EXAM 4 :NSAIDS and ANALGESICS
Nystatin (topical)
tx of candida diaper rash or oral candida infections
ampherotericin B
tx of systemic infections with broad spectrum fungi
Amantadine (Symmetrel)
used as influenza A treatment
Oral forms of analgesics should be taken _______
with food to minimize gastric upset
delayed reaction
days to weeks
Sulfonamides and birth control
decreased efficacy
superinfection
overgrowth of normal microbiota that is resistant to antibiotics
Uses for opioids
pain cough center suppression treatment diarrhea balanced anesthesia
severe reaction ( anaphylaxis) to penicillin
avoid administration of Cephalosporin
Macrolides interactions
drugs metabolized in the liver, anticoagulants, and theophylline
sulfonamides adverse effects - other
Hepatotoxicity, convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria, cough
When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct?
b. "Dissolve the lozenge slowly and completely in your mouth."
chronic pain
episode of pain that lasts for 6 months or longer; may be intermittent or continuous
Macrolides
erythromycin, clarithromycin, azithromycin
Sulfonamides
Take with LOTS OF WATER regardless of whether you give it at mealtime or not -- Bactrim, Septra, Gantricin, ie, used to treat UTI
acute pain
pain that is felt suddenly from injury, disease, trauma, or surgery
analgesic
painkiller
Monobactams
parenteral use only
commonly used penicillin
penicillin g, nafcillin, amoxicillin, ampicillin/ clavulanic acid (augmentin) , piperacillin/ tazobactam ( zosyn)
Penicillins MOA
prevents bacteria from forming a cell wall
COX-1
protects stomach lining and regulates blood platelets
Metronidazole (Flagyl)
protocol infections interact with alcohol
Red man syndrome
rash on the upper body caused by certain anti-infectives
BUN normal range
10-20 mg/dL
The order reads: "Give vancomycin, 1250 mg in 250 mL NS, IVPB every 12 hours. Infuse over 90 minutes." The nurse will set the infusion pump to what setting for mL/hour? Round to a whole number
167 ml/hr
Diagnosis of Tuberculosis
Tuberculin skin test screening Positive reaction means current or previous infection Followed by X-ray or CT exam, acid-fast staining of sputum, culturing of bacteria
Hematocrit normal range
female: 37-47% male: 42-52%
onchomycosis
fungal infection of the nail
Long-term Acetophenomin use:
may cause Liver damage and nephropathy use short-term!
________ not recommended for long term use because of the accumulation of a neurotoxic metabolite, normeperidine, which can cause seizures.
meperidine
Amphotericin B
monitor VS every 15 minutes during administration
Opthalmic Antifungals
natamycin
Pleuromutilins
new class in 2000, retapamulin is a semisynthetic approved from topical use, effective only on Gram positive
nsaid
non-steroidal anti-inflammatory drug
Amantadine and Rimantadine
not recommended for treatment or prevention of flu gi effects: anorexia, nausea
sulfonamides
not safe for pregnant women or infants younger than 2 months
Oxycodone
often combined acetaminophen
Hydrocodone
often combined with acetaminophen
Naloxone (Narcan)
opioid antagonist
Patients should be instructed to change positions slowly to prevent possible _____
orthostatic hypotension
immediate allergic response
reaction 2-30 minutes
ketoralac adverse effects
renal impairment, edema, gi pain, dyspepsia, and nausea
Ketorolac
short term use ( up to 5 days) to manage moderate to severe acute pain
Ketoralac (Toradol)
some anti-inflammatory activity used primarily for its powerful analgesic effects which are comparable to those narcotic drugs such as morphine
Pt education for enteric coated aspirin
swallow whole
During antitubercular therapy with isoniazid, a patient received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this second medication?
b. "This vitamin helps to prevent neurologic adverse effects."
The nurse is reviewing the orders for a patient who has been admitted for treatment of pneumonia. The antibiotic orders include an order for doxycycline. However, when the patient is asked about his allergies, he lists "doxycycline" as one of his allergies. What is the nurse's first action at this time?
b. Ask the patient to explain what happened when he had the allergic reaction.
4. Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Pruritus d. Urinary frequency e. Nausea
b. Constipation c. Pruritus e. Nausea
The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity which of these? (Select all that apply.)
b. Darkened urine d. Fatigue f. Jaundice
The nurse is teaching a patient who is starting antitubercular therapy with rifabutin. Which adverse effects would the nurse expect to see? (Select all that apply.)
b. GI tract disturbances c. Reddish brown urine f. Neutropenia
The nurse is assessing a patient who is about to receive antifungal drug therapy. Which problem would be of most concern?
b. Hepatic disease
A patient has been receiving therapy with the aminoglycoside tobramycin, and the nurse notes that the patient's latest trough drug level is 3 mcg/mL. This drug is given daily, and the next dose is to be administered now. Based on this trough drug level, what is the nurse's priority action?
b. Hold the drug, and notify the prescriber.
