Exam 3
the patients wife is taking rifampin to preventy her from developing a TB infection. Which statement by the wife indicate that further teaching is needed?
"I will take the medication for 1 week and then stop"
Treatment of Malaria
-Not initiated until the diagnosis has been confirmed with diagnostic tests -Treatment is guided by: The infecting Plasmodium species, Clinical status of the patient, Drug susceptibility of the infecting parasites as determined by the geographic area where the infection was acquired
Bacteria
-Outnumber ius 10:1 -Normal flora-healthy ecosystem -Pathogenic bacteria-can cause infection
Protozoal infections
-Parasitic protozoa: live in or on humans -Malaria -Leishmaniasis -amebiasis -Giardiasis -Trichomoniasis -Trypanosomiasis
adrenergic nasal decongestants Nursing Implications
-Patients should avoid caffeine and caffeine-containing products -Patients should report a fever, cough, or other symptoms lasting longer than 1 week -Monitor for intended therapeutic effects
Beta Lactam Antibiotics
-Penicillins -Cephalosporins -Carbapenems -Monobactams
Penicillin: MOA
-Penicillins enter the bacteria via the cell wall- bind to penicillin- binding protein and disrupt normal cell wall synthesis- results in bacteria cells dying from cell lysis.
Inhaled Corticosteroids Adverse Effects
-Pharyngeal irritation -Coughing -Dry mouth -Oral fungal infections -Low dose inhaled corticosteroids- systemic effects are rare
Anticholinergic Indications
-Prevention of the bronchospasm associated with chronic bronchitis or emphysema. -Not for treatment of acute asthma attack
Inhaled Corticosteroids Drug Interactions
-Drug interactions are more likely to occur with systemic (versus inhaled) corticosteroids. -May increase serum glucose levels, possibly requiring adjustments in dosages of antidiabetic drugs -Cyclosporine and tacrolimus (immunosuppressants) -Itraconazole -Phenytoin, phenobarbital, and rifampin
nitrofurantoin (Macrodantin)
-Primarily used for UTIs (E. coli, S. aureus, Klebsiella spp., Enterobacter spp.) -Use carefully if renal function is impaired -Drug concentrates in the urine: why is this relevant? -May cause fatal hepatotoxicity- rare but fatal
Cephalosporins- First Generation Indications
-Used ofr surgical prophylaxis and for susceptible staphylococcal infections --cefazolin (Ancef and Kefzol): IV or IM --cephalexin (Keflex):PO
Isoniazid (INH)
-Drug of choice for TB -Resistant strains of Mycobacterium emerging -Metabolized in the liver through acetylation—watch for "slow acetylators" -Used alone or in combination with other drugs: used alone for treatment of latent TB infection (LTBI) -Contraindicated with liver disease
Antitussives
-Drugs used to stop or reduce coughing -Opioid (normally used for pain "Narcotics") and nonopioid -Used only for nonproductive coughs!
Antifungal Therapeutic effects
-Easing of symptoms of infection -Improved energy levels -NormaL vits, including temp -Monitor carefully for adverse effects
three types of Beta Adrenergic Agonists Bronchodilators
- Nonselective adrenergics- Stimulate alpha, beta (Cardiac), and beta (Respiratory) receptors: Example: epinephrine (EpiPen) -Nonselective beta adrenergics- Stimulate only Beta 1 and Beta 2 receptors: Example: metaproterenol. -Selective beta 2 drugs- Stimulate only Beta 2 receptors: Example:Albuterol (Proventil). Used during acute asthma attacks
Macrolide indications
- Strep Infections: Strep pyogens (group A beta-hemolytic strep) -Mild to moderate upper and lower respiratory tract infections: Haemophilus influenzae -spirochetal infections: Suphilis and Lyme disease -Gonorrhea, Chlamydia, Mycoplasma.
Pediatric Concerns for OTC meds
-No OTC cough and cold products for children under the age of 2. -2008 FDA Recommendation -Reason: Over sedation, seizures, tachycardia, and even death in toddlers. Also, evidence that these medications are not effective for small children- Small airways
Macrolides
- end in mycin - Erythromycin (E-mycin, E.E.S, others): Note- taken on an empty stomach -Azithromyacin (Zithromax) -Clarithromyacin (Biaxin) -Fidaxomicin (Dificid, Dificlir) - MOA: prevemts protein synthesis within bacterial cells: considered bacteriostatic- bacteria will eventually die. In high enough concentrations, may also be bactericidal.
Leukotriene Receptor Antagonists (LTRAs)
-Nonbronchodilating -Newer class of asthma medications -Currently available drugs: MONTELUKAST (Singulair),zafirlukast (Accolate), and zileuton (Zyflo)
Beta Adrenergic Agonists Interactions
-Diminished bronchodilation when nonselective beta blockers are used with the beta agonist bronchodilators -Monoamine oxidase inhibitors (MAOI's) -Sympathomimetics -Monitor patients with diabetes; an increase in blood glucose levels can occur.
A home care nurse is visiting a patient with a diagnosis of TB. The patient traveled abroad 2 months ago. He lives with his wife and 5 y/o son. The patient tells the nurse that he is concerned that his son will also get TB, so he wants to share his pills with his son. What is the best response by the nurse?
"Do not share any of your medications with anyone. Contact your son's HCP to discuss your concerns."
Sofosbubir (Solvald)
- First in class RNA polymerase inhibitor for the treatment of chronic hepatitis C -First drug treatment for hepatitis C that can be given without interferon- Used in combination with ribivirin. and not to be used as monotherapy.
Mycobacterium Infections
- First infectious episode: Primary TB infection- Active TB infections: Look Sick -Reinfection: Chronic form of the disease - Formancy: Test positive for exposure but no active disease- Latent TB infection -Current Concern: increasing number of multidrug-resistant TB (MDR-TB) cases in the US.
Aminoglycosides
- Natural and semisynthetic -Very potent antibiotics with serious toxicities- Ototoxicity and Nephrotoxicity -Bactericidal; prevent protein synthesis -Drugs: GENTAMICIN, neomycin (Neo-fradin), tobramycin (TOBI), and amikacin.
Disinfectant for antiseptic
-Disinfectant: Kills organisms, used only on nonliving objects, and cidal agent. -Antiseptic: Generally only inhibits the growth of microorganisms but does not necessarily kill them, applied exclusively to living tissue, static agent.
Multidrug-resistant TB (MDR-TB) Bedaquiline (Sirturo)
- 2013: FDA granted accelerated approval for bedaquiline (Sirturo) for the treatment of MDR-TB -MOA: inhibits mtcobacterial adenosine triphosphate (ATP) synthase. First drug in 40 years to treat TB with a new mechanism of action - Side effects: HA, chest pain, nausea, Prolonged QT interval.
Tetracycline Nursing Implications
- ALWAYS obtain cultures from appropriate sites BEFORE beginning antibiotic therapy- when possible (usually empiric treatment) -Most common adverse effects of antibiotics: N/V, and diarrhea -Oral antibiotics will have enhanced absorption if taken with 6-8 ounces of water.
Penicillin Adverse Effects
- Allergic reactions to the penicillins occur in 0.7% to 4% of treatment courses- Urticaria, pruritis, angioedema -Patients allergic to penicillins have an increased risk of allergy to other beta lactam antibiotics -Only patients with a history of throat swelling or hives from penicillin should not recieve cephalosporins -Common adverse effects: N/V, diarrhea, and abdominal pain.
Quinolones MOA
- Alter DNA of bacteria, causing death -DO NOT affect human DNA
Antibiotic Resistance: 3 Factors that will predict which developments happen
- Antibiotic Concentration: Must be adequate to penetrate biofilm -Bacterial mutation: Multiply within hours, mutation can happen quickly - Bacterial genetic exchange: Genes that resist ABX are passed on
tetracycline Patient Education
- Antibiotics may reduce the efficacy of oral contraceptives: Use additional contraceptive methods when in antibiotics - Take all antibiotics as prescribed for the whole length of time: Do not stop taking them when you feel better- leads to SuperBugs.
Ipratropium Bromide (Atrovent)
- Anticholinergic -Oldest and most commonly used anticholinergic bronchodilatoe -Available as a liquid aerosol for inhalation (nebulizer treatment) and multidose inhaler -Usually dosed twice daily
Oseltamivir (Tamiflu) and zanamivir (Relenza)
- Neuraminidase Inhibitors -Active against influenza types A and B -Reduce duration of illness -Adverse effects: --Tamiflu: N/V --Relenze: Diarrhea, nausea, and sinusitis - Treatment should begin within 2 days of influenza symptom onset: decreases duration of illness by 2-3 days.
