Pharmacotherapy Exam 1*

Toddlerhood is the age period from

1-3 years

SGLT2 inhibitor

Sodium-glucose co-transporter-2 inhibitor

Decongestants

Sympathomimetics with alpha adrenergic activity. Relieves nasal congestion associated with the common cold or AR when given by either the oral or intranasal route.

Bilberry

Terminate diarrhea, improve and protect vision, antioxidant

A patient will be discharged after surgery with a prescription for penicillin. When planning at-home instructions, what will the nurse include? 1.Penicillins can be taken while breast-feeding. 2.The entire prescription must be finished. 3.All penicillins can be taken without regard to eating. 4.Some possible side effects include abdominal pain and constipation.

The entire prescription must be finished.

Postmarketing surveillance

The fourth and final phase of the drug approval process, begins after clinical trials and the NDA review have been completed. The purpose of this phase is to survey for harmful drug effects in a larger population. Some adverse effects take longer to appear and are not identified until a drug is circulated to large numbers of people.

Superinfections are an adverse effect common to all antibiotic therapy. Which of the following best describes a superinfection? 1.An initial infection so overwhelming that it requires multiple antimicrobial drugs to treat successfully 2.Bacterial resistance that creates infections that are difficult to treat and are often resistant to multiple drugs 3.Infections requiring high-dose antimicrobial therapy with increased chance of organ toxicity 4.The overgrowth of normal body flora or of opportunistic organisms such as viruses and yeast no longer held in check by normal, beneficial flora

The overgrowth of normal body flora or of opportunistic organisms such as viruses and yeast no longer held in check by normal, beneficial flora

Cigarette smoking accounts for ___-___% of all cases of non asthmatic COPD

85-90

black box warning

A type of warning that appears in a drug's prescribing information and is required by the U.S. Food and Drug Administration (FDA) to alert prescribers of serious adverse events that have occurred with the given drug.

Intranasal corticosteroids

AKA glucocorticoids applied directly to the nasal mucosa to prevent symptoms of allergic rhinitis Largely replaced antihistamines as preferred drugs for the treatment of perennial allergic rhinitis Systemically Corticosteroids may have serious adverse effects but intranasally they have virtually no serious adverse effects. *First line drugs in the treatment of AR 1-3 weeks may be required to ACHIEVE PEAK RESPONSE especially when treating perennial rhinitis. MOST EFFECTIVE when taken in advance of expected allergen exposure. Adverse effects intense burning sensation in the nose that occurs immediately after spraying. Excessive drying of the nasal mucosa may occur leading to epitaxis.

sulfonamide uses

UTIs, pneumocystis, camii pneumonia, shigella, small bowel infections, chronic bronchitis

Adverse effect

Unfavorable drug reaction Warrants either lowering the dosage of the drug or discontinuing the drug Generally perceived as negative

Nystatin (Mycostatin, Nystop, others) - Interactions

Unknown to all (Drug/lab/food) No overdose treatment

Acai

Vitamin and mineral supplement, antioxidant, possible weight loss

whole-bowel irrigation

Act of mechanically flushing the ingested poison from the gastrointestinal tract after the patient has ingested potentially toxic doses of lead, zinc, or illicit drugs; this technique may be used for overdosed sustained-release or enteric-coated drugs.

Dextromethorphan (Robitussin DM): Actions and Uses

Actions and Uses -Acts in the medulla -lacks the analgesic and euphoric effects of the opioids -doesn't produce dependence Available in tablet, liquid caps, lozenges, and liquids Rapid onset of 15-30 mins

Fluticasone (Flonase, Veramyst): Actions and Uses

Actions and Uses treat seasonal allergic rhinitis -decreases local inflammation in the nasal passages, thus reducing nasal stuffiness

Oxymetazoline (Afrin): Actions and Uses

Actions and Uses -activates alpha-adrenergic receptors in the sympathetic nervous system -Causes arterioles in the nasal passages to constrict which dries the mucous membranes -relief occurs within minutes and lasts for 10+hours -Metered spray device or nasal drops, and eye drops -causes vasoconstriction of vessels in the eye and is used to relieve redness and provide relief from dryness and minor eye irritations

Ipratropium (Atrovent): Actions and Uses

Actions and Uses Relieve and prevents the bronchospasm that is characteristic of asthma and COPD. *When combined with albuterol (Combivent Respimat) it's a first-line drug for treating bronchospasm due to COPD including bronchitis and emphysema. -Alternative to SABAs and for patients experiencing severe asthma exacerbations -Sometimes combined with beta antagonists or corticosteroids to provide additive bronchodilation. -Nasal spray: approved for symptomatic relief of runy nose associated with common cold and allergic rhinitis -Inhibits nasal secretions but doesn't have decongestant action -Treatment is limited to 3 weeks

Albuterol: Actions and Uses

Actions and Uses SABA that is used to relieve bronchospasm of asthma. Rapid onset excellent safety profile makes it preferred drug for termination of acute bronchospasm. -also facilitates mucus drainage and can inhibit the release of inflammatory chemicals from mast cells -inhale 15-30mins before physical activity....this can prevent exercise-induced bronchospasm. -short acting beta2 agonists are not recommended for asthma prophylaxis The oral form has longer onset of action and aren't suitable for terminating acute asthma attacks.

Montelukast (Singulair): Actions and Uses

Actions and Uses Used for prophylaxis of persistent, chronic asthma, exercise-induced bronchospasm, and allergic rhinitis. -Prevents airway edema and inflammation by blocking leukotriene receptors in the airways -given PO and acts rapidly -not recommended for termination of acute bronchospasm -APPROVED FOR PEDIATRICS, chewable available or can mix with applesauce, mashed carrots, or ice cream

Diphenhydramine (Benadryl): Actions and Uses

Actions and uses -1st GEN H1-receptor antagonist -treat minor symptoms of allergy and the common cold such as sneezing, runny nose, and tearing of the eyes. -Topically to treat rashes -IM and IV for severe allergic reactions Parkinson's, motion sickness, and insomnia

Specific defense that may act against only a single species of bacteria and be ineffective against ll others are known as _____________.

Adaptive (specific) body defenses or more commonly the Immune Response

Booster Vaccine

Administered months or years after the initial vaccine, booster vaccines stimulate the immune system to maintain enough memory cells to mount a rapid response to an allergen.

Dextromethorphan (Robitussin DM): Administration Alerts

Administration Alerts -avoid pulmonary irritants, such as smoking or other fumes because these agents may decrease drug effectiveness -preg cat C

Diphenhydramine (Benadryl): Administration Alerts

Administration Alerts -increased risk of anaphylactic shock when drug is administered parenterally -IV: inject at rate of 25 mg/min to reduce risk of shock -IM: inject deep into a large muscle to minimize tissue irritaiton -Preg. C

Fluticasone (Flonase, Veramyst): Administration Alerts

Administration Alerts -instruct to follow directions -Preg cat C

Ipratropium (Atrovent): Administration Alerts

Administration Alerts -Proper use is important -Wait 2-3 minutes between dosages -avoid contact with eyes, or blurred vision will occur -Preg cat B

Montelukast (Singulair): Administration Alerts

Administration Alerts -do not use to terminate acute asthma attacks -if preventing exercise-induced bronchospasm take at least 2 hours before activity -Preg cat B

Albuterol: Administration Alerts

Administration Alerts -use only actuator that comes with canister -proper use is important -observe and instruct patient in proper use -Preg cat C

Oxymetazoline (Afrin): Administration Alerts

Administration Alerts -wash hands after administration to prevent anisocoria (blurred vision) -preg cat C

Enteral route

Administration of drugs orally, and through nasogastric or gastrostomy tubes.

Passive Immunity Definition

Administration of immunoglobulins (antibodies) gives passive immunity which has a fast onset, but lasts only 3-6 months.

Active Immunity Definition

Administration of vaccine or exposure to an antigen stimulates the body to produce antibodies and memory cells.

Compare the advantages and disadvantages of using the inhalation route of administration for pulmonary drugs

Advantages It delivers pulmonary drugs to their immediate site of action thus reducing systemic side effects Disadvantages the precise dose received by the patient is difficult to measure. Accurate hand-breath coordination is essential to prove correct dosage. Swallowing the medication may cause systemic adverse effects if absorbed in the GI tract.

Diphenhydramine (Benadryl): Adverse Effects

Adverse Effects -significant drowsiness for first generation, diminishes with long-term use -occationally, paradoxical CNS stimulation and excitability will be observed rather than drowsiness *more frequent in children than adults -Anticholinergic effects such as dry mouth, tachycardia, and mild hypotension occur in some patients -may cause photosensitivity

Fluticasone (Flonase, Veramyst): Adverse Effects

Adverse Effects Intranasally: adverse effects are rare Nasal irritation and epistaxis can occur *most frequent is headache and nasopharyngitis

Dextromethorphan (Robitussin DM): Adverse Effects

Adverse Effects at therapeutic doses effects are rare. Diszziness, drowsiness, and GI upset occur in some patients. In abuse situations can cause CNS toxicity with a wide variety of symptoms which include: slurred speech, ataxia, hyperrexcitability, stupor, respiratory depression, seizures, coma, and toxic psychosis

Montelukast (Singulair): Adverse Effects

Adverse Effects -Headache is most common complaint and nausea and diarrhea in some patients -Rare: serious neuropsychiatric events, suicidal ideation, hallucinations, aggressiveness, depression

Ipratropium (Atrovent): Adverse Effects

Adverse Effects -little is absorbed by lungs so produces few systemic effects. -Irritation fo the upper respiratory may result in cough, drying of nasal mucosa or hoarseness. -bitter taste -Intranasal: may cause epistaxis and excessive drying of the nasal mucosa

Oxymetazoline (Afrin): Adverse Effects

Adverse Effects Rebound congestion is common when used for more than 3-5 days -minor stinging and dryness in nasal mucosa may be experienced -systemic adverse effects are unlikely unless lg act of med is swallowed

Albuterol: Adverse Effects

Adverse Effects Uncommon -may experience palpitations, headaches, throat irritation, tremor, nervousness, restlessness, and tachycardia. -less common: insomnia and dry mouth -uncommon effects: chest pain, paradoxical bronchospasm, allergic reactions

Gram-Positive bacteria

Bacteria that have a thick peptido glycan cell wall, and no outer membrane. They stain very darkly (purple) in Gram stain. •Gram-positive bacteria include Staphylococci, Streptococci and Enterococci

Bronchodilators for treating asthma

Beta2-adrenergic agonists -first line drugs for the treatment of acute bronchoconstriction Beta-adrenergic agonists are drugs that activate the sympathetic nervous system which relaxes bronchial smooth muscle resulting in bronchodilator. These medications act on receptors which are found in the smooth muscle of the lung, uterus, and other organs.

What are agents naturally produced in animal cells, by microorganisms, or by the body itself

Biologics

Ipratropium (Atrovent): Classes

Bronchodilator Classes Therapeutic: bronchodilator Pharmacologic: anticholinergic

Ipratropium (Atrovent)

Bronchodilator Classes Therapeutic: bronchodilator Pharmacologic: anticholinergic Actions and Uses Relieve and prevents the bronchospasm that is characteristic of asthma and COPD. *When combined with albuterol (Combivent Respimat) it's a first-line drug for treating bronchospasm due to COPD including bronchitis and emphysema. -Alternative to SABAs and for patients experiencing severe asthma exacerbations -Sometimes combined with beta antagonists or corticosteroids to provide additive bronchodilation. -Nasal spray: approved for symptomatic relief of runy nose associated with common cold and allergic rhinitis -Inhibits nasal secretions but doesn't have decongestant action -Treatment is limited to 3 weeks Administration Alerts -Proper use is important -Wait 2-3 minutes between dosages -avoid contact with eyes, or blurred vision will occur -Preg cat B Adverse Effects -little is absorbed by lungs so produces few systemic effects. -Irritation fo the upper respiratory may result in cough, drying of nasal mucosa or hoarseness. -bitter taste -Intranasal: may cause epistaxis and excessive drying of the nasal mucosa Contraindications -hypersensitivity to soya lecithin or related food products such as soybean and peanut. Soya lecithin is used as a propellant in the inhaler Interactions D/D: usage with other drugs in this class (atropine) may lead to additive anticholinergic side effects -should not be used with antidiabetic drug pramlintide because both slow peristalsis and can cause serious or life-threatening GI symptoms OD: doesn't occur because not enough absorbed when given by aerosol

Albuterol: Classes

Bronchodilator Classes Therapeutic: bronchodilator Pharmacologic: beta2-adrenergic agonist

Albuterol

Bronchodilator Classes Therapeutic: bronchodilator Pharmacologic: beta2-adrenergic agonist Actions and Uses SABA that is used to relieve bronchospasm of asthma. Rapid onset excellent safety profile makes it preferred drug for termination of acute bronchospasm. -also facilitates mucus drainage and can inhibit the release of inflammatory chemicals from mast cells -inhale 15-30mins before physical activity....this can prevent exercise-induced bronchospasm. -short acting beta2 agonists are not recommended for asthma prophylaxis The oral form has longer onset of action and aren't suitable for terminating acute asthma attacks. Administration Alerts -use only actuator that comes with canister -proper use is important -observe and instruct patient in proper use -Preg cat C Adverse Effects Uncommon -may experience palpitations, headaches, throat irritation, tremor, nervousness, restlessness, and tachycardia. -less common: insomnia and dry mouth -uncommon effects: chest pain, paradoxical bronchospasm, allergic reactions Contraindications hypersensitivities -hx of cardiac disease or hypertension HTN because may exhibit cardiovascular effects in some patients use caution Interactions D/D: concurrent use with beta blockers will inhibit the bronchodilator effect of albuterol -patients should avoid monoamine oxidase inhibitors (MAOIs) within 14 days of beginning therapy Lab: may cause hypokalemia at high doses Food/herbal: coffee may cause nervousness, tremor, or palpitations OD: cardioselective beta-adrenergic antagonist

Strategic National Stockpile (SNS)

a CDC-managed program that provides the national repository of antibiotics, chemical antidotes, antitoxins, other pharmaceuticals, and medical supplies and equipment to be used in the event of a terrorist attack or major natural disaster.

Inflammation

a body defense mechanism that occurs in response to many different stimuli, including physical injury, exposure to toxic chemicals, extreme heat, invading microorganisms, or death of cells. -Considered an innate (nonspecific) defense mechanism because inflammation proceeds in the same manner regardless of the cause.

Drug

a chemical agent capable of producing biologic responses within the body

nerve agents

a chemical category of main pharmacologic significance Exposure to these acutely toxic chemicals can cause convulsions and loss of consciousness within seconds and respiratory failure within minutes

Asthma

a chronic pulmonary disease with inflammatory and bronchospasm components Most common conditions in America. Characterized by acute bronchospasm, intense brethlessness, coughing, gasping for air. AIrway becomes hyper-responsive to allergens. Acute or chonic symptoms Goal of drug therapy: terminat acute bronchospasm in progress and reduce the frequency of asthma attacks

Cushings syndrome

a condition caused by prolonged exposure to high levels of cortisol

Rebound congestion

a condition characterized by hyper secretion of mucus and worsening nasal congestion once the drug effects wear off

agonist

a drug that produces the same type of response as the endogenous substance. -sometimes produce a greater maximal response than the endogenous chemical.

mycoses

a fungal infection

systemic mycoses

a fungal infection of the internal organs (lungs, brain, digestive organs) sometimes fatal often requires long periods of intensive pharmacotherapy

superficial mycoses

a fungal infection of the scalp, skin, nails, and mucous membranes (mouth, vagina) s/s drying of skin, stinging, pruritus, urticaria, contact dermatits

Frequency distribution curve

a graphical representation of the number of patients responding to a drug action at different doses

Complementary and Alternative Medicine (CAM)

a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine

A male, 67, reports taking diphenhydramine (Benadryl) for hay fever. Considering the patients age, the nurse assess for which of the following findings?

a history of prostatic or urinary conditions

Histamine

a key chemical mediator of inflammation

Pharmacopoeia

a medical reference summarizing standards of drug purity, strength, and directions for synthesis.

Therapeutic classification

a method of organizing drugs based on their therapeutic usefulness in treating particular diseases or disorders

Absorption

a process involving the movement of a substance from it's site of administration, across body membranes, to circulating fluids

Anaphylaxis

a severe type of allergic reaction that involves the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to a life-threatening shock.

status asthmaticus

a severe, prolonged form of asthma unresponsive to drug treatment that may lead to respiratory failure

Nebulizer

a small machine that vaporizes a liquid medication into a fine mist that is inhaled using a face mask or handheld device

activated charcoal

a substance that absorbs many poisons and prevents them from being absorbed by the body

Aerosol

a suspension of minute liquid droplets or fine solid particles suspended in a gas. Major advantage is that it delivers pulmonary drugs to their immediate site of action thus reducing systemic side effects. Disadgantages: precise dose is difficult to measure Adverse reactions: swallowing medications can cause systemic adverse effects in GI tract.

