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Pharm 2 > treatment of infection part 2 > Flashcards

treatment of infection part 2 Flashcards

1
Q

what are macrolides used for

A
  • penicllin sub
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2
Q

name some macrolides

A
  • erythromycin
  • azithromycin
  • clrithromycin
  • fidaxomicin
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3
Q

what are some adverse reactions of macrolides

A

black box warning for caution with use in patients wit liver disease, can cause hepatotoxicity

  • GI: pseudomembraneous colitis
  • CNS: reversible hearing loss, confusion
  • cardiac: can alter cardiac conduction, prolong QT interval, and cause a lethal rhythm
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4
Q

what are some contraindications/cautions for macrolides

A
  • liver disease
  • inflammatory bowel disease
  • numerous drug interactions: warfarin and digoxin (macrolides cause slow increase in serum level and are more likely to cause adverse effects and toxicity)
  • do not use if patient is on fluconazole and/or diltiazem , can cause cardiac death
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5
Q

what are some nursing considerations for macrolides

A
  • antacids reduce absorption
  • assess meds patient is receiving for interactions
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6
Q

describe clindamycin

(not.a macrolide)

A
  • topical for staph infections
  • systemic for very serious infections

black box warning for fatal pseudomembraneous colitis

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7
Q

name a lipoglycopeptides

A

vancomycin

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8
Q

lipoglycopeptides

what are some uses of vancomycin

A
  • not many due to VRE
  • PO treats cdiff
  • MRSA (prophylactic or tx)
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9
Q

lipoglycopeptides

whats important to remember about vancomycin

A
  • nephrotoxic (draw trough before 4th dose)
  • IV is vesicant/irritant (may recommend central line if given over 2-3 days)
  • red man syndrome (if given too quickly… rash on face, neck, and trunk may occur)
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10
Q

oxazolidinone

describe linezolid and its use

A
  • not used for long term therapy
  • serious hematologic and neurologic complications
  • used for VRSA
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11
Q

oxazolidinone

what are some adverse effects of linezolid

A
  • bone marrow depression: can occur if given longer then 2 weeks, cause anemia, neutropenia, pancytopenia, and thrombocytopenia

black box warning: interferes with breakdown of serotnin in the brain, if given with SSRIs, SNRIs, TCAs, MAOIs it can cause serotonin syndrome

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12
Q

oxazolidinone

what are some nursing considerations for linezolid

A
  • serotonin syndrome
  • CBC monitoring
  • remember your patients with psych issues will be off of there psych meds
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13
Q

what are some signs of serotonin syndrome

A

muscle twitching, excessive sweating, shivering, shaking, fever, diarrhea

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14
Q

what are some adverse effects of chloramphenicol

A
  • black box warning: hospitalization is recommended
  • reported to cause aplastic anemia that is irreversible and deplete bone marrow
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15
Q

what lab is important to check frequently when giving chloramphenicol

A

CBC

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16
Q

describe daptomycin

A
  • used for complicated skin and skin structure infections
  • also used for bacteremia caused by S. aureus
  • often used with gentamicin
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17
Q

what drug should you use with caution with daptomycin and why

A

statins

risk of musculoskeletal complications

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18
Q

your patient is receiving IV vacomycin and develops a rash on the face, neck, and trunk. what is the nurses priority action?

A

slow down the infusion

red man syndrome is associated with giving the med too quickly

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19
Q

the nurse should question the combo of which two meds?

1) daptomycin and gentamicin
2) diltiazem and erythromycin
3) azithromycin and gentamicin
4) vancomycin and rifaximin

A

2) diltiazem and erythromycin

macrolides and diltiazem can lead to cardiac arrest

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20
Q

name some sulfonamides

A
  • trimethropim-sulfamethoxazole (bactrim)
  • sulfadiazine
  • sulfasalazine
  • sulfisoxazole
21
Q

what are some adverse effects of sulfonamides

A
  • hypersensitivity reacions common
  • GI: risk of pancreatitis
  • renal
  • hematologic: risk for thrombocyopenia, leukopenia, aplastic anemia
  • dermatological: itching, skin photosensitivity, steven-johnson syndrome
22
Q

what are some contraindications/cautions with sulfonamides

A
  • allergies to sulfa drugs or thiazide diuretics
  • megaloblastic anemia
  • renal disease
  • elderly (increased risk of developing hyperkalemia)
  • infants <2mo
  • pregnancy
23
Q

what are some nursing considerations for sulfonamides

A
  • CBC monitoring
  • BMP in elderly
  • sulfasalazine can stain skin
24
Q

name some tetracyclines

A
  • tetracycline
  • doxycycline
  • minocycline
25
Q

what are some nursing considerations for tetracyclines

A
  • administer on empty stomach with lots of water
  • remain upright for 30mins
  • throw outdated meds away (can cause renal failure)
  • many drug and food interactions: antacids, iron, dairy, digoxin (enhance dig effects), anticoagulants (decrease in effectiveness)
26
Q

what are some adverse effects of tetracyclines

A
  • GI (can cause esophagitis if not upright for 30mins afterwards)
  • dental (can cause permanent yellowing/browning of teeth)
  • skeletal (harm bone growth)
  • derm (severe skin photosensitivity)
27
Q

what are some cautions/contraindications of tetracyclines

A
  • pregnancy/lactating
  • children <8years
  • hepatic/renal dysfunction
28
Q

urinary antiseptics

describe phenazopyridine (pyridium)

