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Pharm Exam 1 > Pharm antiinfectives > Flashcards

Pharm antiinfectives Flashcards

1
Q

antibiotic resistant - a bacterium that releases several toxins that cause severe & foul-smelling diarrhea.

A

Clostridium difficile (C. difficile)

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2
Q

C diff caused by

A

abx, fecal-oral, contaminated fomites

dont take unnecessary or incomplete antibiotics

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3
Q

carbapenems, cephalosporins, isoniazid, penicillin’s, vancomycin

A

Cell wall synthesis inhibitors:

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4
Q

aminoglycosides, ketolides, macrolides, streptogramins, tetracyclines

A

Protein synthesis inhibitors:

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5
Q

sulfonamides

A

Antimetabolites:

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6
Q

fluoroquinolones

A

DNA synthesis inhibitors

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7
Q

rifampin

A

RNA synthesis inhibitors

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8
Q

medications that kill the bacteria

A

bactericidal

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9
Q

medication that slows growth of bacteria

A

bacteriostatic

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10
Q

free to grow, and the patient develops an infection that is resistant to conventional drug therapy. The bacteria is resistant, not the patient

A

acquired resistance

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11
Q

An individual with an infection that is resistant to certain antibacterial drugs can transmit the resistant bacteria to others through:

A

poor hygiene, poor sanitation, poor infection control, close proximity

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12
Q

The longer an abx is used and the more often it is prescribed

A

the larger percentage of resistant strains occur

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13
Q

antibiotic resistance - infection in the intestines, lungs, urinary tract, wound, blood

A

Carbapenem-resistant Enterobacteriaceae (CRE)

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14
Q

antibiotic resistant: intestines; most common HAI; very contagious

A

Clostridium difficile (C. difficile)

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15
Q

antibiotic resistant - gram positive bacteria; skin, surgical wounds, bloodstream, lungs, urinary tract

A

Methicillin-resistant Staphylococcus aureus (MRSA)

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16
Q

antibiotic resistant - wide range of infections, blood, UTI, intestines, wounds

A

Vancomycin-resistant enterococci (VRE

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17
Q

given antibiotic to prevent infection

A

prophylactic

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18
Q

a specimen of urine, stool, spinal fluid, sputum, blood, purulent wound drainage is collected per sterile technique and sent to the lab for organism identification and sensitivity to a drug

A

Culture & Sensitivity (C&S)

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19
Q

how long for results of culture

A

2-3 days

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20
Q

given after cultures are drawn
before results come back

A

broad spectrum antibiotics

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21
Q

a secondary infection resistant to the treatment of the original infection. Normal floral of the body is destroyed

A

Superinfections

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22
Q

CM of superinfections

A

fever
leukocytosis
diarrhea
bladder pain
dysuria
vaginal discharge

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23
Q

The most important factors for abx therapy:

A

-Selecting the appropriate abx that kills the bacteria
-Regarding the host factors that can influence drug therapy: nutritional status, pregnancy, comorbidities

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24
Q

how the immune system functions

A

Host defenses

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25
Q

the infection site, CNS and blood-brain barrier, poor circulation, excessive pus blocks drugs from reaching their target

A

Local tissue conditions

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26
Q

obtained on admission; avoid all drugs in the chemical class

A

Allergy history

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27
Q

doses of antibiotics are low to very young and very old because

A

unable to metabolize/excrete

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28
Q

pregnancy status effects from abx

A

tetracyclines discolor teeth in utero; aminoglycoside affect infant’s hearing

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29
Q

genetics effect from abx

A

some patients have genetic absence of certain enzymes needed to metabolize abx

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30
Q

inhibit bacterial cell wall synthesis; bactericidal

A

Penicillins (PCNs)

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31
Q

Penicillinase-Resistant PCNs: narrow spectrum MOA and ex

A

Effective against gram-positive bacteria
Penicillinase-producing Staphylococcus aureus
Other Staphylococcus species
Treats endocarditis, meningitis, bacteremia, skin, and respiratory infections

dicloxacillin (Dynapen, Dycill)
nafcillin (Unipen)
oxacillin (Bactocil)

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32
Q

Natural PCNs: narrow spectrum MOA and ex

A

penicillin G benzathine (Bicillin); penicillin G potassium (Pfizerpen); penicillin G procaine; penicillin V

Effective against gram-positive and a few gram-negative bacteria
Streptococcus and Clostridium species
Neisseria and Staphylococcus species
Treats anthrax, tetanus, diphtheria, endocarditis, respiratory infections, syphilis

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33
Q

Broad spectrum PCNs MOA and examples

A

amoxicillin (Amoxil)
amoxicillin and clavulanate (Augmentin)
ampicillin (Omnipen)
ampicillin and sulbactam (Unasyn)

