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NURS 365 - Pharmacology in Nursing > Week 7: Anti-Infectives > Flashcards

Week 7: Anti-Infectives Flashcards

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1
Q

14 Prototype Anti Infective Drugs

A
  1. Penicillin
  2. Cephalosporins
  3. Aminoglycosides
  4. Tetracycline
  5. erythromycin
  6. ciprofloxacin (Cipro)
  7. metronidazole (Flagyl)
  8. Sulfa Drugs
  9. Isoniazid (INH)
  10. Rifampin (Rifadin)
  11. Amphotericin B (Fungizone)
  12. Acyclovir (Zovirax)
  13. zidovudine (Retrovir)
  14. saquinavir (Fortovase)
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2
Q

Selective Toxicity

A

a trait of a compound where it focuses on a specific organism or cell without injuring the host cells or body - does not cause unintended damage

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3
Q

Anti infectives interfere with what things?

A

Cell walls (bacteria have rigid cell walls, mammal cells dont)

Necessary Enzymes

Bacterial protein synthesis

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4
Q

Broad Spectrum v Narrow Spectrum

A

Broad agents kill off lots of organisms but narrow spectrums kill only one class or subclass of organism

We may end up treating with broad spectrum until we know exacts but broad spectrum opens up the possibility for microbial resistance

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5
Q

Bactericidal

A

Kills Bacteria

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6
Q

Bacteriostatic

A

Does not kill bacteria but prevents them from multiplying

Things will come to a halt and then the immune system finishes the job

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7
Q

What is important to do after C&S testing

A

match the bug to the drug!

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8
Q

Superinfection

A

“Secondary Infection”

A supra/secondary infection on top of a regular infection you already had

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9
Q

What are some common secondary infections

A

AAD Diarrhea

Urinary Pain, Infection

Vaginal Infections

Thrush

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10
Q

What is the most common secondary infection

A

AAD - Antibiotic Associated Diarrhea

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11
Q

How to avoid resistance in bacteria

A

avoid inappropriate use!!!

use narrow spectrum drugs when possible

send cultures and samples FIRST (before using anti infective agents)

do not discontinue ant infectives prematurely

anti infective use in animals, like livestock

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12
Q

Prophylaxis

A

Prevention through early drug use

not used as often as it once was

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13
Q

Prophylaxis with anti infectives is mainly for what situations

A

Surgery (but gets discontinued promptly)

Valvular Heart Disease (Endocarditis)

Immunosuppressed Patients

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14
Q

Penicillin

A

One of the first major classes of anti infective agents

A class of anti infectives with various preparations

Bacteriocidal

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15
Q

What is the action of penicillin

A

BACTERIOCIDAL - it interferes with bacterial cell wall synthesis and allows it to take up so much water -> increase osmotic pressure -> bursts

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16
Q

Penicillin is bacteriostatic of bactericidal

A

Bactericidal

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17
Q

Penicillin mostly affects what type of bacteria

A

gram positive bacteria

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18
Q

What sort of bacterial cells does penicillin influence

A

new and newly forming ones not already mature cells

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19
Q

Penicillin drugs usually end in what suffix

A

-cillin

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20
Q

What is the most common ADR of penicillin

A

GI Symptoms

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21
Q

What is the major ADR of concern with Penicillin

A

ANAPHYLACTIC REACTIONS

Includes: Vascular Collapse, Cardiac Arrest, Laryngeal Edema, Bronchospasm

A fairly high incidence of allergic rxns exist

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22
Q

What is penicillin densitization

A

a treatment designed to help the body overcome penicillin allergies

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23
Q

What is a mechanism bacteria have developed to stop the effect of penicillin

A

some bacteria produce penicillinase (usually Beta lactamase) which will block the action of penicillin

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24
Q

How have we overcome the defense of penicillinase in resistant bacteria

A

We mix penicillin with a beta lactamase inhibitor like K Clavulanate (together makes Augmentin) to inhibit that effect and allow penicillin to work

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25
Q

What is the important Beta Lactamase Inhibitor often mixed with penicillin

A

Potassium (K) Clavulanate

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26
Q

Cephalosporins

A

A type of antimicrobial that is the most extensively used type of antimicrobial used worldwide

