Exam 2 Flashcards
(473 cards)
1
Q
4 types of drugs that affect the respiratory system
A
- Bronchodilators
- Anti-inflammatory agents
- Antihistamines
- Medications for Colds, Coughs, Nasal Decongestion
2
Q
3 types of bronchodilators
A
- Adrenergics
- Anticholinergics
- Xanthine or “oophyllines”
3
Q
3 types of anti-inflammatory medications
A
- Corticosteroids
- Mast Cell Stabilizers
- Leukotriene Inhibitors
4
Q
inhalant abuse can cause what kind of injury?
A
Permanent injury to the brain, liver, kidneys, heart, and lungs
5
Q
Expectorants (function, example)
A
liquefy secretions
ex. Guaifenesin
6
Q
Mucolytic (function, example)
A
liquefies mucus
ex. Normal saline, Acetylcysteine
7
Q
Cold remedies (function, example)
A
combination of antihistamine, nasal decongestant and a mild analgesic
ex. Nyquil
8
Q
Antitussives (function, 2 types)
A
Suppress a cough
- Central acting
- Peripherally acting
9
Q
Central acting Antitussives (2 types, examples of each)
A
Opioid: codeine
- Examples: Hycotuss, Hycodan
Non-opioid: dextromethorphan
- Example: Robitussin DM
10
Q
Peripherally acting Antitussive: example
A
glycerin
11
Q
3 nasal decongestant contraindications
A
- HTN
- CAD (coronary artery disease)
- Arrhythmias
12
Q
how do nasal decongestants work, and what are some examples?
A
they relieve nasal obstruction and discharge through vasoconstriction
this reduces fluid loss from blood vessels which decreases inflammation and mucus production
ex. Phenylephrine (Neosynephrine), Pseudoephedrine (Sudafed)
13
Q
5 drugs to treat colds and coughs
A
- Nasal decongestants
- Antitussives
- Expectorants
- Mucolytics
- Cold remedies
14
Q
1st Generation Antihistamine is ____, and the prototype is:
A
Non-selective
Diphenhydramine (Benadryl)
15
Q
2nd Generation Antihistamine is more selective for ____ than ____. Some examples are:
A
More selective for peripheral H1 receptors than CNS
So, fewer ADEs
Examples:
Zyrtec
Allegra
Claritan
16
Q
5 situations when it is appropriate to use Diphenhydramine (Benadryl)
A
- Allergic rhinitis
- Mild Anaphylaxis
- Drug allergies
- Blood transfusion reaction
- Contact dermatitis
17
Q
common ADE of Benadryl
A
drowsiness, sedation, dizziness, Thickening of bronchial secretions
18
Q
serious ADE of Benadryl
A
Hemolytic anemia
19
Q
Benadryl contraindications
A
Allergy to med
Use of other CNS meds:
ETOH (ethanol), Antianxiety, sedative-hypnotics, opioids
20
Q
5 situations when you should use Benadryl cautiously
A
- UA retention
- BPH
- tachycardia
- arrhythmias
- narrow angle glaucoma
21
Q
Type I allergic reaction
A
Immediate hypersensitivity
ex: rhinitis to anaphylactic shock
22
Q
Type II allergic reaction
A
damage to cell surface
Ex: blood transfusion reaction
23
Q
Type III allergic reaction
A
antigen-antibody formation
ex. Some types of arthritis, Lupus
24
Q
Type IV allergic reaction
A
delayed hypersensitivity
Ex: poison ivy, transplant rejection
25
Anticholinergic effects of antihistamines
Dry mouth, nose, throat
Blurred Vision
UA Retention
Anorexia, N/V, Constipation
26
paradoxical reaction to antihistamines
e.g. when kid goes crazy on benadryl
27
how do antihistamines work?
they bind to central and peripheral H1 receptors
28
what 5 effects can histamine release cause?
1. Bronchoconstriction
2. Cough
3. Increased capillary permeability
4. Increased mucus production
5. Stimulation of sensory peripheral nerve endings
6. Dilation of capillaries
29
Anticholinergic bronchodilators: prototype
```
Atropine
ipratropium bromide (Atrovent)
```
30
Anticholinergic bronchodilators: uses
Not for acute treatment
Used for daily maintenance
Tiotropium (Spiriva)
31
serious ADE of anticholinergic bronchodilators
bronchospasm, arrhythmias
32
common ADE of anticholinergic bronchodilators
cough and anticholinergic effects
33
Absolute contraindication for anticholinergic bronchodilators
allergy to med, soybeans, peanuts
34
what are the early signs of hypoxia?
confusion, restlessness, increased HR and RR
35
what are the late signs of hypoxia?
cyanosis, decreased BP and HR
36
what are the 4 signs of respiratory distress?
Tachycardia
Dyspnea
Use of accessory muscles
Hypoxia
37
what are the 4 ways that corticosteroids suppress airway inflammation?
- edema of mucosa
- in airway reactivity
- mucus secretions
- sensitivity to B2 adrenergic receptors
38
corticosteroids prototype: chronic
flunisolide (Aerobid) - inhaler
39
corticosteroids prototype: acute
Prednisone (methylprednisolone) - systemic
40
Always administer bronchodilators BEFORE
corticosteroids
41
Dysrhythmia is an
abnormal heart rhythm
42
What is the number 1 cause of arrhythmias?
hypoxia (low oxygen levels)
43
arrhythmias become significant when they
interfere with cardiac function and the ability to adequately perfuse the body
44
2 functions of the cardiovascular system
1. Transport supplies to the cell
| 2. Remove waste products
45
the heart pumps ____ L per min
5-6 L/min
46
55% of the blood
is plasma
47
normal HCT levels for men and women
M: 42-50%
F: 40-48%
48
normal WBC (leukocytes) levels
5,000-10,000
49
normal HGB levels for men and women
M: 13-18
F: 12-16
50
normal Thrombocytes (platelets) count
100,000-400,000
51
4 types of blood vessels
Arteries, veins, capillaries, Lymphatic vessels
52
Positive inotropics ___ the force of myocardial contraction
increase
53
Inotropic anti-arrhythmic prototype
digoxin (Lanoxin)
54
Potassium (K+) normal levels
3.5–5.2 mEq/L
55
Calcium (Ca++) normal levels
8.5-10mg/dL
56
Magnesium (Mg+) normal levels
1.3-2.5 mEq/L
57
Effects of Digoxin
- increased contractility: positive inotropic
- increased Cardiac Output
- decreased HR: negative Chronotropic
- Anti-arrhythmic
- Indirect diuretic
58
Digitalis or “loading dose” of digoxin for IV administration and oral administration
between 0.75- 1.5 mg with intravenous administration and 1-1.5 mg with oral administration
59
Hypokalemia
not enough potassium
60
SA: ___ bpm
60-100bpm
61
AV: ____ bpm
40-60bpm
62
Ventricles: ___ bpm
20-40bpm
63
3 main uses for digoxin
1. treat heart failure
2. treat Atrial arrhythmias
3. treat Sinus Tachycardia
64
2 common GI-related ADEs of digoxin
N/V, anorexia
65
3 common CNS-related ADEs of digoxin
Blurred vision, diplopia, halos
66
3 common cardio-related ADEs of digoxin
Bradycardia, tachycardia, PVCs
67
Serious ADE of digoxin
ventricular fibrillation
68
6 contraindications for digoxin
```
V tack
V fib
Bradycardia
Heart block ( 2nd or 3rd degree)
Bradycardia
Hypokalemia
```
69
What is the therapeutic level for digoxin?
