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Pharmacology Mod 8

Immune, Antibiotic, Chemotherapeutic Contd.

Antibacterials include Penicillin, Cephalosporins, Monobactams, Carbapenems, Vancomycin
indications for penicillin broad spectrum infections (ear, throat, urinary tract), gonorrhea
prototype penicillin drug amoxicillin (Amoxil), Amoxicillin and clavulanic acid (Augmentin), other drugs: Nafcillin (Unipen), Methicillin, Ticarcillin-clanulanate (Timentin), Piperacillin (Zosyn)
adverse effects of penicillins N/V/D, superinfection, allergy (rash, hives), anaphylactic reaction (swelling of airway, wheezing, difficulty breathing)
interventions for penicillins monitor for GI symptoms, report bloody stools or long periods of watery diarrhea, report candida infections of mouth or vagina, monitor for allergy symptoms
administration of penicillins not crush extended release form, chewable forms for children, place drops directly on tongue of young child (ok to mix with juice or formula), take at beginning of meals to decrease GI symptoms
instructions for penicillins report watery or bloody diarrhea, take at start of meals, report mouth pain or inability to eat, report vaginal burning/itching/discharge, stop if signs of allergic reaction, call 911 for trouble breathing
interactions with penicillins probenecid, tetracyclines
indications for cephalosporins pharyngitis, tonsillitis, otitis media, upper & lower respiratory tract infetions, meningitis, UTI
prototype cephalosporin drug cephalexin (Keflex), cephradine (Anspor), cefaclor (Ceclor), cefotetan (Cefotan), ceftriaxone (Rocephin), cefotaxime (Claforan), cefepime (Maxipime)
adverse effects of cephalosporins N/V/D, abdominal pain, increased risk for bleeing, rash, superinfections, thrombophlebitis
interventions for cephalosporins monitor for bloody stools or watery diarrhea, prepare to treat a severe allergic reaction, expect to administer vitamin K if bleeding occurs, monitor for thrombophlebitis, monitor renal function (reduce dose with renal insufficiency)
administration of cephalosporins capsules/tabs/oral suspension/IV/IM, carefully differentiate because generic names very similar
instructions for cephalosporins take with food to decrease GI symptoms, report watery or bloody diarrhea, inform & stop if rash or hives, report unusual bruising or bleeding, inform about potential for N/V/D/severe headache/hypotension if taken with alcohol, report IV site burning/pain
interactions with cephalosporins probenecid, alcohol, IV calcium and ceftriaxone
indications for monobactams lower respiratory infections, UTIs, abdominal & gynecological infections
prototype monobactam drug aztreonam (Azactam)
adverse effects of monobactams thrombophlebitis & inflammation at IV site, superinfection
interventions for monobactams monitor IV site for redness/swelling/pain, change IV site if inflammation occurs
administration of monobactams IM/IV/powder for inhalation, monitor IM sites, can give as IV slow bolus or infusion, follow recommendations for dilution
instructions for monobactams report pain/tenderness/swelling at IV site, report mouth pain & inability to eat, report vaginal buringg/itching/discharge, take inhaled three times a day for 28 days
interactions with monobactams incompatible in IV solution with other multiple drugs, probenecid, some other antibiotics
indications for carbapenems serious infections that multiple types of organisms cause
prototype carbapenem drug imipenem and cilastatin (Primaxin), other: meropenem (Merrem IV)
adverse effects of carbapenems N/V, thrombophlebitis, possible cross sensitivity with other antibiotics, superinfection
interventions for carbapenems follow recommended infusion rate, treat nausea with an antiemetic, monitor IV site for infiltration, assess & report antibiotic allergy, monitor for secondary infections
administration of carbapenems IM/IV, not interchangeable, follow recommendations for rate and dilution when infusing IV doses
instructions for carbapenems report nausea, report pain/swelling/redness at IV site, report mouth pain/difficulty chewing or swallowing, report vaginal irritation
interactions with carbapenems monobactam, penicillin, cephalosporin
indications for vancomycins MRSA infections, c. dif, infections in patients with a penicillin allergy
prototype vancomycin drug vancomycin (Vancocin)
adverse effects of vancomycins hypotension, flushing of face and trunk (red man syndrome), ototoxicity, nephrotoxicity, thrombophlebitis at IV site & tissue damage with IV infiltration
interventions for vancomycins administer IV infusion for 1 hour, monitor vancomysin blood levels, closely monitor hearing,, monitor for redness & swelling
administration of vancomycins give orally for colitis, IV for all other infections, administer slowly, infuse separately if possible
