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PN115
PHARM
| Question | Answer |
|---|---|
| Pre-Administration Assessment | Data that establish a patient’s baseline before administration of a drug. |
| Pre-Administration Assessment 4 Goals | Establish Baseline Measurements Anticipate Adverse Effects Identify High-Risk Patients Determine Self-Care Capacity |
| Subjective Data | Current health history (difficulty swallowing) Pt signs & symptoms Current drugs, (OTC) drugs, herbal remedies, supplements; doses & frequency Ability to pay for & access prescribed drugs Medical & surgical history Pt’s environment and support system |
| Objective Data | Data from physical health assessment Laboratory and diagnostic tests Data from the HCP’s notes Vital signs The patient’s body language |
| Nursing Diagnosis for drug therapy | A diagnosis based on information found in the nursing assessment regarding patient responses to actual or potential problemsAcute pain. Includes: Confusion Decreased adherence Need for health teaching |
| How does a medical diagnosis differ from a nursing diagnosis? | A medical diagnosis identifies a disease process. A medical diagnosis identifies results of procedures. A medical diagnosis identifies results of diagnostic tests. |
| Five Rights of Drug Administration | They include the right patient, the right drug, the right dose, the right time, and the right route |
| Incorporating religious considerations into the implementation of drug therapy relates to which component? | Patient education Adherence, self-administration, diet, side and adverse effects, and cultural considerations, such as religious beliefs, need to be addressed during patient education. |
| Five-Plus-Five Rights of Drug Administration | Assessment Collection of data after drug administration Doc. Pt has remained free of injury; pt is alert & oriented Pt education Provision of drug info Evaluation Appraisal of a drug’s therapeutic, side, & adverse effects. To refuse. |
| To determine patient response to drug therapy, which factors would the nurse evaluate? | Adherence Adverse effects Patient satisfaction Therapeutic response |
| Which methods can be used to evaluate the patient’s adherence to a drug regimen? | Interviewing the patient Counting pills Measuring plasma drug levels |
| Which statement describes how the nursing process applies to pharmacology? | It promotes adherence to a prescribed drug regimen. The nursing process promotes positive patient outcomes and promotes adherence to a prescribed drug regimen. |
| Which interventions related to drug therapy are part of the planning phase of the nursing process? | Providing patient education Enhancing therapeutic effects Minimizing drug interactions |
| Actions that occur during the planning stage of the nursing process ? | Define goals (Resolution of confusion within 48 hours) Collecting data Setting priorities (Patient safety during period of resolution) |
| Cont. | Identifying interventions (Move the patient to a room closer to the nurses’ station) ID high-risk pts Establish Evaluation Patient has remained free of injury; patient is alert and oriented) |
| Which components need to be addressed to facilitate patient adherence to pharmacologic therapy? | Diet Side effects Self-administration Cultural considerations |
| Which factors may cause a patient’s dissatisfaction with their current drug regimen? | High cost Unacceptable side effects Difficulty of administration Inconvenient dosing schedule |
| What regulations govern prescription drugs? | State law & agency policy require all drugs must be ordered by lic. provider. State laws & agency policies restrict prescriptive authority. Written in the pt’s chart. Transcribed to a pharmacy order form. Recurring orders can be issued for pt’s drugs. |
| Prescriptive authority | the authority to write an order or prescription for drugs) to physicians, dentists, nurse practitioners, nurse midwives, nurse anesthetists, and physician assistants. |
| What must a legal prescription order contain? | The patient’s full name Date Name of drug Route of administration Dose Frequency Duration Signature of prescriber |
| What are the nursing implications regarding drug orders? | Notes: written to indicate the order was read back to the prescriber for validation. Cosigning: prescriber must- cosign the order, usually w/in 24 hrs, -valid. Verbal Orders: The receiving & transcribing of verbal tel. orders may resp. of the (RN). |
| What are the types of drug orders? | Standing drug order Drug given for a certain number of doses. Stat drug order Drug given immediately Single drug order Drug given at a specified time As needed/PRN drug order Drug given based on a nurse’s judgment |
