Topic 3: Drugs for inflammation, fever & pain (Analgesic) & Topic 4: Drugs for infection Flashcards

Question

Mechanism of action for analgesic opioid agonists

Answer 1

- binds to opioid pain receptor in brain & causes analgesic response-reduction of pain sensation - diff. drugs in this class exert their effects by binding to different degrees of kappa and mu opioid receptors

Answer 2

The mu, kappa, and delta receptors are most responsive to drug activity with the mu being the most popular

Answer 3

Bind to a pain receptor and causes a weaker pain response than does a full agonist

Answer 4

Binds to a pain receptor but does not reduce pain signals. It functions as a competitive antagonist because it competes with the and reverses the effects of agonist and agonist-antagonist drugs at the receptor site

Answer 5

Refers to the ability to provide equivalent pain relief by calculating dosages of diff. drugs and/or routes of administration that provide comparable analgesia

Answer 6

- Strong opioid (morphine, hydromorphone, oxycodone) control postop and other pain - morphine/hydromorphone=1st line analgesics in immediate postop setting due to their injectable forms - oxycodone=orally administered - oxycontin=sustained release, 12 hrs - opioids suppress medullary cough center - constipation=unwanted side effects of opioids due to decrease GI tract motility

Answer 7

- known drug allergy and severe asthma - itching not allergic reaction, result of histamine - caution in cases of respiratory insufficiency especially when resuscitative equipment not available and in conditions involving INTRACRANIAL PRESSURE (severe head injury); morbid obesity &/or sleep apnea; myasthenia gravis; paralytic ileus (bowel paralysis); * pregnancy, especially w/long term use

Answer 8

Cardiovascular: hypotension, flushing, bradycardia CNS: Sedation, disorientation, euphoria, lightheadedness, dysphoria GI: N/V, constipation, biliary tract spasm Genitourinary: urinary retention Integumentary: itching, rash, wheal formation Respiratory: respiratory depression and possible aggravation of asthma

Answer 9

1) Acetylsalicylic acid (Aspirin) 2) Ketorolac (Toradol) 3) Indomethacin (Indocin) 4) Ibuprofen (Advil/Motrin)

Answer 10

1) Ibuprofen 2) Acetaminophen (Tylenol) 3) Aspirin (platelet inhibition)

