DONE: Immune PHARMACOLOGY Flashcards by Delia Archer

What are these drugs classified as?  
Penicillins
Cephalosporins
Aminoglycosides
Tetracyclines 
Fluoroquinolones
Macrolides

A: antibacterial drugs/anti-infectives

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It is important that your pt is receiving the right antibiotic and that it’s effective against whatever type of infection that they have going on or that it will prevent whatever we want it to prevent because some of these are given ________

A prophylactically

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It’s important to know if your pt has _____ if they have ____ to a certain class of anti-infectives sometimes there are cross ____ with other classes that are closely related

A: allergies
Note: same answers for all blanks

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You ___ get the cultural and sensitivity so collect the specimen before you begin the antibiotic or it can alter your result; you don’t have to ___to get the results but you do have to collect the specimen

A: MUST
Wait
Note: IMPORTANT

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It kills the bacteria and it does that by inhibiting cell wall synthesis

A: bactericidal

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Most effective against fast growing bacteria they are more susceptible to this
Partially metabolized in the liver
Mostly excreted in the urine

A: penicillins

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If you have somebody with liver and kidney issues you are going to have to use caution with?

A: penicillins

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Abbreviation: PCN and is commonly used for what medication?

A: penicillins

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What are the 4 types of penicillins?

A: Aminopenicillins, Extended-spectrum, Natural, and Penicillinase-resistant

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These are very common, old drugs so it’s really cheap

A: Aminopenicillins: amoxicillin (Amoxil), amoxicillin/clavulanate (Augmentin, Augmentin XR)

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This type of anti-infective is effective against more bacteria

A: Extended-spectrum

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An enzyme that is located on the penicillin and some bacteria is resistant to that enzyme so they would be resistant to the other penicillins

A: Penicillinase-resistant

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Medication we would use if a patient is Penicillinase resistant

A: dicloxacillin (Dynapen), nafcillin, and oxacillin

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Penicillins are effective against what types of bacteria?

A: Gram-positive cocci and bacilli
Some gram-negative cocci, some anaerobes
Aminopenicillins are used for enterococcal infection
Gonorrhea
Staphylococci

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Up to 10% cross sensitivity so ppl who have an allergy to ____ might also have an allergy to _____; no one is ever allergic to a medication the first time they have it; an allergy is an immune system response and for your immune system to react to something it has to be exposed to it first and identify it as an invader and mount a defense against it so first dose is not going to get an allergic reaction any dose after that can.

A: cephalosporin

Penicillin

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End in “cillin”
Nausea, vomiting, diarrhea, epigastric distress
Rash and it’s an allergic reaction and we will talk about that in a couple of seconds
Pain at IM site, thrombophlebitis at IV site it’s an irritating medication
Resistant bacterial and fungal super infections
Anaphylaxis
These adverse reactions are for what type of medication?

A: penicillin

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If you receive penicillin then they should watch you for about ____ afterwards to see if you are going to have an anaphylactic reaction

A: 15-20 mins

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If giving penicillin at the same time as an aminoglycoside it May decrease effectiveness of aminoglycosides
May diminish effectiveness of oral contraceptives, so you get strep throat, take penicillin and 9 months later have a baby
Extended spectrum penicillins with other PCNs may inhibit platelet aggregation so there you are having a risk for bleeding

A: Penicillin interactions

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Probenecid (anti-gout medication) decreases renal excretion of PCN so again we would have to be cautious
Used with clavulanate or sulbactam enhances resistance against those bacteria that are resistant to Penicillinase; produces beta lactamase (which inactivates PCN)
Tetracyclines may decrease effectiveness so here you’ve got 3 antibiotic classifications on this 1 slide penicillin, amino glycosides, and tetracyclines and if you are giving those together you are not going to get the full effect so it’s really important to know and watch for that

A: Penicillin interactions

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Directions for taking: include drug name, dosage, frequency, duration, possible adverse reactions; Take complete course of antibiotics; Advise patients on oral contraceptives to use another method; Precautions re: food, other meds; Signs of superinfection

A: general nursing responsibilities: Patient Education
Note: General nursing responsibilities apply to all classes of antibiotics

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Watch for s/sx of allergic reaction; Anaphylaxis: rash, pruritus, laryngeal edema, wheezing and this will happen within the first 15 mins after taking it; Keep epinephrine, anti-histamine, and resuscitation equipment close by; Instruct the pt to avoid acidic or carbonated beverages if taking it orally because that can decrease drug absorption; general nursing responsibilities