| What are the 9 Rights of Drug Administration? | Right patient Right drug Right dose Right route Right time Right reason Right documentation- after drug administration, chart the time, route, & any other specific information as necessary. Right response |
| Regulations that control drug administration | Individual states set who may prescribe and give drugs. Nurse Practice Acts vary by state. Nursing licenses may be recognized by another state. |
| Which statement describes the impact healthcare agency regulations have on drug administration? | Agency policies may be more restrictive than Nurse Practice Acts. A nurse who accepts a position at a hospital implies willingness to follow policies and procedures. |
| Which statement describes the state and healthcare agency regulation of drug administration? | The nurse must be able to document educational preparedness. Professional responsibility must be accepted by the nurse. Good judgment must be expected of the nurse. Nurses are expected to follow the nursing process. |
| Which action is a critical nursing responsibility? | Ensure that the patient’s drug orders are correct. |
| Bar-coded drug administration system | It is integrated w/ an electronic medical record. Bar codes are located on the pt wristband & on each drug. Prevents errors due to illegible clinician handwriting. Some are designed to indicate errors *dosing. Many checks drug allergies |
| Kardex system | The record is regularly updated and changed. It keeps important information available to all team members. The system has been in use for many years. All drugs are listed on the drug profile sheet. |
| Strategies would the unit manager use to reduce drug errors | Improve staffing levels. Reduce the need for multitasking. Reduce the use of abbreviations while reporting. Minimize interruptions. |
| High-alert drugs that are recalled utilizing the PINCH acronym | Potassium Insulin Narcotics (Hydromorphone) Chemotherapeutics Heparin |
| Drugs with black box warning. | This means that the drug has a higher-than-normal risk for causing serious and even life-threatening problems in addition to its positive benefits. |
| Medication (drug) reconciliation includes: | comparing current drug orders- drugs taken by the pt. Asking- OTC drugs, herbal supplements & vitamins. Assessing for incorrect dosages. Assessing for duplication of drugs. Teaching pt to update their drug list & take list to all appts. |
| Pyxis drug delivery system | automated drug dispensing system that uses a computer to dispense drugs. Provides computer-controlled storage Ensures patient safety with drugs Improve efficacy when providing drugs (time management) |
| Which information would the nurse document on the drug Kardex? | Signature with initials Order date with initials Location site of an injection Drug dose with frequency and route |
| When providing drugs, at which time would the nurse take action to reduce the risk of an error? | When preparing the drug When administering the drug to the patient When bringing the drug to the patient |
| Which action would the nurse take if a drug error is made? | Check the patient. Measure vital signs. Notify the charge nurse Notify the healthcare provider |
| Drug Trade name | It is often followed by the symbol ® indicating the name is registered to a specific owner |
| Which name is most commonly used for a drug? | Nonproprietary name of a drug, also known as the GENERIC name given to the drug by the manufacturer. |
| Chemical drug name is derived | From the chemicals used in the drug |
| Which term is used to indicate a way that a drug works at the receptor site in the body? | Agonist- drug-completely attaches to a receptor site. * Captopril, Lisinopril Antagonist- drug attachs but does not produce a response/blocks a response. *Losartan, Valsartan Partial agonist- drug that produces a small response. *Buspirone (BuSpar) |
| Antigungal drugs | Fluconazole |
| Antibiotic drugs | Cephalexin Cefaclor Doxycycline Sulfadiazine |
| Alpha blockers Include: | Relax muscles in the blood vessels & prostate gland. *Doxazosin and Prozosin. * High blood pressure, Benign prostatic hyperplasia (BPH), Raynaud`s syndrome. |
| Beta blockers Include: | Decreases the workload of the heart, blocks effects of Epinephrine. Atenolol and Metprolol. |
| Corticosteroids Include: | Help reduce inflammation. *Methylprednisolone and Triamcinolone |
| Benzodiazepines Include: | Slow down brain activity to produce a calming effect. *Alprazolam and Lorazepam. * Anxiety, insomnia, seizures & muscle spasms, and alcohol withdrawals. |
| Phenothiazine Include: | Treat mental health and physical conditions. *Prochlorperazine and Chlorpromazine. *Schizophrenia, Bipolar disorder. |
| Diffusion | Movement from high to low concentration |
| Osmosis | Diffusion through membrane from thicker to thinner concentration |