Answer 11

``` Opioids 1) Morphine 2) Oxycodone Hydrochloride (OxyContin/Percocet) 3) Meperidine (Demerol) 4) Hydromorphone (Dilaudid) 5) Nalbuphine (Nubain) Opioid antagonist 1) Naloxone ```

Answer 12

Penicillin G

Answer 13

1) Ancef | 2) Rocephin

Answer 14

1) Erythromycin

Answer 15

1) Tobramycin | 2) Gentamicin

Answer 16

1) Trimethoprim and Sulfamethoxazole (Bactrim)

Answer 17

1) Isoniazid (INH) | 2) Rifampin

Answer 18

1) Nystatin (Mycostatin) 2) Fluconazole (Diflucan) 3) Amphotericin B

Answer 19

1) Acyclovir (Zovirax) | 2) Tamiflu

Answer 20

1) Metronidazole (Flagyl)

Answer 21

Naloxone (Narcan): binds to receptor sites (mu, kappa, delta). - competitive antagonists - reverse opioid affects (resp. depression, itching) - short lived (1 hour)

Answer 22

-gradual dose reduction after chronic opioid use helps minimize risk of severity of withdrawal symptoms

Answer 23

-alcohol -antihistamines -barbiturates -benzodiazephiens -phenothiazine -other CNS depressants Can all result in additive resp. depressant effectss -combined use of opioids can result in respiratory depression, seizures, and hypotension

Answer 24

Can cause abnormal increase in - serum levels of amylase - alanine aminotransferase - alkaline phosphatase - bilirubin - lipase - creatinine kinase - lactate dehydrogenase - urinary 17-ketosteroid levels - an increase in urinary alkaloid and glucose concentrations

Answer 25

-perform thorough health history,

Answer 26

Bactericidal antibiotics, meaning they kill a wide variety of gram-positive and some gram-negative bacteria

Answer 27

Bacteria that have acquired the capacity to produce enzymes capable of destroying penicillins

Answer 28

Inhibition of bacterial cell wall synthesis - penicillin binding proteins: by binding to proteins the penicillin molecule interefers with normal cell wall synthesis - bacterial death results from lysis (rupture) of its cell walls

Answer 29

For prevention and Tx of infections caused by susceptible bacteria - most common bacteria destroyed by penicillins are: gram-positive such as streptococcus, enterocuccus, staphlococcus - extended-spectrum penicillins can destory gram-+/- and anaerobic. These are used to treat many health-care associated infections

Answer 30

- known drug allergy/type of reaction - important to know that some penicillins don't end with "cillin" so don't give it to a pt that is allergic to penicillin

Answer 31

- allergic reactions - urticaria, pruritus, angioedema - idiosyncratic (unpredictable) reactions: maculopapular eruptions, eosinophilia, Stevens-Johnson syndrome, exfoliative dermatitis - Anaphylactic reactions - those with history of throat swelling or hives from penicillin should not receive cephalosporins - most common involve GI system - IV formulations (some) contain large amounts of sodium and/or potassium. Doses must be adjusted for pt's w/renal dysfunction

Answer 32

- NSAIDs - oral contraceptives - warfarin - rifampin - probenecid - methotrexate - aminoglycosides (IV) and clavulanic acid

Answer 33

- history/symptoms of hypersensitivity or allergic reactions - determine pt's age, weight, baseline vital signs w/body temperature - lab tests such as liver function (AST, ALT levels), kidney function (BUN, creatinine levels), cardiac function (EKG), ultrasonography, culture and sensitivity tests, CBC, platelet clotting tests - obtain specimens for cultures BEFORE beginning antibiotic therapy - assess I&O - record baseline neurologic assessment findings - assess bowel sounds/patterns - check for contraindications, cautions, drug interactions - obtain list of pt's medications (herbs, etc.) - cultural assessment (racial/ethnic) - assess learning preparedness, willingness, education level for pt education of safe administration - baseline findings for oral mucosa, respiratory tract, GI tract, genitourinary tract (risk for superinfection)

Answer 34

Fever, lethargy, mouth sores, perineal itching

Answer 35

1) give oral w/in time frame and fluids/foods 2) give as prescribed to maintain effective blood levels 3) dont omit or double doses 4) Dont give oral at same time w/antacids, calcium supplements, iron products, laxatives containing magnesium, or antilipemic drugs 5) herbal/dietary supplements can be used unless they interact 6) continually monitor for hypersensitivity reactions past the initial assessment phase because immediate reactions may occur w/in 1-72 hrs. Characterized by wheezing, SOB, swelling of face/hands, itching/rash 7) signs of hypersensitivity=stop dosage form IMMEDIATELY (if IV, stop infusion), contact prescriber, monitor pt

Answer 36

- determine drug allergies BEFORE therapy - assess history of asthma, sensitivity to multiple allergins, aspirin allergy, and sensitivity to cephalosporins. These are associated w/ higher risk for penicillin allergy - note results of C&S tests - assess neuro, abdominal, bowel assessment - pt's w/electrolyte imbalances, cardiac disease, and/or renal disease assessment of serum sodium and potassium levels because some penicillins contain those concentrations - w/any dose important to assess for patient safety of immediate, accelerated, or delayed allergic reaction - remember, not all penicillins end in "CILLIN"

Answer 37

To prevent getting C. diff when giving penicillin have pt consume probiotics, supplements, or cultured dairy products (e.g kefir) Points to remember 1) take oral w/6 oz of water (not juice) 2) penicillin V, amoxicillin, & amoxicillin/clavulanate given w/water & 1hr before or 2hrs after meals, take w/snack 3) Procaine & benzathine salt penicillin are thick so give them IM w/21-guage needle 4) Reconstitute IM imipenem/cilastin in sterile saline w/lidocaine into large muscle mass 5) IV penicillins use diluent & infuse over time. Monitor IV site for swelling, tenderness, heat, redness, leaking, and pain 6) check compatibilities of IV fluids and drugs prior to infusion 7) if pt has anaphylactic reaction give epinephrine & other emergency drugs. Supportive equipment (oxygen)

Answer 38

Penicillin G has 3 salt forms: benzathine, procaine, potassium. All given by injection (IV, IM). - benzathine and procaine salts are used as longer-acting IM injections. Never give them IV because their consistency is too thick - IM helpful for syphilis - penicillin G potassium for IV - penicillin V oral use only

Answer 39

Photosensitivity is a common adverse effect. The client should avoid direct sun exposure and tanning bed use while taking this medication. Exposure to the sun can cause severe burns.

Answer 40

It can cause permanent discoloration of the adult teeth and tooth enamel, which are still forming in the child.

Answer 41

beta-lactam antibiotics. The incidence of cross-reactivity between cephalosporins and penicillins is reported to be between 1% and 4%.

Answer 42

Clients should be encouraged to drink plenty of fluids (2000 to 3000 mL/24 hours) to prevent drug-related crystalluria associated with sulfonamide antibiotics.

