Pharmacology III final exam

The HCP prescribes phenobarbital sodium for a client who has had a tonic-clonic SZ. What statement indicates to the nurse that the client understands the side effects of phenobarbital? (SAP)

" I can expect a loss of appetite or persistent fatigue" "I might feel lightheaded or off balance" "I should be aware of becoming depressed" rationale: phenobarbital depresses the CNS, particularity the motor cortex, producing side effects such as lethargy, loss of appetite, and vertigo. It also depresses the CNS, particularly the motor cortex, producing side effects such as depression

medication counseling/teaching for pregnant or breastfeeding client

1-5 categories with breast feeding 5 being the worst (contraindicated) -1=safest -2=safer -3=moderate safe -4= possibly hazardous -5= contraindicated Counsel mother not to take herbal supplements because they are not regulated by the FDA

Warfarin (coumadin): mechanism of action, use, administration, adverse effects, contraindications, monitoring dosage and accuracy, antidotes

A vitamin K Antagonist Mechanism of action: prevents conversion of vitamin K, thereby decreasing its production in liver and subsequently reducing several clotting factors (II,VII,IX and X) -oral anticoagulant= inhibits activity of vitamin K required for the synthesis of clotting factors Use: tx of DVT, PE, acute MI, heart valve replacement , afib Administration: -delayed onset, not for emergency use -Full anticoagulant effect is seen at approximately 1 week; thus drug may be started during heparin therapy and overlap while heparin is tapered -given during evening based on lab results during the day -therapy can last severy months to lifelong depending on need OD: vitamin K (if life-threatening bleeding occurs, give IM or subQ) Monitoring: -drug levels= (1-10) -Prothrombin time (PT)= (1.5-2.5 times control value) International normalized ratio (INR)= (2-3) Contraindicated: -pregnancy (cat X) (may be given during breastfeeding) -hemorrhage or bleeding tendencies -HTN -hx of allergic reaction -bacterial endocarditis -severe hepatic or renal impairment Adverse effects: -bleeding -thrombocytopenia -nause, diarrhea, intestinal obstruction, anorexia abdominal cramping -rash urticaria, purple toe syndrome (due to decreased perfusion from release microemboli) -hepatitis, jaundice -Burning sensation in feet -transient hair loss Nursing considerations: -vitamin K diet -bleeding precautions

Priority treatment for acute pancreatitis vs chronic pancreatitis and patient teaching

Acute: -Hydration (aggressive) -Pain -NPO -H2 receptor blocker -PPI Chronic: -Antiemetics -insulin -pancreatic enzyme supplementation *Pancrelipase (creon)- pork origin, dissolves in an alkaline enviornment (duodenum) *breaks down fats, protien and carbs *symptoms of insufficiency 1. bloating and distention 2. foul smelling stool 3. cramping and diarrhea following meals 4.weight loss * kids with CF cannot give as capsule

Heparin: mechanism of action, use, administration, adverse effects, contraindications, monitoring dosage and accuracy, antidotes

Anticoagulant (parenteral)-Indirect Thrombin inhibitor-unfractionated heparin Mechanism of action: prolong coagulation- preventing excess clotting, prevents enlargement of existing clots, DOES NOT DISSOLVE EXISTING CLOTS Use: prevent thromboembolic events arising from open heart and vascular surgery, dialysis procedures, or pts with unstable angina or in acute stage of MI; DVT and PE (higher dose) Administration: -Immediate onset (IV) -1 hour onset (subQ) -poorly absorbed by GI mucosa because of rapid metabolism by hepatic enzyme heparinase-> must be given either SubQ or IV bolus injection/continuous infusion -IM contraindicated d/t bleeding risk -Pregnancy category C Adverse effects: -Abnormal bleeding -Heparin induced thrombocytopenia (HIT) = s/s appear after 5-10 days, INCREASE in excessive adverse thromboembolic events Monitoring: -aPTT (25-40) -free fatty acids -AST an ALT -Serum cholesterol (under 200) and triglycerides decreased BB warning: Epidural or spinal hematomas may occur = long-term or permanent paralysis (frequent neuo impairment monitoring) Contraindicated: -active internal bleeding -bleeding disorders -HTN -Trauma -Intracranial hemorrhage -bacterial endocarditis OD: Protamine sulfate (IV)- 5 min onset