A: Penicillin: Nursing Responsibilities

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Begins with “cef” or “ceph”
Bactericidal; Does NOT kill fungi or viruses
Metabolism varies by drug but they are excreted primarily in the urine and you have to be sure that you have good renal function

A: cephalosporins

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There are 4 generations of cephalosporins: 4th generation cephalosporins are more effective against ____and 1st generation is more effective against ___; least effective ____ at 4 and getting more and more until they are most effective at generation 1 and with ____ they are least effective with the 1st generation and more effective with the 4th generation

A: gram negative (4 to 1)
gram positive (1 to 4)
gram positive
gram negative
Note:  other than that gram negative, gram positive there is really no reason that you have to be aware of which generation it is;

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I want to point out in the 1st generation ___ is the medication that you see given prophylactically in the peri-operative period to prevent infection

A: Ancef

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Gram-positive and gram-negative bacterial infections and that would be a reason a physician would order one or another generation Gram-positive and gram-negative cocci infections Some gram-negative bacilli infections

A: Cephalosporins: Contraindications

Nausea, vomiting, diarrhea (not allergic reactions) so you will see how that might not be a good thing with someone with colitis Rash – allergic reaction Anaphylaxis and remember that is an exaggerated allergic reaction Pain at IM site, phlebitis at IV site-there can be irritation at the site Pseudomembranous colitis can develop as a result of being on this medication and this is something that you know as C-diff if somebody develops a rash or hives do not give them this medication; you need to stop it and notify the physician

A: Cephalosporins: Adverse Reactions

If also on aminoglycosides they are not compatible you have to use separate IV site and that is very important because we don’t want them mixing in the IV tubing and you can find that information in your drug guide under the compatibility chart

A: Cephalosporins: Interactions

____ is medication given to alcoholics that want to quit drinking so they take this medication and they get really sick if they drink so _____ will have a similar reaction

