Test 5 Flashcards
How much water should we teach our patients to drink with medication?
8 ounces
What is the drug of choice for MRSA diseases?
Vancomycin
What should we monitor when giving drugs such as Dramamine?
Dizziness
What drug is the drug of choice for fever in children? Do we give ASA?
Drug of choice: Tylenol
If you give children ASA, it will cause Reyes Syndrome
What do we ask during assessment for antibiotic drugs?
Allergies
What are side effects of Erythromycin?
Monitor for ringing in ears - tinnitus
What is an Antiviral drug and what is its purpose?
Antibiotics help immune system fight bacteria.
Antiviral help immune system to fight viruses (cyclovir, retrovir)
What tests should be completed before administering antibiotics?
Culture and sensitivity
Does Aluminum hydrate cause diarrhea or constipation?
Constipation
What are the side effects of Retrovir? What would be the next step?
Bone marrow suppression and change the drug
What drugs should not be used with patients with Glaucoma?
Atropine
Atrovent
Scopamine patches
Any sulfa drug-bactrim
Tagamet
Zrytec
Can stool softeners be used long term? Why or why not?
No because decreased bowel tone
When giving ear drops what is a priority to ensure prior to administration?
Make sure to open canal by removing earwax and positioning patient
What is the most common eye drop? What is it used for?
Restasis
-Used for dry eyes
What drugs cause IOP intraocular pressure? As opposed to what drugs are used for intraocular pressure?
Corticosteroids
What is eye ointment given to newborns at birth?
Erythromycin ointment
Gram positive organisms
Very thick cell wall, known as a peptidoglycan, thick outer capsule.
Gram negative organisms
More complex cell wall structure, small outer capsule and peptidoglycan layer, with 2 cell membranes; harder to treat.
Sulfonamides
One of the first groups of antibiotics.
Sulfonamide Indications
Treatment of UTI’s
SMX-TMP is commonly used for outpatient Staphylococcus infections because of the high rate of community-acquired MRSA infections.
Sulfonamide Indications
Beta-Lactam Antibiotics
Some bacterial strains produce the enzyme beta-lactamase, providing bacterial resistance to these antibiotics.
Penicillins Indications and adverse effects
Prevention and treatment of infections caused by susceptible bacteria, such as:
Gram-positive bacteria, including Streptococcus spp., Enterococcus spp., and Staphylococcus spp.
Penicillins Contraindications
Not all end in “cillin” (e.g., Zosyn, Augmentin)
Many med errors have occured when a penicillin drug called by its trade name is given to a patient with a penicillin allergy.
Penicillins Adverse Effects
Patients allergic to penicillins have an increased risk of allergy to other beta-lactam antibiotics. (penicillins, cephalosporins, carbapenems, monobactams)
Only patients with a history of throat swelling or hives from penicillin should not receive cephalosporins.
Cephalosporins (5 generations)
Structurally and pharmacologically related to penicillins.
Broad spectrum
Cephalosporins: First Generation Drugs
Cefazolin (Ancef)
Cephalexin (Keflex)
Cephalosporins: Second Generation
Better gram-negative coverage than first generation.
Cephalosporins: Third Generation
Most potent group against gram-negative bacteria.
Ceftriaxone (Rocephin)
*3rd generation cephalosporin
*IV and IM, long half-life, once-a-day dosing
*Easily passes meninges and diffused into cerebrospinal fluid to treat central nervous system infections
Ceftazidime (Ceptaz, Fortaz, Tazidime)
*3rd generation cephalosporin
*Used for difficult-to-treat organisms such as Pseudomonas spp.
*Resistance is limiting usefulness.
Carbapenems
*Broadest antibacterial action of any antibiotics to date.
*Must be infused over 60 minutes.
*May cause drug-induced seizure activity.
Macrolides: MOA
Prevent protein synthesis within bacterial cells
Macrolides: Indications
*fidaxomicin (Dificid, Dificlir): newest drug in this class and used ONLY for Clostridium difficile-associated diarrhea.