| Filtration | Passage through a material that prevents certain molecules from passaging |
| When the heart contracts | the sodium-potassium pump moves Na+ inside the cell and K+ outside the cell. |
| passive transport | Movement of molecules from an area of high to low concentration |
| Active transport | Movement of molecules up the gradient from lesser to greater concentration |
| Solubility | The ability of the drug to dissolve. Liquids are more soluble and are absorbed faster than capsules or tablets. |
| Parenteral route of administration | Subcutaneous Intramuscular Intravenous Intrathecal |
| Order the drug absorption methods from fastest to slowest | 1. Intravenous 2. Subcutaneous 3. Suspensions 4. Powders 5. Tablets 6. Time-release capsules |
| Drug Distribution. | Movement of a drug occurs via the blood and lymph systems. |
| Biotransformation | Drugs that are absorbed and distributed in the body are transformed into active or inactive chemicals. This process occurs mainly in the liver, where enzymes that break down the drug into its usable and unusable parts |
| Prodrugs | An inactive or partially active drug that is metabolically changed in the body to an active drug. Drug have to be transformed by enzymes before the body can use them. Liver disease may impair the transformation of a prodrug. |
| How generic differences affect a patient’s drug dose requirement | The human body uses specific enzymes to process drugs. Inherited traits cause variations in these enzymes, which explains why diff. drugs may affect each person uniquely & why patients respond differently to the same drug. May cause sensitivities. |
| Which body system is involved in the process of drug excretion? | Renal- Chemicals that can be made water-soluble are dissolved & filtered-kidneys &-urination. Respiratory-Some chemicals are removed from the lungs through exhalation. Gastrointestinal-Insoluble/fibrous waste is passed-GI tract & excreted-stool. |
| Drug half-life | Half-life describes the time it takes for 50% of a drug to be excreted from the body. If the half-life of a drug is short, as with many antibiotics, the patient must take frequent doses to keep the blood level correct. |
| Which test result would be monitored for a patient who is at high risk for drug overdosage due to end stage kidney disease? | Basic metabolic panel Drugs are often dosed based on kidney function, especially in cases of kidney disease, which is why blood is drawn for the basic metabolic panel, which includes markers for renal function. |
| Bioequivalent drug | Bioequivalent generic drug is chemically identical to the brand name product. Reg. generic drugs can commonly cause variations in: absorption distribution metabolism |
| Side effects | Effects of a drug on the body that are not limited to its desired action. *nausea, diarrhea, vomiting. |
| Adverse reaction | Development of severe or life-threatening problems. |
| Paradoxical Effects | Paradoxical effects are a type of idiosyncratic response where the patent’s reaction is the opposite of what is expected. |
| Idiosyncratic responses: | reactions: are usually rare. may be the result of missing or defective metabolic enzymes caused by a genetic or hormonal variation in that individual. often produce either an unexpected result, such as pain or bleeding, or an overresponse to the drug. |
| Hypersensitivity responses: | An increased reaction to a drug. Allergy is sensitivity caused by an antibody response to a drug. Some drugs-aspirin, penicillin, & some conditions,-asthma, are more like -produce allergic reactions. Produces: hives, rash, itching, swelling of the skin. |
| Anaphylactic Reaction | to a drug is a severe & dangerous allergic reaction resulting -severe breathing difficulty, which can even cause the heart to stop. A pt. who has a mild allergic reaction to a drug is likely to develop an anaphylactic reaction if the drug is given again |
| Which drug is given to displace the effects of diazepam? | Flumazenil |
| Which type of juice should the patient avoid when taking a cholesterol-lowering drug? | Grapefruit |
| Which food should the patient avoid eating when taking a monoamine oxidase inhibitor? | Aged cheeses |
| Which information accurately describes the administration of drugs and their effects? | Alcohol intake can often increase the activity of metabolic enzyme systems. Acetaminophen is often given w/codeine for more effective pain relief. Many of Asian descent have a greater risk for excessive bleeding when starting warfarin therapy. |
| Which reason explains why oral drugs are absorbed poorly in the GI tract of neonates? | Lack of gastric acid Lack of enzyme function Lack of intestinal bacteria |
| Which organ is responsible for the slow metabolism of prodrugs in neonates and young infants? | Liver |