Answer 43

longer duration of action, as well as fewer and less severe GI adverse effects than erythromycin.

Answer 44

An infection that is acquired during the course of receiving treatment for another condition in a health care facility. The infection is not present or incubating at the time of admission; also known as a nosocomial infection.

Answer 45

prevent infections in individuals who are at high risk of development of an infection during or after a procedure. The antibiotics are given before the procedure for prophylactic treatment.

Answer 46

- structurally & pharmacologically related to penicillins - bactericidal, interfere bacterial cell wall synthesis - bind to same penicillin binding proteins in bacteria - 5 generations; depending on generation they can be active against gram +/-, or anaerobic - not active against fungi, viruses or enterococci - 1st generation most gram + coverage, later generations most gram - - Anaerobic coverage found only with second-generation - 5th generation covers gram + (MRSA) and gram -

Answer 47

- mild diarrhea, abdominal cramps, rash, pruritus, redness, edema - chemically similar to penicillins so a pt allergic to penicillin may also have allergic reaction to cephalosporins, called cross sensitivity

Answer 48

Pregnancy category B

Answer 49

Patients with known hypersensitivity to them and in patients with a history of life-threatening allergic reaction to penicillins

Answer 50

- Prototypical 1st generation - provides coverage against gram+ but limited coverage against gram- - available for parenteral use - used commonly for surgical prophylaxis and for susceptible staphylococcal infections

Answer 51

- long acting 3rd generation given ONLY once a day for Tx of infections - easily pass through blood-brain barrier so it is one of the few that are indicated for Tx of meningitis - given both IV and IM (only injection) - 93-96% bound to plasma protein - metabolized in the INTESTINE after biliary excretion - not given to hyperbilirubinemic neonates or to pt's w/severe liver dysfunction - should NOT be administered w/calcium infusions

Answer 52

- bacteriostatic except in high concentrations they can be bactericida - azithromycin and clarithromycin have longer durations of action than erythromycin which allows them to be given less often. Produce fewer and milder GI tract adverse effects than erythromycin

Answer 53

- bitter taste & quickly degraded by acidity of stomach, so several salt forms and many dosage formulations developed to circumvent these problems - therapeutic effect is its ability to irritate GI tract, which stimulates smooth muscle and GI motility. Benefit to pt's w/decreased GI motility and helpful in facilitating passage of feeding tubes from stomach into small bowel

Answer 54

- bacteriostatic, inhibit protein synthesis by binding reversibly to 50s ribosomal subunits of susceptible microorganisms - Tx for wide range of infections: upper/lower respiratory tract, skin, and soft tissue caused by some strains of Streptococcus & Haemophilus, syphilis, lyme disease, gonorrhea, chlamydia, mycoplasma, corynebacterium infections - effective against several bacterial species that often reproduce inside host cells instead of just in the bloodstream or interstitial spaces

Answer 55

- Streptococcus pyogenes - mild-moderate upper/lower respiratory tract infections caused by Haemophilus influenzae - spirochetal infections such as syphilis, lyme disease - gonorrhea, chlamydia, mycoplasma infections

Answer 56

Known drug allergy | -often used as alternative drugs for pt's w/allergies to beta-lactam antibiotics

Answer 57

- Erythromycin: GI-related, N/V - Azithromycin and clarithromycin: lower incidence of these GI tract complications - palpitations, chest pain QT prolongation - Headache, dizziness, vertigo - N, hepatotoxicity, heartburn, vomiting, diarrhea, flatulence, cholestatic jaundice, anorexia, abnormal taste - rash, urticaria, phlebitis @ IV site - hearing loss, tinnitus

Answer 58

Possess two properties that can cause drug interactions: they are highly protein bound, they are metabolized in the liver - drugs metabolized in the liver, drug interactions arise from competition between the drugs for metabolic enzymes (cytochrome P-450) leads to pronounced drug interactions, result is delay in the metabolic clearance of one or more interacting drugs thus prolonged and toxic drug effect - reduce efficacy of oral contraceptives - clarithromycin & erythromycin not used w/moxifloxacin, pimozide, thioridazine, or other drugs that prolong QT interval, because malignant dysrhythmias can occur

Answer 59

The results are enhanced effects and possible toxicity of the latter drugs, and pt's must be monitored

Answer 60

- available in several diff. salt and dosage forms for oral use that were developed to circumvent some of the drawbacks it have chemically - injectable form available for IV use - also available in topical forms for dermatologic use & in ophthalmic dosage forms - absorption of oral form enhanced if taken on empty stomach, taken w/meal or snack - associated w/many drug interactions because it is a strong inhibitor of cytochrome P450 enzymes

Answer 61

- Bacteriostatic, inhibit bacterial protein synthesis by binding to 30S bacterial ribosome - 3 naturally occurring tetracycline: demeclocycline, oxytetracycline, tetracycline. 2 semisynthetic: doxycycline, minocycline - tigecycline (Tygacil) indicated for skin and soft-tissue infections, intraabdominal infections, pneumonia. Effective against many resistant bacteria - ability to bind to (chelate) divalent (Ca++, Mg++) and trivalent (Al++++) metallic ions to form insoluble complexes. The COADMINISTRATION with MILK, ANTACIDS, or IRON salts causes REDUCTION in oral absorption - strong affinity for calcium precludes use in pediatric pt's younger than 8, can result in TOOTH DISCOLORATION - avoid if PREGNANT and NURSING MOTHERS. They pass in breast milk can be route of exposure leading to tooth discoloration in nursing children

Answer 62

- Oral absorption: all except tigecycline are adequately absorbed - Body tissue penetration: doxycycline and minocycline possess best penetration potential - Half life and resulting dosage schedule:

Answer 63

- Inhibit protein synthesis in susceptible bacteria - inhibit growth of and kill wide variety of Rickettsia, chlamydia, mycoplasma, gram -/+ - Tx of spirochetal infections (syphilis, lyme disease, pelvic inflammation) - Demeclocycline inhibits action of antidiuretic hormone, useful in Tx of SIADH

Answer 64

- Chlamydia - Mycoplasma - Rickettsia - Other bacteria: acne, cholera, lyme disease etc. - Protozoa

Answer 65

- Known drug allergy | - Must be avoided in pregnant and nursing women and children younger than 8 years old

Answer 66

