Chapter 38 39 40 42 exam 1 Flashcards

1
Q

antibiotics taken before exposure to an infectious organism in an effort to prevent the development of infection

A

prophylactic

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2
Q

this class of antibiotics may cause tooth discoloration in children under age 8

A

teracycline

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3
Q

anaphylactic reactions are coon with this class of antibiotics

A

penicilin

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4
Q

antibiotics that kill bacteria

A

bactericidal

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5
Q

there is a chance of cross-reactivity between this class of antibiotics and the class in PCN

A

cephalosporin

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6
Q

the classification for the drug erythomycin

A

macrolide

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7
Q

this class of antibiotics is commonly used in urinary tract infections

A

sulfonamide

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8
Q

antibiotics that inhibit the growth of bacteria

A

bacteriostatic

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9
Q

an infection that occurs during antimicrobial treatment for another infection and involves overgrowth of a nonsusceptible organism

A

superinfection

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10
Q

antimicrobials are used to treat ____ infection.

A

bacterial

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11
Q

We use antibiotics to significantly _____ morbidity and mortality from ____ infection

A

reduce, bacterial

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12
Q

Antibiotics treat ___

A

bacterial infections

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13
Q

Antiviral treat __-

A

virus

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14
Q

broad spectrum antibiotics kill: ____ and ___

A

broad range and normal flora bacteria

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15
Q

Bacteriocidal antibiotics kill the

A

bacteria

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16
Q

bacteriostatic do what:

A

slow the bacterial growth

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17
Q

___ allows the host defense mechanisms to take over and kill the bacteria

A

bacteriostatic

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18
Q

Patient with Pseudomembranous Colitis having a watery diarrhea with >10-20 stools/day, what does that indicate?

A

Nothing, Normal. If >5 stools/day notify prescriber

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19
Q

In a sign of infection, what test should a nurse do before anything else?

A

Culture

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20
Q

What type of Antibiotics should be given to the patient during the 72 hours of culture sensitivity testing?

A

Broad spectrum

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21
Q

What is the normal WBC count?

A

5000-10000

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22
Q

What indicates a high WBC count?

A

Systemic Infection

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23
Q

What indicates a low WBC count?

A

Blood infection, cancer.

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24
Q

What type of patients are more susceptible to drug fever?

A

Elderly & AIDS pt.s

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25
Q

A life threatening superinfection caused by c. diff?

A

Pseudomembranous Colitis

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26
Q

Patient with Pseudomembranous Colitis having a watery diarrhea with >10-20 stools/day, what does that indicate?

A

Notify Physician

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27
Q

What is the cause of fungal overgrowth?

A

When Antibiotic kills all of the bacteria susceptible to the drug, the normal flora bacteria that keeps fungi in check.

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28
Q

What bacteria example has B-lactamase enzyme in it?

A

streptococcus pneumoniae

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29
Q

Vancomycin is a drug of choice for what type of infection?

A

MRSA

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30
Q

If Vancomycin is infused quickly, what could be one of the effect of it?

A

Red man/red neck syndrome

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31
Q

The main use of sulfonamides today is for ____

A

UTI

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32
Q

Tetracycline should not be taken with ____

A

Antacids, dairy

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33
Q

What routes can PCN G be administered?

A

IM or IV

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34
Q

4 mechanisms for acquired resistance

A
  1. spontaneous bacterial mutation
  2. conjugation of bacteria
  3. To much exposure to broad spectrum
  4. large amounts of antibiotics used in livestock
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35
Q

what is critical when getting a clean catch UA

A

patient teaching about catching the urine after the flow has started

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36
Q

what does empiric therapy/treatment treat

A

presumptive cause of the infection

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37
Q

in empiric therapy/treatment when do we start giving the antibiotic?

A

before we have sensitivity results back or know exactly what the bacteria is.

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38
Q

what is important about identifying the infecting organism

A

so we can match the drug with the bug

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39
Q

when do you do a Culture and sensitivity test?

A

before any antibiotic is given.

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40
Q

You are given the following orders; what should you do first for a patient with pneumonia?