Macrolides: Adverse Effects
*GI effects, primarily with erythromycin
*Hepatotoxicity
*Jaundice (aka icteric sclera)
Tetracyclines
*Bind (chelate) to Ca+++ and Mg++ and Al+++ ions to form insoluble complexes.
*Dairy products, antacids, and iron salts reduce oral absorption of tetracyclines.
*Should not be used in children younger than age 8 years or in pregnant or lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth.
Tetracyclines: Adverse Effects
*Alteration in intestinal flora may result in:
-Superinfection
-Pseudomembranous colitis (C. diff)
*May also cause:
-Vaginal candidiasis
-Gastric upset
-Enterocolitis
-Maculopapular rash
Nursing Implications for Antibiotics
*Before beginning therapy, assess for drug allergies; renal, liver, and cardiac function.
*Obtain a thorough patient health history, including immune status.
*Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed.
*The most common adverse effects of antibiotics are nausea, vomiting, and diarrhea.
Multidrug-Resistant Organisms
Organisms that are resistant to one or more classes of antimicrobial drugs.
MRSA
*Approximately 50% of staphylococcal infections contracted in the community involve MRSA.
VRE & MRSA
Newer antibiotics have been developed to successfully treat VRE and MRSA.
ESBL
*Organisms that produce ESBL are resistant to all beta-lactam antibiotics and aztreonam.
*Use of carbapenems: resistance occurred; production of carbapenemase, which renders all carbapenems ineffective.
Aminoglycosides
POTENT antibiotics with SERIOUS toxicities, kill mostly gram-negative bacteria (some gram-positive bacteria)
Aminoglycosides Indications
*Often used in combination with other antibiotics for synergistic effects (beta-lactams or vancomycin)
*Aminoglycosides are poorly absorbed through the GI tract and are given parenterally.
Aminoglycosides Adverse Effects
*Cause serious toxicities
-Nephrotoxicity (renal damage)
-Ototoxicity (auditory impairment and vestibular impairment [8th cranial nerve])
*Most monitor drug levels to prevent toxicities.
Aminoglycosides Therapeutic Drug Monitoring
*Serum levels measured for toxicity prevention. Levels must be at least eight times higher than the MIC for the aminoglycosides to be effective.
Quinolones
Absorption reduced by antacids
Quinolones Indications
Anthrax (ciprofloxacin)
Quinolones Interactions
*Oral quinolones: antacids, calcium, magnesium, iron, zinc preparations, or sucralfate
*Enteral tube feedings
*Oral anticoagulants
TAKE INTERACTING DRUGS 1 HOUR BEFORE OR AFTER TAKING QUINOLONES
Quinolones Adverse Effects
*CNS
-Convulsions
*GI
-Increased liver function study results
*Cardiac
-Prolonged QT interval
*Other
-Ruptured tendons
-Tendonitis
Black box warning: increased risk of tendonitis and tendon rupture
Miscellaneous Antibiotic Drugs
*clindamycin (Cleocin)
*linezolid (Zyvox)
*nitrofurantoin (Macrodantin, Furadantin)
*vancomycin (Vancocin, Vancoled)
Clindamycin (Cleocin)
*May cause pseudomembranous colitis (aka C. difficile infection)
*Additive neuromuscular blocking effects in patients receiving neuromuscular blockers (like vecuronium)
linezolid (Zyvox)
*Used to treat vancomycin-resistant Enterococcus faecium (VREF, VRE), hospital-acquired, and skin structure infections, including those with MRSA.
*May cause hypotension, serotonin syndrome if taken with SSRIs, and reactions if taken with tyramine-containing foods.
nitrofurantoin (Macrodantin)
*Primarily used for UTIs
*Drug concentrates in the urine
*May cause fatal hepatotoxicity
vancomycin (Vancocin)
*Treatment of choice for MRSA and other gram-positive infections
*Must monitor blood levels to ensure therapeutic levels and prevent toxicity.
*May cause ototoxicity and nephrotoxicity.