- discoloration of teeth - tooth enamel hypoplasia in both fetuses and children, possibly retard fetal skeletal development if taken during pregnancy - photosensitivity - alteration of intestinal and vaginal flora: diarrhea, vaginal candidiasis, reversible bulging fontanelles in neonates; thrombocytopenia, coagulation, hemolytic anemia, exacerbation of systemic lupus - GI upset, enterocolitis, maculopapular rash

Answer 67

- When taken w/antacids, antidiarrheal drugs, dairy products, calcium, enteral feeding, iron preparations, the oral absorption is reduced - can potentiate effects of oral anticoagulants, more monitoring of anticoagulant effect and possible dosage adjustment - antagonize effects of bactericidal antibiotics and oral contraceptives - can cause increased blood urea nitrogen levels

Answer 68

- inhibit bacterial growth (bacteriostatic) by preventing bacterial synthesis of folic acid - compete w/PABA for bacterial enzyme tetrahydopteroic acid synthetase - also considered antimetabolites

Answer 69

- Against gram +/- - achieve high concentrations in kidneys, where eliminated so Tx of UTI's - common susceptible organisms: Enterobacter, Escherichia coli, Klebsiella, Proteus mirabilis, Proteus vulgaris, S. aureus - results of C&S testing helps optimize drug selection - urinary analgesic (phenazopyridine (Pyridium) is given w/it to help w/pain associated with UTI - sulfamethoxazole/trimethoprim used for respiratory tract infections. Also prophylaxis and Tx of opportunistic infections in pt's w/HIV. Drug of choice for infection caused by bacterium Stenotrophomonas maltophilia - Staphylococcus

Answer 70

Natural and semisynthetic antibiotics that are bactericidal drugs -potent antibiotics (virulent infections) -several routes NOT ORAL -

Answer 71

- Serum levels monitored in pt's blood - dosages adjusted to maintain optimal levels that maximize drug efficacy/minimize toxicity (therapeutic drug monitoring) - nephrotoxicity/ototoxicity associations - dosage adjusted to pt's level of renal function based on estimates of creatinine clearance - in order to be effective the serum level needs to be @least 8x higher than minimum inhibitory concentration (MIC) - work through concentration-dependent killing - ONCE daily dosing - trough (lowest) levels routinely measured to ensure adequate renal clearance of drug and avoid toxicity (drawn 8-12 hours after administration) - lower dosages Tx UTI's

Answer 72

MIC for any antibiotic is a measure of the lowest concentration of drug needed to kill a certain standard amount of bacteria. This value determined in vitro (in lab) for each drug

Answer 73

Achieving a drug plasma concentration that is a certain level above the MIC, even for a brief period, results in most effective bacterial kill

Answer 74

Greater risk for both ototoxicity and nephrotoxicity

Answer 75

Reduced creatinine clearance by the kidneys and is indicative of declining renal function -measured @least every 3 days

Answer 76

When given 3x a day

Answer 77

-Bind to ribosomes (30s) & prevent protein synthesis in bacteria -mostly combinations w/other antibiotics, combined effect greater (synergistic effect) -

Answer 78

Beta-lactam given first so they can break down cell walls to allow aminoglycosides to gain access to ribosomes

Answer 79

Period of continued bacterial growth suppression that occurs AFTER short term antibiotic exposure. -enhanced with higher peak drug concentrations and concurrent use of beta-lactam antibiotics

Answer 80

- use for serious gram- infections (Pseudomonas, Escherichia coli, Proteus, Klebsiella, Serratia, acinetobacter - specific conditions involving gram+ cocci (Enterococcus, S.aureus, bacterial endocarditis) NEVER used alone to Tx gram + infections - Prophylaxis in procedures of GI or GU tract - given in combination w/ empicillin or vancomycin for penicillin allergic pt's - Administer w/caution in premature and full-term neonates due to renal immaturity - in pediatric pt's: pneumonia, meningitis, UTI can occur - inactive against fungi, viruses, most anaerobic bacteria

Answer 81

- known drug allergy - Pregnancy category= C-D - can cross placenta and cause fetal harm - used for pregnant women ONLY in event of life-threatening infections. - don't give to lactating women

Answer 82

- nephrotoxicity (kidneys) occurs in 5-25% & manifested by urinary casts, proteinuria, increased blood urea nitrogen (BUN) & serum creatinine levels. Reversible but monitor renal function - ototoxicity (ears) hearing/balance function. 3-14%, not reversible, permanent. 8th cranial nerve. Dizziness, tinnitus, sense of fullness in ears, hearing loss - headaches, paresthesia, vertigo, skin rash, fever, over growth of nonsusceptible organisms, neuromuscular paralysis. Greatest risk in pt's w/preexisting renal impairment, pt's already receiving other renally toxic drugs, & pt's receiving high-dose/prolonged aminoglycoside therapy

Answer 83

- nephrotoxicity increased w/concurrent use of other nephrotoxic drugs (vancomycin, cyclosporine, amphotericin B) - concurrent use w/ loop diuretics increases risk for ototoxicity - can potentiate warfarin toxicity - concurrent use w/neuromuscular blocking drugs

Answer 84

Used in Tx for recurrent pulmonary infections in pt's with cystic fibrosis by both injectable and inhaled dosing -available in topical and opthalmic dosage forms

Answer 85

- IV/IM dosage same for both routes - indicated for Tx of infection w/several susceptible gram+/- bacteria - available in several dosage forms (injections, topical ointments, opthalmic drops/ointments)

Answer 86

Potent bactericidal broad-spectrum antibiotics | -excellent oral absorption comparable to IV injections

Answer 87

Destroy bacteria by altering their deoxyribonucleic acid (DNA) by interfering w/bacterial enzymes DNA gyrase and topoisomerase IV - do not inhibit production of human DNA - kill mostly gram- and some gram+ - some diffuse into & concentrate themselves in human neutrophils - some bacterial resistance

Answer 88

- active against gram- and select gram+ - most secreted by kidneys as unchanged drug - Tx of complicated UTI infections - Respiratory, skin, GI, and bone and joint infections - combination w/aminoglycosides Tx P. aeruginosa infections - In prepubescent children NOT recommended, they can affect cartilage development - children w/cystic fibrosis can use them

Answer 89

Known drug allergy

Answer 90

- Bacterial overgrowth associated w/long term use - Cardiac effect: prolongation of QT interval, dysrhythmias (those taking class Ia & class III antidysrhythmic drugs), - Black box warning: tendinitis/tendon rupture seen in older adult, renal failure, concurrent glucocorticoid therapy pt's - CNS stimulation (seizures) - peripheral neuropathy - liver injury

Answer 91