Effective against gram-positive and gram-negative bacteria
Escherichia coli, Haemophilus influenzae
Shigella dysenteriae
Proteus mirabilis and Salmonella species
Treats respiratory, skin, intraabdominal, urinary tract, gynecologic infections, otitis media, sinusitis

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34
Q

inhibit Gram positive bacteria & some Gram negative bacteria

A

Extended-Spectrum PCNs

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35
Q

Extended-Spectrum PCNs MOA and ex

A

piperacillin (Pipracil)
piperacillin and tazobactam (Zosyn)
ticarcillin and clavulanate (Timentin)

Effective against gram-negative bacteria
Pseudomonas aeruginosa
Proteus and Serratia species
Klebsiella pneumoniae
Enterobacter and Acinetobacter species
Treats respiratory, intraabdominal, and skin infections

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36
Q

Recap PCNs indications:

A

PNA, meningitis, skin/bone/joint infections, gastric infections, blood & heart valve infections, gas gangrene, tetanus, anthrax, sickle-cell anemia in infants

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37
Q

Adverse Effects of PCNs

A

Rash, pruritus, NV, fever, anaphylaxis symptoms, nephrotoxicity, including angioedema, circulatory collapse, cardiac arrest

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38
Q

penicillin G classes

A

Therapeutic Class: antibacterial
Pharmacologic Class: cell wall inhibitor, natural PCN

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39
Q

PCN G actions

A

Drug of choice against streptococci, pneumococci, staphylococci, gonorrhea, syphilis

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40
Q

PCN alerts

A

Observe for allergic reactions for 30 minutes, esp. after first dose
Do not mix PCN and aminoglycosides in same IV solutions; dampens effects of aminoglycosides. Give 1 hour apart

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41
Q

adverse effects and contraindications of PCN G

A

Adverse Effects
NVD
Anaphylaxis; monitor for late reactions…several weeks
Contraindications
Hypersensitivity
Use caution in patients with severe renal dz

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42
Q

Lab tests for PCN G

A

may give a positive Coombs test, a test to detect antibodies stuck to RBC surface
May give false positive urinary or serum proteins

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43
Q

largest antibiotic class
gram negative infections

A

cephalosporin

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44
Q

each cephalosporin generation has increasing

A

bactericidal activity

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45
Q

First Generation Cephalosporins MOA and ex

A

cefadroxil (Duricef), cefazolin (Ancef, Kefzol), cephalexin (Keflex)

Effective against mostly gram-positive and some gram-negative bacteria
Staphylococci, Streptococci
E. coli, Klebsiella, Proteus, Salmonella, and Shigella species

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46
Q

Second Generation Cephalosporins MOA and ex

A

cefaclor (Ceclor), cefotetan (Cefotan), cefoxitin (Mefoxin), cefprozil (Cefzil), cefuroxime (Zinacef), cefuroxime (Ceftin)

Effective against gram-positive and gram-negative bacteria
Staphylococci, Streptococci, E. coli
Klebsiella, Proteus, Salmonella, and Shigella species
Haemophilus influenza, Enterobacter species
Neisseria gonorrhoeae, Neisseria meningitidis

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47
Q

Third Generation Cephalosporins MOA and examples

A

cefdinir (Omnicef), cefditoren (Spectracef), cefixime (Suprax), cefotaxime (Claforan), cefpodoxime (Vantin), ceftazidime (Fortaz, Tazicef), ceftibuten (Cedax), ceftizoxime (Cefizox), ceftriaxone (Rocephin)

Effective against gram-positive and gram-negative bacteria

Has increased resistance to destruction by beta-lactamases

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48
Q

Fourth Generation Cephalosporin
MOA and examples

A

Effective against gram-positive and gram-negative bacteria

Staphylococci, Streptococci
E. coli, Klebsiella, and Proteus species
Pseudomonas aeruginosa

Highly resistant to destruction by beta-lactamases

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49
Q

Fifth Generation Cephalosporins
MOA and ex

A

ceftaroline (Telfaro), ceftolozane and tazobactam (Zerbaxa)

Effective against gram-positive and gram-negative bacteria
Staphylococci, MRSA, Streptococci, E. coli
Klebsiella and Proteus species, Pseudomonas aeruginosa

Highly resistant to destruction by beta-lactamase

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50
Q

Adverse Effects of cephalosporins

A

Anaphylaxis, superinfection
Mouth sores, headache, dysgeusia, GI distress
Clostridium difficile-associated diarrhea
Increased bleeding, seizures
Nephrotoxicity
Stevens-Johnson syndrome
Elevated hepatic enzymes
Oral or vaginal candidiasis