  1. chest x-ray
  2. administer pain medication
  3. get a clean catch urine
  4. culture and sensitivity test
A
  1. culture and sensitivity test because you cant do the xray you have to call for that. You do not have her pain level for the pain meds the clean catch urine is nice but not the most important you need the c&S so you can know what antibiotics your pt. needs
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41
Q

lab results are what? ____ _____

A

patient specific

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42
Q

2 reasons getting a gram stain report is important

A
  1. tells if the bacteria will be sensitive to the antibiotic
  2. it guids the choice of antibiotic until the sensitivity results are back
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43
Q

in order for antibiotics to work they must be ____ and ____

A

at the site of infection
and
for sufficient time

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44
Q

patient teaching regarding the duration of antibiotics should focus on

A

taking the medication fully so that the patient does not build up a resistance

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45
Q

what is potentiative and antagonistic given to treat a bacterial infection

A

used together but given at different times

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46
Q

why do we give antibiotic combinations

A

for more than one bacteria

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47
Q

Two examples that we do potentiative and antagonistic to help the prevention of resistance

A

Tb, H pylori

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48
Q

what is prophylactic use of antimicrobial definition

A

agents given to prevent infection rather than to treat an estalished infection

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49
Q

3 ways we use prophylactic antimicrobials

A
  1. pre-op surgery
  2. bacterial endocarditis
  3. neurtropenic pts.
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50
Q

attempted treatment of untreatable infections leads to :

A

resistance

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51
Q

how do we monitor antimicrobial therapy

A
  1. we check for clinical indicators of success
  2. serum drug levels for toxicity
  3. retest for laboratory results
  4. frequency of monitoriing should increase or decrease depending on the severity of the infection
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52
Q

What is drug fever

A

fever that can be the sole manifestation of an adverse drug reaction

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53
Q

If your patient suddenly develops a fever what do you need to do

A

rule out other causes of infection

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54
Q

what is the only treatment for drug fever

A

removal of the offending drug rather than adding to it

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55
Q

drug fever can be two types of reactions .. they are:

A
  1. hypersensitivity/allergic response

2. non allergic reaction

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56
Q

what is the common cause of drug fevers

A

antibiotics

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57
Q

who is most likely to get a drug fever

A

elderly and aids patients

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58
Q

risk of developing drug fever ___ with the number of drugs prescribed

A

increases

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59
Q

what happens in supra/superinfectons

A

the normal flora bacteria that keeps fungi in check is gone resulting in fungal overgrowth

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60
Q

are supra/super infections bacterial, viral or fungus?

A

fungus

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61
Q

what is pseudomembranous colitis

A

life threatening superinfection caused by clostridium difficile

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62
Q

When do you notify the prescriber if your patient has profuse watery diarrhea

A

when > 5 stools a day

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63
Q

You should suspect ____ if your patient has abd pain, fever, high wbc, and distinct smel

A

C. Diff

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64
Q

What is the drug to treat C. Diff

A

Metronidazole (flagyl) or if severe PO Vanco

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65
Q

Your patient requests antidiarrheal meds while he has c diff what do you educate him about

A

that the anitdiarrheal meds will compound the problem that his body needs to rid itself of the bacteria causing the infection

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66
Q

You are administering an antibiotic when you notice a diffuse maculopapular rash all over the back of your pt. what do you think the next steps will involve

A

notify the doctor, expect to d/c the antibiotic, benadryl may be prescribed, watch for anaphylactis

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67
Q

What is the drug to treat strep pneumonia?

A

Penicillin

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68
Q

Mycoplasma pneumoniae and Haemophilus influenzae (H.Flue) are both bacterias. What can they cause?

A

atypical pneumonia and lots of URIs (Upper resp infections)

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69
Q

How long must you monitor pts when starting penicillin?

A

Monitor pt taking penicillin for an allergic reaction for at least 30 minutes after administration

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70
Q

What can make penicillin go inactive?

A

Bacteria produce enzymes known as beta lactamases capable of destroying penicillin

71
Q

What bacteria has a b lactamase enzyme?

A

Strep pneumo

72
Q

Penicillin weakens the __ __ causing __ to take up excessive water and rupture?

A

cell wall; bacteria

73
Q

How is Zosyn used?

A

IV only and used for pseudomonas

74
Q

Piperacillin/tazobactam is another word for?