Has 5 generations of types with each successive one getting more improvements

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27
Q

What is often seen in the name of a cephalosporin drug

A

“Cef” or “Ceph” in the generic name

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28
Q

What is often used as an alternative to penicillin

A

Cephalosporins (To prevent allergic reactions)

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29
Q

What is the most extensively used antimicrobial worldwide

A

cephalosporins

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30
Q

Are cephalosporins bactericidal or bacteriostatic

A

Bactericidal

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31
Q

Action of Cephalosporins

A

Bactericidal - related to penicillin structurally and pharmacologically so it inhibits mucopeptide synthesis of the bacteria cell wall

New cell walls cannot form

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32
Q

What is interesting about the absorption of cephalosporins

A

Can be given oral or IV but it is better absorbed on an empty stomach

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33
Q

ADRs of Cephalosporins

A

Allergic Rxn, Rash

N/V/D

Phlebitis

Superinfection

Sometimes: Kidney Damage, Bone Marrow Depression, Mild Hepatotoxicity, Acute Colitis

Some cause bleeding tendencies by decreasing prothrombin levels or interfering with platelet aggregation

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34
Q

What is the unique ADR of cephalosporins

A

Phlebitis - inflammation of veins; may be at the IV site - more common with cephalosporins

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35
Q

What is important to keep in mind even if you are using cephalosporins instead of penicillin

A

There is a partial cross allergy that exists for those hypersensitive to penicillin, 1% of the population, that are also allergic to cephalosporins if they are allergic to penicillin

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36
Q

Cephalosporins are commonly used as…

A

an alternative to penicillin

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37
Q

Vancomycin

A

Only drug in its own class that also impacts the cell wall, but also inhibits RNA synthesis

used for serious and resistant infections like MRSA and VRE

It impacts gram positive organisms but is highly regulated because of resistance

ADRs: Hearing and Kidney Damage, Histamine Release leading to Red Man Syndrome, Anaphylaxis, Ototoxicity

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38
Q

Aminoglycosides

A

Class of antimicrobials that are not seen as often as penicillin or cephalosporins but are used for serious infections

ex: Gentamicin, Streptomicin, Neomycin, Amikacin, Tobramycin

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39
Q

Is there a suffix or prefix specific to aminoglycosides

A

no, mycin is commonly seen but it is not specific to this class alone

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40
Q

Action of Aminoglycosides

A

Bactericidal or Bacteriostatic!

Instead of working on cell walls, it directly impacts protein synthesis instead - it impacts 30S Subunits of the ribosomes

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41
Q

Are aminoglycosides narrow or broad spectrum

A

narrow they are used for serious infections of gram negative bacteria to impact their protein synthesis

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42
Q

What is the therapeutic level of gentamycin (a type of aminoglycoside)

A

4-8 mg/L

This is just for gentamycin, all aminoglycosides have different levels

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43
Q

Why do we monitor peaks and trough levels very carefully for aminoglycosides

A

Potential Kidney Damage - we want above MEC but below maximum

Other ADRs as well

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44
Q

What anti microbial is very important to have drug levels drawn and administration timing exact because of potential impacts

A

Aminoglycosides

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45
Q

Aminoglycosides effect what type of organism

A

serious aerobic gram negative ones - that could cause sepsis

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46
Q

ADRs of Aminoglycosides

A
  1. Potential Kidney Damage (Proteinuria)
  2. Vestibular Issues (vertigo and loss of balance)
  3. Auditory issues (deafness)

Other: high doses cause neuromuscular issues causing resp. paralysis ; Enhance blockade of skeletal muscle relaxants

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47
Q

It may not be a good idea to give aminoglycosides with what

A

skeletal muscle relaxants

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48
Q

Why are aminoglycosides used less nowadays

A

because they have serious side effects and there are newer drugs that can be used without these side effects

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49
Q

What is important to know about giving an aminoglycoside to a geriatric patient, premature patient, or renal failure patient

A

These factors increase the incidence of ototoxicity

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50
Q

Why may we not give aminoglycosides to someone with renal insufficiency

A

it can cause further kidney damage!