During treatment with zidovudine, the nurse needs to monitor the patient for which potential adverse effect? (Select all that apply.)
b. Nausea d. Headaches e. Bone marrow suppression
Praziquantel is prescribed for a patient with a tapeworm infection. The nurse prepares to administer the medication by which route?
b. Oral
A patient is receiving intravenous linezolid as part of treatment for an infected leg ulcer. The nurse will watch for which possible drug interactions with linezolid? (Select all that apply.)
b. Selective serotonin reuptake inhibitor antidepressant d. Vasopressor
7. An opioid analgesic is prescribed for a patient. The nurse checks the patient's medical history knowing this medication is contraindicated in which disorder? (Select all that apply.) a. Renal insufficiency b. Severe asthma c. Sleep apnea d. Severe head injury e. Liver disease
b. Severe asthma c. Sleep apnea d. Severe head injury
Two days after surgery, an elderly client refuses a PRN dose of analgesic dose for fear of becoming "hooked." The nurse should respond by stating that: a. It is impossible to become hooked on PRN narcotics. b. Short-term use of narcotics is not likely to cause a person to become dependent on them. c. Side effects that occur in the elderly mean that medications will be discontinued as soon as possible. d. The elderly are least likely to become dependent on narcotics.
b. Short-term use of narcotics is not likely to cause a person to become dependent on them.
The nurse is reviewing the use of multidrug therapy for HIV with a patient. Which statements are correct regarding the reason for using multiple drugs to treat HIV? (Select all that apply.)
b. The use of multiple drugs is more effective against resistant strains of HIV. d. The goal of this treatment is to reduce the viral load.
A patient is scheduled for colorectal surgery tomorrow. His white blood cell count is normal, he has no fever, and he is otherwise in good health. However, there is an order to administer an antibiotic on call just before he goes to surgery. The nurse knows that the rationale for this antibiotic order is which of these?
b. To provide prophylactic therapy
Which instruction does the nurse give to the patient to prevent complications associated with SMZ-TMP?
"Avoid exposure to sunlight"
NSAIDs black box warning
(except aspirin) regarding an increased risk of adverse cardiovascular thrombotic events, including fatal MI and stroke. counteract the cardioprotective effects of aspirin.
6. The nurse is administering an intravenous dose of morphine sulfate to a 48-year-old postoperative patient. The dose ordered is 3 mg every 3 hours as needed for pain. The medication is supplied in vials of 4 mg/mL. How much will be drawn into the syringe for this dose?
0.75 mL
Nursing Implications tetracycline
Avoid milk products, iron preparations, antacids, and other dairy products because of the chelation and drug-binding that occurs Take all medications with 6 to 8 ounces of fluid, preferably water Because of photosensitivity, avoid sunlight and tanning beds
Patient instructions while taking SMZ/TMP
Avoid sunlight exposure while taking
acetaminophen dose for older adults and those with liver disease
2000 mg /day
Opioid interactions
Alcohol Antihistamines Barbiturates Benzodiazepines Monoamine oxidase inhibitors
Monobactams MOA
Bactericidal, synthetic Inhibits bac cell wall synthesis resulting lysis
Fentanyl (transdermal)
Duragesic used for long term pain management
patients taking ____ should use a backup birth control
Fluconazole
Sulfonamides adverse effects - GI
Nausea, vomiting, diarrhea, pancreatitis
Indomethacin (Indocin)
NSAID. Inhibit prostaglandin synthesis resulting in decreased inflammatory responses. Uses: provide rapid, symptomatic relief of inflammation and pain. Precautions/Interactions: hypersensitivity to aspirin or other NSAIDs, may increase the risk of MI and stroke.
Penicillin interactions
NSAIDs, oral contraceptives, warfarin
When monitoring a patient who is receiving caspofungin, the nurse will look for which serious adverse effects? (Select all that apply.)