Antimalarial Drugs
- Attack the parasite during the asexual phase, when it is vulnerable - asexual phase occurs in human (sexual occurs in the mosquito) -Erythrocytic phase drugs (in the blood): chloroquine, hydroxychloroquine, quinine, mefloquine, pyrimethamine -Primaquine: kills parasite in both phases (in the blood and in the tissue) -may be used together or with a sulfonamide for synergistic or additive killing power -CDC: most up to date information on resistance patterns basec on geographical location
antitussive nursing implications
- Avoid driving or operating heavy machinery: because of possible sedation, drowsiness, or dizziness. -Report the following symptoms to your caregiver: Cough that lasts more than 1 week, Persistent cough, Fever, and Rash -Monitor for intended Therapeutic effects.
Monobactams
- Aztreonam (Azactam) - Synthetic beta Lactam antibiotic -Primarily active against aerobic gram- bacteria (E. Coli, Klebsiella spp., Pseudomonas spp.) - Bactericidal -PN use only (IV and IM) -Used for moderately severe systemic infections and UTI's.
TB- related injection (Vaccine)
- Bacille Calmette-Guerin (BCG) - A vaccine injection derived from an inactivated strain of mycobacterium bovis; vaccinate young children against TB- used worldwide- Not U.S. -DOES NOT prevent infection -Reduces active TB by 60-80% -TB skin test: False Positive test result
Clostridium difficile (C. diff)
- Bacteria usually invades after ABX have ruined the normal bacterial ecosystem of the gut -Causes symptoms like painful, bloody diarrhea and fevers -Found in hospitals and group homes -Frequently fatal for the elderly -Naturally resistant to many ABX and generates spores that are particularly tough to kill
Cephalosporins- Fourth Generation
- Broader spectrum of antibacterial activity than third generation, especially against Gram + bacteria -Uncomplicated and complicated UTI -Cefepime (Maxipime)
Asthma
- Bronchial Asthma: Recurrent and reversible shortness of breath - Narrowing of the airways of the lungs: Bronchospasms, Inflammation of the bronchial mucosa, and production of viscous mucus. -The alveolar ducts and alveoli remain open but the airflow to them is obstructed -Symptoms: Expiratory Wheezing, and difficulty breathing.
Polyenes adverse effects
- Cardiac Dysrhythmias -Neurotoxicity; tinnitus; visual disturbances; hand or feet numbness, tingling, or pain; convulsions -renal toxicity, potassium loss, hypomagnesemia -Pulmonary infiltrates -fever, chills, HA, Nausea, occasional hypotension, GI upset, anemia -Prevention of Adverse Effects: Prescribers commonly order various premedications: antilipemics, antihistamines, antipyretics, and corticosteroids.
Neisseria gonorrhoeae
- Cause of the second most common infections (Gonnorrhoeae) in North America -Can lead to serious reproductive complications -Used to be easy to treat: Now- 30% of infections are resistamt to an ABX
Aminoglycoside Adverse effects
- Cause serious toxicities: Nephrotoxicity (renal damage), ototoxicity (suditory impairment and vestibular impairment [eighth cranial nerve]) -Must monitor drug levels to prevent toxicities: Minimum inhibitory concentration (MIC) -Other: HA, paresthesia, fever, superinfections, vertigo, skin rash, and dizziness.
Cephalosporin- Second Generation Indications
- Cefoxitin (Mefoxin): IV or IM: Used prophylactically for abdominal and colorectal surgeries- Kills intestinal bacteria (Gram+, Gram-, and anaerobes). Also kills anaerobes. - Cefuroxime: Zinacef is parenteral form; Ceftin is PO, Surgical Prophylaxis, and does not kill anaerobes.
Cephalosporins- Fifth Generation
- Ceftaroline (Teflaro) - Broader spectrum of antibacterial activity - Effective against a wide variety of organisms: like MRSA
Cephalosporin - Third Generation Indications
- Ceftriaxone (Rocephin): IV and IM, long half life, once a day dosing, Elimination in primary hepatic, And easily passes meninges and diffused into cerebrospinal fluid to treat central nervous system infections
Miscellaneous Antibiotics
- Nitrofurantoin (Macrodantin) -metronidazole (Flagyl) -clindamycin (Cleocin) -vancomycin (Vancocin) -Drugs to treat MRSA, CRE, and VRE
COPD
- Chronic Bronchitis: Continuous inflammation and low grade infection of the bronchi. --Excessive secretion of the mucus and certain pathologic changes in the bronchial structure --Result of prolonged exposure to bronchial irritants: Smoking -Emphysema: Air spaces enlarge as a result of the destruction of alveolar walls --Caused by the effect of proteolytic enzymes released from leukocytes in response to alveolar inflammation --Reduction in the surface area of gas exchange: inability to exchange Carbon dioxide for Oxygen --results in impaired respirations.
LTRA's Nursing implications and Patient education
- Chronic Management (Maintenance) of Asthma -Purpose of the therapy -NO OTC or other prescribed medication w/o hcp approval -Assess liver function before beginning therapy and throughout. -Take daily (even if symptoms improve)
Primaquine
- Classified as an 8-aminoquinoline -MOA: Only exoerythrocytic drug (works in both phases), Binds and alters parasitic DNA -Contraindications: Disease states that cause granulocytopenia (rheumatoid arthritis, systemic lupus erythematosus)
Beta Lactam Inhibitors
- Clavulanic Acid -Sulbactam -Tazobactam -Inhibit beya- Lactamase: what breaks down the beta ring of your beta lactam antibiotics. Keeps your ABX alive to kill off bacteria.
Topical Antifungal Drugs
- Clotrimazole (Lotrimin, Mycelex-G) --Lozenge for oral candidiasis (thrush) --Vaginal suppository or cream for yeast infections --Other forms used for fungal infections -Miconazole (Monistat) --Topical cream --Vaginal suppository or cream --OTC remedies- Athletes foot, jock itch, and yeast infections -Adverse effects: Burning, itching, stinging, and contact dermatitis
Drugs for MRSA and VRE
- Daptomycin (Cubicin): Used to treat complicated skin and soft tissue infections caused by susceptible gram+ bacteria, including MRSA and VRE -telavacin (vibativ): Effective against MRSA and VRE.
Topical Fungal Infections
- Difficult to eradicate -Therapy may be prolonged: several weeks to 1 year -Topical fungal infections caused by: Candida albicans: a yeastlike opportunistic fungus present in the normal flora of the mouth, vagina, and intestinal tract. Dermatophytes: tinea or ringworm infections
Antimalarial drugs contraindications
- Drug allergy -tinnitus (ear ringing) -pregnancy (quinine) -Severe renal, hepatic, or hematologic dysfunction
Antifungal Drugs
- Drugs used to treat infections caused by fungi - Major groups based on their chemical structure --Synthetic triazoles: fluconazole, itraconazole, voriconazole: Azoles --Echinocandins: caspofungin --Synthetic allylamine: terbinafine --polyenes: amphotericin B, Amphotec (B), Abelcet (B), AmBisome (B), nystatin. -Indications: Systemic and topical fungal infections --Drug of choice for many severe systemic fingal infections: amphotericin B --Choice of drug; Depends on type and location of infection
Anticholinergic Adverse Effects
- Dry mouth or throat -Nasal congestion -Heart Palpitations -GI distress -HA -Coughing -Anxiety
Carbapenems
- End in "Penem" -Broadest antibacterial action of any antibiotics to date -MOA: Bactericidal- inhibit cell wall synthesis - Reserved for complicated body cavity and connective tissue infections- acutely ill hospitalized patients: Big Guns-IV only -May cause drug-induced seizure activity: Reduced risk with proper dosage in compromised patients.
Anti-TB drugs
- First Line Drugs: ISONIAZID (INH): primary drug used, PYRAZINAMIDE (PZA), RIFAMPIN (rifapentine, rifabutin) - Length of treatment: several abx for at least 6 months and sometimes for as long as 12 months- possible 24 if multi-drug resistant TB (MDR-TB)- most cases of TB can be cured.