*Red man syndrome may occur.
*Should be infused over 60 minutes.
*Rapid infusions may cause hypotension.
Viruses
*Viruses are difficult to kill because they live inside the cells.
*Any drug that kills a virus may also kill cells.
Antiviral Drugs
*Antiviral drugs kill or suppress the virus by destroying virions or inhibiting the ability of viruses to replicate.
*Effective drug therapy is available for a small number of viral infections.
An 82-year-old woman is unable to take the influenza vaccine because of allergies, but she has been exposed to the virus through a family reunion. She does not yet have symptoms of the flu. Which option would be best for her?
A. She should receive the flu vaccine as soon as possible.
B. She should receive zanamivir (Relenza) in the inhalation form.
C. She should begin oral oseltamivir (Tamiflu) therapy when symptoms begin.
D. She should begin oral oseltamivir (Tamiflu) therapy as soon as possible.
D. She should begin oral oseltamivir (Tamiflu) therapy as soon as possible.
HSV-2 (genital herpes)
*“Neonatal” herpes can be life-threatening. Mothers with active genital herpes lesions should give birth via “C-section”
Shingles (HHV-3 or VZV)
*Painful: opioids for pain control
*A new vaccine, Zostavax, is available for prevention of herpes shingles in patients 50 years of age and older.
Hepatitis C
*Leading cause of liver failure leading to liver transplantation.
*Transmission: infected blood and sexual contact
Antiviral Drugs (Non-HIV) MOA
Most of the current antiviral drugs work by blocking the activity of a polymerase enzyme that normally stimulates the synthesis of new viral genomes.
Antiviral Drugs (Non-HIV) Adverse Effects
*Healthy cells are often killed also, resulting in serious toxicities.
Ganciclovir (Cytovene)
*Used to treat infections caused by CMV.
*CMV retinitis
oseltamivir (Tamiflu) and zanamivir (Relenza)
*Active against influenza types A and B.
*Reduce duration of illness
*Treatment should begin within 2 days of influenza symptom onset.
Ribavirin (Virazole)
*Inhalation form (Virazole) used for hospitalized infants with RSV infections.
HIV and AIDS
*New cases of HIV have decreased by 19% since between 2005 and 2014.
*The risk for transmission to health care workers via percutaneous (needlestick) injuries is currently calculated at approximately 0.3%.
Highly active antiretroviral therapy (HAART)
*Now considered standard treatment, started immediately upon confirmation of HIV infection.
Reverse transcriptase inhibitors (RTIs)
Block activity of the enzyme reverse transcriptase, preventing production of new viral DNA.
PI’s (protease inhibitors)
Inhibit the protease retroviral enzyme, preventing viral replication.
Fusion inhibitors
Inhibit viral fusion, preventing viral replication.
Enfuvirtide (Fuzeon)
*Suppresses the fusion process whereby a virion is attached to the outer membrane of a host T cell before entry into the cell and subsequent viral replication.
*Used for treatment of HIV infection in combination with other antiretroviral drugs.
*Drug is currently available only in injectable form.
Indinavir (Crixivan)
*Best absorbed in gastric environment therefore, best taken on empty stomach.
Maraviroc (Selzentry)
*Oral route only
*Interacts with multiple medications. Wait one hour.
Nevirapine (Viramune)
Often combined with NRTIs (nucleoside reverse transcriptase inhibitors)
Tenofovir (Viread)
*Adverse effects: lactic acidosis, severe hepatomegaly
*Often used in combination with other agents
Zidovudine (Retrovir)
*AZT
*Safely used in pregnancy and newborns
Nursing Implications for Antivirals
*Before beginning therapy, assess medical history, including allergies.
*Assess baseline vital signs and nutritional status.
*Emphasize hand washing before and after administration of meds
*Inform patients that antiviral drugs are not cures but do help to manage symptoms.
*Instruct patients on the importance of taking these meds exactly as prescribed and for the full course of treatment.