Cefazolin (Ancef, Kefzol) 545

CLASSES Therapeutic Class- Antibacterial Pharmacologic Class- Cell wall inhibitor: first-generation cephalosporin ACTIONS AND USES -beta-lactam antibiotic used for treating prophylaxis of bacterial infections caused by susceptible gram-positive organisms -treats infections of the respiratory tract, urinary tract, skin structures, biliary tract, bones, and joints. -useful in the pharmacotherapy of genital infections, septicemia, and endocarditis -NOT EFFECTIVE AGAINST MRSA -longer half-life of other first-generation cephalosporins -most frequently prescribed parenteral antibiotic ADMINISTRATION ALERTS -administer IM injections deep into large muscle mass to prevent injury to surrounding tissues -Pregnancy Category B ADVERSE EFFECTS -Rash and diarrhea are most common -SUPERinfections are likely when the antibiotic is used for prolonged periods -hypersensitivity RXNS are rare but potentially fatal -Pain and phlebitis can occur at IM injection sites -Seizures are rare though potentially serious: adverse rxn to cephalosporin therapy CONTRAINDICATIONS -hypersensitivity to a drug in the cephalosporin class -caution in patients with severe renal disease INTERACTIONS -concurrent use with nephrotoxic drugs such as AMINOGLYCOSIDES or VANCOMYCIN increases the risk of nephrotoxicity -this drug may have additive or synergistic antimicrobial action with other antibiotics such as AZTREONAM, CARBAPENEMS, and the PENICILLINS. -Anticoagulant effect of WARFARIN may be increased if given concurrently LAB TESTS -false-positive urine glucose results are possible -may give positive Coomb's test OVERDOSE TREATMENT -no specific treatment

Ibuprofen (Advil, Motrin, others) 506

CLASSES Therapeutic- Analgesic, anti-inflammatory drug, antipyretic Pharmacologic- NSAID ACTIONS AND USES -for the treatment of mild to moderate pain, fever, and inflammation -inhibits prostaglandin synthesis -indications include pain associated with chronic musculoskeletal disorders such as RA, osteoarthritis, headache, dental pain, and dysmenorrhea. ADMINISTRATION ALERTS -give drug on an empty stomach, however, if nausea, vomiting or abdominal pain occurs then give with food -pt.s with asthma or who have allergies to aspirin may have hypersensitivity rxn to this drug -Pregnancy Category C till after 30 weeks gestation, then Category D ADVERSE EFFECTS -generally mild nausea, heartburn, epigastric pain, and dizziness. -GI ulceration with occult or gross bleeding may occur, especially in pt.s who take high doses for prolonged periods -Chronic use may lead to Renal Impairment !!! BBW !!! NSAIDs may cause an increased risk of serious thrombotic events, MI, and stroke which can be fatal. -Pt.s with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk -NSAIDs increase the risk of serious GI adverse events including bleeding, ulceration, and perforation of the stomach or intestine which can be fatal. -events can occur at any time without warning CONTRAINDICATIONS -NSAIDs are contraindicated for the treatment of preoperative pain in those undergoing coronary artery bypass graft surgery -Patient with active peptic ulcers -Patients with significant renal or hepatic impairment -Patients who have the syndrome of nasal polyps, angioedema, or bronchospasm due to aspirin or other NSAID usage -Use cautiously in patients who have HF, serious HTN, or a hx of stroke or MI. INTERACTIONS DRUG/DRUG -because this drug can affect platelet function it should be avoided when taking anticoagulants and other coagulant modifiers -Aspirin can decrease the anti-inflammatory action of this drug -Actions of certain diuretics may be diminished when taken concurrently with this drug -Use with other NSAIDs, alcohol, or corticosteroids may cause serious adverse GI events. LAB TESTS -this drug may increase bleeding time, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels -this drug may decrease hemoglobin and hematocrit HERBAL/FOOD feverfew, garlic, ginger, ginkgo may increase the risk of bleeding OVERDOSE TREATMENT -Administration of an alkaline drug may increase the urinary excretion of this drug. No other specific treatment

Gentamicin (Garamycin, others) 549

CLASSES Therapeutic- Antibacterial Pharmacologic- Aminoglycoside, protein synthesis inhibitor ACTIONS AND USES -broad-sprectrum BACTERICIDAL antibiotic -usually prescribed for serious urinary, respiratory, nervous, or GI infections when less toxic antibiotics are contraindicated -Effective against a few gram-positive bacteria INCLUDING SOME STRAINS OF MRSA -Drug is not absorbed by the oral route -topical, IV, IM ADMINISTRATION ALERTS -IM: inject deep into a large muscle -Use only clear IV and IM solutions -Withhold drug if peak serum level lies above the normal range of 5-10 mcg/mL -Pregnancy Category C ADVERSE EFFECTS -Rash, nausea, vomiting, and fatigue !!! BBW !!! Adverse effects may be severe and include: -NEUROTOXICITY may manifest as ototoxicity and produce a loss of hearing or balance which may become permanent with continued use. Tinnitus, vertigo, and persistent headaches are early signs of ototoxicity. Other signs include muscle twitching, seizures, and paresthesias. Risk of neurologic effects higher in patients with impaired renal functions. -NEUROMUSCULAR blockade and respiratory paralysis are possible. The drug may cause severe neuromuscular weakness that lasts for several days -NEPHROTOXICITY is possible. Signs of reduced kidney function include oliguria, proteinuria, and elevated BUN and creatinine levels. Nephrotoxicity is a MAIN concern for patients with preexisting kidney disease. Concurrent usage with other nephrotoxic drugs should be avoided. CONTRAINDICATIONS -Hypersensitivity to drugs in the aminoglycoside class -drug therapy must be monitored carefully in patients with impaired renal functions or those with pre-existing hearing loss INTERACTIONS DRUG/DRUG -Risk of ototoxicity increase if the patient is currently taking AMPHOTERICIN B, FUROSEMIDE, ASPIRIN, BUMETANIDE, ETHACRYNIC ACID, CISPLATIN, or PAROMOMYCIN. -Concurrent use with AMPHOTERICIN B, CAPREOMYCIN, CISPLATIN, POLYMYXIN B, or VANCOMYCIN increases the risk of nephrotoxicity LAB TESTS -this drug may increase values of the following: serum bilirubin, serum creatinine, serum lactate dehydrogenase (LDH), BUN, AST, or ALT. -may decrease values for the following: serum calcium, sodium, or potassium OVERDOSE TREATMENT -no specific treatment

medication error index

Categorization of medication errors according to the extent of the harm an error can cause.

Elderberry

Congestion in respiratory system due to colds and flu

Diphenhydramine (Benadryl): Contraindications

Contraindications -hypersensitivities -benign prostatic hypertrophy BPH -Narrow-angle glaucoma -gastrointestinal obstruction *use cautiously in pts with asthma or hyperthyroidism

Dextromethorphan (Robitussin DM): Contraindications

Contraindications -treatment of chronic cough due to excessive bronchial secretions such as asthma, smoking, and emphysema -children under 6 -extreme caution in all children

Fluticasone (Flonase, Veramyst): Contraindications

Contraindications prior sensitivities patients with known bacterial, viral, fungal, or parasitic infections (of respiratory tract) shouldn't take because it masks signs of infection

Montelukast (Singulair): Contraindications

Contraindications -Only one is hypersensitivity to drug -pre-existing hepatic impairment should be cautioned

Ipratropium (Atrovent): Contraindications

Contraindications -hypersensitivity to soya lecithin or related food products such as soybean and peanut. Soya lecithin is used as a propellant in the inhaler

Oxymetazoline (Afrin): Contraindications

Contraindications -pts with thyroid disorders, hypertension, diabetes, or heart disease should use sympathomimetics only in direction of HCP

Albuterol: Contraindications

Contraindications hypersensitivities -hx of cardiac disease or hypertension HTN because may exhibit cardiovascular effects in some patients use caution

Fluticasone (Flonase, Veramyst): Classes

Corticosteroid Therapeutic Class drug for allergic rhinitis Pharmacologic Class Intranasal corticosteroid

Fluticasone (Flonase, Veramyst)

Corticosteroid Therapeutic Class drug for allergic rhinitis Pharmacologic Class Intranasal corticosteroid Actions and Uses treat seasonal allergic rhinitis -decreases local inflammation in the nasal passages, thus reducing nasal stuffiness Administration Alerts -instruct to follow directions -Preg cat C Adverse Effects Intranasally: adverse effects are rare Nasal irritation and epistaxis can occur *most frequent is headache and nasopharyngitis Contraindications prior sensitivities patients with known bacterial, viral, fungal, or parasitic infections (of respiratory tract) shouldn't take because it masks signs of infection Interactions D/D: use of other intranasal decongestants increases risk of nasal irritation or bleeding -use with ritonavir should be avoided because it increases plasma fluticasone levels Herbal/food: licorice may potentiate effects of corticosteroids NO SPECIFIC TREATMENT FOR OD

Fluticasone (Flonase, Veramyst, Flovent)

Corticosteroid Therapeutic Class drug for allergic rhinitis Pharmacologic Class Intranasal corticosteroid Actions and Uses treat seasonal allergic rhinitis -decreases local inflammation in the nasal passages, thus reducing nasal stuffiness Administration Alerts -instruct to follow directions -Preg cat C Adverse Effects Intranasally: adverse effects are rare Nasal irritation and epistaxis can occur *most frequent is headache and nasopharyngitis Contraindications prior sensitivities patients with known bacterial, viral, fungal, or parasitic infections (of the respiratory tract) shouldn't take because it masks signs of infection Interactions D/D: use of other intranasal decongestants increases the risk of nasal irritation or bleeding -use with ritonavir should be avoided because it increases plasma fluticasone levels Herbal/food: licorice may potentiate the effects of corticosteroids NO SPECIFIC TREATMENT FOR OD

Anti-inflammatory drugs for treating asthma

Corticosteroids Inhaled: Used for long-term prevention *preferred method -local side effects: hoarseness and oropharyngeal candidiasis -systemic effects: adrenal gland atrophy, peptic ulcers and hyperglycemia Oral: used for short-term management of acute severe asthma Leukotriene Modifiers Oral meds approved for prophylaxis of chonic asthma Ineffective in terminating acute asthma attacks Headache, cough, nasal congestion, gi upset. Mast Cell Stabilizers Important roles in prophylaxis of asthma. MOA: inhibit mast cells from releasing histamine and other chemical mediators of inflammation. By reducing inflammation they prevent asthma attacks. -max therapeutic effect may take weeks -adverse effect: stinging or burning of nasal mucosa, irritation of throat, nasal congestion. Monoclonal Antibodies Designed to attach to a specific receptor on a target cell or molecule. (Cancer cells) Attaches to receptor on IgE and prevents inflammation and dampens the body's response to allergens that trigger asthma.

specific antidotes

Counter the effects of poisons or toxins in a number of cases

gastric lavage and aspiration

Course of treatment (within 60 minutes) after the patient has ingested a potentially life-threatening amount of poison; this is performed by washing out the stomach with sterile water or a saltwater solution followed by removal of the fluid or mixed substances.

Nonopioid Antitussives

Dextromethorphan is most frequently used, available in OTC cold and flu medications Robitussin DM, Delsym are most popular nonopijoid antitussives. It is chemically similar to the opioids and can also act on the CNS to raise the cough threshold. Does not have same same level of abuse potential: large amounts of dextromethorphan produces-hallucinations, slurred speech, dizziness, drowsiness, euphoria, and lack of motor coordination. *nurses be aware

DPP-4 inhibitor

Dipeptidyl Peptidase-4 inhibitor

H1 antagonist prototype

Diphenhydramine (Benedryl) PO, IV in acute care sedation, hypotension, respiratory depression

Mucolytics

Directly loosen thick, viscous bronchial secretions by breaking down the chemical structure of mucus molecules. The mucus becomes thinner and can be removed more easily by coughing. Acetylcysteine (Mucomyst) is most used Inhaliation route Not available OTC Used in patients who have cystic fibrosis, chronic bronchitis or other diseases that produce large amounts of thick bronchial secretions. Mucomyst can trigger bronchospasm and smells like rotten eggs. Acetylcysteine (Acetadote) IV for acetaminophen OD.

Factors that affect absorption

Drug formulation and dose Dose Route of administration Size of the drug molecule Surface are of the absorptive site Digestive motility Blood flow Lipid solubility of the drug

Antipyretics definition

Drugs that reduce fever

What is the term used to describe the magnitude of maximal response that can be produced from a particular drug?

Efficacy

Echinacea

Enhance immune system, treat the common cold

macrolide ADRs

GI upset, diarrhea, abdominal pain, superinfections

tetracycline ADRs

GI upset, photosensitivity, permanent yellow-brown discoloration of permanent teeth (cannot give to pregnant women and children under age 8), affect fetal bone growth, superinfection, hepatotoxicity at high doses

Antihistamines block the actions of histamine at the

H1 receptor, thereby alleviating allergic symptoms

Corticosteroids

Has numerous therapeutic applications -most useful properties is the ability to suppress severe inflammation!

Allergic rhinitis

Hay fever -inflammation of the nasal mucosa due to exposure to allergens

Schedule 2 drugs (Chart)

High potential for abuse High potential for physical dependency High potential for psychological dependency Limited or no therapeutic use Examples: hydromorphone, methadone, oxycodone, fentanyl, meperidine

Schedule 1 drugs- U.S. (Chart)

Highest potential for abuse High potential for physical dependency High potential for Psychological dependency Limited or no therapeutic use, Examples: Heroin, marijuana, LSD, ecstasy

___________is initiated when an antigen encounters a type of lymphocyte known as a B cell.

Humoral Immune response

Chronic asthma

Hypersensitivity type 1 hyperresponsive tissue Location- small bronchi, bronchioles Patho- inflammation, bronchoconstriction, increased mucus produced, obstruction, repeat attacks lead to damage. Cough, dyspnea, wheezing, thick sputum,

tetanus toxoid

IM (primary immunization age 7 or older) 3 doses, the second dose is given 4-8 weeks after the first dose, the third dose is given 6-12 months after the second dose

hep b immune globulin (HBIG)

IM 0.06 mL/kg ASAP after exposure (no later than 7 days) repeat 28-30 days after exposure

rabies immune globulin (bayrab, imogam, rabies-ht, hyperrad, kedrab)

IM 20 units/kg as a single dose with vaccine for postexposure prophylaxis

varicella zoster immune globulin (varizig)

IM 625 units within 10 days after exposure

rh(D) immune globulin (rhogam)

IM/IV one vial or 300 mcg at approximately 28 weeks followed by one vial of minidose or 120 mcg within 72 hours of delivery if infant is rh+

poliovirus inactivated

IPOL or poliovax children subcut at ages 2 months, 4 months, 6-18 months, and 4-6 years

immune globulin IV (carimune, gammagard, hyqvia, IGIV, octagam)

IV 100-400 mg/kg every 3-4 weeks IM 1.2 mL/kg followed by 0.6 mL/kg every 2-4 weeks to boost weakened immune system

cytomegalovirus immune globulin (cytogam)

IV 150 mg/kg within 72 hours of transplantation then 100 mg/kg for 2, 4, 6, and 8 weeks post transplant then 50 mg/kg for 12 and 16 weeks post transplant for prophylaxis

Which drugs contraindicate hypertension?

Ibuprofen (Advil, Motrin) Naproxen (Aleve) Methylprednisolone (Medrol)

Chlorophyll/chlorella

Improve digestion, vitamin and mineral supplement

Exicipients

Inactive ingredients

A patient has been prescribed tetracycline. When providing information regarding this drug, the nurse should include what information about tetracycline? 1.It is classified as a narrow-spectrum antibiotic with minimal adverse effects. 2.It is used to treat a wide variety of disease processes. 3.It has been identified to be safe during pregnancy. 4.It is contraindicated in children younger than 8 years.

It is contraindicated in children younger than 8 years. Tetracycline has the ability to cause permanent mottling and discoloration of teeth and therefore is not advised for children younger than 8 years of age

Which of the following is the best advice that the nurse can give the patient with viral rhinitis who intends to purchase an OTC combo cold remedy?

It is safer to use a single-drug preparation if you are experiencing only one symptom

___________ will have more difficulty crossing plasma membranes

Large molecules, ionized drugs, and water soluble agents

Schedule 4 drugs (Chart)

Lower potential for abuse Lower potential for physical dependency Lower potential for psychological dependency Used therapeutically with prescription Examples: alprazolam, clonazepam, clorazepate, diazepam, lorazepam

Schedule 5 drugs (Chart)

Lowest potential for abuse Lowest potential for physical dependency Lowest potential for psychological dependency Used therapeutically without prescription Examples: cough preparations containing not more than 200mg of codeine per 100mL or per 100g

measles, mumps, rubella

MMR II subcut single dose at age 12-15 months second dose at age 4-6 years

H1 receptors are histamine receptors responsible for allergic symptoms.

MOA: blocks histamine from reaching H1 receptors which relieves symptoms -Effectiveness to reverse allergic symptoms is limited Anticholinergic-blocks neurotransmitter acetylcholine which affects muscle contraction-the gastric mucosa Alcohol and CNS depressants should be used with caution because of sedative effects Alternative uses: vertigo and motion sickness of the inner ear, Parkinson's disease, insomnia, urticaria

Schedule 3 drugs (Chart)

Moderate potential for abuse Moderate potential for physical dependency High potential for psychological dependency Used therapeutically with prescription Examples: combination products containing less than 15g of hydrocodone per dosage unit, products containing not more than 90mg of codeine per dosage unit, buprenorphine products

Oxymetazoline (Afrin): Classes

Nasal Decongestant Classes Therapeutic class: nasal decongestant Pharmacologic: sympathomimetic

Bradykinin

Present in an inactive form in plasma and mast cells; vasodilator that causes pain; effects are similar to those of histamine; broken down by angiotensin-converting enzyme (ACE)

Prostaglandins

Present in most tissues and stored and released by mast cells; increase capillary permeability, attract WBCs to the site of inflammation, cause pain, and induce fever

Cranberry

Prevent urinary tract infection

Black box warnings

Primary alerts for identifying extreme adverse drug reactions discovered during and after the review process. -Warning to monitor drugs with a potential for causing death or serious injuries.