| A child’s ability to excrete drugs is dependent on which factor? | The growth and maturity of a child’s organs is a key factor in a child’s metabolism and their ability to excrete drugs. |
| special pharmacokinetic considerations for adults over 65 | Drugs are absorbed, metabolized, and excreted more slowly and less completely Problems with drugs are often due to a lack of understanding of: The way drugs are processed in the aging body The body’s changed response to drugs. |
| Polypharmacy | Being treated by several specialists and prescribed different drugs. May put the patient at risk for adverse interactions. |
| Teaching considerations related to drug therapy for older adults? | he cost of a drug difficulty in getting it from a pharmacy poor memory lack of desire to take the drug depression feeling overwhelmed arthritis poor eyesight |
| Dehydration can affect an older person’s ability to metabolize drugs? | It causes the amount of drug in the blood to increase. |
| A reduction in which body function results in delayed drug absorption? | Blood flow Enzyme activity Bowel motility Gastric emptying |
| Aging liver | It gets smaller. It has decreased blood flow. It becomes overloaded with fluid. |
| What are drug therapy considerations for patients who are pregnant or lactating? | Consider stopping all drugs until the baby is born Avoid as many drugs as possible Avoid drugs with teratogenic potential (i.e., likely to cause malformations or damage in the embryo or fetus) |
| Factors related to different types of malformations from teratogenic drugs include: | What drug the mother takes How much is taken The age of the fetus when the drug is taken |
| What is the potential for teratogenic drugs to cause developmental malformations in a developing fetus? | 2 wks after conception (before implantation)= all-or-nothing effect: The ovum dies of exposure/recovers completely. Critical period-lasts 2-10 wks after last menstrual period. Period of organ development (14–56 days),major abnormalities in the embryo. |
| CONT. | Taking a teratogen later in the pregnancy (57 days to term), may result in minor structural changes, but abnormalities are more likely to involve problems with: growth mental development reproductive organ abnormalities |
| drug therapy considerations for patients who are pregnant or lactating? | As fetus grows, the placenta allows most drugs to cross-mother-baby. A fetus reacts diff to a drug than mother. The immature blood–brain barrier prevents many drugs from passing - brain of fetus. Liver immaturity prevents proper metabolism in the fetus. |
| Drugs that can pass through human breast milk | including the following illicit drugs: Nicotine Cocaine Heroin Marijuana Angel dust (PCP) |
| A breast-feeding mother taking a prescription can lessen the infant’s drug exposure by: | Taking the drug just before the infant is due to sleep Taking the drug immediately after a feeding Substituting a bottle for the next scheduled feeding Expressing and discarding the affected breast milk |
| After a breast-feeding mother takes a prescription the infant should be watched for: | Emotional changes Altered feeding habits Sleepiness Restlessness |
| Which factor is important to understand when giving oral drugs to a neonate? | Drug effectiveness is not very predictable. Drugs are absorbed poorly in the gastrointestinal tract. |
| Which response are neonates and young infants at a greater risk for experiencing when they take prodrugs? | Side Effects Toxic effects Over dosages |
| Laboratory test for a patient who is taking a drug excreted by the kidneys and requires drug dosage adjustment? | Creatinine clearance |
| Drug elimination, specific to the kidneys, in older adults? | There is a decrease in renal blood flow. There is a decrease in the number of nephrons. |
| Which information would the nurse include when teaching a lactating mother about a newly prescribed drug? | Many drugs can pass to the baby while breastfeeding. |
| Infection | is an invasion of body tissue by disease-producing pathogens that multiply and produce toxins that react in a dangerous way and produce illness in a host organism. |
| Infections can be caused by: | Bacteria Viruses Parasites Fungi Insects |
| Normal flora | are usually nonpathogen organisms that are always present in a healthy person on or in the: Skin Mouth Intestinal tract Vagina |
| Conditions that Promote Infection by Normal Flora when | A person has very low immunity They occur in excessive amounts and overwhelm the body They are located in the wrong place, such as when: Escherichia coli, normally in the bowel, enter the bladder or surgical incision. |
