle cramping* which is NOT an adverse affect

Answer 84

**Severe Gram + infections resistant to safer antibiotics** - Use to treat C. diff** Effective against MRSA Mechanism of action: - Inhibits synthesis of bacterial cell wall - Increases permeability of bacterial cell membrane - Alters RNA synthesis Narrow Therapeutic Range: - Peak = highest concentration in bloodstream, measured 1-2hrs after a vanco infusion - Troughs = Lowest concentration in bloodstream, usually measured 30min before next dose **BETWEEN 10-20 mcg/mL IS NORMAL** Adverse Effects: - **"red man" syndrome** = CAUSED BY RAPID INFUSION, flushing, tachy, rash on upper body (hypotension*) - Nausea, rash, fever, chills - Burns during administration** can slow it down more or get a bigger vein/pic line Serious Adverse Effects: - Confusion, seizures and hallucinations - Extravasation leading to tissue necrosis - **Ototoxicity (cause balance issues, vertigo) - **Nephrotoxicity - Anaphylaxis **Give Vanco over 1hr**

Answer 85

Kidneys (pyelonephritis), Bladder (cystitis), Urethra Caused by: - Escherichia coli (E. coli) - Klebsiella, Proteus, Staphylococcus saprophyticus (sexually active women), enterococcus species Treatment: - Sulfonamides - Fluoroquinolones OR - Nitrofurantoin (macrobid) = used in uncomplicated acute cysritis and usually for prophylaxis of recurrent UTI) MOA: - Intermediates attack bacterial ribosomal proteins - Prevents DNA and RNA synthesis - Prevent protein synthesis** - Inhibits Cell Wall synthesis** Adverse Effects: - Hypersensitivity responses - Nausea & Vomiting - Anorexia - Headache - Rash Serious Adverse Effects: - Hepatotoxicity - Acute and chronic pulmonary toxicity

Answer 86

Pathophysiology: - Caused by Mycobacterium tuberculosis - Spread via AIRBORNE DROPLETS - Immune system response leads to formation of tubercles in lungs that surround mycobacteria (visible on x-ray) - In healthy person, mycobacteria remains dormant, person is asymptomatic - If immunocompromised, infection becomes active Pharmacotherapy: - Initial phase = Active cells are killed - Continuation Phase = Dormant mycobacteria are killed (may last 6-12months) - Directly observed therapy (DOT) = necessary for high-risk pats that are non-compliant *Nurse must see patient swallow pills* Eg) Isoniazid = FIRST LINE Ciprofloxacin = SECOND LINE MOA = Inhibits synthesis of mycollic acid, a critical component of mycobacterial cell wall Adverse Effects: - Rash - Fever - Numbness of hands and feet Serious Adverse Effects: - **Neurotoxicity (no EtOH, related to decrease in Vit B6) - Hepatotoxicity