Cytokines

Proteins produced by macrophages, leukocytes, and dendritic cells that mediate and regulate immune and inflammatory reactions

PPI

Proton pump inhibitor

Asthma drugs: Two classes

Quick relief medications short and intermediate acting beta2-adrenergic agonists, anticholinergics and systemic corticosteroids Long acting medications inhaled corticosteroids, mast cell stabilizers, leukotriene modifiers, long acting beta 2 adrenergic agonists, methylxanthines, and immunomodulators

Flaxseed (ground) and/or oil

Reduce blood cholesterol, laxative

Garlic

Reduce blood cholesterol, reduce blood pressure, anticoagulation

Ginseng

Relieve stress, enhance immune system, decrease fatigue

The 7 Rights of Drug Administration

Right Patient Right Drug Right Dose Right Route Right Time Right Reason Right Documentation

CCB

calcium channel blocker

age, pregnancy, genetics

can all vary the response to an antibiotic some medications are toxic, some genetic variations lack enzymes needed to metabolize some of the antibiotics (Enzyme Glucose-6-phosphatase dehydrogenase)

injury/inflammation

can cause a decrease in circulation making drugs less effective

fourth and fifth gen cephalosporins

can enter CNS can be effective against MRSA

immunosuppressed pts

cancer, AIDS, pts taking immunosuppressive drugs require larger amounts of antibiotics prophylactic antibiotics may be given to suppress the number of microbes, or when a patient has low white blood cell count

CV

cardiovascular

tb drug therapy

cell wall resistant to anti-infective drugs therapy must be a minimum of 6-12 months multi-drug resistant infection may require 24 months of therapy 2-4 concurrent drugs needed to treat tb bc bacteria grows slowly and develops resistance

Antibiotics target bacteria differences which are:

cell walls, biochemical pathways, enzymes, etc.

antifungal mech of action

cells use different steroid than humans in their cell membranes called ergosterol azoles target ergosterol biosynthesis and the cell wall becomes leaky, allowing fungus to die some use enzymatic pathways to inhibit DNA and RNA synthesis

CNS

central nervous system

human papalomavirus

cervarix and gardasil age 9-26 years in females and 9-21 in males IM 2 doses with the second dose 6-12 months after the first a three dose schedule is indicated for those who start the series at age 15 or older

Bronchoconstriction

closes the lumen resulting in less airflow largely regulated by two branches of ANS The parasympathetic branch causes bronchiolar smith muscle to contract, the airway diameter to narrow, and bronchoconstriction to occur

proquad

combo of MMR and varicella vaccines subcut first dose usually at age 12-15 months, second dose (if needed) at age 4-6 years

cornvax

combo of haemophilus and hep b vaccines IM ages 2 months, 4 months, and 12-15 months

twinrix

combo of hep a and hep b vaccines over the age of 18 IM 3 doses with the second dose 1 month after the first, and the third dose 6 months after the first

adacel and boostrix

combo of tetanus toxoid and DTaP IM single dose as an active booster after age 10 (boostrix) or between age 11-64 (adacel)

short acting suffix

cortisone, hydrocortisone

The cause of allergic rhinitis is

exposure to an antigen

virulence

degree of pathogenicity

Parenteral route

delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles, or veins

Intramuscular (IM) injection

delivers medication into specific muscles. Because muscle tissue has a rich blood supply, medication moves quickly into the blood vessels to produce a more rapid onset of action than with oral, ID, or SUBCUT administration.

Sustained-release (SR) tablets

designed to dissolve very slowly AKA extended-release (XR) or Long-acting (LA) meds *do not crush or open!

dissolution

determines how quickly the drug disintegrates and disperses into simpler forms; therefore, drug formulation is an important factor of bioavailability.

cephalosporin ADRs

diarrhea, abd cramping, nausea, fatigue, rash, pruritus, pain at injection site, oral or vaginal candidiasis, nephrotoxicity, anaphylaxis

carbapenem ADRs

diarrhea, nausea, rashes, thrombophlebitis

CNS infections

difficult to treat d/t difficulty of drugs to cross blood brain barrier

The pH of the local environment DIRECTLY/INDIRECTLY influenced drug absorption through its ability to ionize the drug.

directly

Pathogens

disease causing agents

OTC drugs DO/DO NOT require a health care providers order.

do

anaerobic

don't require oxygen

___________will easily reach their target cells

drug molecules that are small, nonionized, lipid soluble drugs

Immunosuppressants

drugs given to dampen the immune response.

Antitussives

drugs that are used to dampen the cough reflex They are of value in treating coughs due to allergies or the common cold. Classified as opioid or nonopioid

Expectorants

drugs that reduce the thickness or viscosity of bronchial secretions which increases mucus flow that can be removed more easily by coughing. *Most effective: guaifenesin (Mucinex) Few adverse effects Most effective in treating dry, nonproductive cough but can also benefit those with a productive cough. Shouldn't be used in kids younger than 6

short term or long term goals

established that focus on what partite will be able to do or achieve, not what the nurse will do

QH or qh

every 2 hours

Q4H or q4h

every 4 hours

Q6H or q6h

every 6 hours

Q8H or q8h

every 8 hours

QAM or qam

every morning or every am

Chronic Bronchitis

excess mucus is produced in lower respiratory tract due to the inflammation and irritation from cigarette smoke or pollutants. Airway becomes partially obstructed with mucus resulting in classic signs of dyspnea and coughing. Early signs: productive cough on awakening, poss wheezing and decreased exercise tolerance.

penicillin

first discovered highest incidence of allergic reactions kills bacteria by disrupting cell walls allowing water to move in gram+ bacteria most susceptible chemical structure includes beta-lactam ring penicillin G is prototype suffix cillin

invasiveness

ability of a bacterial pathogen to rapidly spread through tissue

invasiveness

ability of a pathogen to grow extremely rapidly and cause damage due to sheer numbers

pathogenicity

ability to cause disease

corticosteroids (glucocorticoids)

ability to suppress severe inflammation most effective class at treating severe inflammation prednisone is prototype drug inhibits synthesis of prostaglandins and suppresses release of histamine

Acids are absorbed in ________, and bases are absorbed in ________.

acids, bases

haemophilus influenza type b conjugate

actHIB, hiberix, pedvaxHIB IM ages 2 months, 4 months, and 12-15 months

fluroquinolones

active against gram-, newer gens more effective against gram+ bactericidal and inhibit DNA gyrase and topoisomerase IV most are absorbed well through GI mucosa (PO) prototype ciprofloxacin suffix floxacin

PRN order

administered as required

ADR

adverse drug reaction

influenza vaccine

afluria, fluarix, flulavel, fluvirin, fluzone children IM first dose at 6 months then annual dose adults IM single annual dose

Allergic rhinitis

aka Hay Fever- inflammation of the nasal mucosa due to exposure to allergens s/s sneezing, itchy nasal mucosa, itchy, watery eyes, nasal congestion, postnasal drip, itching throat Cause: exposure to an antigen Antigen could be: pollens, molds, dust mites, foods, animal dander, chemical fumes, tobacco smoke, air pollution, genetic predisposition Pathophysiology: inflammation of the nasal mucosa, throat and airways. Nasal mucosa rich in vascular supply and mast cells and basophils - these recognize antigens as they come in Sufferers have high numbers of mast cells. Immediate response to antigen is a release of histamine and other inflammatory mediators from the mast cell and basophils 0 sneezing, itchy nose, watery eyes delayed response to antigen 4-8 hours after exposure, causes continuous inflammation of the mucosa and adds to chronic nasal congestion Goal: prevent occurrence and relieve symptoms Preventers: antihistamines, intranasal corticosteroids, mast cell stabilizers *used for prophylaxis Relievers: oral and intranasal decongestants *used to provide immediate, temporary relief of symptoms Nursing implications: -treat through pharmacotherapeutics -educate on identifying sources of allergens -educate on avoidance or other appropriate interventions of allergens

anti-infective

aka antibacterial or antimicrobial more than 300 drugs available grouped into classes with similar properties

Innate defenses

aka nonspecific defenses, include physical barriers such as the epithelial lining of the skin and the respiratory and gastrointestinal mucous membranes which are potential entry points for pathogens. Other innate defenses are phagocytes, natural killer cells, the complement system, fever, and interferons.

Bronchospasm

an acute condition where the bronchiolar smooth muscle rapidly contracts leaving the patient gasping for air

The provider has ordered atropine, a drug that will prevent the patient's own chemical, acetylcholine, from causing parasympathetic effects. What type of drug would atropine be considered?

an antagonist

cyclooxygenase (COX)

an enzyme responsible for the formation of prostaglandins (promote inflammation)

vendor-managed inventory (VMI)

an inventory management system whereby the supplier determines the product amount and assortment a customer (such as a retailer) needs and automatically delivers the appropriate items

Idiosyncratic reaction

an unexpected reaction to a drug that is specific to the individual

Interleukins (ILs)

another class of cytokines that are synthesized primarily by lymphocytes, monocytes, and macrophages that enhance the capabilities of the immune system. Stimulate cytotoxic T cells against tumor cells, increase B cell and plasma cell production and promotes inflammation.

Medication Administration Record (MAR)

another source that should contain information about what medication was given or omitted

Ginger

antiemetic, antithrombotic, diuretic, promote gastric secretions, anti-inflammatory, increase blood glucose, stimulation of peripheral circulation

Microbes and foreign substances that elicit an immune response are called

antigens

milk thistle

antitoxin, protection against liver disease

Adverse event (AE)

any undesirable experience associated with the use of a medical product in a patient

Buccal route

application of a drug within the cheek or the cavity of the mouth

STIs

approximately 110 million occur annually with over half of new infections 15-24 years of age

Interferons (INFs)

are cytokines secreted by lymphocytes and macrophages that have been infected with a virus. IFNs are unable to protect the infected cell, but they warn surrounding cells that a viral infection has occurred.

Enteric-coated tablets

are designed to dissolve in the alkaline environment of the small intestine. *do not crush!

Nursing diagnoses

are the clinical judgements of a patient's actual or potential health problem that is within the nurse's scope of practice to address

staph and enterococcus

are the most common cause of health care acquired infections

Influenza and pneumonia

are the top infectious causes of death

Preventers

are used for prophylaxis and include antihistamines, intranasal corticosteroids, and mast cell stabilizers

Relievers

are used to provide immediate, though temporary relief for acute allergy symptoms once they have occurred. Relievers include the oral and intranasal decongestants, usually drugs from the sympathomimetic class

G6PD deficiency

asian, african american, middle eastern are more at risk and should not be given acetaminophen as it may cause hemolysis

Generic name

assigned by the U.S. Adopted Name Council -With few exceptions these are less complicated and easier to remember than the other names :)

Severe inflammation is a characteristic of __________

autoimmune disorders

Anticholinergic

blocks neurotransmitter acetylcholine which affects muscle contraction-the gastric mucosa

Salmonella is the most common cause of

food poisoning

GERD

gastroesophageal reflux disease

GI

gastrointestinal

Immunomodulator

general term referring to any drug or therapy that affects body defenses

drugs for superficial mycoses

griseofulvin: topical or PO nystatin is prototype: may be given PO, topical, capsule, intravaginal terbinafine (lamisil): PO or topical tolnaftate (tinactin): topical

pharmacologic classes

groups of drugs that share a similar mechanism of action

chemical classes

groups of drugs that usually have similar antibacterial properties and ADRs

hepatitis a

havrix and VAQTA children IM age 12 minths followed by a booster 6-12 months later adults IM 1 mL followed by a booster 6-12 months later

Staphylococci and Enterococcus are the most common cause of

health care inquired infections

In addition to treating allergic rhinitis with medications, nurses should

help patients identify sources of the allergies and recommend appropriate interventions> Tthis may include: removing pets, cleaning moldy surfaces, using microfilmers on ac units, and cleaning dust mites out of bedding, carpet, or couches.

H1 receptors

histamine receptors responsible for allergic symptoms

Examples of Biologics

hormones monoclonal antibodies natural blood products and components interferons vaccines

Infection is a major cause of

hospitalization and death in long-term care facilities

ad lib

hour

herpes

hsv-1, hsv-2, cytpmegalovirus, varicella-zoster, epstein barr goals are to relieve symptoms and prevent recurrences (not cure) many drugs have suffix ovir acyclovir, famciclovir, valacyclovir (all PO) acyclovir is prototype resistance may occur especially in hiv/aids lab values monitored for kidney function

Emphysema

hyperinflation of air sacs with destruction of alveolar walls Pt. suffers from extreme dyspnea from the slightest activity.

cox-1 and cox-2 inhibitors

ibuprofen (prototype for NSAID) has less adverse GI effects than ASA relatively high safety margin low incidence of adverse effects available OTC

STAT

immediately

Antibodies

immunoglobulins (Ig) physically interact with the antigens to neutralize or mark them for destruction by other cells of the immune response

Ethnicity

implies that people have biologic and genetic similarities

wheat or barley grass

improve digestion, vitamin and mineral supplement

ginkgo

improve memory, reduce dizziness

linezolid (zyvox)

in the class of oxazolidinones alternative to vancomycin for treating MRSA and VRE infections

syrup of ipecac

induces vomiting

amebiasis

infection with amoebae symptoms are highly variable, ranging from an asymptomatic infection to severe dysentery

Inh

inhalation

nonsteroidal anti-inflammatory drugs (NSAIDs)

inhibit cyclooxygenase (COX) reducing inflammation and pain NSAIDs have antipyretic, analgesic, and anti-inflammatory properties cox-1 and coax-2 inhibitors

bacteriostatic

inhibits bacterial growth

tetanus immune globulin (beytet, hypertet, hypertet s/d)

initial treatment in an unimmunized person with a puncture wound is IM for prophylaxis 250 units as single dose

Intradermal (ID) injection

injection is administered into the dermis layer of the skin. Because the dermis contains more blood vessels than the deeper SUBCUT layer, drugs are more easily absorbed.

First line of protection from pathogens consists of ____________ which serve as general barriers to microbes or environmental hazards.

innate (nonspecific) body defenses

I & O

intake and output

systemic mycoses

internal organs (lungs, brain, digestive organs) sometimes fatal

IM

intramuscular

IV

intravenous

Therapeutic Drug Index

is a measure of a drug's safety margin: THE HIGHER THE VALUE, THE SAFER THE DRUG!

Culture

is a set of beliefs, values, and traditions that provide meaning for an individual or group

teratogen

is a substance, organism, or physical agent to which an embryo or fetus is exposed that produces a permanent abnormality in structure or function, causes growth retardation, or results in death

Allergic reaction

is an acquired hyper response of body defenses to a foreign substance (allergen). Signs vary in severity and include: skin rash with/without itching, edema, runny nose, or reddened eyes with tearing

Antigen or Allergen

is anything that is recognized as foreign and provokes a response from the body's defense system. The specific allergen responsible for a patients allergic rhinitis is often difficult to pinpoint.

Chemical name

is assigned using standard nomenclature established by the IUPAC

Subcutaneous (SUBCUT) injection

is delivered to the deepest layers of the skin. Insulin, heparin, vitamins, some vaccines, and other medications are given in this area because the sites are easily accessible and provide rapid absorption.

psychosocial

is often used in healthcare to describe one's psychological development in the context of one's social environment.