Triazoles (Azoles)
- Fluconazole (Diflucan) -inhibit fungal cell cytochrome P-450 enzymes, resulting in cell membrane leaking -Results in altered cellular metabolism and fungal cell death -indications: Excellent coverage against many fungi: passes into the CSF- inhibits growth of cryptococcal fungi: effective in the treatment of cryptococcal meningitis. -Adverse effects: Preferred to Amphotericin B due to less adverse effects- N/V, diarrhea, stomach pain, increased liver enzymes, use with caution in patients with renal and liver dysfunction
Inhaler Patient Education
- For any inhaler prescribed, ensure that the patient is able to self administer the medication -Demonstration and return demonstration -When to take and how often -Use spacer if patient has difficulty coordination breathing with inhaler activations -Know when inhaler is empty- when is refill needed -Keep track of the number of doses in the inhaler device.
Macrolide Adverse Effects
- GI effects. primarily with erythromyacin: n/v, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia. Erythromycin : Stimulates GI motility -Azithromycin and clarithromycin: Fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration. -Interactions: Highly Protein Bound drugs
Cephalosporin First Generations
- Good Gram+ Coverage -Good Gram - Coverage - PN and PO forms -Examples: CEFAZOLIN (Ancef)- IV, and CEPHALEXIN (Keflex)- Oral
Cephalosporins- Second Generation
- Good Gram+ coverage -Better Gram- coverage than first generation -Examples: CEFOXITIN (Mefoxin), CEFUROXIME (Zinacef)
Anti-TB Adverse effects
- INH: peripheral neuropathy, hepatotoxicity -Ethambutol: retrobulbar neuritis, blindness -Rifampin: hepatitis, discoloration of urine, stools, and other body fluids.
Mefloquine (Larium)
- MOA: Alter pH within the parasite, interfere with parasite's ability to metabolize and use erythrocyte hemoglobin, effective only during the erythrocytic phase -Analogue of quinine -Drug effects: Kill parasitic organisms -Indications: Mild to moderate acute malaria and prevention and treatment of chloroquine-resistant organisms -Prophylactically: Travelers visiting malarial-endemic areas to prevent malarial infection.
Non-HIV Antiviral Drugs
- MOA: Most work by blocking the activity of a polymerase enzyme that normally stimulates the synthesis of new viral genomes -Used to treat non-HIV viral infections: Influenza viruses, HSV, VZV, CMV, Hepatitis. - Contraindications: Usually well tolerated: Known severe drug allergy, drug specific. -Adverse effects: Vary with each drug, Healthy cells are often killed also, resulting in serious toxicities -Interactions: Higher with systemic administration than topical administration.
Antifungal Drugs interactions
- Many antifungal drugs are metabolized by the cytochrome P-450 enzyme system.
Candida Albicans
- May follow abx therapy, antineoplastics, or immunisuppressants (corticosteroids) -May result in overgrowth and systemic infections -Growth in the mough is clled THRUSH or oral candidiasis -Common in newborn infants and immunocompromised patients
Antibiotics (ABX)
- Medicine used to treat bacterial infections -Stick to important parts of bacterial cells (proteins/sugars in the cell wall and enzymes that make DNA) and interfere with the ability to survive and multiply
Dermatological- Antibacterial Drugs
- Most common skin disorders caused by Strep pyogenes and Staph aureus bacteria -Most common drugs: Bacitracin, Neomycin, Polymycin, Meomycin adn polymycin B (Neosporin), Mupirocin (Bactroban) -Unfortunately, because of the high incidence of infection with methicillin-resistant S aureus (MRSA), mupirocin is now becoming resistant.
Theophylline
- Most commonly used Xanthine Derivative -Oral, rectal, Injectable (as aminophylline), and topical dosage forms -Aminophylline: IV treatment of patients with status asmaticus -Therapeutic range for theophylline blood levels is 10 - 20 mcg/mL- Risk for Overdose: Most Clinicians now advise levels between 5 and 15 mcg/mL
Cephalosporins- third generation
- Most potent group against Gram- bacteria -Less active against Gram+ bacteria - Examples: CEFTAZIDIME (Fortaz), CEFTRIAZONE (Rocephin)
Penicillin Interactions
- Nonsteroidal antiinflammatory drugs- compete dor protein binding: may have more free and active penicillin-beneficial?- can be sometimes, and sometimes not. -Oral contraceptives- may decrease efficacy: Risk for pregnancy. What education should you provide to a woman who is on oral contraceptives who has been prescribes penicillin (or any antibiotic)?-Condoms or abstaining. - Warfarin- Enhanced anticoagulation: increased risk of bleeding.
Antiretroviral Adverse Effects
- Numerous and vary with each drug -Drug therapy may need to be modified because of adverse effects -Goal: Find the regimen that best controls the infection woth a tolerable adverse effect profile -Medication regimens change during the course of the illness.
Sulfonamides
- One of the first groups of antibiotics -Often combined with another abx -Sulfamethoxazole combined with trimethoprim (a nonsulfonamide antibiotic known as Bactrim, Septra, or co-trimoxazole: Abbreviated as SMX-TMP- Used commonly in clinical practice.
Drug therapy considerations with TB
- Perform drug-susceptability testing on the first Mycobacterium spp. that is isolated from a aptient specimen- prevents the development of MDR-TB - Begin regimen with multiple anti-TB drugs before test results (Susceptability) are known: reduces the chance of development of resistacne, and once results are known adjust the drug regimen -Monitor closely for Compliance- Why? : because length of treatment is long and most cases of TB can be cured.
Penicillin: Indications
- Prevention and treatment of infections cause by Gram+ bacteria, including Streptococcis spp., Enterococcus spp., Staphylococcus spp. - Little effect on Gram-, exept for extended-spectrum penicillins: Gram Positive, Gram Negative and Anaerobic infections.
Antimalarial Drugs: Adverse Effects
- Primarily GI: N/V, diarrhea, anorexia, abdominal pain.
Antimalarial Nursing Implications
- Prophylaxis: Drugs should be started 1-2 weeks before potential exposure to malaria and for 4-8 weeks after leaving the area -Medications are taken weekly with 8 oz of water -Instruct patient to notify prescriber immediately if ringing in the eats, hearing decrease, visual difficulties, n/v, profuse diarrhea, or abdominal pain occurs -Alert patient to the possible recurrence of the symptoms of malaria so that he or she will know to seek immediate treatment.
Simeprxevir (olysio)
- Protease inhibitor (PI)- treatment of Chronic hepatitis C -Used in conjunction with standard hepatitis C treatments: interferon and ribavirin- not to be used as monotherapy.
Bronchodilators
- Relax Bronchial smooth muscles: causes dilation of the bronchi and bronchioles that are narrowed as a result of the disease process. -Three classes: --Beta adrenergic agonists --Anticholinergics --Xanthine derivatives
HIV and AIDS
- Retrovirus: The risk for transmission to health care workers via percutaneous (needlesick) injuries is currently calculated at approximately 0.3% -Antiretroviral drugs: Highly active antiretroviral therapy (HAART): includes at least three medications- Combination of antiretroviral drugs (Cocktail): These medications work in different ways to reduce the viral load (therapeutic effect).
Aminoglycoside Therapeutic Drug Monitoring
- Serum levels measured to prevent toxicity: Peak: highest drug levels for nce-daily regimens. Trough: lowest to ensure adequate renal clearence of the drug and avoid toxicity. Serum level needs to be at least eight times higher than the MIC. -Postantibiotic effects: Continues bacterial suppression that occurs after short-term antibiotic exposure; dosing once daily.
Cephalosporin Adverse Effects
- Smiliar to penicillins: Mild diarrhea, abdominal cramps, rash, puritus, redness, and edema -If allergic to penicillins: potential for cross-sensitivity to cephalosporins.
Diagnosing TB
- Step 1: TB skin test (Mantoux): Purified protein derivative (PPD) (Mantoux)- A diagnostic injection given intradermally in doses of 5 tuberculin units (0.1 mL) to detect exposure to the TB organism.Positive result is indicated by induration (not erythema) at the site of injection -Step 2: If skin test results are positive, then chest X-Ray -Step 3: If chest X-Ray shows signs of YB, then culture of sputum or stomach secretions
Tetracycline Adverse Effects
- Strongly affinity for calcium: Discoloration of permanant teeth and tooth enamel in fetuses and children or nursing infants if taken by the mother. May retard fetal skeletal development if taken during pregnancy. -Alteration in intestinal flora may result in: superinfection (overgrowth of nonsusceptible organisms such as Candida spp.), Diarrhea, and pseudomembranous colitis. -May also cause photosensitivity: Avoid sunlight and tanning beds - May also cause: Vaginal candidiasism, Gastric upset, enterovolitis, and maculopapular rash.
