Quiz 5 Flashcards
Vascular stage of infective inflammation
Prostaglandins are released
Vasoconstriction–>vasodilation–>exudation
(Exudate: wound damage)
Cellular stage of infective inflammation
Neutrophils: fight infection
Edema = build up of fluid in interstitial space
Opsonization stage for infective inflammation
Pathogens are tagged for removal
Contributing factors for antibiotic resistant microorganisms
Skipping doses
Inappropriately using antibiotics
Stopping antibiotic
Giving too small dose of antibiotic
Frequently taking antibiotics as prescribed
Antibiotics for influenza infection
How long does a culture and sensitivity take?
48-72 hours
Antimicrobrial vs antibacterial vs antifungal vs antiviral
anti-infective
Harmless, some are pathogenic
Yeasts, filamentous, and dermatophytes
Viruses replicate only inside the living cell
Narrow-spectrum vs broad-spectrum antibiotics
Narrow: 1 specific bacteria
Broad: everything is targeted
Gram negative vs gram positive
+ = normal and simple
- = extra wall, complicated. Harder to treat due to extra shield
Bacteriostatic vs bactericidal
Static: inhibits growth
Cidal: Kills bacteria
Causes of opportunistic infection
Genetic predisposition
Chemotherapy for cancer
HIV/AIDS infection
Bone marrow disease
Pregnancy
What is empiric therapy
treatment of an infection before specific culture information has been reported or obtained
Caution: Salicylates
Teratogenic
Do not give to children = reye syndrome (potentially lethal encephalopathy)
Oxicams
Medication name
Action
use
Meloxicam
Action: inhibits prostaglandin synthesis
Use: osteoarthritis, rheumatoid arthritis
Requires prescription. Preferred for long term use, generally well tolerated
Acetic acid derivative: indomethacin
Action
Use
Strong anti-inflammatory
Gout attacks, rheumatoid arthritis, tendonitis
Benefits outweigh risks
Acetic acid derivatives: indomethacin
Severe adverse effects
Contraindication
GI issues, renal impairment, and bleeding
Hx of GI bleeds
Acetic acid derivative: Ketorolac
Risk
No antipyretic effect
Greater risk for bleeding and ulcer
Selective Cox-2 Inhibitor
Adverse effects
Contraindication
GI distress/ulceration and bleeding
Increased cardiovascular and cerebrovascular risks
Contraindication: renal dysfunction
Anti gout drugs
Colchicine. What is it
Action
Use
Side effects
administration
Anti-inflammatory gout drug
Inhibits migration of leukocytes to inflamed sites
Alleviates and prevents gout symptoms
GI distress, N/V/D
PRN for flaring pain due to gout
Action of probenecid
Administration
Adverse effects
Blocks re absorption of uric acid which promotes its excretion
Taken daily for prevention
Adverse effects: kidney stones
How are prostaglandins formed?
Arachidonic acid: building block + Cyclooxygenase enzyme: turns arachidonic acid into prostaglandins
Function of COX-1
Platelets: proper adhesion, ensure clotting, stop bleeding
GI tract: mucous secretion and protects GI lining
Kidneys: maintain blood flow and function, perfuses kidneys
Function of COX-2
Numerous tissues. Inactivates
Pain and inflammation
NSAID
Action
Inhibit COX enzyme
Inhibit synthesis of prostaglandins: Analgesic effect, antipyretic effect, inhibit platelet aggregation
Salicylates
Medication name
Action
Adverse effects
Aspirin
Action: inflammatory, antiplatelet, antipyretic effects
Adverse effects: tinnitus
Propionic acid derivatives
Medication name
Action
Use
Ibuprofen
Action: inhibits prostaglandin synthesis
Use: OTC pain, osteoarthritis, fever, dysmenorrhea
Acetic acid derivatives: Ketorolac
Use
Recommendation
Exceptional pain relief
Short-term management of pain (<5 days). After 5 days risks outweigh benefits
Selective COX-2 Inhibitor
Prototype
Action
Benefits
Celecoxib (celebrex)
Selectively inhibits COX-2 enzyme without inhibition of COX-1
Benefits: inhibits pain and inflammation, less adverse effects
NSAIDs in older adults
> drug interactions
incidence of GI distress, ulceration
Encourage > fluid intake: reduce nephrotoxicity
Non-opioid analgesic antipyretics
Medication name
Action
Use
Max dose
Acetaminophen
Inhibits prostaglandin synthesis
Use for muscular aches and pain, fever
Max dose: 4 g/day. Give less Tylenol for those with liver failure
Gout pathophysiology
inflammatory disease of joints, tendons, and other tissues
Uric acid solidifies in the joints
Causes of gout
uric acid accumulation
Defect in purine metabolism
Purine-containing foods
organ meats, sardines, salmon, gravy, herring, liver, meat, soups, and alcohol
How is uric acid made
Purine becomes uric acid by the kidneys
Action of allopurinol
Decreases uric acid synthesis
Glucocorticoids/Corticosteroids
Protype
Use
Prednisone
Correct Addison’s disease, decrease inflammation, weakens immune response, inhibit tissue repair
