Ch 45: Drugs for Diabetes Mellitus, Ch 35: Drugs for bacterial infections, Ch 18: Drugs For The Control Of Pain

Tuberculosis

-1/3, 32% of the worlds population is infected -airborne precations -prevenative therapy preffered -active therapy/ prolonged multiple agents -cellwalls are resistant to anti-infectives -6-12 months therapy, up to 24 for pts with multidrug resistant infections -considered non onfectious after a few weeks of treatment

Antiseptic (alcohols/isopropyl)

-60-70% to be considered effective -rubbed on skin for 2 mins

Cephalosporins

-Chemically and pharmacology related to penicillins -widely prescribed -either bactericidal or bacteristatic -depends on suceptability of organism, dose of a drug -cross-sensitivity to penicillins

Tetracycline therapeutic use

-DOC for only a few diseases because of resistent bacterial strains -lyme disease and peptic ulcers

Aminoglycosides

-DOC tobramycin -potent ( serious toxicitys) -narrow spectrum -narrow therapeutic range -used to treat gram-negative aerobic bacilli -poorly absorbed from the GI tract, IM or IV preferable -depend on the kidney for excretion and are toxic to the kidney ( 25% of the pt have kidney damage)

5 classes of cephlasporins

-First: good gram positive coverage -Second: more potent, good gram positive coverage, some gram negative coverage -Third: less gram positive coverage, more gram negative coverage **can enter the CNS** -Fourth & fifth: effective against resistant organisms, good gram negative coverage ** can enter the CNS, MRSA infections**

Metformin Adverse Effects

-GI related including nausea, vomiting, abdominal discomfort, metallic taste, diarrhea , and anoerxia -headaches, dizziness, agitation, fatigue

DOC for chemoprophylaxis

-INH isoniazid -safest, lowest cost

General concepts antibiotics M.E.D.I.C.A.T.E.

-Monitor superinfactions -Evaluate renal/liver functions -Diarrhea, take probiotics -Inform provider prior to taking other meds -Cultures prior to initial dose -Alcohol is out, ask about allergy -Take full course of medications -Evaluate cultures, WBC,temp and blood

Metformin contraindications

-advanced CKD -heart failure, liver failure, history of lactic acidosis, or concurrent serious infection -anemia, diarrhea, vomiting or dehydration, fever, gastroparesis, GI obstruction, hyperthyroidism, pituary insufficiency, trauma, pregnancy and lactation

Antiseptics

-aka static agents -inhibit growth and reproduction -applied exclusively to tissue -living tissue can not be sterolized

Metformin drug interactions

-alcohol increases the risk for lactic acidosis -IV radiographic contrast may cause lactic acidosis or acute renal failure

Human Regular Insulin drug interactions

-alcohol, salicylates, monoamine oxidase inhibitors (MAO), anabolic steroids, ACE inhibitors

Fidaxomicin (Dificid)

-antibiotic, macrolide -newsest approved for c-diff

Chemoprophylaxis

-antituberculosis drugs used to prevent disease in high-risk populations -close contacts and family members of recently infected tuberculosis patients -patients with AIDS -patients who are HIV-positive or are receiving immunosuppressant drugs

Fluoroquinolones

-bactericidal -broad spectrum -tetragenic

Carbapenems

-broad spectrum -disadvantage- can only be given parentally -cross-sensitivity to penicillins

Metformin Administration Alerts

-cannot crush XL -fasting blood glucose levels should be obtained every 3 months -discontinue if signs of acidosis -preg. cat. B

Disinfectants

-chemical products that destroy all bacteria, fungi, and viruses (but not spores) on surfaces -aka cidel agents -used only on nonliving surfaces

Tetracyclines

-developed as semisynthetic antibiotics based on the structure of a common soil mold -have one of the broadest spectrums of any class of antibiotic

Tetracyclines toxic effects

-do not give to children 8 month old-8yrs -affects tooth development - temp. or permanent tooth discoloration of developing teeth (gray/black) -photosensitivity (burn more easily) -superinfection -do not give with Ca and/or Iron, give at least two hours after -Discard any unused, can become toxic overtime