Clopidogrel (Plavix): mechanism of action, use, administration, adverse effects, contraindications, monitoring dosage and accuracy, antidotes

Antiplatelet-ADP receptor blocker Mechanism of action: prolongs bleeding time by inhibiting platelet aggregation, directly inhibiting ADP binding to its receptor. This binding is IRREVERSIBLE and the platelet will be affected for the remainder of its life span Use: a form of secondary prevention for clients who have had MI, stroke, and peripheral arterial disease; prevention of thromboembolic events in pts with a hx of MI, stroke, or PAD; thrombi prophylaxis; when aspirin is not tolerated Administration: -PO -Tablets SHOULD NOT be crushed or split -Discontinue drug AT LEAST 5 DAYS PRIOR SURGERY -pregnancy catergory B -delayed onset -no reversing agent Adverse effects: flulike symptoms, h/a,dizziness, chest pain, edema, HTN, bruising, rash, pruritus, bleeding BB warning: -effect dependent on its metabolic activation by CYP 450 enzymes, poor metabolizers WILL EXHIBIT LESS THERAPUETIC EFFECT AND MORE ADVERSE CARDIOVASCULAR EVENTS Contraindications: -pts with active bleeding -with NSAIDS (aspirin) Monitoring: -prolongs bleeding time (PT) OD: platelet transfusions may be necessary to prevent hemorrhage

Phenobarbital (Luminal) :administration and alerts, teaching, lab monitoring

Antiseizure, barbiturate- treats all forms of epilepsy by decreasing impulse transmission of cerebral cortex Administration: -If prescribed by IM route, inject into large muscle mass to prevent tissue sloughing; use less than 5mL/site -when prescribed IV, give slowly (after dilution) per protocol Alerts: -parental is a soft-tissue irritant. IM may produce a local inflammatory reaction. IV is rarely used because of extravasation may produce tissue necrosis -controlled substance schedule IV -pregnancy category D Teaching: -avoid use of other CNS depressants; carry Medic-Alert bracelet stating medication use - Avoid hazardous activities until stabilized on drug; drowsiness may occur -therapeutic effects may not be seen for 2-3 weeks Lab monitoring: -Liver function test -bromsulphalein test -increase serum phosphatase (2.5-4.5)

Valporic Acid (Depakene): administration and alerts, teaching, lab monitoring

Antiseizure- treats by reducing or eliminating seizure activity Administration: -Don't crush delayed- or extended-release tablets - Give drug with food or milk to reduce adverse GI effects -Don't mix syrup with carbonated beverages; mixture may be irritating to oral mucosa Alerts: -Is a GI irritant -Do not chew extended release tablets -Do not take with soda -Pregnancy category D -BB warning= liver failure and pancreatitis, may result in fatal hepatic failure especially in children under the age of 2 years. Nonspecific symptoms often precede hepatic toxicity (weakness, facial edema, anorexia, and vomiting). Can produce life-threatening pancreatitis and teratogenic effects including spina bifida -Alcohol and other CNS depressants potentiate CNS action Teaching: -Avoid abrupt discontinuation of antiepileptic drugs, which would lead to return of seizure activity and possible status epilepticus -Warn patients and caregivers that abdominal pain, nausea, vomiting, and anorexia can be symptoms of pancreatitis that require prompt medical evaluation -Advise patient to avoid driving and other potentially hazardous activities that require mental alertness until drug's CNS effects are known Lab monitoring: -CBC -Liver function (performed prior to tx and at specific intrevals during the first 6 months of tx) -Renal function -May increase eosinophil count and bleeding time. May decrease platelet, RBC, and WBC count

A client with a history of seizures is scheduled for an arteriogram at 10am and is to be NPO before the test. The client is scheduled to receive a daily prescribed dose of phenytoin at 9AM. What action should the nurse take regarding this situation?

Ask the prescriber if the drug can be given IV rationale: the therapeutic blood levels of the antiepileptic need to be maintained. The nurse should question the prescriber about alternate routes of administration.

