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Nurs 330 - Test #4

Pharmacology for Nursing

T/F: Penicillin-resistance bacteria are the most common type of antibiotic resistant "bugs". True: "Because it has been around the longest." - lecture
What are common side effects for penicillins? Allergic reaction (carry ID, bands in hospital, cross-sensitivty; Diarrhea—usually superinfection; Increasing, mucoid→C. Dificile? IV preparations may be high Na+; Caution with CHF
What are the nursing implications for administration of **Cephalexin (Keflex) PO If allergic to PCN (question order if sever), monitor carefully--first few doses; push PO fluids, monitor for diarrhea (c.dif), teach NOT to add ETOH!!
What are some common uses for **Sulfamethoxazole? UTI's, Some pneumonias, infectious diarrheas, legionnaire’s Dx
What are adverse effects of **Sulfamethoxazole? Allergic reactions common Rashes—Erythema multiforma Stevens-Johnson syndrome Most common with HIV infection Crystalluria—can lead to renal failure Risk with dehydration (push fluids) Rare anemia, Agranulocytosis
**Trimethoprim works synergistically with what antibiotic? **Sulfamethoxazole
**Trimethoprim is usually used how (route) and for what? Usually PO—common for UTI’s, can be IV for severe pneumonias
What should a nurse teach when administering **Trimethoprim? - Push fluids—prevent crystalluria - Report rashes!!!
What sort of bacterium do Aminoglycosides target? Primarily for aerobic gram negative.
Aminoglycosides: high risk implications? Clients that are hypocalcemic, have a hx of MG, or are on NM blockers (anesthesia)
What are common side-effects of Aminoglycosides [e.g. **Gentamycin (Garamycin)] Nephrotoxicity, ototoxicity (tinnitius), neuromuscular blockade (paralysis), hypocalcemia, myasthenia gravis
What should a nurse monitor when administering **Gentamycin (Garamycin) BUN, creatinine. I & O Signs of hearing loss Push fluids
T/F: "Red man syndrome" is considered an allergic reaction. False: usually it's from pushing IV Vancomycin to quickly.
What are adverse reactions with **Vancomycin Flushing reaction: “Red Man syndrome” Face, neck chest, hypotension Non-immunologic histamine reaction—on mast cells Give IV slowly—reaction clears slowly, Monitor BP
What bacteria do Quinolone Antibiotics (Fluoroquinolones) target? Broad spectrum--gram negative, positive
What are some adverse effects of ***Cipro and/or Levaquin? GI—nausea, vomiting, diarrhea CNS—dizziness, headache, confusion (Rare) seizures (usually with NSAID or theophylline) Allergic reactions, rashes Effects on growing cartilage—not used in children (<18) or pregnancy; renal function (reduce dose)
What are the nursing implications of ***Cipro and/or Levaquin? Well absorbed PO (can start IV, must DILUTE), TEACH: No dairy, antacids, or grapefruit juice (absorption),
What are the common side effects of Macrolide antibiotics like ***Azithromycin (Zithromax; Z-PAC)? ➢ Allergies (rare) ➢ GI upset common with PO, less with IV ➢ Newer agents, less GI upset ➢ Teach to take with food if needed ➢ High dose IV—reversible hearing loss ➢ Thrombophlebitis—slow IV infusion
What are common side effects of Tetracyclines? - Allergy rare - Photosensitivity common—teach! - GI upset common—take with food - Diarrhea→C. Diff (see notes for more)
What's not shitty about Flagyl? It's effective against both C.Diff, and Giardia!!
