Antibiotics and Respiratory Pharmacology
Which instruction would the nurse include for a patient who will be using an expectorant?
"Increase your fluid intake to decrease viscosity of secretions."
Which medication order does the nurse anticipate for a patient diagnosed with herpes simplex type 1?
Acyclovir
Drugs for Herpes Virus Infections
Acyclovir - zovirax ´Herpes Labialis (Herpes simplex virus 1 or HSV-1) cold sores on the lips ´Varicella - chicken pox ´Herpes zoster - shingles ´Genital herpes - (Herpes simplex virus 2 or HSV-2) Famciclovir - Famvir ´Herpes zoster and genital herpes Valacyclovir - Valtrex ´Herpes labialis, zoster, recurrent genital herpes Famvir and Valtrex need titration with impaired renal function
clinical teaching for anti-tussives
Adverse effects: Headache, Sedation, Nausea, Constipation, Pruritis, Nasal congestion Opioids can depress respirations and constipation, dry mouth Opioids potentially addictive Often combined with decongestants and/or antihistamines
The nurse would instruct a patient to avoid caffeine and stimulants when the individual is using which medication?
Albuterol
A patient with chronic obstructive pulmonary disorder (COPD) is retaining carbon dioxide. Which respiratory therapy would the nurse administer to lower the patient's carbon dioxide concentration?
Albuterol nebulizer
Beta-Adrenergic Agonists Adverse Effects
Alpha and beta (epinephrine)- Insomnia, Restlessness, Anorexia, Vascular headache, Hyperglycemia, Tremor, Cardiac stimulation ( tachycardia) Beta1 and beta2 (metaproterenol) - Cardiac stimulation, Tremor, Anginal pain, Vascular headache, Hypotension Beta2 (albuterol)- Hypotension OR hypertension, Vascular headache, Tremor
Bactericidal agents that treat: gram negative organisms (Proteus, Klebsiella, Enterobacter, Escherichia coli, Pseudomonas Mechanism of action: Penetrate cell walls of susceptible bacteria and bind to 30S ribosomes, Bottom line—prevent protein synthesis and replication. Effective against: Gram-negative bacteria, Pseudomonas, Acinetobacter, and Enterobacter, Some Mycobacteria, including the bacteria that cause tuberculosis, are susceptible to aminoglycosides. Uses: Complicated intra-abdominal infections, Complicated urinary tract infections, Nosocomial respiratory tract infections, Sepsis Routes: IV and IM
Aminoglycosides
The nurse is caring for a patient who is receiving epinephrine for status asthmaticus. The nurse finds that symptoms of status asthmaticus are persistent, even after administration of epinephrine. Which medication will the primary health care provider prescribe for this patient?
Aminophylline
Used for specific gram-positive and gram-negative bacteria ´Respiratory tract infections ´Urinary tract infections ´Meningitis ´Endocarditis May also be used to prevent group B streptococcal infection in newborns Routes: Oral, IM or IV Side effects ´Most common? Mild rash and diarrhea ´Less common? Nausea, vomiting, itching Best tolerated antibiotic by clients.
Ampicillin
Ipratropium bromide (Atrovent) and tiotropium (Spiriva) Slow and prolonged action Used to prevent bronchoconstriction NOT used for acute asthma exacerbations
Anticholinergics
Used for the treatment of: ´Dermatophytes - need keratin for growth ´tinea capitis, tinea pedis, tinea cruris, tinea corporis Examples of fungal diseases ´Candida albicans - most common (thrush, vaginitis) ´Aspergillosis - fungal respiratory infection ´Cryptococcus ´most prominent medically important species ´causes a severe form of meningitis Histoplasmosis B ´Airborne fungi from bird or bat droppings
Antifungals
ALLERGIC REACTION work by blocking the histamine receptors on the surfaces of basophils and mast cells, thereby preventing the release and actions of histamine stored within these cells. They are most beneficial when given early in a histamine-mediated reaction Actions- Relaxation of smooth muscle: bronchodilation, Reduction in salivary, lacrimal and bronchial secretions, Decreased pruritis (itching), Decreased venous congestion
Antihistamine
Which drug is indicated by the following? Nasal Allergies Seasonal and Perennial Allergic Rhinitis Allergic Reactions Motion Sickness Parkinson's Disease Vertigo Sleep
Antihistamines
The nurse observes a mild cough in a patient after hernia repair. Which medication would the nurse expect the provider to prescribe for this patient?