General nursing implications for antimicrobial therapy

-do not stop before antimicrobials are gone -oral agents are taken on an empty stomach 1 hr AC or 2 hr PC with 8 oz glass of water -avoid alcohol -avoid acidic beverages -take as evenly spaced out as possible -not for viruses

Fluoroquinolones teaching

-do not take with multi-vitamins or mineral supplements, decrease absorption by 90% -consume at least 1 liter a day of water -avoid sunlight and tanning beds -use alternative contraception

Tetracycline Teaching

-don't take with food, milk, or other dairy products -sodium bicarbonate or iron compounds can affect absorption -avoid longterm sun exposure -wait 3 hrs after you take before you take an antiacid

Antiseptic (povidone-iodine) betadine

-effective against all forms of microorganisms -must be allowed to dry for max effect

Human Regular Insulin Administration Alerts

-ensure patient has sufficient food and not hypoglycemic -IV injection -rotate injection sites -30 minutes before meals -preg cat b

Culture and sensitivity testing

-examination of specimen for microorganisms -grown in lab and identified -tested for sensitivity to different antibiotics -bacteria may take several days to identify -viruses may take several weeks to identify -broad spectrum antibiotics may be started before lab culture is completed

Human Regular Insulin herbal/food

-garlic, bilberry, and ginseng

Human Regular Insulin Action and Use

-help maintain blood glucose levels within normal limits -promote cellular uptake of glucose, amino acids, and potassium -promote protein synthesis, glycogen formation and storage, fatty acid storage as triglyceridesades -short acting and often combines with long acting -lower blood glucose in type 1 -combination with oral antidiabetic drug for type 2 diabetes -emergency treatment of DKA -gestational diabetes

metiformin treatment of OD

-hemodialysis to correct acidosis and remove excess metformin

Antitubercular Agents Isoniazd INH

-hepatotoxicity: jaundice -peripheral neuritis ( vit B6 given to protect the nerves) -no alcohol, oral contraceptives not effective

Sulfonamides adverse effects

-hypersensitivity -renal dysfunction ( crystals form in urine) -hematological changes

Human Regular Insulin adverse effects

-hypoglycemia from taking too much insulin or not proper timing -tachycardia, confusion, sweating, and drowinsess -irritation at injection sites -weight gain

Adverse reactions to anti-infective therapy

-kidney damage -GI tract toxicity -neurotoxicity -hypersensitivity reactions -superinfections

Metformin Black Box Warning

-lactic acidosis increased with CKD, liver disease, severe infection, excessive alcohol intake, shock, or hypoexmia

Antibiotics

-made by; living organisms, synthetic manufacture(majority) -through genitic engineering - >300 drugs available -natural substance produced by bacteria that kills other bacteria -mainly used to treat systemic bacterial infections

Human Regular Insulin lab tests

-may increase urinary vanillymandelic acid (VMA) and interfere with liver test and thyroid function -decrease serum potassium, calcium, and magnesium

Penicillins

-not the first discovered, but the 1st mass produced -part if a large group of chemically related antibiotics -derived from fungus or mold -the safest class of antibiotics

Combination therapy

-often a smaller dosage of each drug may be used -some drugs are synergistic, some antagonistic -in infections caused by more than one organism, each pathogen may react to a different anti-infective agent -sometimes, the combined effects of the diff drugs delay the emergance of resistant strains

Metformin Action and Use

-oral antidiabetic for managing type 2 diabetes -can be combined -approved for children under 10 -reduces fasting and postprandial glucose levels by decreasing hepatic production of glucose -does not cause hypoglycemia -lower glucose levels and triglycerides and LDL cholesterol levels and promotes weight loss -women with polycystic ovary syndrome

Aminoglycosides adverse effects

-ototoxicity and nephrotoxicity -monitor drug level trough, draw 30 mins before next dose -avoid combination w/ potent diuretics

Human Regular Insulin treatment of OD

-overdose causes hypoglycemia -oral glucose and parenteral glucagon IV

Antiseptic (CHG)

-preferred IV site prep and for dressing over sentral lines -popular for pre-op skin prep

Human Regular Insulin Contraindications

-pregnancy, CKD, fever, thyroid disease -hypoglycemia

Penicillins Indications (therapeutic use)

-prevention and treatment of gram+ bacterial infections -pneumonia, skin, bone, joint infections, gas gangrene, tetanus, and anthrax