Diazepam (Valium): administration and alerts, teaching, lab monitoring

Benzodiazepine- treats status epilepticus by enhancing inhibitory neurotransmitter GABA to decrease anxiety and only as an adjunct for SZ activity Administration: -give with food or milk to reduce GI symptoms; give IV injection into large vein -Can lead to dependency; monitor client's use Alerts: -pregnancy category D -Monitor respiration when giving IV (every 5 to 15 minutes, have airway and resuscitative equipment accessible) -Don't withdraw drug abruptly after long-term use because withdrawal symptoms may occur; taper gradually Teaching: -Avoid alcohol, OTC drugs, and herbal medications -Avoid nicotine -Avoid driving and hazardous activities; drowsiness may occur -Rebound seizures if discontinued abruptly -Take with food -Dug often used illegally Lab monitoring: -Hepatic and renal function (AST, ALT, bilirubin, creatinine (0.6-1.2), high-density lipoprotien) -alkaline phosphatase -May decrease neutrophil count (1.5-8.0) OD: give flumazenil (s/s-Somnolence, confusion, coma, diminished reflexes) Black box warning: -Opioids use: May cause slow or difficult breathing, sedation, and death. Avoid use together. -Alcohol use: May cause additive CNS effects. Don't use together

A client is receiving thrombolytic therapy. The nurse monitors the client for which potential problems? (SAP)

Bruising, Hematuria, Hypotension rationale: the client receiving thrombolytic therapy should be monitored closely for skin bruising, which can be an indication of bleeding. Urine should be monitored for the presence of occult or obvious bleed, indications of hemorrhage or bleeding. When on thrombolytic therapy the clients BP should be monitored for dose related or hemorrhage related hypotension

Phosphate binders: nursing role, rationale, POC/teaching

Calcium carbonate, calcium acetate, sevelamer (used when dietary restriction are not enough) Hyperphosphatemia -for kidney failure (CKD) Dietary management (restrictions): -protein -sodium -phosphorus -magnesium -potassium need to be taken with meals to bind to the phosphorus (w/ high phosphorus snack )

A client is in the intensive care unit following a serious closed head injury. Mannitol is administered to decrease developing intracranial pressure. What is the priority manifestation the nurse should assess for after the drug is given?

Cardiovascular collapse Rationale: mannitol is an osmotic diuretic and cardiovascular collapse can occur because of the amount of fluid that can be lost. This life-threatening adverse effect should be the nurse's priority concern

A client has a new order to receive vancomycin to treat a systemic infection. The nurse anticipates the prescription would indicate which route for optimal administration?

Central venous access rationale: vancomycin can cause thrombophlebitis; the best route of administration is with central IV where the drug will be diluted enough to lessen irritation to the vein. Peripheral IV administration increases the risk of thrombophlebitis from irritating effects of the drug. IM is contraindicated. Vancomycin is not absorbed in the GI tract, so the oral route is used to treat Cdiff

Epoetin Alfa (Epogen, Procrit)

Erythropoietin Use: for pts with chronic renal failure who often cannot secrete enough endogenous erythropoietin and benefit from epoetin alfa administration (kidney failure) ; pts undergoing cancer chemotherapyto counteract anemia caused by antineoplastic drugs; for pts prior to blood transfusion or surger and to treat anemia in pts infect w/ HIV administration: -SubQ -do not shake vial (deactivates drug) -visibly inspect solution adverse effects: -HTN -h/a -fever -nausea -diarrhea -edema BB warning: -risk of serious cardiovascular and thromboembolic events is increased with epoetin alfa therapy (TIA,MI, strokes in pts with CKD undergoing dialysis)-BEFAST Contraindications: -can promote tumor progression (low doses prescribed) -HTN -hypersentivity to mammalian cell products -Myeloid malignancies Considerations: -ensure client has adequate intake of iron, folic acid and vitamin B12 (will have poor response with deficiencies)

Which medication does the nurse anticipate will be used for a pregnant client who requires anti coagulation therapy?