Antitussive
Viruses have uncertain evolutionary origin Appear to have evolved independently E.g. influenza (RNA) vs. Herpes Competitive exclusionary principle Viruses can't occupy same niche Even related Herpes viruses are different Specific drugs for specific viruses
Antivirals
´Indications for Usage: Anti-platelet dosage, Cardiac dosing: 81-325 mg daily, Anti-pyretic, Anti-inflammatory, Mild to moderate pain ´Routes: PO, rectal, topical
Aspirin
A patient with type 2 diabetes mellitus is started on sulfamethoxazole/trimethoprim. Which nursing intervention is a necessary priority for this patient?
Assess blood sugar.
A patient is prescribed theophylline for the treatment of chronic bronchitis. Which instruction would the nurse give to the patient for safe administration of theophylline?
Avoid intake of a high-protein diet."
What is the chief complaint of those who use antihistamines?
Drowsiness
Contraindications and drug to drug interactions for macrolides
Drug to drug interactions: ´Warfarin - Coumadin ´Theophylline - TheoDur ´Prednisone - Deltasone ´Digoxin - Lanoxin ´Carbamazepine - Tegretol ´Bromocriptine - Parlodel Contraindicated in the following: ´Hepatic disease ´Hypersensitivity to drug
What are the adverse effects of anticholinergics?
Dry mouth or throat Nasal congestion Heart palpitations Gastrointestinal distress Headache Coughing Anxiety
A patient who is prescribed intravenous vancomycin reports frequent ringing in the ears. Which condition would the nurse suspect?
Early vestibular damage
based on experience and, more specifically, therapy begun on the basis of a clinical educated guess in the absence of complete or perfect information.
Empiric Therapy
Nursing implications for LTRAs
Ensure that the drug is being used for chronic management of asthma, not acute asthma; Teach the client the purpose of the therapy; Improvement should be seen in about 1 week; Advise clients to check with prescriber before taking over-the-counter or prescribed medications to determine drug interactions; Assess liver function before beginning therapy and throughout; Teach client to take medications every night on a continuous schedule, even if symptoms improve
The patient has been diagnosed with Legionnaires' disease. Which drug does the nurse anticipate the health care provider will order?
Erythromycin
•Decrease viscosity of secretions •Uses for: Aid in expectoration (coughing up and spitting out) secretions •Found in most OTC cough/cold preparations
Expectorants/ mucolytics
´Released in allergic and/or inflammatory reactions ´Immune system releases as one of body defenses against infection. ´Causes: Vasodilation (Leads to hypotension as blood pools in periphery), Increased capillary permeability (edema or third spacing), Constriction smooth muscles (lungs = bronchoconstriction) release of excessive amounts can lead to anaphylaxis and severe allergic symptoms and may result in any or all of the following physiological changes- constriction of the smooth muscle, especially in the stomach and lungs, increase in body secretions, and vasodilation
Histamine
Drug to Drug Interactions for NSAIDs
Interfere with the anti-platelet properties of aspirin: ´ibuprofen ´naproxen ´celecoxib Do not interfere with anti-platelet properties of aspirin: ´diclofenac ´ketorolac Must use caution with the following drug classes: ´Diuretics ´Angiotensin changing enzyme inhibitors (ACEIs) ´Angiotensin receptor blockers (ARBs0 Anticoagulants - may increase risk of gastrointestinal bleeding
Used for most gram-positive bacteria and gram-negative cocci Common side effects-Pain, redness, swelling at injection site Twitching or muscle spasms, Overactive reflexes, Mild skin rash, Gastrointestinal distress Cross-sensitivity to cephalosporins Safe for unborn children; likely not safe for breastfeeding Routes: IV, IM, intrathecal, intrapleural
Penicillin G
Used for most gram-positive bacteria Not as effective for gram-negative bacteria Common side effects: Pain, redness, swelling at injection site Twitching or muscle spasms, Overactive reflexes, Mild skin rash, Gastrointestinal distress, Seizures, black furry tongue Route: oral
Penicillin V
Which medication may sometimes be overlooked when considering penicillin allergies in patients?