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51
Q

percentage of patients showing cross sensitivity of cephalosporin

A

1-7%

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52
Q

ceph contraindication

A

patients with previously severe adverse reaction to PCN

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53
Q

reasonable alternative to PCN

A

Ceph

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54
Q

class of cefazolin

A

Therapeutic Class: antibacterial
Pharmacological Class: cell wall inhibitor; first generation cephalosporin

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55
Q

cefazolin actions

A

Treats for Gram-positive organisms in the respiratory tract, urinary tract, skin, biliary tract, bones, joints
Treats genital infections, septicemia, endocarditis
Not effective against MRSA
Used prophylactically preoperatively

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56
Q

adverse effects and contraindications of cefazolin

A

Adverse Effects
Rash, diarrhea, superinfections
Contraindications: hypersensitivity to cephalosporins or PCNs; use with caution in CKD
Drug-Drug Interactions: if used with nephrotoxic drugs (aminoglycosides/vancomycin ↑ risk of nephrotoxicity; anticoagulant effect of heparin & warfarin may be ↑ ; additive/synergistic effect with other abx (aztreonam, carbapenems, PNCs)

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57
Q

lab test of cefazolin

A

false positive on coombs test

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58
Q

Effective against gram-positive and gram-negative bacteria

Inhibit bacterial protein synthesis, slow microbial growth, exert bacteriostatic effect

A

tetracyclines (cycline)

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59
Q

tetracycline classes

A

Therapeutic Class; antibacterial
Pharmacologic Class: tetracycline; protein synthesis inhibitor

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60
Q

tetracycline actions

A

inhibits protein synthesis; bacterial resistance
Treats acne, anthrax, plague, gingivitis, cholera, gram +/- STIs, skin, and urinary and respiratory infections, Helicobacter pylori, MRSA

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61
Q

adverse effects of tetracycline

A

GI effects,
rash stinging/burning with topical applications, anaphylaxis,
secondary infections,
hepatotoxicity, ototoxicity, nephrotoxicity, permanent teeth discoloration in children
Increased mortality with tigecycline (Tygacil); should be reserved for infections not responsive to other antiinfectives

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62
Q

tetra alert

A

Administer antacids & tetracycline 1-3 hours apart

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63
Q

tetra labs

A

May ↑ blood urea nitrogen (BUN) aspartate aminotransferase (AST),
alanine
aminotransferase (ALT),
amylase,
bilirubin,
alkaline phosphatas

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64
Q

Inhibits protein synthesis by binding to the bacterial ribosome

A

macrolides

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65
Q

macrolides treat

A

whooping cough (pertussis), Legionnaires’ dz, streptococcus, H. influenza, & M. Pneumoniae, Listeria, Chlamydia, Neisseria

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66
Q

erythromycin classes

A

Therapeutic Class: antibacterial
Pharmacologic Class: Macrolide; protein synthesis inhibitor

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67
Q

erythromycin actions

A

for patients unable to take PCNs or have a PCN-resistant infection

Inactivated by stomach acids, made to dissolve in the small intestine (do not crush or chew)

Treats Bordetella pertussis, Legionella pneumophila, Mycoplasma pneumoniae, Corynebacterium diphtheriae

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68
Q

alerts fro erythromycin

A

Give on empty stomach with full glass of water. Food ↓ levels of drug in the body
Mix suspensions well
Do not give with milk or fruit juices

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69
Q

adverse effects of erythromycin

A

GI effects, hearing loss, vertigo/dizziness in high doses, high doses of IV may be cardiotoxic/fatal dysrhythmias

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70
Q

erythromycin labs

A

erythromycin interferes with AST; gives false urinary catecholamine values

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71
Q

More toxic than many other abx
Important for treatment of aerobic gram-negative bacteria, mycobacteria, protozoans

A

aminoglycosides

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72
Q

gentamicin classes

A

Therapeutic Class: antibacterial; bactericidal
Pharmacologic Class: aminoglycoside; protein synthesis inhibitor

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73
Q

actions of gentamicin

A

broad spectrum for serious urinary, respiratory, nervous, or GI infections
E. coli, Proteus, Pseudomonas, Serratia, Klebsiella, Citrobacter

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74
Q

alerts for gentamicin

A

Withhold if peak serum value is above normal range of 5-10 mcg/mL & advise HCP

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75
Q

adverse effects and contraindications of gentatmicin

A

Adverse Effects
Rash, GI effects, fatigue
Neurotoxicity, ototoxicity (tinnitus, vertigo, HA)
Neuromuscular blockade and respiratory paralysis
Nephrotoxicity: ↓ renal function (oliguria, proteinuria, ↑ BUN and creatinine levels). Be aware of patients with preexisting CKD
Contraindications
Hypersensitivity, impaired renal function, preexisting hearing loss