- Concurrent use of oral quinolones w/antacids, calcium, magnesium, iron, zinc preparations, or sucralfate=reduction in oral absorption of quinolone. So take interacting drugs 1 hour before or after quinolones - Dairy products - Enteral tube feedings - Probenecid=reduced renal excretion - Nitrofurantoin - oral anticoagulants use w/caution

Answer 92

- broad coverage - oral, injectable, ophthalmic, otic - excellent bioavailability, can work orally as well as many IV antibiotics - capable of killing wide range of gram- - effective against difficult to kill gram- - kill some anaerobic bacteria as well as atypical organisms such as Chlamydia, Mycoplasma, Mycobacterium - Drug of choice for anthrax

Answer 93

-Class nitroimidazole -against anaerobic used to Tx intraabdominal/gynecologic infections (Peptostreptococcus, Eubacterium, Bacteroides, Clostridium) -Tx of protozoal infections (amebiasis, trichomoniasis) -interferes with microbial DNA synthesis -used orally to Tx antibiotic-associated colitis Contraindicated: known drug allergy -oral/injectable forms -pregnancy B category but DON'T use during first trimester ADVERSE EFFECTS: -Dizziness, headache, GI discomfort, nasal congestion, reversible neutropenia and thrombocytopenia DRUG INTERACTIONS -acute alcohol intolerance, avoid for 24 hrs before therapy then 36 hrs after -Increase toxicity of lithium, benzodiazepines, cyclosporine, calcium channel blockers, various antidepressants, warfarin

Answer 94

- Reserved for Tx of potent infections & given parenteral routes - critical assessment for history of/current symptoms indicative of hypersensitivity or allergic reactions - nursing physical exam - document age, weight, baseline vital signs - diagnostic/lab values (AST, ALT, ECG, ultrasonography, and/or cardiac enzymes - C&S - WBC count - Hemoglobin level - Hematocrit - RBC count - clotting values - sensory/motor intactness - baseline abdominal/GI assessments - note contraindications, cautions, drug interactions - obtain medication lists - cultural assessment - assess for SUPERINFECTION - assess immune system status

Answer 95

Assess for - hypersensitivity/preexisting health conditions or altered neurologic and renal function - obtain medication list due to cautions, contraindications, & drug interactions - known for ototoxicity & nephrotoxicity so perform baseline hearing tests & assessment of vestibular function - nephrotoxicity=increased risk w/use of other nephrotoxic drugs - perform renal function studies (BUN level, urinalysis, serum & urine creatinine levels), document - if renal baseline functioning is decreased prescriber will need to adjust dosage amounts due to risk of nephrotoxicity - neuromuscular assessment - neonates & older adults at higher risk for nephrotoxicity, neurotoxicity, and ototoxicity & require careful assessment before and during drug therapy - assess hydration status

Answer 96

- careful assessment of preexisting CNS conditions may be exacerbated by concurrent use - assess existing neuropathies, quinolones may precipitate peripheral neuropathy - assess cardiac history - assess baseline liver function - drug interactions: antacids, iron, zinc, ucralfate as they affect absorption of the quinolone - oral anticoagulants interact w/and alter antibacterial activity

Answer 97

- allergy & other nitroimidazole derivatives - contraindications, cautions, drug interactions & document findings - review C&S BEFORE therapy (sometimes medication administration may be started prior to results then medication can be changed) - baseline assessments for neurologic system, GI system, GU system - acquire alcohol intake

Answer 98

- given as ordered w/hydration (fluid intake up to 3000 mL/day) - because of nephrotoxicity/ototoxicity determine/monitor pt's renal function during therapy - dosing adjusted based on creatinine clearance calculated from pt's serum creatinine level - monitor renal function to prevent toxicity - monitor BUN levels, glomerular filtration rate (GFR) during therapy - alteration in auditory, vestibular, or renal function may indicate need for dosage adjustment/withdrawal - consumption of yogurt/buttermilk and/or probiotics may help prevent antibiotic-induced superinfections - ophthalmic dosage forms: redness, burning, itching of eyes adverse reaction - check instramuscular sites for induration, DON'T reuse site - monitor IV sites for heat, swelling, redness, pain, phlebitis & initiate measures per protocol

Answer 99

-Instruct pt to report any changes in hearing, tinnitus, or a full feeling in ears, N/V w/motion, ataxia, nystagmus, & dizziness may indicate issues w/vestibular nerve

Answer 100

1) IM: give deeply/slowly into muscle mass to minimize discomfort 2) IV: check for incompatibilities w/drugs, give only clear or slightly yellow solutions diluted w/NS or D5W

Answer 101

- give as prescribed/full course - DON'T take w/antacids, iron, zinc, multivitamins, sucralfate due to decreased absorption of antibiotic - if pt needs to take calcium/magnesium instruct them to take 1 hr before or after quinolone - Force fluids

Answer 102

- given w/food or meals to help decrease GI upsed - Do not chew extended-release forms - avoid alcohol - Intravaginal give at bedtime w/applicator - Topical creams (not near eyes), ointments, lotions apply thinly, wear gloves - store IV form at room temp.

Answer 103

- Educate about drug, purpose, adverse effects including hearing loss which may occur after completion of therapy - advise pt to report any change in hearing to prescriber - Increase in fluids up to 3000mL/day to maximize absorption of oral doses, minimize some adverse effects, ensure adequate hydration - Report persistent headache, N, vertigo. Educate about s/s of superinfection (diarrhea); vaginal discharge; stomatitis, loose and foul smelling stools; cough

Answer 104

Educate about - incidence of PHOTOSENSITIVITY (use sunscreen, sunglasses) - advise to report headache, dizziness, diarrhea, restlessness, V, oral candidiasis, flushing of face, inflammation of tendons - drug interactions w/calcium, magnesium, probenecid, nitrofurantoin, oral anticoagulants, antacids, iron, zinc, sucralfate - instruct to take Ca+/Mg+ 1hr before/after therapy - Probenecid may reduce excretion of antibiotic & cause toxicity - Since quinolones may alter intestinal flora, thus vit. K synthesis, oral anticoagulants use w/caution - instruct to take ciprofloxacin/levofloxacin EXACTLY how ordered

Answer 105

- avoid alcohol or alcohol products due to risk for disulfiram-like reaction (severe V) - purpose of drug such as its use as either antibacterial or an antifungal medication, because this knowledge is crucial to achieving therapeutic effects and preventing adverse effects

Answer 106

Aminoglycosides

Answer 107

Quinolones

Answer 108

Metronidazole

Answer 109

Fever, lethargy, perineal itching, and other anatomically related symptoms

Answer 110

BUN and creatinine must be monitored closely throughout therapy.

Answer 111

disopyramide and amiodarone. For this reason, such drug combinations should be avoided.