Antibacterial and antifungal otic drugs
- Topical formulations applied to the external ear -Often combined with steroids for antiinflammatory, antipruritic, and antiallergic drug effects -Middle ear infections generally require systemically administered antibiotics -Antibiotics:Neomycin and polymyxin B plus hydrocortisone combination (cortisporin Otic), Others containing ciprofloxacin, ofloxacin (Floxin Otic) -Antifungals: Cortic (combination of antifingal drugs and hydrocortisone)
Antitubercular Drugs
- Tuberculosis (TB)- caused by Mycobacterium tuberculosis -Antitubercular drugs treat all forms of Mycobacterium (MTB) - TB is most commonly characterized by granilomas in the lungs: Nodular accumulations of inflammatory cells (e.g., macrophages, lymphocytes) that are delimited ("walled off' with clear boundaries) and have a center that has a cheesy or caseated consistency -Common infections sites: Lung (primary site); brain (cerebral cortex); bone (growing end); lver; kidney; and genitourinary tract.
Beta Adrenergic Agonists Contraindications
- Uncontrolled HTN -Cardiaac Dysrhythmias -High Risk of Stroke (because of the vasoconstrictive drug action)
Quinolones Indications
- Used to treat S. Aureus, serratia marcescens, and mycobacterium fortuitum -Bacterial resistance to quinolone antibiotics- identified in several bacterial species. -Gram - bacteria such as pseudomonas spp. -Complicated urinary tract, respiratory, boner and joint, GI, skin, and STI's -Anthrax (ciprofloxacin)
Penicillin Contraindications
- Usually safe and well tolerated medications: Take oral doses with water not juice (acidic fluids nullify the drugs antibacterial action) -Known drug allergy -Patient with allergy to penicillins- note the type of reactions -Brand names do not end in -cillin (ex. Zosyn, Augmentin)- Their generic name does though.
Antifungals (General)
- Very small group of drugs -Fungi that cause infections are very difficult to kill and research into new drugs very slow pace -Systemic infections: Usually occur in immunocompromised patient- can be life threatening.
General Principles of Virology
- Viral replication: A virus cannot replicate on its own, it must attach to and enter a host cell, it then uses the host cells energy to synthesize protein, DNA, adn RNA. -Viruses are difficult to kill because they live inside the cells: Any drug that kills a virus may also kill the host cell.
Inhaled Corticosteroids (Glucocorticoids)
- beclomethasone dipropionate (Beclovent) -BUDESONIDE (pilmicirt Tubuhaler) -dexamethasone sodium phosphate (Decadron Phosphate Respihaler) -flunisolide (AeroBid) -FLUTICASONE (Flovent) -triamcinolone acetonide (Azmacort) -ciclesonide (Omnaris)
4-Aminoquinoline Derivatives
- chloroquine (Aralen) -hydroxychloroquine -MOA: Bind to parasite nucleoproteins and interfere with protein synthesis; also alter PH within the parasite. Interfere with parasites ability to metabolize and ise erythrocyte hemoglobin. Effective only during the erythrocytic phase -Drug effects: Kill parasitic organism- Malaria and amebiasis -In addition: Hydroxychloroquine: Has antiinflammatory effects, Sometimes used in the treatment of rheumatoid arthritis and systemic lupus erythematosus
Tetracyclines
- end in "cycline" -Natural and semisynthetic -MOA: Bacteriostatic: inhibits bacterial growth. Inhivits protein synthesis, and stop many essential functions of the bacteria - chemical CHaracteristic: Bind (chelate) to Ca+++ and Mg++ and Al+++ ions to form insoluble complexes: causes tooth discoloration-do not give to children younger than 8 y/o or to pregnant or lactating women -DO OT ADMINISTER WITH DAIRY PRODUCTS, ANTACIDS, AND IRON SALTS- reduce oral absorption of tetracyclines
Quinolones
- end in "floxacin" -Also called fluoroquinolones -Excellent oral absorption -Absorption reduced by antacids -Effectove against gram- and some gram+ organisms.
malaria
- most significant protozoal disease in terms of morbidity and mortality -1200 cases of malaria are reported in the US annually: peopple who traveled to malaria-infested countries -caused by Plasmodium protozoa -Transmitted by the biye of an infected adult female anopheline mosquito -Also transmitted by infected individual: blood transfusion, congentially, or form infected needles by drug abusers -s/s: fever to 104, diaphoresis.
Fidaxomicin (Dificid) indications
- newest macrolide -the msot common adverse effects are n/v, and GI bleed -Indicated only for treatment of C Diff- associated siarrhea -Pregnancy category B - Minimal Absorption
Ribavirin (Virazole)
- synthetic nucleoside analog -Given orally, or by oral or nasal inhalation -inhalation form (Virazole) used for hospitalized infants with RSV infections.
Acyclovir (Zovirax)
- synthetic nucleoside analog -Used to suppress replication of HSV-1, HSV-2, and VZV -Drug of choice for treatment of initial and recurrent episodes of oral herpes, genital herpes, and Chicken pox. -Oral, topical, PN forms.
Vaginal candidiasis
- yeast infection - Pregnancy, women with diabetes mellitus, women taking oral contraceptives.
Newer Antiasthmatic Medication: Phosphodiesterase-4-inhibitor: roflumilast (Daliresp)
--Indicated to prevent coughing and excess mucus from worsening --Decreases the frequency of life threatening COPD exacerbations --Adverse effects: Nausea, diarrhea, HA, insomnia, dizziness, weight loss, and psychiatric symptoms.
Antihistamine (H1 blockers)
--TRADITIONAL: diphenhydramine (Benadryl), brompheniramine, chlorpheniramine, dimenhydrinate, meclizine, promethazine (Phenergan) -Work both peripherally and centrally -Have anticholinergic effects, making them more effective than nonsedating drugs in some cases. -Cross the Blood Brain Barrier- Reason for the sedation --NONSEDATING: Loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allerga) -Developed to eliminate unwanted adverse effects mainly sedation -Work peripherally to block the actions of histamine; thus, fewer central nervous system adverse effects -Linger duration of action ( increases compliance)
Anticholinergics MOA
-Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways -Anticholinergics bind to the ACh receptors, preventing ACh from binding -Result: bronchoconstriction is prevented, airways dilate
Inhaled Corticosteroids Contraindications
-Acute Asthma Attacks- Use in conjunction wiith other drugs- not for sole therapy -Hypersensitivuty to glucocorticoids -Sputum positive for Candida Organism: Candida are what type of organism? -Systemic fungal infection-immunosuppresion.
Beta Adrenergic Agonists Nursing Implications
-Albuterol, if used too frequently, loses its beta2-specific actions at larger doses: As a result, beta1 receptors are stimulated, causing nausea, increased anxiety, palpitations, tremors, and increased heart rate -Instruct Patient- Take exactly as prescribed with no omission or double doses. -Report the following to the hcp: Insomnia, jitteriness, restlessness, palpitations, chest pain, or any change in symptoms.
LTRAs: Contraindications
-Allergy to povidone, lactose, titanium dioxide, or cellulose derivatives.
Polyenes
-Amphotericin B -MOA: Bind to sterols in cell membrane lining- results in fungal death- Fungicidal. Do not bind to human cell membranes or kill human cells -Drug of choice for severe systemic Mycoses (Fungal Infection)
Antihistamine adverse effects
-Anticholinergic (DRYING) effects, most common ~Dry mouth ~Difficulty urinating ~Constipation ~Changes in vision ~DROWSINESS ~Mild drowsiness to deep sleep
Inhaled Corticosteroids Indications
-Antiinflammatory: treatment of bronchospastic disorders -Trearment of chronic asthma-maintenance therapy: Often used concurrently with Beta-Adrenergic agonists (LABA's and SABA's) -Oral or inhaled forms: --Systemic corticosteroids- used to treat acute exacerbations: usually short five day burst if flare up, and long term use- Must taper off --IV corticosteroids: Acute exacerbations of asthma or other COPD --inhaled- Reduced systemic effects --Must take severa; weeks before full effects are seen
Antiviral Drugs
-Antiviral drugs kill or suppress the virus by destroying virions or inhibiting the ability of viruses to replicate; controlled by current antiviral therapy -Immunoglobulins are concentrated antibodies that can attack and destroy viruses -Key Characteristics of antiviral drugs: Able to enter the cells infected wth virus, interfere with viral nucleic acid synthesis, regulation, or both. Some drugs interfere with ability of virus to bind to cells. Some drugs stimulate the body's immune system. -
Disease of the lower respiratory tract
-Asthma -COPD (chronic obstructive pulmonary disease)- Applied collectively to the emphysema and chronic bronchitis: Obstruction is relatively constant, also applies to asthma that is persistent and present most of the time.
