Exam 3 Patho Pharm 1
What are the risk factors for a suppressed immune system?
- Age - Nonimmunized state - Environmental factors - Chronic illness - Medical treatments - Genetics - High risk behaviors + substance abuse - Pregnancy
How long should someone wait to take doxycycline after taking supplements?
1-3 hr
Arrange the steps involved in skin testing for an allergen causing a type I allergic reaction in their correct sequence. 1. Clean the inner side of the forearm with soap and water. 2. Apply topical steroid on the skin. 3. Use skin testing needle to scratch surface of skin 4. Place drops of sera containing the known allergen on skin 5. Observe for a wheal formation on the skin. 6. Discontinue corticosteroid medications.
6, 1, 4, 3, 5, 2
A client with a history of cardiac dysrhythmias is admitted to the hospital due to a fluid volume deficit caused by a pulmonary infection. The registered nurse assesses the recorded vital signs. Which vital sign assessment requires reassessment? Select all that apply. One, some, or all responses may be correct. A. Respiratory rate of 14 breaths/minute B. Blood pressure of 120/80 mm Hg. C. Oxygen saturation of 95% D. Temporal temperature of 99.3?F (37.4?C) E. Radial pulse rate of 72 and irregular
A, B, C
Which client condition is an example of a cell-mediated immunity? Select all that apply. One, some, or all responses may be correct, A. Tuberculosis (TB) B. Graft rejection? C.Allergic rhinitis D. Contact dermatitis E. Anaphylactic shock
A, B, D
What are the adverse rxns to vancomycin?
ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS DRUG RXN WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS LINEAR IGA BULLOUS DERMATITIS SJS TOXIC EPIDERMAL NECROLYSIS ototoxicity nephrotoxicity
What is cefotaxime active against?
Acinetobacter Citrobacter Enterobacter Haemophilus influenzae Haemophilus parainfluenzae E. coli Klebsiella pneumoniae Morganella morganii N. gonnorhoeae and meningitidis Proteus Providencia Serratia Moraxella catarrhalis Borrelia bugdorferi Bacteroides fragilis *not active against methicillin-resistant staphylococcus
What is ceftaroline used for?
Acute bacterial skin/skin structure infections Community acquired pneumonia
What is the broad spectrum penicillin?
Amoxicillin
How should tetracycline be taken?
Around the clock and finish completely, even if feeling better
How should doxycycline be taken?
Around the clock and finished completely, even if feeling better.
How should you take erythromycin?
Around the clock and until finished, even if feeling better.
What assessments should you do with Penicillin G + V?
Assess for infection History of reactions to penicillin, cephalosporins, and other beta-lactam antibiotics Obtain specimens for culture and sensitivity Observe for signs/symp of anaphylaxis
What assessments should you do with amoxicillin?
Assess for infection at beginning and throughout therapy Monitor for signs/symp of anaphylaxis Monitor bowel function Obtain culture and sensitivity test before therapy
What assessments would you do with fluconazole?
Assess infected area and monitor CSF Obtain specimens for culture Assess patient for rash (mild to moderate rash usually occurs in the 2nd wk of therapy and resolves within 1-2 wk of continued therapy).
What assessments should be done with acyclovir?
Assess lesions before and daily during therapy. Monitor frequency of recurrences. Monitor neurologic status in patients with herpes encephalitis.
What are the assessments for griseofulvin?
Assess skin at site of fungal infection routinely during therapy. Assess patient for allergy to penicillin; potential cross-sensitivity exists. Assess for rash periodically during therapy (may cause Stevens-Johnson syndrome or toxic epidermal necrolysis)
Which assessment findings would the nurse identify in a client with clinical manifestations of rheumatoid arthritis (RA)? Select all that apply. One, some, or all responses may be correct. A. Obesity and asymmetric joint disease B. Development of antinuclear antibodies C. Inflammatory disease, pattern D. Bilateral involvement of metacarpophalangeal joints E. Disease process involving the distal interphalangeal joints F. Disease in the weight-bearing joints and hands
B, C, D
Which infection would the nurse monitor for in the toddler based on structural characteristics at this age? Select all that apply. One, some, or all responses may be correct. A. Bronchiolitis B. Ear infection C. Acute sinusitis D. Laryngotracheobronchitis E. Inflammation of the tonsils
B, C, D, E
After a client experiences a cardiac arrest, the client is transferred to the intensive care unit (ICU). Which nursing intervention is the major attribute that affects the quality of care provided to the client? Select all that apply. One, some, or all responses may be correct. A. Develop a diet plan according to the client's food preference. B. Coordinate with the members of the ICU while transferring the client. C. Provide cardiopulmonary resuscitation before transferring the client. D. Encourage the client's family members to visit the client frequently. E. Administer digoxin to the client according to the prescription.
B, C, E
What labs should be done with acyclovir?
BUN, serum creatinine, and CCr
Which nursing intervention would prevent septic shock in the hospitalized client? A. Maintain the client in a normothermic state. B. Administer blood products to replace fluid losses. C. Use aseptic technique during all invasive procedures. D. Keep the critically ill client immobilized to reduce metabolic demands.
C
What labs should be done with amphotericin B?
CBC BUN Kidney function
What are the labs done with griseofulvin?