0.5-2
70
What are the top 5 signs/symptoms of digoxin toxicity?
```
N/V
confusion
blurred vision
Bradycardia
PVCs
```
71
PVC
premature ventricular contraction
72
What kind of patients are at risk for digoxin toxicity?
```
Hypokalemia (not enough K)
Renal or liver failure
Large loading dose
Large maintenance doses
Infants and elderly
Hypothyroidism
Hypoxia
```
73
Treatment of digoxin toxicity
```
Stop Digoxin
Tx symptomatically:
- KCL
- Anti-arrhythmic
- Atropine for bradycardia
- Digibind
```
74
What are the 3 main nursing interventions for digoxin?
K+
Explain med regime (patient teaching)
Administer w/ meals or water
75
Hold digoxin if pulse is
below 60 bpm
76
4 types of Arrhythmias/Dysrhythmias
1. Sinus arrhythmias
2. Atrial arrhythmias
3. Nodal or Junctional
4. Ventricular arrhythmias
77
Arrhythmias/Dysrhythmias are caused by changes in ___, changes in ____, or both
automaticity, conductivity
78
What three patient conditions can bring about Arrhythmias/Dysrhythmias?
Hypoxia (number 1)
Ischemia
K levels – high or low
79
What happens in stage 1 of the Na-K pump cycle?
Polarized or Resting or Ready State
cells around the node are in resting/polarized state -- at this point sodium and calcium are normal and extracellular, potassium is intracellular
80
What happens in stage 2 of the Na-K pump cycle?
Depolarization or Discharge State
as electrical impulses come, the cell is depolarized
when the impulse hits, Na and Ca switch places with K as the cell contracts
so Na and Ca move intracellular, and K moves extra-cellular
P wave & QRS
81
What happens in stage 3 of the Na-K pump cycle?
Repolarization or Recovery State
once the electrical impulse is cast on to the next stage, the cell relaxes and repolarized - Na and K switch back to original position (so NA and Ca move back to extracellular, and K moves back to intracellular)
T wave
82
4 Classifications of Antiarrhythmic Meds
Class I Na Channel Blockers
Class II Beta Adrenergic Blockers
Class III Potassium Channel Blockers
Class IV Calcium Channel Blockers
83
Class I Na Channel Blockers prototype
lidocaine (Xylocaine)
84
Class II Beta Adrenergic Blockers prototype
propranolol (Inderal)
85
Class III Potassium Channel Blockers prototype
Amiodarone (Cordarone)
86
Class IV Calcium Channel Blockers prototype
verapamil (Calan)
87
How do Class I: Na Channel Blockers work?
Blocks the movement of Na into cardiac cells and slows conduction
88
Common ADE of Lidocaine
Hypotension, bradycardia, “lidocaine crazies”
89
Serious ADE of Lidocaine
Cardiac arrest, seizures
90
Lidocaine is used to treat
rapid ventricular arrhythmias
91
contraindications for lidocaine
Digoxin toxicity, Heart failure, heart block, Allergy to med
92
Class IA Na Channel Blocker prototype
Quinidine
93
Class IC Na Channel Blocker prototype
flecanide (Tambor)
94
How do Class II: Beta Adrenergic Blockers work?
Blocks the SNS, thereby slows ventricular conduction
95
Common ADE of Propranolol
Bradycardia, hypotension, lethargy
96
Serious ADE of Propranolol
bronchoconstriction
97
Propranolol is used to treat
rapid ventricular arrhythmias, HTN and Angina
98
Propranolol is a ___ chronotropic and a ___ inotropic
negative, negative
99
What is the 1st line med for antiarrhythmic for ACLS?
Class III: K Channel Blockers (Amiodarone)
100
Class III: K Channel Blockers (Amiodarone) are used to treat
life threatening arrhythmias
101
Class III: K Channel Blockers work by ____ repolarization and ____ the refractory period
slowing; prolonging
102
How do Class IV: Calcium Channel Blockers work?
Slows depolarization
103
Common ADEs of verapamil (Calcium Channel Blockers)
Constipation, dizziness, orthostatic hypotension, edema
104
Serious ADEs of verapamil (Calcium Channel Blockers)
Hypotension, bradycardia
105
Aside from treating arrhythmias, verapamil is also used to treat
HTN and Angina
106
5 Non-Pharmacological Treatments for Arrhythmias
1. Treat underlying disorder
2. Valsalva or carotid artery massage
3. Defibrillate
4. Pacemakers, AICDs
5. Ablation
107
Rule for nursing care of arrhythmias:
treat the patient, NOT the monitor
108
Nursing diagnoses for arrhythmias (6)
- decreased cardiac output
- Alt in comfort
- Alt tissue perfusion
- Self-care deficit
- FVE
- Noncompliance
109
What are the 5 coronary arteries?
1. aorta
2. right coronary artery
3. left anterior descending coronary artery
4. circumflex coronary artery
5. left main coronary artery
110
What are the characteristics of Stable or Classic Angina?
- Relieved by rest and/or Nitroglycerine
- Same pattern of onset, duration, and intensity
- Predictable
111
Symptoms of angina
angina can spread anywhere between the belly button and the jaw, including to the shoulder, arm, elbow or hand - usually on the left side
112
3 classifications of anti-anginal medications
1. Nitrates
2. Beta Blockers
3. Calcium Channel Blockers
113
How do all of the antianginal medications work?