Antibiotics can be one of 3 things
-Bactericidal: Antibiotic kills the bacteria -Bacteriostatic: Antibiotic cripples or stops bacteria from multiplying -Not effective against parasites, viruses or fungi
Sulfonamide MOA
-Bacteriostatic action -Prevent synthesis of folic acid required for the synthesis of purines and nucleic acids
Cephalosporins
-Begin with cef or cep -First, second, third, fourth, and fifth generations -Semisynthetic antibiotics -Structurally and pharmacologically related to penecillins- Note: assess for penicillin allergy- cross-allergy -Bactericidal action -Broad Spectrum -Divided into groups acording to their antimicrobial activity.
Beta Adrenergic Agonists MOA
-Begins at the specific receptor stimulated -Ends with dilation of the airways --Activation of beta2 receptors activates cyclic adenosine monophosphate (cAMP), which relaxes smooth muscle in the airway and results in bronchial dilation and increased airflow
antitussive adverse effects
-Benzonatate (Tessalon Perles): Dizziness, headache, sedation, nausea, and others -Dextromethorphan (Robitussin DM): Dizziness, drowsiness, nausea -Opioids: Sedation, nausea, vomiting, lightheadedness, constipation.
antihistamine mechanism of action
-Block the actions of histamine at the H1 receptor. -Competes with histamine for binding at unoccupied receptors —cannot push histamine iff the receptor if already bound -the bunding of H1 blockers to the histamine receptors prevents thw adverse consequences of histamine stimulation —vasodilation —increased GI and respiratory secretions —increased capillary permeability
sulfonamides Adverse Effects
-Blood: Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia. -Integumentary: Photosensitivity, exfoliative dermatitis, steven-Johnson syndrome, epidermal necrolysis-Delayed Cutaneous reaction -GI: n/v, diarrhea, pancreatitis- Take doses with food -Other: Hepatotoxicity, convulsions, crystalluria, toxic nephrosis, HA, periphreal neuritis, urticaria, cough
Xanthine Derivatives Indications
-Bronchodilation- Treatment for asthma, Chronic Bronchitis, and emphysema -Mild to moderate cases of asthma -NOT for acute asthma attack: Will use for patients in status asthmaticus -Adjunct drug in management of COPD -Not used frequently due to drug to drug interactions and risk for nontherapeutic levels (overdose)
Xanthine Derivatives Drug effects
-Bronchodilation-Relaxes smooth muscle in the airways -Result: relief of bronchospasm and greater airflow into and out of the lungs. -Are CNS stimulants - Cause cardiovascular stimulation: Increased force of contraction and increased HR. Results in increased CO and increased blood floe to the kidneys (diuretic effect)
xanthine (caffeine)
-CNS Stimulant: Used w/o prescription to promote alertness (ex: for long duration driving or studying) -Cardiac Stimulant in infants with bradycardia -Enhancement of respiratory drive in infants -naturally occurring Xanthine (so not a derivative)
Quinolones Adverse effects
-CNS: HA, dizzinessm insomnia, depression, restlessness, convulsions GI: N/V, diarrhea, constipation, thrush, increased liver function study results -Cardiac: Prolonged QT interval -Integumentary: Rash, pruritus, urticaria, flushing. -Other: Ruptured Tendons, tendonitis (Both Black Box Warning: Increased risk of tendonitis and tendon rupture), fever, chills, blurred vision, tinnitus.
Anti TB drug Patient Education
-CRITICAL -Therapy ,ay last for up to 24 months -Take medications exactly as ordered at the same time every day -Remind patient that they are contagious furing the intital period of their illness -Rifampin- Oral contraceptives are ineffective- use another form of birth control -turns everything reddish orange (urine, stool, saliva, sputum, sweat, or tears) -Oral preparations may be given with meals to reduce GI upset even though recommendations are to take them 1 hour before or 2 hours after meal -monitor for adverse effects- Report immediately to provider: includes fatigue, N/V, numbness and tingling of the extrmities, fever, loss of appetite, depression and jaundice -Monitor for therapeutic effects: Decreased symotoms of TB, such as cough and fever. Lab study results (culture and sensitivity tests) and chest rediographs should confirm clinical findings. Watch for lack of clinical response to therapy, indicating possible frug resistance.
Xanthine Derivatives Nursing Implications and Patient Education
-Cautious use: Cardiac disease -Timed-release preparations- DO NOT crush or chew: causes gastric irritation -Report to prescriber: N/V, Restlessness, Insomnia, Irritability, and tremors- Indicators of overdose -No Smoking: decreases serum drug levels -Interacting foods include: Charcoal-broiled, High-protein, and Low-carb foods
Antitussives MOA Opioids
-Codeine and Hydrocodone: -Suppress the cough reflex: Direct acting on the cough center in the medulla. -analgesia-Pain -Also, dry up the mucous- make secretions thicker: reduce runny nose and postnasal drip (dry up the secretions)
Antihistamine Nursing Implications and Patient Education
-Contraindicated: Acute asthma attack and lower respiratory disease (pneumonia) -Avoid driving and operating heavy machinery; advise against consuming alcohol or other CNS depressants --Report excessive sedation, confusion, or hypotension -Take with meals --Reduces GI upset -To alleviate dry mouth discomfort- frequent mouth care, chew gum, or suck on hard candy (preferably sugarless) -Monitor for intended therapeutic effects.
Therapeutic Response of Antibiotic Therapy
-Decrease in specific signs and symptoms of infection (fever, elevated wbc count, redness, inflammation, drainage, pain)- Caused by a decrease in the number of bacterial.
therapeutic Effects of respiratory drugs
-Decreased dyspnea -Decreased wheezing, restlessness, and anxiety -Improved respiratory patterns with return to normal rate and quality -Improved activity tolerance -Decreased symptoms and increased ease of breathing
Antibiotic therapy (3 types)
-Empiric Therapy: Treatment of an infection based on what usually causes this type of infection in this patient population. -Definitive Therapy: Antibiotic therapy tailored to treat organim identified with cultures- Do a culture and sensitivity (remember microbiology?) -Prophylactic therapy: Treatment with antibiotics to prevent an infection: as is the case intraabdominal
4 common mutations
-Enzymes in the bacteria eat and deactivate ABX -ABX are ejected from the bacteria -The bacterial wall prevents ABX from entering -The bacteria adopts new ways of processing energy
Expectorants
-For productive coughs -Drugs that aid in the expectoration (removal) of mucus -Reduce the viscosity of secretions -Disintegrate and thin secretions -Example: guafenesin (Mucinex)
Sulfonamide Indications
-Gram + and Gram - bacteria -Treatment of UTI caused by: Enterobacter spp., Escherichia Coli, Klebsiella spp., Proteus mirabilis, Proteus vulgaris, Steph aureus- concentrated in the Kidney- Lower dose- higher effect -Pneumocystis Jiroveci oneumonia-Co-trimoxazole -Upper respiratory tract infections -Community-acquit=red MRSA infections: SMX-TMP [sulfamethoxazole/trimethoprim (Bactrim)]- Combination- synergistic effect
Anticholinergics
-IPRATROPIUM(ATROVENT), Tiotropium (Spiriva), Aclidinium (Tudorza) -Indirectly cause airway relaxation and dilation -Help reduce secretions in COPD patient
Xanthine Derivatives MOA
-Increase levels of energy-producing cAMP: This is done competitively inhibiting phosphodiesterase, the enzyme that breaks down cAMP -Result: Increased cAMP levels, amooth muscle relaxation, bronchodilation, and increased airflow. -Note: Only THEOPHYLLINE is used as a bronchodilator
Antitussives Interactions and Contraindications
-Indications: Used to stop the cough reflex when the cough is nonproductive or harmful -Contraindications: Drug Allergy, Opioid dependency, and Respiratory depression.