CBC serum creatinine hepatic (liver) functions
What are the lab considerations for trimethoprim?
CBC urinalysis
What are the adverse rxns to ceftaroline?
CDAD ENCEPHALOPATHY SEIZURES HYPERSENSITIVITY RXNS hemolytic anemia
What are the adverse rxns to cefepime?
CDAD ENCEPHALOPATHY SEIZURES HYPERSENSITIVITY RXNS rash pain at IM site phlebitis at IV site eosinophilia thrombocytopenia
What are the averse effects of cefoxitin?
CDAD SEIZURES ANAPHYLAXIS bleeding eosinophilia hemolytic anemia leukopenia thrombocytopenia
What are the adverse rxns to imipenem?
CDAD SEIZURES HYPERSENSITIVITY RXNS sweating hypotension dizziness somnolence
What are the adverse rxns of amoxicillin?
CDAD SEIZURES SERUM SICKNESS ANAPHYLAXIS urticaria blood dyscrasias superinfection increased liver enzymes
What are the adverse rxns of cephalexin?
CDAD SEIZURES HYPERSENSITIVITY RXNS eosinophilia hemolytic anemia neutropenia thrombocytopenia
What are the adverse rxns to cefotaxime?
CDAD SEIZURES ANAPHYLAXIS agranulocytosis bleeding eosinophilia hemolytic anemia neutropenia thrombocytopenia
What is ganciclovir used for?
CMV
How would you use ciprofloxacin while breastfeeding?
Can be used while breastfeeding for post-exposure prophylaxis of anthrax if potential maternal benefit justifies potential risk to infant
What are the fluoroquinolones noted?
Ciprofloxacin (prototype), ofloxacin, moxifloxacin, levofloxacin, gemifloxacin
How do you take ceftaroline?
Completing the course, even if feeling better
Which recommendation would the nurse make to the family of a child with juvenile idiopathic arthritis who has difficulty getting ready for school in the morning due to joint pain and stiffness? A. Administer acetaminophen before bedtime. B. Ice the joints that are painful in the evening. C. Encourage a program of active exercise after awakening. D. Provide warm, moist heat to the affected joints before arising.
D
What are the adverse rxns with doxycycline?
DRESS ERYTHEMA MULTIFORME EXOFOLIATIVE DERMATITIS SJS TOXIC EPIDERMAL NECROLYSIS CDAD HEPATOTOXICITY PANCREATITIS photosensitivity glossitis
What is the long acting tetracycline?
Doxycycline
What is cefepime active against?
Enterobacter Haemophiles influenzae E.coli Klebsiella pneumoniae Neisseria Proteus Providencia Pseudomonas aeruginosa Serratia Moraxella catarrhalis
What are the lab considerations for cefepime?
Fales positive Coombs test Increase ALT, AST, bilirubin, BUN, and serum creatinine
What is the brand name for metronidazole?
Flagyl
What are the narrow spectrum penicillins?
G+V
What is tetracycline used for?
Gonorrhea and syphilis Prevention of exacerbations of chronic bronchitis Treatment of acne Various infections: -Mycoplasma -Chlamydia -Rickettsia -Borrelia burgdorferi
What are the adverse rxns with griseofulvin?
HEPATOTOXICITY ERYTHEMA MULTIFORME STEVENS-JOHNSON SYNDROME TOXIC EPIDERMAL NECROLYSIS SERUM SICKNESS headache dizziness hearing loss diarrhea epigastric distress extreme thirst flatulence photosensitivity rashes leukopenia lupus-like syndrome
What are the adverse rxns for amphotericin B?
HYPERSENSITIVITY REACTIONS anxiety confusion headache insomnia dyspnea hypoxia wheezing chest pain hypotension tachycardia edema hypertension hyperbilirubinemia ↑ liver enzymes abdominal pain nephrotoxicity hematuria hyperglycemia hypocalcemia hypokalemia hypomagnesemia anemia leukopenia thrombocytopenia pruritus rashes phlebitis arthralgia myalgia chills fever acute infusion reactions
What is cefoxitin active against?
Haemophilus influenzae E. coli Klebsiella pneumoniae Morganella morganii Neisseria gonorrhoeae Proteus Providencia Moraxella catarrhalis Bacteroides fragilis *not active against methicillin-resistant staphylococci or enterococci
What is acyclovir used for?
Herpes simplex
How toxic is amphotericin B?
Highly toxic (most toxic in this unit)
What are the contraindications for nystatin?
Hypersensitivity
What are the contraindications to vancomycin?
Hypersensitivity
What are the contraindications of imipenem?
Hypersensitivity Cross-sensitivity with penicillins and cephalosporins Pregnancy Children with CNS infections
What are the contraindications for erythromycin?
Hypersensitivity Hepatic insufficiency Long QT syndrome Hypokalemia Hypomagnesia HR <50 bpm Known alcohol intolerance Tartrazine sensitivity Neonates
What are the contraindications for metronidazole?
Hypersensitivity Hypersensitivity to parabens (topical only) First trimester of pregnancy.
What are the contraindications for amphotericin B?
Hypersensitivity Lactation (may cross into breastmilk)
What are the contraindications for trimethoprim?