The nurse looks up butorphanol (stall) in a drug reference guide prior to administering the drug and notes that it is a partial agonist. What does this term tell the nurse about the drug?

it is a drug that produces a weaker, or less efficacious, response than an agonist drug.

antihelminthic drugs

ivermectin: PO mebendazole: PO

cephalosporins

largest antibiotic class similar mech of action as pcn primarily used for gram- or those who can't tolerate pcn contain beta-lactam ring classified by generation prefix cef

azoles

largest most versatile group of antifungals, have broad spectrum of use less toxic than amphotericin b (an older antifungal with multiple side effects) can be administer PO fluconazole is prototype suffix azole

antivirals

least effective of all anti-infective drug classes rapid mutation makes treatment difficult vaccines are primary treatment and prevention some drugs interrupt replication some drugs boost host's immune response so the patient remains symptom free

antipyretics

lower body temp, while treating underlying cause of fever aspirin, ibuprofen, acetaminophen acetaminophen is prototype drug avoid in patients with G6PD deficiency acetadote antidote for overdose MAX DAILY DOSE 3000 MG

The primary cell fo the immune response is the

lymphocyte

infection

major cause of hospitalization and death in long term care facilities

sulfonamide ADRs

many pts are allergic, formation of urinary crystals, hypersensitivity, nausea, vomiting, fatal blood abnormalities, acute hemolytic anemia, agranulocytosis (severe reduction in leukocytes)

These contain histamine, line the nasal mucosa, and play a major role in causing the symptoms of allergic rhinitis

mast cells

Leukotrienes

mediators of the immune response that are involved in allergic and asthmatic reactions

After a drug is administered it is called a

medication

Intravenous (IV)

medications and fluids are administered directly into the bloodstream and are immediately available for use by the body. This route is used when a very rapid onset of action is desired.

meningococcal conjugate vaccine

menactra, menomune, menveo IM first dose at age 11-12 years and second dose at age 16 years

long acting suffix

methasone, betamethasone, dexamethasone, budesonide

common health care associated infections

methicillin resistant staphlococcus areus (MRSA) vancomycin resistant enterococci (VRE)

intermediate acting suffix

methylprednisolone (medrol), prednisolone, prednisone, triamcinolone

pathogen

microbes capable of causing disease: viruses, bacteria, fungi, protozoans, fleas, mites, worms may enter through compromised skin, ingestion, inhalation, or contact with mucus membranes

mg

milligrams

mL

milliliters

The ______ ______ is part of the first line of body defense.

nasal mucosa

stevia

natural sweetener

azole ADRs

nausea and vomiting, pts must avoid alcohol

The first 28 days of life are referred to as the

neonatal period

hiv

no pharmacologic cure education and prevention are best transmission of hiv from mother to baby can be reduced with meds symptom free living can be achieved through pharmacotherapy (not a cure) post exposure chemoprophylaxis for occupational exposure

viruses

non-living, require a host to live intra-cellular parasites must insert their genetic material into the host's chromosomes to cause infection

NSAID

non-steroidal anti-inflammatory drug

NPO

nothing by mouth

Delayed hypersensitivity response

occurs 4-8 hours after the initial exposure causing continuous inflammation of the mucosa and adding to the chronic nasal congestion experienced by these patients.

red man syndrome

occurs with rapid IV infusion of vancomycin large amounts of histamine are released causing hypotension, flushing, and red rash of face, neck, trunk, and upper body

non-malarial parasites

often flourish where sanitation is poor and high-density populations

sentinel event

one that results in an unexpected, serious, or fatal injury following the administration of a medication

Bronchodilation

opens the lumen, allowing air to enter the lungs more freely which increases the supply of oxygen to the body's tissues. largely regulated by two branches of ANS The sympathetic branch activates Beta 2-adrenergic receptors which causes bronchiolar smooth muscle to relas, the airway diameter to increase, and bronchodilation to occur

Opth

opthalmic

PO

orally

Routine orders

orders not written as STAT, ASAP, NOW or PRN

Late/older adulthood

over 65 years

A drugs ability to become ionized depends on the surrounding ______.

pH

Albuterol

page 662

Ipratropium (Atrovent)

page 663

helminthic infections

parasitic worms, common in areas of poor sanitation: roundworms (nematodes), flukes (trematodes), tapeworms (cestodes) some attach themselves to the GI tract, skeletal muscle, or organs such as the liver most common is pinworms no drug resistance documented

Acute Asthma

periodic attacks and symptom-free periods between attacks

carbapenem uses

peritonitis, bacterial meningitis, serious abdominopelvic infections, serious skin infections, community acquired pneumonia, complicated UTIs

macrolide uses

pertussis, legionnaires' disease, streptococcus, h. influenza, listeria, chlamydia, neisseria, legionella, h. pylori, c. difficile (fidaxomicin only)

objective data

physical assessment, laboratory tests, and other diagnostic sources

Teratogenic risk

places drugs into categories A, B, C, D, and X. Category A is the safest group of drugs while Category X poses the most danger to the fetus. Birth defects are most probable in the first trimester; thus, nurses must be mindful of the risks of various drugs.

penicillin uses

pneumonia, meningitis, skin, bone, and joint infections, stomach infections, blood and heart valve infections, gas gangrene, tetanus, anthrax

pneumococcal polyvalent

pneumovax 23 or prevnar 7 valent children prevnar IM 4 doses at ages 2 months, 4 months, 6 months, and 12-15 months adults pneumovax 23 or pnu-immume 23 subcut or IM single dose

toxin

poison

Most common agents causing allergic rhinitis are:

pollens from weeds, grasses, and trees; mold spores; dust mites; certain foods; animal dander. Chemical fumes, tobacco, smoke, or air pollutants such as ozone are nonallergenic factors that may worsen symptoms. Also there is a strong genetic predisposition to allergic rhinitis.

drug resistance prevention

prevent inflection immunizations find right drug for infection (culture) restrict antibiotics educate pts to take entire series of antibiotics

Bacteriostatic

prevent/stops microbes from growing

prophylaxis

prevention of disease

Methylxanthines

primarily reserved for long term asthma management that is unresponsive to beta agonists or inhaled corticosteroids Chemically related to caffeine; can cause nervousness and insomnia like caffeine. Infrequently prescribed because have narrow safety margin especially with prolonged use.

Medication reconciliation

process of tracking medications as the patient proceeds from one health care provider to another

Intranasal sympathomimetics

produce few systemic effects because almost non of the drug is absorbed into the circulation

dietary supplements

products intended to enhance or supplement the diet

COPD

progressive pulmonary disorder characterized by chronic and recurrent obstruction of airflow. 2 (most frequent) conditions that cause COPD: emphysema and chronic bronchitis

C-Reactive protein

protein found in the plasma that is an early marker of inflammation

Orally disintegrating tablets

rapidly dissolve on tongue within seconds

valerian

receive stress, promote sleep

Red rice yeast extract

reduce blood cholesterol

St. John's wort

reduce depression, reduce anxiety, anti-inflammatory

Pharmacologic classification

refers to the way a drug works at the molecular, tissue, or body system level.

Immediate hypersensitivity response

releases histamine and other inflammatory mediators from the mast cells and basophils which produces itchy nasal membranes, sneezing, and watery eyes.

Black cohosh

relief of menopausal symptoms

aerobic

requires oxygen

aminoglycoside uses

reserved for serious infection from e. coli, serratia, proteus, klebsiella, pseudomonas

vancomycin (vancocin)

reserved for severe infections from gram+ bacteria s. aureus and s. pneumoniae most effective drug for MRSA, used when other antibiotics have failed may cause ototoxicity, hepatotoxicity, red man syndrome, super infections, generalized tingling, chills, fever, skin rash hives, hearing loss, and nausea

fluroquinolone uses

respiratory, GI, genitourinary, skin and soft tissue infections

tetracycline uses

rocky mountain spotted fever, typhus, cholera, lyme disease, peptic ulcers, chlamydia, acne

bacilli

rod shaped

SSRI

selective serotonin reuptake inhibitor

SNRI

serotonin norepinephrine reuptake inhibitor

ASAP order

should be available for administration to the patient within 30 minutes of the written order

fungi

single celled or multicellular organism that decompose dead plants and animals, recycling the deceased to the soil grow slowly and may take months before symptoms occur few are transmissible (athlete's foot) those that infect healthy people are often different than those that attack immunocompromised people

Fungi

single celled or multicellular organisms that decompose dead plants and animals, recycling the deceased to the soil

toxin

some bacteria create toxins, disrupting normal cellular activity and/or death

beta-lactam ring

some bacteria secrete beta-lactamase or penicillincase that disrupts the beta-lactam ring resulting in drug ineffectiveness or resistance drugs with beta-lactamase inhibition are used when beta-lactamase organisms are the cause of infection

grape seed

source of essential fatty acids, antioxidant, restore microcirculation to tissues

Evening primrose

source of essential fatty acids, relief of premenstrual or menopausal symptoms, relief of rheumatoid arthritis and other inflammatory symptoms

soy

source of protein, vitamins, and minerals; relief of menopausal symptoms, prevent cardiovascular disease, anticancer

cocci

spherical shaped

spirella

spiral shaped

gram positive

staphylococci, streptococci, enterococci contain thick cell wall and retain a purple color after staining using a crystal violet stain

antiprotazoan drugs

target parasites: malaria, plasmodium, amebiasis, toxoplasmosis, giardiasis, trichomoniasis

Herb

technically a botanical that does not contain any woody tissue such as stems or bark

pathogenicity

the ability of an organism to cause infection some are very infectious and life threatening, others just bothersome

Cultural competence

the ability to interact effectively with people of different cultures

Subligual route

the medication is placed under the tongue and allowed to dissolve slowly. *rich blood supply under the tongue which results in a rapid onset of action

Metered-dose inhaler MDI

the most common type of device used to deliver respiratory drugs consist of a propellant inside a canister filled with medication pt depresses the canister while inhaling a slow, deep breath. Helps to deliver a measured dose of meds to the lungs.

Active transport

the movement of materials through a cell membrane using energy

Pharmacology

the study of medicine

Opioid Antitussives

these are the most effective antitussives, they act by raising the cough threshold in the CNS. Codeine and Hydrocodone are the most frequently used opioid antitussives. Doses needed are low so there is minimal potential for dependence. Most are classified as Schedule 3, 4, or 5 Care for those with asthma because bronchoconstriction may occur. Adverse effects: Codeine: nausea, vomiting, constipation Hydrocodone combined with homatropine: hypotension, seizures, bradycardia, respiratory depression, severe somnolence

B-cell

this cell becomes activated and divides rapidly to form millions of copies, or clones, of itself.

yeasts

unicellular fungi, normally grow as part of the hosts normal flora

aminoglycoside ADRs

use is limited d/t ADRs including ototoxicity (hearing loss, dizziness, loss of balance, persistent headache, ringing in ears), permanent deafness, nephrotoxicity (usually reversible)

A patient has been prescribed (flucasone) Flonase to use with (oxymetazoline) Afrin. How should the patient be taught to use these drugs?

use oxymetazoline first, then the fluticasone after waiting 5 minutes

aminoglycoside

used for aerobic gram-, mycobacteria, and some protozoan more toxic than other antibiotics bactericidal by inhibiting bacterial protein synthesis can be given with pcn, cephalosporin, vancomycin for enterococcal infections usually given parentally (poorly absorbed by GI mucosa) gentamicin is prototype suffix mycin

penicillin ADRs

usually a safe class of antibiotic allergy is most common ADR, including: rash, pruritus, fever less common: nausea, vomiting, low RBCs, low WBCs, low platelets anaphylaxis in approximately 0.04% to 2% of people

varicella

varivax subcut at ages 12-15 months and 4-6 years zostavax subcut single dose at age 50+ shingrix IM 2 doses 2-6 months apart

In addition to allergic rhinitis, antihistamines have been used to treat:

vertigo and motion sickness Parkinson's disease Insomnia Urticaria and other skin rashes

These passageways _____, _____, and ____ the air before it enters the lungs.

warms, humidifies, and cleans

preimplantation period

weeks 1-2 of the first trimester "all-or-none" period because exposure to a teratogen either causes death or has no effect.

embryonic period

weeks 3-8 post conception Rapid development of internal structures. Period of MAXIMUM sensitivity to teratogens

Fetal period

weeks 9-40 post conception or until birth. Continued growth and maturation fo the fetus's organ systems.

Pharmacokinetics

what the body does to the drug

Pharmacodynamics

what the drug does to the body

Subjective data

what the patient says or perceives

PC or pc

whenever there is a need or as needed

sulfonamides

wide spectrum against gram+ and gram- bacteriostatic by suppressing growth through the inhibition of folic acid synthesis in bacteria substantial bacterial resistance has lead to decreased use prototype bactrim prefix sulfa

Where is histamine primarily stored?

within mast cells located in tissue spaces under epithelial membranes such as the skin, bronchial tree, digestive tract, and along blood vessels.

Antipyretics

• Goal is to lower body temperature while treating the underlying cause of the fever • Aspirin, Ibuprofen, and acetaminophen are safe, inexpensive, and easily accessible • Come in gels, caplets, tablets, enteric-coated and suspensions • Avoid in patients with G6PD deficiency • N-acetylcysteine (Acetadote) antidote for overdose • PO, PR • Maximum daily dose is 3000mg (3gm)

Vancomycin (Vancocin)

•) - reserved for severe infections from gram-positive bacteria: S. aureus and S. pneumoniae. •Most effective drug for MRSA. Used when other antibiotics have failed. ADRs: ototoxicity, hepatotoxicity. Must monitor levels. •Red Man Syndrome - occurs with rapid IV infusion. Large amounts of histamine are released: hypotension, flushing, red rash of face, neck, trunk, upper body. •Side effects: super infections, generalized tingling, chills, fever, skin rash hives, hearing loss, nausea.

Linezolid (Zyvox)

•- in the class of oxazolidinones. •Alternative to vancomycin for treating MRSA and VRE infections.

CORTICOSTEROIDS (GLUCOCORTICOIDS)

•Ability to suppress severe inflammation •Short acting suffix cortisone: cortisone, hydrocortisone •Intermediate acting suffix of one: methylprednisolone (Medrol), prednisolone, prednisone, triamcinolone •Long acting suffix may include methasone: betamethasone, dexamethasone, budesonide

Adolescence occurs between the ages of

13-16 years

Appx. 110 million STI's occur annually with over half of new infections among what age groups?

15-24 year olds

Young adulthood occurs between the ages of

18-40

influenza and pneumonia

(were) top infectious causes of death

Erythromycin (Eryc, Erythrocin, others) - Administration Alerts

-Oral: empty stomach with a full glass of water -IV suspension: shake bottle thoroughly to make sure drug is thoroughly mixed -Do not give with or immediately before or after fruit juices -Pregnancy Category B

Planning

-Prioritize problems/diagnoses -formulate goals/desired outcomes -select nursing interventions -write nursing interventions

Ibuprofen (Advil, Motrin, others) - Actions and Uses

-for the treatment of mild to moderate pain, fever, and inflammation -inhibits prostaglandin synthesis -indications include pain associated with chronic musculoskeletal disorders such as RA, osteoarthritis, headache, dental pain, and dysmenorrhea.

Cefazolin (Ancef, Kefzol) - Adverse Effects

-Rash and diarrhea are most common -SUPERinfections are likely when the antibiotic is used for prolonged periods -hypersensitivity RXNS are rare but potentially fatal -Pain and phlebitis can occur at IM injection sites -Seizures are rare though potentially serious: adverse rxn to cephalosporin therapy

Cefazolin (Ancef, Kefzol) - Interactions

-concurrent use with nephrotoxic drugs such as AMINOGLYCOSIDES or VANCOMYCIN increases risk of nephrotoxicity -this drug may have additive or synergistic antimicrobial action with other antibiotics such as AZTREONAM, CARBAPENEMS, and the PENICILLINS. -Anticoagulant effect of WARFARIN may be increased if given concurrently LAB TESTS -false positive urine glucose results are possible -may give positive Coomb's test OVERDOSE TREATMENT -no specific treatment

Intranasal corticosteroids

-decrease secretion of inflammatory mediators -reduce edema -cause mild vasoconstriction directly to nasal passages -don't have immediate results -action limited to nasal passages Virtually no ADR's

Fluconazole (Diflucan) - Administration Alerts

-do not mix IV drug with any other drugs -Pregnancy Category C

Penicillin G - Actions and Uses

-drug of choice against streptococci, pneumococci, and staphylococci organisms that are susceptible by C&S testing. -med of choice for gonorrhea and syphilis caused by susceptible strains -Available as either a potassium or sodium salt -only 15-30% of an oral dose is absorbed so it's often given by the IV or IM routes.

Tetracycline (Sumycin, others) - Action and Uses

-effective against a broad range of gram-positive and gram-negative organisms -Effective against H. pylori in the treatment of peptic ulcer disease -PO, topical, IM -Topical and oral available for treating acne

Erythromycin (Eryc, Erythrocin, others) - Actions and uses

-for patients who are unable to tolerate penicillins or who may have a penicillin-resistant infection -inactivated by stomach acid, coated, acid-resistant tablets or capsules that dissolve in the S.Intestine -Effective against most gram-positive bacteria -Used to treat susceptible infections by Bordetella pertussis (Whooping cough), Legionella pneumophilia (Legionnaires' disease), M. pneumonia, and Corynebacterium diphtheria.

Chronic asthma Pharmacotherapy

*anticholinergics, aka antagonists, are alternative bronchodilators for patients with pulmonary diseases. They block the parasympathetic nervous system. -Has actions similar to those stimulating the sympathetic nervous system *Ipratropium (Atrovent) is the most common anticholinergic prescribed

Substances applied for therapeutic purposes fall into one of the following three general categories:

- drugs or medications -Biologics -Complementary and alternative medicine therapies

Prednisone - Administration Alerts

-Administer IM injections deep into the muscle mass to avoid atrophy or abscesses -do not use if signs of a systemic infection are present -When using the drug for more than 10 days, the dose must be slowly tapered -Pregnancy Category C

Acute asthma pharmacotherapy

-Beta-adrenergic agonists are drugs that activate the sympathetic nervous system which relaxes bronchial smooth muscle resulting in bronchodilator. -These beta agonist meds act either on beta1 receptors located in the heart or on beta2 receptors found in the smooth muscle of the lung, uterus, and other organs. -Beta 2 adrenergic agonists are effective bronchodilators used for the management of asthma and other pulmonary diseases. *They are the first line drugs for the treatment of acute bronchoconstriction.

Acyclovir (Zovirax) - Actions and Uses

-First antiviral drug for herpes viruses -Prevents viral DNA synthesis which decreases the duration and severity of acute herpes episodes. -When given for prophylaxis it may decrease the frequency of herpes appearance but dues not cure the patient. -Oral, Ointment, IV

Gentamicin (Garamycin, others) - Contraindications

-Hypersensitivity to drugs in the aminoglycoside class -drug therapy must be monitored carefully in patients with impaired renal functions or those with pre-existing hearing loss

Tetracycline (Sumycin, others) - Administration Alert

-IM injections may cause local irritation and be extremely painful -administer oral drug with a full glass of water to decrease esophageal and GI irritation -Administer antacids and this drug 1 to 3 hours apart -Pregnancy Category D

Gentamicin (Garamycin, others) - Administration Alerts

-IM: inject deep into a large muscle -Use only clear IV and IM solutions -Withhold drug if peak serum level lies above the normal range of 5-10 mcg/mL -Pregnancy Category C

Acyclovir (Zovirax) - Administration Alerts

-IV: drug may cause painful inflammation of vessels at site of IV -administer around the clock -administer with food and a full glass of water -Pregnancy catagory C

Prednisone - Adverse Effects

-Long-term therapy may result in Cushing's syndrome (hyperglycemia, fat redistribution to the shoulders and face, muscle weakness, bruising, and bones that easily fracture) -Gastric ulcers may occur with long-term therapy at which an anti ulcer medication may be prescribed

Nystatin (Mycostatin, Nystop, others) - Adverse Effects

-Minor skin irritaiton -high incidence of contact dermatitis related to the preservatives found in some of the formulations -when given PO it may cause diarrhea, nausea, and vomiting

Penicillin G - Adverse Effects

-Most common: diarrhea, n/v -Pain at injection site -Superinfections -Most serious: anaphylaxis -Late hypersensitivity may occur

H1-receptor antagonists (antihistamines) and Mast Cell Stabilizers

-Mostly OTC -Used for allergy relief, motion sickness, insomnia -often combined with cold and sinus medications -most effective when taken prophylactically -effectiveness can diminish with long term use Cause anticholinergic effects which include: increased heart rate, urinary retention, constipation, blurred vision, drying of mucus membranes, drowsiness Contraindicated in: benign prostatic hypertrophy, narrow-angle glaucoma, go obstruction. *caution with asthma and hyperthyroidism

Acquired resistance

-Mutations occur during bacterial cellular division due to rapid replication, some are random, some spontaneous. -Advantageous mutations include drug resistance. -Killing bacteria that is sensitive to a drug leaves some that have developed resistance in the body --Resistant bacteria multiply and pass the drug resistant genetic material to the newly produced bacteria --Acquired resistance -The bacteria develops a resistance, not the patient. -These bacteria can be passed to others.