Antibiotics: MOA
-Interference with bacterial cell wall synthesis -Interference with protein synthesis -Interference with DNA replication -Acting as a metabolite to disrupt critical metabolic reactions inside the bacterial cell -Bactericidal versus bacteriostatic
Skin Preparation Drugs
-Isopropyl Alcohol: Most commonly used product, Lowers the bacterial count for 20-40 minutes after application -Povidone-iodine (betadine): Antiseptic that kills bacteria, fungi, and viruses-Prevention and treatment of topical infections associated with surgery, burns, and minor cuts and scrapes. Also relief of minor caginal infections. Most widely used antiseptic. Screen for iodine and shellfish allergy. -Chlorohexadine (Hibiclens): MOA: disrupts the bacterial membranes and inhibits cell wall synthesis- Primarily used as a surgical scrub.
imipenem/ cilastatin )Primaxin)
-Know this Carbapenem -Used for treatment of bone, joint, skin, and soft tissue infections, many other uses -Cilastatin inhibits an enzyme that breaks down imipenem- enhancing blood concentrations
Salmeterol (Serevent)
-LABA bronchodilator -Not for treatment of acute asthma attack -Maintenance treatment of asthma and COPD: Used in conjunction with an inhaled corticosteroid -Salmeterol should never be given more than twice daily nor should the maximum daily dose (One puff twice a day) be exceeded.
Nonbronchodilating Respiratory Drugs
-Leukotriene receptor antagonists. -Corticosteroids. -Mast cell stabilizers: rarely used: cromolyn and nedocromil-sometimes used for exercise-induced asthma
Leukotriene Receptor Antagonists (LTRAs) MOA
-Leukotrienes- Substance released when a trigger causes a chemical reaction in the body -Allergen- Cat hair or dust -Cause inflammation, bronchoconstriction, and Mucus Production -LTRA's prevent leukotrienes from attaching to receptors on immune cells in the lungs and on the circulation immune cells (lymphocytes in the blood)
Nystatin (Mycostatin)
-MOA: Bind to sterols in cell membrane lining- results in fingal cell death: fungicidal. Do not bind to human cell membranes or kill human cells -Indications: Topically: treatment of candidal diaper rash. Orally: oral and vaginal candidiasis. May also be given prophylactically to prevent candidiasis infection in immunocompromised patients - Adverse effects: N/V, anorexia, diarrhea, and rash
Histamine
-Major inflammatory mediator in many allergic disorders: • allergic rhinitis (fever and mold, dust) • Anaphylaxis • Angioedema • Drug fevers • Insect bite reactions • Urticaria (itching)
Antihistamine Indications
-Management of: Nasal allergies, Seasonal or perennial allergic rhinitis (hay fever), Allergic reactions, Motion sickness, Parkinson's disease (due to anticholinergic effects), Vertigo, Sleep disorders - Also used to relieve symptoms associated with the common cold: Sneezing and runny nose, and palliative treatment; not curative.
Antibiotic Therapy: Adverse Effects
-Most common severe reactions: difficulty breathing; significant rash, hives, or other skin reactions; and severe GI intolerance- Basically almost all antibiotics cause GI upset and skin rashes that itch -Allergic anaphalactic reactions- typically caused by Penicillins and sulfonamides.
Antihistamine contraindications
-Narrow Angle glaucoma. -Caridac disease, Hypertension. -Kidney disease. -Bronchial asthma, COPD: sole drug therapy during acute asthmatic attacks-Albuterol or epinephrine-needed. -Peptic ulcer disease -seizure disorders -BPH -Pregnancy
Xanthine Derivatives: Adverse Effects
-Nausea, vomiting, anorexia -Gastroesophageal reflux during sleep -Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias -Transient increased urination -Hyperglycemia
Antibiotic nursing implications
-Prior to starting Antibiotic Therapy: Assess drug allergies; hepatic, renal, and cardiac function, and other lab study results- because of potential adverse effects -Monitor for therapeutic effects: Improvement of s/s of infection, return to normal vital signs, Negative culture and sensitivity tests, disapperance of fever, lethargy, drainage, and redness.
Two Basic Types of Cough
-Productive cough-Congested, removes excessive secretions -Nonproductive cough-Dry cough
Oral Decongestants
-Prolonged decongestant effects, but delayed onset -Effect less potent than topical -No rebound congestion Example: pseudoephedrine (Sudafed)
LTRAs: Indications
-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 -Improvement usually seen in a week
Expectorants MOA
-Reflex stimulation: Irritation of the GI tract- Causes loosening and thinning of the respiratory secretions -Direct Stimulation: Stimulates secretory glands-Increases the production of respiratory tract fluids -Final Result: Thinner mucus that is easier to remove -Drug effects: Indirectly diminishes cough
Inhaled Corticosteroids Nursing Implications and Patient Education
-Rinse mouth with lukewarm water after use -Use LABA several minutes before corticosteroids if both are ordered -Monitor disease with a peak flow meter -Use spacer device to ensure successdul inhalations -Clean inhalers and nebulizer equipment after use.
Antibiotics are classified based on:
-Shape -Gram Positive or Gram Negative
adrenergic nasal decongestant MOA
-Site of Action: ~Blood vessels surrounding nasal sinuses: Constrict small BV's, and Shrink swollen mucous membranes -Drug Effects: Shrink engorged nasal mucous membranes and Relieve nasal stuffiness -Sustained use- Rebound Congestion -Oxymetazoline (Afrin) ~~what situations would this drug be used for?
CRE (carbapenem-resistant enterobacteriaceae)
-Some strains of CRE are incurable and are resistant to all antibiotics -Bloodstream infections with CRE- 50% mortality rate: This is rare- concern about the spread of CRE.
Corticosteroids (Glucocorticoids) MOA
-Stabilize membranes of cells that release harmfull bronchoconstricting substances: these cells are called leukocytes or WBC's -Dual Effects: Reduce inflammation, and Enhance activity of Beta Agonitst- more pronounced stimulation of the beta 2 receptors by beta agonist drugs (albuterol)
Gancyclovir (Cytovene)
-Synthetic nucleoside analog -Used to treat infection with CMV -Oral, PN forms -CMV retinitis: Opthalmic form surgically implanted (Vitrasert) -Dose-limiting Toxicity: Bone Marrow Suppression.
How do we prevent Antibiotic resistance?
-Take ANX responsibly -Take ABX only if you have a bacterial infection (not a virus) -Pick ABX that are narrow spectrum: dont kill off the healthy bacterial ecosystems -HCP needs to make these smart choices: Narrow spectrum ABX should be used to treat bacterial infections rather than indiscriminate ABC (broad spectrum), and Be selective in how we use ABX will keep them from becoming obsolete. -Trash antibiotics responsibly: Disposal of ABX in a way to minimize exposure of bacteria to the ABX. DOnt flush them down the toilet: ABX have direct access to bacteria living in the soil and water. -Two Options of Disposal: Give them back to the pharmacist for disposal, or put them into a sealed plastic bag and toss them into the trash.