Hypersensitivity Megaloblastic anemia secondary to folate deficiency Pregnancy, lactation, or children <12 yr
What are the contraindications of doxycycline?
Hypersensitivity Pregnancy (staining of teeth)
What are the contraindications for griseofulvin?
Hypersensitivity Severe liver disease or porphyria.
What are contraindications for acyclovir?
Hypersensitivity to acyclovir or valacyclovir Hypersensitivity to milk protein concentrate (buccal only)
What are the contraindications for cefepime?
Hypersensitivity to cephalosporins Serious hypersensitivity to penicillins
What are the contraindications for fluconazole?
Hypersensitivity to fluconazole or other azole antifungals use with pimozide, erythromycin, or quinidine Pregnancy
What are the contraindications of gentamicin?
Hypersensitivity to gentamicin or other aminoglycosides Most parenteral products contain bisulfites and should be avoided in patients with known intolerance Pregnancy (may cause fetal harm) Products containing benzyl alcohol should be avoided in neonate
What are contraindications of amoxicillin?
Hypersensitivity to penicillins severe renal imparement infectious mononucleosis acute lymphatic leukemia cytomegalovirus infection
What signs/symp should patients report to HCP when taking vancomycin?
Hypersensitivity, tinnitus, vertigo, or hearing loss
How is cefotaxime administered?
IM or IV
How is ceftaroline administered?
IV
How is imipenem administered?
IV
How is cefoxitin administered?
IV and IM
How is amphotericin B administered?
IV only
How is Penicillin G administered?
IV or IM
How is gentamicin administered?
IV or IM
How is metronidazole administered?
IV or PO
How is vancomycin administered?
IV or PO
How is methylprednisolone administered?
IV push or IV drip
What is erythromycin used for?
IV+PO o Upper and lower respiratory infections o Otitis media o Skin/skin structure infections o Pertussis o Diptheria o Erythrasma o Intestinal amebiasis o Pelvic inflammatory disease o Nongonococcal urethritis o Syphilis o Legionnaire's disease o Rheumatic fever o Streptococcal infections o Gonorrhea Topical o Acne
How is cefepime administered?
IV, IM
What is vancomycin used for?
IV: Endocarditis Meningitis Osteomyelitis Pneumonia Septicemia Soft tissue infections (if allergic to penicillins) Part of endocarditis prophylaxis (if allergic to penicillins) PO: CDAD Staphylococcus enterocolitis
What should the patient do if they are taking metronidazole?
If needed, use single dose and interrupt nursing for 24 hr after taking
What do carbapanems do?
Inhibit bacteria cell wall synthesis
What do cephalosporins do?
Inhibit bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins, causing the cell wall to break apart and kills bacteria. Caution with severe penicillin allergy
What does NYSTATIN do?
Inhibits fungal wall synthesis leading to cell leakage and death
What assessments should be done with nystatin?
Inspect oral mucous membranes before and frequently during therapy
How should nystatin be taken?
Instruct patient to take medication as directed (if a dose is missed, take as soon as remembered but not if almost time for next dose)
What are the adverse rxns of tetracycline?
Intracranial hypertension Diarrhea Esophagitis Photosensitivity Blood dyscrasias
Why do you not take gentamicin with loop diuretics?
It may increase ototoxicity
What are the contraindications for ceftaroline?
Known serious hypersensitivity to cephalosporins Pregnancy
What are the lab considerations with erythromycin?
Liver function
What are the labs done for metronidazole?
Liver function
What are the lab tests for ciprofloxacin?
Liver function Blood glucose Alkaline phosphatase
What is imipenem used for?
Lower respiratory infections UTI Abdominal infections Gynecologic infections Skin/skin structure infections Bone and joint infections Bacteremia Endocarditis Polymicrobic infections
What are the lab considerations for ceftaroline?
May cause a seroconversion from a negative to a positive Coombs test result
Why would you not use cefepime with aminoglycosides or loop diuretics?
May increase risk of nephrotoxicity
Why do you not take erythromycin with pimozide?
May increase risk of serious arrhythmias
What are the lab considerations with imipenem?
May increase: BUN AST ALT LDH serum alkaline phosphatase bilirubin and creatinine May decrease: Hemoglobin and hematocrit concentrations
Why do you not take ciprofloxacin with tizanidine?
May ↑ risk of hypotension and sedation
What are the lab considerations with vancomycin?
Monitor for: Casts Albumin Cells in urine Decreased specific gravity CBC Renal function May cause increased BUN lvls
What are the lab considerations for gentamicin?
Monitor renal function
What is Cushinoid appearance?
Moon face, truncal obesity and the formation of a buffalo hump
why would you prefer to rake one generation of cephalosporin over the other?
More gram negative coverage with each generation
What is doxycycline used for?
Mycoplasma Chlamydia Rickettsia B. burgdorferi Inhalational and cutaneous anthrax Gonorrhea and syphilis Chronic bronchitis prophylaxis Treatment of acne Inflammatory lesions associated with rosacea Malaria prophylaxis Rocky Mountain spotted fever (<8y/o)
Should you admix imipenem with aminoglycosides?
No
Should you take doxycycline with calcium?
No
Should you take tetracycline with calcium/dairy products?