A
  • most commonly used
  • urinary analgesic (provides relief of burning and itching of lower urinary tract)
  • give with food
  • reddish/orange urine
  • no UA, only C&S
  • black box warning: med can accumulate in system and skin may appear yellow)
  • do not take more than two days (can lead to renal failure)
29
Q

the nurse knows an adverse reaction to doxycycline is which of the following?

1) esophagitis
2) prolonged QT interval
3) pseudomembraneous colitis
4) anemia

A

1) esophagitis

tetracyclines have an adverse effect of causing esophagitis is not taken properly

30
Q

describe tuberculosis

A
  • tuberculosis affects primarily the lungs
  • may also affect lymph, pleura, GI, bones/joints, kidneys, and brain
  • leading cause of death worldwide for people with HIV
  • multi-drug resistant TB (MDR-TB) is a MAJOR CONCERN
31
Q

what is the causitive agent in TB and describe it a little

A

mycobacterium tuberculosis
- clow growing bacteria
- lays dormant
- different types of mycobacteria
- found in water and soil
- airborne transmission

32
Q

what are the four phases of TB

A
  • transmission
  • primary infection
  • latent TB infection
  • active TB
33
Q

describe transmission of TB

A

when the person inhales infected airborne droplets

34
Q

describe primary infection of TB

A
  • 2-10 weeks after transmission
  • mild flu-like symptoms
  • often undiagnosed at this point
35
Q

describe latent TB infection

A
  • immune system has stopped bacterial growth and they become inactive but may become active later on
  • no symptoms and do not spread to others
36
Q

how might a person with latent TB develop active TB?

A
  • further exposure to TB
  • reactivation due to weakened immune system
37
Q

describe active TB

A
  • only 5-10% of people develop active when first infected
  • lungs are common site of infection
38
Q

what are the clinical manifestions of TB

A
  • low grade fever
  • cough
  • fatigue
  • weight loss
  • night sweats
  • hemoptysis
39
Q

what digonostic tests are used for TB

A
  • mantoux skin test (can give false positives if vaccinated)
  • quantiferon-tb gold (blood test, preferred ove skin test)
  • chest xray (gold standard for actual diagnosis)
  • sputum cultures
40
Q

describe drug therapy for TB

A
  • used to treat both latent TB (in patients at higher risk) and active TB
  • 10 drugs appoved by FDA
  • four treatment regimens approved for treatment of latent TB
  • first line of anti-TB drugs used in combination therapy: izoniazid (INH), rifampin (RIF) , ethambutol (EMB), pyrazinamide (PZA)
41
Q

prior to startign therapy for TB, what should be included in patient teaching

A
  • should start feeling better 2-3 weeks
  • direct observational therapy (used with possible noncompliance)
  • highly individualized therapy
  • report adverse symptoms (liver toxicity and peripheral neuropathy)
  • educated on how disease is spread and what latent TB is
42
Q

what are some adverse effects of isoniazid (INH)

A
  • CNS: seizures
  • GI: pancratitis
  • black box warning for liver toxicity: RUQ pain, no appetitie, jaundice, peripheral neuropathy
43
Q

what are some cautions/contraindications of isoniazid (INH)

A
  • hepatic/renal dysfunction
  • CNS dysfunction
44
Q

what are some adverse effects of rifampin

A
  • skin: skin, tears, urine, sweat, and contacts stain a reddish/orange color
  • GI
  • renal: renal injury
45
Q

what are some contraindications/cautions of rifampin

A
  • hepatic dysfunction or history of alcoholism (hard on the liver)
  • being treated for HIV (HIV meds interfere with TB ones)
  • pregnancy/lactation
46
Q

what two drugs are adjuvant first line drugs for first two months of treatment

A

pyrazinamide (PZA) and ethambutol

47
Q

what are some adverse effects of pyrazinamide (PZA)

A
  • GI upset
  • hyperuricemia (stop gout tx before starting this med)
  • hepatotoxicity
48
Q

whats an adverse effects of ethambutol

A

optic neuritis (color blindness)

Pharm 2 (34 decks)

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