A: Disulfiram | Cephalosporins

``` End in “cin” Bactericidal Poor oral absorption, most given IV Not metabolized Excreted unchanged in urine What type of drug class is this? ```

A. aminoglycosides

_____ is NOT an aminoglycoside; ___ is in a category all by itself DO NOT GET THIS CONFUSED

A: Vancomycin Vancomycin Note: VERY IMPORTANT TO KNOW

Aerobic gram-negative bacilli and some gram-positive bacteria (some gram-positive are resistant) Septicemia, postoperative pulmonary, intra-abdominal, and serious recurrent UTIs so we will use other medications for UTI’s unless they are serious and reoccurring, infections of bone, skin, soft tissue, and joints Ammonia forming bacteria in gut of pt with hepatic encephalopathy In conjunction with others: serious staph, serious pseudomonas aeruginosa infections, nosocomial pneumonia, TB, pelvic inflammatory disease, serious Klebsiella infections This is used for serious infections and if they can use something else they will because the side effects of these drugs can be bad What type of medication has these indications?

A: Aminoglycosides

Hypersensitivity as with any drug Severe renal disease because it’s cleared there or excreted there Pregnancy Breast feeding What medication has these contraindications?

A: Aminoglycosides

Must Use with caution for the following reasons for what medication? Renal disease that is just renal disease not severe renal disease Neuromuscular disorders such as Parkinson’s and myasthenia gravis Heart failure Elderly Infants

A: Aminoglycosides Note: We have to do that again because of the side effects

Vestibular and cochlear ototoxicity, nephrotoxicity, and neurotoxicity it can destroy someone’s ears and kidneys…very important to be aware of that Oto- and Nephro- toxicity: reversible ONLY if caught early and then discontinued the medication IMMEDIATELY; I can’t emphasize this enough; I have seen somebody go into renal failure totally lose all kidney function and die because they were on ______? What medication classification has this serious adverse reaction?

A: Aminoglycosides Note: VERY, VERY, VERY IMPORTANT FOR YOU TO KNOW THIS FOR YOUR CAREER AS A NURSE; REMEMBER THAT I AM NOT JUST FOCUSING ON A TEST I AM ALSO THINKING ABOUT WHEN YOU ARE A NURSE MOST SERIOUS:

What are the most common adverse reactions for Aminoglycosides?

A: nausea, vomiting, diarrhea Hypersensitivity Transient neutropenia, leukopenia, thrombocytopenia aka transient pancytopenia Elevated liver enzymes Phlebitis if given IV, sterile abscess if given IM

Name the Aminoglycosides Interactions

A: Interact with other aminoglycosides or loop diuretics: additive ototoxicity and added together they can be more ototoxic Inactivated when given with PCNs Given at same site with cephalosporins inactivates and needs to be given in 2 separate sites when you are giving both same as with cephalosporins Used with some inhalation anesthetics or neuromuscular blockers may cause respiratory paralysis and that kind of makes sense why we want to be careful if we are giving it to somebody who already has some neuromuscular disorder we don’t want to cause respiratory distress

Assess for vertigo and hearing loss before starting the medication and if there is any change during therapy then the medication needs to be stopped and of course you will notify the physician, but you know, educate the pt, how is your hearing now? Maybe do a hearing test, and then monitor during tx to make sure that we don’t have any hearing loss Monitor renal function VERY important Make sure patient well hydrated; Encourage fluids 1500-2000 mL a day MONITOR PEAK AND TROUGH See General Nursing Responsibilities What medication do these nursing responsibilities refer to?

A: Aminoglycosides

Drawn to determine if SAFE level of antibiotic is being administered

A: peak and trough

peak and trough note: please read

Note: Peak level is drawn after target dose (e.g. 3rd dose) most often seen the 3rd dose being used, the physician will write an order for gentamycin because Gentamycin is actually an aminoglycoside; the Dr. will write dosing per pharmacy so pharmacy will start at what is a reasonable dose based on their assessment of the pt and they’ll say do a peak and trough with the 3rd dose; so when the 3rd dose is due to be hung, they will go ahead and hang it and it has to be hung exactly on time, it has to run over exactly the amt of time that it’s supposed to so here comes your math skills, say it’s supposed to run over an hour and it was due at 9 o’clock so you hang it at 9 o’clock it runs until 10 it has to do that for this to be accurate and then after the medication has been infused then 45-60 mins after like 10:45 to 11 we will draw the peak because the target dose is the 3rd dose so we are drawing it when the medication is at its highest concentration in the blood; then say it is every 12 hours at 9 pm we need to do another dose so we draw the trough right before we give that next dose; this is before the target dose and different hospitals will do it different ways so you will have to do that; just know that the trough is lowest level of medication in the blood and for Gentamycin the trough should be between 0.5-1.5 and the peak should be between 6-10  Peak levels questioned with Vancomycin (non-classified anti-infective) they just do troughs so that’s FYI and they don’t really do peaks anymore with Vancomycin; but something very important for you to know; I would like you to know the Gentamycin though

Trough level is drawn before ___ dose

A: target

Nursing usually draws ___ to ensure done on time

A: P & T=peak and trough

Tetracyclines are:

A: Bacteriostatic they might actually kill some bacteria’s and Inhibits bacterial protein synthesis

Tetracyclines are _____ in urine or feces

A: Excreted Note: So it’s important for your pt to be moving your bowels right or they are not going to be excreting this drug; these drugs

Tetracyclines are metabolized in?

A: kidneys

``` End in “cline” Demeclocycline hydrochloride (Declomycin), doxycycline hyclate (Vibramycin), minocycline hydrochloride (Minocin), oxytetracycline hydrochloride (Terramycin), tetracycline hydrochloride (Sumycin) These are examples of what type of medication classification? ```

A: tetracycline

This is a very commonly used tetracycline:

A: tetracycline hydrochloride (Sumycin)

 Gram-positive and gram-negative infections  Lyme disease  Gonorrhea  Syphilis  Mycoplasma, chlamydia, Rickettsia  Acne These are indications for what type of medication?

A: tetracyclines

____ this is an atypical use but if someone has _____ tetracycline can actually inhibit the action of ADH so it might be used

Note: same answer for both blanks A: SIADH

Demeclocycline hydrochloride (Declomycin) is the medication that’s used and it actually works as a diuretic in someone that has ____

A: SIADH

Pregnancy and breast feeding Hypersensitivity again if they have a hypersensitivity to this med we don’t give it and that’s any tetracycline so they can’t say they are allergic to one and take others because it works across the whole class Children under 8 unless no alternative; it’s not good for the formation of teeth and to the enamel in kids  Causes permanent tooth discoloration Use cautiously in elderly These are contraindications for what medication?