Heparin rationale: heparin is the drug of choice in pregnancy. LMWH are not recommended for use during pregnancy

Phenytoin (Dilantin): administration and alerts, teaching, lab monitoring

Hydantoin- treats general tonic-clonic seizures, status epilepticus, and psychomotor seizures (complex focal)by inhibiting the spread of seizure activity in motor cortex Administration: -do not interchange chewable products with capsules -readily binds with protein, so do not give with gastric feedings, which inhibit uptake -contraindicated with hypersensitivity, pregnancy, bradycardia, SA and AV node block, Stokes-Adams syndrome, hepatic failure -Iv administered slowly (hypotension and cardiac arrythmias; CV toxicity may increase with infusion rates above those recommended. Toxicity has also been reported at or below the recommended infusion rate. Reduction in administration rate or discontinuation of dosing may be needed) Alerts: -IV= rune with saline only, may cause precipitate with other meds or dextrose -is a tissue irritant -avoid using hand veins = may cause vasoconstriction (purple glove syndrome) Adverse effects- BB (dysrhythmias), confusion, peripheral neuropathy with long term use, blood dyscrasias, gingival hypertrophy (teach good oral hygiene) Teaching: -carry Medic-Alert bracelet stating medication use -Urine may turn pink or red-brown but this is expected -Perform proper brushing of teeth with soft toothbrush and proper flossing to prevent gingival hyperplasia; maintain routine or more frequent dental exams -Do not change brand of medication once seizure activity has stabilized; bioavailability differs among formulations -Immediately report signs of toxicity, unusual bleeding, signs of liver or brain disease, heart block, hypoglycemia, or pregnancy Lab monitoring: -Cardiovascular status -CBC with differential -platelet count (150-440) -Liver function and kidney test -calcium (4.5- 5.5) and magnesium (1.5-2.5) -blood glucose Therapeutic Drug Monitoring 1. to confirm therapeutic dosing (effective concentrations) 2. To monitor for toxicity (or avoid) 3. To investigate lack of efficacy (compliance)

A client is taking warfarin for atrial fibrillation. The nurse would include in a teaching plan that the client will need to remain on drug therapy for what period of time?

Indefinite, or long-term rationale: clients who have afib are at risk to develop an emboli. Therapy with warfarin is considered to be ongoing in nature, in order to prevent such an occurrence.

Mechanism of action and adverse effects for anticoagulants

Inhibit clotting mechanism-prevent progression of thrombosis (DOES NOT DISSOLVE EXISTING CLOTS) Side effects -most serious= bleeding (assess internal bleeding and monitor CBC, lumbar pain, abdominal bulging, guaiac tests on stool) Essential for patient safety to assess coagulation studies Bleeding risk increases during transition from heparin to warfarin -do not give warfarin to pregnant pt -heaparin, LMWH can be given to pregnant pts -monitor intake of vitamin K- rich foods; limit intake of garlic

Mechanism of action and adverse effects for anti platelets

Interfere with platelet aggregation- prevent clot formation (to alter the plasma membrane of platelets so they CANNOT aggregate) Use: to prevent thrombi formation after stroke or MI prolong bleeding time by interfering with aggregation of platelets

When caring for a client who is receiving phenytoin, the nurse emphasizes meticulous (detailed) oral hygiene to the client. This nurse intervention is based on the nurse's knowledge that phenytoin has what effect on oral tissue?

It causes hyperplasia of the gums rationale: gingival hyperplasia (overgrowth of gum tissue) is an adverse effect of long- term phenytoin therapy

Enoxaparin (Lovenox): mechanism of action, use, administration, adverse effects, contraindications, monitoring dosage and accuracy, antidotes

Low molecular weight heparin Mechanism of action: keeps clot from getting bigger Use: DVT and PE prophylaxis Administration: -higher bioavailability when compared to standard UFH -SQ -Do not massage after injection -rotate injection sites Adverse effects: -Hemorrhage -thrombocytopenia -angioedema Contraindications: -Hemorrhage -NSAIDs Benefit: -duration is 2-4x longer -more stable response, less follow up labs -inpatient or outpatient