Ibuprofen (Advil, Motrin, others) - Contraindications

-NSAIDs are contraindicated for the treatment of preoperative pain in those undergoing coronary artery bypass graft surgery -Patient with active peptic ulcers -Patients with significant renal or hepatic impairment -Patients who have the syndrome of nasal polyps, angioedema, or bronchospasm due to aspirin or other NSAID usage -Use cautiously in patients who have HF, serious HTN, or a hx of stroke or MI.

Acetaminophen (Tylenol) - Administration Alerts

-Never administer to alcoholics due to potential for drug-induced hepatoxicity -There are many OTC products with this in it, don't duplicate doses. -Pregnancy Category B

Nystatin (Mycostatin, Nystop, others) - Administration Alerts

-Oral candidiasis: apply with a swab for children and infants because can't swish well -Oral candidiasis: swish in the mouth for at least 2 minutes for adults -Pregnancy Category C (oral) or A (topical)

Gentamicin (Garamycin, others) - Adverse Effects

-Rash, nausea, vomiting, and fatigue !!! BBW !!! Adverse effects may be severe and include: -NEUROTOXICITY which may manifest as ototoxicity and produce a loss of hearing or balance which may become permanent with continued use. Tinnitis, vertigo, and persistent headaches are early signs of ototoxicity. Other signs include muscle twitching, seizures, and paresthesias. Risk of neurologic effects higher in patients with impaired renal functions. -NEUROMUSCULAR blockade and respiratory paralysis are possible. The drug may cause severe neuromuscular weakness that lasts for several days -NEPHROTOXICITY is possible. Signs of reduced kidney function include oliguria, proteinuria, and elevated BUN and creatinine levels. Nephrotoxicity is a MAIN concern for patients with preexisting kidney disease. Concurrent usage with other nephrotoxic drugs should be avoided.

Acyclovir (Zovirax) - Adverse Effects

-Topically or PO: few adverse effects -IV: Nephrotoxicity and neurotoxicity are possible -Resistance to the drug in HIV-AIDS patients

Trimethoprim-Sulfamethoxazole (Bactrim) - Contraindications

-Use cautiously in patients with preexisting KIDNEY DISEASE -hypersensitivities to drugs in SULFONAMIDE class -documented MEGALOBLASTIC ANEMIA due to folate deficiency -PREGNANT AND LACTATING women -patients with HYPERKALEMIA

Prednisone - Contraindications

-Use with caution in patients with peptic ulcer, ulcerative colitis, or diverticulitis -Patients with active viral, bacterial, fungal, or protozoan infections should not take prednisone

Cefazolin (Ancef, Kefzol) - Administration Alerts

-administer IM injections deep into large muscle mass to prevent injury to surrounding tissues -Pregnancy Category B

Trimethoprim-Sulfamethoxazole (Bactrim) - administration alerts

-administer oral doses with full glass of water -Pregnancy category C

Penicillin G - Administration Alerts

-after parenteral administration must observe for 30 mins, especially following the first dose -don't mix this drug with aminoglycosides in the same IV solution. -give IV meds 1 hour apart to prevent interactions -Pregnancy Category B

Diagnosing

-analyze data -Identify health problems, risks, and strengths -Formulate diagnostic statements

Cefazolin (Ancef, Kefzol) - Actions and Uses

-beta-lactam antibiotic used for treating prophylaxis of bacterial infections caused by susceptible gram-positive organisms -treats infections of the respiratory tract, urinary tract, skin structures, biliary tract, bones, and joints. -useful in the pharmacotherapy of genital infections, septicemia, and endocarditis -NOT EFFECTIVE AGAINST MRSA -longer half-life of other first-generation cephalosporins -most frequently prescribed parenteral antibiotic

Gentamicin (Garamycin, others) - Actions and Uses

-broad-sprectrum BACTERICIDAL antibiotic -usually prescribed for serious urinary, respiratory, nervous, or GI infections when less toxic antibiotics are contraindicated -Effective against a few gram-positive bacteria INCLUDING SOME STRAINS OF MRSA -Drug is not absorbed by the oral route -topical, IV, IM

Assessing

-collect data -organize data -validate data -document data

Evaluating

-collect data related to outcomes -compare data with outcomes -relate nursing actions to client goals/outcomes -draw conclusions about problem status -continue, modify, or terminate the client's care plan

Ibuprofen (Advil, Motrin, others) - Adverse Effects

-generally mild nausea, heartburn, epigastric pain, and dizziness. -GI ulceration with occult or gross bleeding may occur, especially in pt.s who take high doses for prolonged periods -Chronic use may lead to Renal Impairment !!! BBW !!! NSAIDs may cause an increased risk of serious thrombotic events, MI, and stroke which can be fatal. -Pt.s with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk -NSAIDs increase the risk of serious GI adverse events including bleeding, ulceration, and perforation of the stomach or intestine which can be fatal. -events can occur at any time without warning

Ibuprofen (Advil, Motrin, others) - Administration Alerts

-give drug on empty stomach, however if nausea, vomiting or abdominal pain occurs then give with food -pt.s with asthma or who have allergies to aspirin may have hypersensitivity rxn to this drug -Pregnancy Category C till after 30 weeks gestation, then Category D

Factors that contribute to medication errors

-health care providers -patients

Fluconazole (Diflucan) - Contraindications

-hypersensitivities -renal dysfunctions -pt.s with hepatic impairment should be monitored closely -used cautiously in patients with preexisting kidney disease

Acyclovir (Zovirax) - Contraindications

-hypersensitivities to drugs in this class

Cefazolin (Ancef, Kefzol) - Contraindications

-hypersensitivity to a drug in the cephalosporin class -caution in patients with severe renal disease

Penicillin G - Contraindications

-hypersensitivity to a drug in this class -drug should be used with caution in patients with severe renal disease

Acetaminophen (Tylenol) - Contraindications

-hypersensitivity to acetaminophen or phenacetin -chronic alcoholism

Erythromycin (Eryc, Erythrocin, others) - Contraindications

-hypersensitivity to drugs in the macrolide class -those taking TERFENADINE, ASTEMIZOLE, OR CISAPRIDE

Tetracycline (Sumycin, others) - Contraindications

-hypersensitivity to drugs in this class -should not be sed during the second half of pregnancy, in children 8 years or younger, and in patients with severe renal or hepatic impairment

Nystatin (Mycostatin, Nystop, others) - Contraindications

-hypersensitivity to the drug

Fluconazole (Diflucan) - Actions and Uses

-interferes with syntheses of ergosterol -rapidly and completely absorbed when given PO -particularly effective against CANDIDA ALBICANS -able to penetrate most body membranes to reach infections in the CNS, bone, eye, urinary tract, and respiratory tract -not as effective against non-albicans candida -approved for prophylaxis of fungal infections in patients with AIDS, those undergoing bone marrow transplants, and those receiving antineoplastic drugs

Trimethoprim-Sulfamethoxazole (Bactrim) - Actions and Uses

-most frequently prescribed for the pharmacotherapy of UTI's -Treats Pneumocystis carinii pheumonia, PCP -treats shigella infections of the small bowel -treats acute episodes of chronic bronchitis -Oral and IV -Inhibits bacterial metabolism of folic acid -synnergistic action -selective for bacterial metabolism

Trimethoprim-Sulfamethoxazole (Bactrim) - Adverse Effects

-nausea and vomiting -hypersensitivities such as skin rash, itching, and fever -agranulocytosis or thrombocytopenia (periodic lab tests should be done) -Photosensitivities

Erythromycin (Eryc, Erythrocin, others) - Adverse Effects

-nausea, abdominal cramping, and vomiting *concurrent administration with food reduces these symptoms -hearing loss, vertigo, and dizziness may be experienced in high doses, especially in older adults and in those with impaired hepatic or renal excretion. -High doses of IV administration may be cardiotoxic and pose a risk for potentially fatal dysrhythmias

Fluconazole (Diflucan) - Adverse Effects

-nausea, vomiting, diarrhea at high doses -Stevens-Johnson syndrome has been reported in patients with immunosuppression

Implementing

-reassess the client -determine the nurses need for assistance -implement the nursing interventions -supervise delegated care -document nursing activities

Acetaminophen (Tylenol) - Action and Uses

-reduces fever by dilating the peripheral blood vessels which enables sweating and dissipation of heat. -Has no anti-inflammatory properties; not effective in treating arthritis or pain caused by tissue swelling after injury -For mild to moderate pain -May be combined with opioids to reduce the dose of the opioid. *Does not cause GI bleeding or ulcers like NSAIDS

risk management department

-required department in hospitals -purpose: to protect hospital, personnel, and improve quality of care -incident reporting

Prednisone - Actions and Uses

-synthetic corticosteroid -when used for inflammation, duration of therapy is commonly limited to 4-10 days -for long-term therapy alternate-day dosing is used -occasionally used to terminate acute bronchospasm in patients with asthma -occasionally used as an antineoplastic agent for patients with certain cancers such as Hodgkin's disease, acute leukemia, and lymphomas -Tablet and Oral

Tetracycline (Sumycin, others) - Adverse Effects

-tendency to affect vaginal, oral, and intestinal flora and cause super-infections -irritates the GI mucosa and may cause nausea, vomiting, epigastric burning and diarrhea -diarrhea may be severe enough to cause discontinuation of therapy -discoloration of teeth and photosensitivity

Nystatin (Mycostatin, Nystop, others) - Actions and Uses

-this drug binds to sterols in the fungal cell membrane, causing leakage of intracellular contents as the membrane becomes weakened -Cream, ointment, powder, tablet, lozenge. -Too toxic for parenteral administration -This drug is primarily used topically for CANDIDA infections of the Gavin, skin, and mouth -PO to treat candidiasis of the intestine because it travels through the GI tract without being absorbed. -can be combined with Matrix and Mycolog 2 cream to treat inflamed subcutaneous lesions

Acetaminophen (Tylenol) - Adverse Affects

-uncommon at a therapeutic dose -not recommended in malnourished patients, may cause acute toxicity which leads to renal failure which may be fatal. !!! BBW !!! Has potential to cause severe/fatal liver injury and may cause serious allergic reactions with symptoms of angioedema, difficulty breathing, itching, or rash.

Functions of Antibodies

1. Activate B lymphocytes 2. Act as opsonins 3. Cause antigen clumping and inactivation of bacterial toxins 4. Activates antibody-dependent cellular activity 5. Triggers mast cell degranulation 6. Activates compliment

The 5 overlapping phases of the nursing process

1. Assessing 2. Diagnosing 3. Planning 4. Implementing 5. Evaluating

Pathophysiology of a fever

1. Pre-optic neurons in hypothalamus directly sense blood temperature 2. Vasomotor changes activated by neurons: shivering, metabolic changes, behavioural changes 3. Cytokines/pyrogens signal hypothalamus to release prostaglandins, resetting temp set-point

A patient has a prescription for Flonase (flucasone). IN what order will nurse instruct to use drug?

1. Prime inhaler prior to first use 2. clear nose by blowing 3. install one spray directed high into nasal cavity 4. spit out any excess liquid that drains into the mouth

4 Phases of approval for Therapeutic and biologic drugs

1. preclinical investigation 2. clinical investiation 3. review of the New Drug Application (NDA) 4. Postmarketing surveillance

Preschool child ranges in age from

3-5 years

HMG-CoA Reductase Inhibitor

3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitor

Middle adulthood

40-65 years

tetracylines

5 in use effective against gram+ and gram- have broadest spectrum of any class of antibiotics inhibit bacterial wall synthesis by attaching to bacterial ribosomes some are lipid soluble and can enter CFS resistance from overuse tetracycline is prototype drug suffix cycline

School-aged child is between

6 and 12 years

Histamine

A chemical mediator of inflammation -When released from mast cells and basophils, this chemical mediator reaches its receptors to cause itching, increased mucus secretion, and nasal congestion. In more severe allergic states it may cause bronchoconstriction, edema, hypotension, and other symptoms of anaphylaxis.

Complement

A series of at least 20 proteins that combine in a cascade fashion to neutralize or destroy an antigen; stimulates histamine release by mast cells

Standing order

A set of postoperative prn prescriptions that are written for all patients who have undergone a specific surgical procedure

Dry powder inhaler DPI

A small device that is activated during inhalation to deliver a fine powder directly to the bronchial tree. Turbuhaler and Flexhaler are types of DPIs

Pharmacogenetics

Area of pharmacology that examines the role of genetics in drug response.

ACEi

Angiotensin Converting Enzyme Inhibitor

Montelukast (Singulair): Classes

Anti-inflammatory for asthma prophylaxis Classes Therapeutic: Anti-inflammatory drug for asthma prophylaxis Pharmacologic: Leukotriene modifier

Montelukast (Singulair)

Anti-inflammatory for asthma prophylaxis Classes Therapeutic: Anti-inflammatory drug for asthma prophylaxis Pharmacologic: Leukotriene modifier Actions and Uses Used for prophylaxis of persistent, chronic asthma, exercise-induced bronchospasm, and allergic rhinitis. -Prevents airway edema and inflammation by blocking leukotriene receptors in the airways -given PO and acts rapidly -not recommended for termination of acute bronchospasm -APPROVED FOR PEDIATRICS, chewable available or can mix with applesauce, mashed carrots, or ice cream Administration Alerts -do not use to terminate acute asthma attacks -if preventing exercise-induced bronchospasm take at least 2 hours before activity -Preg cat B Adverse Effects -Headache is most common complaint and nausea and diarrhea in some patients -Rare: serious neuropsychiatric events, suicidal ideation, hallucinations, aggressiveness, depression Contraindications -Only one is hypersensitivity to drug -pre-existing hepatic impairment should be cautioned Interactions D/D: few Lab: may increase serum alanine aminotransferase ALT values NO SPECIFIC TREATMENT FOR OD

Diphenhydramine (Benadryl)

Antihistamine Therapeutic class: drug to treat allergies Pharmacologic class: H1 receptor antagonist; antihistamine Actions and uses -1st GEN H1-receptor antagonist -treat minor symptoms of allergy and the common cold such as sneezing, runny nose, and tearing of the eyes. -Topically to treat rashes -IM and IV for severe allergic reactions Parkinson's, motion sickness, and insomnia Administration Alerts -increased risk of anaphylactic shock when drug is administered parenterally -IV: inject at rate of 25 mg/min to reduce risk of shock -IM: inject deep into a large muscle to minimize tissue irritaiton -Preg. C Adverse Effects -significant drowsiness for first generation, diminishes with long-term use -occationally, paradoxical CNS stimulation and excitability will be observed rather than drowsiness *more frequent in children than adults -Anticholinergic effects such as dry mouth, tachycardia, and mild hypotension occur in some patients -may cause photosensitivity Contraindications -hypersensitivities -benign prostatic hypertrophy BPH -Narrow-angle glaucoma -gastrointestinal obstruction *use cautiously in pts with asthma or hyperthyroidism Interactions D/D: alcohol or opioids will cause increased sedation, other OTC cold meds may increase anticholinergic side effects, MAOIs may cause hypertensive crisis. Lab: discontinue at least 4 days prior to skin allergy test: false neg tests may result Herbal/food: henbane may cause increased anticholinergic effects NO SPECIFIC TREATMENT FOR OVERDOSE

green tea

Antioxidant; lower LDL cholesterol; prevent cancer; relieve stomach problems, nausea, vomiting

Dextromethorphan (Robitussin DM): Classes

Antitussive Classes Therapeutic: cough suppressant Pharmacologic: drug for increasing cough threshold

Dextromethorphan (Robitussin DM)

Antitussive Classes Therapeutic: cough suppressant Pharmacologic: drug for increasing cough threshold Actions and Uses -Acts in the medulla -lacks the analgesic and euphoric effects of the opioids -doesn't produce dependence Available in tablet, liquid caps, lozenges, and liquids Rapid onset of 15-30 mins Administration Alerts -avoid pulmonary irritants, such as smoking or other fumes because these agents may decrease drug effectiveness -preg cat C Adverse Effects at therapeutic doses effects are rare. Dizziness, drowsiness, and GI upset occur in some patients. In abuse situations can cause CNS toxicity with a wide variety of symptoms which include: slurred speech, ataxia, hyperrexcitability, stupor, respiratory depression, seizures, coma, and toxic psychosis Contraindications -treatment of chronic cough due to excessive bronchial secretions such as asthma, smoking, and emphysema -children under 6 -extreme caution in all children Interactions D/D: concurrent MAOIs usage-excitation, hypotension, hyperpyrexia -sedation occurs if used with alcohol, opioids, or other CNS depressants Food/Herbal: grapefruit juice can raise serum levels and cause toxicity NO SPECIFIC TREATMENT FOR OD

Dextromethorphan (Robitussin DM)

Antitussive Classes Therapeutic: cough suppressant Pharmacologic: drug for increasing cough threshold Actions and Uses -Acts in the medulla -lacks the analgesic and euphoric effects of the opioids -doesn't produce dependence Available in tablet, liquid caps, lozenges, and liquids Rapid onset of 15-30 mins Administration Alerts -avoid pulmonary irritants, such as smoking or other fumes because these agents may decrease drug effectiveness -preg cat C Adverse Effects at therapeutic doses effects are rare. Dizziness, drowsiness, and GI upset occur in some patients. In abuse, situations can cause CNS toxicity with a wide variety of symptoms which include: slurred speech, ataxia, hyper-excitability, stupor, respiratory depression, seizures, coma, and toxic psychosis Contraindications -treatment of chronic cough due to excessive bronchial secretions such as asthma, smoking, and emphysema -children under 6 -extreme caution in all children Interactions D/D: concurrent MAOIs usage-excitation, hypotension, hyperpyrexia -sedation occurs if used with alcohol, opioids, or other CNS depressants Food/Herbal: grapefruit juice can raise serum levels and cause toxicity NO SPECIFIC TREATMENT FOR OD

Characteristics of viruses

Antivirals are the least effective of all the anti-infective drug classes Viruses are non-living, require a host to live. Intra-cellular parasites! Must insert their genetic material into the host's chromosomes to cause infection. •Rapid mutation of viruses makes treatment very difficult. •Vaccines are the primary treatment/prevention of viruses. •Some drugs interrupt the replication of viruses •Some drugs boost host's immune response so the patient remains symptom free

What important information should be included in the patient's education regarding taking ciprofloxacin (Cipro)? 1.The drug can cause discoloration of the teeth. 2.Fluid intake should be decreased to prevent urine retention. 3.Any heel or lower leg pain should be reported immediately. 4.The drug should be taken with an antacid to reduce gastric effects.