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51
Q

What is the problem with IV form aminoglycosides

A

there are many incompatibilities with other drugs in this form

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52
Q

Neomycin

A

a type of aminoglycoside

it is a topical one that works locally at area of instillation

it may be used to sterilize the GI tract to prevent gram negative sepsis within a surgery

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53
Q

When thinking of aminoglycoside ADRs, think ___, ___, and ____

A

Kidneys (Nephrotoxicity), Ears (Ototoxicity), Neurons (Neurotoxicity)

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54
Q

Why is the neurotoxicity of aminoglycosides less of an immediate concern as compared to the nephrotoxicity or ototoxicity

A

Because while there is high potential, it only occurs in higher doses which are rarely if ever given

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55
Q

Tetracyclines

A

class of antimicrobial drugs

used for a variety of infections when penicillin cannot be used, but is more pleasant in use than aminoglycosides

ex: Doxycycline, Achromycin, Terramycin

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56
Q

When might a tetracycline be given

A

if someone is allergic to penicillin/cephalosporin, and in substitute to a more serious aminoglycoside (more pleasant ADR wise)

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57
Q

Tetracyclines are ___ use, why?

A

broad; they are used for many conditions including:

Acne
Chlamydia
Rocky Mtn Spotted Fever
Rickettsial Disease
Psittacosis
Cholera
Lyme Disease !!!!
H Pylori !!!
Mycoplasma Pneumonia
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58
Q

What is the problem with use of tetracyclines

A

if they are used to much it leads to resistance

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59
Q

Action of Tetracycline

A

Inhibits protein synthesis by binding to the ribosomal sub unit - so it only affects rapidly multiplying organisms

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60
Q

Is tetracyclines bactericidal or bacteriostatic

A

Bacteriostatic normally, but it is bactericidal at higher doses

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61
Q

Tetracyclines are relatively _______

A

non-toxic

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62
Q

ADRs of Tetracyclines

A
  1. Photosensitivity
  2. Child Tooth Mottling

Other: Sensitization, Anaphylaxis, GI discomfort, Dizziness, Ataxia, Nephropathy

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63
Q

Why does tetracyclines cause child tooth mottling

A

because if the child’s permanent teeth are still developing, tetracyclines will bind to calcium and leave permanent staining in the teeth

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64
Q

What is important to know about when absorption interference and tetracyclines

A

do NOT take with food - especially dairy products or antacids because they will chelate the drug and decrease absorption

however, they will readily bind with calcium, Mg, Aluminum, zinc and iron

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65
Q

How does Doxycycline differ from other tetracyclines

A

dairy products and antacids will not decrease its absorption - non affected

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66
Q

What patients have tetracycline contraindicated

A

those with renal dysfunction

it does not cause it but it does linger

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67
Q

_____ are a type of anti microbial used for so many conditions

A

Tetracyclines

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68
Q

Macrolide Antimicrobial

A

Macrolides are a family of drugs

they inhibit bacterial protein synthesis like aminoglycosides and tetracycline

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69
Q

What is the prototype drug for macrolides

A

erythromycin (E-Mycin, Ery-Tab)

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70
Q

Erythromycin

A

macrolide antimicrobial prototype

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71
Q

What is the action of erythromycin

A

blocks ribosomal sub unit to prevent new AA to chain –> Inhibits protein synthesis

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72
Q

erythromycin is similar to what drugs and is often used as the preferred substitute

A

penicillin

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73
Q

Is erythromycin bactericidal or static

A

Bacteriostatic normally, but can be bactericidal against certain organisms or at high doses

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74
Q

erythromycin works well against what organisms

A

gram positive bacteria (like penicillin - but it also affects some negative)

75
Q

What is one of the safest antibiotics available

A

Macrolides like erythrmoycin

76
Q

ADRs of Erythromycin

A

GI Symptoms - NVD, cramping, cholestatic hepatitis, suprainfection of bowel, thrombophlebitis

A PRETTY SAFE GROUP, NO MAJOR ADRS

77
Q

It is important to note what about the dosage of erythromycin

A

the oral version amount varies very drastically depending on age of the patient

78
Q

erythromycin is commonly used for what infections

A

respiratory, skin, and skin structure infections

79
Q

What is unique about liver metabolism and erythromycin

A

it inhibits cytochrome P450 enzymes so it will increase plasma levels of several drugs in the body as a result since its inhibiting some metabolism