Answer 112

flushing or itching of the head, face, neck, and upper trunk area. This phenomenon is called red man syndrome.

Answer 113

8 to 12 hours after the medication is infused.

Answer 114

Alcohol, leading to facial flushing, tachycardia, palpitations, nausea, and vomiting.

Answer 115

a penicillin antibiotic.

Answer 116

metronidazole | -alert the nurse to notify the health care provider because of the potential significant interaction.

Answer 117

prepubescent children because of the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or ruptured tendons in adults.

Answer 118

- known drug allergy (chemically related drugs such as sulfonylureas, thiazide, and loop diuretics, and carbonic anhydrase inhibitors generally safe in pt who has allergy) - cyclooxygenase-2 inhibitor celecoxib (Celebrex) should NOT be used w/known allergy - pregnant women at term and in infants younger than 2 months

Answer 119

- allergic reactions (sulfa allergy or sulfur allergy) - delayed cutaneous reactions; begin w/fever followed by a rash (morbilliform eruptions, erythema multiforme, or toxic epidermal necrolysis - Photosensitivity reactions (common w/tetracycline class) - mucocutaneous, GI, hepatic, renal, hematologic - immune mediated & involve production of reactive drug metabolites in body

Answer 120

- may potentiate hypoglycemic effects of sulfonylureas in diabetes Tx, toxic effects of phenytoin, and the anticoagulant effects of warfarin, which can lead to hemorrhage - may increase cyclosporine-induced nephrotoxicity - may reduce efficacy of oral contraceptives

Answer 121

A fixed combination drug product containing 5:1 ratio of sulfamethoxazole to trimethoprim -oral and injectable dosage forms

Answer 122

- Tx infections caused by Mycobacterium - two categories: primary or first line drugs and secondary or second-line drugs - do drug susceptibility tests, then pt started on four-drug regimen - pt adherence to regimen monitored closely due to nonadherence and adverse effects

Answer 123

Primary antitubercular drug | -either sole drug in prophylaxis of TB or in combination w/other antitubercular drugs

Answer 124

Inhibit protein synthesis, cell wall synthesis, various other mechanisms - reduction of cough, therefore, reduction of the infectiousness. Normally occurs w/in 2 weeks of drug therapy - successful Tx means taking mult. antibiotic drugs for at least 6 months or longer

Answer 125

Tx of both pulmonary and extrapulmonary TB - combination of isoniazid and ethambutol used to treat pregnant women w/out teratogenic complications. Can also used Rifampin - effective in management of Tx failures and relapses - infection w/Mycobacterium, M tuberculosis - prophylaxis Tx of TB

Answer 126

- severe drug allergy - major renal or liver dysfunction - chronic alcohol use

Answer 127

- Isoniazid causes pyridoxine deficiency and liver toxicity so supplements of pyridoxine are given - QT prolongation

Answer 128

Isoniazid can cause false positive readings on urine glucose tests and in increase in the serum levels of the liver function enzymes alanine aminotransferase and aspartate aminotransferase

Answer 129

- Most used - single drug for prophylaxis or combination w/other antitubercular drugs - bactericidal drug that kills mycobacteria by disrupting cell wall synthesis and essential cellular functions - metabolized in liver through process called acetylation - slow acetylators are people that have a genetic deficiency of the liver enzymes - mostly used in oral form, injection available - oral formulation containing isoniazid and rifampin - contraindicated in those w/previous isoniazid-associated hepatic injury or any acute liver disease - causes pyridoxine deficiency so take w/supplements

Answer 130

- synthetic macrocyclic antibiotics - activity against mycobacterium, meningococcus, haemophilus type b, M. leprae - bactericidal, inhibits protein synthesis - used alone or in combination - oral/parenteral formulations - contraindicated for those with allergy to rifamycin - potent enzyme inducer - Urine, saliva, tears, sweat to be red-orange-brown colored

Answer 131

- obtain history, medication profile, nursing history - head-to-toe - note specific history of diagnosis or symptoms of TB - results of last purified protien derivative (PPD) or tuberculin skin test & reaction at intradermal site - review recent chest x-ray/results - liver function studies (bilirubin lever, liver enzyme levels), kidney function (BUN, creatinine clearance) - major liver &/or renal dysfunction contraindications - note baseline neurologic functioning prior to therapy - assess hearing status - gross eye examination (visual disturbance and optic neuritis w/isoniazid, levofloxacin, ofloxacin, Blindness w/ethambutol - age (toxicity increased in older adults, or 13 years and younger) - CBC prior to giving isoniazid, streptomycin, and rifampin (hematologic disorders) - analysis of sputum specimens

Answer 132

-strict adherance to drug regimen -use audiovisuals and take-home info -mult. drugs often used to improve cure rates -pt needs to state understanding of all instructions -taken EXACTLY as ordered & at same time (critical to maintain steady blood levels) -finish ENTIRE prescription -may take w/food to minimize GI upset -

Answer 133

- Monitor for s/s of liver dysfunction (fatigue, jaundice, N/V, dark urine, anorexia) contact prescriber immediately - Monitor kidney function (BUN, creatinine) notify altered levels - Vision changes report ASAP - Monitor uric acid levels/advise pt report symptoms of gout - notify s/s of peripheral neuropathy - obtain sputum sample early - follow up visits - monitor IV site every HOUR - Cultural considerations (patient teaching w/all family members)

Answer 134

Monitor pt's for adverse reactions: -hearing loss (ototoxicity); nephrotoxicity; seizure; altered vision; blindness; GI upset; fatigue; N/V; fever; jaundice; numbness; tingling, or burning of extremities; abdominal pain, easy bruising

Answer 135

- take medications as ordered - stress follow up appts. - avoid antacids, phenytoin, carbamazepine, beta blockers, benzodiazepines, oral anticoagulants, oral antidiabetic drugs, oral contraceptives, theophylline - those taking isoniazid watch for adverse effects - pyridoxine (vit b6) prevents isoniazid-precipitated peripheral neuropathies and numbness/tingling - those taking rifampin report adverse effects of fever, N/V, anorexia, jaundice, bleeding, may indicate hepatitis or hematologic disorders - wear sunscreen PHOTOSENSITIVITY - women taking rifampin and contraceptives switch birth control - wash hands/cover mouth - proper disposal of secretions - proper rest, nutrition, general health - medical alert tag w/allergies - contact prescriber w/increase in fatigue, cough and/or sputum - rifampin may have red-orange-brown discoloration of skin, sweat, tears, urine, feces, sputum, saliva, and tongue. Reverses s/discontinuation - those taking bedaquline (Sirturo), take w/food, drug interactions, alcohol