A

Zosyn

75
Q

What do beta-lactmase inhibitors (subclass of PCN) do?

A

adds a substance to stop the beta lactam enzyme

76
Q

What are some beta-lactamase inhibitors ?

A

Ampicillin/sulbactam (Unasyn)
Amoxicillin/clavulanic acid (Augmentin)
Piperacillin/tazobactum (Zosyn)

77
Q

Another word for Amoxicillin/clavulanic acid?

A

Augmentin

78
Q

Another word for Ampicillin/sulbactam?

A

Unasyn

79
Q

What are some beta-lactam PCNs?

A
  • amoxicillin

- pencillin G

80
Q

Amoxicillin (Amoxil) is a?

A

broad-spectrum beta lactam penicillin

81
Q

Amoxicilin is effective against?

A

gram positive bacteria

82
Q

Adverse effects of amoxicillin?

A
  • diarrhea: antibiotic associated diarrhea not caused by C is very common
  • rash
83
Q

Amoxil can disrupt the normal gut flora to your pt. what should you teach them?

A

Teach the pt to eat yogurt (probiotics) to replenish normal flora

84
Q

What are the % rates to penicillin allergy?

A
  • About 5% rate of allergic response to pcn most common cause of drug allergies.
  • 10% of pcn allergic pts are allergic to cephalosporins also.
85
Q

Anaphylaxis S/S of pcn?

A
  • severe hypotension
  • laryngeal edema
  • bronchoconstriction
86
Q

Anaphylaxis tx of pcn?

A

epinephrine dose

87
Q

What should the nurse ask the pt who will be receiving pcn and why?

A

Need to ask if they are allergic to pcn, what type of reaction they will have, side effects, because that can develop an allergic response at any time.

88
Q

What route of administration would you give a 1% concentration of epinephrine solution?

A

Oral inhaltion

89
Q

What route of administration would you give a 0.1% concentration of epinephrine solution?

A
  • Subcutaneous
  • Intramuscular
  • Intraspinal
90
Q

What route of administration would you give a 0.01% concentration of epinephrine solution?

A
  • Intravenous

- Intracardiac

91
Q

What route of administration would you give a 0.001% concentration of epinephrine solution?

A

In combination with local anesthetics

92
Q

Vancomycin can cause what if infused too quickly?

A

Red man/Red neck syndrome

93
Q

Vancomycin is the treatment choose for?

A

MRSA (Methicillin-resistant Staphylococcus aureus)

94
Q

What must you monitor when a pt is on vancomycin?

A
  • Must monitor blood levels to ensure therapeutic levels and prevent toxicity
  • Must monitor trough levels
95
Q

Vancomycin should be infused over how many minutes otherwise what?

A

60 minutes; rapid infusions may cause hypotension

96
Q

Inflammation and clot due to trauma of vein?

A

Thrombophlebitis

97
Q

Thrombophlebitis is?

A

Inflammation and clot due to trauma of vein

98
Q

Tetracycline is best on a?

A

empty stomach

99
Q

Tetracyline can cause an esophageal infection, how can you prevent this?

A

When taking Tetracycline, always drink with a FULL glass of water (6-8oz)

100
Q

What must you watch for when using tetracycline?

A
  • epigastric discomfort
  • diarrhea
  • heartburn
  • photosensitivity
101
Q

Tetracycline is a broad spectrum. What do you use it for?

A

chlamydia-syphilis-gonorrhea

102
Q

What should be avoided when taking tetracycline?

A

Avoid milk products, iron preparations, antacids, and other dairy products because of chelation and drug-binding that occurs

103
Q

Causes the most c. diff of all antibx

A

Clindamycin

104
Q

Causes the urine to turn brown/orangy color

A

Nitrofurantion

105
Q

What are Nitrofurantoin only used for?

A

treat and prevent UTI

106
Q

What are some side effects of sulfa?

A

Stevens-Johnson syndrome, toxic epidermal necrosis, photosensitivity, and hemolytic anemia.

107
Q

Drugs which are extensively metabolized through the what?

A

CyP450 liver enzyme system

108
Q

CyP450 has what?

A

lots of drugs interactions

109
Q

DI’s means?

