EXAM 4 : antiinfective agents/antiinflammatory agents

In combination with Ibuprofen =

(Combunox)

In combination with Acetaminophen =

(Percocet)

In combination with Aspirin =

(Percodan)

Acute Poisoning of aspirin *test*

*Tinnitus (ringing in the ears!)* Respiratory excitation, replaced by respiratory depression Metabolic Acidosis Hyperthermia Electrolyte imbalances

Aminoglycosides

- Narrow spectrum antibiotics used to treat gram-negative bacteria. More potent than other antibiotics: Used for serious infections - Given IM/IV - Narrow Therapeutic Window - Often do peak and trough levels

Two Categories of Agents Used for Migraine Headaches

1) Agents that will abort a Migraine Headache 2) Agents that will prevent Migraine Headaches from occurring

Rule of Ergot and Triptan drugs

24 hours between Ergot and Triptan drugs

The dosage of WHAT NSAID that you take everyday to prophylactically prevent MI?

81 mg of ASPIRIN every day

The antibiotic most frequently prescribed to the patient who has a hypersensitivity (allergy) to Penicillin is: A) Erythromycin (E-mycin) B) Vancomycin (Vancocin) C) Cefazolin (Ancef) D) Cedphalexin (Keflex)

A

Which one of the following statements is accurate regarding Selective COX 2 Inhibitors? A) Inhibiting COX 2 leads to a reduction in pain and suppression of inflammation B) Several drugs, including Celecoxib, Indomethacin, Sulfasalazine and ketorolac are considered selective COX 2 Inhibitors C) It is common for Selective COX 2 inhibitors to lead to gastric ulcer formation and GI bleeding D) Selective COX 2 inhibitors are frequently prescribed as antipyretic agents (decrease fever)

A

Which is a higher priority for the nurse who is teaching the client taking Bactrim? A) Encourage an increase in fluid intake. B) Report signs of ototoxicity (e.g., tinnitus...) C) Teach the client that individuals taking this drug are not affected by sun exposure. D) Advise the client to take this drug with dairy products or antacids to protect the stomach.

A (bactrim = sulfonamide)

According to your text, which of the following statements are true regarding Acetaminophen? Select all that apply A) An overdose of Acetaminophen can be treated with the antidote, Acetylcysteine (Mucomyst) B) Contrary to NSAIDs, Acetaminophen is not thought to cause gastric distress and does not interfere with platelet aggregation. C) An overdose of Acetaminophen can lead to hepatotoxicity. D) Acetaminophen is indicated to relieve pain, fever and inflammation. E) Acetaminophen is commonly toxic to the kidneys. As such, Creatinine and BUN should be monitored routinely on patients who take Acetaminophen for a prolonged period of time.

A, B, C

According to your textbook, which of the following are true statements regarding resistance to antibiotics? Select all that apply A) Misuse of antibiotics is one contributing factor of emerging drug resistance. The textbook states that 50% of hospitalized patients who are receiving antibiotics, are prescribed them inappropriately. B) Taking antibiotics for viral infections will increase the risk of developing drug resistance. C) A culture and sensitivity test can help to decrease the chance of resistance by determining the actual microbe and the appropriate antibiotic. D) The patient should be instructed to take the antibiotic long enough to see symptoms disappear. Once symptoms are gone, the antibiotic should be discontinued. Taking an antibiotic for 10 - 14 days, even though symptoms are gone, is one contributing factor to antibiotic resistance.

A, B, C

Which of the following statements are accurate regarding the inflammatory process? Select all that apply A) COX 2 is the specific COX enzyme responsible for triggering pain and inflammation B) Drugs that inhibit the biosynthesis of prostaglandins (prostaglandin inhibitors) can be given to decrease inflammation C) Prostaglandin synthesis relies on the cyclooxygenase (COX) enzyme. D) Prostaglandins, a chemical mediator of inflammation, lead to vasodilation and increased capillary permeability. E) The terms "inflammation" and "infection" can be used interchangeably.

A, B, C, D

Nursing considerations for Aminoglycosides... Would it most important to monitor...(Select all that apply) A) Hearing B) Skin color C) Urine output D) Body temperature

A, C

According to the textbook, there are three general adverse reactions to antibacterial agents. These include.... Select all that apply A) Superinfection B) Fatigue C) Allergy or hypersensitivity D) Organ toxicity E) Decrease in GI motility (constipation)

A, C, D

Common side effects of most opioid agents include which of the following? Select all that apply: A) Respiratory depression B) Hypertension C) Urinary retention D) Constipation E) Diarrhea F) Urinary frequency G) Hypotension H) Hyperventilation

A, C, D, G

Which of the following are true statements regarding Tetracycline agents? Select all that apply A) Tetracycline antibiotics may lead to superinfections B) Tetracycline antibiotics should be taken with meals/dairy products to decrease gastric upset and enhance absorption. C) One benefit of the tetracycline antibiotic group is that there has been no resistance developed to date. D) Photosensitivity is an adverse reaction commonly seen with Tetracycline antibiotics. E) Women in their last trimester of pregnancy and children younger than the age of 8-years should not take tetracycline antibiotics because it irreversibly discolors the teeth.