a. Blood dyscrasias b. Hypotension e. Hepatotoxicity
Penicillin adverse effects
the safest class of antibiotics; bacteria can become resistant; allergy is possible; lowered red/white blood cell and platelet levels
Hydromorphone (Dilaudid)
*class*: opioid agonist *Indication* moderate to severe pain *Action*: alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex *Nursing Considerations*: -Assess BP, respirations, and pulse before and during administration - medication causes general CNS depression - Narcan is the antidote for overdose - use caution with concurrent use of MAOI - avoid use within 14 days of each other - may be used as an antitussive - advised to dilute with NS prior to administration and to administer slowly to decrease CNS depression
NSAID adverse effects
- Diminished gastric mucus and ulcer - Decreased renal perfusion - Diminished clotting -increased risk of MI or stroke - hepatotoxicity -skin eruption, sensitivity reaction - tinnitus, hearing loss
Penicillins: Adverse Effects
-Allergies (urticaria, pruritus, angioedema) -Anaphylaxis -Renal impairment -Hyperkalemia/dysrhythmias (high doses of penicillin G), hypernatremia (IV ticarcillin) -seizures -Nausea and vomiting -diarrhea, rash, urticaria -pseudomembranous colitis, candida albicans -may decrease the effectiveness of oral contraceptives
Aspirin uses
-Headache, neuralgia, myalgia, and arthralgia -Pain syndromes resulting from inflammation: arthritis, pleurisy, and pericarditis -Systemic lupus erythematosus: antirheumatic effects -Antipyretic action
Salicylic acid (aspirin)
-Inhibits platelet aggregation. -Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders.
Quinolones interactions
-Oral quinolones: antacids, calcium, magnesium, iron, zinc preparations, or sucralfate -Patients need to take the interacting drugs at least 1 hour before or after taking quinolones. -Dairy products -Enteral tube feedings -Probenecid -Nitrofurantoin -Oral anticoagulants
Cephalosporins
-Structurally and functionally similar to penicillins -Broad-spectrum antibiotics that can be used by most patients that are allergic to penicillin
Isoniazid (INH)
-antiTB - take daily for 6-12 months and most likely with other meds too -worked if 3 neg. sputum cultures, no temp. - Liver toxicity (hepato) check liver fxn - Don't take with alcohol (liver fxn remember?) - Take on empty stomach
Opioid adverse effects
-respiratory depression - itching -constipation -urinary retention -orthostatic hypotension -emesis -birth defects -elevated ICP
Acyclovir/Valacyclovir
-slow viral reproduction -most effective against Epstein-Barr Virus, cytomegalovirus, herpes simplex virus types 1 and 2, varicella-zoster virus oral, topical, and parenteral
Which teaching point would be appropriate to include when the nurse is informing a patient about the adverse effects of antimalarials?
.b. These medications may cause anorexia and abdominal distress.
Methadone (Dolophine)
Abstinence maintenance med. Binds with opiate receptors in CNS to produce analgesic and euphoric effects. Prevents withdrawal symptoms in clients who were addicted to opiate drugs. Precautions/interactions: do not use in clients who have severe asthma, chronic respiratory disease, or history of head injury. Side/adverse effects: sedation, respiratory depression, paradoxical CNS excitation.
accelerated reaction
1-72 hours
The order for a patient reads: "Give ampicillin via PEG tube, 500 mg every 6 hours." The oral suspension has 250 mg/5 mL. How many milliliters will the nurse give for each dose?
10 ML/dose
Withhold dose and contact HCP if PT RR is
10-12 breaths/minutes
Therapeutic effects of aspirin may take up to_____
3-4 weeks
acetaminophen max daily dose of normal adult
3000 mg/day
A teenage patient is taking a tetracycline drug as part of treatment for severe acne. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey?
c. The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity.
The order reads, "Give nystatin suspension, 500,000 units by mouth (swish and swallow) 4 times a day for 1 week." The medication is available in a suspension of 100,000 units per mL. How many milliliters will the nurse give per dose?
5 mL
A 5-year-old patient has been diagnosed with malaria after returning from an overseas trip. The patient is to receive one dose of mefloquine, 25 mg/kg PO. The child weighs 44 lb. How much mefloquine will this child receive?
500 mg
TB treatment time
6-24 months
The order for isoniazid reads: "Give 5 mg/kg PO daily." The patient weighs 275 lb. What is the amount per dose? Is this a safe dose?
625 mg per day. No max dose is 300 mg per day.
The order for a patient who has a severe case of shingles is for acyclovir 10 mg/kg IV every 8 hours for 7 days. The patient weighs 165 lb. How much is each dose?
750 mg
Aspirin common dosage
81mg and 325 mg
Stevens-Johnson Syndrome
A severe, possibly fatal reaction that mimics a burn; may be due to a medication.
Which agent below is most likely to cause serious respiratory depression as a potential adverse reaction?
A) Morphine (Duramorph)
Nitrofurantoin (Macrobid)
UTI may cause fatal hepatoxicity use carefully in renal function is impaired due to drug concentrations in kidneys
Which instruction would the nurse provide to a patient taking doxycycline daily for the treatment of acne to prevent complications?
Avoid midday sun, consume yogurt daily, Use an alternate form of birth control.
Streptomycin
Aminoglycoside injectable form only
Tramadol (Ultram)
Analgesic adverse effects similar to opioids
A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect?
