Pharm Exam #2
What is the priority instruction a nurse gives to a male patient who is scheduled to receive ribavirin [Rebetol] combined with peg-interferon-alfa-2a for treatment of hepatitis C? "Combining these two medications will greatly increase response rates." "An antidepressant can be prescribed to alleviate symptoms of depression." "If you are sexually active, use two reliable forms of birth control to prevent pregnancy." "It is very important that you have blood counts checked every 2 weeks."
"If you are sexually active, use two reliable forms of birth control to prevent pregnancy." Because ribavirin is embryo lethal when taken by female patients and causes sperm abnormalities when taken by males, it is a priority that pregnancy be avoided during its use. Pregnancy must be avoided by female patients and by female partners of men taking ribavirin. Couples should use two reliable forms of birth control during treatment and for 6 months afterward. It is less important that the patient know that ribavirin is not effective against hepatitis C unless it is combined with interferon alfa. Less important information to provide than avoiding pregnancy includes hemolytic anemia is an adverse effect; frequent blood checks are advised; and depression is an adverse effect of peg-interferon-alfa-2a for which antidepressants can be prescribed.
A patient who is receiving vancomycin [Vancocin] IV for a methicillin-resistant Staphylococcus aureus (MRSA) infection asks a nurse, "Why can't I take this medicine in a pill?" Which response should the nurse make? "The prescription could be changed, because vancomycin comes in two forms." "You're allergic to penicillin, and this is the only way this medication can be given." "It will cause too much loss of appetite and nausea if given in the oral form." "It is more effective by IV, because the pill form will stay in the digestive tract."
"It is more effective by IV, because the pill form will stay in the digestive tract." Only given orally for infections in the intestine.
A nurse should give which nonmedication instruction to a patient who has peptic ulcers? "Reduce your intake of caffeine-containing beverages, such as coffee and colas." "Take a nonsteroidal anti-inflammatory drug once a day to help with pain." "It would be better to eat five or six small meals a day instead of three larger ones." "An ulcer diet of bland foods with milk and cream products will speed healing."
"It would be better to eat five or six small meals a day instead of three larger ones."
When teaching a patient about tuberculosis, the nurse will include which statements? (Select all that apply.) "Most people infected with M. tuberculosis are asymptomatic." "Most people infected with M. tuberculosis harbor dormant bacteria for life if they do not receive drug therapy." "Treatment of tuberculosis lasts 3 months." "Isoniazid can cause peripheral neuropathy by depleting vitamin B12." "Rifampin can cause optic neuritis."
"Most people infected with M. tuberculosis are asymptomatic." "Most people infected with M. tuberculosis harbor dormant bacteria for life if they do not receive drug therapy." Treatment for tuberculosis usually lasts 6 months to 2 years. Isoniazid can cause peripheral neuropathy by depleting vitamin B6.
Which statements will the nurse include when teaching a patient about isoniazid therapy for the treatment of tuberculosis? (Select all that apply.) "Take the isoniazid on an empty stomach." "Notify your healthcare provider if your skin starts to turn yellow." "Numbness or tingling in your extremities is a normal response when taking this drug." "Your urine will turn reddish orange because of the effects of this drug." "Use of this drug is associated with vision problems."
"Take the isoniazid on an empty stomach." "Notify your healthcare provider if your skin starts to turn yellow." Numbness and tingling in the extremities is associated with the development of peripheral neuropathy and should be reported to the healthcare provider.
A nurse instructs a female patient with peptic ulcer disease who is to start a treatment regimen that includes ranitidine [Zantac] and bismuth subsalicylate [Pepto-Bismol]. Which statement by the patient indicates that the teaching has been effective? "While I'm taking these medications, my bowel movements could look black." "I have a medicine at home to take when I start having some loose diarrhea stools." "I'm so glad that my allergies will be helped while I'm taking these medications." "I'll include more calcium and vitamin D in my diet to prevent osteoporosis."
"While I'm taking these medications, my bowel movements could look black."