Answer 136

Vitamin B6

Answer 137

The ineffectiveness of oral contraception

Answer 138

Tx fungal infections, systemic mycotic infections & some cutaneous or subcutaneous mycoses Tx w/oral or parenteral drugs -topical used w/out prescriptions

Answer 139

- fungistacic or fungicidal, dependent on concentration - rapid growing fungi & inhibit fungal cell cytochrome P-450 enzyme which produces ergosterol - when ergosterol is inhibited, results in defect (leaky cell membrane) so fungal cells die

Answer 140

Bind to sterols in cell membrane of fungi, once bound to ergosterol, channel forms in fungal cell membrane that allows potassium and magnesium ions to leak out of fungal cell. Loss of ions causes fungal cellular metabolism to be altered & leads to death of cell

Answer 141

-Specific to drug

Answer 142

- Amphotericin B effective against wide range. Sometimes given w/flucytosine in Tx of Candida. Also Tx for aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, fungal endocarditis, histoplasmosis - Nystatin similar, use limited due to toxic effects. Parenteral form. Tx of oropharygeal candidiasis (thrush)

Answer 143

Tx of esophageal, oropharyngeal, peritoneal, UTI, vaginal, systemic candida infections & cryptococcal meningitis

Answer 144

- Drug allergy - liver failure - kidney failure - porphyria

Answer 145

- drug interactions - hepatotoxicity - Amphotericin B associated w/multitude adverse effects, prescribers often order premedication (antimetics, antihistamines, antipyretic, corticosteroids) to prevent/minimize infusion-related reactions

Answer 146

-underlying source of problem is many antifungal drugs & other drugs, are metabolized by cytochrome P-450 enzyme system. Result of coadministration of two drugs that are broken down by this system is that they compete for limited amount of enzymes, one of the drugs ends up accumulating it

Answer 147

- Tx of severe systemic mycoses - main drawback is it causes many adverse effects - almost all pt's given IV experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, N/V, headache. Pretreament w/antipyretics, antihistamines, antimetics, and corticosteroids decrease severity of infusion-related reaction - lipid formulations higher cost - contraindicated in pt's w/known hypersensitivity & severe bone marrow suppression or renal impairment - injectable, oral, topical - 1mg test dose given over 20-30 min - local irrigant (bladder irrigation) for Tx of candidal cystitis and has been used intrapleurally & intraperitoneally for Tx of fungal infections in those body cavities

Answer 148

- better adverse effect profile than amphotericin B, excellent coverage against many fungi - oral excellent bioavailability (almost completely absorbed into circulation) - oral & injectable - single dose effective for the Tx of vaginal candidiasis infections

Answer 149

Polyene often applied topically for Tx of candidal diaper rash, taken orally as prophylaxis against candidal infections during periods of neutropenia in pt's receiving immunosuppressive therapy, used for Tx of oral and vaginal candidiasis -parenteral, several oral and topical formulations

Answer 150

- Before therapy assess/document vital signs, weight, hemoglobin levels, hematocrit, RBC, CBC w/differential, liver & renal function test results, C&S - before amphotericin B identify contraindications, cautions, drug interactions. Baseline renal function, hepatic function test due to adverse effects of nephrotoxicity and hepatotoxicity - avoid concurrent admin. of nephrotoxic drugs

Answer 151

- IV: use in-line filter/monitor for extravasation - IV amphotericin B: DON'T administer cloudy/precipitates - monitor vitals every 15min - severe reaction discontinue infusion/closely monitor, contact prescriber - monitor IV site for: phlebitis - monitor I&O, report decreasing urinary output <240mL/8hrs - monitor lab values during therapy - document weight frequently - weight gain of 2 or more lbs in 24 hrs or 5 or more lbs in a week indication of medication-induced renal damage

Answer 152

- female pt's use of antifungal for vaginal infection abstain from sex until Tx completed - long term Tx of amphotericin B possible adverse effects: tinnitus, blurred vision, burning/itching @IV site, headache, rash, fever, chills, hypokalemia, GI upset, anemias. Notify prescriber of bleeding, bruising, and/or soft tissue swelling - aspirin, acetaminophen, and/or ibuprofen, antihistamines, antiemetics, and antipasmotics prescribed for management of adverse effects - good hand washing techniques - proper dosing for nystatin. Oral solutions shaken before measuring dose, avoid mouthwash - fluconazole alternative method of contraceptive. Report jaundice, N/V, clay-colored stools, dark urine

Answer 153

An opportunistic fungal infection caused by C. albicans, occurs in pt's taking broad-spectrum antibiotics, antineoplastics, or immunosuppressants, as well as in immunocompromised persons. - When it occurs in the mouth (oral candidiasis or thrush) common in newborns or immunocompromised - vaginal is yeast seen in diabetes mellitus, women taking oral contraceptives, pregnant women, post antibiotic therapy

Answer 154

Systemically or topically

Answer 155

Thoroughly assess for allergies as well as interactions w/other drugs the patient may be taking, including prescription, OTC, and herbals

Answer 156

Properly diluted according to manufacturer guidelines and administered using an IV infusion pump. Tissue extravasation of fluconazole at the IV infusion site leads to tissue necrosis; therefore, check the site hourly and document the assessment

Answer 157

Nystatin (Mycostatin) antifungal drug that is used for a variety of candidal infections. It is applied topically as a cream, ointment, or powder. It is also available as a troche and an oral liquid or tablet.

Answer 158

Check for premedication prescriptions. Almost all clients given IV amphotericin B experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions.

Answer 159

Fluconazole is an antifungal drug that does not cause the major adverse effects of amphotericin when given intravenously. It is also very effective against vaginal yeast infections, and a single dose is often sufficient to treat vaginal infections.

Answer 160

Amphotericin B (Amphocin) The major adverse effects caused by antifungal drugs are encountered most commonly in conjunction with amphotericin B treatment. Drug interactions and hepatotoxicity are the primary concerns in clients receiving other antifungal drugs, but the IV administration of amphotericin B is associated with a multitude of adverse effects.

Answer 161

Impetigo Impetigo is a bacterial skin infection and would not be classified as a fungal skin infection. If the client included this in the discussion, further teaching is needed.

Answer 162