A, D, E

Agent of first choice for most infections caused by the herpes viruses and Varicella-zoster virus

Acyclovir

Antiviral Agents:Examples

Acyclovir Famciclovir Ribavirin Palivizumab Zanamivir Oseltamivir

Bacitracin (Bactrin)

Administered topically and ophthalmic Available OTC as an ointment for skin application Must apply in thin layers Could be nephrotoxic and ototoxic Allergies common

Corticosteroids are hormones that are released from the ________

Adrenal Gland

Adverse Effects: Acetaminophen

Adverse effects are rare at therapeutic doses Overdose or overuse of Acetaminophen will cause liver damage Should limit dosage to less than 4000mg/daily

Three Major Adverse Reactions to Antibacterials...

Allergic Reactions Superinfections Organ Toxicities

Side Effects of Tetracycline:

Allergies not common Photosensitivity Teratogenic effect to fetus and children less than 8 years of age : effects teeth coloration

What do you want to do before you administer antibiotics? *TEST*

Always complete the culture prior to administration of the antibiotic!

What do you want to teach your patient about NSAIDS? *test*

Always give with food or milk

Tricyclic Antidepressants

Amitriptyline (Elavil) Indicated for prevention of migraine and tension headaches

What is the most commonly used penicillin?

Amoxicillin

_____ and ______ should not be taken with acidic fruits and juices... and why?

Amoxicillin & Dicloxacillin: Will decrease the effectiveness

All Penicillins except for _____ are absorbed better on an empty stomach

Amoxicillin (Amoxicillin absorption has no regard for meals)

examples of Polyenes

Amphotericin B Nystatin

Mu & Kappa Receptors

Analgesic effect requires activation of the Mu receptor. Activation of Kappa alone, will not cause analgesic effect

examples of Echinocandins

Anidulafungin Caspofungin Micafungin

Other drug-drug Interactions of aspirin

Anticoagulants - increases risk of bleeding Oral antidiabetics - may induce hypoglycemia Glucocorticoids - increases gastric ulcer risk

Acetylcysteine (Mucomyst) *TEST*

Antidote to acetaminophen overdose Reduces injury to the liver Most effective if given shortly after acetaminophen ingestion

Ketoconazole

Antifungal agent

NSAIDS have the following effects:

Antiinflammatory (COX 2) Antipyretic (COX 2) Analgesic (COX 2) Inhibits platelet aggregation (COX 1)

Colchisine explained

Antiinflammatory Agent whose effects are specific for Gout: Will not treat other inflammatory disorders 75% of patients will have GI adverse effects

ARV

Antiretroviral

ART

Antiretroviral Therapy

Zidovudine (AZT)

Antiviral agent used to treat HIV infection

Acyclovir (Zovirax)

Antiviral drug used to treat herpes infections

Drug-food interactions of aspirin

Any foods with salicylates Prunes & raisins Licorice Some spices such as curry powder and paprika

Resistance to Antibacterials

As the bacteria reproduce, some mutation occurs and eventually the mutant bacteria survive the effects of the drug

Also called ASA (Acetylsalicylic Acid)

Aspirin

Best anti platelet aggregation drug?

Aspirin

______________________ are sold OTC. All other NSAIDs require a prescription.

Aspirin, Ibuprofen & Naproxen

Agents that will abort a Migraine Headache

Aspirin/ Acetaminophen Serotonin (5-HT) Agonists (Triptans) Ergot Alkaloids

Protease inhibitors

Atazanivir (Reyataz) Ritonavir (Norvir)

What is the gold standard of DMARD Agents:

Auranofin

DMARD Agents Include:

Auranofin Methotrexate (Mexate) Azathioprine (Imuran) Etanercept (Enbrel) Infliximab (Remicade) Hydroxychloroquine (Plaquenil)

Contraindications of Selective COX 2 Inhibitors

Avoid during 3rd trimester Avoid in patients with renal dysfunction, hypertension, fluid retention, heart failure...