What are the ADRs of metronidazole (serious and less severe)
(Flagyl) Stevens Johnson dark urine GI upset metallic taste
Glucocorticoids
(QVAR/beclomethasone, budesonide, fluticasone - flovent) For SEVERE symptoms of COPD or when long-acting bronchodilators are insufficient. Give in combination with LABA; not adequate alone. Anti-inflammatory Adverse reactions to inhaled formulation usually minor. Long term use of systemic drug - likely severe side effects. Oral use for acute exacerbations only. Decrease histamine and prostaglandins, eosinophils and leukocytes, decrease edema of airway mucosa secondary to decrease in vascular permeability. Reduce bronchial hyperreactivity. For long term, routine management of asthma. Indicated for COPD exacerbations. Most common ADRs of inhaled form: thrush, hoarseness. Rinse mouth and use spacer. Intranasal side effect - sore throat, dry nasal passages, burning/itching. Monitor young children for adrenal side effects after six months - hypoglycemia, hypotension, mental status alterations. Can slow growth but do not affect final adult height. Adult height may be delayed but not reduced. Bone loss long term side effect. Use lowest dose possible, ensure intake of vitamin D and calcium, weight bearing exercise. Contraindicated with fungal infection or live vaccine CAUTION in patients with glaucoma, MG or DM ADR: hyperglycemia, water and sodium retention, incr. gastric acid secretion, cataracts Intranasal glucocorticoids are most effective drugs for preventing and treating seasonal and allergic rhinitis. They reduce nasal congestion, rhinorrhea, sneezing, nasal itching, and erythema
ADRs of prednisone
(glucocorticoid) hyperglycemia PUD fluid/electrolyte imbalance - HYPERNATREMIA (salt with the sugar), hypokalemia edema weakness
acyclovir
-cyclovirs are anti-herpes. (circle here, herpes look like circles) antiviral - take daily, no cure prevents reproduction of DNA; cells cannot replicate Treats herpes simplex, varicella zoster. Risk of phlebitis at infection site. Nephrotoxic - infuse over one hour, ensure hydration for two hours after Give high dose for shingles; also oral therapy for chicken pox if begun within 24 hours of rash onset Apply topical with glove to avoid transfer of virus.
Antifungals
-nazoles candida infection. treats nail and skin infections. taken for 2-6 weeks. very hepatotoxic. -nazole treats nails, -dazole treats da diff
antivirals
-ovirs interferon alfa pavlivizumab ribavirin lamivudine ziduvodine amantadine
Glucocorticoid mechanism of action
Anti-inflammatory; decreases histamine, prostaglandins, eosinophils and leukocytes. Decreases vascular permeability, which decreases edema and airway mucosa
tiotropium
Anticholinergic Spiriva LAMA for maintenance therapy of COPD-associated bronchospasm off-label for asthma Most common ADR is dry mouth
Which statements about antiseptics, disinfectants, and sanitization does the nurse identify as true? (Select all that apply.) Sanitization indicates complete destruction of all microorganisms. Antiseptics are used to bathe neonates. Disinfectants are commonly used to decontaminate surgical instruments. Antiseptics are commonly used to treat local infections. Germistatic drugs are used to kill all microorganisms.
Antiseptics are used to bathe neonates. Disinfectants are commonly used to decontaminate surgical instruments.
A nurse should recognize that antibiotic prophylaxis is appropriate in patients with which medical conditions? (Select all that apply.) Aortic valve replacement Ruptured appendix Bronchitis Neutropenia Chickenpox
Aortic valve replacement Neutropenia Situations include patients who have prosthetic valves and are at risk for bacterial endocarditis. The use of antibiotics in "dirty" surgeries, such as those for ruptured organs, is considered treatment, not prophylaxis. Severe neutropenia can put patients at risk for severe infection, and antibiotics can reduce infections but may encourage fungal invasion.
serum levels for vancomycin
15-20 mcg/mL for serious infections 10 mcg/mL for less severe infections
sympathomimetics nursing considerations
Avoid caffeine, do not take at bedtime
A patient who has human immunodeficiency virus (HIV) infection has a tuberculin skin test (TST) for latent tuberculosis. The nurse assesses the result 48 hours after the injection. An induration of what size indicates that the patient needs to be treated for latent tuberculosis? 1 mm 2 mm 3 mm 5 mm
5 mm A positive reaction on the TST is indicated by an area of induration (hardness) around the injection site. The decision to treat latent tuberculosis is based on the risk category and size of the induration area. Treatment is recommended in high-risk individuals, such as those with HIV infection, for an induration of 5 mm. An induration of 10 mm is required to treat moderate-risk individuals. An induration of more than 15 mm is required to treat low-risk individuals.