By decreasing myocardial O2 demand and/or increasing blood supply to the myocardium
114
Organic Nitrates prototype
nitroglycerine (Nitrostat)
115
3 ways that nitrates work through dilation
1. Dilates veins to decrease preload
2. Dilates coronary arteries to increase myocardial flow
3. Dilates arterioles to decrease afterload
116
All nitrates work to offset cardiac output, thereby ____ O2 demand and reducing angina
lowering
117
Common ADE of nitrates
Headache, orthostatic hypotension
118
Serious ADE of nitrates
Severe hypotension
119
Contraindications of nitrates
```
Hypotension,
Phosphodiesterase inhibitors (Viagra)
```
120
Hold giving nitrates if BP is
121
Beta-Adrenergic Blockers prototype
propranolol (Inderal)
122
When used PA, propranolol (Inderal) helps to give
long term treatment of angina
123
Common ADE for propanolol
Hypotension, bradycardia, lethargy
124
Serious ADE for propanolol
Bronchoconstriction, heart block
125
propanolol works by ____ heart rate and ___ BP, making it a ____ chronotropic and inotropic
decreasing, decreasing, negative
126
Calcium Channel Blockers are used to treat angina when
nitrates or beta blockers don’ t work
127
How do Calcium Channel Blockers work?
Slows the movement of extracellular Ca into the cell, which causes coronary and peripheral arterial dilation -
this decreases afterload and increases blood supply to the heart
overall, they decrease workload of the heart
128
Diuresis
excretion of fluid, esp water
129
Diuretics
medications that increase renal excretion of water and other electrolytes, and increase urine formation and urine output
130
4 categories of diuretics
1. Thiazide
2. Loop
3. Potassium sparing or Aldosterone Antagonists
4. Osmotic
131
Thiazides prototype
Hydrochlorothiazide
132
Loop prototype
Furosemide (Lasix)
133
K+ Sparing Aldosterone Antagonist prototype
Spironolactone (Aldactone)
134
Osmotic prototype
Mannitol (Osmitrol)
135
Thiazides are used to treat which 3 issues?
HTN
Edema
CHF
136
Loop is used to treat which 4 issues?
HTN
Edema
CHF
Renal diuresis
137
K+ Sparing Aldosterone Antagonists are used to treat which 2 issues?
HTN
| Liver disease
138
Osmotics are used to treat which 3 issues?
1. increased ICP
2. glaucoma
3. Oliguria/ Anuria
139
Thiazides are ___ for immediate diuresis
NOT
140
Loop provides ____ diuresis
Rapid, immediate
141
When are K+ Sparing Aldosterone Antagonists NOT to be used?
in renal disease
142
Osmotics are best for ____ IV use
Short term
143
All of the diuretics lose H20, K+, Na and Cl except ____, which results in ____ K+
K+ Sparing Aldosterone Antagonists; increased
144
1L of fluid = ___ kg or ____ lbs
1 ; 2.2
145
Normal range for Na
135 -145
146
Normal range for K
3.5 -5.2
147
Normal range for Cl
94-110
148
When giving diuretics, you should always monitor for
orthostatic hypotension
149
What time of day should you administer diuretics?
AM
150
Common ADE for Thiazides, Loop and Osmotics
1. light headed, dizzy, orthostatic hypotension
| 2. hypokalemia
151
Common ADE for K Sparing
1. light headed, dizzy, orthostatic hypotension
| 2. HYPERkalemia
152
Serious ADE for Thiazides
Hypokalemia
| Thrombocytopenia
153
Serious ADE for Loop
Hypokalemia
154
Serious ADE for K Sparing
Hyperkalemia
155
Serious ADE for Osmotics
Fluid and electrolyte imbalances
156
Thrombocytopenia
deficiency of platelets in the blood that causes bleeding into the tissues, bruising, and slow blood clotting after injury
157
First treatment of choice for bradycardia is ____, second treatment of choice is
atrophy anticholinergic
second choice is anticholinergic
158
Treatment of choice for tachycardia
beta blocker
159
Ventricular arrhythmias originate in the ____ and are our main focus with medication because they ____
ventricle; are very often life-threatening
160
What is the normal procedure of the Na-K pump?
cells around the node are in resting/polarized state -- at this point sodium is normal, extracellular, potassium is intracellular
as electrical impulses come, the cell is depolarized
when the impulse hits, Na and K switch places as the cell contracts
once the electrical impulse is cast on to the next stage, the cell relaxes and repolarized - Na and K switch back to original position
isoelectric line - time before the P wave - the cells are polarized/waiting to get impulse
impulse hits in atria, products P wave
as impulse continues down to AV node, we get small delay then the impulse continues down through the ventricles which produces the QRS
once the wave has gone through and depolarized the ventricles, once that’s finished, then the T wave comes - this marks the repolarization of the cells from the ventricles
161
isoelectric line
the baseline on the ECG - the flat line between the T wave and the next P wave
162
P wave represents
atrial depolarization
163
QRS complex
corresponds to the depolarization of the right and left ventricles of the human heart
164
T wave represents
the repolarization (or recovery) of the ventricle
165
Class I Na Channel Blockers are given given ___ for PVCs
intravenously
166
key safety concern for Class I Na Channel Blockers
you want it to say on the label, “IV use for ventricular arrhythmias” or “for cardiac use only” -- DO NOT use if it says “for nerve blocks”
167
Class I Na Channel blockers are metabolized by the ____ and excreted by the ____
liver ; kidneys
168
Examples of sinus arrhythmias
bradycardia, tachycardia
169
Examples of atrial arrhythmias
Fibrillation or flutter: digoxin
170
Nodal/Junctional arrhythmias come from
the AV node
171
Examples of ventricular arrhythmias
PVC - premature ventricular contraction
V Tachycardia
V fibrillation
172
Bronchoconstriction is an important, serious ADE of propranolol especially if the patient has
underlying pulmonary disease
173
ACLS
advanced cardiac life support
174
Valsalva
exhalation against a closed -- when we have a patient bear down like they’re having a bowel movement, which stimulates the vagus nerve, gets the enervation of the PSNS to help slow the heart rate
175
When performing carotid artery massage, palpate
only ONE side of the heart at a time
176
Ablation
using lasers to destroy the cells using to cause the arrhythmias
177
ALL anti-arrhythmic medications can cause
other arrhythmias
178
Explain procedures to patient -- EVEN WHEN
patient is comatose - no one knows when hearing stops
179
2 main causes of angina
```
1. increased Myocardial O2 demand
(Strenuous exercise (note that this is relative)
Stress, anxiety
Smoking
Cold weather)
```
2. decreased O2 supply to myocardium
180
Atherosclerosis
buildup of plaque within the vessels so that they narrow over time, as they narrow, they become less patent and its harder for blood to flow through them
181
Atherosclerosis
when there’s a stiffening/thickening of the vessel walls and they no longer dilate/constrict like they should
182
Atherosclerosis and Atherosclerosis have different pathology but it's very likely that they will both
be occurring AT THE SAME TIME
183
diabetes melanous causes
vascular changes
184
If the patient is having chest pain
tell them to stop and rest
185
5 non-pharmalogical treatments for angina
```
Stop smoking
Wt loss
decreasing fat in diet
Relaxation techniques
Stress management
```
186
preload
amount of blood returning to the right side of the heart
187
When does peripheral vascular pressure fall to the lowest point?