What are common side effects of Metronidazole (Flagyl)** - Nausea, vomiting, diarrhea - Headache, metallic taste in mouth - Disulfiram-like reaction with Ethanol - Interaction with several drugs: Coumadin, Phenytoin, Lithium (increases effects)
What are important nursing implications with Metronidazole (Flagyl)**? Teach clients re: interactions with meds, ALCOHOL (CAN NOT DRINK) Teach to report adverse effects
What are some adverse effects of the antitubercular drug **Isoniazid (INH)? • ***Peripheral neuropathy—take Vit. B6 (pyridoxine) to prevent • Blood dyscrasia (rare) • Gastric distress • Hepatotoxicity—esp. With ETOH, Rifampin
What are nursing implications for **Isoniazid (INH)? ➢ Monitor hepatic enzymes, CBC ➢ Teach need for long term use
What are some adverse effects of **Rifampin, Rifapentin? GI irritation, rashes, colors body fluids orange/red -->may stain contact lenses; immune reaction w/ intermittent use, flu-like sx, vomiting, diarrhea, myalgia to acute renal failure --> reduced w/ lower doses
What is important teaching when giving **Rifampin, Rifapentin to a client with TB? ➢ Plan for body fluid stain ➢ Do not miss a dose ➢ Monitor hepatic enzymes
What are the adverse reactions for **Pyrazinamide? Inhibits urate excretion→ Gout—check uric acid Rare jaundice—monitor hepatic enzymes
What should a nurse administering **Ethambutol for TB monitor for? • Visual changes—may need to DC drug • Optic neuritis—may be reversible • GI upset • Confusion, headaches
What is the most important thing to teach a client on **Ethambutol Report visual changes—blurring, color blindness
What is the most effective therapy for TB? Directly observed therapy (DOT)
Why do we use combination therapy with TB? Combination therapy—lower doses, fewer adverse effects, fewer resistances
What are neuraminidase inhibitors like **Oseltamivir (Tamiflu) used for? As a prophylactic alternative to flu vaccine.
What effect does **Oseltamivir (Tamiflu) do? Reduces severity and length of symptomatic period...made Liz sick
What is the issue with taking **Amantadine for influenza? Only effective in influenza A, many resistances
When must one take **Amantadine for treating influenza? *Must be taken when first flu symptoms identified (1st 2 days)
What are the adverse effects to consider when taking **Amantadine for the flu? Adverse effects—CNS Anxiety, insomnia, confusion→worse in elderly
When taking **Ribavirin for hepatitis or RSV, what effects should be monitored? Aerosol for RSV—can cause eye irritation Pregnancy CATEGORY X—do NOT GIVE, pregnant nurse should not administer
**Zidovudine (AZT) is used for tx against HIV. What are the common side effects? Fatigue, malaise, myalgia, nausea, anorexia, headache insomnia Usually resolve in first few weeks Anemia, granulocytopenia—worse with very low cd4 counts
What are some adverse effects of protease inhibitors like **Saquinavir (Invirase, Fortovase)? Nausea, vomiting, diarrhea, Abd. Pain—common Headache, altered taste, perioral paresthesia Increased liver enzymes - Dose related
What are some long-term effects of **Saquinavir (Invirase, Fortovase)? Increased blood glucose, blood fats, Redistribute body fat (abd, back of shoulders)
What are adverse effects of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI’s) like Nevirapine (Viramune)? Rash, stomach upset, increase liver enzymes
What are **HAART--Highly Active Antiretroviral Therapy made up of? A protease inhibitor, or non-NRTI combined with 2 NRTI drugs
What route(s) are appropriate for administration **Amphotericin B? Primarily IV, can be used topically, intrathecal
What are some adverse effects of **Amphotericin B ? Hypersensitivity common—within 3 hours • Headache, nausea, vomiting, low BP, sweating • Confusion, joint pain muscle pain • Fever with rigors (severe chilling) RENAL TOXICITY ***BTW these aren't abnormal; thus we may pre-treat***
When treating with **Amphotericin B, what medications would be administered to pre-treat certain symptoms? 1. Preload with Sodium, fluids (normal saline IV) 2. Pretreat with Corticosteriods, (antipyretics, antihistamines, antiemetics) 3. Meperidine for pain and rigors 4. Careful monitoring of VS Give slowly IV—well diluted, Monitor IV site for thrombophle
What is the goal when giving the anti-fungal **Ketoconazole to treat Cushing’s syndrome Suppresses glucocorticoid production***
What are some nursing implications for the ant-fungal **Terbinafine (Lamisil)? • For onchomycosis (of the nails)—up to 3 months • Adverse: hepatotoxicity (rare) • PO or topical (less toxicity)