Any heel or lower leg pain should be reported immediately. Fluoroquinolones such as ciprofloxacin (Cipro) have been associated with an increased risk of tendinitis and tendon rupture.

Medication error

Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or may not cause the patient harm.

A 32-year-old female has been started on amoxicillin (Amoxil, Trimox) for a severe U T I. Before sending her home with this prescription, the nurse will provide which instruction? 1.Teach her to wear sunscreen. 2.Ask her about oral contraceptive use and recommend an alternative method for the duration of the ampicillin course. 3.Assess for hearing loss. 4.Recommend taking the pill with some antacid to prevent gastrointestinal upset.

Ask her about oral contraceptive use and recommend an alternative method for the duration of the ampicillin course. Penicillin antibiotics such as amoxicillin (Amoxil, Trimox) may significantly decrease the effectiveness of oral contraceptives and another method of birth control should be suggested during the time the drug is taken.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Asprin, Celebrex, Ibuprofen, Motrin

This phase of the nursing process is the systematic collection, organization, validation, and documentation of patient data.

Assessment Phase

Trade names

Assigned by the company marketing the drug. The name is usually short and easy to remember. Sometimes called the proprietary, product, or brand name.

The nurse is teaching a patient about the use of Dextromethorphan with graifenesin (robitussin dm) syrup for a cough accompanied by thick mucus. Which instruction should be included in the pt. teaching?

Avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day

Trimethoprim-Sulfamethoxazole (Bactrim) 553

CLASSES Therapeutic- Antibacterial Pharmacologic- Sulfonamide, folic acid inhibitor ACTIONS AND USES -most frequently prescribed for the pharmacotherapy of UTI's -Treats Pneumocystis carinii pneumonia, PCP -treats shigella infections of the small bowel -treats acute episodes of chronic bronchitis -Oral and IV -Inhibits bacterial metabolism of folic acid -synergistic action -selective for bacterial metabolism ADMINISTRATION ALERTS -administer oral doses with a full glass of water -Pregnancy Category C ADVERSE EFFECTS -nausea and vomiting -hypersensitivities such as skin rash, itching, and fever -agranulocytosis or thrombocytopenia (periodic lab tests should be done) -Photosensitivities CONTRAINDICATIONS -Use cautiously in patients with preexisting KIDNEY DISEASE -hypersensitivities to drugs in SULFONAMIDE class -documented MEGALOBLASTIC ANEMIA due to folate deficiency -PREGNANT AND LACTATING women -patients with HYPERKALEMIA INTERACTIONS DRUG/DRUG -may enhance effects of certain ANTICOAGULANTS -may increase METHOTREXATE toxicity -by decreasing the hepatic metabolism of phenytoin this drug may cause PHENYTOIN toxicity -this drug exerts a potassium-sparing effect on the nephron and should be used with caution with DIURETICS such as SPIRONOLACTONE (ALDACTONE) to prevent hyperkalemia HERBAL/FOOD -POTASSIUM supplements should not be taken unless directed by HCP OVERDOSE TREATMENT -if signs of bone marrow suppression occur during high-dose therapy 5-15 mg of leucovorin should be given daily

Penicillin G 543

CLASSES Therapeutic- Antibacterial Pharmacologic- cell wall inhibitor, natural penicillin ACTION AND USES -drug of choice against streptococci, pneumococci, and staphylococci organisms that are susceptible by C&S testing. -med of choice for gonorrhea and syphilis caused by susceptible strains -Available as either a potassium or sodium salt -only 15-30% of an oral dose is absorbed so it's often given by the IV or IM routes. ADMINISTRATION ALERTS -after parenteral administration must observe for 30 mins, especially following the first dose -don't mix this drug with aminoglycosides in the same IV solution. -give IV meds 1 hour apart to prevent interactions -Pregnancy Category B ADVERSE EFFECTS -Most common: diarrhea, n/v -Pain at the injection site -Superinfections -Most serious: anaphylaxis -Late hypersensitivity may occur CONTRAINDICATIONS -hypersensitivity to a drug in this class -drug should be used with caution in patients with severe renal disease INTERACTIONS DRUG/DRUG -this drug may decrease the effectiveness of oral contraceptives -COLESTIPOL taken with this drug will decrease the absorption of this drug. -Potassium-sparing diuretics may cause hyperkalemia when administered with the potassium version of this drug. -These drugs can antagonize the actions of aminoglycoside antibiotics, so they should not be administered concurrently LAB TESTS -this drug may give positive Coombs' test -this drug may give false-positive urinary or serum proteins OVERDOSE TREATMENT -no specific treatment

Tetracycline (Sumycin, others) 547

CLASSES Therapeutic- Antibacterial Pharmacologic- tetracycline, protein synthesis inhibitor ACTIONS AND USES -effective against a broad range of gram-positive and gram-negative organisms -Effective against H. pylori in the treatment of peptic ulcer disease -PO, topical, IM -Topical and oral available for treating acne ADMINISTRATION ALERTS -IM injections may cause local irritation and be extremely painful -administer the oral drug with a full glass of water to decrease esophageal and GI irritation -Administer antacids and this drug 1 to 3 hours apart -Pregnancy Category D ADVERSE EFFECTS -tendency to affect vaginal, oral, and intestinal flora and cause super-infections -irritates the GI mucosa and may cause nausea, vomiting, epigastric burning, and diarrhea -diarrhea may be severe enough to cause discontinuation of therapy -discoloration of teeth and photosensitivity CONTRAINDICATIONS -hypersensitivity to drugs in this class -should not be used during the second half of pregnancy, in children 8 years or younger, and in patients with severe renal or hepatic impairment INTERACTIONS DRUG/DRUG -milk products, iron supplements, magnesium-containing laxatives, and antacids reduce the absorption and serum levels of this drug -this drug binds with the lipid-lowering drugs COLESTIPOL and CHOLESTYRAMIN thereby decreasing the absorption of the antibiotic -This drug decreases the effectiveness of oral contraceptives -should not be given concurrently with ACITRETIN because the combination can increase intracranial pressure -concurrent use with LOMITAPIDE is contraindicated because this drug will increase serum levels of lomitapide several fold LAB TESTS -may increase these lab values: BUN, AST, ALT, amylase, bilirubin, and alkaline phosphatase HERBAL/FOOD -dairy products interfere with the absorption rate of this drug OVERDOSE TREATMENT -no specific treatment

Fluconazole (Diflucan) 572

CLASSES Therapeutic- Antifungal Pharmacologic- Inhibitor of fungal cell membrane synthesis, azole ACTIONS AND USES -interferes with syntheses of ergosterol -rapidly and completely absorbed when given PO -particularly effective against CANDIDA ALBICANS -able to penetrate most body membranes to reach infections in the CNS, bone, eye, urinary tract, and respiratory tract -not as effective against non-albicans candida -approved for prophylaxis of fungal infections in patients with AIDS, those undergoing bone marrow transplants, and those receiving antineoplastic drugs ADMINISTRATION ALERTS -do not mix IV drug with any other drugs -Pregnancy Category C ADVERSE EFFECTS -nausea, vomiting, diarrhea at high doses -Stevens-Johnson syndrome has been reported in patients with immunosuppression CONTRAINDICATIONS -hypersensitivities -renal dysfunctions -pt.s with hepatic impairment should be monitored closely -used cautiously in patients with preexisting kidney disease INTERACTIONS DRUG/DRUG -strong inhibitor of hepatic CYP enzymes and has the potential to interact with many drugs -use with WARFARIN may cause an increased risk for bleeding -Hypoglycemia may result if used concurrently with certain ORAL HYPOGLYCEMICS including GLYBURIDE -drug levels may be decreased with concurrent RIFAMPIN or CIMETIDINE use -Effects of FENTANYL, ALFENTANIL, or METHADONE may be prolonged with concurrent usage of this drug LAB TESTS values for AST, ALT, and alkaline phosphatase may be increased OVERDOSE TREATMENT -no specific treatmenT -dialysis can be sued to lower serum drug level

Nystatin (Mycostatin, Nystop, others) 574

CLASSES Therapeutic- Superficial anti-fungal Pharmacologic- Polyene ACTIONS AND USES -this drug binds to sterols in the fungal cell membrane, causing leakage of intracellular contents as the membrane becomes weakened -Cream, ointment, powder, tablet, lozenge. -Too toxic for parenteral administration -This drug is primarily used topically for CANDIDA infections of the Gavin, skin, and mouth -PO to treat candidiasis of the intestine because it travels through the GI tract without being absorbed. -can be combined with Matrix and Mycolog 2 cream to treat inflamed subcutaneous lesions ADMINISTRATION ALERTS -Oral candidiasis: apply with a swab for children and infants because can't swish well -Oral candidiasis: swish in the mouth for at least 2 minutes for adults -Pregnancy Category C (oral) or A (topical) ADVERSE EFFECTS -Minor skin irritation -high incidence of contact dermatitis related to the preservatives found in some of the formulations -when given PO it may cause diarrhea, nausea, and vomiting CONTRAINDICATIONS -hypersensitivity to the drug INTERACTIONS Unknown to all (Drug/lab/food) No overdose treatment

Erythromycin (Eryc, Erythrocin, others) 548

CLASSES Therapeutic- antibacterial Pharmacologic- macrolide, protein synthesis inhibitor ACTIONS AND USES -for patients who are unable to tolerate penicillins or who may have a penicillin-resistant infection -inactivated by stomach acid, coated, acid-resistant tablets or capsules that dissolve in the S.Intestine -Effective against most gram-positive bacteria -Used to treat susceptible infections by Bordetella pertussis (Whooping cough), Legionella pneumophilia (Legionnaires' disease), M. pneumonia, and Corynebacterium diphtheria. ADMINISTRATION ALERTS -Oral: empty stomach with a full glass of water -IV suspension: shake bottle thoroughly to make sure drug is thoroughly mixed -Do not give with or immediately before or after fruit juices -Pregnancy Category B ADVERSE EFFECTS -nausea, abdominal cramping, and vomiting *concurrent administration with food reduces these symptoms -hearing loss, vertigo, and dizziness may be experienced in high doses, especially in older adults and in those with impaired hepatic or renal excretion. -High doses of IV administration may be cardiotoxic and pose a risk for potentially fatal dysrhythmias CONTRAINDICATIONS -hypersensitivity to drugs in the macrolide class -those taking TERFENADINE, ASTEMIZOLE, OR CISAPRIDE INTERACTIONS DRUG/DRUG -ANESTHETICS, AZOLE ANTIFUNGALS, and ANTI-CONFULSANTS may interact to cause serum drug levels of this drug to rise and result in toxicity -interacts with CYCLOSPORINE increasing the risk for nephrotoxicity -may increase effects of WARFARIN -concurrent use with LOVASTATIN or SIMVASTATIN is not recommended...may increase the risk of muscle toxicity. -ETHANOL use may decrease the absorption of this drug LAB TESTS -may interfere with AST and give false urinary catecholamine values. HERBAL/FOOD -St. John's wort may decrease the effectiveness of this drug OVERDOSE -no specific treatment

Acetaminophen (Tylenol) 509

CLASSES Therapeutic- antipyretic and analgesic Pharmacologic- centrally acting COX inhibitor ACTIONS AND USES -reduces fever by dilating the peripheral blood vessels which enable sweating and dissipation of heat. -Has no anti-inflammatory properties; not effective in treating arthritis or pain caused by tissue swelling after an injury -For mild to moderate pain -May be combined with opioids to reduce the dose of the opioid. *Does not cause GI bleeding or ulcers like NSAIDS ADMINISTRATION ALERTS -Never administer to alcoholics due to potential for drug-induced hepatoxicity -There are many OTC products with this in it, don't duplicate doses. -Pregnancy Category B ADVERSE EFFECTS -uncommon at a therapeutic dose -not recommended in malnourished patients, may cause acute toxicity which leads to renal failure which may be fatal. !!! BBW !!! Has the potential to cause severe/fatal liver injury and may cause serious allergic reactions with symptoms of angioedema, difficulty breathing, itching, or rash. CONTRAINDICATIONS -hypersensitivity to acetaminophen or phenacetin -chronic alcoholism INTERACTIONS DRUG/DRUG -inhibits WARFARIN metabolism causing the anticoagulant to accumulate to toxic levels. -High-dose or long-term use may result in elevated WARFARIN levels and bleeding. -Ingestion with alcohol or other hepatotoxic drugs may cause liver failure from hepatic necrosis LAB TESTS -may increase hepatic function test values HERBAL/FOOD -avoid taking comfrey, coltsfoot, and chaparral OVERDOSE TREATMENT -acetadote

Acyclovir (Zovirax) 603

CLASSES Therapeutic- antipyretic and analgesic Pharmacologic- centrally acting COX inhibitor. ACTIONS AND USES -First antiviral drug for herpes viruses -Prevents viral DNA synthesis, which decreases the duration and severity of acute herpes episodes. -When given for prophylaxis, it may decrease the frequency of herpes appearance but does not cure the patient. -Oral, Ointment, IV ADMINISTRATION ALERTS -IV: drug may cause painful inflammation of vessels at the site of IV -administer around the clock -administer with food and a full glass of water -Pregnancy Category C ADVERSE EFFECTS -Topically or PO: few adverse effects -IV: Nephrotoxicity and neurotoxicity are possible -Resistance to the drug in HIV-AIDS patients CONTRAINDICATIONS -hypersensitivities to drugs in this class INTERACTIONS DRUG/DRUG -concurrent use with NEPHROTOXIC agents -PROBENECID decreases * elimination -ZIDOVUDINE may cause increased drowsiness and lengthy LAB TESTS -kidney function tests such as the BUN and serum creatinine may increase HERBAL/FOOD -unknown OVERDOSE TREATMENT -no specific treatment

Prednisone 508

CLASSES Therapeutic: Anti-inflammatory drug Pharmacologic: corticosteroid ACTION AND USES -synthetic corticosteroid -when used for inflammation, the duration of therapy is commonly limited to 4-10 days -for long-term therapy alternate-day dosing is used -occasionally used to terminate acute bronchospasm in patients with asthma -occasionally used as an antineoplastic agent for patients with certain cancers such as Hodgkin's disease, acute leukemia, and lymphomas -Tablet and Oral ADMINISTRATION ALERTS -Administer IM injections deep into the muscle mass to avoid atrophy or abscesses -do not use if signs of systemic infection are present -When using the drug for more than 10 days, the dose must be slowly tapered -Pregnancy Category C ADVERSE EFFECTS -Long-term therapy may result in Cushing's syndrome (hyperglycemia, fat redistribution to the shoulders and face, muscle weakness, bruising, and bones that easily fracture) -Gastric ulcers may occur with long-term therapy at which an anti-ulcer medication may be prescribed CONTRAINDICATIONS -Use with caution in patients with peptic ulcer, ulcerative colitis, or diverticulitis -Patients with active viral, bacterial, fungal, or protozoan infections should not take prednisone INTERACTIONS DRUG/DRUG -Because BARBITURATES, PHENYTOIN, and RIFAMPIN increase the metabolism of this drug, increased doses may be required. -Concurrent use with AMPHOTERICIN B or DIURETICS increases potassium loss which may be serious for patients taking DIGOXEN -Since this drug can raise blood glucose levels, patients with diabetes may require an adjustment in the doses of insulin or oral hypoglycemic drugs LAB TESTS -this drug may inhibit antibody response to toxoids and vaccines and may increase blood glucose -Serum calcium, potassium, and thyroxine may decrease HERBAL/FOOD -Aloe, buckthorn and Senna may increase potassium loss. -Licorice may potentiate the effect of corticosteroids -St. John's wort may decrease this medications drug levels OVERDOSE TREATMENT no specific treatment