Piperacillin/tazobactam (Zosyn)
any type of therapy or treatment designed to improve or maintain a person's health
Prophylactic Therapy
Which infections are treated with metronidazole?
Protozoans Clostridium Bacteroides Streptococcus
The nurse checks a patient's serum creatinine level before starting antibiotic therapy in order to assess which function?
Renal
Clinical teaching for Xanthine Derivatives?
Report: Nausea, Vomiting, Restlessness, Insomnia, Irritability, Tremors
Combination of ampicillin and the beta lactamase sulbactam Uses: Gram-positive bacteria, Staph aureus (not MRSA or MRSS), Staphylococcus epidermis, Enterococcus, Strep Pneumoniae, Gram-negative bacteria, E. Coli, Klebsiella, Anaerobes, Clostridium Types of infections: intra-abdominal, skin/skin structures, Gynecologic Common side effects - same as Zosyn Serious side effects- hypersensitivity, anaphylaxis, hepatotoxicity, Stevens Johnson Syndrome, Clostridium difficile diarrhea Routes: IV
Unasyn
•Poliomyelitis •Measles •Rubella •Varicella - chicken pox and shingles virus •Respiratory syncytial virus •Human papilloma virus •Herpes Zoster
Viral Vaccines
Which antifungal agent is teratogenic?
Voriconazole
Which antifungal drug is contraindicated during pregnancy?
Voriconazole
Which of the following drugs is contraindicated for a patient who is receiving erythromycin therapy?
Warfarin
How does superinfection occur in a patient?
When the antibiotic eliminates the normal bacterial flora
What drug is indicated by the following?: •Mild to moderate cases of acute asthma •Adjunct drug in the management of COPD ´chronic bronchitis, and emphysema
Xanthine Derivatives
´Prototype drug: theophylline ´3 distinct actions in the airways of clients with reversible obstruction ´smooth muscle relaxation (bronchodilation) ´suppression of the response of the airways to stimuli (non-bronchodilator prophylactic effects) ´increases the force of contraction of diaphragmatic muscles
Xanthine Derivatives
Which information would the nurse give a patient who mentions being afraid to take antihistamines because of being a truck driver?
You may be able to safely take a nonsedating antihistamine.
Very common and widely used antibiotic clinically Combination of piperacillin and the beta lactamase taxobactam Uses: Many gram-positive and gram-negative including pseudomonas aeruginosa: Pneumonia, Sepsis, Cellulitis, Intra-abdominal infections, Pelvic inflammatory disease, Peritonitis, Diabetic-related wounds/ulcers Common side effects: thrombocytopenia, headache, trouble sleeping, rash, nausea, constipation, and diarrhea. Serious adverse effects include Clostridium difficile infection and allergic reactions including anaphylaxis. Routes: IV
Zosyn
member of the oxalodinone class Active against aerobic gram positive bacteria bacterial pneumonia septicemia skin and skin structure infections vancomycin-resistant enterococcal (VRE) infections, Can cause myelosuppression and pseudomembranous colitis Routes: IV, PO
Zyvox (linezolid)
What are the anticholinergics used to treat COPD
aclidinium (Tudorza), and the combination product umeclidinium and vilanterol (anoroa Ellipta)
Indicated for life-threatening fungal infections such as: ´Aspergillosis ´Candidiasis ´Cryptococcus ´Histoplasmosis Adverse effects: Infusion reaction with chills, fever, tachypnea ´Treat with Benadryl, Tylenol or steroids Give in D5W using an inline filter and a separate IV site Nephrotoxicity most serious adverse effect
amphotericin B aka "amphoterrible"
Drugs that suppress the cough reflex when coughing can be harmful, Used post-operatively to prevent wound dehiscence, Used if a non-productive cough interferes with comfort
anti-tussives
•Sympathomimetics- Stimulate the adrenergic receptors in the sympathetic nervous system •Used during acute phase of asthmatic attacks •Quickly reduce airway constriction •Restore normal airflow the prevention or relief of bronchospasm related to bronchial asthmas, bronchitis, and other pulmonary diseases. However, they are also used for effects outside the respiratory system because some of these drugs have the ability to stimulate both beta 1 and beta 2 alpha adrenergic receptors, they may be used to treat hypotension and shock,
beta-adrenergic agonists
What are the 3 classes of bronchodilators?
beta-adrenergic agonists anticholinergics xanthine derivatives
Kills
Bactericidal
inhibits
Bacteriostatic
Which assessment would be conducted by the nurse before starting antibacterial therapy for a patient?