A. tetracyclines

GI – anorexia, GI upset, flatulence, nausea, vomiting, bulky and loose stools, epigastric burning Hypersensitivity Pancreatitis, hepatotoxicity Photosensitivity Rash Pain at IM site, phlebitis at IV site Mild BUN increase These adverse reactions are for what medication?

A. tetracyclines

Antacids, calcium supplements, iron, magnesium containing laxatives, milk and dairy decrease absorption so if you are going to be giving these at the same time you really need to be careful May increase effects of oral anti-coagulants so we have an issue there with bleeding Decrease effectiveness of oral contraceptives so we have an issue there with having a baby Decrease effectiveness of PCNs These interactions describe what medication?

A. tetracyclines

ONLY doxycycline and minocycline are given IV all the others are either given PO or IM Patient Education Avoidance of milk products and drugs containing calcium, magnesium, aluminum or iron because it’s going to effect the absorption of the medication and if they do have to use some of those medications then they need to be taken 2-3 hours before or after the tetracycline Take on an empty stomach Avoid direct sunlight because of that photosensitivity See General Nursing Responsibilities Use these nursing responsibilities for what medication?

A. tetracyclines

______ are used as a Broad spectrum which means that they are effective against a wide variety of bacteria

A: Fluoroquinolones

_____ Inhibit intracellular enzymes

A: Fluoroquinolones

_____ Excreted, mostly unchanged, in urine and mostly unmetabolized

A: Fluoroquinolones

This med Ends in “floxacin”

A: Fluoroquinolones

Ciprofloxacin (Cipro), gatifloxacin (Tequin) is one that I haven’t seen too much, gemifloxacin (Factive), levofloxacin (Levaquin) is very common, lomefloxacin hydrochloride (Maxaquin), moxifloxacin hydrochloride (Avelox) norfloxacin (Noroxin), ofloxacin (Floxin), sparfloxacin (Zagam) Ciprofloxacin (Cipro) and levofloxacin (Levaquin) are the ones that you will see the most often Name the classification for these medications?

A: Fluoroquinolones

``` What classification of drug has this long list of indications? Aerobic gram-positive and gram-negative infections Bone and joint infections Skin and soft tissue infections Intra-abdominal infections Urinary tract infections Pyelonephritis Acute sinusitis Chronic bronchitis Gonorrhea Endocervical and urethral chlamydial infections Pelvic inflammatory disease ```

A: Fluoroquinolones

______ was in the news because that’s the medication that was given post anthrax exposure to prevent cutaneous anthrax

A: ciprofloxacin

Children Cautiously: CV disorders, CNS disorders, seizures (it can cause seizures), renal insufficiency, cerebral ischemia, severe hepatic dysfunction What classification of drugs has these contraindications?

A: Fluoroquinolones

``` Nausea Crystalluria Phototoxicity Diarrhea Rash Can cause C-diff What classification of drugs has these adverse reactions? ```

A: Fluoroquinolones

May increase serum levels of methylxanthines which are a respiratory medication, a bronchodilator, aminophylline, theophylline is a methyl xanthine

A: Antacids; Fluoroquinolones: Interactions Note: Can cause toxicity and this is something that you don’t want to see; it can be very unpleasant and harmful

______ may reduce effectives

A: Antacids; Fluoroquinolones: Interactions

________ may decrease renal excretion

A: Probenecid (anti-gout med); Fluoroquinolones: Interactions

Give 2 hours apart from: antacids, calcium, and iron | Monitor renal function

A: Fluoroquinolones: Nursing Responsibilities Note: See General Nursing Responsibilities

Take with 8 ounces of water Wear sunscreen due to photo sensitivity, if there is a C & S ordered you need to do that before giving the medication although you do NOT have to wait for the results