| Those with an increased risk for infection by normal flora include: | Infants Young children Older people People with AIDS People receiving cancer chemotherapy or taking a drug that suppresses the immune system People with poor circulation, poor nutritional status, or a chronic disease |
| Antibiotics in Disrupting Normal Flora Balance | Antibiotic use can upset the balance of the normal flora in the body and cause yeast or fungal infections to occur (e.g., Candida overgrowth). This type of infection, known as a secondary infection or superinfection. |
| Secondary infection or Superinfection, occurs when: | Given antibiotics to kill infectious bacteria. Antibiotics kills infectious bacteria & normal flora. Normal flora include bacteria of gut, mouth, & vaginal mucosa= barriers against fungal infections. The barrier weakens, & a yeast infection can occur. |
| Gram-negative bacteria | Antibiotics have a difficult time penetrating the cell walls of gram-negative bacteria, which makes these infections more difficult to treat. |
| Use of Probiotics to Restore Normal Flora Balance | using probiotic (beneficial) bacteria with an antibiotic as a strategy to prevent yeast infections. Probiotic bacteria can be found in many foods: Yogurt Dark chocolate Miso soup Pickles Sauerkraut |
| pathogen | is an organism expected to cause infection even in people with a strong immune system. |
| Bacteria | are a large domain of single-celled microorganisms that exist everywhere. Bacteria can be both beneficial and dangerous. |
| Fungi | Include yeasts and molds Have cell features similar to those of human cells Are everywhere and exist by absorbing nutrients from a host organism Can cause an infection, known as a fungal infection or mycosis |
| Viruses: | Are small infectious agents Can replicate (reproduce) only inside the living cells of organisms |
| Parasites: | Are organisms that live on or in humans Rely on humans for their food and other functions Include: Worms (helminths) Amebas Protozoa |
| Infections Not Requiring Identification | Are diagnosed based on: Patient’s symptoms Provider’s knowledge of most likely organism Are treated based on the healthcare provider’s: Knowledge of drugs needed & empiric treatment/therapy) |
| Infections Requiring Identification | Staining Culture Sensitivity testing Are treated based on established evidence of which drug is most: effective to kill specific organism |
| Anti-infective agents (antimicrobial) | Antibacterials: kill or slow the reproduction of bacteria Antibiotics: destroy or interfere with the development of a living organism Antivirals Antifungals Anthelmintics |
| Antimicrobial Resistance | Susceptible organisms: can be killed/have their reproduction suppressed by drugs. Resistant organisms: are neither killed nor suppressed by drugs. Multidrug-resistant (MDR) (superbugs): resistant to 3/+ types of drugs to which they were once susceptible |
| Consequences of Antimicrobial Resistance | Cost more to treat Increase the length of hospital stays Lead to higher mortality ratesdrugs used against MDR organisms often: Are more powerful Have more side effects |
| Drug-Resistant Threats | Of those threats, three are considered urgent: Clostridium difficile (C-diff) Carbapenem-resistant Enterobacteriaceae (CRE) Neisseria gonorrhoeae |
| Inhibitor Agents to Combat Beta-Lactamases (penicillinases) | Beta-lactam antibiotics include: Penicillins Cephalosporins Monobactams Carbapenems |
| How are antibiotics classified? | classified according to their site of action on the cell of the bacteria (cell wall/mebrane, DNa/RNA, Rybosome/cytoplasm), effect of action (Kill the bacteria (bactericidal)/slow growth (bacteriostatic) ,spectrum (narrow/broad), generation (older/newer). |
| An older-generation drug (e.g., first-generation drug) | More refined, purified, and sensitive as a result of long-term testing |
| A newer-generation drug (e.g., second- or third-generation drug) | Improved effectiveness Fewer side effects Faster onset of action Narrower spectrum but more powerful |
| Antimicrobial drugs are used to kill or inhibit the spread of which organism? | Fungi Viruses Protozoans Bacteria |
| Rifampin | kills susceptible bacteria by modifying their process of nucleic acid synthesis. |
| Vancomycin | is a cell wall synthesis inhibitor, which means it kills susceptible bacteria by preventing their cell walls from being made and maintained. |
| Erythromycin | is a bacteriostatic antibiotic that limits the growth of bacteria by interfering with their synthesis of protein. |
| Trimethoprim | kills susceptible bacteria by interfering in the cellular metabolism of folic acid. |
| pharmacodynamic parameters of penicillins? | The penicillin interferes w/the creation & repair of a bacterial cell wall. Also binds/sticks to specific enzymes that the bacterium needs so that the bacterium cannot use them. This process makes the bacterial cell weak & allows it to break down & die. |