diastole
188
When administering nitrates sublingually, make sure
they are NOT to be chewed - only put right under the tongue`
189
Patient teaching for nitroglycerin
take a nitroglycerin and wait 5 min, if pain is not relieved within 5 min, take a second nitroglycerin and call 911 or get to the ER
190
Patches: Transdermal Nitro can be left in place for
24 hours (but tolerance can develop this way)
191
Preferred method for applying/removing Transdermal Nitro patches
use in the morning when the patient first gets up, put on the patch in the area where there's not a lot of hair - upper arm or chest
make sure to change where you put it each time
wear it all day, then take patch off before bed -- dispose of it carefully so no one can get to it, then clean the area
as a nurse, always WEAR GLOVES when handling these patches
192
When giving verapamil (Calcium Channel Blockers) through IV, check BP and HR after
5 min
193
When giving verapamil (Calcium Channel Blockers) PO, check BP and HR after
30 min
194
Thiazide can take ___ hours to start acting
2-4
195
When we talk about antibiotics that have a sulfate base (like Thiazide), know that patient may have
a cross-allergy
196
Thiazides lowers blood pressure because
they’re giving off excess fluid from the vascular system
197
Why are Potassium sparing or Aldosterone Antagonists not used to treat patients with renal disease?
because those patients can’t get rid of potassium they already have
198
Oliguria
the production of abnormally small amounts of urine
199
Anuria
failure of the kidneys to produce urine
200
Hypertension affects ____ adults
75 million
201
Less than ___ percent of patients diagnosed with HTN are adequately controlled
30
202
HTN increases the risk for:
- MI
- CHF
- CVA and hemorrhage
- Renal disease
203
Cardiac Output determines
systolic pressure
204
PVR (peripheral vascular restriction) determines
diastolic pressure
205
peripheral vascular restriction is determined by the
degree of constriction or dilation of arteries
206
HR x SV =
cardiac output
ex. 80min x 70mL = 5600 = 5.6 L/min
207
As the patient’s blood pressure starts dropping, baroreceptors
pick it up and are stimulated -- this causes stimulation of SNS, which releases epi, and causes PV contraction
208
Body's response to hypotension: As the blood pressure is falling, there is a decrease in
renal blood flow (because the body is shunting blood to the heart), which stimulates the SNS
209
Decrease in flow to the kidneys causes
Renin to be released
210
First effect when Renin is released:
Renin will take inactive Angiotensin I and convert it to Angiotensin II, which is a very potent vasoconstrictor
211
Second effect when Renin is released:
Renin signals Adrenals to secrete Aldosterone, which signals to the kidneys to start holding on to sodium and water
212
The two effects of Renin when it's released lead to
an increase in blood volume, increase in cardiac output, and increase in blood pressure
all of this increases the preload or volume
213
Pre-hypertension
120-139/80-89
214
HTN
140/90 or greater, usually on more than 1 occasion
215
HTN Crisis:
210/120 or greater
216
90-95% of people have ____, which no one cause that we can put our finger on (variety of issues)
Primary/Essential Hypertension
217
Secondary Hypertension occurs in
5- 10% of patients
218
causes of secondary hypertension
there’s an additional/primary diagnosis - find the cause, you can cure the hypertension
ex. may be from renal, endocrine, CNS, or renal artery problems
also can be caused from long-term steroid use, medications that cause patient to hold on to sodium and water
219
long-term steroid use can cause
secondary hypertension
220
3 ways in which HTN profoundly affects the heart
increased cardiac workload
arteriosclerosis
hypertrophy of myocardium
221
True or false: HTN is asymptomatic
True
222
HTN targets which 4 organs, and how?
heart -- MI (heart attack)
brain -- CVA (stroke)
kidneys -- renal failure
eyes -- retinopathy
223
Angiotensin Converting Enzyme Inhibitors (ACE inhibitors) prototype
captopril (Capoten)
224
How do ACE inhibitors work?
decrease afterload and decrease preload -- so they decrease the overall workload of the heart
225
ACE inhibitors are often used along with or may be combined with
Thiazide diuretic
226
Common ADE of ACE inhibitors is a
dry, hacking cough (this is not responsive to any sort of cough suppressant, because it's not coming from those receptors)
227
Why do ACE inhibitors and ARBs have a black box warning for the 2nd and 3rd trimesters of pregnancy?
can cause severe fetal harm/fetal demise
228
Patients with diabetes tend to do very well on
ACE inhibitors
229
Serious ADE for ACE inhibitors and ARBs is
angioedema (swelling of the airways)
230
Angiotensin II Receptor Blockers (ARBs) prototype
losartan (Cozaar)
231
Why are calcium channel blockers good for patients w/ migraines or asthma?
because they can’t take beta blockers
232
Common ADE for ARBs
URIs, dizziness, orthostatic hypotension
233
remember first dose phenomenon for
peripherally acting alpha 1 blockers (prazosin)
234
In which patients might beta blockers be the 1st line response for hypertension?