No
Should parents use household items to administer amoxicillin to their child?
No, the measuring tool should come from the pharmacy or be included in the product.
Should you drive with fluconazole?
Not until alertness is determined
Should you use doxycycline while lactating?
Only if maternal benefit outweighs infant cost
Should you use imipenem if lactating?
Only if maternal benefit outweighs infant's risk
Should you use ceftaroline while lactating?
Only if maternal benefit outweighs infants risk.
Should you use vancomycin while lactating?
Only if maternal benefit outweighs the infant risk
Should you use cephalexin when lactating?
Only if the benefit outweighs the costs
What are the adverse rxns with nystatin?
Oral: stomach pain (large doses) contact dermatitis Stevens-Johnson syndrome Topical: burning itching local hypersensitivity reactions, redness stinging
How is Penicillin V administered?
PO
How is amoxicillin administered?
PO
How is cephalexin administered?
PO
How is griseofulvin administered?
PO
How is prednisone administered?
PO
How is trimethoprim administered?
PO
What is fluconazole used for?
PO IV Fungal infections caused by susceptible organisms, including: ● Oropharyngeal or esophageal candidiasis ● Serious systemic candidal infections ● Urinary tract infections ● Peritonitis ● Cryptococcal meningitis. Prevention of candidiasis in patients who have undergone bone marrow transplantation. PO Single-dose oral treatment of vaginal candidiasis.
What is ciprofloxacin used for?
PO IV ●Skin and skin structure infections ●Bone and joint infections ●Complicated intra-abdominal infections (with metronidazole) ●Urinary tract infections ●Chronic bacterial prostatitis ●Lower respiratory tract infections ●Acute bacterial sinusitis (should be used only when there are no other alternative treatment options) ●Post-exposure prophylaxis of inhalational anthrax ●Treatment and prophylaxis of plague. PO ●Infectious diarrhea ●typhoid fever ●uncomplicated cervical and urethral gonorrhea. IV ●Nosocomial pneumonia ●Febrile neutropenia (with piperacillin/tazobactam).
How is doxycycline administered?
PO and IV
How is ciprofloxacin administered?
PO or IV
How is fluconazole administered?
PO or IV
How is nystatin administered?
PO or topically
How is acyclovir administered?
PO, IV, topical
How is erythromycin administered?
PO, parenteral, topical
How is tetracycline administered?
Po
What are the contraindications of tetracycline?
Pregnant/breast feeding women Children under 8 y/o (staining of teeth) Hypersensitivity
What is ribavirin used for?
RSV, chronic Hep C
What are the lab considerations with doxycycline?
Renal and hepatic function CBC
What are the lab considerations with tetracycline?
Renal and hepatic function CBC
What are the adverse rxns of Penicillin G + V?
SEIZURES ANAPHYLAXIS SERUM SICKNESS CDAD epigastric distress rash leukopenia eosinophilia pain at IM site phlebitis at IV site interstitial nephritis urticaria
What are the adverse rxns for acyclovir?
STEVENS-JOHNSON SYNDROME RENAL FAILURE THROMBOTIC THROMBOCYTOPENIC PURPURA/HEMOLYTIC UREMIC SYNDROME SEIZURES acne hives rash unusual sweating changes in menstrual cycle, polydipsia ↑ liver enzymes, hyperbilirubinemia abdominal pain anorexia crystalluria hematuria renal pain pain phlebitis local irritation joint pain dizziness headache hallucinations trembling
What are the adverse rxns with metronidazole?
STEVENS-JOHNSON SYNDROME (SJS) SEIZURES rash urticaria burning (topical) mild dryness (topical) skin irritation (topical) transient redness (topical) optic neuropathy tearing (topical) abdominal pain anorexia, diarrhea dry mouth furry tongue glossitis unpleasant taste leukopenia phlebitis at IV site peripheral neuropathy dizziness headache aseptic meningitis (IV) encephalopathy (IV) psychosis superinfection
What is vancomycin active against?
Staphylococci Group A beta-hemolytic streptococci Streptococcus pneumoniae Corynebacterium C. diff Enterococcus faecalis Enterococcus faecium
What is ceftaroline active against?
Staphylococcus aureus Streptococcus pyogenes Streptococcus agalactiae Streptococcus pneumoniae E. coli Klebsiella pneumoniae Klebsiella oxytoca Haemophilus influenzae
What is imipenem active against?
Staphylococcus pneumoniae Group A beta-hemolytic streptococci Enterococcus Staph aureus E. coli Klebsiella Proteus Serratia Pseudomonas aeruginosa Salmonella Shigella Neisseria gonnorhoeae Numerous anareobes
What is cephalexin active against?
Streptococcus pneumoniae group A beta-hemolytic streptococci staphylococci (including penicillinase-producing strains) E. coli Haemophilus influenzae (flu) Klebsiella pneumoniae (UTI) Moraxella catarrhalis Proteus Enterococcus *not active against anaerobes
What are the adverse rxns of erythromycin?
TORSADES DE POINTES CDAD HYPERSENSITIVITY RXNS ototoxicity abdominal pain infantile hypertrophic pyloric stenosis interstitial nephritis
What are the adverse rxns for fluconazole?