Goal of anti-infective therapy

-reduction of the population of invading organism -slow/kill enough so that the immune system can take care of the rest

Vancomycin

-reserved for severe infections -nephrotoxic and ototoxic -IV admin over 60-90mins to avoid red-man syndrome

superinfection

-secondary infections that occur when too many host flora are killed by an antibiotic -host flora prvent growth of pathogenic organisms -opportunistic infection -signs and symptoms include; diarrhea, bladder pain, painful urination, or abnormal vaginal discharge

Tetracyclines side effects

-superinfections -abdominal distress or distention -photosensitivity -hepaptoxicity -renal toxicity

Tetracycline adverse effects

-superinfections -abdominal distress or distention -photosensitivity -renal toxicity -hepatic toxiicity

Anti-infective goals

-the infection will resolve -fluid volume within normal limits -pt and family have an understanding of drug therapy

Sulfonamides

-treatment of UTI

Selection of antibiotic

-use of culture and sensitivity, for effective phatmacotherapy; to limit adverse effects -check allergies

Classifications Of Pain

1. acute 2. chronic

Other Drugs For Migraine Prophylaxis

1. antiseizure drugs 2. beta-adrenergic blockers 3. calcium channel blockers 4. tricyclic antidepressants

Role Of The Nurse In Opioid Therapy

1. assess potential for opioid dependency 2. assist with activity 3. monitor urine output for retention 4. monitor patients bowel habits for constipation

Effective Pharmacotherapy Depends On

1. assessment of degree of pain 2. determining underlying disorders

Role Of The Nurse In Nonopioid Analgesics

1. careful monitoring and giving education 2. assessment for hypersensitivity and bleeding disorders 3. assessment for gastric ulcers, severe renal/hepatic disease, and pregnancy 4. obtain lab tests on renal and liver function 5. pain assessment 6. monitor for side effects

Opioid Receptors

1. mu 2. kappa 3. delta 4. nociceptin/orphanin FQ peptide

Several Target Areas

1. peripheral level 2. CNS level

Treatment For Intractable Cancer Pain

1. radiation or chemotherapy 2. relieving nerve stimulation 3. surgery 4. nerve block

Antimigraine Drugs

1. triptans 2. ergot alkaloids

4. The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include? a. Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis b. Cranial nerve testing for peripheral neuropathy c. Pedal pulse palpation for arterial insufficiency d. Auscultation of the carotids for bruits associated with atherosclerosis

ANS: A High blood sugar, low blood sugar, and ketoacidosis are short-term complications of diabetes. Microvascular and macrovascular complications, such as peripheral neuropathy, are long-term complications of diabetes. Arterial insufficiency and atherosclerosis also are long-term complications of diabetes.

7. An adolescent patient recently attended a health fair and had a serum glucose test. The patient telephones the nurse and says, "My level was 125 mg/dL. Does that mean I have diabetes?" What is the nurse's most accurate response? a. "Unless you were fasting for longer than 8 hours, this does not necessarily mean you have diabetes." b. "At this level, you probably have diabetes. You will need an oral glucose tolerance test this week." c. "This level is conclusive evidence that you have diabetes." d. "This level is conclusive evidence that you do not have diabetes."

ANS: A If a person has not fasted for 8 hours, a blood sugar level of 125 mg/dL would be considered normal, because it is less than 200 mg/dL for a random sampling. Also, a person must have positive outcomes on two separate days to be diagnosed with diabetes. This patient does not need to have an oral glucose tolerance test, because the 125 mg/dL reading is so far below 200 mg/dL, which would require further work-up. No conclusive evidence indicates that this patient has diabetes, because the random sample value is so low, and the patient has not had two separate tests on different days. However, this also is not conclusive evidence that the patient does not have diabetes.

10. A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. What should the nurse tell the patient? a. This is an acceptable practice. b. These two forms of insulin are not compatible and cannot be mixed. c. Mixing these two forms of insulin may increase the overall potency of the products. d. NPH insulin should only be mixed with insulin glargine.

ANS: A NPH insulin is the only insulin suitable for mixing with short-acting insulins, such as insulin aspart [NovoLog]. These insulins are compatible and are mixed frequently for management of diabetics. The overall potency of each insulin is not increased by mixing them. Insulin glargine cannot be mixed with any other insulin for administration.