80
Q

What class are azithromycin and clarithromycin

A

macrolides

both have less GI impact than erythromycin

81
Q

Is Clindamycin a macrolide like erythromycin

A

NO - but it does inhibit protein synthesis in a similar way, but can cause diarrhea (PMC) that can be fatal

82
Q

Fluoroquinolone

A

class of antimicrobials

includes Ciprofloxacin and Levofloxacin

83
Q

What is the suffix for all fluoroquinolone drugs

A

-floxacin

84
Q

Fluoroquinolones like Ciprofloxacin and Levofloxacin work well against what kind of bacteria

A

AEROBIC GRAM NEGATIVE (some effect on positive as well)

85
Q

What type of drug has supplanted many kinds of aminoglycosides since there is less ADRs associated with it

A

Fluoroquinolones

86
Q

What are the 2 important prototype drugs to know for Fluoroquinolones

A
  1. ciprofloxacin (Cipro)

2. levofloxacin (Levaquin)

87
Q

What is particularly unique about fluoroquinolones

A

it has a unique post antibiotic effect - so it seems to have an effect even long after the treatment has ended

88
Q

ciprofloxacin

A

Cipro

fluoroquinolone prototype

antimicrobial

89
Q

levofloxacin

A

Levaquin

fluoroquinolone prototype

antimicrobial

90
Q

Action of ciprofloxacin and levofloxacin

A

it inhibits bacterial DNA gyrase, an enzyme needed for bacterial DNA replication

This is rapidly bactericidal and has both gram negative and positive activity while causing the unique post-antibiotic effect that is prolonged

91
Q

ADRs of levofloxacin and ciprofloxacin

A
  1. Peripheral Nerve Damage (Neuropathy)
  2. Cartilage Toxicity (Tendon Damage) / Joint Disease

Other: GI, CNS dizziness, confusion, sometimes seizure

GENERALLY THIS DRUG IS WILL TOLERATED WITH ONLY MILD SIDE EFFECTS!!!!

92
Q

Why does levofloxacin and ciprofloxacin have a black box warning

A

Because it can cause permanent peripheral nerve damage (neuropathy) and tendon damage/Joint Disease

93
Q

Never give ciprofloxacin or levofloxacin to what group of patients and why

A

those under 18 because they are at higher risk for joint disease and ruptures of tendons like the Achilles tendon

94
Q

What should be done if a patient has pain in the tendons while taking a fluoroquinolone

A

stop immediately and see a doctor

95
Q

What decreases ciprofloxacin and levofloxacin absorption

A

antacids, iron salts, sucralfate, and dairy products

*so these things can only be taken 6 hours before or 2 hours after Cipro - separate these from taking at the same time

96
Q

How can ciprofloxacin lead to bleeding

A

it elevates warfarin levels if they are taking it

97
Q

What unique infection can be reduced by fluoroquinolone use

A

Anthrax- a bioterrorism infection

98
Q

Amebicide

A

tissue and luminal anaerobic antimicrobial class

99
Q

What is the prototype drug for Amebicides

A

metronidazole (Flagyl)

100
Q

Action of metronidazole (Flagyl)

A

Inhibits bacterial DNA synthesis in ANAEROBIC BACTERIA

It kills trophozoites on contact and deprives cells of normal DNA repair while interrupting RNA synthesis

101
Q

ADRs of metronidazole

A
  1. GI - Nausea, HA, METALLIC TASTE, NVD

2. CNS - insomnia, weakness, vertigo, paresthesia, rash, dry mouth

102
Q

What is important to know when taking metronidazole

A

it turns the urine a reddish brown color so dont be frightened

103
Q

What is an Antabuse effect and what drug has it

A

Antabuse is a medicine effect that deters drinking alcohol by causing someone to become violently ill if they do

The Amebicide metronidazole (Flagyl) also has this effect

104
Q

What is one unique IV administration instruction, incompatibility, and use fact about metronidazole?