What forms does ***Nystatin (Mycostatin) used to treat Candidiasis come in? Liquid, powder, cream, vaginal tablets
How are anti-fungals often named? The are a bunch of **azoles. (Julie)
What is an important implication of taking bulk forming laxatives such as **Psyllium (Metamucil, etc.)? • **Must take adequate fluids—Can cause impaction; • Adverse effects: Bloating • May take a while to work
What is an important effect of the saline cathartic such as **Magnesium hydroxide (Milk of Magnesia) ? **Can cause dehydration in large doses Also causes some irritation
What's the problem with taking stimulants/irritants such as ***Bisacodyl (Dulcolax, Correctol) ? • May induce low grade inflammation • Can precipitate laxative dependence • Higher incidence of cramping • Use short-term
How do lubricants such as **Mineral oil (Haley’s MO) work? • May induce low grade inflammation • Can precipitate laxative dependence • Higher incidence of cramping • Use short-term
So, John is going into Liver failure. As his ammonia levels rise what should we consider giving John to prevent hepatic encephalopathy? ***Lactulose—intestinal flora processes into acid→ammonia diffuses into gut→increases excretion of ammonia...he will shit his pants.
When is the stool softener **Docusate used? When one can't shit...or for prophylaxis post-op when on opioids.
Why wouldn't we want to use **Kaolin (Kaopectate) for diarrhea? We would, but only if we have to. May slow down the ridding of the "bug."
Jake wasn't traveling, but he did have traveler's diarrhea. He decided to take **Bismuth Subsalicylate. What should we tell jake about the side effects of Pepto-Bismol? Causes dark stools, black tongue
What happens to your bod when taking **Lomotil (Diphenoxylate) for diarrhea? • Anticholinergic side effects—dry mouth • Decrease GI motility, decrease secretion • Blurred vision, urinary retention, tachycardia
What kind of effects might one experience when taking **Loperamide (Imodium) for diarrhea? Sedation, dependence; uses constipating effects of opioids
What is the downside of using **Sodium Bicarbonate (Baking Soda) as an antacid? High sodium content
What are the implications of taking Calcium Carbonate (Tums)? • Can cause hypercalcemia • Use as calcium supplement • Calcium stimulates gastrin→rebound hyperacidity • Constipation with high doses
What are the implications of taking aluminum salts--AlOH, AlCO3 • Poor acid neutralizers alone • Phosphate binder--used in renal failure • Constipation--push fluids • (Amphogel, Basalgel)
What are the implications of taking Magnesium salts--MgOH Moderate neutralizers Cause diarrhea DO NOT USE WITH RENAL FAILURE Milk of Magnesia (MOM)
Why is it so great to combine magnesium and aluminum salts? Effects diarrhea and constipation cancel each other out; still CANNOT have in renal failure.
What is important education for someone taking the non-antacid **Sucralfate (Carafate) ➢ Give 1 hour before meals, do not take with antacids! One hour apart ➢ May cause constipation ➢ May inhibit absorption of some drugs
T/F: ***Ranitidine (Zantac) has no effect on gastric motility, emptying or esophageal sphincter tone. TRUE
What are some adverse reactions of Zantec? • GI—constipation, diarrhea, nausea • Confusion, dizziness, lethargy, HA • Worse in elderly—differentiate from dementia
_____ is an H2 receptor antagonists that is used IV as a third-line drug in anaphylaxis. ***Ranitidine (Zantac)
What are the three components to "Triple Therapy" 1. Bismuth subsalicylate a. “Pepto-Bismol” 2. Omeprazole (Prilosec) a. Antisecretory 3. Antibiotics
What are adverse effects of PPI's like **Omeprazole (Prilosec)? • GI—N/V/D, constipation • CNS—HA, dizzy • Mild, rare elevation of hepatic enzymes • May interfere with elimination of some drugs—more interactions with Omeprazole
What are some adverse effects of prokinetic drugs such as **Metoclopramide (Reglan)? • CNS (20%)—drowsiness, restlessness, fatigue, confusion , depression • Increase prolactin—gynecomastia • Parkinsonian Symptoms—EPS, tardive dyskinesia • Cholinergic Sx—diarrhea, cramps • Increased gastric emptying—alter drug absorption
How is **Metoclopramide (Reglan) given? IV or PO
What is an important action of serotonin receptor modulators like **Misoprostol (Cytotec)? ** Inhibits gastric secretion. Also, Misoprostol (Cytotec) is sometimes referred to as "the abortion pill."