B) Antitussive
The nurse is planning care for a patient receiving morphine sulfate (Duramorph) by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug?
B) Insert Foley catheter.
Pyrazinamide (PZA)
Anti-tuberculosis agent
A nurse is preparing to administer an Amphotericin B infusion to a patient with a fungal infection. Which premedication will the nurse expect to administer?
Antiemetics, Antihistamines, corticosteroids
Fluconazole (Diflucan)
Antifungal. Use: candidiasis infections. Precautions: monitor hepatic and renal function, refrigerate suspensions, increased risk of bleeding for clients taking anticoagulants.
Rifabutin (Mycobutin)
Antitubercular
Rifapentine (Priftin)
Antitubercular Agent
Rifampin (Rifadin)
Antitubercular. Use: prevention and treatment of TB. Latent TB INH: 6-9 months. Active TB: multiple therapy up to 24 months. Precautions: risk of neuropathies and hepatotoxicity, consume foods high in vitamin B6, avoid alcohol, discoloration of urine, saliva, sweat, and tears. ( red-orange- brown color) ORAL USE ONLY
A patient is admitted to the emergency department with a diagnosis of " Acetaminophen overdose." Which lab value is essential for the nurse to assess?
Aspartate transaminase ( AST) and Alanine transaminase ( ALT) levels
The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide?
C) Another type of nonsteroidal antiinflammatory drug may be indicated.
A nurse administers naloxone (Narcan) to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication?
C) Increased pain
Which nursing intervention is appropriate before initiating streptomycin therapy in a patient with Tuberculosis?
Asses the patient's hearing status
The nurse is working on a postoperative unit where pain management is part of routine care. Which statement below is the most helpful in guiding clinical practice in this setting?
B) The development of opioid dependence is rare when opioids are used for acute pain.
A nurse is caring for a cancer patient receiving subcutaneous morphine sulfate for pain. Which of the following nursing actions is most important in the care of this patient?
B. Monitor respiratory rate
Analgesics: Nursing Implications
Be sure to medicate patients before the pain becomes severe so as to provide adequate analgesia and pain control Pain management includes pharmacologic and nonpharmacologic approaches; be sure to include other interventions as indicated
Carbapenems MOA
Bind to penicillin-binding proteins and inhibit peptidoglycan synthesis and cell wall formation Bactericidal
The nurse is creating a pain management plan for a client with a previous history of substance abuse. Which of the following should be included in this plan? a.) Ask the physician to prescribe short-acting analgesics. b.) Ask the physician to prescribe a medication similar to the one the client abused. c.) Ask the physician to prescribe analgesics for the oral route. d.) Keep a dose of Narcan at the bedside.
C.) Ask the physician to prescribe analgesics for the oral route. Extended-release and long-acting analgesics are recommended for clients with a history of abuse. Specific interventions should: - Avoid analgesics similar to the abused drug - Utilize long-acting analgesics, - Avoid Narcan - Administer medications through the oral route
Labs for Antibiotics
CBC
Quinolones adverse effects
CNS:Headache, dizziness, insomnia, depression, restlessness, convulsions GI:Nausea, vomiting, diarrhea,constipation,thrush, increased liver function study results,others Cardiac: Prolonged QT interval Integumentary: Rash, pruritus, urticaria, flushing Other: Ruptured tendons,*tendonitis, fever,chills,blurred vision, tinnitus *Black box warning: increased risk of tendonitis and tendon rupture
tetracycline interactions
Calcium containing foods, anacids with calcium, magnesium and aluminum thry inactivate it, (antidiarrheals with kaolin, dairy products, iron and zinc decrease absorption), tetracycline decrease oral contraceptives
adverse effects of amphotericin b
Cardiac dysrhythmias Neurotoxicity; tinnitus; visual disturbances; hand or feet numbness, tingling, or pain; convulsions Renal toxicity, potassium loss, hypomagnesemia Pulmonary infiltrates Fever, chills, headache, nausea, occasional hypotension, gastrointestinal upset, anemia
most common antibiotics
Cephalosporins (target cell wall), Penicillins (target cell wall), and quinolones (target nucleic acid synthesis)
Quinolones
Ciprofloxacin
Which antibiotic is the drug of choice for the treatment of anthrax?
Ciprofloxacin
HAART (highly active antiretroviral therapy)
Combination of drugs effective against AIDS
______ is common adverse effect and may be prevented with adequate fluid and fiber intake
Constipation
After giving an injection to a patient with HIV infection, the nurse accidentally receives a needlestick. Current recommendations for occupational HIV exposure may include the use of which drug(s)?
c. emtricitabine and tenofovir
Cidofovir
Cytomegalovirus (CMV)
A patient takes oxycodone (OxyContin), 40 mg PO twice daily, for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects?