Macrolides, such as Azithromycin, Clarithromycin and Erythromycin, are... A) Narrow Spectrum Antibiotics B) Broad Spectrum Antibiotics

B

The antibiotic group that most closely resembles Penicillin agents, have similar molecular structure and a 10% risk of cross-allergy reaction, is: A) Tetracyclines B) Cephalosporins C) Aminoglycosides D) Macrolides

B

The antidote for an overdose of an opioid analgesic is: A) Vitamin K (Phytonadione) B) Naloxone (Narcan) C) Flumazenil (Romazicon) D) Aetylcysteine (Mucomyst)

B

Which nursing intervention is a higher priority for the client who is taking cefepime (Maxipime)? A. Wait until culture results are received before initiating antibiotic. B. Monitor the client for signs and symptoms of a superinfection. C. Administer all cephalosporins IV regardless of the physician's order D. Instruct the client to avoid driving while on this medication

B

A client is taking piperacillin-tazobactam (Zosyn). Which nursing interventions are appropriate for this drug? (Select all that apply.) A. Administer with an aminoglycoside. B. Spend specimen to lab for C&S before antibiotic therapy is started. C. Instruct client to take entire prescribed drug. D. Instruct client to restrict fluid intake. E. Monitor for symptoms of superinfection including stomatitis and vaginitis.

B, C, E

Aspirin (ASA) is one of the oldest anti-inflammatory agents. Which of the following are true statements regarding ASA? Select all that apply A) ASA should be taken on an empty stomach, at least one hour before meals and two hours following meals. B) ASA is considered an anti-inflammatory agent as well as an antiplatelet agent. C) ASA inhibits both COX 1 and COX 2 enzymes D) ASA is most effective when used concurrently with other NSAID agents in the treatment of inflammation. E) ASA overdose causes symptoms of tinnitus and bronchospasms.

B, C, E

Rod-shaped bacteria

Bacilli

Examples of peptides

Bacitracin (Bactrin) Polymyxin B (Aerosporin)

Superinfections

Bacterial or fungal "overgrowth" Secondary infection that occurs because the normal microbial flora of the body is disturbed: when someone is on a broad spectrum antibiotic, which destroys normal floral

Why do you have hypernatremia if you are on long term corticosteroid therapy?

Because of the aldosterone, they will hold on to fluids.

Why do you have hyperglycemia if you are on long term corticosteroid therapy?

Because of the cortisol, will raise blood glucose level

If a corticosteroid is abruptly discontinued, it will result in acute adrenal insufficiency... why?

Because the body will become used to the corticosteroid doing the work, and the adrenal glands will stop making any corticosteroids itself. If we abruptly discontinue the drug, it will result in acute adrenal insufficiency.

Nursing considerations for Aminoglycosides: Would culture and sensitivity be done (before/after) the first dose?

Before

Agents that will prevent Migraine Headaches from occurring

Beta Blockers Tricyclic Antidepressants Antiepileptic agents

Preventive Treatment of Migraine Headaches

Beta Blockers Anticonvulsants

Examples of corticosteriods

Betamethasone Dexamethasone Hydrocortisone Methylprednisolone Prednisone Triamcinolone (ALL END IN ONE)

Naloxone (Narcan)

Blocks the Mu and Kappa receptors Drug of choice for reversal of opioid overdose Has no effect on the patient if opioids have not been administered

_______ spectrum antibiotics are more prone to a developing resistance than ______ spectrum antibiotics

Broad ... Narrow

Sulfonamides

Broad spectrum antibiotics Frequent drug reactions and drug resistance Mostly used to treat UTI's, Otitis Media and newborn eye prophylaxis High rate of Allergies

Macrolides

Broad spectrum antibiotics (Superinfections are likely) Bacteriostatic and bacteriocidal Hepatotoxicity is an issue Allergies is not a problem

Azoles are used for:

Broad spectrum antifungal, ring worm, athletes feet... Given orally or topically Hepatic liver enzyme inhibitors: *INHIBIT METABOLISM OF OTHER DRUGS*

Ribavirin

Broad spectrum antiviral drug Drug of choice for Hepatitis C when combined with interferon Category X agent: Pregnant nurses should not administer this agent

Examples of Anaerobic organism

C Difficile and C Tetanus

Examples of Superinfections

C-diff, or thrush or vaginal yeast infection

Aspirin inhibits ____ and ____

COX 1 and COX 2

Indomethacin (Indocin) *test*

Can be given IV to preterm infants to promote closure of the ductus arteriosus

Examples of Selective COX 2 Inhibitors

Celecoxib (Celebrex) Nanabumetone (Relafen) Meloxicam (Mobic)

Examples of four generations of Cephalosporins

Cephalexin (Keflex, Ancef) Cefaclor (Ceclor) Ceftriaxone (Rocephin) Cefipime (Maxipime)

What is your most commonly used class of antibiotics?