| What are the uses of penicillins? | Syphilis, Endocarditis, Infections- mouth, throat, skin, other soft tissues, heart, lungs, & ears. Prophylactic (preventive) treatment- bacterial endocarditis-pts w/ rheumatic/ heart disease before procedures. Treat exposure to agents- biological warfare |
| side effects of penicillins | Diarrhea Nausea Vomiting Epigastric distress C-diff -diarrhea caused by antibiotic us |
| adverse reactions to penicillins | Rash Erythema (redness or inflammation) Urticaria (hives) Angioedema (swelling of the skin and mucous membranes) Laryngeal edema (swelling of the larynx) Anaphylaxis (shock) |
| penicillins interact with other drugs | tetracycline & erythromycin may decrease effects. Probenecid blocks the excretion of penicillin, prolonging blood levels and making the antibiotic more effective. Indomethacin, phenylbutazone/ aspirin may ↑ serum levels. Antacids may↓ the absorption. |
| Ampicillin | Reduces the effectiveness of oral contraceptives |
| 5 generations of penicillins.List in chronological order, from earliest to latest | 1. Natural penicillins - penicillin G 2. Penicillinase-resistant penicillins - oxacillin 3. Aminopenicillins - amoxicillin 4. Carboxypenicillins - carbenicillin 5.Ureidopenicillins and piperazine penicillin -piperacillin |
| After given Penicillin observe patient | 30 minutes after giving the first dose of a penicillin orally or IM to observe for signs of adverse or allergic reactions. |
| pharmacodynamic parameters of cephalosporins? | Cephalosporins are cell wall synthesis inhibitors that are chemically similar to penicillin and work in the same way to kill bacteria. |
| cephalosporins are used for: | Uncomplicated skin and soft tissue infections Infections of the: Lower respiratory tract Central nervous system Genitourinary system Joints Bones Serious infections, such as infections of the blood: Bacteremia Septicemia |
| side effects and adverse reactions to cephalosporins | side effects:Nausea, Vomiting, Diarrhea Adverse effects: Acute hypersensitivity (allergy),Never give cephalosporins to a patient who had an anaphylactic reaction to penicillin in the past. Nephrotoxicity (adverse kidney effects). pain in injection site. |
| Drugs that may interact with cephalosporins include: | Alcohol: may cause a disulfiram (alcohol sensitivity) results in severe flushing, copious vomiting, hrobbing headache, dyspnea,Tachycardia Hypotension, Chest pain. Antacids & iron:↓ absorption. Probenecid: can decrease elimination of the drug |
| Common Penicillins, Cephalosporins , Vancomycin and carbapenems | are cell wall synthesis inhibitors that kill susceptible bacteria by preventing their cell walls from being made and maintained. |
| pharmacodynamic parameters of Vancomycin: | cell wall synthesis inhibitors known as carbapenems. given by IV push or infusion over 1 hr or more in an acute care setting. Dosages and schedules are based on the patient’s weight, their organ health, and the severity of the infection. |
| Vancomycin used: | MRSA & drug-resistant infections. Oral form-pseudomembranous colitis caused-C-diff. Associated w/ vancomycin-resistant enterococci (VRE)- bacteria-intestines & female genital tract. Affect pts-hospitals/ nursing homes-critically ill & take #s antibiotics |
| pharmacodynamic parameters of Carbapenems | Broadest spectrum against gram+ & gram- bacteria. Severe side effects & adverse effects. usually limited to treatment of severe, life-threatening bacterial infections.Are associated w/CRE Enterobacteriaceae ( E. coli & Klebsiella): bacteria in intestines |
| Side effects to vancomycin & carbapenems | Nausea, Vomiting, Diarrhea, Headache, Rash, Fever, Chills, Flushing (v), Hypotension (v), Red man syndrome deep red rash upper body- caused-histamine release. May be prevented slowing- infusion rate & pretreating w/antihistamines & H2-receptor blocker |
| Adverse reactions to vancomycin & carbapenems | Nephrotoxicity (in high doses) Ototoxicity (in high doses) CNS effects (carbapenems), such as: Confusion Seizures |
| Vancomycin interactIons with other drugs | Antibiotics such as the aminoglycosides and other drugs that are ototoxic or nephrotoxic: increased toxicity Cholestyramine and colestipol: decreased absorption of the oral form of vancomycin |
| Carbapenems interactIons with other drugs | Probenecid: competes with carbapenems; never give at the same time Valproic acid (given to prevent seizures): reduced activity Ganciclovir: increased risk of seizures |
| The carbapenem formulation containing lidocaine is to be given intramuscularly | not intravenously, as lidocaine given intravenously can cause severe cardiac side effects. not intravenously, as lidocaine given intravenously can cause severe cardiac side effects. |