Specific uses of glucocorticoids/corticosteroids
Inflammatory bowel problems, rheumatoid arthritis, asthma, dermatitis
Preferred short-term: adverse effects get worse over time
Adverse effects of glucocorticoids/corticosteroids
Moon face, hypertension, > risk of infection, diabetes mellitus, hyperglycemia, fluid retention, hypokalemia, mood swings, appetite changes, blurry vision
When would you want to weaken the immune system
Organ transplant, autoimmune disorder
How do you discontinue glucocortoicoids/corticosteroids
tapering
S&S of corticoids/glucocorticoids
fatigue, weakness, body aches and joint pain, nausea, loss of appetite, mood swings
Nursing interventions for corticosteroids/glucocorticosteroids
Monitor vital signs and lab values
Watch for evidence of hypokalemia: Heart dysrhythmias, muscles feel weird
Assess for side effects of corticosteroids
Advise pts to eat foods high in potassium
General adverse reactions of Beta-lactam antibacterials
N/V/D
Allergic reaction: hypersensitivity, rash, pruritus, hives, anaphylactic shock
Superinfection
What is a superinfection
usual sites of superinfection
Secondary infection when normal flora killed
Usual sites: Mouth: thrush, fungal
Genitourinary tract- yeast infection
Intestines: C-Diff
Penicilins
Side effects/adverse reactions
Hypersensitivity, anaphylaxis, superinfection, GI distress, clostridium difficile (associated diarrhea)
Broad-spectrum penicillins
vs
Extended- spectrum penicillins
Ampicillin
Piperacillin
Beta-lactamase inhibitors
Action
Inhibit bacterial beta-lactamases extending
Beta-lactamase inhibitor
Administration
Combined with penicilinase-sensitive pencilin
Tazobactam+piperacilin
What is beta lactamase
Enzyme produced by bacteria to destroy B-lactam ring thus destroying pencillin
Cephalosporins
Adverse effects
Dysgeusia (weird taste in mouth), GI distress, headache, nephrotoxicity
Cephalosporins
Drug interactions and symptoms
Alcohol: flushing, dizziness, headache, nausea, vomiting, and muscular cramps
What is cross sensitivity
If you have an allergy to some substance, then you are much likely to have an allergy to similar substances.
What is cross resistance
Resistance to one antimicrobial agent may confer resistance to similar drugs.
Aminoglycosides
Prototype
Use
Administration
Adverse effects
Gentamicin
Treats serious infection
Combination with other antibiotics
Ototoxic and nephrotoxic
Aminoglycoside dosing
Extended-interval dosing Concentration-dependent on effects
Postantibiotic effect
Loading dose
What is a loading dose
initial higher dose of a drug that may be given at the beginning of treatment to RAPIDLY achieve a therapeutic level
Extended-interval dosing
once daily; higher doses initially to get concentration of drug
Post-antibiotic effect
organisms do not grow for several hours even after discontinuation of medication
Fluoroquines
Prototype
Effective against
Side effects
Ciprofloxacin
Gram negative
Photosensitivity, eye damage, tendonitis, tendon rupture
(More likely to get sunburned when taking this)
Tetracycline
Prototype
Adverse effects
Administration
Tetracycline hydrochloride
GI upset, superinfection, photosensitivity, renal and hepatic impairment, permanent tooth discoloration
> 8y/o
Sulfonamides
Prototype
Use
Action
trimethoprim-sulfamethoxazole
Prevents further growth and replication
Inhibit bacterial synthesis of folic acid
Adverse effects of sulfonamides
GI upset
Superinfection
Renal: acute renal failure, crystalluria, hyperkalemia
(stay hydrated to flush crystals out)
Urinary antiseptics
Prototype
Use
Adminstration consideration
Adverse effects
Nitrofurantoin
used only for UTIs. Relief of inflammation, hypermotility, and pain
Give with food
Hepatotoxic and nephrotoxic
Urinary analgesic
Prototype
Function
Phenazopyridine (pyridium)
Helps with burning, urgency, and frequency with UTI
NOT AN ANTIBIOTIC
Macrolides
Prototype
Function
Contraindication
Erythomycin
Stops growth of bacteria. Prevent and treat infections in many different parts of the body
Hepatotoxic: existing hepatic injury
When to take tetracyclines
Empty stomach
1 hour before or 2 hours after eating
Food and drug interactions of tetracyclines
Dairy-calcium
Antacids-calcium carbonate
Iron supplements
Calcium and iron + tetracycline disrupts chemical structure = prevent absorption
Vancomycin
Use for
Adverse effects
MRSA
C-Diff
Drug resistant organisms
Red man syndrome
What is red man syndrome
Can occur if Vancomycin is given IV too fast
Histamine release
clinical manifestation of red man syndrome
flushing, erythema, pruritus, affecting upper body, neck and face > lower body, myalgia, dyspnea, and hypotension
Nursing interventions of red man syndrome
stop infusion, administer antihistamine, can restart at a slower rate once symptoms resolve