Cephalosporins

Organ Toxicities

Certain antimicrobials are prone to cause toxicity: Ear, liver, kidneys

Pathophysiology of Gout

Characterized by Hyperuricemia Can occur either through: Excess production of uric acid Impaired renal excretion of uric acid Acute attacks are precipitated by crystallization in the synovial space

Uses of Tetracyclines

Chlamydia Anthrax Cholera Lyme Disease Peptic ulcers caused by Helicobacter Pylori Mycoplasma pneumonia Rickettsial Diseases

Examples of Fluoroquinolones

Ciprofloxacin (Cipro) Levofloxacin (Levaquin) Ofloxacin (Floxacin)

Examples of Lincosamides

Clindamycin (Cleocin) Lincomycin (Lincocin)

Spherical-shaped bacteria

Cocci

Emtricitabine/Tenofovir (Truvada)

Combination product Both are NRTI Agents Frequently included in HAART Therapy for HIV + person Considered a "Pre-Exposure Prophylactic" Used by adults who are HIV - , but high risk

Nitrofurantoin (Macrodantin)

Considered a "urinary antiseptic/ antiinfective": Superinfections Peripheral neuropathy Hepatotoxicity GI Distress Dizziness and Drowsiness

Used most frequently for acute inflammatory problems and arthritis "flare-ups", not preferred agent for long term therapy.

Corticosteroid therapy

Crystalluria

Crystals in the urine

Culture and Sensitivity

Culture and Sensitivity testing can be done to determine sensitivity: When a bacteria is "sensitive" to the drug, the organism is inhibited or destroyed Determines the appropriate antibiotic based on the culture

A client has been prescribed Bactrim. The nurse realizes that this drug is most commonly used to treat which condition? A. Gonorrhea B. Rickettsial infection C. Chlamydial infection D. Urinary tract infection

D

A patient with a lower urinary tract infection has been prescribed nitrofurantoin (Macrodantin). What side effects/ adverse reactions would the nurse teach the client to expect? A) Irritability B) Anxiety C) Crystalluria D) Brown, discolored urine

D

Aspirin is Pregnancy Category ______

D

Action of aspirin

Decreases inflammatory process Decreases the protection of the stomach lining Decreases pain Inhibits platelet aggregation

Uric Acid Inhibitors

Decreases uric acid levels Allopurinol Febuxostat

Nonaspirin NSAIDS

Developed as an alternative to Aspirin in an attempt to decrease adverse effects

DMARDs stands for:

Disease-modifying antirheumatic drugs

Viruses:

Do not contain both RNA and DNA Instead viruses enter healthy cells and use the cell's DNA and RNA in order to duplicate Viruses live and reproduce when they are "inside" of living cells

Patient Teaching on aspirin...

Do not take w/other NSAIDs Take with food to decrease GI problems Do not give to children with viral febrile illnesses (Reye's syndrome) Do not give during 3rd trimester of pregnancy

What patient teaching would be important for the patient regarding NSAIDs?

Don't take with aspirin, or take two NSAIDS together Take with food/milk Don't take during your last trimester of pregnancy

Patient teaching with Fluoroquinolone

Drink LOTS of water: because of Crystalluria -> kidney stones Wear sunscreen: Photosensitivity

Amphotericin

Drug of choice for most SEVERE systemic fungal infections Administered IV Highly nephrotoxic Ototoxic

For any drug that is toxic to the kidneys, what do patient teaching do you want to do? *nclex q*

ENCOURAGE LOTS OF FLUIDS

When is it best to take a sputum sample?

Early morning

What would you want to teach your patient about diet with taking penicillins?

Eat buttermilk, yogurts...

Non-Nucleotide Reverse Transcriptase Inhibitors

Efavirenz (Sustiva) Delavirdine (Rescriptor)

Broad Spectrum antibiotic:

Effective against a wide variety of microbes Use this when we don't know what the offending organism is

When taking antigout medications, pt teaching includes:

Encourage patient to increase fluid intake alcohol, caffeine and thiazide diuretics increase uric acid levels. avoid aspirin Probenecid should not be used during the first 2 - 3 weeks of an acute attack: prolongs inflammatory process

Ergot Derivatives examples

Ergotamine (Ergostat) Dihydroergotamine (DHE)

Examples of Macrolides

Erythromycin Azithromycin Clarithromycin

Immunomodulators examples:

Etanercept (Enbrel) & Infliximab (Remicade)

True or False? Superinfections such as thrush, are more likely to occur with "narrow" spectrum antibiotics than with "broad" spectrum.

False

True or false? According to the text, overtreatment of pain has become a serious national issue. Healthcare providers over-treat pain and this is the reason for serious addiction and abuse issues.

False

True or false? Corticosteroids include glucocorticoids and mineralcorticoids. Aldosterone, the main mineralocorticoid, has the anti-inflammatory effect.