1. The nurse working on a high-acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first? a. The NPO patient with a blood glucose level of 80 mg/dL who just received 20 units of 70/30 Novolin insulin b. The patient with a pulse of 58 beats per minute who is about to receive digoxin [Lanoxin] c. The patient with a blood pressure of 136/92 mm Hg who complains of having a headache d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin [Vancocin]

ANS: A The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because this patient needs to consume a good source of glucose immediately or perhaps the NPO status will be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58 beats per minute, but this is not a priority action. The patient with a headache needs to be followed up, but because the blood pressure is 136/92 mm Hg, the headache is probably not caused by hypertension. The patient with an allergy to penicillin will not have a reaction to the vancomycin.

13. Which statement is correct about the contrast between acarbose and miglitol? a. Miglitol has not been associated with hepatic dysfunction. b. With miglitol, sucrose can be used to treat hypoglycemia. c. Miglitol is less effective in African Americans. d. Miglitol has no gastrointestinal side effects.

ANS: A Unlike acarbose, miglitol has not been associated with hepatic dysfunction. Sucrose should not be used to treat hypoglycemia with miglitol. Miglitol is more effective in African American patients. Miglitol has gastrointestinal side effects.

3. A nurse is educating the staff nurses about ketoacidosis. To evaluate the group's understanding, the nurse asks, "Which sign or symptom would not be consistent with ketoacidosis?" The group gives which correct answer? a. Blood glucose level of 600 mg/dL b. Blood glucose level of 60 mg/dL c. Acidosis d. Ketones in the urine

ANS: B A patient with diabetic ketoacidosis (DKA) has a high glucose level (at least 500 mg/dL or higher); therefore, a glucose level of 60 mg/dL would not be consistent with DKA. A blood glucose level of 600 mg/dL, acidosis, and ketones in the urine are consistent with DKA.

A patient newly diagnosed with diabetes expresses concern about losing her vision. Which interventions should be included in the plan of care to reduce this risk? (Select all that apply.) a. Initiation of reliable contraception to prevent pregnancy b. Ways to reduce hyperglycemic episodes c. Use of a prokinetic drug (eg, metoclopramide) d. Smoking cessation e. Emphasis on the importance of taking antihypertensive drugs consistently

ANS: B, D, E Tighter glycemic control and fewer hyperglycemic episodes have been correlated with fewer complications. Smoking cessation and strict compliance with any drugs prescribed for hypertension also help reduce the risk of complications. The use of contraception or a prokinetic drug is not related to a reduced risk of vision loss in patients with diabetes.

A nurse counsels a patient with diabetes who is starting therapy with an alpha-glucosidase inhibitor. The patient should be educated about the potential for which adverse reactions? (Select all that apply.) a. Hypoglycemia b. Flatulence c. Elevated iron levels in the blood d. Fluid retention e. Diarrhea

ANS: B, E Acarbose and miglitol frequently cause flatulence, cramps, abdominal distention, borborygmus (rumbling bowel sounds), and diarrhea. Acarbose also can cause liver damage. Neither acarbose nor miglitol causes hypoglycemia, elevated iron levels, or fluid retention.

6. A patient with type 1 diabetes recently became pregnant. The nurse plans a blood glucose testing schedule for her. What is the recommended monitoring schedule? a. Before each meal and before bed b. In the morning for a fasting level and at 4:00 PM for the peak level c. Six or seven times a day d. Three times a day, along with urine glucose testing

ANS: C A pregnant patient with type 1 diabetes must have frequent blood sugar monitoring (eg, six or seven times a day) to manage both the patient and the fetus so that no teratogenic effects occur. Monitoring the blood sugar level before meals and at bedtime is not significant enough to provide the necessary glycemic control. Morning and 4:00 PM monitoring is not enough to provide glycemic control. Urine glucose testing is not sensitive enough to aid glycemic control, and monitoring three times a day is not enough.

14. An elderly patient who has type 2 diabetes has a history of severe hypoglycemia. The patient's spouse asks the nurse what the optimum A1c level is for the patient. Which is correct? a. Between 6.5 and 7.0 b. Below 7.0 c. Below 8.0 d. Between 7.0 and 8.5

ANS: C For patients with a history of severe hypoglycemia and those with a limited life expectancy or advanced micro- and macrovascular complications, the target A1c level should be below 8.0. For most other patients with diabetes, the target is 7.0 and below.

11. Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug? a. Approximately 15 to 30 minutes before each meal b. In the morning and at 4:00 PM c. Once daily at bedtime d. After meals and at bedtime

ANS: C Glargine insulin is indicated for once daily subcutaneous administration to treat adults and children with type 1 diabetes and adults with type 2 diabetes. According to the package labeling, the once-daily injection should be given at bedtime. Glargine insulin should not be given more than once a day, although some patients require bid dosing to achieve a full 24 hours of basal coverage.

15. A patient who has type 2 diabetes will begin taking glipizide [Glucotrol]. Which statement by the patient is concerning to the nurse? a. "I will begin by taking this once daily with breakfast." b. "It is safe to drink grapefruit juice while taking this drug." c. "I may continue to have a glass of wine with dinner." d. "I will need to check my blood sugar once daily or more."

ANS: C Glipizide is a sulfonylurea antidiabetic agent and can cause a disulfiram-like reaction when combined with alcohol. Patients should be taught to avoid alcohol while taking this medication. The initial dosing is once daily with breakfast. There is no drug interaction with grapefruit juice. Patients will need to monitor their blood glucose.

12. A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? a. The beta blocker can cause insulin resistance. b. Using the two agents together increases the risk of ketoacidosis. c. Propranolol increases insulin requirements because of receptor blocking. d. The beta blocker can mask the symptoms of hypoglycemia.

ANS: D Beta blockers can delay awareness of and response to hypoglycemia by masking signs associated with stimulation of the sympathetic nervous system (eg, tachycardia, palpitations) that hypoglycemia normally causes. Furthermore, beta blockade impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose; beta blockers, therefore, can worsen insulin-induced hypoglycemia. Propranolol does not cause insulin resistance. The incidence of DKA is not increased by concurrent use of propranolol and insulin. Insulin requirements are not increased because of receptor blocking by propranolol.

5. Which statement is accurate about the long-term complications of diabetes? a. Long-term complications are almost always the result of hypoglycemia and ketoacidosis. b. The complication rates for patients with optimally controlled type 2 diabetes are the same as for those whose disease is not optimally controlled. c. Optimal control of type 1 diabetes produces excessive episodes of life-threatening hypoglycemia. d. Optimal control of both types of diabetes reduces the risk of eye, kidney, and nerve damage.

ANS: D In both types of diabetes, optimal control of the disease slows the development of microvascular complications. Short-term complications are more apt to result from hypoglycemia and ketoacidosis. Patients with type 2 diabetes have fewer complications if their blood sugar level is optimally controlled. Hypoglycemia does not occur more frequently in patients with optimally controlled type 1 diabetes.

8. A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included? a. "You may eat any foods you want and cover the glucose increase with sliding scale, regular insulin." b. "Most of the calories you eat should be in the form of protein to promote fat breakdown and preserve muscle mass." c. "Your total caloric intake should not exceed 1800 calories in a 24-hour period." d. "You should use a carbohydrate counting approach to maintain glycemic control."

ANS: D Patients with diabetes should be given intensive insulin therapy education using either a carbohydrate counting or experience-based estimation approach in achieving glycemic control. A patient with diabetes cannot eat any foods desired and then cover the glucose increase with a sliding scale of regular insulin. Evidence suggests that there is not an ideal percentage of calories that should be ingested from carbohydrate, fat, or protein. Every patient with diabetes must be assessed individually to determine the number of total calories the person should have daily. The total caloric intake should be spread evenly throughout the day, with meals spaced 4 to 5 hours apart.

2. A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? a. No insulin should be administered. b. NPH c. 70/30 mix d. Lispro [Humalog]

ANS: D Regular insulin is indicated for sliding scale coverage. Insulin is definitely indicated for this high blood sugar level. NPH is used for scheduled insulin doses and is a longer-acting insulin. A 70/30 mix is also used for scheduled insulin coverage.