What are some adverse effects of serotonin receptor modulators like **Misoprostol (Cytotec)? ➢ GI—Abd cramps, nausea, vomiting ➢ Diarrhea in 15-40%--dose dependent ➢ Increased uterine contractions Spotting, spontaneous abortions
What kind of drug interactions are present with **Promethazine (Phenergan)? • Any CNS Depressant—will increase sedation • MAOI—will increase sedative and anticholinergic effects
What kind of adverse reactions can happen w/ **Promethazine (Phenergan)? • Sedation, dizziness, weakness, hypotension • Pain on injection • Anticholinergic effects: dry mouth, urinary retention, constipation, blurred vision—caution with glaucoma
T/F: The phenothiazine **Prochlorperazine (Compazine), and/or the butyrophenone **Droperidol (Inapsine) would be suffice in treating nausea and vomiting r/t chemotherapy? FALSE: • Useful for moderate nausea & vomiting • Not uniformly effective for chemo-induced N & V
What do you need to remember when pushing **Prochlorperazine (Compazine)? It burns like a mutha, so push it slow, yo.
When can **Ondansetron (Zofran) be given for N,V r/t chemotherapy? BEFORE the client gets sick. (pre-treatment)
When should a client take their pancreatic enzymes? With meals (immediately before or with food)
What is cyclo-oxygenase? Enzyme in pathway of synthesis of prostaglandins from arachadonic acid (COX 1, COX 2)
What is the difference between cyclo-oxygenase 1 and 2? (COX 1/2) COX-1 → affect gastric mucosa and platelets COX-2 → affect inflammation, pain receptors, temperature control
T/F: NSAIDs have been found to actually slow the progress of certain degenerative diseases FALSE
What client's should avoid NSAIDs? Those who have either CHF, or CKD/ESRD (kidney disease)
What are the S/S of salicylism (ASA toxicity)? Tinnitus, nausea, vomiting, confusion
Why should we question an order of aspirin for a 14 y/o who has the flu? Do not give ASA to children <16 yrs in viral illness as it is associated with Reye’s Syndrome
Jason presents for a well check-up w/his cardiologist. The nurse asks him about his current medications and he states that he takes 600mg of ASA daily for stroke/MI prevention. What kind've teaching does Jason need? Low dose for stroke/MI prevention should only be 80-160 mg q.d.
Which acetic acid derivative can be given not only IV, but also PO, IM, AND ophthalmic? **Ketorolac (Toradol)
What is the main issue with acetic acid derivatives like **Ketorolac (Toradol)? Most commonly GI. IV may help, though push slow/dilute to prevent irritation.
What are the major advantages of propionic acid derivatives such as **Ibuprofen (Motrin, Advil, Nuprin, etc)? • Less GI effect than ASA • Greater renal effects
What are the benefits of taking a COX-2 inhibitor like **Celecoxib (Celebrex) instead of Ibuprofen? Fewer effects on kidney, GI bleeding, and platelet dysfunction - though they should all still be monitored.
What are important facts about ***Acetaminophen (Tylenol)? (hint: how does it contrast from NSAIDs?) **Analgesic for mild to moderate pain **Antipyretic **Not anti-inflammatory (not an NSAID substitute for arthritis)
How much Tylenol is too much Tylenol? --Hepatotoxicity—at doses > 2-3 gm/day much greater w/ ETOH (>2 drinks/day)
How do we determine dosages for Tylenol for children? By weight
What is a major risk in using the biologic response modifier ***Infliximab (Remicaid) for treating for RA or Crohn’s disease? Anaphylaxis--watch for flu-like symptoms (fever, chills, sore throat). MUST MONITOR FOR INFECTION BEFORE GIVING IMUNE SUPPRESSANTS!