False

Side effects of Nonaspirin NSAIDS

Fewer side effects than aspirin Gastric irritation and bleeding is a problem Sodium and water retention may occur Increased bleeding with anticoagulants

Ergot Derivatives

First line drug for abortive therapy Pregnancy category X agents Should not be combined with triptans

Serotonin (5-HT) Agonists (Triptans)

First-line treatment for abortive therapy Constrict intracranial vessels Available in multiple formulations

examples of Pyrimidine Analogs

Flucytosine

Neuraminidase Inhibitors

For influenza A and B Decrease the release of the virus from infected cells, thus decreasing the viral spread

Action of antitubercular drugs

For medication to reach the isolated microorganisms in the tubercles, treatment must continue for 6 - 24 months. Two to four agents will be administered to the patient during the course of the treatment.

Common Side Effects of all NSAIDS:

GI upset GI Bleed Bleeding Peripheral Edema Increased clotting time

Opioid

General term defined as any drug, natural or synthetic, that has actions similar to those of morphine

Adverse Effects of the Triptans

Generally well tolerated Coronary vasospasm is the biggest concern 50% of patients will experience "heavy arms" and "chest pressure". Teratogenic Effects

Examples of Aminoglycosides

Gentamycin Amikacin Tobramycin Streptomycin

Corticosteroids consist of a ________ and a _________

Glucocorticoid and a Mineralcorticoid

Also called Chrysotherapy or Heavy Metal Therapy

Gold Drug Therapy "Auranofin"

Anaerobic

Grow best without oxygen

Adverse Effects: INH *NCLEX q*

HIGHLY Hepatotoxic Peripheral Neuropathy

Reyes Syndrome *test*

Has a mortality rate of 20 - 30% Associated with use of Aspirin in kids with viral febrile illnesses *"causes fatty infiltrates (fatty deposits) on the brain and the liver"*

Side effects of Selective COX 2 Inhibitors

Headache, dizziness Peripheral edema

Common Virus Infections:

Herpes Simplex - 1 : Mouth, face Herpes Simplex - 2: Genitals, rectum, skin, hands and meninges Cytomegalovirus (CMV): Spread by direct contact with saliva, urine, blood, tears, semen... Varicella Zoster (VZV): Epstein-Barr virus Influenza Respiratory Syncytial Virus

Acyclovir is used for:

Herpes simplex virus type 1 & 2 Varicella-zoster Epstein-Barr Cytomegalovirus

Oxycodone

High abuse potential Administration is oral Available in multiple oral formulations

HAART

Highly Affective Antiretroviral Therapy (Combination of ART agents given together in a treatment protocol)

Polymyxin B (Aerosporin)

Highly nephrotoxic and neurotoxic Usually reversible when drug is discontinued Must monitor serum BUN and creatinine levels

Why do you have hypokalemia if you are on long term corticosteroid therapy?

Holding on to sodium, so the body will release the kalemia

Antimalarial Agent example

Hydroxychloroquine (Plaquenil) Retinal damage may result from toxicity

Side effects of Long-Term Corticosteroid Therapy

Hyperglycemia Fluid Retention Hypokalemia Hypernatremia Euphoria Osteoporosis Gastric Distress Weight gain Moon Face Buffalo Hump Decreased Extremity Size Immunesuppression Muscle Weakness Increased bruising Thin skin Growth retardation in children

Symptoms of Acute Adrenal Insufficiency

Hypotension Tachycardia Dehydration Hyponatremia Hyperkalemia Hypoglycemia Weakness Fever May lead to circulatory collapse and shock

Examples of Nonaspirin NSAIDS

Ibuprofen (Advil, Motrin) Naproxen (Aleve) Indomethacin (Indocin) Ketorolac (Toradol) Flurbiprofen (Ansaid)

Fungal infections

If the persons' natural defenses are weakened, the fungus can spread and result in an "opportunistic infection", Causing an overgrowth of the fungus

Uricosurics

Increase rate of uric acid excretion Probenecid Sulfinpyrazone

Immunomodulators are indicated for ____ but side effect = _____

Indicated for patients with moderate to severe Rheumatoid arthritis Immunosuppression is a major disadvantage Monitor for infection

Migraine Headaches Pathophysiology

Inflammation and Dilation of intracranial blood vessels

Colitis

Inflammation of the colon

Antivirals:

Inhibit replication, but they don't kill the virus

Acetaminophen (Tylenol)

Inhibits prostaglandins only in the CNS NSAIDs inhibit prostaglandins also in the periphery Analgesic and antipyretic effect equivalent to aspirin No antiinflammatory effect No effect on platelet aggregation Does not cause gastric ulcers

Bacteriostatic Drugs:

Inhibits the growth of bacteria

Fentanyl is available in many formulations, like:

Injectable Sublimaze Transdermal Duragesic Transmucosal Lozenges on a stick Buccal film Buccal tablets Sublingual tablets Intranasal

Examples of antitubercular drugs

Isoniazid (INH) Rifampin Rifapentine Rifabutin Ethambutol Pyrazinamide

examples of Azoles

Ketoconazole Fluconazole Itraconazole Miconazole Nitrate (Monistat)

Bacteriocidal Drugs:

Kills the bacteria

Z-Pack Azithromycin (Zithromax)

Long half life Given one time a day for 4- 5 days

Allergic reactions

May be mild or severe Treated with antihistamines, bronchodilators, epinephrine...