A: Patient education; Fluoroquinolones: Nursing Responsibilities

``` Broad spectrum Block protein synthesis High doses- bacteriocidal Low doses – bacteriostatic Given IV or po What drug classification is this? ```

A: Macrolides Note: Not given IM – too painful Give IV slowly to avoid pain

Absorbed from GI tract Poorly metabolized or not metabolized Excreted in either urine or feces (depending on which drug it is) What drug classification is this?

A: Macrolides

This is where is gets a little confusing with the amino glycosides you just might have to do some memorization here What classification of drugs are these?

A: Macrolides

End in “mycin” remember this is similar to amino glycosides so this isn’t perfect What drug classification is this?

A: Macrolides

Azithromycin (Zithromax), clarithromycin (Biaxin), erythromycin (E-mycin) What classification of drugs are these?

A: Macrolides Note: I think with this one you will just have to memorize it and I know in the past that I have often thought oh erythromycin is an amino glycoside and then I look it up and go whoops so that is something you will have to memorize because the rules don’t really work well with this one

_____ and _____ upper and lower respiratory, skin and soft tissue infections, helicobacter pylori remember that it causes ____, mycobacterial and gram-positive and –negative organisms so you will see that there is a lot of over lapping here like the things we just read the upper and lower respiratory, skin and soft tissue…hey that’s what Cipro is for also so a lot of times it’s just physician preference or maybe what’s going around in the community right now have you ever gone to the doctor with some type of an infection and they will say well we know that this is going around in the community right now so they will give you an antibiotic because that what whatever in the community is susceptible to and that’s call ____ _____ ___ it’s the use of an educated guess to prescribe a medication

``` A: Azithromycin and clarithromycin GERD empirical antibiotic use These are Macrolides: Indications Note: If we don’t have cultural and sensitivity results than that’s the best we have at that time is an educated guess of course if the pt doesn’t get better than or we get C & S back that tells us it’s the wrong medication then we can change it but just in case you have some confusion about hey all these medications seem to overlap, they do overlap but they may be more effective, one will be more effective than the other and we find that through C & S and we start out with education first, educated guess to dose them until we get the results back ```

______ moderate to severe infections (e.g Pneumococcal pneumonia, acute PID, intestinal amebiasis, Legionnaire's disease, chlamydial infections)

A: Erythromycin: Macrolides: Indications

Hypersensitivity | Use with caution: hepatic dysfunction, lactation, renal dysfunction

A: Macrolides: Contraindications

Nausea, vomiting, diarrhea, abdominal cramps those can be side effects depending on the severity Hypersensitivity Hepatotoxicity when in conjunction with other hepatotoxic drugs (e.g. acetaminophen, sulfonamides) Anytime it causes organ damage it’s an adverse reaction especially in conjunction with other drugs that are hepatotoxic like Acetametaphen which can be really hepatotoxic it can put you in liver failure and sulfonamides

A: Macrolides: Adverse Reactions

Increases serum levels: theophylline (the bronchodilator), carbamazepine, and warfarin; we have to be very cautious so you can see we can cause bleeding if we increase serum levels of Coumadin, Do not use erythromycin with these types of drugs: risk for toxicity _______peaks may be reduced when taken with antacids and be less effective

A: Azithromycin Macrolides: Interactions

Monitor liver functions during therapy-remember that it can cause liver damage

A: Macrolides: Nursing Responsibilities Note: Labs: liver enzymes: alkaline phosphatase, alanin aminotransferase, aspartate aminotransferase and bilirubin Assess for jaundice; to assess for jaundice you are going to look at the whites of their eyes to see if they are tinged yellow, urine will get darker, skin will get yellow

Oral _____ given 1 hour ac or 2 hours pc

A: azithromycin; Macrolides: Nursing Responsibilities |  Give antacids 2 hours before or after

Assess for superinfection

A: Macrolides: Nursing Responsibilities

BEFORE first dose: allergy history, C&S Observe for allergic reactions Monitor relevant labs that we talked about Assess for superinfection

A: General Nursing Responsibilities Note: Black furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools and there we are talking about C-diff which is probably the superinfection that you are going to see the most often so these general nursing responsibilities are things that you do for EVERY anti-infective that a pt is on

Directions for taking: include drug name, dosage, frequency, duration, possible adverse reactions Take complete course of antibiotics Advise patients on oral contraceptives to use another method Precautions re: food, other meds Signs of superinfection

A: Patient Education: General Nursing Responsibilities

``` Selected Disorders from the following categories: Infections Allergies Autoimmune Diseases (select) Rheumatoid arthritis Systemic lupus erythmatosus (SLE) HIV/AIDS These follow under what type of responsibilities? ```

A: general nursing responsibilities

DONE: Immune PHARMACOLOGY Flashcards

(83 cards)