D) Increase fluid and fiber in the diet.
A patient arrives at the emergency department complaining of back pain. He reports taking at least 3 acetaminophen tablets every three hours for the past week without relief. Which of the following symptoms suggests acetaminophen toxicity?
D. Hepatic damage.
A client in the ICU who sustained a traumatic abdominal injury 1 week ago continues to complain of severe pain. The nurse notes his vital signs are normal. Which of the following would be appropriate for the nurse to do? a.) Encourage early return to ambulation. b.) Offer nonnarcotic analgesics for pain. c.) Utilize distraction d.) Provide the client with pain medication.
D.) Provide the client with pain medication.
Tetracycline
Do not give with milk products, do not give to pregnant women or children before age 8 or damage to tooth enamel occurs
Ciprofloxacin (Cipro)
Fluoroquinolone Antibiotic
Macrolides adverse effects
GI effects, primarily with erythromycin Nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia Azithromycin and clarithromycin: fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration
Sulfonamides adverse effects -blood
Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia
Penicillin Contraindications
Hypersensitivity to beta-lactams, seizure disorders, renal impairment
Acetaminophen Contraindications
Hypersensitivity, liver disease, major burns, g6pd deficiency
Carbapenems
Imipenem Meropenem Ertapenem Doripenem
A nurse receives a question from a patient about amantadine, and knows that the patient has which condition?
Influenza A
Rimantadine (Flumadine)
Influenza A
Zanamivir, oseltamivir
Influenza A and B tx must begin within 2 days of symptoms decreases duration of illness
Drug of choice against TB
Isoniazid (INH)
Anti-tubercular drugs
Isoniazid (INH) Rifampin Ethambutol Streptomycin
A client who incurred an arm injury describes his pain as "sharp and localized to the lower arm." The nurse recognizes that this type of pain would be relieved best by administration of which type of medication? (Select all that apply)
c.) Narcotic analgesics d.) NSAIDs
Aminoglycosides contraindications
Known allergies, renal or hepatic disease, hearing loss
Opioid Contraindications
Known drug allergy Severe asthma Use with extreme caution in patients with: Respiratory insufficiency Elevated intracranial pressure Morbid obesity and/or sleep apnea Paralytic ileus Pregnancy
Lidocaine (transdermal)
Lidoderm Topical Analgesic indications : postherpetic neuralgia ( post shingles nerve pain)
G6PD deficiency
Low NADPH leads to hemolytic anemia (free radicals) with bite cells and heinz bodies Fava beans, sulfonamides, primiquine, dapsone X-linked recessive
infection sites of Myobacterium (MTB)
Lung ( primary) brain ( cerebral cortex) bone ( growing end) liver kidney genitourinary tract
Strong opioids
Morphine Hydromorphone Oxycodone Methadone Fentanyl Oxymorphone
Ibuprofen (Advil, Motrin)
Most commonly used NSAID Uses: analgesic effects in the management of RA, OA, primary dysmenorrhea, gout, dental pain, musculoskeletal disorders, antipyretic actions
Tuberculosis
Mycobacterium tuberculosis
Acetaminophen toxicity antidote
N-acetylcysteine (replenishes glutathione)
A postoperative patient has an epidural infusion of morphine sulfate (Astramorph). The patient's respiratory rate declines to 8 breaths/min. Which medication would the nurse anticipate administering?
Naloxone (Narcan)
Aminoglycosides uses
Narrow spectrum antibiotics. Treats severe infections, topical forms to treat skin and eye infections
codeine sulfate
Natural opiate alkaloid (Schedule II) obtained from opium Less effective Ceiling effect More commonly used as an antitussive drug GI disturbance
Which assessment findings does the nurse determine is a possible adverse effect associated with morphine sulfate administration?
Nausea, urinary retention, decreased peristalsis, delayed gastric emptying
Which adverse effect of aminoglycoside therapy would be prevented when the nurse continues to monitor the drug concentrations in the patient's blood?
Nephrotoxicity
WHO three-step analgesic ladder
Step 1: nonopioids (with or without adjuvant medications) after the pain has been identified and assessed. If pain persists or increases, treatment moves to Step 2: opioids with or without nonopioids and with or without adjuvants. If pain persists or increases, management then rises to Step 3: opioids indicated for moderate to severe pain, administered with or without nonopioids or adjuvant medications.
Sulfonamides adverse effects - integumentary
Photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrolysis
The client admitted with hepatitis B is prescribed Vicodin 2 tabs for treatment of pain. The appropriate nursing action is to:
c.) Question the physician about the order.