Adverse Effects and Special Considerations of Acyclovir.... *TEST*

May effect renal function Assess BUN and Creatinine prior to therapy Assess urine output, throughout course of therapy BUN and Creatinine will elevate with renal dysfunction *Encourage adequate fluid intake to decrease the risk of nephrotoxicity*

Immunosuppressants example:

Methotrexate, Considered first-choice DMARD agent. Need to monitor liver and kidney function, as well as CBC.

Primary opioid analgesic

Morphine Sulfate

Metronidazole (Flagyl)

Most commonly used to treat organisms in the GI tract, GU tract and CNS Broad Spectrum Used to treat C Difficile

Metronidazole (Flagyl)

Most effective at treating disorders of the GI tract

There are three main classes of opioid receptors

Mu Kappa Delta Analgesics primarily exert their effect on Mu and Kappa

Side effects of

Must monitor CBC (anemia/neutropenia) and for nephrotoxicity, Anorexia, nausea, vomiting, diarrhea, stomatitis...

Ketorolac (Toradol)

NSAID that is a GREAT analgesic (equivalent to morphine in analgesic effectiveness) - Use should be limited to 5 days - (Minimal anti-inflammatory action)

Non-opioid

NSAIDs Acetaminophen

Classes of Antiarthritic Drugs

NSAIDs Corticosteroids DMARDs

examples of Opioid Antagonist

Naloxone (Narcan) Methylnaltrexone (Relistor) & Alvimopan (Entereg)

Selective COX 2 Inhibitors

Newest class of NSAID's Treats inflammation and pain without the adverse effects of blocking COX-1

Rinse mouth after taking which drug?

Nitrofurantoin (Macrodantin) (can stain teeth: but not the same as Tetracycline)

Sensory pain receptors that are activated by stimuli in peripheral tissues

Nociceptor

Analgesia/ Pain Management

Non-opioid Opioid

Drugs for Relieving Pain from *Acute* Gouty Arthritis:

Nonsteroidal Anti-inflammatory drugs Agent of first choice Indomehtacin (Indocin) Naproxen (Naprosyn) Glucocorticoids Used when NSAIDs aren't tolerated or are contraindicated Prednisone Colchicine Anti-inflammatory agent, *specific* for gout

Phenazopyridine (Pyridium)

Not an antibiotic Urinary Analgesic Frequently prescribed along with an antibiotic for treatment of a UTI

Classes of Antiretroviral Medications...

Nucleotide Reverse Transcriptase Inhibitors Non-Nucleotide Reverse Transcriptase Inhibitors Protease Inhibitors Entry Inhibitors CCR5 Antagonists Integrase Inhibitors

Tetracyclines

One of the broadest spectrums of any class of antibiotics: superinfections!

Examples of Neuraminidase Inhibitors

Oseltamivir Phosphate (Tamiflu) Zanamivir (Relenza)

Adverse Effects of aminoglycosides:

Ototoxicity -> tinnitus Nephrotoxicity

Gamma Globulin

Passive Antibodies, may provide immediate immunity

Aerobic

Pathogens that thrive in an oxygen environment

Examples of Penicillins

Penicillin G Penicillin V Ampicillin Ampicillin-Sulbactam (Unasyn) Amoxicillin Amoxicillin/Clavulanate Dicloxacillin Piperacillin-Tazobactam

Categories of Antibacterial Drugs:

Penicillins Cephalosporins Macrolides Tetracycline Aminoglycosides Sulfonamides

Opioid Agonist-Antagonists examples

Pentazocine (Talwin) Nalbuphine HCl (Nubain)

Antifungal Drugs: Examples

Polyenes Azoles Echinocandins Pyrimidine Analogs

Fluoroquinolones

Potent antibiotics Broad Spectrum

Narrow Spectrum antibiotic:

Primarily effective against one type of organism Use this one if you know the organism: It will be more effective

Hydromorphone (Dilaudid)

Produces less sedation, nausea, vomiting and constipation than Morphine Respiratory depression is a major concern

Rheumatoid Arthritis

Progressive inflammatory autoimmune disorder Inflammation of the synovium Membrane that encloses the joint capsule

Beta Blockers

Proranolol (Inderal) First line choice for prophylaxis Thought to stabilize vascular tone

COX1

Protects the stomach lining, supports renal function and regulates blood platelet aggregation

Glucocorticoids use as antiarthritic drugs:

Provide rapid relief of symptoms May slow disease progression Cannot be used long term due to serious side effects

Examples of Aerobic organism

Pseudomonas and Neisseria Gonorrhea

Addiction

Psychological and/or physical dependence on a substance.