sulfasalazine
5-aminosalicylate. sulfonamide antibiotic converted in intestine into 5-aminosalicylic acid (mesasalamine) and sulfapyridine. Prostaglandin inhibitor - decreases intestinal inflammation. Immunosuppresive for Crohn's/colitis Monitor for worsening symptoms. Check stool for intact enteric-coated tablets. Monitor CBC for white/red blood cell counts. Warn patient re: change in urine and skin color. Photosensitivity. Check for sulfa allergy. Do not give with sensitivity to trimethoprim or aspirin, folate deficiency, anemia, renal failure, porphyria, GI/urinary obstruction. IRON and antibiotics interfere with absorption. Take with food or water
how long does treatment for TB typically last?
6 months to 2 years
corticosteroids
A group of hormones, including cortisol, released by the adrenal glands at times of stress. SIDE EFFECTS such as weight gain, bloating, insomnia, headache, and mood swings Long-term use of OCS can lead to some serious problems including decreased bone density, diabetes, and adrenal fatigue
The nurse expects laxatives to be ordered for which of the following patients? (Select all that apply.) A patient with chronic pain A patient recovering from cardiac surgery A patient who recently delivered a child A patient with acute food poisoning A patient with no bowel sounds
A patient with chronic pain A patient recovering from cardiac surgery A patient who recently delivered a child
Magnesium hydroxide ADRs
ADR: does not cause constipation, can cause diarrhea, hypophosphatemia. Counter with aluminum hydroxide if needed. Can cause Mg toxicity in patients with renal impairment.
Trimethoprim/Sulfamethoxazole ADRs
ADR: hemolytic anemia, renal damage, stevens-johnson syndrome (lesions on skin and mucous membranes), hyperkalemia, rash, photosensitivity SULFA Sunburn (photosensitivity) Urine crystals/ high specific gravity due to renal damage Lesions on skin (stevens johnson) Folic acid - take daily Anemia
ribavarin ADRs
ADRs: hemolytic anemia, onset 1-2 weeks after starting treatment Contraindicated for pregnancy (embryolethal) In combination with interferons - ADRs include increased risk of autoimmune disorder, infection, hypersensitivity reaction, bone marrow suppression, periodontal problems, pancreatitis/diabetes, pulmonary complications
sulfasalazine ADRs
ADRs: nausea, fever, rash, headache, agranulocytosis, megaloblastic/hemolytic anemia, JOINT PAIN SULFA ULCA - used to treat ulcerative colitis by suppressing inflammation. It has the adverse hematologic effects of agranulocytosis, hemolytic anemia, and macrocytic anemia. Patients should report any signs of infection and/or fatigue.
The nurse is aware that mother-to-child transmission of HIV occurs primarily during labor and delivery. Which of the following can reduce the risk of transmission? (Select all that apply.) ART during gestation to minimize maternal viral load IV zidovudine to the mother during labor and delivery Two forms of birth control, including barrier and hormonal Oral or IV zidovudine to the infant for 6 weeks following delivery Planned induction of labor
ART during gestation to minimize maternal viral load IV zidovudine to the mother during labor and delivery Oral or IV zidovudine to the infant for 6 weeks following delivery
An antimicrobial medication that has selective toxicity has which characteristic? Ability to transfer DNA coding Ability to suppress bacterial resistance Ability to avoid injuring host cells Ability to act against a specific microbe
Ability to avoid injuring host cells
The nurse is aware that which medications are used to treat genital herpes? (Select all that apply.) Oral metronidazole Vaginal metronidazole Acyclovir Valacyclovir Famciclovir
Acyclovir Valacyclovir Famciclovir Genital herpes can be treated with three drugs: acyclovir, famciclovir, and valacyclovir. These agents do not eliminate the virus, but they can reduce symptoms and shorten the duration of viral shedding and pain.
sucralfate administration tips
Administer orally on empty stomach 4x/day, one hour before meals and at bedtime, not within 30 minutes of antacids. Not within two hours of FLUROQUINOLONES, WARFARIN, DIGOXIN, TETRACYCLINE, phenytoin, theophylline, or diazepam. Can effect serum levels. Tablets large and difficult to swallow - can be cut in half or dissolved in water, but do not crush.
