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Pharmacy week 1, 2, 3, 4 > Week 3 (12 questions) > Flashcards

Week 3 (12 questions) Flashcards

1
Q

Four adverse effects of ALL antibiotics

A

1) ALLERGIC REACTIONS

2) SUPER/SUPRA INFECTION (interchangeable terms)

3) ALWAYS FINISH THE ENTIRE THERAPY

4) ANTIBIOTICS CAN INTERACT WITH LOTS OF DRUGS

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2
Q

An adverse effects of all antibiotics

A

Diarrhea

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3
Q

Allergic reactions

Assess
Evaluate

How long to observe patient if they have allergy?

A

ASSESS- allergies of your patients

If they list an allergy, investigate! What happened?
Type I or Type 4?

EVALUATE- after giving an antibiotic, observe your patient for a reaction (~30 minutes after end of infusion)

◦Manage reaction!

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4
Q

SUPER/SUPRA INFECTION (interchangeable terms)

CDIFF
CANDIDA ALBICANS

A

Antibiotics kill bad bacteria + protective bacteria

◦RISK 1: Clostridium difficile infection (Pseudomembranous Colitis)
◦Preventative- probiotics
◦Treatment: antibiotics

◦RISK 2: Candida albicans infection
◦Oral/vaginal- treat with antifungals

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5
Q

ALWAYS FINISH THE ENTIRE THERAPY

A

◦Never stop early (even if feeling better )

◦Premature stoppage can cause resistant bacteria

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6
Q

ANTIBIOTICS CAN INTERACT WITH LOTS OF DRUGS

warfarin?

A

ORAL CONTRACEPTIVES
Oral contraceptives require healthy gut flora for proper absorption

antibiotics may kill gut flora that helps absorb oral contraceptives (unintended pregnancy risk!)

warfarin blocks vit. K + antibiotics reduce vit. K = increased bleeding risk

blood thinning 2X with decreased vit k and warfarin in system

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7
Q

ALLERGIC/HYPERSENSITIVITY REACTIONS

Type 1

A

*Anaphylaxis (B-Cell Mediated)

*PENICILLIN

*LIFE THREATENING

*IgE mediated

*Histamine gets released- causes capillary leakage (swelling of airways-difficulty breathing), causes itching and more dangerously a drop in blood pressure

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8
Q

How do I remember Anaphylaxis? UH-OH Angie!

A

Urticaria (HIVES)
Hives

Oxygen is gone (angioedema= narrowing of air ways)
Hypotension
(blood pressure is dropping)

Angie- Angioedema

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9
Q

Type 1 ANAPHYLAXIS TREATMENT

nursing actions

A

◦1) Stop medication immediately (turn off the IV!) and notify Rapid Response Team

◦2) Establish Airway to maintain ventilation (bronchodilators if needed)

◦3) Administer Oxygen

◦4) Treat with Epinephrine (IM or IV) every 5 to 10 minutes if needed
◦WHY?

◦5) Administer diphenhydramine (decrease angioedema and urticaria)

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10
Q

Epi-Pen® - Epinephrine (how to use)?

A

*Do not place hands over any ends of the pen (risk for accidental poke)

*“Blue to the Sky, Orange to the Thigh”

*Remove the safety cap

*Okay to inject through clothes!

*“Hold for 3-10 seconds”

*Can massage site afterwards (10 seconds) Generally, the only time you massage

*You can use another dose 5-15 minutes after (max is 2 doses)

SEEK MEDICAL HELP

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11
Q

ALLERGIC/HYPERSENSITIVITY REACTIONS

Type 4

SCAR?
SJS?
TEN?
#1 CULPRIT?

A

Delayed Hypersensitivity (T-Cell Mediated)

SCAR- Severe Cutaneous Adverse Reactions (skin melts off)

◦Steven Johnson Syndrome (SJS)

◦Toxic Epidermal Necrolysis (TEN)

***#1 Culprit? Drugs

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12
Q

Type 4 Early warning signs:

ONSET?

A

FEVER + Flu-like symptoms

RASH -> Blistering

Lip peeling, mouth sores

onset (type 4)
Not instant, can take days, maybe even weeks

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13
Q

Broad spectrum

A

Targeting a type of infection

(don’t know what it is, give antibiotics that kills a lot of stuff)

◦Example: Patient presents with Sepsis
◦Piperacillin-Tazobactam (Zosyn®) + Vancomycin

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14
Q

Narrow spectrum

A

Targeting a specific bacteria

*Example: Hospital Acquired Pneumonia caused by Pseudomonas aeruginosa

*Aztreonam (Azactam®)

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15
Q

bactericidal?

bacteriostatic?