Voriconazole
can cause fetal harm in pregnant women
Antibiotic used to treat Anthrax
ciprofloxacin
NSAID contraindications
Pregnancy PUD Bleeding d/o Hypersensitivity to aspirin and other NSAID Kids w/chickenpox or flu
Penicillins: Indications
Prevention and treatment of infections caused by susceptible bacteria, such as: Gram-positive bacteria, including Streptococcus spp., Enterococcus spp., Staphylococcus spp.
Misoprostol (Cytotec)
Prostaglandin E analog Used w/ NSAIDs to prevent gastric ulcers Can induce labor Can cause diarrhea, abdominal pain, dysmenorrhea, spotting Take w/ meals and at bedtime
Naltrexone (ReVia)
Reduces or eliminates alcohol craving
A resident of the nursing home has quite severe arthritis. When administering an analgesic to this elderly resident, the nurse should: a. Give the medication before the activity session in the day room b. Give the medication when the resident states the pain is at 6 or higher on a 1-10 pain scale c. Give the pain medication at mealtime d. Make sure that the medication is not a narcotic
a. Give the medication before the activity session in the day room.
commonly uses quinolones
ciprofloxacin, norfloxacin, levofloxacin, moxifloxacin
Ribavirin
Respiratory syncytial virus (RSV) orally or oral/nasal inhalation caution in pregnant/ childbearing aged health care workers
tetracycline indications
Rocky Mountain Spotted fever, typhus, cholera, Lyme disease, peptic ulcers caused by H.pylori, chlamydial infections, acne, Anthrax
Ethambutol (Myambutol)
SE - Optic neuritis, decrease in visual acuity Notes - Routine vision test (monthly), Serum Creatine
Naproxen
Second most commonly used NSAID Somewhat better adverse effect profile than ibuprofen Fewer drug interactions with ACE inhibitors given for hypertension
Cephalosporins adverse effects
Similar to penicillins Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema Potential cross-sensitivity with penicillins if allergies exist
Four stages of HIV infection
Stage 1: asymptomatic infection Stage 2: early, general symptoms of disease Stage 3: moderate symptoms Stage 4: severe symptoms, often leading to death
mild opioids
codeine and hydrocodone
Antibiotic Classes
Sulfonamides Penicillins Cephalosporins Macrolides Quinolones Aminoglycosides Tetracyclines
Nursing Implications penicillin
Take oral doses with water (not juices) as acidic fluids may nullify drug's antibacterial action Monitor patients taking penicillin for an allergic reaction for at least 30 minutes after administration use probiotics
Which instruction is appropriate for a patient who is on NSAID therapy?
Take the NSAID with food, milk, or an antacid.
Nursing Implications - sulfonamides
Take with 2000 to 3000 mL of fluid/24 hr Assess RBCs prior to beginning therapy Take oral doses with food
Candida albicans treatment
Topical azoles (vaginitis); nystatin, fluconazole, caspofungin (oral/esophageal); fluconazole, caspofungin, amphotericin B (systemic)
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
quinolones indications
Treatment of serious infections caused by susceptible bacteria complicated uti, respiratory, bone and joints gi infections anthrax
Linezolid
Treats vancomycin-resistant (VRE) and methicillin-resistant (MRSA) bacteria
Clindamycin (Cleocin)
Used for chronic bone infections, GU infections, intraabdominal infections, other serious infections May cause pseudomembranous colitis (also known as antibiotic-associated colitis, Clostridium difficile diarrhea, or C. difficile infection) Potential interaction with vecuronium
When giving metronidazole, the nurse implements appropriate administration techniques, including which of these? (Select all that apply.)
a. Giving oral forms with food c. Infusing intravenous doses over 30 to 60 minutes e. Obtaining ordered specimens before starting the medication
mild reaction to penicillin
consider to cephalosporin
Itraconazole (Sporanox)
contraindications for tx of onychomycoses in patients with severe cardiac problems
Foscarnet
cytomegalovirus, herpes simplex
Before the scheduled dose of opioid, the nurse assesses the patient's vital signs. The respiratory rate is 8 breaths/ min, pulse rate is 80 beats/ min, and blood pressure 108/60 mm HG. Which action would the nurse take FIRST?
Withhold the scheduled opioid dose
Multidrug-resistant TB (MDR-TB)
a form of tuberculosis that is caused by an organism that is resistant to medication that is used to treat TB
Pre-exposure prophylaxis (PrEP)
a pill containing antiretroviral drugs taken before someone is exposed to the virus to prevent HIV acquisition
Reye's syndrome (RS)
a potentially fatal condition that has been linked to giving aspirin to children suffering from viral infections
vaginal candidiasis
a vaginal infection caused by the yeast-like fungus Candida albicans; also known as a yeast infection
Bedaquiline is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which statement by the patient indicates a correct understanding of the instructions?
a. "I will take this with food."
When the nurse is teaching a patient who is taking acyclovir for genital herpes, which statement by the nurse is accurate?
a. "This drug will help the lesions to dry and crust over."