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76
Q

labs for gentamicin

A

Gentamicin ↑ serum bilirubin, serum creatinine, serum lactate dehydrogenase (LDH), BUN, AST, ALT
May ↓ values of serum calcium, sodium, or potassium

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77
Q

nursing interventions for aminoglycosides

A

Send a sample from the infected area to the lab for C&S to determine organism and its sensitivity

Check for hearing loss and renal function

Check that therapeutic drug monitoring has been ordered for peak and trough drug levels

Monitor for signs and symptoms of superinfection (fever, chills, dyspnea, cyanosis)

Encourage patient to increase fluids unless fluids are restricted

Monitor BUN (7-22) and creatinine (0.6-1.2)

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78
Q

Broad spectrum against gram-negative pathogens. Newer drugs are effective against gram-positive microbes
Well absorbed orally

A

fluroquinolones

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79
Q

ciprofloxacin classes

A

Therapeutic Class: antibacterial
Pharmacologic Class: fluroquinolone; bacterial DNA synthesis inhibitor

80
Q

actions of ciproflaxin

A

Inhibits DNA replication and growth
Effective against gram-positive and gram-negative bacteria S. pneumoniae, S. aureus, H. influenza, P. aeruginosa, Salmonella, and Shigella species
Treats: anthrax, skin, soft-tissue, bone/joint, gynecologic, intraabdominal, urinary and respiratory tract infections

81
Q

adverse effects of ciproflaxin

A

Anaphylaxis, superinfection
Photosensitivity, eye damage, visual disturbances GI distress, dysgeusia (taste disorder)
Tendinitis, tendon rupture (Achilles tendon common)
Clostridium difficile–associated diarrhea
Stevens-Johnson syndrome
May cause extreme weakness in patient with Myasthenia Gravis

82
Q

lab changes from ciproflaxin

A

may ↑ AST, AST, BUN, creatinine levels

83
Q

nursing interventions from fluroquinolones

A

Obtain a specimen from the infected site for C&S
Monitor theophylline levels (increases)
Monitor blood glucose (levofloxacin increases effects or oral hypoglycemics)
Teach to avoid antacids & calcium; they interfere with absorption
Monitor patients for increased affects of anticoagulants
Monitor intake and output
Check lab values for renal function
Check for signs and symptoms of superinfection
Encourage patient to report side effects
Advise patient to wear sunglasses, sun block, and protective clothing when in the sun

84
Q

Only antibiotic not derived from biologic substances; comes from a sulfur-containing chemical
Folic acid inhibitors. Sulfonamides stop cells from using folic acid to make DNA

A

sulfonamides

85
Q

trimethoprim-sulfamethoxazole actions

A

Inhibit bacterial synthesis of folic acid, which is essential for bacterial growth

Effective against gram-negative bacteria
Proteus, Klebsiella, E. coli, and Chlamydia
species
Pneumocystis carinii pneumonia, shigella
infections of the small intestine
Acute episodes of chronic bronchitis
Treats otitis media, meningitis, malaria, and
respiratory and urinary tract infections

86
Q

adverse effects of trimethoprim-sulfamethoxasole

A

Anaphylaxis
Photosensitivity
GI distress, stomatitis
Insomnia, tinnitus
Crystalluria, renal failure
Blood dyscrasias
Stevens-Johnson syndrome
Vaginal itching/discharge (super infection)

87
Q

overdose treatment for trimethoprim-sulfamethoxazole

A

increase acidification of the urine
5-15 mg leucovorin daily

88
Q

trimethoprim-sulfamethoxazole pregnant and nursing mothers

A

crossed the placenta and excreted in breast milk

89
Q

nursing intervention for sulfonamides

A

Administer sulfonamides with a full glass of water (increase fluid intake to avoid crystalluria)
Record vital signs and intake and output.
Observe the patient for hematologic reactions (bleeding, bruising)
Check for signs and symptoms of superinfection
Counsel patient not to take antacids with sulfonamides
Warn patient to wear sunglasses, avoid direct sunlight, use sun block, and wear protective clothing in the sun.
Advise patient with allergy to one sulfonamide to avoid all sulfonamide preparations

90
Q

Bactericidal. Contain a beta-lactam ring & kill bacteria by inhibiting cell wall synthesis
The ring is resistant to destruction by beta-lactamase

A

carbapenems

91
Q

common allergic reaction to vancomycin, caused by degranulation of mast cells & basophils that result in histamine release

A

RMS -Red Man Syndrome

92
Q

To prevent Red Man Syndrome

A

To prevent Red Man Syndrome: run IV no faster than 10 mg/min; at least over 60 min (whichever is longer)
Stop the infusion & notify provider

93
Q

sometimes given to help prevent RMS

A

diphenhydramine (Benadryl)

94
Q

therapeutic trough of benadryl

A

10-20 mcg/mL

95
Q

metronidazole (flagyl)