CDAD

Clostridium difficile-associated diarrhea

Erythromycin (Eryc, Erythrocin, others) - Interactions

DRUG/DRUG -ANESTHETICS, AZOLE ANTIFUNGALS, and ANTI-CONFULSANTS may interact to cause serum drug levels of this drug to rise and result in toxicity -interacts with CYCLOSPORINE increasing the risk for nephrotoxicity -may increase effects of WARFARIN -concurrent use with LOVASTATIN or SIMVASTATIN is not recommended...may increase the risk of muscle toxicity. -ETHANOL use may decrease the absorption of this drug LAB TESTS -may interfere with AST and give false urinary catecholamine values. HERBAL/FOOD -St. John's wort may decrease the effectiveness of this drug OVERDOSE -no specific treatment

Prednisone - Interactions

DRUG/DRUG -Because BARBITURATES, PHENYTOIN, and RIFAMPIN increase the metabolism of this drug, increased doses may be required. -Concurrent use with AMPHOTERICIN B or DIURETICS increases potassium loss which may be serious for patients taking DIGOXEN -Since this drug can raise blood glucose levels, patients with diabetes may require an adjustment in the doses of insulin or oral hypoglycemic drugs LAB TESTS -this drug may inhibit antibody response to toxoids and vaccines and may increase blood glucose -Serum calcium, potassium, and thyroxine may decrease HERBAL/FOOD -Aloe, buckthorn and Senna may increase potassium loss. -Licorice may potentiate the effect of corticosteroids -St. John's wort may decrease this medications drug levels OVERDOSE TREATMENT no specific treatment

Gentamicin (Garamycin, others) - Interactions

DRUG/DRUG -Risk of ototoxicity increase if the patient is currently taking AMPHOTERICIN B, FUROSEMIDE, ASPIRIN, BUMETANIDE, ETHACRYNIC ACID, CISPLATIN, or PAROMOMYCIN. -Concurrent use with AMPHOTERICIN B, CAPREOMYCIN, CISPLATIN, POLYMYXIN B, or VANCOMYCIN increases the risk of nephrotoxicity LAB TESTS -this drug may increase values of the following: serum bilirubin, serum creatinine, serum lactate dehydrogenase (LDH), BUN, AST, or ALT. -may decrease values for the following: serum calcium, sodium, or potassium OVERDOSE TREATMENT -no specific treatment

Ibuprofen (Advil, Motrin, others) - Interactions

DRUG/DRUG -because this drug can affect platelet function it should be avoided when taking anticoagulants and other coagulant modifiers -Aspirin can decrease the anti-inflammatory action of this drug -Actions of certain diuretics may be diminished when taken concurrently with this drug -Use with other NSAIDs, alcohol, or corticosteroids may cause serious adverse GI events. LAB TESTS -this drug may increase bleeding time, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels -this drug may decrease hemoglobin and hematocrit HERBAL/FOOD feverfew, garlic, ginger, ginkgo may increase the risk of bleeding OVERDOSE TREATMENT -Administration of an alkaline drug may increase the urinary excretion of this drug. No other specific treatment

Acyclovir (Zovirax) - Interactions

DRUG/DRUG -concurrent use with NEPHROTOXIC agents -PROBENECID decreases * elimination -ZIDOVUDINE may cause increased drowsiness and legarthy LAB TESTS -kidney function tests such as the BUN and serum creatinine may increase HERBAL/FOOD -unknown OVERDOSE TREATMENT -no specific treatment

Acetaminophen (Tylenol) - Interactions

DRUG/DRUG -inhibits WARFARIN metabolism causing the anticoagulant to accumulate to toxic levels. -High-dose or long-term use may result in elevated WARFARIN levels and bleeding. -Ingestion with alcohol or other hepatotoxic drugs may cause liver failure from hepatic necrosis LAB TESTS -may increase hepatic function test values HERBAL/FOOD -avoid taking comfrey, coltsfoot, and chaparral OVERDOSE TREATMENT -acetadote

Trimethoprim-Sulfamethoxazole (Bactrim) - Interactions

DRUG/DRUG -may enhance effects of certain ANTICOAGULANTS -may increase METHOTREXATE toxicity -by decreasing the hepatic metabolism of phenytoin this drug may cause PHENYTOIN toxicity -this drug exerts a potassium-sparing effect on the nephron and should be used with caution with DIURETICS such as SPIRONOLACTONE (ALDACTONE) to prevent hyperkalemia HERBAL/FOOD -POTASSIUM supplements should not be taken unless directed by HCP OVERDOSE TREATMENT -if signs of bone marrow suppression occurs during high-dose therapy 5-15 mg of leucovorin should be given daily

Tetracycline (Sumycin, others) - Interactions

DRUG/DRUG -milk products, iron supplements, magnesium containing laxatives, and antacids reduce the absorption and serum levels of this drug -this drug binds with the lipid-lowering drugs COLESTIPOL and CHOLESTYRAMIN thereby decreasing the antibiotics absorption -This drug decreases effectiveness of oral contraceptives -should not be given concurrently with ACITRETIN because the combination can increase intracranial pressure -concurrent use with LOMITAPIDE is contraindicated because this drug will increase serum levels of lomitapide several fold LAB TESTS -may increase these lab values: BUN, AST, ALT, amylase, bilirubin, and alkaline phosphatase HERBAL/FOOD -dairy products interfere with the absorption rate of this drug OVERDOSE TREATMENT -no specific treatment

Fluconazole (Diflucan) - Interactions

DRUG/DRUG -strong inhibitor of hepatic CYP enzymes and has the potential to interact with many drugs -use with WARFARIN may cause increased risk for bleeding -Hypoglycemia my result if used concurrently with certain ORAL HYPOGLYCEMICS including GLYBURIDE -drug levels may be decreased with concurrent RIFAMPIN or CIMETIDINE use -Effects of FENTANYL, ALFENTANIL, or METHADONE may be prolonged with concurrent usage of this drug LAB TESTS values for AST, ALT and alkaline phosphatase may be increased OVERDOSE TREATMENT -no specific treatment -dialysis can be sued to lower serum drug level

Penicillin G - Interactions

DRUG/DRUG -this drug may decrease the effectiveness of oral contraceptives -COLESTIPOL taken with this drug will decrease the absorption of this drug. -Potassium-sparing diuretics may cause hyperkalemia when administered with the potassium version of this drug. -These drugs can antagonize the actions of aminoglycoside antibiotics, so they should not be administered concurrently LAB TESTS -this drug may give positive Coombs' test -this drug may give false-positive urinary or serum proteins OVERDOSE TREATMENT -no specific treatment

Pharmacogenomics

Deals with the influence of genetic variation on drug response in patients by correlating gene expression or actual variants of the human genome.

Describe the role of expectorants and mucolytics in treating bronchial congestion

Expectorants reduce thickness or viscosity of bronchial secretions thus increasing mucus flow that can be removed more easily by coughing. *most effective OTC is guaifenesin (Mucinex) Mucolytics directly break down the chemical structure of the mucus molecules. The mucus becomes thinner and can be removed more easily by coughing. *acetylcysteine (mucomyst)

Inj

Injection

Diphenhydramine (Benadryl): Interactions

Interactions D/D: alcohol or opioids will cause increased sedation, other OTC cold meds may increase anticholinergic side effects, MAOIs may cause hypertensive crisis. Lab: discontinue at least 4 days prior to skin allergy test: false neg tests may result Herbal/food: henbane may cause increased anticholinergic effects NO SPECIFIC TREATMENT FOR OVERDOSE

Dextromethorphan (Robitussin DM): Interactions

Interactions D/D: concurrent MAOIs usage-excitation, hypotension, hyperpyrexia -sedation occurs if use with alcohol, opioids, or other CNS depressants Food/Herbal: grapefruit juice can raise serum levels and cause toxicity NO SPECIFIC TREATMENT FOR OD

Albuterol: Interactions

Interactions D/D: concurrent use with beta blockers will inhibit bronchodilator effect of albuterol -patients should avoid monoamine oxidase inhibitors (MAOIs) within 14 days of beginning therapy Lab: may cause hypokalemia at high doses Food/herbal: coffee may cause nervousness, tremor, or palpitations OD: cardioselective beta-adrenergic antagonist

Montelukast (Singulair): Interactions

Interactions D/D: few Lab: may increase serum alanine aminotransferase ALT values NO SPECIFIC TREATMENT FOR OD

Oxymetazoline (Afrin): Interactions

Interactions D/D: no clinically important interactions occur because absorption is limited Herbal/Food: use with caution with herbal supplements such as St. Johns Wart that have properties of MAOIs NO SPECIFIC OD TREATMENT

Ipratropium (Atrovent): Interactions

Interactions D/D: usage with other drugs in this class (atropine) may lead to additive anticholinergic side effects -should not be used with antidiabetic drug pramlintide because both slow peristalsis and can cause serious or life-threatening GI symptoms OD: doesn't occur because not enough absorbed when given by aerosol

Fluticasone (Flonase, Veramyst): Interactions

Interactions D/D: use of other intranasal decongestants increases risk of nasal irritation or bleeding -use with ritonavir should be avoided because it increases plasma fluticasone levels Herbal/food: licorice may potentiate effects of corticosteroids NO SPECIFIC TREATMENT FOR OD

Preclinical investigation

Involves extensive lab research. Tests are done on human and microbial cells cultured in the lab. Studies are performed in several species of animals to examine effectiveness at different doses to find adverse effects.

The key to comparing trade-name drugs and their generic equivalents lies in

Measuring the bioavailability of the two preparations; Measuring how long a drug takes to exert its effect gives pharmacologists a crude measure of bioavailability.

Partial agonist

Medication that produces a weaker, or less efficacious, response than an agonist.

Oxymetazoline (Afrin)

Nasal Decongestant Classes Therapeutic class: nasal decongestant Pharmacologic: sympathomimetic Actions and Uses -activates alpha-adrenergic receptors in the sympathetic nervous system -Causes arterioles in the nasal passages to constrict which dries the mucous membranes -relief occurs within minutes and lasts for 10+hours -Metered spray device or nasal drops, and eye drops -causes vasoconstriction of vessels in the eye and is used to relieve redness and provide relief from dryness and minor eye irritations Administration Alerts -wash hands after administration to prevent anisocoria (blurred vision) -preg cat C Adverse Effects Rebound congestion is common when used for more than 3-5 days -minor stinging and dryness in nasal mucosa may be experienced -systemic adverse effects are unlikely unless lg act of med is swallowed Contraindications -pts with thyroid disorders, hypertension, diabetes, or heart disease should use sympathomimetics only in direction of HCP Interactions D/D: no clinically important interactions occur because absorption is limited Herbal/Food: use with caution with herbal supplements such as St. Johns Wart that have properties of MAOIs NO SPECIFIC OD TREATMENT

NRI

Norepinephrine reuptake inhibitor

Passive immunity

Occurs when preformed antibodies are transferred or donated from one person to another. i.e. maternal antibodies cross the placenta and provide protection for the fetus and newborn. Drugs for passive immunity are usually administered when the patient has already been exposed to a virulent pathogen, or is at very high risk of exposure and there is not sufficient time to develop active immunity. Do not stimulate the patient's immune system, memory cells are not produced, and the protective effects will disappear within several weeks to several months after the infusions are discontinued. drugs include: antivenins for snakebites, following exposure to hepatitis, sera used to treat botulism, tetanus, and rabies

basic supportive care

One of the first elements of toxicity treatment involving maintaining the patient's airway, breathing, and circulation; making sure proper blood glucose levels are stable; maintaining proper arterial blood gases; treatment of developing seizures; and management of acid-base disturbances.

Complementary and Alternative Medicine (CAM) therapies

Other therapeutic approaches that include: -natural plant extracts -herbs -vitamins -minerals -dietary supplements -additional techniques outside of the realm of conventional therapeutics

Almost all strains of S. aureus in the US are resistant to

PCN- penicillin

Helper T Cells

Stimulate both humoral and cell-mediated immunity by releasing cytokines Cytokines released by helper T cells stimulate B cells and cytotoxic T cells Memory cells confer future immunity to this virus

Histamine- chemical mediator

Stored and released by mast cells; causes vasodilation, smooth-muscle constriction, tissue swelling, and itching

Leukotrienes

Stored and released by mast cells; effects are similar to those of histamine; contribute to symptoms of asthma and allergies

T cells

T-lymphocytes Two major types of T cells are called helper T cells and cytotoxic T cells. They are responsible for activating most other immune cells, including B cells. Cytotoxic T cells travel throughout the body, directly killing certain bacteria, parasites, virus-infected cells, and cancer cells. Rapidly clone after activated. Unlike B cells, they do not produce antibodies. Like B cells, some sensitized T cells become memory cells.

Antiprotozoan drugs

Target parasites: malaria, plasmodium, amebiasis, toxoplasmosis, giardiasis, trichomoniasis Non-malarial parasites often flourish where sanitation is poor and high-density populations Primary symptom caused by amebiasis is dysentery Nursing Implications with protozoa infections: •Prevention •Malaria precautions •Safe drinking water, water purification, etc.

Cell-Mediated Immunity

Targets defective body cells e.g. infected cells and cancer cells transplants Cytotoxic T cells release pore-forming proteins that destroy infected cells

Humoral Immunity

Targets invaders outside cells e.g. viruses, bacteria, fungi, protists, and toxins B-cell ab's bind to viral antigens and stimulate the B cells to divide and differentiate. Plasma cells secrete ab's into the blood and extracellular fluid

Clinical Investigation

The second phase of drug testing, takes place in three different stages termed clinical phase trials. These trials are the longest part of the drug approval process. Volunteers are needed to perform various tests on.

New Drug Application (NDA) Review

The third phase of the drug approval process. The drug's trade name is finalized. The average NDA review time for new drugs is apt 17-24 months.

Active Immunity

The type of response induced by the real pathogen, or it's vaccine. The body produces it's own antibodies in response to exposure. The active immunity induced by vaccines closely resembles that caused by natural exposure to the antigen, including the generation of memory cells.

Polypharmacy

The use of many different drugs concurrently in treating a patient, who often has several health problems.

Cefazolin (Ancef, Kefzol) - Classes

Therapeutic Class- Antibacterial Pharmacologic Class- Cell wall inhibitor: first-generation cephalosporin

Diphenhydramine (Benadryl): Classes

Therapeutic class: drug to treat allergies Pharmacologic class: H1 receptor antagonist; antihistamine

Ibuprofen (Advil, Motrin, others) - Classes

Therapeutic- Analgesic, anti-inflammatory drug, antipyretic Pharmacologic- NSAID

Gentamicin (Garamycin, others) - Classes

Therapeutic- Antibacterial Pharmacologic- Aminoglycoside, protein synthesis inhibitor

Trimethoprim-Sulfamethoxazole (Bactrim) - Classes

Therapeutic- Antibacterial Pharmacologic- Sulfonamide, folic acid inhibitor

Penicillin G - Classes

Therapeutic- Antibacterial Pharmacologic- cell wall inhibitor, natural penicillin

Tetracycline (Sumycin, others) - Classes

Therapeutic- Antibacterial Pharmacologic- tetracycline, protein synthesis inhibitor

Fluconazole (Diflucan) - Classes

Therapeutic- Antifungal Pharmacologic- Inhibitor of fungal cell membrane synthesis, azole

Nystatin (Mycostatin, Nystop, others) - Classes

Therapeutic- Superficial anti-fungal Pharmacologic- Polyene

Erythromycin (Eryc, Erythrocin, others) - Classes

Therapeutic- antibacterial Pharmacologic- macrolide, protein synthesis inhibitor

Acetaminophen (Tylenol) - Classes

Therapeutic- antipyretic and analgesic Pharmacologic- centrally acting COX inhibitor

Acyclovir (Zovirax) - Classes

Therapeutic- antiviral for herpes viruses Pharmacologic- nucleoside analog

Prednisone - Classes

Therapeutic: Anti-inflammatory drug Pharmacologic: corticosteroid

Antagonist

These are drugs that will occupy a receptor and prevent the endogenous chemical from acting. They often compete with agonists for the receptor binding sites.

Symptoms of Allergic rhinitis

These resemble those of the common cold: -tearing eyes, sneezing, nasal congestion, postnasal drip, and itching of the throat.

Beta agonists are bronchodilators that do what exactly?

They relax bronchial smooth muscle which widens the airway and making breathing easier for the patient

Side effect

This describes a non therapeutic reaction to a drug. They may be transient, but this is not always the case! May require nursing intervention.

STAT order

This refers to any medication that is needed immediately and is to be given only once.

Aloe vera

Topical application for minor skin irritations and burns

Antihistamines are widely used as OTC remedies for relief of

allergy symptoms, motion sickness, and insomnia.

s. aureas

almost all strains in US are resistant to penicillin d/t overuse

Anticholinergics

alternative bronchodilators Block the parasympathetic nervous system Slower onset than most beta agonists but when combined effects are greater and more prolonged -long term. maintenance systemic effects uncommon

carbapenems

bactericidal by inhibiting bacterial cell wall synthesis resistant to destruction of beta-lactamase broadest spectrum of any antibiotic can only be given parentally suffix penem

nursing implications

basic nursing assessments are vital drug hx is imperative allergy hx is imperative care plans must be individualized per pt

AC or ac

before meals

Nonselective bronchodilators

beta agonists that activate both beta1 and beta2 receptors

selective drugs

beta agonists that activate only beta2 receptors

Basic drugs are absorbed and distributed ____ in alkaline environments such as the small intestines.

better

Vaccines

biologic agents used to stimulate the immune system

Infancy is the period from

birth to 12 months of age.