TORSADES DE POINTES SJS HEPATOTOXICITY HYPERSENSITIVITY RXNS QT interval prolongation adrenal insufficiency hypokalemia hypertriglyceridemia abdominal discomfort diarrhea headache dizziness seizures
What should a patient taking tetracycline do before treatment or surgery?
Tell HCP about medication
What is the short acting tetracycline?
Tetracycline
What do tetracyclines do?
Tetracyclines bind to 30S subunit, preventing attachment of aminoacyl tRNA
What do aminoglycosides do?
They bind the 30S and inhibit the formation of the initiation complex and causes the misreading of mRNA.
What sulfonamide is used for burns?
Topical silver sulfadiazine
What is trimethoprim used for?
Treatment of uncomplicated urinary tract infections. Treatment of uncomplicated otitis media in children. Prophylaxis of chronic recurrent urinary tract infections. Treatment of head lice.
What assessments should you do with trimethoprim?
UTI (fever, cloudy urine, frequency, urgency, pain and burning on urination) Obtain specimens for culture and sensitivity Monitor intake and output ratios (Fluid intake should be sufficient to maintain urine output of at least 1200-1500 mL daily)
What should patients with rheumatic heart disease or valve replacements do?
Use an antimicrobial prophylaxis before invasive dental/medical procedures.
What assessments do you do with tetracycline?
Vitals Appearance of wound, sputum, and stool WBC Culture and sensitivity
What assessments do you do with erythromycin?
Vitals Appearance of wound, sputum, and stool WBC Culture and sensitivity Monitor bowel function
What assessments should you do with doxycycline?
Vitals Appearance of wound, sputum, and stool WBC Culture and sensitivity Monitor bowel function Assess for rash Assess IV site frequently
What assessments should you do with vancomycin?
Vitals Appearance of wound, sputum, and stool WBC Monitor IV site closely Audiometry Intake and output ratios Signs/symps of anaphylaxis (CDAD) Bowel sounds, frequency/consistency of stools, presence of blood in stool
What does chronic treatment of prednisone lead to?
adrenal suppression
What are the adverse rxns to trimethoprim?
altered taste epigastric discomfort glossitis drug-induced hepatitis pruritus rash megaloblastic anemia neutropenia thrombocytopenia fever
How should the patient take Penicillin G + V?
around the clock and finish completely, even if feeling better
How should the patient take amoxicillin?
around the clock and finish completely, even if feeling better
How should the patient take cephalexin?
around the clock at evenly spaced intervals and completely as directed, even if feeling better
How should vancomycin be taken?
as directed, take missed doses ASAP (unless close to time of next dose)
what assessments should you do with prednisone?
assess for adrenal insufficiency monitor intake and output ratios periodic growth assessment in children look for signs of hypokalemia
What should the fluid intake be with ciprofloxacin?
at least 1500-2000 mL/day
If tendon pain occurs with ciprofloxacin, what should you avoid?
avoid exercise and use of affected area
What are the long acting glucocorticoids?
betamethasone and dexamethasone
What does amphotericin B do?
binds to fungi cell membrane, increasing permeability
What is the fourth generation cephalosporin?
cefepime
What is the third generation cephalosporin?
cefotaxime
What is the second generation cephalosporin?
cefoxitin
What is the fifth generation cephalosporin?
ceftaroline
What is the first generation cephalosporin?
cephalexin
How should griseofulvin be taken?
complete full course of therapy; several wk of therapy may be necessary
What kind of antacids/medications should the patient avoid when taking ciprofloxacin?
containing calcium, magnesium, aluminum, iron, or zinc (should not be taken within 4 hr before and 2 hr after taking ciprofloxacin)
What are the short acting glucocorticoids?
cortisone and hydrocortisone
What are the adverse rxns of prednisone?
depression euphoria cataracts psychosis PEPTIC ULCERATION acne decreased wound healing ecchymoses (bruising) anorexia ADRENAL SUPPRESSION THROMBOEMBOLISM muscle wasting osteoporosis cushingoid appearance
What should the caregiver know about amphotericin B?
dilution, rate, and administration of drug and proper care of IV equipment
Why would you not use prednisone with live virus vaccines?
due to decreased antibody response and increased risk of adverse rxns
What can nystatin do to clothes or hair?
dye it
What does broad spectrum mean?
effect various groups of microorganisms; more toxic
What does narrow spectrum mean?
effective only against a limited variety of microbes; limited toxicity
What are the three macrolides that we need to know?
erythromycin (prototype), clarithromycin, and azithromycin
What are the "AZOLES" noted?
fluconazole (prototype), itraconazole, ketoconazole, clotrimazole, and miconazole
How should someone take care of dry mouth from medication?
frequent mouth rinses, good oral hygiene, and sugarless gum or candy
What signs/symp should a patient report to HCP when taking cefepime?
furry overgrowth on the tongue vaginal itching/discharge loose/foul-smelling stools fever blood, pus, or mucous in stool
What signs/symp should a patient report to HCP when taking cefotaxime?
furry overgrowth on the tongue vaginal itching/discharge loose/foul-smelling stools fever blood, pus, or mucous in stool
What signs/symp should a patient report to HCP when taking imipenem?