In patients w/ hx of MI, stable HF, angina
235
With hypertensive crisis, the goal is to decrease BP ___ percent in ___ hours
25 ; 2
236
When dealing with Hypertensive Crisis, use
Nitropress
237
Primary danger of nitropress is
having a stroke or MI
238
Nitropress must be
mixed in the IV fluid
239
Note: breath gets sweet almond smell when
cyanide levels start going up
240
nursing interventions for nitropress
properly dilute it
IV pump
increase dose slowly
check BP every 2-3 minutes, as BP falls decrease rate
check arterial line (giving readout on monitor second-to-second)
make sure to wrap the IV bag
once BP comes down, switch the patient to a longer-acting antihypertensive
241
What is the major reason why patients are admitted to the hospital and also return?
heart failure
242
Potential nursing diagnoses for heart failure
```
impaired gas exchange
change in levels of consciousness
decrease in urine output
peripheral edema
FVE (fluid volume excess)
activity intolerance and self-care deficits because they can’t move a lot or take care of themselves
```
243
5 "stepped" program for HTN treatment
1. Lifestyle modifications (Lose wt, exercise, stop smoking, decrease Na in diet)
2. Diuretics (Thiazide or loop diuretics)
3. Combination therapy (Thiazide diuretic, ACE Inhibitor or ARB, Beta Blocker, or Calcium Channel Blocker)
4. Add a third medication
5. Maximize drug doses
244
Why is captopril great to treat DM?
b/c it preserves kidney function
245
3 components of Black Box Warning for nitropress
1. Not for IV Push
2. Can cause excessive hypotension
3. Can cause cyanide toxicity
246
3 compensatory mechanisms involved in heart failure
1. increased Sympathetic activity which increases cardiac workload
2. Activation of the renin-angiotensin-aldosterone system: Renin converts Angiotensin I to Angiotensin II which creates high pressure or high afterload
Renin causes adrenal glands to secrete Aldosterone which encourages H2O and Na reabsorption: hi fluid or hi preload
3. Ventricular hypertrophy- 2nd to increased afterload and increased preload
247
main signs of heart failure
- decreased BP, increased HR
- decreased peripheral perfusion
- crackles, tachypnea
- pulmonary congestion and edema
- FVE
- cardiomegaly
248
2-pronged goal of drug therapy for heart failure
Improve myocardial function
| Alter compensatory mechanisms
249
Nursing Diagnosis of Heart Failure Patient:
```
Impaired gas exchange
Altered tissue perfusion related to decrease in cardiac output (cardiac, cerebral, renal, peripheral)
decrease in C.O. r/t arrhythmias.
FVE
Activity intolerance
Self-care deficit
Noncompliance
Knowledge deficit
```
250
FVE stands for
fluid volume excess
251
digoxin is used as drug therapy for heart failure because
it’s a positive inotropic and makes the heart more efficient
252
Another option for heart failure is Outpatient Treatment, which involves
4 hours of drug treatment, usually about 2x/week
253
beta blockers are used for heart failure patients who can't take ACE inhibitors because of
dry cough
254
when heparin is given through IV it acts
immediately
255
when heparin is given subcutaneously it acts
after 20-30 min
256
Thrombus
blood clot
257
Embolus
piece of blood clot breaks off and travels to the heart, brain, or lungs
258
Anticoagulants are best in preventing
venous thrombus
259
Anti platelet drugs are best in preventing
arterial thrombus
260
Thrombolytics are best in preventing
lyse thrombus
261
Fragmin and Lovenox are usually for
prevention
262
Anticoagulant prototype
heparin
263
What does PTT stand for and what are normal levels?
partial thromboplastin time
| Norm: 25-35 secs
264
Thrombocytopenia
decreased platelets - serious ADE of heparin
265
Therapeutic PTT is
1 ½ - 2x’s norm or 38-70 secs
266
Heparin antidote is
Protamine Sulfate
267
Warfarin (Coumadin) is used for
Oral use/ Used in long term px or tx of clots
268
What does PT stand for and what are normal and therapeutic levels?
PT: prothrombin time
N: 12-13 secs
therapeutic 1 ½ x’s norm or 18 secs
269
Therapeutic INR is
2.0-3.0
270
Antidote for Warfarin (Coumadin) is
Vitamin K
271
Anti platelets prevent ____ by interfering with ____
arterial thrombus; platelet adhesion
272
Clopidogrel (Plavix) binds ____ to the platelet
irreversibly
273
Thromboxane A2 Inhibitors (ASA) bind ___ to the platelet. Normal does are between ____ mg daily. ASAs are used most commonly in ____ prevention of MI and CVA.
irreversibly ; 81mg or 325 mg ; Long term
274
Glycoprotein 11b/111a Receptor Antagonists prototype
Tirofiban (Aggrastat)
275
PTCA
percutaneous transluminal coronary angioplasty
276
Tirofiban is used with ____ and with ____
PTCA ; Heparin
277
ASA, Clopidogrel (Plavix), Tirofiban (Aggrastat) are contraindicated when
Active bleeding
Thrombocytopenia
Tirofiban (Aggrastat) –stroke, major surgery or trauma in the last 6 weeks
278
Alteplase (Activase) antidote
Amicar
279
Why is Alteplase (Activase) also called t-PA or tissue plasminogen activators?
binds to fibrin and converts tissue plasminogen to plasmin, which causes fibrinolysis (breakdown of clots)
280
Alteplase (Activase) is used to treat acute thromboembolic events such as
MI, Pulmonary Embolism, femoral thrombus
281
“Time is tissue” – door to needle time:
no > 30mins but no > 3 hours from onset
282
Cholesterol norm
283
HDL and LDL norms
HDL N: > 60
| LDL N:
284
Trigylcerides norms in M and F
under 200 for both
F: 35 – 135
M: 40-160
285
Start drug therapy for hyperlipidemia immediately for patients with
signs and symptoms of CAD, DM, HTN, smokers
286
drug therapy for hyperlipidemia is used to
- Decrease lipids
- prevent or delay atherosclerotic plaques
- Promote regression of existing plaques
- decreased morbidity and mortality from CAD
287
Statins prototype
Lovastatin (Mevacor)
288
Common ADE of Lovastatin (Mevacor)
v/d, constipation, abd cramps
289
Serious ADE of Lovastatin (Mevacor)
hepatotoxicity, Rhabdomyolysis
290
Rhabdomyolysis
A breakdown of muscle tissue that releases a damaging protein into the blood
291
5 Current recommendations of AHA for all patients with CVD
```
ACE Inhibitor
Beta Blocker
ASA daily
Statin
Nitro sl prn
```
292
decreased O2 causes
impaired cellular function
293
Asthma, chronic bronchitis, and emphysema are respiratory disorders characterized by what 4 things?