A

Drug interactions

110
Q

Tetracycline

A

prototype: achroymicn
uses: to treat syphilis and gonorrhea; some acne cases; broad spectrum and IV route

SE: epigastric discomfort; heartburn; diarrhea; photosensitivity

nrs impl: have PT drink with big glass of water
do not combine with dairy products

Info: Better to take on empty stomach
Do not take tetracycline with anti acid (but can be an hour before or after just not together)
Do no give this drug to 8 y/o causes teeth staining

111
Q

Macrolides

A

Prototypes: erythromycin; clarithromycin (biaxen)

uses: mainly used for respiratory tract infections including streptococcal pharyngitis; sinitis; bronchitis and pneumonia. gram positive bacteria

SE: headache; steven-johnson, hepatoxicity, pseudomembranous colitis.

Nrs imp: monitor bowl function; alert the physician at first sign of pseudomembranous colitis

Info: Instruct patient to alert medical staff for rash, fever, blood, pus or mucous present.

Diarrhea needs to be reported ASAP

112
Q

Tetracycline has a strong affinity for?

A

calcium

113
Q

Alteration in intestinal flora may result in?

A
  • superinfection
  • diarrhea
  • pseudomembranous colitis
114
Q

True of False: Macrolide is a broad spectrum.

A

True

115
Q

Another name for Clarithromycin?

A

Biaxen

116
Q

Which drugs can prolong the QT interval?

A

Emycin and Azithro

117
Q

Another word for Emycin?

A

Erythromycin

118
Q

Erythromycin can prolong the QRS interval? True of False

A

False, Erythromycin prolongs the QT interval

119
Q

penicillins

A

Prototype: amoxicillin (amoxil) 500mg q8h

Uses: Broad spectrum- many gm pos infections

SE: suprainfections; ras; N/V/D; anaphylaxis

Nsg Imps: notify rash; inactivates aminoglycosides

Info: Most common drug allergy

120
Q

Cephalosporins

A
prototype drug: 
1 gen: cefazolin 
2 gen: cefuroxime 
3 gen: cefotaxime 
4 gen: cefepine 

uses: broad spectrum

SE: mild stomach cramps, nausea, vomiting, and diarrhea

Nsg Imps: use lidocaine for IM injections

Info: very similar to penicillin drugs and some PTs allergic to penicillin allergic to cephalosporin

121
Q

Vancomycin

A

Prototype: Vancocin

Uses: MRSA and CDIFF

SE: red man syndrome, ototoxic, hypotensions

Ns Imp: if bp or pulse drops notify the physician ASAP; monitor all lab work for an urinary issues; assess skin throughout antibiotic

Info: needs to be administered over an hour, too fast causes red man syndrome

122
Q

Tetracycline

A

prototype: achroymicn
uses: to treat syphilis and gonorrhea; some acne cases; broad spectrum and IV route

SE: epigastric discomfort; heartburn; diarrhea; photosensitivity

nrs impl: have PT drink with big glass of water
do not combine with dairy products

Info: Better to take on empty stomach
Do not take tetracycline with anti acid (but can be an hour before or after just not together)
Do no give this drug to 8 y/o causes teeth staining

123
Q

Macrolides

A

Prototypes: erythromycin; clarithromycin (biaxen)

uses: mainly used for respiratory tract infections including streptococcal pharyngitis; sinitis; bronchitis and pneumonia. gram positive bacteria

SE: headache; steven-johnson, hepatoxicity, pseudomembranous colitis.

Nrs imp: monitor bowl function; alert the physician at first sign of pseudomembranous colitis

Info: Instruct patient to alert medical staff for rash, fever, blood, pus or mucous present.

Diarrhea needs to be reported ASAP

124
Q

Side effects of clindamycin?

A
  • Causes the most c.dif of all antibiotics

- rash

125
Q

What are the 4 big macrocodes “Mycins?”

A
  • Azithromycin (zithromax (take for 3-5 days))
  • Clarithomycin (Biaxin)
  • Erythromycin (Emycin)
  • Dirithromycin (Dynabac)
126
Q

Clindamycin is used to treat what?