The nurse is counseling a woman who is beginning antitubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interactions?
a. "You will need to switch to another form of birth control while you are taking the rifampin."
The nurse is reviewing the orders for wound care, which include use of an antiseptic. Which statements best describe the use of antiseptics? (Select all that apply.)
a. Antiseptics are appropriate for use on living tissue. d. The patient's allergies must be assessed before using the antiseptic. e. Antiseptics are used to inhibit the growth of microorganisms on the wound surface.
Before administering antiprotozoal drugs, the nurse will review which baseline assessment?
a. Complete blood count
Before administering analgesics
asses PT for PA, VS, and I&O
3. A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches. The patient asks the nurse what benefits these patches have. The nurse's best response includes which of these features? a. More constant drug levels for analgesia b. Less constipation and minimal dry mouth c. Less drowsiness than with oral opioids d. Lower dependency potential and no major adverse effects
a. More constant drug levels for analgesia
The nurse knows that antimalarial drugs are used to treat patients with infections caused by which microorganism?
a. Plasmodium spp.
When administering vancomycin, the nurse knows that which of these is most important to assess before giving the medication?
a. Renal function
During patient education regarding an oral macrolide, such as erythromycin, the nurse will include which information? (Select all that apply.)
a. Use another form of birth control if the patient is taking oral contraceptives. e. The patient may take the drug with a small snack to reduce gastrointestinal irritation.
3. A patient has a new order for clarithromycin, and the nurse is reviewing the patient's current medication list. Which medication or medication class may have an interaction with clarithromycin? (Select all that apply.)
a. Warfarin c. Simvastatin d. Oral contraceptives
Naloxone (Narcan) is administered to a client with severe respiratory depression and suspected drug overdose. After 20 minutes, the client remains unresponsive. The most likely explanation for this is:
a.) The client did not use an opioid drug.
Macrolides contraindications
allergy
Systemic Antifungals
amphotericin B (Fungizone), fluconazole, griseofulvin, itraconazole, ketoconazole (Nizoral), micafungin, nystatin, terbinafine, posaconazole, and voriconazole
Acetaminophen
analgesic that reduces pain and fever, but does not relieve inflammation
Acetaminophen (Tylenol)
analgesic, antipyretic
Cephalosporins interactions
antacids, iron, oral contraceptive, alcohol, drugs that promote bleeding
Nursing Implications Cephalosporins
assess for penicillin allergy, give PO with food
When teaching a patient about the potential drug interactions with antiprotozoal drugs, the nurse will include information about:
b. warfarin.
Nursing intervention for a client receiving opioid analgesics over an extended period of time should include:
b.) Encouraging increased fluids and fiber in the diet.
Macrolides MOA
bind to the 50s ribosomal subunit, resulting in inhibition of RNA dependent protein synthesis
Which assessment finding in a patient taking NSAIDs requires immediate intervention?
black , tarry stools
Nsaid symptom that requires immediate intervention
black tarry stool
Aspirin MOA
blocks COX irreversibly. Blocks production of TXA2 which impairs AGGREGATION. Important chemoattractant for other platelets.
5. Several patients have standard orders for acetaminophen as needed for pain. While reviewing their histories and assessments, the nurse discovers that one of the patients has a contraindication to acetaminophen therapy. Which patient should receive an alternative medication? a. A patient with a fever of 103.4° F (39.7° C) b. A patient admitted with deep vein thrombosis c. A patient admitted with severe hepatitis d. A patient who had abdominal surgery 1 week earlier
c. A patient admitted with severe hepatitis
A woman who has been taking an antibiotic for a urinary tract infection (UTI) calls the nurse practitioner to complain of severe vaginal itching. She has also noticed a thick, whitish vaginal discharge. The nurse practitioner suspects which of these?
c. A superinfection has developed.
2. A patient is receiving an opioid by a PCA pump as part of his postoperative pain management program. During rounds, the nurse finds him unresponsive, with respirations of 8 breaths/min and blood pressure of 102/58 mm Hg. After stopping the opioid infusion, what should the nurse do next? a. Notify the charge nurse. b. Draw arterial blood gases. c. Administer an opiate antagonist per standing orders. d. Perform a thorough assessment, including mental status examination.
c. Administer an opiate antagonist per standing orders.
The nurse notes in the patient's medication history that the patient is taking sofosbuvir with ribavirin. Based on this finding, the nurse interprets that the patient has which disorder?
c. Chronic hepatitis C
While monitoring a patient who is receiving intravenous amphotericin B, the nurse expects to see which adverse effect(s)? (Select all that apply.)
c. Fever d. Headache e. Chills f. Nausea and vomiting
After surgery for organ transplantation, a patient is receiving ganciclovir, even though he does not have a viral infection. Which statement best explains the rationale for this medication therapy?
c. Ganciclovir is given to prevent CMV infection.