instructions for vancomycins report facial flushing/feelings of faintness/hearing loss, report pain/swelling/redness at IV site
interactions with vancomycins metformin, drugs that are toxic to hearing or kidneys, incompatible in solution with multiple other IV drugs
antibacterials: antibiotics that inhibit protein synthesis include tetracyclines, macrolides, aminoglycosides
indications for tetracyclines chlamydia, mycoplasmal infections, rikettsial infections, syphillin in patients with a penicillin allergy, tetanus, cholera, anthrax, acne
prototype tetracycline drug tetraclycine, others: doxycycline (Vibramycin), minocycline (Minocin)
adverse effects of tetracyclines N/V/D, abdominal pain, liver toxicity, superinfections, photosensitivity, teeth discoloration
interventions for tetracyclines give with nondairy foods if GI symptoms occur, decrease in dose may be needed if GI symptoms severe, determine if patient pregnant prior, monitor liver function tests closely, monitor for signs of superinfection, monitor for photosensitivty reactions
administration of tetracyclines oral form: best on empty stomach, 1 hour before or 2 hours after meals, do not give right before bedtime, give with nondairy food if needed but best on empty stomach
instructions for tetracyclines take with nondairy foods for GI upset, report pregnancy, avoid giving to children under 8, report signs of liver damage (jaundice, abdominal pain, fatigue), report symptoms of superinfection, wear protective clothing and sunscreen
interactions with tetracyclines calcium containing foods, antacids, antidiarrheals, dairy products, supplements with iron or zinc, decrease effectiveness of oral contraceptives
indications for macrolides legionnaires disease, whooping cough, acute diptheria, chlamydia, pneumonia, common infections for patients with allergy to penicillin
prototype macrolide drug erythromycin, other: azithromycin (zithoromax)
adverse effects of macrolides N/V/D, abdominal pain, ventricular dysrhythmias, ototoxicity (hearing loss, vertigo, tinnitus), superinfection
interventions for macrolides decrease in dose may be needed if GI symptoms severe, monitor for signs of ototoxicity, monitor and report superinfection
administration of macrolides tablets/capsules/topical/opthmalic, if GI symptoms occur give with food
instructions for macrolides take with food if GI symptoms occur, report continuing symptoms to provider, report palpitations. & fainting spells to provider, report hearing loss/vertigo/tinnitus, report bloody or watery diarrhea, report mouth pain or vaginal irritation
interactions with macrolides clindamycin, digoxin, warfarin, theophylline, grapefruit juice, protease inhibitors, diltiazem
indications for aminoglycosides severe infections, skin & eye infections
prototype aminoglycoside drug gentamicin, others: amikacin (Amikin), Tobramycin, neomycin (Mycifradin)
adverse effects of aminoglycosides elevation of trough levels of drug causes ototoxicity (tinnitus, vertigo), nephrotoxicity (polyuria, proteinuria, elevated BUN & creatinine)
interventions for aminoglycosides monitor & report signs of ototoxicity, monitor peak & trough blood levels, monitor lab values (BUN, creatinine, proteinuria, casts)
administration of aminoglycosides topical/opthalmic/IM/IV/intrathecal
instructions for aminoglycosides report onset of tinntus/headache/vertigo/hearing loss, report an increase in output of dilute urine
antibacterials: drugs that inhibit DNA replication or cell division Fluoroquinolones
indications for fluoroquinolones severe UTIs, prevention of anthrax, wide range of bacterial infections
prototype fluoroquinolone drug ciprofloxacin (Cipro), others: ofloxacin (Floxin)
adverse effects of fluoroquinolones mild CNS symptoms (dizziness, headache, confusion in older adults), N/V/D, achilles tendon rupture, photosensitivity
interventions for fluoroquinolones monitor and report CNS symptoms, decrease in dose may be needed for severe GI symptoms, monitor for and report tendon pain during treatment, dont allow patients to go outside without covering skin and applying sunscreen
administration of fluoroquinolones oral/opthalmic/ointment/IV, administer antacids/iron/calcium supplements 2 hours after or 6 hours before
instructions for fluoroquinolones report CNS symptoms, decrease caffeine use, report GI symptoms, report tendon pain, avoid sunlight or sunlamp exposure, apply sunscreen
interactions with fluoroquinolones antacids, iron, calcium, sucralfate, theophylline, warfarin
antibacterials: drugs that inhibit folic acid synthesis include sulfonamides, urinary tract antiseptics
indications for sulfonamides UTI, pneumonia, travelers diarrhea, chronic bronchitis, acute otitis media
prototype sulfonamide drug trimethoprim and sulfamethoxazole (Bactrim, Septra)