NSAIDs use as antiarthritic drugs:

Rapid relief of symptoms Does not prevent joint damage or slow disease progression Safer than DMARD's or Glucocorticoids

Gout

Recurrent inflammatory condition that attacks joints, tendons and other tissues Joint of the big toe is the most common site of acute gouty inflammation

HIV Virus: Antiretroviral Agents, goals of treatment

Reduce HIV-associated morbidity and mortality: Enhance CD4 Cell Count to restore and preserve immunologic function

Goal of Pharmacotherapy:

Reduce pain and inflammation

What do DMARDs do?

Reduces joint destruction Retards disease progression Onset of benefit typically will take several weeks to months Potential for toxicity : requires close monitoring

Opioid Antagonist indicated for

Relief of opioid overdose Relief of opioid induced constipation

Goals of Treatment for Gout

Relieve symptoms Given short term for severe pain and inflammation Prevent Gout Attacks Lower blood levels of uric acid Given long term

contraindications of Opioid Agonist-Antagonists

Renal/hepatic dysfunction Head injuries/increased ICP Impaired respirations History of drug abuse/emotional instability

Penicillins: Resistance

Resistance is common with the Penicillins: Limits their use

Opioid Side Effects/Adverse Effects

Respiratory depression Constipation Orthostatic hypotension Urinary retention Cough suppression Nausea and vomiting Elevation of intracranial pressure Due to respiratory depression, CO2 increases which leads to dilated cerebral vessels Sedation Miosis

side effects of Opioid Agonist-Antagonists

Respiratory depression, confusion, depression, restlessness...

Nephrotoxicity *NCLEX q*

Risk is also related to excessive trough levels Symptoms include proteinuria, elevated serum creatinine and BUN Usually reversible

Ototoxicity *NCLEX q*

Risk of ototoxicity is related to excessive trough levels, rather than excessive peak levels First sign of ototoxicity is tinnitus The ototoxicity is largely reversible

Classification Based on Cellular Shape

Rod-shaped bacteria Spherical-shaped bacteria Spiral-shaped bacteria

Adverse Effects

Salicylism Reyes Syndrome GI upset GI Bleed Bleeding Peripheral Edema Increased clotting time

Codeine is schedule _____

Schedule II and III Analgesic and Antitussive 10% of codeine is metabolized to morphine

Hydrocodone (Lortab, Vicodin) is schedule ____

Schedule III Used for analgesia and cough suppression

What do you have to watch with Glycopeptides?

Serum levels... because ototoxicity and nephrotoxicity is common

Cephalosporins

Similar to Penicillins Broad spectrum Safe and effective Minimal side effects

Pain located in bones and muscles

Somatic pain

Spiral-shaped bacteria

Spirilla

What is an example of penicillin resistance?

Staphylococcus Aureus is an example MRSA

Serotonin (5-HT) Agonists (Triptans) Examples:

Sumatriptan (Imitrex) Rizatriptan (Maxalt) Zolmitriptan (Zomig)

Since Cephalosporins have a broad spectrum, they are more at risk for...

Superinfections

Treatment of acute aspirin poisoning

Supportive IV Sodium Bicarbonate to reverse the acidosis and enhance renal excretion

What is Salicylism (and symptoms)?

Syndrome that begins when aspirin levels climb just above therapeutic level. (Aspirin toxicity) *Symptoms include tinnitus, sweating, headache and dizziness*

Examples of Tetracyclines

Tetracycline Demeclocycline Doxycycline; Minocycline

Pain tolerance

The amount of pain a person can endure without having it interfere with normal functioning

Pain threshold

The level of stimulus needed to create a painful sensation

Cycloocygenase (COX):

This enzyme is responsible for converting arachidonic acid into prostaglandins COX promotes syntheses of prostaglandins

Treatment of Latent TB is used for...

Those who have had direct close contact with active TB person Those who have a positive TB skin test or blood test, but negative Chest X Ray

How is TB transmitted?

Transmitted from one person to another by droplets dispersed in the air through coughing and sneezing

The DMARD won't work for a while, so what do we do? (The New Plan)

Treatment is now more aggressive Start the DMARD early Delays joint degeneration Will take weeks to months to work, so an NSAID is given for symptom relief until the DMARD is effective.

Nitrofurantoin (Macrodantoin)

Treatment of Urinary Tract Infections (UTI)

Indications for Aspirin usage

Treatment of mild to moderate pain Reduce fever Suppress platelet aggregation Treatment of mild inflammatory conditions

COX2

Triggers inflammation, pain and fever, maintains renal function

Examples of Sulfonamides:

Trimethoprim and Sulfamethoxazole Silver Sulfadiazine (Silvadene)

True or False? According to your text, Vancomycin is the treatment of choice for Methicillin Resistant Staphylococcus Aureus (MRSA).