furry overgrowth on the tongue vaginal itching/discharge loose/foul-smelling stools fever blood, pus, or mucous in stool
What sings/symp would you report to HCP when taking cefoxitin?
furry overgrowth on the tongue vaginal itching/discharge loose/foul-smelling stools fever blood, pus, or mucous in stool
What kind of diet should someone who takes prednisone have?
high protein, calcium, and potassium with low sodium and carbohydrates. no alcohol
What signs/symp should patients report with gentamicin?
hypersensitivity tinnitus vertigo hearing loss rash dizziness difficulty urinating
What are contraindications of cefoxitin?
hypersensitivity to cephalosporins serious hypersensitivity to penicillins renal imparement history of GI disease
What are the contraindications for cefotaxime?
hypersensitivity to cephalosporins serious hypersensitivity to penicillins renal impairment history of GI disease
What are contraindications of cephalexin?
hypersensitivity to cephalosporins serious hypersensitivity to penicillins renal impairment history of GI disease, especially colitis
What would happen if you mixed imipenem with ganciclovir and cyclosporine?
increase risk of seizures
Why would you not use prednisone with NSAIDs?
increases risk of adverse GI effects
What is dexamethasone used for?
inflammation of the brain and spine, and eyes
What is prednisone used for?
inflammatory, allergic, hematologic, neoplastic, and autoimmune disorders; alternate day dosing in the management of chronic illness; adjunctive therapy of hypercalcemia; adjunctive management of nausea and vomiting during chemotherapy
What do fluroquinolones do?
inhibit DNA synthesis in bacteria
What do macrolides do?
inhibit bacterial protein synthesis by binding to the 50s ribosomal subunit, thus preventing movement of the ribosome along the mRNA
What do sulfonamides do?
inhibit folic acid synthesis in bacteria
What do "azoles" do?
inhibit the synthesis of membrane sterols (fungi)
What does vancomycin do?
inhibits bacteria cell wall synthesis
What does griseofulvin do?
inhibits fungal mitosis
What does metronidazole do?
inhibits nucleic acid synthesis in bacteria
What do "VIRS" do?
inhibits viral replication by suppressing synthesis of viral DNA
What should a patient taking metronidazole avoid?
intake of alcoholic beverages or preparations containing alcohol during and for at least 3 days after treatment (vaginal gel)
Why do you not take aminoglycosides with cefoxitin?
it may increase risk of nephrotoxicity
Why would you not use cephalexin with aminoglycosides or loop diuretics?
it may increase the risk of renal toxicity
What are contraindications of prednisone?
lactation, active untreated infections, OB
What signs/symp should a patient report to HCP when taking ceftaroline?
loose/foul-smelling stools fever blood, pus, or mucous in stool
What is cefoxitin used for?
lower respiratory tract infections skin/skin structure infections urinary tract infections gynecological infections intra-abdominal infections septicemia preoperative prophylaxis
What are the lab considerations for cefotaime?
may cause false positive Coombs test (esp in patients with azotemia) may cause increased increased AST, ALT, LDH, BUN, alkaline phosphatase, bilirubin, and serum creatinine may cause false increased serum urine creatinine test results may rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and eosinophilia
What are the lab considerations for cefoxitin?
may cause false positive Coombs test (esp in patients with azotemia) may cause increased increased AST, ALT, LDH, BUN, alkaline phosphatase, bilirubin, and serum creatinine may cause false increased serum urine creatinine test results may rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and eosinophilia
What are the lab considerations with cephalexin?
may cause false positive for Coombs test may cause increase in AST, ALT, LDH, BUN, alkaline phosphate, bilirubin, and creatinine may cause neutropenia, thrombocytopenia, and eosinophilia (rare)
Why do you not take Penicillin with oral contraceptives?
may decrease effectiveness of the oral contraceptives
Why do you not take amoxicillin with allopurinol?
may increase frequency of rash
Why would you not use prednisone with insulin/oral hypoglycemics?
may increase requirements
What happens when you mix cefotaxime, aminoglycosides, NSAIDs, and loop diuretics?
may increase risk of nephrotoxicity
Why would you not use prednisone with fluroquinolones?
may increase risk of tendon rupture
What is trimethoprim?
not a sulfonamide but commonly given with sulfonamides
Should a patient treat diarrhea when on Penicillin G + V?
not without consulting a HCP
How are cortisone and hydrocortisone used?
often used as a topical agent
Should acyclovir be used during pregnancy and lactation?
only if maternal benefit outweighs infant/fetal risk
Should you use ciprofloxacin in children 1-17 y/o?
only if no alternatives due to possible arthropathy.
Should you use cefotaxime while pregnant and lactating?
only if the benefit is greater than the risks
Should you take ciprofloxacin with dairy?
only take ciprofloxacin 1 hr before or 2 hr after consuming dairy.
What is nystatin used for?
only used for candidiasis (yeast fungal infection) of skin, mouth, esophagus, and vagina.