Thirty minutes after receiving an intramuscular (IM) injection of penicillin G [Pfizerpen], a patient reports itching and redness at the injection site. Which action should the nurse take first? Elevate the lower legs. Place an ice pack on the site. Make sure the patient stays calm. Administer subcutaneous epinephrine.
Administer subcutaneous epinephrine.
drugs for acute asthma
Albuterol (always 1st) Ipratropium Methopronisalone (steroid last - act slowly)
Before administering trimethoprim, it is most important for the nurse to assess the patient for a history of what? Heart failure Alcoholism Diabetes Emphysema
Alcoholism Trimethoprim inhibits bacterial synthesis of folic acid. It is avoided in patients when folate deficiency is likely, such as in alcoholism, because bone marrow suppression may occur.
Gentamicin
Aminoglycoside Disrupts protein synthesis - rapid bacterial death Ototoxic at high trough levels, nephrotoxic, intense neuromuscular blockade (flaccid paralysis, respiratory depression) Caution in kidney/MG patients Measure peak levels one hour after IM or 30 min after IV completion. Text inner ear function (hearing and balance), kidney labs Do not use penicillin in same PORT TERATOGENIC - no pregnancy
metaclopramide
DOPAMINE antagonist/prokinetic Reglan For nausea due to chemo or radiation. ADR: sedation, extrapyramidal reactions, restlessness. Tardive dyskinesia with long term high dose (may be irreversible). Monitor for restlessness, spasms of face/neck, lip smacking PRE-TREATING with diphenhydramine decreases risk of extrapyramidal reactions Contraindicated with GI obstruction or bleed, hemorrhage, seizure, breast cancer
Tetracycline information for patients
Decreases contraceptive efficacy Take on empty stomach with 8 oz water Remain upright after administration
glucocorticoid effect on growth
Delays adult height but does not reduce it. Bone loss long term; increase vitamin D and calcium. Weight bearing exercises
Which test is the most widely used method for assessing drug sensitivity? Minimum inhibitory concentration (MIC) Minimum bacterial concentration (MBC) Broth dilution Disk diffusion
Disk diffusion - also known as Kirby Bauer what everyone does in microbiology
magnesium hydroxide drug interactions
Do not give within two hours of: tetracyclines digoxin FLUOROQUINOLONES IRON salts salicylates chlorpromazine
penicillin nursing considerations
Do not mix in IV with aminoglycoside. Avoid intraarterial injection into peripheral nerves. Decreases contraceptive effectiveness. Take one hour AC or two hours PC Shake before administration Monitor platelet count
Promethazine mechanism of action
Dopamine antagonist Blocks receptors in CTZ
promethazine
Dopamine antagonist - block receptors in the CTZ. Phenergan ADRs: respiratory depression, local tissue injury - extravasation leading to necrosis/gangrene, extrapyramidal reactions, anticholinergic effects, hypotension, sedation
A patient is taking nitrofurantoin [Macrodantin]. Which finding should a nurse recognize as an indication that the treatment is having an undesired effect? Hyperpigmentation of the palms Dyspnea with chills Gum irritation with bleeding Scalp tenderness and thinning hair
Dyspnea with chills Nitrofurantoin, a urinary tract antiseptic, may induce a pulmonary reaction that manifests with dyspnea, chest pain, and chills. These symptoms, which resolve 2 to 4 days after the drug is stopped, are thought to be hypersensitivity reactions.
codeine (mech of action)
Effective against chronic nonproductive cough, but not against common cold. Act in the CNS to ELEVATE cough threshold. Most effective cough suppressant available. Doses are low - about one tenth of that needed for pain relief. Can suppress respiration, (orthostatic) hypotension (slows CNS), cause constipation, sedative. NOT for COPD. Take with food, increase fluid intake. OD can be fatal. Naloxone can reverse. 10-20 mg orally, 4-6 times per day. Rarely recommended for children.
magnesium hydroxide onset/dosing
Effective in 6-12 hours GIve up to 4x/day, follow with eight oz water
When administering prednisone to a patient, the nurse will do what? Administer the prednisone in the evening to coincide with the natural secretion pattern of the adrenal cortex. Instruct the patient to stop taking the prednisone immediately if diarrhea develops. Ensure that meals are at bedside so that administration with food reduces gastric irritation. Avoid intravenous delivery to prevent adverse effects.