A

It is NOT REFRIDGERATED like other IV drugs

105
Q

What sort of infections might metronidazole be given

A

serious ANAEROBIC infections - like some abdominal infections not involving the GI tract

Trichomoniasis

106
Q

Sulfonamides

A

“Sulfa Drugs”

Antimicrobial class

includes trimethoprim-sulfamethoxazole, etc

107
Q

When are sulfonamides primarily used

A

for UTIs, but also other respiratory and other infections.

However, MOSTLY FOR UTI

108
Q

Action of Sulfonamides

A

inhibits bacterial METABOLISM OF FOLIC ACID

109
Q

Are sulfonamides bacteriostatic or bactericidal

A

bacteriostatic

110
Q

Forms of sulfonamides

A

oral or IV

111
Q

ADRs of sulfonamides

A
  1. GU - crystalluria, dehydration
  2. GI

Other: Rashes, PHOTOSENSITIVITY, contact dermatitis, rash, anemia, hypersensitivity

112
Q

Why is it so important to keep those on sulfa drugs so well hydrated with non acidic fluids

A

Because the drug can cause crystals in the urine if things are acidic or dehydrated and this can lead to hematuria or obstructions

113
Q

The drug of choice for UTIs are what

A

sulfa drugs

114
Q

What is important to know regarding Cranberry Juice, UTIs, and Sulfa Drugs

A

Cranberry juice is good for PREVENTING UTIs by keeping things acidic

However, once you have a UTI you need to stay hydrated and urine dilute/non acidic so the cranberry juice will not help

If you are drinking cranberry juice with sulfa drugs it can increase incidence of crystaluria

115
Q

Commonly sulfonamides are given with ____ for what reason

A

trimethoprim

this is for a synergistic effect and a 2 prong attack on infection

116
Q

Antituberculosis Drugs

A

class of drugs that are anti-mycobacteria / tuberculosis

117
Q

Prototype drug of Antituberculosis Drugs

A

isoniazid (INH)

118
Q

Is isoniazid usually given alone

A

no usually tuberculosis treatment involves 3-4 drugs including something like rifampin

119
Q

Action of isoniazid (INH)

A

inhibits mycolic acid production (what is needed for the mycobacterium tuberculosis cell wall) which kills dividing organisms and can lead to death from immune response for mature ones

120
Q

Is isoniazid (INH) bacteriostatic or bactericidal

A

both:

It is bactericidal in dividing mycobacterium

It is bacteriostatic during an organisms resting phase

121
Q

Why does drug treatment with antituberculosis drugs go on for so long

A

because mycobacterium tuberculosis is very slow growing

122
Q

ADRs of isoniazid (INH)

A
  1. NEUROTOXICITY - paresthesia, seizure, dizziness, HA, peripheral neuropathy
  2. HEPATIC DYSFUNCTION/TOXICITY
    other: HA, allergic reaction, vertigo
123
Q

What is given with isoniazid (INH) and other antitubculosis drugs to prevent the neurotoxicity and peripheral neuropathy that can occur

A

Vitamin B - it will help prevent this and also fight deficiency anemia

124
Q

Why should you never drink alcohol with isoniazid?

A

because the ADR already includes hepatic dysfunction which can compound with alcohol to cause worse damage

125
Q

What is the most important anti-tuberculosis drug

A

isoniazid (INH)

126
Q

Does isoniazid (INH) only get used for active tuberculosis treatment?

A

No. if used with other drugs it is fighting an active case, but if given alone it is used for prophylaxis from exposure to Tb

127
Q

While isoniazid is for tuberculosis only, what other drug has anti tuberculosis effects as well as being a macrocyclic antibiotic

A

rifampin (Rifadin, Rimactane)

128
Q

rifampin

A

a macrocyclic antibiotic that also can be used as an anti tuberculosis drug

Trade; Rifadin and Rimactane

129
Q

Action of rifampin

A

Inhibits RNA synthesis

130
Q

Is rifampin bactericidal or bacteriostatic

A

bactericidal

131
Q

ADRs of rifampin

A

THERE ARE NONE IN GREAT FREQUENCY

SE: Hypersensitivity, NV, jaundice, rash, fever, liver damage!, flu like symptoms

132
Q

rifampin is usually very well….