Diuretic therapy: monitoring and teaching

Monitor for fluid overload by measuring intake, output, and daily weights. (Intake, output, and daily body weight are indications of the effectiveness of diuretic therapy Monitor laboratory values, especially potassium and sodium. (Diuretics can cause electrolyte imbalances.) Monitor vital signs, especially blood pressure. (Diuretics reduce blood volume, resulting in lowered blood pressure.) Observe for changes in level of consciousness, dizziness, fatigue, and postural hypotension. (Reduction in blood volume due to diuretic therapy may produce changes in level of consciousness or syncope.) Monitor potassium intake. (Potassium is vital to maintaining proper electrolyte balance and can become depleted with thiazide or loop diuretics.) Observe for signs of hypersensitivity reaction. (Allergic responses may be life threatening.) Monitor hearing and vision. (Loop diuretics are ototoxic. Thiazide diuretics increase serum digoxin levels; elevated levels produce visual changes.) Teaching: ■ Limit exposure to the ■ Wear dark glasses and light-colored loose-fitting clothes when outdoors.

Mannitol: action and uses; nursing care

Osmotic diuretic Action: Increase osmotic pressure of glomerular filtrate in proximal tubule and loop of Henle inhibiting reabsorption of water and electrolytes, thus promoting diuresis; draws water out of brain by an osmotic gradient and helps to decrease blood viscosity = decreased ICP and increased CBF Use: to decrease intracranial or intraocular pressure due to cerebral edema; used with chemotherapy to cause diuresis Nursing care: -administered IV by slow infusion -do not infuse with blood or blood products -crystallizes at low temperature -maintain adequate hydration -monitor fluid and electrolyte balance, daily weight -indwelling catheter should be used in comatose pts for accurate I&O -monitor I&O and VS hourly -Monitor renal function (BUN, creatinine), fluid balance, serum and urinary sodium and potassium levels -assess for signs of decreasing intracranial pressure -monitor lung and heart sounds for signs of pulmonary edema -To relieve thirst, give frequent mouth care or fluids --------------------- •An increase in intracranial pressure can reduce cerebral perfusion pressure and lead to ischemia - BAD •Increased pressure within the brain can lead to tissue shifts - that can lead to herniation - VERY BAD

The client receiving phenytoin asks the nurse why the HCP has prescribed folic acid with this medication. The nurse's response would be based on which item of information?

Phenytoin inhibits the absorption of folic acid from foods rationale: phenytoin inhibits folic acid absorption and potentiates effects of folic acid antagonists.

Warfarin patient teaching

Rationale/Physiology: definition of oral anticoagulants, MOA and clinical indication Medication: dose, schedule, storage, duration of tx Monitoring of anticoagulation: meaning of INR (2.5-3.5) and normal value expected for each indication, collection period and consultations Using other drugs: interaction with allopathic medicines and those considered "natural" Meals: Intake of food rich in vitamin K and fats Alcoholic beverages: Avoid drinking alcohol, if it occurs, do not stop taking the oral anticoagulant Pregnancy: need to start anticoagulant for injection Activities: In physical, domestic or labor activities use protective measures Health care: Alert about oral anticoagulant to another professional and take the INR value card Traveling: take the oral anticoagulant and plan to perform the INR outside of your healthcare facility

Thromboembolic disorders that are indicators for anticoagulants

Red thrombi are venous -> vein White are arterial -arterial will cause tissue ishemia as seen with MI and Stroke (embolism which is moving clot can travel from the right atrium cause a PE or left atrium causing a stroke) -platelets are the main cellular components -> form in arterial system -Afib, TIA, stroke in evolution Venous thrombi occur with sluggish blood flow -DVT, PE, prophylaxis for DVT or PE

A client is brought to the emergency department in the midst of a persistent tonic-clonic seizure. Diazepam is administered intravenously. The nurse anticipates the in addition to decreasing central neuronal activity, what other effects of diazepam will occur

Relaxation of peripheral muscles rationale: Diazepam is a benzodiazepene tranquilizer and an anticonvulsant used to relax smooth muscles during seizures.