Antitubercular Drugs
*TB is most commonly characterized by granulomas in the lungs: nodular accumulations of inflammatory cells (e.g., macrophages, lymphocytes) that are delimited (“walled off” with clear boundaries) and have a center that has a cheesy or caseated consistency
Incidence for multidrug TB cases
Concern now: increasing number of multidrug-resistant tuberculosis (MDR-TB) cases
Bacille Calmette-Guerin (BCG)
*Used in much of the world to vaccinate young children against TB.
*Does not prevent infection
*Reduces active TB by 60% to 80%
*Can cause false-positive results on the tuberculin skin test
Antitubercular Drug Therapy Considerations
*Successful treatment: several antibiotic drugs for at least 6 to 12 months, sometimes up to 24 months!
*Monitor patient compliance closely during therapy.
A patient with TB has been taking antitubercular drugs. A sputum culture is ordered to test for acid-fast bacilli. When is the best time for the nurse to obtain the sputum culture?
A. In the morning
B. Noon
C. 5pm
D. 10pm
A. In the morning
Isoniazid
*Drug of choice for TB
*Metabolized in the liver through acetylation–watch for “slow acetylators” (patients with genetic deficiency)
*Contraindicated with liver disease
Ethambutol (Myambutol)
*Diffuses into the mycobacteria and suppresses RNA synthesis, inhibiting protein synthesis.
*Contraindications: optic neuritis, pediatric patients (younger than 13)
Rifabutin, Rifampin, and Rifapentine
*Adverse effects: turns urine, feces, saliva, skin, sputum, sweat, and tears a red-orange-brown color
A patient with a diagnosis of TB will be taking INH as part of the anti-TB therapy. When reviewing the patient’s chart, the nurse finds documentation that the patient is a “slow acetylator.” This means that:
A. the dosage of INH may need to be lower to prevent INH accumulation.
B. the dosage of INH may need to be higher because of the slow acetylation process.
C. he should not take INH.
D. he will need to take a combination of anti-TB drugs for successful therapy.
A. the dosage of INH may need to be lower to prevent INH accumulation
Nursing Implications for TB Drugs
*Therapy may last for up to 24 months.
*Remind patients that they are contagious during the initial period of their illness–instruct in proper hygiene and prevention of the spread of infected droplets.
*Patients should not consume alcohol while taking these medications
*Rifampin causes oral contraceptives to become ineffective
*Watch for lack of clinical response to therapy, indicating possible drug resistance.
The patient’s wife is taking rifampin to prevent her from developing a TB infection. Which statement by the wife indicates that further teaching is needed?
A. “Because my oral contraceptives will not work while I am taking rifampin, I will use another form of birth control.”
B. “I will take the medication for 1 week and then stop.”
C. “I will avoid prolonged exposure to the sun.”
D. “My urine may turn a reddish color when taking rifampin.”
B. I will take the medication for 1 week and then stop.
Hydrochloric acid (HCl)
Aids in digestion, barrier to infection
Bicarbonate
Base that is a natural mechanism for hyperacidity prevention
Pepsinogen
Enzymatic precursor to pepsin, an enzyme that digests dietary protein
Intrinsic factor
glycoprotein which facilitates gastric absorption of vitamin B12
Mucus
protects the stomach from HCl and digestive enzymes
Prostaglandins
variety of anti-inflammatory and protective functions
Glands of the stomach
Gastric
*the cells of the gastric gland are the largest in number and of primary importance when discussing acid control.
Parietal cells
Produce and secrete HCL - primary site of drug action
Chief Cells
*Pepsin breaks down proteins (proteolytic)
Mucous cells
Provide a protective mucus coat against self-digestion by HCl and digestive enzymes
Hydrochloric Acid
*Secreted by parietal cells when stimulated by food, caffeine, chocolate, and alcohol
*This acidity aids in the proper digestion of food, and serves as one of the body’s defenses against microbial infection via the GI tract.
Antacids
*Aluminum, magnesium, calcium, and/or sodium - containing antacids
*Many antacid preparations also contain the antiflatulent (antigas) drug simethicone.