A
  • severe strep infections
  • Gangrene (anaerobic)
  • MRSA: some resistance
  • Useful empirical tx if not sure celluitis is d/t strep or staph
127
Q

Typical dose of clindamycin?

A

300mg q6h po or IV

128
Q

Linezolid (Zyvox) is a new class of drug also known as?

A

oxazolidinones

129
Q

Linezolid treats what?

A
  • VRE: Vanco resistant enterococci

- Serious MRSA

130
Q

Side effects of linezolid?

A
  • neuropathy

- bone marrow suppression

131
Q

Zyvox is another named for?

A

Linezolid

132
Q

Zyvox needs weekly what?

A

CBC monitoring

133
Q

clindamycin

A

prototype: cleocin
uses: anaerobic gm pos/gm neg

Treats: severe strep, gangrene, MRSA

SE: most C. DIFF, rash,, weakness

nrs Imp: asses for infection, obtain specimens for culture and sensitivity prior, monitor bowel elimination

info: administer with full glass of water

134
Q

Linezolid

A

Prototype: Zyvox

uses: multidrug resistant to gm positive, used for serious MRSA

SE: neuropathy, bone marrow suppression

NRS Imp: the pt should have a weekly CBC to check for toxicity

Info: should be a last resort; big guns

135
Q

aminoglycosides

A

Prototype: gentamycin

uses: serious gram-negative bacillary infections, and infections caused by staphylococci

SE: nephrotoxic, ototoxicity, hypersensitivity

Nrs Imp: give in spate line and time from penicillin

push fluids 2L/day

monitor BUN/CR

Info: blood tests should be done to check for toxicity, commonly found in elderly, perform hearing tests

136
Q

Sulfas

A

Prototype: Bactrim
DS at the end means double strength

Uses: Broad spectrum

SE: steven-johnson syndrome (rare), Toxic epidermal necrosis (rare), photosensitivity, hemolytic anemia (rare)

nrs Imp: Push fluids if crystals are found within the urine

Protect the skin from UV light

Check the CBC and assess the skin for changes such as jaundice

Info: Do NOT give to last trimester pregnant, breastfeeding or infants.

Do NOT give to someone who might be on folate deficient

Do NOT give to alcoholic

137
Q

What is the symptoms of vestibular toxicity (balance center) when on aminoglycosides (gentamycin)?

A
  • 1st symptom is headache, then nausea/dizzy, unsteady on feet.
  • Stop drug & contact MD stat for either!
  • Educate the pt to tell you if they have these
138
Q

Aminoglycosides (gentamycin) are used for?

A

-serious gram negative infections, like pseudomonas.

139
Q

What route can amino glycosides be used?

A

Narrow spectrum, IV only. Frequently used in combo w/ other antibiotics

140
Q

Side effects of amino glycosides?

A

-irreversible ototoxicity. worse if have renal impairment

141
Q

What is tinnitus?

A

Ringing in the ears

142
Q

What is the symptoms of vestibular toxicity (balance center) when on aminoglycosides (gentamycin)?

A
  • 1st symptom is headache, then nausea/dizzy, unsteady on feet.
  • Stop drug & contact MD stat for either!
  • Educate the pt to tell you if they have these
143
Q

What are some side effects of sulfa?

A
  • Stevens-Johnson Syndrome (SJS)
  • Toxic Epidermal Necrosis (TEN)
  • Photosensitivity “Protect the skin”
  • Hemolytic anemia “Check the CBC and look for Jaundice”
  • Crystals in urine “Push fluids”
144
Q

Stevens Johnson Syndrom and Toxic Epidermal Necrosis causes? What is the mortality rate?

A
  • Causes sloughing of skin and mucus membranes.

- Mortality rate 25%

145
Q

Which drugs contain sulfa?

A

celebrex, diuretics, thiazides (hctz), sulfonylureas (glipzide, glyburide), silvadene

146
Q

What must you be careful with sulfa drugs?

A

don’t give to last trimester pg, breastfeeding, or infants d/t kernicterus (bilirubin deposits in brain) or those who are likely to be folate deficient (megaloblastic anemia)- alcoholic, pg, frail

147
Q

Nitrofurantoin is used to treat and prevent what?

A

UTI’s only

148
Q

What happens to the urine when using nitrofurantoin?