| pharmacodynamic parameters of Tetracyclines | Protein synthesis inhibitors ( enter the bacterium). Interfere w/ the bacterial processes to make proteins needed for growth- bacterium will not be able to reproduce & may die. then the patient’s immune system must rid the body of the organism. |
| uses of Tetracyclines | Acne Urinary tract infections Infections of the skin and respiratory tract Lyme disease Stomach ulcers-Helicobacter pylori Rocky Mountain spotted fever Typhoid fever STD (e.g., chlamydia, syphilis, gonorrhea) Inhalation anthrax exposure |
| Side effects of tetracyclines | nausea, vomiting, diarrhea Increased sensitivity of the skin to the sun, with increased risk for severe sunburnsYeast infections of the mouth (thrush) and vagina, particularly in patients with: Lengthy tetracycline therapy Immunosuppression Diabetes |
| Adverse reactions to tetracyclines | Growth & development (pregnat,breastfeeding, kids ↓8)bone & tooth enamel, fetus-skeletal retardation Defects Liver toxicity ↓kidney function (↑ dose) ↑pressure inside brain (dizziness, Blurred vision, Ringing in the ears, Confusion, Headache) |
| tetracyclines interact with other drugs | Food (particularly dairy products), Aluminum, Magnesium, Calcium. Best taken w/water on an empty stomach 1 hour before eating or 2 hours after eating. |
| pharmacodynamic parameters of macrolides | Protein synthesis inhibitors, either bactericidal or bacteriostatic, depending on the organisms and the dose used. 1st. gen: erythromycin. 2nd gen: azithromycin & clarithromycin-Longer duration-action,↓side effects,↑penetration tissues, blood levels. |
| Side effects of macrolides? | GI tract effects (most common): Mild abdominal pain Nausea Flatulence Diarrhea Increased sensitivity of the skin to sunlight |
| Adverse effects of macrolides? | Liver impairment and resulting jaundice Phlebitis and other types of vein irritation (when given IV) |
| Macrolides interact and produce toxic effects with other drugs: | Digoxin, Theophylline, Warfarin, Cyclosporine, Carbamazepine Anesthetic agents, Anticonvulsant drugs. Precipitate life-threatening cardiac dysrhythmias when combined with either: Ergotamine (treat migraines)Pimozide (treatment for Tourette syndrome) |
| nursing implications and teaching points for macrolides | keep the pt well hydrated, min urine output of 1500 mL, to ↓ the odds of renal toxicity. The nurse should avoid topical administration of macrolides to prevent sensitization (photosensitivity). take on empty stomach. |
| Common Tetracyclines, Macrolides, Aminoglycosides | are a group of antibacterial drugs classified as protein synthesis inhibitors |
| Pharmacodynamic parameters of aminoglycosides treat: | Protein synthesis inhibitors. Serious aerobic gram - bacteria: E. coli, Serratia, Proteus, Klebsiella, Pseudomonas Aerobic gram- bacteria Mycobacteria, some protozoans sterilize-bowel before intestinal surgery & treat hepatic encephalopathy. |
| Side effects to aminoglycosides? | Nausea Vomiting Rash Lethargy Fever Vein irritation (when given IV) |
| Adverse reactions | Vancomycin↑risk-nephrotoxicity. Kidney damage (nephrotoxicity) reversible if stopped quick Permanent damage- inner ear (ototoxicity) Hearing impair Dizziness ↓balance Ringing in ears Persistent headache/ neurotoxicity, particularly w/gentamicin |
| Blood Level Tests and Dosage Considerations | have a narrow therapeutic range, requiring blood drawn & level tested just before next scheduled dose. Trough determines whether the dosage needs to be adjusted to stay w/in therapeutic range. BUN, glomerular filtration rates & close monitoring required |
| Aminoglycosides interact with other drugs | Ototoxicity is increased with: Aspirin Furosemide Ethacrynic acid Many other drugs |
| Implications and teaching points for aminoglycosides | Aminoglycosides are given parenterally for systemic bacterial infections because they are poorly absorbed from the GI tract |
| 3 other miscellaneous protein synthesis protein synthesis inhibitors: Lincosamides, Oxazolidinones, and Streptogramins. | They are usually given intravenously to treat bacterial infections that have not responded to other antibiotics, and their use is limited to life-threatening infections such as MRSA and vancomycin resistant Staphylococcus aureus (VRSA). |
| Clindamycin is:A lincosamide | Orally for: Skin infections -impetigo & cellulitis Complicated skin & soft tissue infections-diabetic foot ulcers Intravenously for: Bone infections Intra-abdominal abscess Peritonitis Cellulitis Septicemia Bacteremia Anaerobic pneumonia |
| Linezolid (Zyvox) is: | An oxazolidinone that can be given orally or intravenously Given for MRSA, VRE, & sepsis after treatment w/ vancomycin has failed. Avoid alcohol, foods with tyramine, take with full glass of water. Report bruising & bleeding to the healthcare provider. |