Ensure that meals are at bedside so that administration with food reduces gastric irritation.
Cephazolin can be given with penicillin allergy, T/F?
FALSE
famotidine ADRs
FAMotidine is efFAMinating for pepcid takers ADRs: impotence, gynecomastia, reduced libido Less common: confusion, arrhythmia, aplastic anemia. PNEUMONIA - more bacterial growth in less acidic stomach travels to respiratory tract.
Which manifestations does the nurse associate with the development of hemolytic anemia? (Select all that apply.) Urticaria Fever Pallor Jaundice Diarrhea
Fever Pallor Jaundice
Side effect of first-gen H1 blockers
First-generation H1 blockers produce adverse effects that include atropine-like properties (i.e., drying of mucous membranes) and gastrointestinal effects (e.g., nausea). Sedation is a pronounced side effect.
metronidazole
Flagyl in the Family of h-pylori meds Most effective against non-resistant h. pylori; also for trichamoniosis, bacterial VAGINOSIS. Alcohol MUST be avoided during treatment AND three days afterward. Deadly side effect: new rash, skin peeling (Stevens Johnson) Darkens urine, GI upset, metallic taste Give with 2-3 other abx in combination for 14 days.
fluticasone
Flomax inhalant Glococorticoid Side effects: dry mucous membranes, epistaxis, sore throat, HA. Use humidifier, pre-treat with decongestant if needed. MDSI with initial loading dose. Taper gradually. Used for asthma treatment and allergic reactions. Greatest benefit when taken daily (not PRN, not for ACUTE) - for perennial rhinitis, may take 2-3 weeks to take effect
ciprofloxacin
Fluoroquinolone -floxacins for travelers diarrhea Broad spectrum, for severe infection (not staph) ADR: achilles tendon rupture. suprainfection, phototoxicity Contraindicated for children (except complicated UTI/kidney infection), MG patients
A nurse is providing teaching to a group of patients regarding flu season in the United States. Which statement should the nurse include in the teaching? In the United States, flu season usually peaks in October or November. To ensure full protection, the best time to vaccinate is September. For people who missed the best time, vaccinating as late as April may be of help. The influenza vaccine may not be administered at the same time as the pneumococcal vaccine.
For people who missed the best time, vaccinating as late as April may be of help. Peak flu season in the United States is usually January or February. To ensure full protection, the best time to vaccinate is October or November. For people who missed the best time, vaccinating as late as April may be helpful.
ribavarin
Former first-line treatment for HCV, combined with interferon alfa. nucleoside analog, broad spectrum antiviral available as aerosol for RSV (pediatric) Ribavirin (inhaled) and palivizumab are used for the treatment of RSV. embryolethal/teratogenic
nitrofurantoin ADRs
GI effects pulmonary reactions hematologic effects (hemolytic anemia in newborns, thrombocytopenia) peripheral neuropathy (numbness/tingling - discontinue use) hepatotoxicity birth defects
do not give bisacodyl with these conditions:
GI obstruction fissures ulcerated hemorrhoids fecal impaction proctitis
metaclopramide contraindications
GI obstruction hemorrhage seizure breast cancer
loperamide dosage considerations
Give up to 16 mg per day (4 mg initial, then 2 mg doses) Stop after 48 hours if symptoms persist
prednisone
Glucocorticoid - for oral therapy of acute asthma exacerbation. Avoid crowds while taking. Increases susceptibility to infection. Suppresses adrenal function; cannot produce endogenous glucocorticoid. Several months are required for recovery of adrenocortical function. ADRs: hyperglycemia, PUD, fluid/electrolyte imbalances (hypernatremia, hypokalemia) - edema and weakness Long term ADR: muscle wasting, bone demineralization. Do not take with recent live virus vaccination, with potassium-depleting DIURETICS Lowest effective dose and ALTERNATE day dosing schedule recommended. Take with food. Taper gradually. Patient may need to supplement in times of adrenal stress.