1. Bronchoconstriction or bronchospasm
2. Inflammation
3. Mucosal edema
4. Excessive mucus production
294
3 therapeutic actions of Bronchodilators and Anti-Asthmatics
Dilate airways
Reduce inflammation
Stabilize mast cells
295
B1 and B2 Adrenergic Bronchodilators Prototype
Epinephrine (Adrenaline)
296
B2 Selective Adrenergic Bronchodilator Prototype
albuterol (Proventil)
297
B2 Selective Adrenergic Bronchodilator is often the first choice because it's
Short acting
298
What is a long-term option of B2 Selective Adrenergic Bronchodilator?
Formoteral (Foradil)
299
why must we use adrenergics cautiously with patients with DM?
their effects on carbohydrate metabolism and their ability to mask the common symptoms of hypoglycemia
300
Anticholinergic bronchodilator prototype
```
Atropine
ipratropium bromide (Atrovent)
```
301
ipratropium bromide is not for acute treatment but rather
for daily maintenance
302
Xanthine
a purine base found in most human body tissues and fluids
303
Xanthines or “ophyllines” are stimulants that are
derived from xanthine and used for medical purposes
304
Xanthines prototype
aminophylline
305
Cardiac effects of xanthines
Increased HR, CO (+ chronotropic)
| Increased Myocardial contraction (+ inotropic)
306
GI effects of xanthines
Increased Gastric acid secretion which can lead to n/v, anorexia
Increased Risk of ulcers
Cramping and diarrhea
307
Bronchus effects of xanthines
bronchodilator
308
CNS effects of xanthines
Insomnia
Headache
Increased reflexes
Increased respiratory rate
309
Contraindications for xanthines
acute gastric and peptic ulcer disease
310
3 early signs of hypoxia
Mental confusion, restlessness, anxiety
increased Resp rate – subtle
increased HR > 100/min
311
3 late signs of hypoxia
increased HR > 150/min
decreased BP
Cyanosis
312
flunisolide (Aerobid) inhaler is for what kind of use?
daily use only - for chronic inflammation
313
Prednisone (methylprednisolone) is best for
systemic, acute
314
serious ADE for corticosteroids
Oral Candidiasis
315
Common ADE for corticosteroids
Dry mouth
316
use corticosteroids cautiously in patients with what 3 issues?
peptic ulcer disease, HTN, DM
317
Contraindications for corticosteroids
systemic fungal infection, TB, or any active infection
318
All inhalers have
minimal systemic absorption
319
Corticosteroids given PO have systemic ADE such as
HTN, peptic ulcer disease, increased blood sugar, decreased immune system
320
Mast Cell Stabilizers prototype
cromolyn sodium (Intal)
321
Mast cell stabilizers prevent the release of
histamine
322
mast cell stabilizers are NOT for
acute treatment
323
Leukotriene Inhibitors prototype
zarfirlukast (Accolate)
324
Leukotriene Inhibitors prevent ___ but are not for ____
asthma attacks ; acute attack
325
Serious ADE for Leukotriene Inhibitors
hepatic failure
326
nursing diagnoses for respiratory drugs assessment
```
Impaired gas exchange
Ineffective breathing pattern
Activity intolerance
Self-care deficit
Altered nutrition
Risk for injury
Noncompliance
Sleep pattern disturbance
Altered thought process
Knowledge deficit
Anxiety
```
327
ischemia
an inadequate blood supply to an organ or part of the body, especially the heart muscles
328
SA
sinoatrial node
329
AV
atrioventricular node
330
heart block
an abnormal heart rhythm where the heart beats too slowly (bradycardia) -- II and III degree are most important
in this condition, the electrical signals that tell the heart to contract are partially or totally blocked between the upper chambers (atria) and the lower chambers (ventricles)
331
diplopia
double vision
332
Negative inotropics ____ force of muscular contractions, while positive inotropics ___ force of muscular contractions
weaken ; increase
333
digibind is the antidote for
digoxin toxicity
334
Bactericidal
will kill bacteria - ex. disinfectants, antiseptics, or antibiotics
335
Bacteriostatic
a biological or chemical agent that stops bacteria from reproducing, while not necessarily killing them otherwise
336
What is the goal of antibiotic therapy?
to cure the illness
337
Infection
multiplication of microorganisms and pathogens throughout the body
338
Colonization
localized microorganisms, but not necessarily and infection ex. MRSA—can be colonized but have no signs
339
Inflammation
body’s protective response to infection
340
Bacteremia
viable bacteria in circulation in the body (in the blood)
341
Sepsis
infection where multiple organs are involved
342
Acquired resistance
bacteria that was once destroyed by an antibiotic that no longer is
343
Gram + (gram positive) and Gram - (gram negative)
if it takes up stain, it is Gram + which usually denotes the bacteria is aerobic (needs oxygen); Gram – doesn’t take up stain and is usually anaerobic
344
Broad spectrum
antibiotic will kill a large spectrum
345
Narrow spectrum
focuses on particular organisms—is selective
346
Often will put patient on broad spectrum while waiting for
culture results to come back
347
Nosocomial
infection that the patient acquired in the hospital
348
Iatrogenic
infection that is the result of a procedure
349
Hospital acquired are more difficult to treat and occur in people who
already have a decreased immune system
350
Superinfection or Secondary Infection can occur when taking an antibiotic, as normal flora can be suppressed as well as
the target bacteria
351
Vaginitis
When an antibiotic kills off some of normal flora which allows normal yeast to overgrow
352
Thrush
white patches in mouth and oral pharynx—can make it difficult to swallow
353
Treatment to recover some of the normal flora that may be killed off during antibiotic routine includes
yogurt with live cultures, buttermilk, probiotics (still research being done about which probiotics work best) –look for seal from pharmacy group
354
What 3 types of patients are most at risk for Superinfection or Secondary Infection
Debilitated
Elderly
Immunosuppressed
355
C+S
culture and sensitivity
356
Culture
Determines the identify of the microbe
357
Sensitivity
Determines which antimicrobial agent will be therapeutic
358
Culture and Sensitivity can tell us quickly whether the bacteria is ___ or ____
gram -
| or gram +
359
MRSA
methicillin resistant staph aureus
360
VRE
vancomycin resistant enteroccocus
361
MDR-TB
multi-drug resistant TB
362
PRSP
Penicillin resistant streptococcus pneumonia
363
Recent study found that ___% of 100 million prescriptions written did not need antibiotics
50
364
Patients in the ICU, at a large university or teaching hospital are at much higher risk for
Bacteria Resistance
365
4 Contributing Factors to bacteria resistance
Widespread use of anti-microbial drugs
Interrupted treatment
Increase number of high risk patients
Location
366
8 Factors that Impair Host Defense
```
Breaks in the skin
Impaired blood supply
Malnutrition
Poor hygiene
Suppression of normal flora
Suppression of immune system
Chronic disease
Advanced age
```
367
____ hospitalizations are because of allergic reactions
140,000
368
50% of drug allergies are to what three antibiotics?