Baseline vital sign values Cardiac history Hypersensitivity Neurologic abnormalities
A patient with a history of asthma is brought to the clinic with acute dyspnea, wheezing, hypercapnia, and hypoxemia. Which type of medication will be administered first to this patient?
Beta2 agonists
The primary health care provider prescribes levofloxacin to treat a patient's urinary tract infection. Which foods will the nurse instruct the patient to avoid during the therapy?
dairy products
Which side effect of a histamine (H1) antagonist is used therapeutically for patients with allergic rhinitis?
dryness
What are the 3 types of Beta-adrenergic antagonists?
´Nonselective adrenergics- Stimulate alpha, beta1 (cardiac), and beta2 (respiratory) receptors;Example: epinephrine ´Nonselective beta-adrenergics- Stimulate both beta1 and beta2 receptors; Example: metaproterenol (Alupent) ´Selective beta2 drugs- Stimulate only beta2 receptors; Example: albuterol (Proventil)
Adverse effects of corticosteroids
´Pharyngeal irritation ´Coughing ´Dry mouth ´Oral fungal infections
Effects of LTRAs
´Prevent smooth muscle contraction of the bronchial airways ´Decrease mucus secretion ´Prevent vascular permeability ´Decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation
´albuterol (Proventil, Ventolin - only rescue inhaler ´levalbuterol (Xopenex)
´Short-acting beta agonist (SABA) inhalers
What are the adverse effects and contraindications of sympathomimetics?
•Adverse effects-Nervousness, Insomnia, Palpitations, tremors, rebound congestion •Contraindications- Uncontrolled HTN and CAD, narrow angle glaucoma, diabetes, thyroid dysfunction, prostatitis
Patient education for antihistamines?
•Caution regarding drowsiness •Avoid alcohol & other CNS depressants •Check for drug interactions with over the counter cold/flu preparations •Measures to relieve dry mouth contraindications may include narrow angle glaucoma, cardia disease, kidney disease, HTN, bronchial asthma, COPD, Peptic ulcer disease , seizure disorders, BPH, and pregnancy. Antihistamines should be used with caution in patients with impaired liver function or renal insufficiency , as well as lactating mothers
clinical teaching for decongestants
•Cautious use with over the counter (OTC) meds •Avoid caffeine and other stimulants •Proper administration of nasal medications- Blow nose gently before use, Clean tip of med after each use, Hold head in upright position for inhalation
Client teaching for Inhaled Corticosteroids
•Gargle and rinse the mouth with lukewarm water afterward to prevent the development of oral fungal infections •Teach how to monitor disease with a peak flow meter •Encourage use of a spacer device to ensure successful inhalations •Teach client how to keep inhalers and nebulizer equipment clean after uses •Teach to always use bronchodilator inhaler first then the corticosteroid inhaler.
Examples of expectorants/ mucolytics and their side effects
•Guaifenesin (Robitussin) - nausea/vomiting, gastrointestinal irritation •Iodinated glycerol - gastrointestinal irritation, rash, enlarged thyroid gland •Potassium iodide (SSKI) - hyperkalemia, nausea/vomiting
What are the three classes decongestants?
•Sympathomimetics:constrict small arterioles surrounding nasal sinuses •Anticholinergics: direct drying effect •Corticosteroids: reduce inflammatory response
common uses for decongestants
•acute/chronic rhinitis •Sinusitis •allergic rhinitis (preoperatively)
Which antiviral drug is used in the treatment of cytomegalovirus infection?
Cidofovir
similar in action to macrolides effective against gram positive cocci and pneumococci Effective in treating mixed infections Great for acne, cellulitis and bacterial vaginosis Can cause pseudomembranous colitis Routes: Oral, IV, topical
Cleocin (clindamycin)
Which antibiotic can be used against several anaerobic organisms?
Clindamycin
Examples of Anti-tussives
´Non-opioid- Guaifenesin with dextromethorphan (Robitussin DM), Benzonatate (Tessalon Perles) ´Opioid- Guaifenesin with Codeine and/or Hydrocodone (Robitussin AC)
What are Second generation antihistamines?