The nurse notes that a patient's medication list includes ceftriaxone. The patient reports a history of sexually transmitted infection but cannot recall the name of the infection. The nurse is aware that ceftriaxone is the preferred medication for treating which sexually transmitted infection? Gonorrhea Trichomonas Chlamydia trachomatis Bacterial vaginosis
Gonorrhea Ceftriaxone is the preferred drug for treating gonorrhea. It should be given in combination with either azithromycin or doxycycline.
Clindamycin treats:
Group A strep bacterial vaginosis
______ is first sign of vestibular damage
Headache is the first sign of impending vestibular damage (balance) and may last 1 to 2 days. Unsteadiness, vertigo, and dizziness appear after headache.
Acyclovir dosing considerations
High dosage for shingles Also oral therapy for chicken pox if given within 24 hours of rash onset Apply topical with glove to avoid transfer of virus.
famotidine mechanism of action
Histamine H2 antagonist blocks histamine receptors in stomach responsible for acid secretion. Increases stomach pH, lowers hydrogen
metaclopramide mechanism of action
Increases tone of lower esophageal sphincter, peristalsis in stomach and intestines, CTZ threshold blocks serotonin and dopamine receptors in the chemoreceptor trigger zone (CTZ) and by increasing motility in the small intestine.
A nurse knows that which condition is a potential long-term complication in a patient with pelvic inflammatory disease (PID)? Bacterial endocarditis Infertility Cervical cancer Renal tubular necrosis
Infertility Acute PID is a syndrome that includes endometritis, pelvic peritonitis, tubo-ovarian abscess, and inflammation of the fallopian tubes. Infertility can result from fallopian tube scarring.
Which approach should a nurse take to administer intravenous (IV) acyclovir [Zovirax] to an immunocompromised patient? Infuse IV fluids during administration of the dose and for 2 hours afterward. Administer IV acyclovir diluted in 20 mL normal saline (NS) over 10 minutes. Only infuse the drug if the white blood cell (WBC) count is above 2500/mm3. Ask the provider to change the route to subcutaneous (subQ) injection.
Infuse IV fluids during administration of the dose and for 2 hours afterward. Acyclovir can cause renal damage, and hydration of the patient during the infusion and for 2 hours afterward minimizes this risk.
Amphotericin B infusion nursing considerations
Infusion reaction common - chills, headache and fever for one to three hours Give a test dose PRE-TREAT with diphenhydramine and acetaminophen Phlebitis is common - rotate sites
trimethoprim-sulfamethoxazole mechanism of action
Inhibits bacterial metabolism of folic acid (blocks DNA synthesis, bactericidal)
vancomycin
Inhibits cell wall synthesis - binds to molecules that build cell wall For MRSA, C diff Ototoxic Nephrotoxic Red man syndrome - due to rapid IV (rash, itching, flushing, tachycardia, hypotension) Slow infusion. Check levels 15-30 min before next dose. trough serum: 15-20 mcg/mL for serious infection. 10 mcg/mL if less severe Call provider for: Creatinine over 1.3 BUN over 20 Urine less than 30 mL/hour
The human immunodeficiency virus (HIV) uses which enzymes to replicate and infect a host cell? (Select all that apply.) Integrase Dihydrofolate reductase Reverse transcriptase Carbonic anhydrase Protease
Integrase Reverse transcriptase Protease
Amphotericin B labs to monitor
K+ between 3.5-5 Creatinine between 0.6-1.3 BUN under 20 Urine output 30 mL/hour or more
CINV regimen
LOADD serotonin receptor antagonist (ondansetron); the substance P/neurokinin1 antagonist aprepitant; benzodiazepine (lorazepam) dolasetron dexamethasone
A nurse should recognize that a patient who is infected with HIV is at the highest risk to develop opportunistic infections during which clinical phase of HIV? Late Intermediate Initial Prodromal
Late
chlorhexidine
Lethal to most bacteria (not to spores) Very safe Surgical scrub, wound cleanser, infection control at central venous catheter, oral rinse
azithromycin
MACROLIDE For treatment of STIs Can prolong QT intervals - MONITOR ECG hepatotoxic - check LIVER labs, no NSAIDs
loperamide drug interactions
MAOIS increase risk of hypertensive crisis Cimetidine and quinine increase risk of cardiac arrest.