Bronchodilators Nursing Implications
-Take bronchodilators exactly as prescribed -Ensure that patients know how to use the inhalers and MDI's: Patient return demonstration on how to use the device -Monitor for adverse effects
Silver sulfadiazine (Silvadene)
-Topical Antiinfective -MOA: Appears to act on teh cell membrane and cell wall of susceptible bacteria -Used to prevent or treat infection at the site of second and third degree burns -Adverse effects: Pain, burning, and itching. -Do not use in patients who are allergic to sulfonamide drugs.
vancomycin (Vancocin)
-Treatment of choice for MRSA and other gram-positive infections -Oral vancomycin is indicated for the treatment of antibiotic-induced colitis (C. difficile) and for the treatment of staphylococcal enterocolitis -Must monitor blood levels to ensure therapeutic levels and prevent toxicity -May cause ototoxicity and nephrotoxicity- serious adverse effects. -Red man syndrome may occur: Flushing or itching of head, neck, face, upper trunk. Antihistamine may be ordered to reduce these effects. -Additive neuromuscular blocking effects in patients recieving neuromuscular blockers -Rapid infusions may cause hypotension
Expectorants: Nursing Implications
-Use with caution in older adults and patients with asthma or respiratory insufficiency -Encourage fluids: helps loosen and liquefy secretions. -Report a fever, cough, or other symptoms lasting longer than 1 week: Infection. -Monitor for intended therapeutic effects
Metronidazole (Flagyl)
-Used for anaerobic organisms- no air in body -Intraabdominal and gynecologic infections -Protozoal infections- worms -Several drug interactions: Also alcoholic beverages- no alcohol for 24 hours before first dose and 36 hours after the last dose.
clindamyacin (Cleocin)
-Used for chronic bone infections, gentiourinary infections, intraabdominal infections, other serious infections. -May cause pseudomembranous colitis (also known as antibiotic-associated C diff. diarrhea, or C diff. infection) - Potential interaction with vecuronium (NMBD)
Aminoglycoside Indications
-Used to kill Gram- bacteria, such as Pseudomonas spp., E. Coli, Proteus app., Klebsiella spp., Serratia spp.: Concentrated in the urine- great for UTI's - Often combined with other antibiotics for synergistic effects (beta Lactams or Vancomycin): Usef for certain gram+ infections that are resistant to other antibiotics -Aminoglycosides are poorly absorbed through the Gi tracyt and are given PN: poor oral absorption, no oral forms (exception: Neomycin) -Exception: Neomycin: Given orally to decontaminate the GI tract before surgical procedures.
Antimalarial drug indications
-Used to kill Plasmodium organisms- Parasite that causes malaria -Drugs have varying effectiveness on the different malaria organisms -Some drugs are used for prophylaxis against malaria -Available only for ORAL use
Antiviral drugs
-Used to treat infections caused by viruses other than HIV -Herpesviridae: HSV1 (Oral Herpes), HSV2 (genetal Herpes), Chickenpox and shingles (HHV-3 or VZV), Epstein-Barr (HHV4), CMV (HHV5), HHV 6 and 7: Clinically significant for immunocompromised patients, and Kaposi's sarcoma (HHV8) -Hepatitis B and Hepatitis C -Influenza Viruses
Mupirocin (bactroban)
-Used topically for Staph and Strep impetigo. -Intranasal form for methicillin-resistant S. aureus (MRSA) - Available by prescription -Adverse reactions: Local burning, itching, and minor pain.
Fungi
-Very large and diverse group of microorganisms, including yeasts and molds -Fungal infections: also known as mycoses -Fungi that cause integumentary infections are known as dermatophytes
Upper Respiratory Infection: "Common Cold"
-Viral Infection -Upper Respiratory Infection- Excess mucus production drips down pharynx. --Results in cold symptoms: sore throat, coughing, upset stomach -Mucosal irritation-dilation of small blood vessels in the nasal sinuses -TREATMENT: symptomatic only, no CURE --What do we treat with?
Supplemental and Herbal Products
-Vit C -Echinacea -Goldenseal --Limited research to support their uses --Risk for Drug-Drug interaction
tetracycline Indications
-Wide Spectrum: Gram- and gram+ organisms. protosoa, Mycoplasma spp., Rickettsia spp., Chlamydia, syphilis, Lyme disease, Acne, other -Demeclocycline: Treats syndrome of inappropriate antidiuretic hormone (SIADH) secretion by inhibiting the action of ADH -Doxycycline: Used for treatment of rickettsial infections (RMSF, chylamydial and mycoplasma infections), spirochetal infections, and many gram-: also treats acne, anthrax, and malaria
Which medication should you administer first for an acute asthma attack?
-albuterol (Proventil) You will see this on the exam!!
Antiretroviral Nursing Implications
-be sure to teach proper application techniques for ointments, aerosol powders, etc.: Instruct patient to wear gloves or finger cot when applying ointments or solutions to affected areas -Emphasize hand washing before and after administration of medications to prevent contamination of the site and spread of infection: Risk for superinfections- immunocompromised -NOT CURES: do help to manage symptoms -Instruct patients on the importance of taking these medications exactly as prescribed and for the full course of treatment.
Echinocandins
-caspofungin (Cancidas) -Prevent the synthesis of glucans (essential components of fungal cell walls): results in fungal cell death- fungicidal - First echinocandin antifungal drug -Indication: treatment of severe Aspergillus infections (invasive aspergillosis)- common mold (fungus) -Only available in injectable form
Drugs for CRE
-colistimethate (coly-mycin): treatment of CRE infections.
antitussives: MOA (non-opioids)
-dextromethorphan (Robitussin DM): Works in the same way as opioids: But, no analgesic properties or CNS depression -benzonatate (Tessalon Perles): Suppress cough reflex- Numbs the stretch receptors in the respiratory tract: prevents the reflex stimulation of the medullary cough center.
Penicillins
-end in -cillin -Natural Penicillins: Pen G, and Pen V -Penicillinase-resistant drugs: Nafcillin-IV, Cloxacillin-Oral, oxacillin, and dicloxacillin- Oral. -Aminopenicillins: amoxacillin- oral, and ampicillin- IV. -Extended-spectrum drugs: carbenicillin, piperacillin, ticarcillin, and piperacillin/tazobactam (Zosyn)- IV.
Antibiotics
-medication used to treat bacterial infection -Ideally : identify the causative organism before antibiotic therapy begins: definitive Therapy, Usually throughEmpiric Therapy-Treatment based on what we think caused the infection(age and location of infection)
Antiretroviral Drugs : types and MOA's
-reverse transcriptase inhibitors (RTI's): Block activity of the enzyme reserse transcriptase, preventing production of new viral DNA -Pls: Inhibit the protease retroviral enzyme, preventing viral rel=plication -Fusion inhibitors: Inhibit viral fusion, preventing viral replication -Entry inhibitor: CCR5 coreceptor antagonists -HIV integrase strand transfer inhibitors.
Newer Antiasthmatic Medication: Monoclonal Antibody Antiasthmatic- omalizumab (Xolair)
-selectively binds to the immunoglobulin E: Limits the release of the mediators of the allergic reaction -Given by injections -Potential for producing anaphalaxis- monitor closely for hypersensitivity reactions (anaphalaxis)
Albuterol (Proventil)
-short acting beta2 specificbronchodilating beta agonist -Most commonly used drug in this class -Acute asthma attacks only- not for prevention of asthma attacks (long term treatment) -Oral and inhalational -Inhalational dosage forms include metered dose inhalers (MDI's) and solution for inhalation (Nebulizers)
Synthetic allylamine:
-terbinafine (Lamisil) -Available in topical cream, gel, and spray -Indications:treatment of superficial dermatological infections- tinea pedis (athletes foot), tinea cruris (jock itch), tinea corporis (ringworm) -Tablet form: Used to treat onychomycoses of the fingernails and toenails
LTRAs: Adverse Effects
-zileuton (Zyflo): Headache, nausea, dizziness, insomnia, liver function -zafirlukast (Accolate) and montelukast (Singulair): Headache, nausea, diarrhea
A patient is prescribed two different types of inhaled medications for treatment of COPD. After administering the first medication, how long should the patient wait to administer the second medication?
5 minutes This is because you need to take LABA before other meds. Wait at least 1 minute before a second puff of the same medication.
Decongestant types
3 main types: -Adrenergics:Largest group: ephedrine, oxymetazoline (Afrin) -Anticholinergics: NOT FOR URI -Corticosteroids: NOT FOR URI --Adrenergics: Two dosage forms: Inhaled or topically applied to the nasal membranes and Oral
Oral Decongestants Adverse Effects and interactions
ADVERSE EFFECTS: - Systemic effects caused by adrenergic stimulation of the heart, blood vessels, and CNS: --Nervousness --Insomnia --Palpitations --Tremors INTERACTIONS: -BP meds and MAOI's- Risk for HTN
Beta Adrenergic Agonists Adverse Effects
Alpha and beta (epinephrine) -Insomnia -Restlessness -Anorexia -Vascular headache -Hyperglycemia -Tremor -Cardiac stimulation Beta1 and beta2 (metaproterenol) -Cardiac stimulation -Tremor -Anginal pain -Vascular headache -Hypotension Beta2 (albuterol) -Hypotension or hypertension -Vascular headache -Tremor
During a regular follow up visit, Jane points out a sore that she has developed on her mouth. She is diagnosed with herpes simplex. Which medication does the nurse anticipate Jane will recieve?