penicillin, ampicillins, and cephalosporins
369
What are the signs of an Anaphylactic (life-threatening) allergic reaction, and how do you treat?
signs: Tightening of the airway, light headed, bronchoconstriction, tachycardia, hypotension, seizure
treat with subQ epinephrine and corticosteroid
370
Allergic/ Hypersensitive Reaction can occur with ___ antimicrobial agents
ALL
371
5 signs of localized infection
Redness, heat, edema, pain, drainage
372
signs of systemic infection
Fever, increased HR and RR
Malaise, loss of E
Anorexia, n&v
May have palpable lymph nodes in the area
Labs: increased WBC, Culture and Sensitivity
373
Antibiotics that inhibit cell wall synthesis interfere with
cell wall synthesis of bacteria—the cell then fills with water and rupture
374
3 Antibiotics that inhibit cell wall synthesis
Penicillins
Cephalosporins
Vancomycin
375
For beta-lactam ring to be effective as antibiotic, the beta-lactam ring has to remain
intact -- if something breaks it, then they are no longer effective antibiotics
376
Beta-Lactam ring Antibiotics (2 kinds)
Penicillins
| Cephalosporins
377
Allergic reactions to Penicillin happen more often than not happen on ___ exposure, not ___
second; first
378
Patients with valvular heart disease—endocarditis are treated prophylactically with ____ before surgery
penicillin
379
2 uses of penicillin
Tx gram + organisms
| Bacterial endocarditis
380
4 key characteristics of penicillin
Widely distributed
Poorly crosses the BBB
Mostly excreted unchanged by kidneys
Crosses placenta & into breast milk
381
penicillinase
produce enzyme that destroys the beta lactum ring and make the penicillin or cephalosporin ineffective
382
Augmentin is the more frequently used option today, and it's a combination of what 2 drugs?
beta lactamase and penicillin
383
BETA-LACTUM: Penicillin prototype
Penicillin G:
| - bicillin, wycillin
384
When Probenecid (Benemid) is taken with penicillin, it ___ the effectiveness of penicillin
increases
385
Empty stomach means
1 hour before eating OR 2 hours after eating
386
BLACK BOX WARNING:
| 3 PEN Gs
Aqueous –only one IV!!! -- must make sure it says for IV use only
Procaine
Benzathine
387
Cephalosporins prototype
cefazolin
| - IM or IV
388
Cephalosporins uses (2)
to treat a wide variety of infections and used a lot for surgical prophylaxis to prevent post-op infection; must have completely administered 30 min to 2 hours prior to surgery start
389
When Cephalosporins are given w/ Lasix or Aminoglycosides, it can cause
kidney damage
390
If a patient takes Cephalosporins for 2 days with no relief, they should
come back in to the hospital/doctor
391
Vancomycin act by inhibiting
wall synthesis
392
Administer vancomycin slowly (60-90 min, even up to 2 hours) to prevent
red man syndrome (a release of histamine that causes this red rash, patient can become hypertensive)
393
Vancomycin is used to treat severe infections, including
C. diff
394
Ototoxicity means a drug
interferes with hearing
395
Nephrotoxicity
a drug's creatine levels
No more than 1 gram if Creatine >2 (N=0.5-1.5)
accumulate in kidneys, leads to hematuria, drop in urine output, high levels of creatinine and BUN; can lead to full renal failure
396
Serious ADE of Vancomycin
Ototoxicity
| Nephrotoxicity
397
3 types of antibiotics that inhibit protein synthesis
Aminoglycosides
Macrocodes
Tetracyclines
398
Antibiotics that affect the ribosomes of the bacterial cells destroys the bacteria’s ability to ____, which kills the bacteria
synthesize protein
399
Aminoglycosides prototype
gentamicin
400
Aminoglycosides are category ___ for pregnancy
D -- it crosses the placenta and is considered "fairly" toxic
401
Aminoglycosides can be prescribed along with penicillin, but should not be
mixed together or given immediately one after the other—the penicillin can inactivate the aminoglycoside; the penicillin destroys the cell membrane of the bacteria which allows the aminoglycoside to get in to destroy it
402
How do Aminoglycosides help treat Hepatic Coma or Hepatic encephalopathy?
in a normally functioning liver, the ammonia is absorbed, for patients with liver failure, the ammonia produced by bacteria in colon gets absorbed systemically and leads to encephalopathy—changes in consciousness and behavior; aminoglycosides will eliminate some of the GI bacteria that are producing the ammonia
403
peak serum aminoglycoside levels:
30-60 min after IV dose
404
trough serum aminoglycoside levels:
30 min before next dose
405
aminoglycoside damage to vestibulocochlear nerve that can be ____. How does it start?
permanent; —starts with a little ringing or buzzing
406
in some cases, aminoglycoside potentiates anesthetic neuromuscular blockers, which could
paralyze the patient or stop breathing entirely
407
Serious ADE of aminoglycosides
- Ototoxicity
- Nephrotoxicity
- Neuromuscular blockade
408
When administering aminoglycosides, remember to avoid
diuretics
409
Macrolides prototype
erythromycin
410
Macrolide's can be either
Bacteriostatic or bacteriocidal
411
erythromycin has a ___ microbial resistance
high
412
Macrolides are used for
Tx resp tract infections
Skin infections
Tx gram + infections
Substitute for PCN allergies
413
tetracycline can cause ____ in mother if pregnant
hepatic necrosis -- Also has the bad effect for fetus: In fetus, gets into developing bone and teeth; long term effect of stunting growth; permanent teeth are mottled (brown) when come in—permanent
414
Contraindications for tetracycline
Renal failure
During pregnancy (Hepatic necrosis in Mom, Effects bones and teeth in fetus)
Children up to 8 yrs
Lactating women
415
When taking tetracycline, patients should be encouraged to consume ___ fluids by mouth
2000-3000mL
416
Whether taking tetracycline or Fluoroquinolones, patients should avoid
Multivitamins (Iron, Ca, Mg, Al)
Dairy (Ca)
Antacids (Mg, Al)
417
Antibiotics that inhibit nucleic acid synthesis
Fluoroquinolones
418
Fluoroquinolones prototype
ciprofloxacin (Cipro)
419
Arthropathy
joint disease present in children 60 years old
420
The liver metabolizes ___ % of Fluoroquinolones, which is excreted in the feces, while the kidneys excrete ___ % unchanged
Liver met 20-40%
| Kidneys excrete 15-40%
421
Uses for Fluoroquinolones
Tx infections of Resp, GU, GI, bones, joints, skin, and soft tissue
Anthrax
422
BLACK BOX WARNING for Fluoroquinolones
Avoid hi-impact exercise and strenuous wt lifting because it can lead to tendon rupture
423
Antibiotics that inhibit metabolic pathways
antimetabolites -- Sulfonamides
424
Sulfonamides ___ the synthesis of folate in cells, which means cell can’t produce
inhibit;
| produce nucleic acids so can’t replicate, which means death of bacteria
425
Sulfonamides prototype
Sulfamethoxazole-trimethoprim (Bactrim, Septra)
426
True or false: Sulfonamides are Bacteriostatic?