A

kills bacteria

Inhibits bacterial growth

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16
Q

What do you do if a patient comes to the clinic with sepsis?

A

Draw STAT blood cultures

Give Broad Spectrum Antibiotics or multiple antibiotics

Review Culture Results (Sensitivity)

Give Narrow Spectrum Antibiotics or targeted antibiotics

17
Q

Name 4 BETA-LACTAMS
PCCM

A

Penicillins- “Cillin”
Cephalosporins- “Cef”, “Ceph”
Carbapenems- “penem”
Monobactams- Aztreonam

18
Q

Almost all beta lactams are eliminated how?

A

Renally

19
Q

Do not give penicillin if?

A

History of a BETA-LACTAM allergy (cross-reactivity)

-This means penicillins, cephalosporins, carbapenems, monobactams

Current infection with EBV (Mononucleosis)

-Common to see rash if patient has Mono (EBV)

-Specifically seen with amino-penicillins (like amoxicillin)

20
Q

PENICILLIN G/V POTASSIUM
what does potassium mean in the name?

A

G is IV, V is Oral

See potassium in the name? This can cause hyperkalemia

Risk for hyperkalemia (can lead to dysrhythmia)

21
Q

Penicillin administration

Education?
Which penicillins are IM?

A

Educate patients to ALWAYS finish the entire course of therapy- never stop antibiotics prematurely (even if symptoms resolve!)

Penicillin G Benzathine and Penicillin G Procaine are IM only!

22
Q

Tazobactam + Clavulanic Acid

Beta-lactamase Inhibitors: enzymes that break down beta lactam

A

NOT AN ANTIBIOTIC!
Adds coverage to other antibiotics

This is NEVER given by itself
ALWAYS combined with an antibiotic

23
Q

Cephalosporins:

Cef, Ceph

gram what?
better resistance to what?

A

Gram + bacteria

Better CSF penetration (ceftriaxone great for meningitis)

Better resistance to penicillinase

24
Q

cephalosporin adverse effects

NO ALCOHOL

four

A

ALLERGIC REACTION

DIARRHEA

Supra-infection

PHLEBITIS with IV Infusion

25
Q

cephalosporin allergic reaction
◦Very similar to penicillin’s
◦Cross Sensitivity- Beta lactams!

A

concern is C.diff- notify provider

pseudomembranous colitis, candida albicans)

26
Q

cephalosporin PHLEBITIS with IV Infusion

A

Observe injection site for findings of phlebitis

Rotate injection sites.

Administer as a dilute intermittent infusion or slowly over 3 to 5 min and in a dilute solution for bolus dosing.

27
Q

Side effects?

UNIQUE TO “Cefs”

A

Disulfiram like reaction with alcohol
(throw up) and bleeding risk

28
Q

Cephalosporins: “Cef”, “Ceph” drug interactions

A

IV CALCIUM+ IV CEFTRIAXONE= NO!
Can form precipitant

29
Q

Cephalosporins: “Cef”, “Ceph” administration

A

IM or ORAL

30
Q

cephalosporins

IM route
How to give?
What is mixed with it to reduce pain?

A

Administer IM injections deep into a large muscle mass (into the ventrogluteal site). Educate client about the possibility of pain at the injection site prior to administration.

Often lidocaine mixed with ceftriaxone to reduce pain of IM injections

31
Q

oral route cephalosporins

A

Refrigerate Oral Suspensions (shake well!)

TAKE these with FOOD!

32
Q

Carbapenems

How many used?
All are what route?

A

Currently only FOUR used-

All are parenteral

Broadest coverage of all antibiotics
◦Gram +/- and anaerobes (except MRSA)

Try to reserve these to avoid resistance

33
Q

Carbapenems are used to treat?

A

SEVERE INFECTIONS, Pseudomonas aeruginosa

34
Q

Adverse effects of carbapenems

A

Same as PCNs, Cephalosporins

-ALLERGIC REACTION!
-Cross sensitivity to beta lactams

-SEIZURE RISK! Big Carbapenem Class effect

-CNS - confusion, hallucinations

35
Q

drug to drug interaction Carbapenems

A

Carbapenems lower levels of Divalproex/Valproate/Valproic Acid (seizure med)

Makes Valproate less effective. IRONIC?

36
Q

Monobactams (beta-lactam)

AZTREONAM

A

Aztreonam is the only one currently

Only covers aerobic gram-negative bacteria

37
Q

nursing process for antibiotics

A

assess- allegies, renal function

diagnosis- Infection?

planning- duration of antibiotics, adverse effects

implementation
-IV/IM
-special oral

evaluation-
intended outcome
uninitended outcome

Pharmacy week 1, 2, 3, 4 (6 decks)

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