What are nursing implications for ***Infliximab (Remicaid)? - Given IV, monitor carefully for anaphylactic reactions - Monitor for signs of infection—teach client to report these - Client must be screened for infection prior to therapy
***Infliximab (Remicaid) is often given on top of ____________? Methotrexate
What route is used for ***Infliximab (Remicaid)? IV; watch for anaphylaxis
What are first-line drugs for RA? Disease-Modifying Antirheumatic Drugs--(DMARD’s); ***Methotrexate
What are the adverse effects of ***Methotrexate? • Oral ulcers • Nausea, vomiting, anorexia • Bone marrow suppression • Monitor CBC’s, hepatic, renal function
What are the main adverse effects of the corticosteroid ***Prednisolone (Prednisone)? • Edema, hypertension • Bone marrow suppression • Osteoporosis • Cataracts • GI irritation • Muscle wasting, truncal obesity • Moon face, acne • Hyperglycemia
What kind of teaching should be included with ***Prednisolone (Prednisone) ? o Take early AM, with food o Do not stop abruptly (Addisonian Crisis) o Carry ID stating on corticosteroids o Report adverse effects o High dose—may need diet, insulin to (manage high BG)
What is important to monitor when caring for a client taking corticosteroids? ➢ BG, BP, weight, edema ➢ CBC ➢ Eye exam q 6 months
John is taking ***Colchicine IV in the hospital for an acute gout attack. They switch John to PO to avoid toxicity. After a few days, John reports the trifecta of symptoms (N,V,D). What should John do? NVD are early signs of toxicity. D/C, call MD.
What are the S/S of late ***Colchicine toxicity? GI bleeding, bone marrow suppression, renal toxicity Push PO fluids (early s/s: NVD)
When taking ***Allopurinol for chronic gout (and prophylaxis of acute gout attack), a client should d/c the drug when experiencing what common side-effect? Monitor for hypersensitivity—rash with pruritis—stop the drug!
What class of antibiotics is contra-indicated with anesthesia? Aminoglycosides (e.g. Gentamycin): hi-risk w/hypocalcemia, MG, and NM BLOCKERS.
Which drugs should not be taken with dairy, antacids, or grapefruit juice? Probably none. For sure: fluoroquinolones (cipro/levaquin), tetracyclines,
Which drugs cause an antibuse-like reaction with alcohol? Cephalosporins (keflex), and Flagyl
Which antibiotic increases the efects of Lithium? ***Metronidazole (Flagyl)**
Which antitubercular drug can cause peripheral neuropathy if not supplemented with pyridoxine (vit. B-6)? **Isoniazid (INH)
**Isoniazid (INH) + **Rifampin (= rifamate) + ETOH = _______. Hepatotoxicity
Which antitubercular drug causes an immune reaction with intermittent use? **Rifampin
What antitubercular drug can cause Gout, or even jaundice (not as common)? **Pyrazinamide
Which antitubercular drug can cause a (hopefully reversible) optic neuritis? **Ethambutol
A female client begins taking **Zidovudine (AZT) to prevent passing the HIV virus to her unborn child, and reports fatigue, malaise, insomnia and loss of appetite. How should the nurse respond? Let her know that these symptoms are common, and usually resolve in first few weeks
What is a client taking **Zidovudine (AZT) with progressed HIV at risk for? Anemia, granulocytopenia—worse with very low cd4 counts
What are the effects of the poisonous kiss of **Saquinavir? Leaves a bad taste in your mouth, and paresthesias around your mouth -> progresses to abdominal pain -> then the trifecta (NVD). Eventually it F's w/your liver enzymes. Just awful.
What class of drugs can actually be prescribed for both constipation, AND diarrhea? Bulk Laxatives: *Psyllium, Mitrolan
Created by: scottheadrick