Ethosuximide: administration and alerts, teaching, lab monitoring

Succinimide- Preferred drug for absence SZ by Inhibit spike and wave formation in absence seizures Administration: -give with food or milk to decrease GI symptoms -Contraindicated with hypersensitivity Alerts: -Do not abruptly stop (may induce SZ) -Adverse effects= impaired mental and physical abilities (extreme mood swings and suicidal intent) Teaching: -Carry ID card or Medic-Alert bracelet with medication, client's name, HCP name, and phone number -Avoid driving and other activities that require alertness -Avoid alcohol ingestion and other CNS depressants because they may increase sedation Lab monitoring: -Periodic renal tests (urinalysis, BUN (10-20), creatinine) -CBC -Liver function test

Folic acid (Folvite)

Thalassemia; megablatic anemia found primarily in fresh green vegetables, dried beans, wheat products adverse effects: -rare -warmth or flushing during IV use -Irritability -depression -loss of appetite -nausea -dyspnea -itching -rash monitoring: -bright yellow urine Contraindicated: -pregnancy (neural birth defects-spina bifida)

AlteplASE (activase): mechanism of action, use, administration, adverse effects, contraindications, monitoring dosage and accuracy, antidotes

Thrombolytic Mechanism of action: converts plasminogen to plasmine which then dissolves fibrin clots; to dissolve clots Use: first line therapy for ischemic stroke, tx of stroke d/t thrombus; off label to restore the patency of IV catheters Administration: -must be given within 12 hours of onset of symptoms of MI and within 3HRS OF THROMBOTIC STROKE for maximum effectiveness -avoid parenteral injections during infusion to decrease risk of bleeding -pregnancy category C Adverse effects: -bleeding (most common) (s/s = spontaneous ecchymoses,hematomas, epistaxis should be reported immediately!) -intracranial bleeding (rare) Contraindications: -hx of HTN and stroke -head injury -Surgery -active bleeding -recent LP within (1 wk) -pregnancy -active peptic ulcer -pericarditis or pericardial fluid -current use of anticoagulant, NSAIDS (aspirin) -over 75 yrs -diabetic retinopathy -tumor -av malformation Monitoring: -Increases PT (10-20s) and PTT (20-45) OD: no specific tx

HIV PrEp

Truvada -90 days oral -do oral/rectal STD testing -assess pregnancy intent; pregnancy test every 3 months -access to clean needles/syringes and drug treatment services

Ferrous sulfate (feosol): use, monitoring, teaching, administration, adverse effects, contraindications, OD

Use: iron supplement for anemia Monitoring: -H&H -low calcium -high bilirubin Administration: - IV= assess infiltration -highly irritating to tissue-> use Z-track method for IM -do not give tablets within 1 hour of bedtime -administered 1 before or 2 hours after meal -no dairy products -OJ or strawberries Adverse effects: -GI upset (give with meals to prevent this but will reduce absorption) -constipation BB warning: non intentional OD of iron-containing products are a leading cause of fatal poisoning in children!!! Contraindications: -hemolytic anemia -peptic ulcer -regional enteritis -UC Patient teaching: -proper self administration of oral iron medications -importance of adequate food sources to maintain iron levels; these include lean meats, liver, egg yolks, dried beans, green vegetables (spinach) -Expected changes in characteristics of stool (black,tarry) -will stain teethso take this with a straw -increase dietary fiber for constipation OD: deferoxamine (deseral)- turns urine brown reddish color

Cynaocobalmin (Nascobal): use, monitoring, teaching, administration, adverse effects, contraindications

Use: vitamin B12 deficiency anemia (pernicious anemia) -found in animal origin foods (liver ,meat, shellfish, dairy food items) -maintenance therapy after normal levels are restored by parenteral preparations Administration: -intranasal spray -parenteral = rapidly reverses s/s of B12 deficiency days-weeks -PO = mixed with fruit juices, administer quickly because ascorbic acid affects stability of vitamin B12 Adverse effects: -uncommon -hypokalemia -arthralgia -dizziness -h/a -anaphylaxis (rare) Contraindications: -sensitivity to cobalt and folic acid-deficiency anemia -severe pulmonary disease -cautiously used with heart disease pts (sodium retention)