BB

black box warning

Potential complications of allergic rhinitis include:

loss of taste or smell, sinusitis, chronic cough, hoarseness, and middle ear infections in children.

diptheria, tetanus, pertussis

daptacel, DTaP, infranrix, tripedia IM ages 2 months, 4 months, and 15-18 months, and 4-6 years

gram negative

e. coli, klebsiella, pseudomonas, salmonela contain thin cell wall and do not retain crystal violet stain

tetracyline nursing implications

educate patients to taje with food and to avoid calcium, iron, and milk

fluroquinolone nursing implication

educate pt to avoid dairy products and calcium as it decreases absorption

metronidazole (flagyl)

effective against anaerobes that cause abscess, gangrene, diabetic skin ulcers, deep wound infections, h. pylori and parasites high doses can be neurotoxic

clindamycin

effective against both gram- and gram + most serious side effect is pseudomembranous colitis

hepatitis b

egerix-b, recombivax HB children IM first dose at birth, second dose 1-2 months after the first, third dose 9-18 months after the first

horny goat weed

enhance sexual function

ionizing radiation

enough energy to dislodge electrons from atoms, forming ions; capable of causing cancer (gamma, X-rays, UV)

Bactericidial

kills bacteria

bactericidal

kills bacterial cells

kg

kilograms

The patient has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. The nurse will provide which of the following instructions?

limit use of this spray to 5 days or less

Liq

liquid

third gen cephalosporins

longer duration of action and more used for beta-lactamase producing bacteria choice of drugs against pseudomonas, klebsiella, neisseria, salmonella, proteus, and hemophilus influenzae

second gen cephalosporins

more potent than first gen more resistant to beta-lactamase producing bacteria broader spectrum than first gen

salmonella

most common cause of food poisoning

fluroquinolone ADRs

most common: nausea, vomiting, and diarrhea also dysrhythmias, hepatotoxicity, CNS effects, cartilage toxicity, tendonitis, tendon rupture (higher risk over age 60)

first gen cephalosporins

most effective against gram+ including strep and staph beta-lactamase producing bacteria are resistant cefazolin (ancef) is prototype

Plasma cells

mostly cloned b-cells -primary function is to secrete antibodies specific to the antigen that initiated the challenge

Diffusion or passive transport

movement of a chemical from an area of higher concentration to an area of lower concentration

acquired resistance

mutations occur during bacterial cellular division d/t rapid replication, some are random, some spontaneous drug resistance

rotavirus

rotarix or rotateq PO 3 doses at ages 2 months, 4 months, and 6 months (rotarix doesnt require dose at 6 months)

macrolides

safe alternative to pcn inhibit protein synthesis in the bacterial ribosome (bacteriostatic) effective against most gram+ and some gram- suffix thromycin erythromycin is prototype

superficial mycoses

scalp, skin, nails, and mucous membranes (mouth, vagina)

Second generation H1 receptor antagonists tend to have less_______

sedative effects. *but should still use alcohol with caution

SQ

subcutaneous

Primary goal of antibiotics

to kill the pathogen or slow growth for the immune system to effectively fight off the infection

Therapeutic goals of treating allergies rhinitis are

to prevent its occurrence and to relieve symptoms. Thus drugs used to treat allergic rhinitis may be grouped into two categories: preventers and relievers

TD

transdermal

hepatitis b

transmitted through blood and body fluids, injected drug use, sex with HBV infected person, ect vaccination for prevention no treatment 90% of infections will clear but 10% will seroconvert to active hbc infection 3 available antivirals to stop viral replication or to boost immune response but no cure

hepatitis c

transmitted through blood and body fluids, no vaccine available, more common than hbv infection viral suppression with antivirals and interferon

hepatitis a

transmitted through oral fecal route vaccination and prevention are best immunoglobulin for post exposure or prophylactically for those traveling (protection for 3 months)

saw palmetto

treatment of benign prostatic hyperplasia

TCA

tricyclic antidepressant

influenza virus

type a linked with most serious pandemics throughout history prevention through vaccination, avoidance of those with symptoms, hand washing goals are to shorten duration of symptoms (not cure) oseltamivir (tamiflu) and zanamivir (relenza)

Gram-negative bacteria

type of bacteria that don't stain, they stay red (the color of the stain) with Gram stain and have a thin cell wall with an outer membrane •Gram-negative bacteria include E. coli, Klebsiella, Pseudomonas and Salmonella

Fluroquinolones

•All are active against gram-negative, newer generations more effective against gram-positive •Bactericidal and inhibit two bacterial enzymes: DNA gyrase and topoisomerase IV •Used in: respiratory, GI, genitourinary, skin and soft tissue infections •Most are absorbed well through GI mucosa, may be administered once or twice daily Side effects/ADRs: nausea, vomiting, diarrhea most common. Dysrhythmias, hepatotoxicity, CNS effects, cartilage toxicity, tendonitis, tendon rupture (higher risk over age 60). Avoid dairy products and calcium - decreases absorption of fluoroquinolones. Most contain suffix floxacin Ciprofloxacin (Cipro) - Given PO/IV Ofloxacin (Floxin) - given PO Levofloxacin (Levaquin) - given PO/IV Gemifloxacin - given PO Moxifloxacin (Avelox) - given PO/IV, ophthalmic solution for eye infections

CLASSIFICATION OF ANTI-INFECTIVES

•Antibacterial, anti-infective, antimicrobial, and antibiotic are terms used interchangeably •More than 300 anti-infective drugs available, grouped into classes that have similar properties •Chemical classes - groups of drugs that usually have similar antibacterial properties and ADRs •Pharmacologic classes - groups of drugs that share a similar mechanism of action

Carbapenems

•Bactericidal - kill bacteria by inhibiting bacterial cell wall synthesis, resistant to destruction of beta-lactamase •Broadest spectrum of any antibiotics •Can only be given parenterally •Side effects/ADRs: diarrhea, nausea, rashes, thrombophlebitis •Used in: peritonitis, bacterial meningitis, serious abdominopelvic infections, serious skin infections, community acquired pneumonia, complicated urinary tract infections Contain the suffix penem Doripenem (Doribax) Ertapenem (Invanz) Imipenem-cilastatin (Primaxin) Meropenem (Merren)

Host Factors in disease

•Cancer, AIDS, immunosuppressive drugs, etc. will require larger amounts of antibiotics. •CNS infections are difficult to treat •Injury and inflammation can cause a decrease in circulation •Allergies •Age, pregnancy, genetics can all vary the response to an antibiotic

Herpes virus

•Family of viruses include: HSV-1, HSV-2, cytomegalovirus, varicella-zoster, Epstein Barr •Pharmacologic goals: relieve symptoms, prevent recurrences. •Patients are not cured Many have the suffix ovir Acyclovir (Zovirax) Famciclovir (Famvir) Valacyclovir (Valtrex) All are PO. Acyclovir can be given IV.

Penicillin (PCN)

•First discovered antibiotics •Have the highest incidence of all antibiotics for allergic reactions •Kill bacteria by disrupting cell walls, allowing water to move into cell, thereby killing the organism. •Gram-positive bacteria are most susceptible: streptococci, staphylococci •Diseases include pneumonia, meningitis, skin bone and joint infections, stomach infections, blood and heart valve infections, gas gangrene, tetanus, anthrax • •Chemical structure of PCN includes a beta-lactam ring. Some bacteria secrete beta-lactamase or penicillinase, that disrupts the beta-lactam ring resulting in drug infectiveness or resistance. A drug with beta-lactamase inhibition is used when beta-lactamase organisms are the cause of infection. •PCNs have the suffix cillin Penicillin G - given IM or IV Penicillin V - given PO Dicloxacillin - given PO Oxacillin - given IV Amoxicillin - given PO Amoxicillin-clavulanate (Augmentin) - given PO Ampicillin - given IM/IV/PO Piperacillin - given IM/IV Piperacillin and tazobactam (Zosyn) - give IV

Tetracyclines

•Five tetracyclines in use •Effective against gram-negative and gram-positive organisms •Have one of the broadest spectrums of any class of antibiotics •Inhibit bacterial wall synthesis by attaching to bacterial ribosomes •Some are lipid soluble and can enter CSF •Overuse has created resistance •Drugs of choice for: Rocky Mtn Spotted Fever, Typhus, Cholera, Lyme disease, Peptic Ulcers, chlamydia, and acne Nursing implications: educate patients to take with food, and to avoid calcium, iron, or milk Contain the suffix cycline Demeclocycline (Declomycin) - given PO Doxycycline (Vibramycin, other trade names) - given PO/IV Minocycline (Minocin, other trade names) - given PO/IV Tetracycline (Sumycin, other trade names) - given PO Tigecycline (Tygacil) - given IV

Mechanism of action of anti fungal drugs

•Fungal cells use a different steroid than humans in their cell membranes called ergosterol •Some of the antifungals, the azoles target ergosterol biosynthesis and the cell wall becomes leaky, allowing fungus to die •Some of the antifungals use the fungal enzymatic pathways to inhibit DNA and RNA synthesis •Systemic fungal infections often require long periods of intensive pharmacotherapy •AIDS has allowed occurrence of previously rare fungal infections (opportunistic infections), immunocompromised individuals, extensive burns, indwelling catheters, organ transplants are also susceptible.

Drugs for superficial mycoses

•Griseofulvin - may give topical or PO •Nystatin - may give PO, topical, capsule, intravaginal •Terbinafine (Lamisil) - may give PO or topical •Tolnaftate (Tinactin) - topical only S&S: drying of skin, stinging, pruritus, urticaria, contact dermatitis

NSAID

•Inhibit cyclooxygenase (COX), reducing inflammation and pain •NSAIDs have antipyretic, analgesic, and anti-inflammatory properties •Cox-1 and Cox-2 Inhibitors •Ibuprofen (Advil) •Relatively high safety margin •Low incidence of adverse effects •Available OTC

Cephalosporins

•Largest antibiotic class. •Have similar mechanism of action and pharmacologic properties of the PCNs. •Primarily used for gram-negative infections, or those who cannot tolerate PCNs. •Contain a beta-lactam ring like the PCNs •Classified by their generation: i.e. first, second, third •First generation - most effective drugs against gram-positive organisms including strep and staph. Beta-lactamase producing bacteria will be resistant. •Second generation - more potent, more resistant to beta-lactamase producing bacteria. Broader spectrum than first generation. •Third generation - longer duration of action and are used for beta-lactamase producing bacteria. Choice of drugs against: Pseudomonas, Klebsiella, Neisseria, Salmonella,Proteus, and Hemophilus influenza •Fourth and Fifth generations - can enter CNS, can be effective against MRSA •Most contain the prefix cef •First Generation: •Cefadroxil (Duricef) - given PO •Cefazolin (Ancef) - given IV/IM •Cephalexin (Keflex) - given PO •Second Generation: •Cefuroxime (Ceftin) - given PO/IM/IV •Third Generation: •Cefdinir (Omnicef) - given PO •Cefixime (Suprax) - given PO •Cefpodoxime (Vantin) - given PO •Ceftazidime (Fortaz) - given IV/IM •Ceftriaxone (Rocephin) given IV/IM •Fourth and Fifth Generations: •Cefepime (Maxipime) - given IV/IM •Ceftraoline (Teflaro) - given IV

Two important Health Care Associated Infections (HAIs)

•Methicillin resistant Staphylococcus aureus (MRSA) •Vancomycin resistant enterococci (VRE)

Antihelminthic drugs

•Parasitic worms, common in areas of poor sanitation: roundworms (nematodes), flukes (trematodes), tapeworms (cestodes) •Some attach themselves to the GI tract, skeletal muscle or organs such as the liver •Round worms are common in the Southeast US. •Most common helminthic infection in the US is Pinworms. •No resistance has been documented • Ivermectin - given PO Mebendazole - given PO Nursing Implications: •Educate immunocompromised people - highest risk •Proper shoes in Southeast US •Antibacterial medications are not effective against helminthic infections

HIV

•Pharmacologic cure is not available. •Education and prevention are the best current weapons against HIV. •Transmission of HIV from mother to baby can be reduced with medication. •Education regarding sharing needles, other drug paraphernalia, safe sex practices, tattoos, etc. •Symptom free living can be achieved through pharmacotherapy, but not a cure. •Post exposure chemoprophylaxis for occupational exposures

Prevention of HAIs

•Prevent infection if possible, stay healthy, wash hands •Immunizations are key •The right drug for the infection - culture and sensitivity of wounds, blood, etc. •Restrict antibiotics for medically necessary - providers will prescribe, but nurses can provide education •Educate patients to take their entire prescribed antibiotic as prescribed - do not stop early

Macrolides

•Safe alternatives to PCN •Inhibit protein synthesis in the bacterial ribosome, causing a bacteriostatic effect. At high doses, may be bactericidal. •Effective against most gram-positive bacteria and many gram-negative bacteria •Drugs of choice for: Pertussis, Legionnaires' disease, streptococcus, H. influenza, Listeria, Chlamydia, Neisseria, Legionella, H. pylori, C. difficile (fidaxomicin only) Most contain suffix thromycin Azithromycin (Zithromax, Zmax, Z pack) - given PO Clarithromycin (Biaxin) -given PO Erythromycin (Erythrocin) - given PO Fidaxomicin (Dificid) - given PO

Tuberculosis Drug Therapy

•TB drug therapy differs from other infections due to the mycobacteria having a cell wall resistant to anti-infective drugs •Therapy must be a minimum of 6 months to 12 months •Multi-drug resistant infection may require 24 months of therapy •A minimum of 2 to 4 or more concurrent drugs are needed to treat TB because the bacteria grows slowly and develops resistance •May be used to prevent the disease (chemoprophylaxis), for 9 months •Pyroxidine is used with isoniazid (INH) to prevent seizures, metabolic acidosis, neuropathy • Initial drug phase: 2 months of daily therapy with isoniazid, rifampin, pyrazinamide, and ethambutol 4 months of therapy with isoniazid and rifampin 2 to 3 times per week Side effects/ADRs: increased liver enzymes (AST and ALT) from hepatotoxicity. These patients must avoid ETOH! INH overdose can be fatal.

Azoles

•The largest and most versatile group of the antifungals, have broad spectrum of use •Less toxic than Amphotericin B (an older antifungal with multiple side effects) •Can be administered PO •Side effects: nausea and vomiting. Patients can not have alcohol while on azoles • Contain suffix azole Fluconazole (Diflucan) - PO, IV Clotrimazole (Lotrimin) - topical, intravaginal Itraconazole - PO Ketoconazole - PO, topical **can cause fatal drug induced hepatitis Miconazole (Monistat) - topical, intravaginal, buccal

Hepatitis C (HCV)

•Transmitted through blood and body fluids •No vaccine is available, more common than HBV infection •Viral suppression with antivirals and interferon

Hepatitis B (HBV)

•Transmitted through blood and body fluids: injected drug use, sex with HBV infected person, men who have sex with men, contaminated needle sticks, perinatal from mother to infant •Vaccination for prevention! •No treatment. 90% of infections will clear, but 10% will seroconvert to active HBV infection •3 available antivirals to stop viral replication or to boost immune response, but no cure

Hepatitis A (HAV)

•Transmitted through the oral fecal route. •Vaccination and prevention are best! •Hepatitis A immunoglobulin post exposure, or prophylactically for those travelling. Protection lasts about 3 months.

Influenza Virus

•Type A is linked with the most serious pandemics throughout history •Prevention through vaccination, avoidance of those with symptoms, handwashing! •Pharmacologic goals: shorten duration of influenza symptoms. Do not cure influenza, not effective against common cold. Oseltamivir (Tamiflu) Zanamivir (Relenza)

Aminoglycosides

•Used for aerobic gram-negative bacteria, mycobacteria and some protozoans •More toxic than other antibiotics •Bactericidal by inhibiting bacterial protein synthesis •Reserved for serious infection from: E. coli, Serratia, Proteus, Klebsiella, Pseudomonas •Can be given concurrently with PCN, cephalosporin, vancomycin for enterococcal infections •Usually given parentally, poorly absorbed from GI mucosa •Can cause ADRs, limiting their application/use Side effects/ADRs: ototoxicity (hearing loss, dizziness, loss of balance, persistent headache, ringing in ears), permanent deafness, nephrotoxicity (usually reversible) Most contain suffix mycin Gentamicin - given IV/IM Kanamycin - given IV/IM Neomycin - given PO Streptomycin - given IM, usually reserved for Tuberculosis Tobramycin - given IV/IM, ophthalmic preparation for eye infections

Sulfonamides

•Wide spectrum against gram-positive and gram-negative bacteria •Bacteriostatic by suppressing growth through the inhibition of folic acid synthesis in the bacteria •Many patient's have sulfa allergies, and cannot use this class •Side effects/ADRs: formation of urinary crystals, hypersensitivity, nausea, vomiting, fatal blood abnormalities, acute hemolytic anemia, agranulocytosis (a severe reduction in leukocytes) •Used in: urinary tract infections, Pneumocystis carnii pneumonia, Shigella, small bowel infections, chronic bronchitis • Some contain the prefix sulfa Sulfadizine - given PO Sulfadoxine-pyrimethamine- given PO Trimethoprim-sulfamethoxazole (TMP-SMZ, aka Bactrim) - given PO or IV Fosfomycin - given PO for urinary infections Nitrofurantoin (Macrobid, Macrodantin) - given PO for urinary infections Silver sulfadiazine - topical for burns

Metronidazole (Flagyl)

•effective against anaerobes that cause abscess, gangrene, diabetic skin ulcers, deep wound infections, H. pylori. Also effective against parasites. •High doses can be neurotoxic.

Clindamycin

•effective against both gram-negative and gram-positive. •Most serious side effect is pseudomembranous colitis