A

Therapeutic Class: antiinfective; antiprotozoan
Pharmacologic Class: disrupts nuclei acid synthesis

96
Q

actions of metronidazole (flagyl)

A

Disrupts DNA and protein syntheses in bacteria and protozoa
Antimicrobial amebicide
Effective against H. pylori, Clostridium, Giardia, Gardnerella, Prevotella, Peptococcus bacteria species, and Trichomonas vaginalis protozoa
Treats Clostridium difficile-associated diarrhea; amebiasis; giardiasis; trichomoniasis; bacterial vaginosis; acne; meningitis; and gynecologic, skin, intraabdominal, and respiratory infections

97
Q

alerts for metronidazole (Flagyl)

A

extended release must be swallowed whole & taken on empty stomach
Contraindicated in first trimester of pregnancy (risk for birth defects)

98
Q

adverse effects of metronidazole (Flagyl)

A

GI effects,
dizziness,
HA,
dry mouth,
metallic taste

99
Q

lab changes from metronidazole (Flagyl)

A

↓ AST & ALT values

100
Q

first and second line drug for Tubercular, Fungal, Protozoan, & Helminthic Infections

A

First-Line Drugs
ethambutol (Myambutol): tuberculosis (TB)
isoniazid (INH); rifampin (Rifadin): latent & active TB
pyrazinamide (PZA): TB
rifabutin (Mycobutin): prevents Mycobacterium dz in HIV patients

Second-Line Drugs
amikacin (Amikin)
aminosalicyclic (Paser)
ciprofloxacin (Cipro)
kanamycin (Kantrex)
ofloxacin (Floxin)
streptomycin

101
Q

isoniazid (INH)

A

Therapeutic Class: antituberculosis drug
Pharmacologic Class: mycolic acid inhibitor

102
Q

actions of isoniazid (INH)

A

Most effective therapy for TB
Used alone or in combination with other anti-TB drugs for treating the active dz

103
Q

adverse effects and contras of isoniazid

A

Adverse Effects
Numbness of hands/feet, rash, fever, optic neuritis, hearing loss, memory loss, psychoses
Hepatotoxicity: monitor for ↑ liver enzymes, for jaundice, fatigue, loss of appetite, avoid ETOH
Contraindications
Hypersensitivity, severe hepatic impairment

104
Q

labs for isoniazid

A

may increase AST and ALT

105
Q

nursing interventions for anti-TB drugs

A

Administer INH 1 hour before or 2 hours after meals.
Give pyridoxine (vitamin B6) as prescribed with INH to prevent peripheral neuropathy
Monitor hepatic function tests: hepatotoxic
Emphasize importance of complying with drug regimen

106
Q

86% of all human fungal infections are caused by

A

Candida albicans (single- or multicell organisms)

107
Q

bind to fungal cell membrane to form open channels that increase cell permeability & leakage of K+

Ex:

A

Polyenes
amphotericin B (Abelcet), nystatin (Mycostatin)

108
Q

inhibit fungal synthesis, interfering with the formation of ergosterol
Ex:

A

Azoles
fluconazole (Diflucan)
ketoconazole (Nizoral)
posaconazole (Noxafil)

109
Q

selectively penetrate fungal cell and disrupts fungal DNA/RNA synthesis
Ex:

A

Antimetabolites
flucytosine (Ancobon)

110
Q

inhibit biosynthesis of essential component of the fungal cell wall
Ex:

A

Echinocandins
caspofungin (Cancidas)

111
Q

amphotericin B (Fungizone) classes

A

Therapeutic Class: antifungal (systemic)
Pharmacologic Class: polyene

112
Q

actions of amphotericin B (fungizone)

A

Treats severe, systemic fungal infections

Binds to fungal cell membranes, causing cell permeability, and leakage of cellular contents
Not absorbed from the GI tract; given IV

113
Q

alerts for amphotericin B (Fungizone)

A

Reactions usually begin 1-3 hours after initiating drug
Avoid reactions: pretreat 30-60 minutes before drug with: acetaminophen, diphenhydramine, hydrocortisone, or antiemetics
Infuse slowly to avoid cardiovascular collapse
Withhold drug if BUN > 40 mg/dL or creatinine > 3 mg/dL. Use with caution with CKD
Normal ranges: BUN (7-22) and creatinine (0.6-1.2)

114
Q

adverse effects of amphotericin (fungazone)

A

Flushing, fever, chills, headache, tachypnea
Dizziness, ototoxicity, hypotension, GI distress
Paresthesia, thrombophlebitis
High doses: nephrotoxicity, hypokalemia, hypomagnesemia

115
Q

lab changes from amphotericin (fungizone)