True

True or false? If a corticosteroid is given less than 2 weeks, there is no need to taper the drug.

True

True or false? When discontinuing steroid therapy that has been longer than 2 weeks, the dose should be tapered off over 5-10 days

True

True or false? According to your textbook, when caring for a patient who is taking an aminoglycoside antibiotic, it is especially important that the nurse monitor the patients' urinary output, balance and changes in hearing. This group of drugs may lead to ototoxicity and nephrotoxicity.

True

True or false? Ibuprofen and other NSAIDs are known to potentially cause gastric irritation and GI bleeding. The concurrent use of NSAIDs with alcohol consumption will increase this risk.

True

Drugs Used to *Prevent* Gout Attacks

Two groups of drugs are used.. Uric Acid Inhibitors Uricosurics

Neuropathic pain

Unusual sensory disturbance. Often described as burning and tingling

Isoniazid (INH)

Used for prophylaxis of tuberculosis

Corticosteroids

Used frequently as an antiinflammatory agent in the treatment of... Asthma, Rheumatoid arthritis, Lupus Erythematosus, Neoplasms, Inflammatory bowel disease, Allergic conditions, dermatologic conditions... Also used as an immunosuppresant agent to suppress organ transplant rejection and in the treatment of autoimmune disorders

Nystatin

Used only for candidas infections Administered orally and topically

Anticonvulsants

Valproic acid (Depakote) Gabapentin (Neurontin)

Glycopeptides (examples, uses, and adverse effects)

Vancomycin (Vancocin; vanco) Used in the treatment of MRSA Adverse Effects: Ototoxicity : ears -> tenitus Nephrotoxicity: kidneys Red Man Syndrome

Pain located in body organs

Visceral pain

What nursing considerations would be important when caring for a patient prescribed a Cephalosporin?

Watch for allergies: rash, itching, etc... Eat probiotics: yogurt, buttermilk Educate about C-Diff risk

Circulatory collapse

When you are not retaining any sodium or water, the body becomes dehydrated, and fluid drops so low that they don't have anything to circulate!

Are super infections common with penicillin?

Yes

Nucleotide Reverse Transcriptase Inhibitors

Zidovudine (Retrovir, AZT) Delavirdine (Rescriptor) Tenofovir (Viread) Emtricitabine (Emtriva)

Activation of the Mu Receptors cause:

analgesia, euphoria, sedation, physical dependence, and respiratory depression

Activation of the Kappa Receptors cause:

analgesia, miosis, sedation and respiratory depression

In contrast to aspirin, nonaspirin NSAIDS, do not have_______ effects.

antiplatelet

opioids are contraindicated in what patients?

any pt with a risk of intracranial pressure

"Prostaglandin Inhibitors" work by inhibiting the ...

biosynthesis of prostaglandins by inhibiting the COX enzyme

What can aspirin taken during pregnancy cause?

cause premature closure of the ductus arteriosus in the fetus... Should not be taken during the last trimester of pregnancy

What is TB?

caused by the acid-fast bacillus, Mycobacterium Tuberculosis: The Mycobacterium Tuberculosis activate cells of the immune response, which attempt to isolate the microorganisms by creating a wall around them

Tetracycline agents will ______ contraceptive agents

decrease the effectiveness

culture

determines organism

sensitivity

determines which antibodies to use "when a bacteria is sensitive to the drug, the organism will be inhibited or destroyed"

Serotonon (5-HT) levels ______ during a migraine

fall

Penicillins

have a "beta-lactam" ring Primarily treat Gram-postive bacteria some are narrow spectrum and some are broad spectrum.

Why do we have to monitor the first dose of penicillin carefully?

in case they are allergic: Incidence of Penicillin Allergy is 5 - 10%

Contraindications for Opioids are: Head injuries, increased ICP Respiratory disorders Hypotension, shock... WHY?

increased co2 levels leads to vasodilation which will increase intracranial pressure. hypotension will be lowered even more because opioids are cns depressants.

List the inflammatory mediators...

leukotrienes, histamine, bradykinin, prostaglandins

if someone overdoses on aspirin, what might become a problem?

metabolic acidosis

Which classes have a high rate of allergies?

penicillin cephalosporins sulfonamides

About 10% of persons allergic to _____ are also allergic to ______

penicillin .... cephalosporins

miosis

pupil constriction

What are the "Cardinal Symptoms of Inflammation"?

redness, heat, pain, swelling

Calcitonin Gene-Related Peptide (CGRP) levels ______ during a migraine

rise

"supportive treatment"

treat whatever symptoms or assessment findings appear

What patient teaching do you want to give for a patient on tetracycline?

use sunscreen monitor for superinfections take it on an empty stomach will decrease effectiveness of birth control pill don't drink with milk/calcium/antacids don't take while pregnant don't give to children