What is griseofulvin used for?
only used to treat superficial mycoses (such as with fungal nail infection)
What "VIRS" are used for influenza?
oseltamivir, zanamivir, and peramivir
What are the adverse rxns to gentamicin?
ototoxicity (vestibular and cochlear) nephrotoxicity muscle paralysis (high parenteral doses) ataxia vertigo hypersensitivity reactions
Who is prednisolone used with?
pediatric patients
What is Penicillin G + V used for?
pneumococcal pneumonia streptococcal pharyngitis syphilis gonorrhea strains enterococcal infections prevention of rheumatic fever treatment of Lyme disease septicemia in children with sickle cell
What are the lab considerations with Penicillin G + V?
positive direct Coombs' test result hyperkalemia serum sodium in patients with HF or hypertension hypernatremia increased AST, ALT, LDH, and serum alkaline phosphate leukopenia neutropenia
What is Betamethasone used for?
pre-term labor to help the pre-term infant's lungs
What are the intermediate acting glucocorticoids?
prednisolone and methylprednisolone
What are contraindications of Penicillin G + V?
previous hypersensitivity to penicillin severe renal insufficiency OB lactation
What do glucocorticoids do? (patho)
raise blood glucose levels by stimulating gluconeogenesis in the liver, stress hormones, affect fat/protein metabolism (low doses)
What signs/symp should be reported with griseofulvin?
rash, sore throat, fever, diarrhea, or soreness of mouth or tongue
What should patients taking metronidazole for trichomoniasis do?
refrain from intercourse or use a condom to prevent reinfection (sexual partners may be asymptomatic sources of reinfection and should be treated concurrently)
What are the lab considerations with fluconazole?
renal and liver function
Why do you not stop glucocorticoids suddenly?
results in adrenal insufficiency; must be tapered
What is gentamicin used for?
serious gram negative infections
What are the lab considerations with amoxicillin?
serum alkaline phosphatase (goes up) LDH, AST, ALT concentrations (goes up) false-positive direct Coombs' test result
What are the lab considerations with prednisone?
serum sodium (goes up) serum calcium and potassium (goes down) glucose (goes up) hematologic values WBC count (goes down) serum cholesterol and lipid values (goes up) uptake of thyroid hormones (goes down)
What signs/symp should a patient report with fluconazole?
skin rash, abdominal pain, fever, or diarrhea
What signs/symp should the patient report to the HCP with trimethoprim?
skin rash, sore throat, fever, mouth sores, or unusual bleeding or bruising
What is cefotaxime used for?
skin/skin structure infections bone/joint infections gynecological infections (including gonorrhea) lower respiratory infection intra-abdominal infections septicemia meningitis lyme disease preoperative prophylaxis
What is amoxicillin used for?
skin/skin structure infections otitis media sinusitis respiratory infections genitourinary infections endocarditis prophylaxis postexposure inhalational anthrax prophylaxis management of ulcer disease due to H. pylori Lyme disease in children <8 yr
What is cephalexin used for?
skin/skin structure infections respiratory tract infections otitis media urinary tract infections bone infections
What are Penicillin G + V active against?
streptococci staphylococci Bacillus anthracis (anthrax) Neisseria meningitidis (meningitis) N. gonorrhoeae (gonorrhea) Borrelia burgdorferi (Lyme disease)
What is amoxicillin active against?
streptococci pneumococci enterococci Haemophilus influenzae (flu) E. coli Proteus mirabilis (Proteus infections) Neisseria meningitidis (meningitis) N. gonorrhoeae (gonorrhea) Shigella Chlamydia trachomatis (Chlamydia) Salmonella Borrelia burgdorferi (Lyme disease) H. pylori (ulcer)
What should patients taking tetracycline wear when outside?
sunscreen and protective clothing
What signs/symp should the patient notify a HCP of when taking Penicillin G + V?
superinfection fever diarrhea stool containing blood, pus, or mucous
What signs/symp should the patient notify a HCP of when taking amoxicillin?
superinfection fever diarrhea stool containing blood, pus, or mucous
What signs/symp should the patient notify a HCP of when taking cephalexin?
superinfection fever diarrhea stool containing blood, pus, or mucous
What do glucocorticoids do? (pharm)
suppression of inflammation and immune response; this is needed in high doses
What does amphotericin B treat?
systemic mycoses (fungus) infections
Why should a patient avoid alcohol with griseofulvin?
tachycardia, flushing, and ↑ CNS depression may result
How should a patient take trimethoprim?
take medication and to finish medication completely as directed, even if feeling better, and take missed doses as soon as remembered
How should ciprofloxacin be taken?
take medication as directed at evenly spaced times and to finish drug completely, even if feeling better, take missed doses as soon as possible (unless within 6 hr of next dose)
How does someone take metronidazole?
take medication as directed with evenly spaced times between doses, even if feeling better
How should fluconazole be taken?
take medication as directed, even if feeling better, doses should be taken at the same time each day
When taking amoxicillin, what should you teach patients with a history of rheumatic heart disease or a valve replacement?
the importance of using antimicrobial prophylaxis before invasive medical or dental procedures.