NONSEDATING ´Claritin (loratadine) ´Zyrtec (cetirizine) ´Clarinex (desloratadine) ´Allegra (fexofenadine) Do not have CNS effects Do not cross blood brain barrier Longer acting than earlier antihistamines Once a day dosage
´Rhinocort (budesonide) ´Flovent (fluticasone) ´Route: intranasal Action: prevent allergic rhinitis, by reducing inflammatory response. Not for acute treatment.
Nasal corticosteriods
Mechanism of action: By inhibiting prostaglandins, it decreases the production of protective mucous found in the stomach Indications for Use: Analgesia, Anti-inflammatory, Antipyretic Examples: Acetylsalicylic acid - ASPIRIN, Ibuprofen- Motrin, Advil, naproxen - Naprosyn, Aleve, Celecoxib - Celebrex- Cox 2 inhibitor, Ketorolac- Toradol, Diclofenac - Voltaren, indomethacin (Indocin)
Nonsteroidal Anti-inflammatory Drugs (NSAIDS)
Which baseline assessment data specific to drug therapy would the nurse obtain before initiating fluconazole therapy in a patient?
Observe skin color for jaundice; evaluate liver function tests Assess for nausea, vomiting, and diarrhea; auscultate bowel sounds. Evaluate intake and output; check blood urea nitrogen and creatinine levels
The nurse is caring for multiple patients receiving antibiotics. Which patient will the nurse assess first?
One taking amikacin with furosemide
During the assessment of a patient, the nurse finds symptoms of dizziness, confusion, sedation, and hypotension. After reviewing the patient's medical history, the nurse finds that the patient is taking diphenhydramine for treatment of nighttime insomnia. Which condition would the nurse interpret from the assessment?
Paradoxical reaction
Which patients are candidates to receive antitussive cough medication?
Patients who have undergone hernia surgery
The nurse is providing care for multiple patients who are prescribed nasal decongestants. For which patients does the nurse need to obtain a change of prescription?
Patients with hypertension Patients with hyperthyroidism Patients with narrow-angle glaucoma
Derived from a fungus Widely distributed except in CSF (except if inflammation is present) and in intraocular fluid Most serious complication is hypersensitivity Can cause seizures, rash, angioedema, anaphylaxis and nephropathy. More effective in treating gram (+) infections Used to treat infections of: Skin, Gastrointestinal, Respiratory tract, Soft tissues Selection depends on the organism and severity of the infection
Penicillin
Synthetic with broad spectrum of activity Inhibits an enzyme needed for synthesis of ergosterol, a structural component of fungal cell membranes Good for treatment of ringworm, nails Hepatotoxic
Terbinafine - Lamisil
Broad spectrum bacteriostatic Effective against: Chlamydia, Mycoplasma, protozoa (e.g. Malaria, Giardia) Examples:Doxycycline - Vibramycin; Minocycline - Minocin Effective in treating: STIs such as chlamydia, Pelvic inflammatory disease, Long-term treatment of acne vulgaris Routes: PO, IV, topical Contraindicated in renal failure except for doxycycline and minocycline Not indicated in children less than 8 years of age because can cause permanent discoloration of teeth and can depress bone growth Can cause photosensitivity Avoid taking within 2 hours of dairy products, w/iron or w/antacids
Tetracyclines
The nurse is caring for a patient who was prescribed nystatin lozenges for oral candidiasis. Which instruction would the nurse give to ensure effective medication administration?
"Slowly and completely dissolve the lozenges in the mouth."
A nursing student asks the nursing instructor about the mechanism of bacteriostatic action of tetracycline. Which answer by the nursing instructor is correct?
"Tetracycline inhibits protein synthesis."
Which instruction will the nurse include in the discharge teaching for a patient receiving tetracycline?
"Use sunscreen and protective clothing when outdoors."
To be effective for treating chickenpox, acyclovir would be initiated within how many hours of the appearance of the rash?
24
A nurse is setting up an intravenous infusion pump to administer a dose of vancomycin to a patient. Which amount of time is the minimum period that the drug may be infused?
60 min
The nurse works in a medical-surgical unit. Which patients would the nurse monitor for atypical signs of infection?
A 78-year-old patient with urinary incontinence A 35-year-old patient who underwent a renal transplant A 55-year-old patient who received radiation therapy for lung cancer
Which patients are susceptible to developing severe systemic fungal infections?