A

May ↑ serum BUN & creatinine, alkaline phosphatase, AST, ALT
May ↓ serum potassium, calcium, magnesium

116
Q

azole antifungals

A

Consist of 2 different chemical classes: imidazoles; triazoles

117
Q

azole antifungals action

A

Broad spectrum
Increases permeability of fungal cell membrane by inhibiting ergosterol synthesis to impair fungal growth

118
Q

Systemic Azoles
Adverse Effects

A
  • fluconazole, ketoconazole are for systemic & topical infections
    -NV, anaphylaxis, rash, may affect glycemic control in patients with DM, hepatotoxic
119
Q

Topical Azoles:
Adverse Effects:

A
  • clotrimazole(Mycelex) for skin, vaginal, oral fungal infections
    fluconazole (Diflucan) for oral candidiasis
  • burning/irritation at application sites
120
Q

fluconazole (Diflucan) classes

A

Therapeutic Class: antifungal
Pharmacologic Class: inhibitor of fungal cell membrane synthesis

121
Q

fluconazole (diflucan) actions

A

Increases permeability of fungal cell membrane by inhibiting ergosterol synthesis to impair fungal growth
Completely absorbed when given orally (PO)
Effective against Candida albicans
Able to penetrate most body membranes to reach infections in the CNS, bone, eye, urinary tract, resp tract
Narrow spectrum

122
Q

adverse effects of fluconazole (diflucan)

A

Headache, rash, GI distress
Hypokalemia, dysrhythmias
Hepatotoxicity, nephrotoxicity
Stevens-Johnson syndrome in the immunocompromised patient

123
Q

drug-drug interactions of fluconazole (diflucan)

A

Fluconazole with warfarin ↑ risk for bleeding
Hypoglycemia if given concurrently with oral hypoglycemics
Levels of the drug may be ↓ with concurrent use of rifampin
Effects of fentanyl (Sublimaze), alfentanil (Alfenta), methadone (Dolophine) may be prolonged

124
Q

lab changes for fluconazole (diflucan)

A

AST, ALT, & alkaline phosphatase may be ↑

125
Q

Topical application for superficial mycoses

A

nystatin (Mycostatin, Nystop)
terbinafine (Lamisil)
tolnaftate (Tinactin)

126
Q

Prototype Drug nystatin (Mycostatin, Nystop) classes

A

Therapeutic Class: superficial antifungal
Pharmacological Class: polyene

127
Q

action of nystatin

A

Binds to sterols causing loss of intracellular potassium and other cell contents

128
Q

application of nystatin

A

Swish for at least 2 minutes, then swallow…swish and swallow
Apply with a swab in infants/children

129
Q

adverse effects of nystatin

A

contact dermatitis, N-V-D

130
Q

nursing intervention for antifungals

A

Monitor renal/liver function studies; urine output, CBC, electrolytes
Advise the patient to take drugs as prescribed
Advise the patient not to consume alcohol
Encourage the patient to report side effects

131
Q

single-celled organisms that inhabit water, soil, animal hosts

A

Protozoa

132
Q

thrive in condition where sanitation & personal hygiene are poor & population density is high
drug resistant if cysts occur inside host

A

Protozoa

133
Q

from fecal-contaminated water = dysentery symptoms: severe diarrhea

A

Amebiasis/Entamoeba histolytica

134
Q

from fecal-contaminated water

A

Cryptosporidiosis/Cryptosporidium parvum
Giardiasis/Giardia lamblia:

135
Q

from female Anopheles mosquito

A

Malaria/Plasmodium

136
Q

congenital transmission or cat feces

A

Toxoplasmosis/Toxoplasma gondii

137
Q

through sexual contact

A

Trichomoniasis/Trichomonas

138
Q

from kissing bug (America) Chagas’ dz, tsetse fly (African)

A

Trypanosomiasis/Trypanosoma

139
Q

the second most common fatal infectious dz in the world
Almost all occur in infected immigrants or travelers bringing the dz from endemic areas

A

malaria

140
Q

Lifecycle of Plasmodium

A

Malaria begins with a bite form an infected female Anopheles mosquito, a carrier of the parasite
Plasmodium travels to the liver, then to the bloodstream
A mosquito bites the animals/humans and becomes infected
The cycle begins again

141
Q

Prevention of malaria

A

Prophylactic antimalarial drugs before travel to infested areas
When infection is confirmed, initiate drug therapy ASAP
Prevention of relapse: drugs are given to eliminate the dormant forms of Plasmodium that reside in the liver
Mosquito netting
Protective clothing

142
Q

treats the acute stage of malaria . It interferes with protein synthesis

A

chloroquine (Aralen)

143
Q

Side effects/adverse reactions of chloroquine (aralen)