Sodium bicarbonate

Used to correct metabolic acidosis bicarb will act as a base to neutralize acids monitor closely for overcorrection -> metabolic alkalosis give 2-3 hours before or after meals and other medications OD: acidic agent

Vitamin B12 Deficiency (pernicious)

Usually due to poor absorption -------------------- Mental problems -brain fog -Alzheimer and dementia symptoms of low B12 Fatigue -most classic symptom Hair problems -thinning hair and grey hair Blood disorders -elevated MCV Infertility -male and female Chronic pain -fibromyalgia -back pain -neuropathy ------------------- Intrinsic factor -protein secreted by stomach cells -required for VB12 metabolism -lack of it -> VB12 deficiency ( inflammatory disease of stomach, surgical removal of stomach, strict vegetarian diet)

Vancomycin: mechanism of action, use, administration, adverse effects, contraindications, monitoring (peak/trough)

bactericidal; parental antibiotic of choice for MRSA and C-diff Mechanism of action: interferes with cell wall synthesis and exhibits bactericidal and bacteriostatic effects Use: gram positive infection and staphylococcus infection (septicemia, bone infections, lower respiratory tract infections) -Cdiff -Endocarditis Administration: -IV= should be through a central venous access device (CVAD) because of high risk of phlebitis; can cause necrosis if it extravastes; red man syndrome (infusion related to rapid infusion over 1 hour, sign appear within min of starting or shortly, rapid infusion can lead to angioedema and hypotension) -PO=poorly absorbed from GI tract so indicated for local surface-infects areas of GI tract -monitor closely when administered with other nephrotoxic/ototoxic medications Adverse effects: -nephrotoxcity -Ototoxicity -nausea, hypotension, flushing -pain and thrombophlebitis at injection site -temporary leukopenia -red neck (or man) syndrome Contraindications/close monitoring -severe or invasive infection -critical illness -impaired or unstable renal function -Morbid obesity (body mass greater than or equal to 40 kg/m) -advanced age -inadequate response to therapy after three to five days Monitoring: -trough= Obtaining vancomycin serum trough concentrations allows healthcare professionals to evaluate the efficacy of the vancomycin dosing regimen and clearance of the drug by the individual patient (10-20) *Serum trough concentrations should ideally be drawn immediately (30 minutes or less) prior to administration of a dose at steady-state conditions *Typically, steady-state is achieved after the third dose of vancomycin -Serial tests of vancomycin blood levels (peak and trough) in pts with borderline kidney function, in infants and neonates, and pts older than 60 -Urinalysis -Kidney and liver functions -Hemtaologic studies Nursing considerations: -Assess hearing (damage of either cranial nerve that can cause deafness) (serum levels of 60-80 = ototoxicity -> tinnitus ,high tone hearing loss, deafness) -Monitor I&O (report changes in I&O ratio and pattern -> oliguria or cloudy or pink urine, high BUN, albumin, and hyaline and granular casts in urine = nephrotoxocity) -monitor BP and HR

A client is receiving mannitol. The nurse assesses the client for evidence of which clinical problem, for which the client is at risk?

dehydration rationale: the client receiving mannitol should be assessed for dehydration because the medication is an osmotic diuretic.

Antibiotic therapy interventions

monitor VS and s/s of infection to determine antibacterial effectiveness Monitor for hypersensitivity reaction (immediate may occur 2-30 min, accelerated in 1-72 hours and delayed after 72 hours) Monitor for severe diarrhea (superinfection) Administering around the clock Monitor for superinfection (elderly, immunosuppressed) Monitor intake of OTC products (antacids, calcium supplements, iron products, laxatives with magnesium )

Iron deficiency

most common cause of nutritional anemia can be successfully treated with iron supplements caused by: -GI malignancies or chronic peptic ulcer disease -blood losses during menses and pregnancy

Mechanism of action and adverse effects for fibronolytic medications

removal of blood clots initiated within 24-48 hours after clot formation and continues until clot is dissolved blood vessel secretes tissue plasminogen activator- which activates the process of clot breakdown

Life-threatening reactions of antiseizure medications

severe mental depression with suicidal intent Less common: bone marrow suppression and blood dyscrasias