adverse effects of sulfonamides N/V/D, anorexia, allergic skin reactions, blood cell deficiencies (thrombocytopenia, leukopenia, aneiai), superinfections, severe rash (including steven johnson syndrome)
interventions for sulfonamides monitor & report severe GI symptom, can give with food if experiencing anorexia, report rash and hives, report blood cell deficiencies, report severe diarrhea, report skin rashes/hives or blisters
administration of sulfonamides fixed dose combination tabs/liquid/IV, give oral with 8 oz water and encourage fluids, administer IV slowly
instructions for sulfonamides drink at least 2500-300 mL of water per day, report severe GI symptoms, take with food to minimize GI symptoms, stop if hives/rash occurs, report fatigue/pallor/easy bruising/new infections, report watery or bloody diarrhea
instructions for sulfonamides contd. report mouth pain/difficulty eating/vaginal burning/discharge, report onset of new rash, decrease effectiveness of oral contraceptives
interactions with sulfonamides alcohol, warfarin, pheytoin, tolbutamide, oral antidiabetics, methotrexate, reduce effectiveness of oral contraceptives
indications for urinary tract antiseptics treatment & prevention of UTI
prototype urinary tract antiseptic drug nitrofurantoin (Macrodantin), other: methenamine (Hiprex)
adverse effects of urinary tract antiseptics N/V/D, permanent peripheral neuropathy, blood cell deficiencies (anemia, thrombocytopenia, neutropenia), tooth staining, brownish appearance to urine, allergic respiratory reactions (chills, fever, cough)
interventions for urinary tract antiseptics may need to reduce dose for severe GI symptoms, discontinue drug for respiratory symptoms, report signs of neuropathy, monitor lab values of blood components, dont crush tablets
administration of urinary tract antiseptics oral capsules/liquid suspension, dilute liquid suspension, swallow capsules whole
instructions for urinary tract antiseptics take with food or milk, report acute respiratoy symptoms to provider, report numbness/tingling/weakness of extremities, report fatigue/easy bruising/infections, swallow whole, dilute liquid suspension, rinse mouth after taking oral suspension
interactions with urinary tract antiseptics antacids, probenecid
antimycobacterials: drug therapy for TB includes isoniazid, rifampin
indications for isoniazids treatment of active TB, treatment of latent TB
prototype isoniazid drug isoniazid (INH, Nydrazid-IM form), others: pyrazinamide (PZA), ethambutol (Myambutol)
adverse effects of isoniazids N/V/C, liver damage (hepatitis, liver failure), peripheral neuropathy (numbness, tingling, pain in hands or feet), dizziness, ataxia, seizures, psychotic symptoms
interventions for isoniazids report GI symptoms, encourage compliance with drug regimen, monitor liver enzyme levels, monitor for liver damage (jaundice, fatigue, abdominal pain), administer vitamin B6 for neurpathy, report CNS symptoms
administration of isoniazids give oral on an empty stomach 1 hour before meals, rotate IM injection sites, give with one or more other drugs for active TB to prevent resistance, 6-9 month treatment, importance of compliance
instructions for isoniazids report GI symptoms- take with food if severe, increase fluid & fiber, report jaundice/abdominal pain/fatigue, report numbness/tingling/pain in hands or feet, report CNS symptoms
interactions with isoniazids alcohol, disulfiram, phenytoin, antacids
indications for rifampins adjunct to treat TB, preventive therapy for carriers of meningitis, leprosy
prototype rifampin drug rifampin (Rifadin)
adverse effects of rifampins liver toxicity, red orange color of body fluids (urine, saliva, tears, sweat; harmless), N/V/D, cramping, abdominal pain
interventions for rifampins monitor liver enzymes, report symptoms of hepatitis (abdominal pain, nausea, unusual fatigue, jaundice), monitor for discoloration of body fluids- assure it harmless, tears may stain contact lenses, monitor for persistent GI symptoms
administration of rifampins capsules, with with other TB drugs to prevent resistance, give oral dose 1 hour before or two hours after meals unless gastric distress if problematic, follow dilution and rate recommendations for IV infusion
instructions for rifampins report abdominal pain/nausea/fatigue/jaundice,, warn about harmless discoloration of body flids, contact lenses may become stained, take with food if necessary, consult provider for birth control change if taking oral contraceptive
interactions with rifampins oral contraceptives, warfarin, HIV drugs, isoniazid, pyrazinamide
antiparasitics: drug therapy for parasites includes metronidazole, chloroquine
indications for metronidazoles bacterial infections, protozoal infections