9. What is the most reliable measure for assessing diabetes control over the preceding 3-month period? a. Self-monitoring blood glucose (SMBG) graph report b. Patient's report c. Fasting blood glucose level d. Glycosylated hemoglobin level

ANS: D The glycosylated hemoglobin level tells much about what the plasma glucose concentration has been, on average, over the previous 2 to 3 months. The SMBG graph report is done by the patient and indicates each blood sugar level the patient has on a daily basis. It is not as reliable as the glycosylated hemoglobin level, because the equipment used might not be accurate and the testing may not reflect actual measurements 100% of the time. The patient's report of blood sugar levels is not considered as accurate as the glycosylated hemoglobin level for the same reason that the SMBG is not. One fasting blood glucose level indicates the patient's blood sugar level for that one time when it was obtained.

Tuberculosis

An infectious disease that may affect almost all tissues of the body, especially the lungs

Gram-positive bacteria

Bacteria with thick cell wall

Salicylate Adverse Effects

GI distress, GI bleeding, and may increase hypoglycemic agents

Triptans Adverse Effects

GI upset

Ergot Alkaloids Adverse Effects

GI upset, weakness in the legs, myalgia, numbness and tingling in fingers and toes, angina-like pain, tachycardia

Two ways pathogens can cause disease

Invasiveness, toxins

Early Treatment

Suboxone which is a mixed opioid agonist - antagonist that is given sublingual or transdermal

Triptans Prototype Drug

Sumatriptan (Imitrex)

Human Regular Insulin Class

Therapeutic Class: Parenteral drug for diabetes; pancreatic hormone Pharmacologic Class: Short-acting hypoglycemic drug

Metformin Class

Therapeutic Class: antidiabetic drug Pharmacologic Class: biguanide

Toxins of a pathogen

Very small amounts disrupt normal cell function

Immune response

a complex process involving chemical mediators, leukocytes, lymphocytes, antibodies, and locally released enzymes and chemicals

Antiseptic (germicide)

a general term for an agent that kills or inhibits growth of microorganisms

Virulence

ability of a microbe to produce disease when present in minute numbers

Pathogenicity

ability of an organism to cause infection

Triptans Mechanism Of Action

act on serotonin agonist and constrict intercranial pressure

Opioid (Narcotic) Agonist Primary Use

analgesia, pain relief

Salicylates Prototype Drug

aspirin

Gram-negative bacteria

bacteria with thin cell walls, cause more serious infections

Opioid Antagonists

block opioid activity but competing for opioid receptor

Psychological Factors

can increase or decreases perception of pain

Later Maintenance

contains both buprenorphine and naloxone

Role Of The Nurse With Opioid Antagonist Therapy

continue careful monitoring or patients condition especially respiratory status - have resuscitate equipment available

Spinal Neurotransmitters

control whether the pain signal will go to the brain

metformin herbal/food

decreases absorption of vit b12 and folic acid -garlic and ginseng increase hypoglycemic effects

Pathogens

disease causing agents ; bacteria, viruses, fungi, intracellular organisms, multicellular animals

invasiveness of a pathogen

divide rapidly to overcome and cause direct damage

Neuropathic Pain

due to injury to nerves and is a burning, shooting, or numbing pain

Nociceptive Pain

due to injury to tissues

C Fibers

dull and poorly localized pain

Nociceptive Visceral Pain

dull, throbbing, and aching

Linezolid

effective against MRSA, alternative to vancomycin

broad spectrum antibiotics

effective for a wide variety of bacteria

Narrow spectrum antibiotics

effective for narrow group of bacteria

Penicillinase

enzyme produced by bacteria that deactivates penicillin

Ergot Alkaloids Prototype Drug

ergotamine - may be supplied with caffeine

metformin lab test

false positives results for urinary ketones

Anti-infective drugs

general term that applys to any drug that is effective against pathogens

Goal Of Migraine Therapy

help the one they have and prevent the next

Opportunistic infections

infection caused by pathogens (bacteria, viruses, fungi, or protozoa) that take advantage of an opportunity not normally available, such as a host with a weakened immune system, an altered microbiota (such as a disrupted gut microbiota), or breached integumentary barriers.