| Dalfopristin/quinupristin is: | Only given intravenously Reserved for patients with bacteremia or sepsis |
| Which sign or symptom would the nurse look for when monitoring a patient taking streptomycin — an aminoglycoside — for nervous system toxicities? | Confusion Weakness Eye disorders Sleep disorders |
| Which action would the nurse take when giving dalfopristin/quinupristin to a patient? | Mix the drug and infuse it over 60 minutes to reduce vein irritation. |
| pharmacodynamic parameters of Sulfonamides | Broad spectrum antibacterial drugs from a class known as metabolism inhibitors (bacteriostatic), prevent bacteria from making the final form of folic acid, needed for growth & function .Eliminated-kidneys & have↑concentration of activity in the kidneys |
| Sulfonamides used: | Are a good choice for treating acute and chronic urinary tract infections, particularly: Cystitis Pyelitis Pyelonephritis Also: Toxoplasmosis Pneumocystis pneumonia |
| Side effects to sulfonamides | Minor: Headache Drowsiness Fatigue Dizziness Insomnia Anorexia (loss appetite) Nausea Vomiting Abdominal pain Worst: Vertigo (dizziness/spinning) Tinnitus (ringing -ears) Hearing loss Stomatitis (inflammation of the mouth) yellow sclera |
| Adverse reactions to sulfonamides | Kidney damage due to crystalizing of the drug in the kidney Allergic reactions, anaphylaxis Skin reactions-rash that begins w/fever ↑ sun sensitivity (photosensitivity) Bone marrow suppression, ↑wks =Anemia, Bleeding, Reduced immunity |
| Sulfonamides interact with other drugs | Sulfonylureas ( for diabetes type 2) =hypoglycemia Phenytoin = neurotoxic effects Warfarin = excessive bleeding Drugs eliminated by the kidneys: increased risk of nephrotoxicity |
| Sulfonamides interact with other drugs Cont. | Some phenothiazine antipsychotic drugs: lethal cardiac dysrhythmia Local anesthetics:↓ effect of sulfonamide. pts with allergy- thiazide diuretics, oral sulfonylureas/ carbonic anhydrase inhibitors maybe allergic to sulfonamides. |
| nursing implications and teaching points for sulfonamides | dosage depends on severity-infection, drug used, Pt’s response & tolerance. Short-acting sulfonamides usually require 1st dose (initial loading dose)-larger than the reg. dose. Take w/food, milk/ full glass of water to minimize stomach irritation. |
| Liters per day | As long as there are no fluid restrictions, the nurse would instruct the patient who is taking a sulfonamide to increase to 1.5 L/day. |
| pharmacodynamic parameters of Fluoroquinolones | destroy bacteria by inhibiting two enzymes needed for DNA synthesis and reproduction. They are a type of bactericidal DNA synthesis inhibitor. |
| Fluoroquinolones Used: | Most effective- gram + microbes Primarily excreted-kidneys, good choice-complicated UTI. Treat respiratory, GI, gynecologic, skin, soft tissue, bone, & joint infections. Ciprofloxacin (Cipro) drug choice-anthrax exposure in bioterrorist attack. |
| Side effects to fluoroquinolones | Nausea Vomiting Diarrhea Abdominal pain Headache Irritation of genital skin in incontinent patients (due to concentrated urine; encourage increased fluid intake to dilute the urine) |
| Adverse reactions to fluoroquinolones | Arthropathy (joint pain & disease)-kids, life threat heart changes, antidysrhythmic (quinidine, sotalol,amiodarone) Tingly, burning, numbness-ft, hands (peripheral neuropathy), rupture-tendon, shoulder, hand, arm, wrist, legs/ heel |
| fluoroquinolones interact with other drugs | reduce absorption of the fluoroquinolone (instruct pt to take these 2 hrs before /4 hrs after): Multivitamins,Minerals,Antacids Iron, Dairy, Enteral tube feedings, Warfarin:↑ anticoagulant effect Antidiabetic drugs: hyperglycemia/ hypoglycemia |
| nursing implications and teaching points for fluoroquinolones | Give fluoroquinolones with food—but not dairy products—to decrease adverse GI effects. Keep older patients well hydrated to prevent decreased renal function. “Avoid exposure to direct sunlight.” |
| sign or symptom would a nurse expect to see in a patient who has developed pseudomembranous colitis due to antibiotic use | Bloody diarrhea Low-grade fever Abdominal cramps |
| sign or symptom would the nurse recognize as a possible anaphylactic response in a patient who has just taken an antibiotic | Difficulty breathing A lump in the throat A sudden drop in blood pressure |
| In which way does an antimicrobial drug kill a pathogen? | |
| Which item would the nurse have available for a patient receiving the first dose of a newly prescribed antibiotic? | Crash cart Epinephrine Diphenhydramine |
| Cues of developing pseudomembranous colitis from antibiotic therapy | Low-grade fever Abdominal cramps Excessive watery bloody diarrhea |
Created by:
jlebron84