``` Creatinine Daily weights Intake and output Blood urea nitrogen Nursing interventions appropriate to clients receiving antifungal drugs vary depending on the particular drug. However, it is important for the nurse to monitor all clients for indications of possible medication-induced renal damage so that prompt interventions can occur to prevent further dysfunction. Monitoring intake and output amounts, daily weights, and renal function tests will help prevent such damage. ```

Answer 163

Drug allergy, liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs.

Answer 164

Infusing the medication over a longer period of time

Answer 165

Dissolve the lozenge slowly and completely in your mouth

Answer 166

Kill or suppress viruses by either destroying virions or inhibiting their ability to replicate

Answer 167

Block activity of polymerase enzyme that normally stimulates synthesis of new viral genomes. -result=impaired viral replication which allows elimination of virus by immune system

Answer 168

Tx of Herpes simplex virus (HSV), Varicella-Zoster Virus (VZV), Cytomegalovirus (CMV), hepatitis B and C infections

Answer 169

- known severe drug allergy - Amantadine contraindicated in lactating women, children younger than 12 months, pt's w/eczematous rash - Famciclovir contraindicated in allergy to drug or similar drug (penciclovir) - Ribavirin has teratogenic potential - aerosol form not for pregnant women

Answer 170

- Specific to drug | - Selective killing difficult, as a result many healthy human cells, may be killed which results in serious toxicity

Answer 171

- arise mostly from systemic routes | - topically administered routes has a decrease in incidence

Answer 172

Synthetic nucleoside analogue used to suppress replication of HSV-1, 2, & VZV - Drug of choice for Tx of initial/recurrent episodes - oral, topical, injectable

Answer 173

Neuraminidase inhibitors - Active against influenza A & B - Indicated for Tx of uncomplicated acute illness caused by influenza infection in adults - Shown to reduce duration of influenza by several days - Adverse effects: N/V - Oral use ONLY - Indicated for prophylaxis and Tx of influenza - Tx w/this drug needs to begin w/in 2 days of symptom onset

Answer 174

-Reverse transcriptase inhibitors block enzymes

Answer 175

Active HIV infection | -few Tx hepatitis B

Answer 176

-known severe drug allergy

Answer 177

- head-toe-physical before administration - obtain medical/medication history - Document allergies - Assess nutritional status, baseline vital signs, contraindications, cautions, drug interactions - Obtain list of prescription, OTC, herbals, dietary supplements - before therapy assess: energy levels, weight loss, vital signs, lesion characteristics - age - before giving acyclovir assess vital signs, medication history, pain levels w/zoster lesions - Oseltamivir useful against influenza virus A&B, must be given as ordered w/in 2 days of onset of flu symptoms; assess presenting symptoms & date of onset

Answer 178

- Closely assess allergies, cautions, contraindications, drug interactions - main contraindication includes severe drug allergy and other toxicities - protease inhibitors requires assessment of medical history, vital signs, baseline weight, allergies, medication history, results of baseline lab tests (CBC, renal & liver function). Also ordered during different phases of Tx - protease inhibitor adverse effect is lipid abnormalities w/redistribution of fat stores so assess emotional status and support systems - Bone demineralization adverse effect with long term use so assessment of calcium and vitamin D levels is crucial to pt safety before, during, after therapy - Assess hydration

Answer 179

-Assessment of knowledge & need for long term -education level, reading level, the way they learn best, familiarity w/community resources -mental status -emotional state -value systems, social patterns, hobbies, support, spiritual beliefs -financial status -

Answer 180

- Appropriate technique when applying ointments, aerosol powders, IV, oral forms - wash hands, gloves before/after administration - use of drugs may lead to superimposed/superinfection - take oral w/meals (minimize GI upset) - store capsules @room temp. do not crush/break - acyclovir double check order - topical apply using finger cot/gloves - avoid eye contact - IV acyclovir stable for 12hrs room temp. will precipitate when refrigerated. Dilute as recommended (5% dectrose in water/NS) infuse w/caution - infuse longer to avoid renal damage - hydration during and after for prevention of crystalluria - monitor IV site - document/report redness, heat, swelling, pain, red streaks indication of phlebitis - document lesion characteristics - isolate those w/chickenpox/herpes zoster, give analgesics

Answer 181

- use caution while driving or activities requiring alterness (dizziness) - take full course - immunocompromised avoid crowds/those infected - safe sex (HIV) condom use. Genital herpes=abstinence - female pt's w/genital herpes undergo papanicolaou spear test every 6 months - report: decreased urinary output, seizures, syncope, nervousness, lightheadedness, jaundice, wheezing, abnormal sensations in hands/feet, anorexia, N/V, diarrhea, weakness, changes in taste, acid regurgitation, abdominal/flank or back pain - provide demonstrations for administration - force fluids 3000mL/24hrs - suppress NOT cure virus - early Tx needed for full results - report difficulty breathing, drastic changes in BP, bleeding, new symptoms; worsening of infection, fever/chills, other unusual problems - follow up appts. - prevent skin reaction due to photosensitivity

Answer 182

Emtricitabine and tenofovir

Answer 183

"This drug will help the lesions dry and crust over."

Answer 184

(1) inhalation through the respiratory tract (2) ingestion via the GI tract (3) transplacentally via mother to infant (4) inoculation via skin or mucous membranes. The inoculation route can take several forms, including sexual contact, blood transfusions, sharing of syringes or needles, organ transplantation, and animal bites (including human, animal, insect, spider, and others). Viruses cannot enter the body through an allergic reaction caused by medication.

Answer 185

Fusion inhibitors Protease inhibitors Reverse transcriptase inhibitors Nonnucleoside reverse transcriptase inhibitors Neuraminidase inhibitors are used in the treatment of the influenza virus.

Answer 186

1) head-to-toe physical assessment 2) take a medical and medication history 3) Document any known allergies before use of these and any other medications 4) assess the client’s nutritional status and baseline vital signs because of the profound effects of viral illnesses on physiologic status, especially if the client is immunocompromised 5) Assess and document any contraindications, cautions, and drug interactions associated with all of the antiviral drugs - Monitoring for adverse effects would occur AFTER the medication has been administered.

Topic 3: Drugs for inflammation, fever & pain (Analgesic) & Topic 4: Drugs for infection Flashcards

(213 cards)