A

Visual disturbances, dizziness
GI distress: A-N-V-D, abdominal cramps
Seizures, confusion, HA, psychosis
Ototoxicity
Renal impairment, hepatomegaly
Hemolytic anemia
Cardiovascular effect

144
Q

teaching for malaria drugs

A

Prophylaxis does can be taken before, during, after trip to malaria-endemic countries
Take with food
Report vision changes immediately
Avoid large quantities of ETOH

145
Q

nursing interventions for antimalarials

A

Monitor renal and liver function by checking urine output, BUN, creatinine, and liver enzymes
Monitor the patient for impaired consciousness, headache, or seizures
Monitor patients returning from malaria-endemic areas for malarial symptoms

146
Q

the drug of choice for nonmalarial protozoan infections

A

metronidazole (Flagyl)

147
Q

treats trichomoniasis, giardiasis, amebiasis

A

tinidazole (Tindamax)

148
Q

helminths and types

A

parasitic worms

Four groups of helminths
Cestodes (tapeworms)
Trematodes (flukes)
Intestinal nematodes (roundworms)
Tissue-invading nematodes (tissue roundworms)

149
Q

helminths trasmission and sites affected

A

Transmission
Entry from infected soil to humans via:
Contaminated food
Bites of carrier insects
Direct penetration of skin

Sites affected
Intestine, lymphatic system
Blood vessels, liver

150
Q

mebendazole (Vermox) classes

A

Therapeutic Class: drug for worm infections
Pharmacologic Class: anthelminthic

151
Q

mebendazole (vermox)

A

Broad spectrum drug for mixed helminth infections, common in regions with poor sanitation
Effective against adult & larval stages of the parasites
Absorbed systemically
For pinworms, 1 dose is sufficient; others require 3 consecutive days of treatment

152
Q

adverse effects of mebendazole (vermox)

A

As worms die, may have abdominal pain, distention & diarrhea

153
Q

least effective of all anti-infectious agents

A

antivirals

154
Q

means of viral transmission

A

Droplets: coughing, sneezing, talking
Contact: infected lesions/secretions
Process of replication of itself

155
Q

There are 3 basic strategies used for antiviral pharmacotherapy

A

Prevent viral infections through vaccinations
Treat active infections with drugs, such as acyclovir (Zovirax) that interrupt the replication cycle
For prophylaxis to boost the person’s immune response; viruses should remain dormant/latent with the person being symptom-free of the virus

156
Q

replicates itself by first reverse-coding its genes into the DNA of the cells it infects. It does this with an enzyme called reverse transcriptase.1

A

retrovirus

157
Q

profound immunosuppression that leads to opportunistic infections & malignancies

A

Acquired Immune Deficiency Syndrome (AIDS)

158
Q

slow the growth of the causative agent for AIDS, the Human Immunodeficiency Virus (HIV), by several mechanisms

A

Antiretroviral drugs

159
Q

drugs for HIV/AIDS

A

Drugs cost $40,000 - $60,000 per year & may produce serious adverse effects that lower quality of life (QOL)

160
Q

therapeutic goal for HIV drugs

A

Reduce HIV-related morbidity & prolong survival
Improve QOL
Restore & preserve immune function
Suppress plasma HIV viral load to the maximum extent possible
Prevent HIV transmission

161
Q

Most important indicator of how the virus is replication in the body

A

viral load

162
Q

drugs that target specific phases of the HIV replication cycle

A

Antiretroviral therapy (ART)

163
Q

zidovudine (Retrovir, ZDV, formerly AZT) classes

A

Therapeutic Class: antiretroviral
Pharmacologic Class: Nucleoside reverse transcriptase inhibitors (NRTI)

164
Q

actions of zidovudine (Retrovir, ZDV, formerly AZT)

A

Creates a defective DNA strand
Treatment of HIV in combination with other antiretrovirals
Prevention of HIV from mother to fetus or neonate

165
Q

adverse effects of zidovudine (Retrovir, ZDV, formerly AZT)

A

Fatigue, generalized weakness, GI symptoms, HA, serious CNS effects have been reported
Fatal lactic acidosis with hepatomegaly and fatty liver dz
Bone marrow suppression resulting in neutropenia or severe anemia
Myopathy with long-term use

166
Q

labs for zidovudine (Retrovir, ZDV, formerly AZT)

A

Mean corpuscular volume (MCV) may be ↑, WBC & Hgb may ↓ due to neutropenia & anemia

167
Q

efavirenz (Sustiva) classes

A

Therapeutic Class: antiretroviral
Pharmacologic Class: Nonnucleoside reverse transcriptase inhibitors (NNRTI)

168
Q

efavirenz (Sustiva) actions

A

Inhibits reverse transcriptase & is approved for children 3 moths or older
Advantage of once-daily dosing & penetration into the cerebrospinal fluid (CSF)
Resistance to NNRTIs can develop, & cross resistance of drugs in this class can occur
High-fat meals ↑ absorption by 50% and may cause toxicity