A

tolerated - few ADRs

133
Q

How does rifampin dosage differ depending on use and person

A

for Tb it is given in a much larger amount, and its given in smaller doses for other infections or in children

134
Q

What is a unique side effect of rifampin to let the contact know about

A

it causes orange-red color urine, feces, saliva, sputum, tears, and sweat

Can cause soft contacts to become a pink orange red color or sweat on a white shirt may appear this color as well

135
Q

What does it mean that rifampin is a potent inducer of microsomal system

A

it can cause a decreased half life for other drugs

136
Q

Why is it important to take caution when giving rifampin with oral anticoagulants and steroids

A
  1. It will decrease anticoagulation / weaken drug impact

2. It enhances steroid catabolism so if someone is taking an oral contraceptive they can be left open to pregnancy

137
Q

What other infections can rifampin be used with

A

leprosy

legionnaires disease

H flu

sometimes Staph and meningococci

138
Q

Why is it important to know if someone is on rifampin before giving a contrast media

A

because the drug can reduce biliary excretion of the visualizer of the gall bladder

139
Q

Of the 14 prototype drugs, what ones are not ant-bacterials

A

Amphotericin B (Fungizone) - antifungal
Acyclovir (Zovirax) - antiviral, herpes
zidovudine (Retrovir) - anti HIV
saquinavir (Fortovase)- anti HIV

140
Q

Antifungals

A

class of antimicrobial that works on fungal infections

141
Q

What is the prototype drug for antifungals

A

amphotericin B (Fungizone)

142
Q

In what case is amphotericin B used

A

In systemic and potentially fatal fungal infections - it has severe effects and is difficult to give but is effective

143
Q

Action of amphotericin B

A

it changes permeability of cytoplasmic membranes of the fungi sensitive organism leading to essential cell components leaking out and causing cell death

144
Q

What is the preferred route for amphotericin B

A

IV usually, oral route has poor absorption

145
Q

ADRs of amphotericin B

A

MANY SEVERE ONES:

  1. HIGHLY NEPHROTOXIC
  2. RIGORS
  3. Lyte imbalances and hypokalemia

Other: Neurologic symptoms, ototoxicity, thrombocytopenia, flushing, generalized pain, phlebitis, anorexia, anemia, convulsions, anaphylaxis, hepatotoxicity

146
Q

___% of patients taking amphotericin B have impaired renal function that is non reversible if the drug is not stopped in time

A

80% (experience renal impacts)

147
Q

It is important to do what daily when you have a patient taking amphotericin B

A

check creatinine levels daily

148
Q

amphotericin B requires other medicines sometimes to deal with ADRs and SE so it is sometimes called ____ by nurses

A

Amphoterrible

149
Q

Amphotericin B is what with most other drugs

A

incompatible

150
Q

With amphotericin there are many specific what

A

directions for administration - such as protecting it from light (comes in a brown bag)

151
Q

Diflucan (fluconazole)

A

a newer antifungal looking to replace amphotericin B but it does not have the same spectrum of activity and therefore is not the magic bullet we wanted

152
Q

Nystatin

A

an antifungal that comes as a liquid that you swish and spit or swish and swallow for thrush or esophageal fungal infections

153
Q

Antiviral, Herpes prototype drug

A

acyclovir (Zovirax)

154
Q

What is acyclovir limited to

A

limited to types of herpes (this includes chickenpox, herpes, shingles, etc - but no other viral infections)

155
Q

Action of acyclovir

A

Inhibits viral replication by preventing viral DNA synthesis in HERPES VIRUSES ONLY

156
Q

What routes of administration is acyclovir given

A

IV, topical, or oral depending on if herpes is systemic or local

157
Q

ADRs of acyclovir if taken orally

A

Nausea
HA
Amnesia

158
Q

ADRs of acyclovir if taken IV

A 
N/V
Local Phlebitis
Rash
Diaphoresis
Hypotension
NEPHROTOXICITY
159
Q

ADRs of acyclovir if taken topically

A

local irritation

transient burning

160
Q

What is important to know about hose acyclovir actually helps with herpes

A

It decreases duration and severity OF ACUTE HERPES EPISODES - not a cure for the conditions

It just shortens the length of time with the actual infection episode / flare

161
Q

What is the prototype drug that is both Anti HIV and a reverse transcriptase inhibitor