A

Concentrates in urine and turns urine brown

149
Q

Your kidney function must be adequate for nitrofurantoin to work. What is the creatinine clearance?

A

> 40mL/min

Limited use in elderly because of this

150
Q

What are some side effects of nitrofurantoin?

A

N/V/D

151
Q

What must you watch for when taking Flagyl?

A
  • headache
  • dry mouth
  • fatigue
  • metallic, bitter taste
  • GI distress
152
Q

Another name for Flagyl?

A

Metronidazole

153
Q

If you take any antibiotics and birth control pills, what happens?

A

you increase your chance of getting pregnant. Antibiotics decrease the effective of a birth control pill

154
Q

Clotrimazole (lotrimin) binds with?

A

the fungal cell membrane altering the permeability of the membrane wall to inhibit its growth

155
Q

When using lotrimin, watch for what?

A

N/V/D, adbominal pain, skin irritation, and H/A

156
Q

What does Lotrimin treat?

A

use oral, topical, or intravaginal for treatment of candidiasis, tinea pedis, tinea crusis, tinea corporis, tinea versicolor and vulovaginal candidiasis

157
Q

Antifungals end in what?

A

-azole

158
Q

Yeast is an example of ?

A

fungal

159
Q

Amphtotericin B is a what drug?

A
  • antifungal drug

- broad spectrum

160
Q

Tuberculosis is treated with?

A

Rifampin; always used with another med due to high resistance including MRSA tx

161
Q

Rifampin makes body fluids what color?

A

red orange

162
Q

Hepatotoxicity is ?

A

toxicity of the liver

-monitor liver function tests and bilirubin levels/jaundice

163
Q

Nephrotoxicity is?

A

toxicity of the kidneys

-watch for increased BUN and Creatinine, decreased urine output, protein in urine

164
Q

What are some TB Medications?

A

Rifampin, Ethambutol, Pyrazinamide (PZA)

165
Q

What are some side effects of ethambutol?

A

SE: optic neuritis-blurred vision, color changes. Assess prior to tx & then monthly

166
Q

What are some side effects of pyrazinamide?

A

SE: hepatotoxic- monitor s/s, labs q2wks

167
Q

Antivirals kill ?

A

intracellular parasite viruses Anti HSV & HZV (herpes simplex & Zoster virus)

168
Q

Side effects of Antivirals?

A

N/V 10%.

Give with food

169
Q

Metronidazole

A

Prototype: Flagyl

Uses: against anaerobic bacteria; disrupts DNA and protein synthesis in susceptible organism

SE: headache, dry mouth, fatigue, DI distress

Nrs IMP: administer on an empty stomach, monitor stool samples, monitor I&O

Info: Lab tests may include serum AST, ALT, and LDH tests

170
Q

Antifungals

A

Prototype: Butenafine

uses: Topical- cutaneous fungal infections

SE: hypersensitivity to active ingredients

Buring, itching, redness

Nrs Imp: inspect involved areas of skin and mucous membranes before and frequently during administration (if any skin irritation discontinue)

Info: have PT use full course of meds even when feeling better

171
Q

Ampho B

A

Prototype: amphotericin

Uses: binds to the fungal cell membrane allowing leakage of cellular contents

SE: hypersensitivity, headache, chest pain, nephrotoxicity, anemia

Nrs Imp: monitor each PT closely after the first dose of chills, fever, headache, and vomiting. Assess the injection site

LAST RESORT

172
Q

Antivirals: HSV:HZV

A

prototype: Acyclovir

uses: kill intracellular parasite virus
Dose: 800 mg 5x day for HZV

SE: usually tolerated well, can be safe in pregnancy

NRS Impl: Asses for decrease in lesions

Assess duration of outbreak

If started soon enough within 48 hours of rash can shorten the course

Info: Helps monitor outbreak during childbirth

173
Q

Neurominidase

A

Prototype: oseltamivir (Tamiflu)

uses: inhibits neuraminidase , active against influenza A&B

SE: N/V 10%, hypersensitivity, seizures, bronchitis, nausea

Nrs ImP: use correct dosing device measuring oral solution

Treatment should be started within 48 hours of symptoms