169
Q

efavirenz (Sustiva) adverse effects

A

CNS effects: sleep disorders, nightmares, dizziness, ↓ ability to concentrate, delusions, rash

170
Q

contraindications of efavirenz (Sustiva)

A

Teratogen (birth defects): neural tube defects (NTDs)
Pregnancy
Teach birth control

171
Q

efavirenz (Sustiva) lab changes

A

may give false-positive for marijuana, may ↑ serum lipid values

172
Q

dolutegravir (DTG, Tivicay)

A

Therapeutic Class: antiretroviral
Pharmacologic Class: integrase strand transfer inhibitor

173
Q

dolutegravir (DTG, Tivicay) actions

A

Blocks the strand transfer of retroviral DNA & interrupts the HIV replication cycle
Fewer drug interactions & greater barriers to resistance than other INSTIs

174
Q

administration alerts for dolutegravir (DTG, Tivicay)

A

↑ risk of NTDs in mothers who took drug during first trimester
Only in pregnancy when benefits outweigh risks

175
Q

adverse effects of dolutegravir (DTG, tivicay)

A

Insomnia, fatigue, HA
May ↑ blood cholesterol & triglycerides
Depression, suicidal ideation, anxiety

176
Q

lab changes for dolutegravir (DTG, Tivicay)

A

total cholesterol & triglycerides may ↑

177
Q

HIV-infected patients can transmit the virus during

A

pregnancy, labor, delivery, and breastfeeding

178
Q

Postexposure prophylaxis regimens (PEP)

PEP regimen should be initiated within

the most common reactions

A

within 72 hours of the event and continued for 4 weeks

most common reactions being nausea, malaise, and fatigue

179
Q

DNA viruses that cause repeated blister-like lesions on the skin, genitals, & other mucosal surfaces

A

Herpes Viruses

180
Q

spread by close contact
Causes

A

Herpes simplex virus type 1 (HSV-1)
cold sores

181
Q

spread by close contact
causes

A

Herpes simplex virus type 2 (HSV-2)
lesions on genitalia, and also can be caused by simplex type 1

182
Q

spread by close contact
Causes

A

Varicella-zoster viruses (HSV-3 or VZV chickenpox and shingles

183
Q

transmitted by body fluids (saliva)
Causes

A

Epstein-Barr virus (HHV-4 or EBV)
Causes mononucleosis

184
Q

transmitted by body fluids
Causes
Causes

A

Cytomegalovirus (HHV-5 or CMV)
Causes weakened immune system
Causes chickenpox and mononucleosis

185
Q

herpesvirus acyclovir (zovirax) classes

A

Therapeutic Class: antiviral for herpesviruses
Pharmacologic Class: nucleoside analog

186
Q

herpesvirus acyclovir (zovirax) actions

A

Interferes with the steps of viral nucleic acid (DNA) synthesis to ↓ the duration/severity of acute herpes episodes
Most effective against HSV-1 & HSV-2
Effective only at high doses against CMV & varicella zoster

187
Q

herpesvirus acyclovir (zovirax) adverse effects

A

Nephrotoxicity & neurotoxicity are possible per IV route
Resistance has developed to the drug, particularly in patients with HIV-AIDS

188
Q

herpesvirus acyclovir (zovirax) lab changes

A

may ↑ BUN & creatinine levels

189
Q

zanamivir (Relenza)

A

Blocks function of viral neuraminidase protein by stopping the release of viruses from infected cells to health cells
Treats influenza A & B
Take bronchodilators before zanamivir
Administered via inhalation

190
Q

zanamivir side effects

A

HA, N-V-D, dizziness, weakness

191
Q

Decreases the release of the virus from infected cells by inhibiting activity of neuraminidase to decrease viral spread and shorten duration of symptoms
Treats and prevents influenza A and influenza B

A

oseltamivir (Tamiflu)

192
Q

oseitamivir (tamiflu) treatment should begin within

A

48 hours of flu symptoms - treat for 10 days

193
Q

oseitamivir (tamiflu) side effects

A

N-V-D, dizziness/vertigo HA, insomnia
Monitor closely for abnormal behavior (delirium, hallucinations)

194
Q

transmission of viral hepatitis

A

Needlestick, intimate sexual contact, or childbirth (HCV)
Blood-borne pathogens spread via blood and body fluids

195
Q

hepatitis CM

A

Fatigue, malaise
Nausea, abdominal pain
Jaundice

196
Q

vaccines for hepatitis

A

A and B

197
Q

drug therapy for hep C

A

epclusa
harvoni
mavyret
zepatier

Pharm Exam 1 (3 decks)

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