A

zidovudine (Retrovir)

162
Q

What is the prototype drug that is both Anti HIV and a Protease Inhibitor (PI)

A

saquinavir (Fortovase)

163
Q

What was zidovudine known as back in the 1980s

A

AZT

164
Q

What was the first Anti HIV drug developed

A

zidovudine (retrovir) / AZT

165
Q

Action of zidovudine

A

It inhibits HIV replication because it has a greater affinity for viral reverse transcriptase than human DNA polymerase thus inhibiting viral replication without blocking human replication

A Reverse Transcriptase Inhibitor for HIV

166
Q

What is important to know about the absorption of zidovudine

A

it has a first pass of 35% so only 65% is bioavailable

167
Q

ADRs of zidovudine

A
  1. DEPRESSION OF FORMED ELEMENTS IN PERIPHERAL BLOOD (granulocytopenia and severe anemia)
  2. SEVERE HEADACHE

Other: Nausea, insomnia, myalgia, symptoms seen also in placebo patients not listed

168
Q

Why is zidovudine given in high frequent (5x daily) doses before labor and then immediately given IV during labor to pregnant women?

A

This is an attempt to prevent Vertical transmission of HIV to the infant

The IV form will be given until the umbilical cord is clamped

169
Q

What may be required for patients as a result of taking zidovudine

A

multiple blood transfusions to fight the anemia

170
Q

Is zidovudine often given alone

A

No, it is often given with at least 2 other drugs

ex: Combivir (Retrovir and Epivir) is given 2x daily to reduce the massive drug cocktail those with HIV have to take

171
Q

Most anti-virals have what in their name

A

“vir”

172
Q

saquinavir (Fortovase)

A

a newer drug that is a protease inhibitor and anti-HIV drug

173
Q

Action of saquinavir

A

Binds to the active portion of HIV protease which inhibits function of HIV proteins and enzymes leaving the virus immature and noninfectious

174
Q

ADRs of saquinavir

A
  1. Risk for hyperglycemia, new onset DM, DM exacerbations, hyperlipidemia, fat redistribution, bone loss, and transaminase level elevation
  2. Pancytopenia and thrombocytopenia

Other: GI effects

175
Q

What is the drug that led to HIV becoming more of a chronic illness rather than a death sentence

A

saquinavir (Fortovase) - very effective

176
Q

Most people do not die of HIV nowadays, they die from what

A

the heart complications that can occur from infection and treatment

177
Q

It is very important to not do what when taking saquinavir

A

NEVER TAKE WITH FOOD - the food with increase the level of protease inhibitors

178
Q

saquinavir inhibits ____ which can ____ protease inhibitor levels

A

P450 (liver metabolism enzyme); increases protease inhibitor level (dont take with food)

179
Q

Agents that induce P450 can ___ levels of protease inhibitors and include what things?

A

decrease levels - rifampin, phenobarbital, st johns wort

180
Q

To minimize ADRs from Isoniazid (INH) the nurse should monitor?

A. AST and ALT levels –> they are liver enzymes and this causes liver damage
B. Creatinine clearance
C. BUN
D. Vital Capacity

A

A. AST and ALT levels –> They are liver enzymes and this will cause liver damage

181
Q

Patients treated with aminoglycoside therapy (such as with gentamicin) should be monitored for?
A. Hepatotoxicity and ototoxicity
B. Peripheral neuropathy and cardiotoxicity
C. Ototoxicity and nephrotoxicity
D. Cardiotoxicity and nephrotoxicity

A

C: Ototoxicity and Nephrotoxicity

182
Q

Before administering any penicillin,. It is important to check?
A. The CBC
B. The urine culture results
C. The most recent blood glucose
D. If there have been any previous reactions to antibiotics

A

D. If there have been any previous rxns to antibiotics

183
Q

When treating with Bactrim (sulfamethoxazole and trimethoprim, a sulfa drug) you will teach the client to…
A. Protect from sunlight
B. Increase fluid intake
C. Avoid large amounts of cranberry juice and other acidic fluids
D. All of the above

A

D. All of the above

NURS 365 - Pharmacology in Nursing (15 decks)

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