Pharm Exam 1

Question 1

Assessments for antibiotics

Answer 1

1.) Allergies
2.) Liver/kidney labs b/c many antibiotics are metabolized in the liver and excreted through the kidneys. Vanco requires BUN/creatinine monitoring b/c it can cause nephrotoxicity. Flagyl requires AST/ALT monitoring b/c it can cause hepatotoxicity.
3.) Blood Cultures to identify the specific bacteria causing the infection. This ensures the antibiotic given is effective against the pathogen.
4.) Vanco trough levels should be drawn 30 minutes before the next dose to monitor for therapeutic range and avoid toxicity

Question 2

Why is it important to monitor trough levels for Vancomycin, and when should they be drawn?

Answer 2

Trough levels for Vancomycin are drawn 30 minutes before the next dose. If the trough level is too high, it can lead to nephrotoxicity and ototoxicity. The trough level is too low, the antibiotic may not be effective in treating the infection.

Question 3

What are the common side effects of antibiotics? (3)

Answer 3

1.) Photosensitivity - Patients should avoid prolonged sun exposure & use sunscreen
2.) Ototoxicity - More common with Vanco, patients should report hearing changes, tinnitus, dizziness
3.) Superinfection (C. Diff or yeast) - Patients should report severe GI issues or itching in mouth or genital area

Question 4

Adverse reactions to antibiotics

Answer 4

1.) Nephrotoxicity
2.) Hepatotoxicity
3.) Allergic reaction

Question 5

What severe reaction does Vancomycin cause?

Answer 5

Red Man Syndrome is caused by infusing Vancomycin too quickly. Symptoms include flushing, red rash, and itching that form on the face, neck, and upper chest. Slowing down the infusion can stop this reaction.

Question 6

What do Vancomycin and Flagyl treat that no other antibiotics can?

Answer 6

C. Diff

Question 7

What severe reaction can Sulfas and Flagyl cause?

Answer 7

Steven Johnsons Syndrome (SJS) is a severe life threatening reaction. Symptoms include a red, blistery rash that progresses to skin peeling and ultimately necrosis. Patients should seek immediate medical attention.

Question 8

Patient education for antibiotics

Answer 8

1.) Complete the full course of antibiotics even if symptoms improve. Stopping antibiotics early can lead to antibiotic resistance, or recurrence of infection.
2.) Take w/food to avoid GI upset
3.) Drink plenty of fluids to help prevent nephrotoxicity and promote excretion of the drug

Question 9

What are 3 safety considerations with antibiotics?

Answer 9

1.) Avoid alcohol especially with Metronidazole (Flagyl) as it can cause severe reaction w/ symptoms like vomiting, headache, and tachycardia.
2.) Many antibiotics (Tetracyclines & Sulfas) are toxic in pregnancy. Always check a pregnancy test before administration & use safter alternatives if needed.
3.) IV Extravasation - Stop the infusion immediately; start a new IV at another site; Apply a warm/cold compress as needed

Question 10

What is the primary use of Adenosine?

Answer 10

Adenosine is the FIRST line treatment for SVT

Question 11

How does Adenosine affect the heart?

Answer 11

Adenosine briefly stops the heart to restore NSR. It is known as the “IT Med” b/c it “turns off/on the heart”

Question 12

Side effects of Adenosine

Answer 12

• Brief asystole
• Flushing
• Angina
• SOB/dyspnea
• Sense of impending doom
• Hypotension/bradycardia

Question 13

Nursing Considerations for Adenosine (5)

Answer 13

1.) Warn pt of side effects before administration
2.) Have crash cart nearby for emergencies
3.) Hook pt up to telemetry monitoring before administration
4.) Administer in the AC
5.) After admin, slam 20mL saline flush and elevate the arm to promote circulation

Question 14

What is the primary use of Amiodarone/when do we use it?

Answer 14

Amiodarone is the LAST resort drug for Afib/Aflutter that has not responded to other medications.

Question 15

What should you try before Amiodarone?

Answer 15

Beta Blockers and Calcium Channel Blockers

Question 16

What are the adverse effects of Amiodarone?

Answer 16

1.) CNS - Ataxia, hallucinations, tremors
2.) Integumentary - Photosensitivity, /grayish-blue skin/cyanosis
3.) Eyes - Vision changes - BL exam
4.) Hypo/hyperthyroidism - BL labs
5.) Pulmonary Toxicity - BL pulmonary function tests & CXR
6.) Cardiac Toxicity - Can cause HF - BL EKG/ECHO
7.) Hepatotoxicity - BL labs

Question 17

Nursing Considerations for Amiodarone

Answer 17

1.) Give PO Adenosine 1hr before starting Amiodarone drip
2.) IV: Monitor for hypotension/bradycardia
3.) No grapefruit juice
4.) Use sunscreen
5.) Signs of toxicity
6.) Appointments for baseline labs
7.) Side effects may persist after med is D/C’d

Question 18

What is the primary use of Lidocaine?

Answer 18

Lidocaine is used for ventricular dysrhythmias like PVCs and Vfib/Vtach

Question 19

What are side effects of Lidocaine?

Answer 19

“Lidocaine brings things down in your LAP”
1.) Hypotension & bradycardia
2.) CNS Changes - Confusion, dizziness, drowsiness, paresthesia, and seizures
3.) Respiratory arrest

Question 20

Nursing considerations for Lidocaine (3)

Answer 20

1.) Frequent neuro checks for changes
2.) Monitor tele for dysrhythmias
3.) Keep the crash cart nearby