True
427
Main use for Sulfonamides is to treat
UTIs
428
Contraindications for Sulfonamides
Late pregnancy or to newborns, b/c it can lead to kernicterus
Lactating women
babies
429
phenazopyridine (Pyridium) is a ___ analgesic
urinary
analgesic used along with Bactrim to decrease the pain of urination for patient with UTI; pyridium can change the color of the urine to almost fluorescent orange or red
430
Sulfonamides are not used for systemic infections because
they are excreted so quickly from the kidneys
431
Kernicterus
the sulfonimide displaces bilirubin from its bonding sites which leads to toxic levels of bilirubin—fetus or newborn—effects developing brain
432
Oral hypoglycemics can make blood sugars go
even lower
433
serious ADE for Sulfonamides
rash, hives, itch, crystals in urine
434
Kevin, age 2 weeks, has been hospitalized with uretovesical reflux and had been cathed 2x’s. He has developed a nosocomial infection and Septra liquid has been ordered for him. How do you intervene?
Do not give this! Hold and call provider.
435
Stevens Johnson Syndrome is
A very often fatal hypersensitivity syndrome related to many kinds of antibiotics and medications (Sulfonamides, PCN, Tetracyclines, Barbiturates, Thiazides, NSAIDS), Viral Infections and Malignancies
436
Signs and symptoms of Stevens Johnson Syndrome
Bulbous cutaneous lesions that are fluid filled
| Ulceration of lips/mouth, eyelids, tongue, genitalia—generally affects mucous membranes
437
Stevens Johnson Syndrome occurs mostly in
males from ages 10-30, most often Caucasian
438
Tx for Stevens Johnson Syndrome
```
treatment with steroids
Comfort measures—decrease pain, very painful
Dressing changes
Prevent open wounds from infection
Plenty of fluids
Stop taking the offending medication
```
439
Clostridium Difficile is associated with the use of which antibiotics?
Penicillin
Cephalosporins
Fluoroquinolones
440
Mild c. diff symptoms
Watery diarrhea 3 or >/day
| Abdominal cramping & tenderness
441
Severe c. diff symptoms
Watery diarrhea 10-15 x/day
Fever
Blood, pus in stool
Dehydration, Wt loss
442
C. diff treatment methods - what is number 1?
```
Stop current antibiotics
Vancomycin (#1)
Fidaxomicin (a Macrolide)
Fluids
Fecal transplants?
```
443
Up until now C. diff has been almost ___ % healthcare related
100
444
What is a drug used for heart failure as well as atrial fibrillation?
Digoxin
445
A group of drugs used to decrease fluid retention and edema?
Diuretics
446
What is a category of drug used to lower serum cholesterol?
Statins
447
Two drug groups used for angina and hypertension?
Beta Blockers and Calcium channel blockers
448
Remember that for angina we use what three types of drugs?
Nitrates, Beta Blockers, and Calcium Channel Blockers
449
Hypokalemia is an adverse effect of which two categories of diuretics?
Loop and Thiazides
450
What is one of the main ADE from anti-hypertensive drugs?
Hypotension
451
What’s one of the prime ADE of anti-coagulants, anti-platelet or thrombolytic drugs?
Bleeding
452
What is a drug that would decrease the absorption of oral digoxin, or almost any other drug?
Antacids
453
Why would we give a patient potassium chloride? And would we give it IV push?
To reverse the diuretic effect of hypokalemia
NO
454
What is a drug I would use to reverse a digoxin-induced bradycardia?
Atropine
455
What type of OTC drugs might decrease the effects of antihypertensive drugs?
Adrenergic medications - Nasal decongestants, sinus or cold remedies
456
What are 2 categories specifically that are very concerned with monitoring blood pressure?
Antihypertensives and nitrates/anti-anginals
457
What are 2 categories of drugs where you really need to monitor the heart rate very closely?
1. Digoxin (monitor PMI for full 60 sec)
| 2. Beta blockers
458
What 2 categories of drugs are you going to be watching serum electrolyte levels?
1. Diuretics
| 2. Digoxin
459
What's the antidote for an overdose of warfarin or coumadin?
Vitamin K
460
What's the antidote for an overdose of heparin?
Protamine
461
Normal potassium level?
3.5-5.2
462
What are three drug groups used to treat HTN and heart failure?
1. Diuretics
2. ACE inhibitors
3. ARBs
463
What is the best, most scientific way to choose the right antibiotic for my patient?
Culture and sensitivity
464
3 Categories of drugs that are contraindicated in children?
Sulfonamides (less than 2 months)
Tetracyclines (less than 8 years old)
Fluorquinolones
465
What is the drug that's often used to treat MRSA?
Vancomycin
466
What are the most common ADE for most oral antibiotics?
nausea/vomiting
467
What are the two ADE from aminoglycosides?
1. Ototoxicity
2. Nephrotoxicity
(3. Prolongs the neuromuscular blockage from medications used in anesthesia)
468
What is the most serious ADE from antibiotics?
Diarrhea leading to C. diff and then death
469
What happens when people stop taking their antibiotics too soon?
Develop drug resistance
470
What classification of antibiotics should not be taken with dairy products?
Tetracyclines AND fluoroquinolones
471
What category of antibiotics should not be taken that are left over and out of date?
Any of them! But also Tetracyclines
472
What are the instructions that we give a patient on how to take their antibiotics?
Take the whole package. Space your doses, and take it until the medication is gone
473
What's one of the prime categories of antibiotics that we don't want to use if the patient has renal failure?
Aminoglycosides