*Many aluminum- and calcium-based formulations also include magnesium, which not only contributes to the acid-neutralizing capacity but also counteracts the constipating effects of aluminum and calcium.
Antacids Indications and Contraindications
Contraindications:
-Severe renal failure or electrolyte disturbances
Aluminum Salts
*Have constipating effects
*Often recommended for patients with renal disease (more easily excreted)
Magnesium Salts
*Commonly cause diarrhea
*Dangerous when used with renal failure
Sodium Bicarbonate
*Buffers the acidic properties of HCl
*Sodium content may cause problems in patients with HF, hypertension, or renal insufficiency
Antacids Adverse Effects
*Overuse: metabolic alkalosis
Antacids Drug Interactions
*Absorption of other drugs to antacids
*Chelation
*Increased stomach pH
*Increased urinary pH
Nursing Implications Antacids
*Patients with HF or hypertension should not use antacids with high sodium content.
*Most medications should be administered 1 to 2 hours after an antacid.
*Be sure that chewable tablets are chewed thoroughly and liquid forms are shaken well before giving.
*Administer with at least 8 oz of water to enhance absorption
Histamine 2 (H2) Receptor Antagonists
*Reduce acid secretion
H2 Antagonists MOA
*Competitively block the H2 receptor of acid-producing parietal cells
H2 Antagonists Drug Interactions
*Smoking has been shown to decrease the effectiveness of H2 blockers.
Proton Pump Inhibitors
*The parietal cells release positive hydrogen ions (protons) during HCl production.
Proton Pump Inhibitors Suffix
-prazole
PPI MOA
*Results in achlorhydria - all gastric acid secretion is temporarily blocked
PPI Adverse Effects
*Osteoporosis and risk of wrist, hip, and spine fractures in long-term users.
*Link between PPIs and dementia as well as development of systemic lupus erythematous (SLE)
PPI Drug Interactions
*Increase serum levels of diazepam and phenytoin
*Warfarin: increased chance of bleeding
Nursing Implications PPI
*May increase serum levels of diazepam and phenytoin; may increase chance for bleeding with warfarin
*NG tube must be at least 16 gauge or the tube may become clogged
Sucralfate (Carafate)
*May impair absorption of other drugs; give other drugs at least 2 hours before sucralfate
Antidarrheals MOA
*Antimotility drugs: anticholinergics
-Slow peristalsis by reducing the rhythmic contractions and smooth muscle tone of the GI tract
Antidiarrheals: Nursing Implications
*Do not give bismuth subsalicylate to children or teenagers with chickenpox or influenza because of the risk of Reye’s syndrome
Laxatives Adverse Effect
*All laxatives can cause electrolyte imbalances
Laxatives Nursing Implications
*Patients should take all laxative tablets with 6 to 8 oz of water.
*Patients should take bulk-forming laxatives as directed by the manufacturer with at least 240 mL (8 oz) of water.
Antiemetics and Antinausea MOA
*Most work by blocking one of the vomiting pathways, thus blocking the stimulus that induces vomiting.
Antibacterial Drugs
*Most common bacteria are Streptococcus pyogenes and Staphylococcus aureus
Nursing Implications Isotretinoin (Amnesteem)
*Ensure that strict guidelines are in place for monthly pregnancy testing and prescription renewal.
*Required patient counseling regarding use of two forms of contraception and not becoming pregnant during use.
Nursing Implications Antibacterial Drugs
*Protect affected area from sunlight.
*Do not double up on dose if a dose is missed.
*Ensure proper disposal of contaminated dressings.
*Provide patient and family teaching as necessary for self-care.
*Monitor for therapeutic responses.
*Monitor for adverse effects
Mydriatics (apraclonidine)
Dilate the pupil
Big word - big pupil
Miotics (acetylcholine, pilocarpine)
Constrict the pupil
Little word - little pupil
Nursing Implications Otic Drugs
*Keep in mind that cold eardrops may cause vomiting and dizziness.