What drugs cause hypokalemia with prednisone?
thiazide, loop diuretics, amphotericin B, piperacillin, ticarcillin and digoxin
What does metronidazole do?
treats: C. Diff infections Gardnerella vaginalis (female genital infection) H. pylori associated with peptic ulcer disease
What is cefepime used for?
uncomplicated skin/skin structure infections bone and joint infections uncomplicated and complicated UTI Respiratory tract infections. complicated intra-abdominal infections septicemia febrile neutropenic patients
What is the use for neomycin?
used as an eye ointment for newborns
What medicine is the main treatment of MRSA?
vancomycin
What assessments do you do with imipenem?
vital signs appearance of wound sputum, urine, stool (sign of infection) WBC history of previous rxns to penicillins a obtain specimen for culture and sensitivity observe for sign/symp of anaphylaxis
What assessments do you do with cefepime?
vital signs appearance of wound sputum, urine, stool (sign of infection) WBC history of previous rxns to penicillins and cephalosporins obtain specimen for culture and sensitivity observe for sign/symp of anaphylaxis Monitor bowel function (CDAD)
What assessments do you do with cefotaxime?
vital signs appearance of wound sputum, urine, stool (sign of infection) WBC history of previous rxns to penicillins and cephalosporins obtain specimen for culture and sensitivity observe for sign/symp of anaphylaxis Monitor bowel function (CDAD)
What assessments do you do with ceftaroline?
vital signs appearance of wound sputum, urine, stool (sign of infection) WBC history of previous rxns to penicillins and cephalosporins obtain specimen for culture and sensitivity observe for sign/symp of anaphylaxis Monitor bowel function (CDAD)
What assessments should you do with cephalexin?
vital signs appearance of wound sputum, urine, stool (sign of infection) WBC history of previous rxns to penicillins and cephalosporins obtain specimen for culture and sensitivity observe for sign/symp of anaphylaxis Monitor bowel function (CDAD)
What assessments would you do with cefoxitin?
vital signs appearance of wound sputum, urine, stool (sign of infection) WBC history of previous rxns to penicillins and cephalosporins obtain specimen for culture and sensitivity observe for sign/symp of anaphylaxis Monitor bowel function (CDAD)
What assessments should you do with ciprofloxacin?
vital signs appearance of wound, sputum, urine, stool WBC urinalysis frequency and urgency of urination cloudy or foul-smelling urine Obtain specimens for culture and sensitivity Observe for signs and symptoms of anaphylaxis Monitor bowel function.
What assessments do you do with gentamicin?
vital signs wound appearance sputum urine stool WBC culture and sensitivity evaluate eighth cranial nerve function by audiometry Monitor blood levels periodically
What signs/symp should a patient report to a HCP when taking erythromycin?
vomiting diarrhea severe abdominal pain yellow discoloration of the skin or eyes darkened urine pale stools unusual tiredness fever if stool contains blood, pus, or mucus
How should a patient apply topical gentamicin?
wash affected skin gently and pat dry, apply a thin film of ointment, apply occlusive dressing (only if ordered by health care professional)
What are the adverse rxns to ciprofloxacin?
●AORTIC ANEURYSM/DISSECTION ●HEPATOTOXICITY ●ELEVATED INTRACRANIAL PRESSURE ●SEIZURES ●SUICIDAL THOUGHTS ●CDAD ●HYPERSENSITIVITY RXNS ●photosensitivity ●rash ●hyperglycemia ●hypoglycemia ●abdominal pain ●↑ liver enzymes ●vaginitis ●arthralgia ●myalgia ●tendinitis ●tendon rupture ●peripheral neuropathy ●agitation ●confusion ●depression ●dizziness ●drowsiness ●hallucinations ●headache ●Insomnia ●nightmare ●paranoia ●toxic psychosis ●tremor
What are the contraindications for ciprofloxacin?
●Hypersensitivity (cross-sensitivity within class may exist) ●History of myasthenia gravis ●Concurrent use with tizanidine ●Patients with or at ↑ risk for aortic aneurysm (use only if no alternatives) ●Avoid breastfeeding during treatment and for 2 days after final dose (except for anthrax)
What are the assessments for amphotericin B?
●Monitor patient closely during test dose and the first 1-2 hr of each dose for fever, chills, headache, anorexia, nausea, or vomiting ●Assess injection site frequently for thrombophlebitis or leakage ●Monitor vital signs every 15 min during test dose and every 30 min for 2-4 hr after administration. ●Assess respiratory status (lung sounds, dyspnea) daily ●Monitor intake and output and weigh daily, adequate hydration (2000-3000 mL/day)
What signs/symp should a patient report to a HCP when taking ciprofloxacin?
●fever and diarrhea develop (especially if stool contains blood, pus, or mucus) ●hepatotoxicity (anorexia, jaundice, dark urine, pruritus, or tender abdomen) ●rash ●signs of hypersensitivity ●serious CNS effects ●peripheral neuropathy (pain, burning, tingling, numbness, and/or weakness, or other alterations in sensations including light touch, pain, temperature, position sense and vibratory sensation, and/or motor strength) ●tendon (shoulder, hand, Achilles, and other) pain swelling ●inflammation
What are the assessments for metronidazole?
●vital signs ●appearance of wound, sputum, urine, and stool ●WBC ●Obtain specimens for culture and sensitivity ●Monitor neurologic status during and after IV infusions. (numbness, paresthesia, weakness, ataxia, or seizures) ●Monitor intake, output, and daily weight ●Assess for rash periodically during therapy (SJS)