Beta-lactamase inhibitors

inhibit penicillinase, often combined with penicillin

Acute

intense pain that lasts fro a short period of time

Opioid Antagonists Mechanism Of Action

interact and block mu and kappa receptors

Ergot Alkaloids

interact with adrenergic, dopaminergic, and serotonin receptors - vasoconstrictors and will terminate an ongoing migraine

Opioid (Narcotic) Agonist Mechanism Of Action

interact with mu and kappa sites to block the receptor and give pain relief

Miosis

kappa

Bacteriocidal

kills bacteria

Substance P

main neurotransmitter for pain message along the spinal cord

Chronic Pain

more dull and lasts more than 6 months

Opioid (Narcotic) Agonist Examples

morphine

Tension Headache

most common type that are self limiting and annoying

Euphoria

mu

Physical Dependence

mu

Respiratory Depression

mu

Analgesia

mu and kappa

Decreased GI Motility

mu and kappa

Sedation

mu and kappa

Reverse Symptoms Of Addiction, Toxicity, And Overdose

naloxone may be used to reverse respiratory depression and other acute symptoms - also used to diagnose overdose

Opioid Antagonists Prototype Drug

narcan - pain transmission will go to the brain so people will experience a lot of pain

Intrinsic resistance

natural insensitivity in bacteria that have never been susceptible to a particular antibiotic

Opioids

natural or synthetic morphine like substances responsible for reducing moderate to severe pain

Endogenous Opiods

naturally occurring NT in our body that effect substance P in pain transmission - endorphins, enkephalins, dynorphins

acquired resistance

occurs when pathogen acquires gene for bacterial resistance due to mutation, antibodies destroy the sensitive bacteria, leaving mutated (insensitvie) behind to multiply

Opioid Agonist Examples

oxycontin and Percocet

PCA

patient controlled analgesia which are helpful for an individual to control their own pain management

Example Of Agonist - Antagonist Drugs

pentazocine

Pain

physiological and psychological experience for patients - can be seen as body's defense mechanisms physiological

Opioid Dependence

potential to cause physical and psychologic dependence

Opioid Antagonist Drug

primarily block the mu and kappa receptors

Ergot Alkaloids Mechanism Of Action

promotes vasoconstriction

Mu And Kappa

receptors generally targeted but the delta receptors have been known to target emotional and effective components of pain experience

Opioid (Narcotic) Agonist Adverse Effects

respiratory depression, sedation, nausea, vomiting, and constipation

Salicylate Mechanism Of Action

results in anticoagulation by blocking platelet aggregation, an antipyretic by decreasing fever, anti-inflammatory by blocking the acid cascade, and analgesic for mild to moderate pain

Triptans

serotonin agonists - contract certain inter cranial vessels

Nociceptive Somatic Pain

sharp and localized

A Fibers

sharp well defined pain

Bateriostatic

slows the growth of bacteria

Pain Transmission

spinal cord receives pain impulse through A fibers or C fibers

Opioid Agonist Drug

stimulate mu and kappa receptors

Opioids With Mixed Agonist - Antagonist Activity

stimulate opioid receptor, thus causing analgesia - withdraws symptoms and side effects are not as intense as those of opioid agonists

Pain Assessment

subjective experience for patients so number scale and surveys assist

Treatment For Opioid Dependence

switch from IV and inhalation forms to methadone, the oral form - this does not give the euphoric feeling

Ergot Alkaloids Primary Use

terminate an ongoing migraine

Penicillin adverse effects

the safest class of antibiotics; bacteria can become resistant; allergy is possible; lowered red/white blood cell and platelet levels

Migraine

throbbing or pulsating pain that have a signal that its coming and often have nausea and triggers

Opioid Agonist Mechanism Of Action

to interact with specific receptors primary mu or kappa

Opioid Agonist Primary Use

to relieve moderate to severe pain and some are used for anesthesia

Opioid Antagonists Primary Use

to reverse respiratory depression and other acute symptoms of opioid addiction, toxicity, overdose, and respiratory depression

Triptans Primary Use

to stop a migraine with or without an aura before it is severe

Nonpharmacological Techniques For Pain Management

used alone or in conjunction with pharmacotherapy - may allow for lower doses and possibly fewer drug related adverse effects

Nonopioid Analgesics

used for fever, inflammation, and analgesia - used for mild or moderate pain - contain NSAIDs, acetaminophen, and a few centrally acting drugs

Aerobic

with oxygen

Anaerobic

without oxygen