A patient with cancer who is receiving chemotherapy A patient who is receiving immunosuppressive agents for lupus A patient who has acquired immune deficiency syndrome (AIDS)
Antibiotic that is effective against a majority of organisms
Broad spectrum
These drugs relax bronchial smooth muscle, which causes dilation of the bronchi and bronchioles that are narrowed as a result of the disease process
Bronchodilators
Broad spectrum, bactericidal, beta-lactam anti-microbial drugs. Inhibit synthesis of cell walls. Indicated for organisms resistant to other antibiotics Route: Intravenous Examples: meropenem - Merrem; imipenem-cilastatin - Primaxin
Carbapenems
The nurse is caring for a postoperative patient. Which antibiotic is used for prophylaxis against infection in surgical patients?
Cefazolin
Broad spectrum with activity against both gram positive and gram negative bacteria Derived from a fungus Less active against gram positives than penicillin Progressively more effective against gram negative pathogens as progress generationally Indications for Use: Surgical prophylaxis, Respiratory tract infections, Skin infections, Bone and joints infections, Urinary tract infections, Brain and spinal cord infections, Septicemia KEY POINT- CAUTIOUS USE FOR THOSE WITH ALLERGY TO PENICILLIN ´Can cause cross-sensitivity anaphylactic reaction
Cephalosporins
Oral- cephalexin - Keflex; cefaclor - Ceclor; Cefdinir - Omnicel Parenteral- cefazolin - Ancef, Kefzol; cefoxitin - Mefoxin; ceftazidime - Fortaz; Ceftriaxone - Rocephin**; Cefepime - Maxipime
Cephalosporins
Aztreonam: Azactam- Active against gram-negative bacteria and to many resistant strains; Similar to aminoglycosides but no kidney damage or hearing loss; Preserves normal gram positive and anaerobic flora Uses: Susceptible bacterial infections; Septicemia; Lower respiratory tract; Complicated or uncomplicated urinary tract; Skin and skin structure; Gynecologic; Intraabdominal; Surgical adjunct.
Monobactam
An older adult with pneumonia is experiencing a cough that is disrupting rest and sleep. Which types of medication would the nurse expect to administer to this patient to promote sleep and rest?
Codeine Guaifenesin
Adverse effects of Aspirin
Common: Gastrointestinal, Bleeding, Nausea and vomiting, Dyspepsia (indigestion), Diarrhea, Tinnitus (ringing in the ears) Serious: Acute or Chronic Salicylate intoxication (salicylism) Adults: tinnitus and hearing problems Children: hyperventilation, dizziness, drowsiness Hypoglycemia Metabolic acidosis Reyes Syndrome in children and teens
Contraindications and management of Fluoroquinolone
Contraindicated in: Allergy to fluoroquinolone, Children under 18 years of age, Pregnant or lactating women (Pregnancy category C) Nursing management: Monitor renal and liver function, Ensure adequate fluid intake to prevent crystalluria, Assess current medications for drugs that interact with, Avoid exposure to sunlight - keep in brown bag for IVPB, Tagamet (cimetidine) and Probenecid increase the effects of the fluoroquinolones
Which antiasthmatic, available only for oral use, is approved for use in children 2 years of age and older?
Montelukast
what are Sympathomimetics?
Most commonly used to shrink engorged nasals mucous membranes and relieve nasal stuffiness ´Sudafed (pseudoephedrine) -OTC, oral ´Neo-Synephrine (phenylephrine) -OTC, Nasal spray
Which phrases describe risk factors for developing vaginal candidiasis infections?
Corticosteroid use Oral contraceptive use Hyperglycemic conditions
•Anti-inflammatory properties •Used for chronic asthma NOT acute asthma attack •Oral or inhaled forms- Inhaled forms reduce systemic effects •May take several weeks before full effects are seen •Stabilize membranes of cells that release harmful Broncho constricting substances •These cells are called leukocytes, or white blood cells •Increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation
Corticosteroids
Which fungi, found in bird droppings, can cause infection in the meninges covering the human brain?