During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related adverse effects?
c. Infusing the medication over a longer period of time
The nurse is administering an intravenous aminoglycoside to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.)
c. Monitor serum creatinine levels. d. Instruct the patient to report dizziness or a feeling of fullness
When giving intravenous quinolones, the nurse needs to keep in mind that these drugs may have serious interactions with which drugs?
c. Oral anticoagulants
An elderly client had abdominal surgery six hours earlier. When the nurse asks the client about pain, the client responds that there is none. The best intervention on the part of the nurse is: a. Administer a PRN dose of IV pain medication as ordered. b. Assist the client into a sitting position in preparation for ambulation. c. Question the client further about discomfort to assess the meaning of pain. d. Assess the abdominal dressing and consult the surgeon about findings.
c. Question the client further about discomfort to assess the meaning of pain.
A patient who has been newly diagnosed with HIV has many questions about the effectiveness of drug therapy. After a teaching session, which statement by the patient reflects a need for more education?
d. "These drugs will eventually eliminate the virus from my body."
For best results when treating severe, constant pain associated with pathologic spinal fractures related to metastatic bone cancer, the nurse should remember that the best type of dosage schedule is to administer the pain medication is which of these? a. As needed b. When requested by the patient c. On schedule during waking hours only d. Around the clock, with additional doses as needed for breakthrough pain
d. Around the clock, with additional doses as needed for breakthrough pain
When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious during which time?
d. During the initial period of the illness and its diagnosis.
The nurse notes in a patient's medication history that the patient is taking terbinafine. Based on this finding, the nurse interprets that the patient has which disorder?
d. Fungal infection of toenails or fingernails
The safest narcotic choice for an elderly client with acute pain is: a. Meperidine (Demerol) b. Oxycodone c. Fentanyl transdermal patch d. Morphine sulfate
d. Morphine sulfate. Rationale: Morphine is the "gold standard" of narcotics for acute pain. The other choices are incorrect.
While assessing a woman who is receiving quinolone therapy for pneumonia, the nurse notices that the patient has a history of heart problems. The nurse will monitor for which potential cardiac effect of quinolone therapy?
d. Prolonged QT interval
During therapy with an intravenous aminoglycoside, the patient calls the nurse and says, "I'm hearing some odd sounds, like ringing, in my ears." What is the nurse's priority action at this time?
d. Stop the infusion immediately.
When administering antifungal drug therapy, the nurse knows that a patient's factor that contributes to many of the drug interactions with antifungals is which of these?
d. The patient's cytochrome P-450 enzyme system
While monitoring a patient, the nurse knows that a therapeutic response to antitubercular drugs would be which of these?
d. There is a decrease in symptoms, along with improved chest radiograph and sputum culture results.
8. A patient with renal cancer needs an opiate for pain control. Which opioid medication would be the safest choice for this patient? a. fentanyl b. hydromorphone (Dilaudid) c. morphine sulfate d. methadone (Dolophine)
d. methadone (Dolophine)
The nurse is reviewing the medication history of a patient who is taking hydroxychloroquine. However, the patient's chart does not reveal a history of malaria or travel out of the country. The patient is most likely taking this medication for:
d. rheumatoid arthritis.
The client informs the nurse that he has experienced pain in the lower extremities for the past eight months. The nurse recognizes that this pain is classified as:
d.) Chronic.
The nurse administers morphine sulfate 4 mg IV to a client for treatment of severe pain. Which of the following assessments requires immediate nursing interventions?
d.) Respiratory rate 10/minute
Aminoglycosides commonly used
gentamicin, tobramycin, neomycin, plazomicin
Nursing Implications Macrolides
give with food
sulfonamides and warfarin(coumadin)
increased anticoagulation effects
Sulfonamides interaction with sulfonylureas
increased hypoglycemia
sulfonamides and phenytoin (dilantin)
increased toxic effects
Terbanifine (Lamisil)
indicated for tx of onchomycosis
NSAID MOA and uses
inhibition of the leukotriene pathway, the prostaglandin pathway or both blocking the chemical activity of the enzyme COX
Quinolones contraindications
known drug allergy prepubescent pediatrics cannot take bc cartilage will not develop
aspartate transaminase (AST) and Alanine aminotransferase (ALT)
lab values should be assessed for acetaminophen overdose
Anaphylaxis
laryngeal edema, bronchoconstriction, sever hotn
Tetracycline adverse effects
liver damage or hepatotoxicity, esp in pregnant pts with history of renal disease, superinfection, photosensitivity, discoloration of newly forming teeth, GI symptoms, diarrhea