Acyclovir (Zovirax)
A patient is taking nystatin (Mycostatin) in an oral troche form for oral candidiasis. Which instruction is correct?
Allow the troche to dissolve slowly in the mouth.
When completing an admission assessment, the patient states that she is allergic to sulfa drugs. What will you do next?
Ask the patient for more information about the allergic reaction she had.
A patient with chronic bronchitis calls the office for a refill of his albuterol inhaler. He just had the prescription filled 2 weeks ago, but says its empty. When asked, he tells you, "I use it whenever i need it, but now when i use it i feel so sick. Ive been needing to use it more often". What is the most appropriate action?
Ask the patient to come to the office for an evaluation of his respiratory status. This is because they are most likely not using it correctly, and we need to look at a med that lasts longer and work better.
How does antibiotic resistance develop?
Bacteria exposure to Antibiotics has 3 possible outcomes: -Death :Bactericidal -Stagnation (no manipulation): Bacteriostatic -They will Multiply
Antibiotic Resistance
Bacteria's ability to not be harmed and survuve while being exposed to antibiotics.
LTRA's Drug Effects
By blocking leukotrienes: -Prevent smooth muscle contraction of the bronchial airways -Decrease mucus secretion -Prevent vascular permeability -Decrease neutrophil and leukocyte: infiltration to the lungs, preventing inflammation
When Primethamine is used to treat malaria, a sulfonamide antibiotic is often also used. The purpose of the antibiotic is to?
Cause synergism, allowing for a stronger antimalarial effect. This is because the 1+1 is greater than 2 effect with this one
Anti-TB Treatment effectiveness
Depends on: -Type of infection -Adequate dosing -Sufficient duration of treatment -Adherence to drug regimen -Selection of an effective drug combination - If multi-drug resistant TB develops consider dirsct observation therapy (DOT)
Antihistamines
Drugs that directly compete with histamine for specific receptor sites —two histamine receptors: H1 (lungs) and H2 (stomach)
Nursing Implications for Respiratory Drugs (In General)
Health carre measures to promote a generally good state of health-Prevent, relieve, or decrease symptoms of COPD -Avoid exposure to conditions that precipitate bronchospasm (allergens, smoking, stress , and air pollutants) -Adequate fluid intake -Compliance with medical treatment -Avoid excessive fatigue, heat, extremes in temp, and caffeine. Encourage Patients to get prompt treatment for flu or other illnesses-Vaccinated for pneumonia and flu Always check with hcp before taking any other medications, including OTC and herbal remedies.
A 94 y/o patient has a severe dry cough. He has coughed so hard that the muscles in his chest are hurting. He is unsteady on his feet and slightly confused. Which drug would be the best choice for this patient?
dextromethorphan (Robitussin- DM) Oral solution: even though it causes drowsiness it doesnt cause sedation.
A patient is recieveing Augmentin (amoxicillin and clavulanic acid) liquid solution through a percutaneous endoscopic gastrostomy tube. What is the purpose of the clavulanic acid?
It inhibits the action of the enzyme produced by the beta lactamase- producing bacteria. This is becaus ethis is how it works.
Alexander Fleming (1928)
discovered penicillin
Antifungal Drug Contraindications
Most common: -Liver failure -Renal failure -Porphyria (griseofulvin) -Drug allergy
Antifungal Nursing Implications
Patient educaion: -Some oral forms should be given with meals to decrease GI upset; others require an empty stomach- be sure to check -Nystatin given as an oral lozenge or troche should be slowly and completely dissolved in the mouth (not chewed or swallowed whole) -Nystatin suspension should be swished throughly in the mouth as long as possible before swallowing
The nurse identifies piperacillin/tazobactam (Zosyn) as being a member of which group?
Penecillins.
Anaphylaxis
Severe allergic reaction Release if excessive amounts if histamine can lead to: -constriction if smooth myscle, especially in thw stomach and lungs -increase in body secretions -vasodilation and increased capillary permeability, movement of fluid out of rhe blood vessels and into the tissues —causes drop in BP and edema •what do we do to treat this? —epinephrine!
Bronchodilators: Beta Adrenergic Agonists
Short-acting beta agonist (SABA) inhalers -ALBUTEROL(Ventolin) -LEVALBUTEROL(Xopenex) -pirbuterol (Maxair) -terbutaline (Brethine) -metaproterenol (Alupent) Long-acting beta agonist (LABA) inhalers -arformoterol (Brovana) -formoterol (Foradil, Perforomist) -SALMETEROL(Serevent) Newer LABA's- Combination meds using the Ellipta delivery system --Quickly reduce airway constriction and restore normal airflow --Agonists, or stimulators, of the adrenergic receptors in the sympathetic nervous system: Sympathomimetics
Subtherapeutic response to antibiotic therapy
Signs and symptoms of infection do not improve, they actually get worse.
Antibiotic Classes
Sulfonamides Beta Lactam ABX -Penicillins -Cephalosporins -Carbapenems -Monobactams Macrolides Tetracyclines Aminoglycosides Quinolones Miscellaneous ABX
During IV quinolone therapy in an 88 y/o patient, which potential problem is of most concern when assessing for adverse effects?
Tendon rupture
Which of the following do you identify as being a concern for patients recieving tetracycline?
Tetracycline should not be administered with dairy products
A patient with a digagnosis of TB will be taking INH as part of the anti-TB therapy. When reviewing the patient's chart, the nurse finds documentation that the psteint is a "slow acetylator" What does this mean?
The dosage of INH may need to be lower to prevent INH accumulation.
A patient had an extremely severe infection with a Mycobacterium that is resistant to all but one anti-TB drug; however, the patient has had an allergic reaction to the drug t=in the past. What does the nurse anticipate as being ordered for this patient?
The patient will recieve the drug and supportive care to help him tolerate the anti-TB therapy. if we do nothing they die, so we have to do something.
When teaching patients about treatment of viral infection with Acyclovir (Zovirax), which of the following statements will you include?
This drug is used mainly to suppress the replication of HSV-1, HSV-2, and VZV.
Anti-TB MOA
Three groups: -Inhibit protein synthesis: rifampin and streptomycin -inhibit cell wall synthesis: INH -Other Mechanisms: ethambutol and PZA
Before admin a antihistamine to a patient, it is most important to assess the patient for a history of which condition?
Urinary Retention
Expectorants: Indications
Used for the relief of productive coughs associated with: Common cold Bronchitis Laryngitis Pharyngitis Coughs caused by chronic paranasal sinusitis Pertussis Influenza Measles
antiretroviral drugs
Used to treat infections caused by HIV, the virus that caused AIDS.
A patient is recieving INH for the treatment of TB. Which vitamin does the nurse anticipate administering with the INH to prevent INH-precipitated peripheral neuropathies?
Vitamin B6, this is because it is indicated to prevent this.
When reviewing the antiviral medications oseltamivir (Tamiflu) and zanamivir (Relenza) used for treatment of the flu, which of the following statements should the nurse include?
Zanamivir is currently indicated only for treatment of active influenza.
Beta Adrenergic Agonists Indications
_Relief of bronchospasms -Treatment and prevention of acute asthma attacks -Used in Hypotension and shock- See afrenergic drugs chapter
Which medication will you teach a patient with asthma to use when experiencing an acute asthma attacks?
albuterol (Ventolin)
A group of office workers is concerned because a package was opened that contained a white powder substance,. Therew is a concern that the white powder is anthrax. Which drug do you anticipate being prescribed for the office workers?
ciprofloxacin (Cipro)- drug of choice to treat anthrax.
A patient with a tracheostomy develops pneumonia. It is very difficult for the patient to cough up the thick, dry secretions he has developed. Which drug would be the most effective in helping the patient?
guaifenesin (Mucinex) because it helps thin the secretions and is used for a productive cough
A patient has been diagnosed with MRSA (topical) on the right arm. You anticipate use of which medication to treat the MRSA?
mupirocin (Bactroban)
a 58 y/o man is recieving vancomycin as part of the treatment for a severe bone infection. After the infusion, he begins to experience some itching and flushing of the neck, face, and upper body. He reports no chills or difficulty breathing. Which of the following do you suspect?
the IV dose may have infused too quickly- red man syndrome- side effect of medication, not considered an allergic reaction or anaphalactic reaction.