Cryptococcus
Synthetic, broad spectrum Used to treat: ´ candidiasis, ´Cryptococcus ´coccidioidomycosis Not effective against aspergillosis Routes: PO or IV Fewer side effects than ketoconazole Reduce dosage in renal failure
Fluconazole - Diflucan
Broad-spectrum bacteriocidal Effective against gram-negative and gram-positive organisms. Most commonly prescribed is Ciprofloxacin (Cipro).; Levofloxacin - Levaquin (cheaper than Cipro); Ofloxacin - Floxin Used to treat: Community-acquired and hospital-acquired pneumonia, Genitourinary infections, Skin and soft tissues such as cellulitis, Gonorrhea Routes: PO, IV Synthetic bactericidal drugs with activity against gram positive and gram negative organisms Most are given orally Excreted via kidneys Mechanism of action is by interfering with DNA gyrase, an enzyme necessary for synthesis of bacterial DNA
Fluoroquinolone
What drug is indicated by the following?: ´Prophylaxis and long-term treatment and prevention of asthma in adults and children 12 years of age and older ´NOT meant for management of acute asthmatic attacks ´Montelukast is also approved for treatment of allergic rhinitis
LTRAs
´prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation ´Inflammation in the lungs is blocked, and asthma symptoms are relieved ´Nonbronchodilating ´Newer class of asthma medications ´montelukast (Singulair)- •used to prevent asthma attacks in adults and children, used to prevent exercise-induced bronchospasm in adults and children who are at least 6 years old., used to treat symptoms of year-round allergies in adults and children who are at least 6 months old., used to treat symptoms of seasonal allergies in adults and children who are at least 2 years old., used to prevent exercise-induced bronchoconstriction in adults and teenagers who are at least 15 years old
Leukotriene Receptor Antagonists (LTRAs)
Prototype: Erythromycin treat infections caused by: Gram-positive bacteria - Streptococcus pneumoniae, Limited Gram-negative bacteria common substitute for those with a penicillin allergy Beta-hemolytic streptococci, pneumococci, staphylococci, and enterococci are usually susceptible to macrolides. a, Mycoplasma, Bacteroides, Clostridia and Corynebacterium Examples: azithromycin - Zithromax; clarithromycin - Biaxin; erythromycin - EES
Macrolides
Which drug is indicated by the following?: Respiratory tract infections Can be useful to treat Legionnaire's disease Skin and soft tissue infections caused by Staph and Strep Genitourinary infections caused by Chlamydia Clarithromycin ´Mycobacterium Avium Complex ´Helicobacter Pylori (H. pylori)
Macrolides
•Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways • bind to the ACh receptors, preventing ACh from binding •Result: Bronchoconstriction is prevented, Airways dilate
Mechanisms of action for anticholinergics
Effective against: anaerobic bacteria, gram positive bacilli such as clostridium, protozoa such as Giardia, amebiasis, trichomoniasis Useful topically for rosacea Used for bacterial vaginosis KEY POINT:MUST NOT BE TAKEN WITH ALCOHOL - DEATHLY SICK
Metronidazole - Flagyl
Bacteriostatic against both gram positive and gram negative bacteria trimethoprim-sulfamethoxazole Bactrim is useful in the treatment of urinary tract infections Contraindications: renal failure, Can cause bone marrow depression, especially in elderlym, folic acid deficiency, Sulfa allergy
Sulfonamides
Which interaction can occur when an asthmatic patient consumes rifampin along with xanthine derivatives?
Theophylline levels are decreased
What are the adverse effects of antihistamines?
´CARDIOVASCULAR: dysrhythmias, arrest, hypotension, palpitations, syncope, dizziness, death ´CENTRAL NERVOUS SYSTEM: sedation, dizziness, muscular weakness, paradoxical excitement, restlessness, insomnia, nervousness, seizures ´GASTROINTESTIONAL: anorexia, nausea, vomiting, diarrhea, constipation, hepatitis, jaundice ´OTHER: dryness of mouth, nose, throat; urinary retention; impotence; vertigo; tinnitus; headache
What is expected with the use of Xanthine Derivatives?
´Cardiovascular stimulation- increased force of contraction, increased heart rate, increased cardiac output, increased blood flow to the kidneys (diuretic effect)
What are the adverse effects of Xanthine Derivatives?