prototype metronidazole drug metronidazole (Flagyl), others: lodoquinol (Yodoxin), tinidazole (Tindamax)
adverse effects of metronidazoles N/V/D, mild to moderate headache/vertigo/ataxia, metallic taste in mouth affecting appetite, severe seizures/peripheral neuropathy, darkening of urine (harmless), superinfection
interventions for metronidazoles report severe GI symptoms, stop drug if patient experiences neuropathy, advise patient about urine discoloration, monitor for infection in mouth/throat/vagina
instructions for metronidazoles take just before/with/after meal if GI symptoms occur, report severe GI symptoms as prescription may need to be changed, report CNS symptoms, dont worry if urine becomes dark, report pain in mouth/difficulty eating/vaginal burning or discharge
interactions with metronidazoles citalopram, ritonavir, IV nitroglycerin, disulfiram, phenobarbital, metronidazole, fluorouracil, azathioprine, multiple solution incompatibilites in IV form, alcohol
indications for chloroquines malaria, amebiasis, rheumatoid arthritis, systemic lupus
prototype chloroquine drug chloroquine (Aralen), others: primaquine, quinine (Qualaquin)
adverse effects of chloroquines visual symptoms (problems seeing, reading, blurred vision), N/D
interventions for chloroquines monitor and report visual symptoms, monitor & report severe GI symptoms
instructions for chloroquines take before or following a meal to minimize GI symptoms, wear sunglasses, report vision changes
interactions with chloroquines antacids & laxatives that contain magnesium or aluminum, lemon juice
antifungals: drug therapy for fungal infections include polyene antibiotics, azoles
indications for polyene antibiotics infections of skin and mucous membranes, severe systemic fungal infections, UTI, bladder infection
prototype polyene antibiotic drug amphotericin B (Fungizone), other: nystatin (Mycostatin)
adverse effects of polyene antibiotics common: chills/fever/tachycardia/hypotension/headache/nausea, start 1-2 hours after infusion begins, decrease over course of therapy, can cause bone marrow suppression primarily affecting red blood cells resulting in anemia, thrombophelibits, renal toxic
interventions for polyene antibiotics give benadryl and tylenol before infusion, monitor vitals before & during infusion, monitor kidney function tests every few days, monitor weight and I&O, monitor CBC for bone marrow suppression signs
instructions for polyene antibiotics warn of fusion reactions, explain what symptoms to expect, comply with lab testing, report increasing fatigue
interactions with polyene antibiotics nephrotoxic chemo drugs, aminoglycosides, cyclosporine, furosemide, vancomycin, corticosteroids, digitalis
indications for azoles severe systemic fungal infections, yeas infections, tinea infections (athletes foot, ringworm, jock itch)
prototype azole drug ketoconazole, others: itraconazole (Sporanox), miconazole (Monistat), clotrimazole (Lotrimin)
adverse effects of azoles liver toxicity, N/V/D/C, drowsiness/dizziness (decreases during treatment), gynecomastia, decreased libido, low sperm count, menstrual irregularity
interventions for azoles monitor for changes in liver function tests, report severe GI symptoms, report CNS effects, report hormonal symptoms
administration of azoles tablet/topical/shampoo, give oral form with water/coffee/tea/juice
instructions for azoles report abdominal pain/jaundice/fatigue/anorexia, take with foods and fluid to minimize GI symptoms, dont take antacids, dont drive or do hazardous activities if drowsy or dizzy, report hormonal symptoms
interactions with azoles rifampin, echinacea herbal supplement, antacids, proton pump inhibitors, H2 antagonists
antivirals: drug therapy for viral infections include acyclovir
indications for acyclovirs herpes
prototype acyclovir drug acyclovir (Zovirax), others: valacyclovir (Valtrex), famciclovir (Famvir)
adverse effects of acyclovirs topical form: burning/itching at application site, oral form: N/V/D/headache/vertigo, IV form: renal toxicity/thrombophlebitis
interventions for acyclovirs topical: monitor for skin reactions, oral form: monitor for severe GI symptoms/monitor BUN & creatinine, IV form: infuse slowly/hydrate during and after infusion/monitor for CNS effects/monitor for signs of infiltration
instructions for acyclovirs topical: avoid scratching application site, avoid getting topical form in eyes (wear gloves), report persistent skin symptoms
instructions for acyclovirs contd. take with food if GI symptoms occur, report persisnte GI symptoms
instructions for acyclovirs contd. IV form: hydration occurs during and for 2 hours after infusion, report signs of CNS toxicity (restlessness, tremors), report burning pain at IV site
interactions with acyclovirs probenecid, zidovudine, nephrotoxic drugs
Created by: twohlers