´Gastrointestinal: Nausea, vomiting, anorexia, reflux during sleep ´Cardiac: Sinus tachycardia, palpitations, ventricular dysrhythmias ´Renal: Transient increased urination ´Endocrine: Hyperglycemia
Adverse effects of Erythomycin:
commonly causes dose-related GI disturbances, including nausea, vomiting, abdominal cramps, and diarrhea; disturbances are less common with clarithromycin and azithromycin. Taking the drug with food may help decrease GI disturbances. Erythromycin may cause dose-related tinnitus, dizziness, and reversible hearing loss.
Which medication given for asthma can suppress bone growth in children?
corticosteriod
Common uses for NSAIDS
´Headache ´Muscle and joint pain ´Post-op pain ´Arthritis ´Gout ´Antiplatelet activity (aspirin) ´Antipyretic (ibuprofen, aspirin)
´salmeterol (Serevent)
´Long-acting beta agonist (LABA) inhalers
Which microorganism is directly affected by acyclovir?
herpes zoster
A patient taking intravenous gentamicin has elevated blood urea nitrogen (BUN). Which action would the nurse take?
hold the medications
A patient is prescribed guaifenesin for treatment of productive cough. Which instruction would the nurse give to the patient for maximum therapeutic effect?
increase fluid intake
Virus Treatment: ´oseltamivir - Tamiflu ´Zanamivir - Relenza ´Rimantadine - Flumadine Course of treatment for 5 days Must be started within 48h of symptoms to be effective Can still decrease severity of symptoms if 48 hr window is closed
influenza
A patient is prescribed albuterol. The nurse is explaining the most common route of administration of albuterol to the patient. Which route would the nurse discuss?
inhalation
´budesonide - Pulmicort ´Flunisolide - Aero Bid ´Fluticasone - Flonase ´triamcinolone acetonide - Azmacort
inhaled corticosteroids
Antibiotics that work on a specific type of organism
narrow spectrum
Which patients are at risk for developing oral candidiasis (thrush)?
newborns immunocompromised
Which antifungal drug is applied topically for the treatment of candidal diaper rash?
nystatin
Used to treat: ´Candida infections of the skin ´Diaper rash ´Thrush (oral candidiasis) ´Esophageal candidiasis ´Vaginal yeast infections Routes: Vaginal suppository, oral rinse, topical, oral
nystatin - Mycostatin
Which is the adverse effect of vancomycin when it is infused too rapidly?
red man syndrome
Which instruction would the nurse give to a patient who is prescribed dextromethorphan for treatment of a cough?
restrict activities that require mental alertness
A patient with asthma is prescribed fluticasone and a salmeterol inhaler. This treatment is a part of which step of asthma management?
step 6
When instructing a patient about antibiotic therapy, the nurse explains that which condition occurs when the normal flora are disturbed during antibiotic therapy?
superinfection
What are the first generation antihistamines?
those associated with sedation. Over the counter; given orally. work peripherally and centrally ´diphenhydramine - Benadryl ´chlorpheniramine - Chlor-Trimeton ´brompheniramine - Dimetan ´Dimenhydrinate - Dramamine ´Promethazine - Phenergan
Active against gram positives only Nephrotoxic - baseline BUN and Creatinine and every 3 days while on this medication Frequently used to treat Methicillin-resistant staph aureus (MRSA) Can cause hypotension, flushing and skin rash if given too quickly Resistance is mounting Can cause "red man syndrome" if given too quickly
vancomycin - Vancocin
What is rebound congestion?
worsening of congestion due to overuse of nasal decongestants
Adverse effects & Contraindications for NSAIDs
´Adverse effects: Gastrointestinal bleeding, Gastric ulceration, Renal Failure ´Contraindications: Allergy to aspirin and/or NSAIDs, Any risk of bleeding (rhinitis / epistaxis), Vitamin K deficiency, Peptic ulcer disease, Pregnancy, Lactation, Renal or hepatic disease, Recent coronary artery bypass graft (Open heart)
Nursing implications for Xanthine Derivatives?
´Be aware of drug interactions with cimetidine, oral contraceptives, allopurinol, certain antibiotics, influenza vaccine, others ´Cigarette smoking enhances xanthine metabolism ´Dosages must be changed if client stops or starts smoking ´Food interactions: charcoal-broiled, high-protein, and low-carbohydrate foods ´These foods may reduce serum levels of xanthine through various metabolic mechanisms