erythromycin drug interactions
Macrolide - max interactions erythromycin has erry interaction Elevates levels of: theophylline, carbamazepine, tacrolimus, digoxin, warfarin Do not take with CYP3A4 inhibitors: verapamil (won't metabolize), diltiazem, HIV protease inhibitors, azole antifungals
Therapeutic for diabetic gastroparesis Use caution with hypokalemia, older adults, asthmatics
Metaclopramide
what drugs cause Stevens-Johnson syndrome?
Metronidazole Trimethoprim-Sulfamethoxazole Ondansetron
magnesium hydroxide
Milk of magnesia For PUD & GERD, pre-op/dx procedures Laxative salts - draw water into intestines, increase peristalsis Alkaline compound - neutralizes acid Give up to 4x/day, follow w/ 8 oz water. Caution in pt's with hypercalcemia Do not give within 2 hours of TETRACYCLINES, DIGOXIN, FLUOROQUINOLONES, iron salts, salicylates, chlorpromazine. Effective in 6-12 HOURS
pseudoephedrine mechanism of action
Mimics effects of SNS. Activates alpha receptors on nasal blood vessels to cause vasoconstriction. Causes shrinkage of swollen membranes, followed by nasal drainage.
bisacodyl ADRs
More ADRs than other laxatives - diarrhea, cramps, burning in suppository formulation. Prolonged use can cause proctitis. Can result in dependence on laxative for BM.
Which are advantages of a dry-powder inhaler (DPI) over a metered-dose inhaler (MDI)? (Select all that apply.) More of the drug is delivered to the lungs and less to the oropharynx. Use of a spacer is not necessary. Less propellant is needed to deliver the medication. Less hand-lung coordination is required. DPIs pose no environmental risk.
More of the drug is delivered to the lungs and less to the oropharynx. Use of a spacer is not necessary. Less hand-lung coordination is required. DPIs pose no environmental risk.
sucralfate
Mucosal protectant Causes chemical reaction that forms gel lining in stomach. May cause constipation. Not absorbed - no systemic effects. Increase fluid and fiber intake to reduce constipation. Report GI bleeding signs. Take on an empty stomach, best at bedtime (sucralFATE taken LATE)
A patient is to begin taking nitrofurantoin [Macrodantin]. The nurse should teach the patient that which manifestation should be the priority to report to the healthcare provider? Headache and drowsiness Brown-colored urine Nausea and vomiting Muscle weakness and tingling
Muscle weakness and tingling Nitrofurantoin is used in acute infections of the lower urinary tract only. Muscle weakness and tingling may indicate irreversible damage to sensory and motor nerves caused by demyelinization of nerves. Patients should be informed of these symptoms and taught to report them immediately.
Before administering an aminoglycoside, it is most important for the nurse to assess the patient for a history of what? Myasthenia gravis Asthma Hypertension Diabetes mellitus
Myasthenia gravis Aminoglycosides can inhibit neuromuscular transmission, causing flaccid paralysis and potentially fatal respiratory depression.
parenteral
NOT given by mouth
nitrofurantoin
NitrofURANtoin Urinary tract AntiSepTic - AST/ALT labs Bacteriostatic at low concentration, bactericidal at high dose Prophylaxis of recurrent UTI ADRs: GI effects, Pulmonary reactions, HEMATOLOGIC effects (hemolytic anemia in newborns, thrombocytopenia), peripheral neuropathy (numbness/tingling - discontinue use), hepatotoxic, birth defects Labs: liver function
gentamicin absorption
Not absorbed from GI tract - oral therapy only for local intestinal effect (i.e. suppression of flora pre-colorectal surgery)
A patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms, which could indicate a vitamin B6 deficiency caused by the medication? Numbness and tingling in the fingers and toes Alopecia and flaking scalp Dry skin and brittle nails Oral ulcers and tongue fissures
Numbness and tingling in the fingers and toes Dose-related peripheral neuropathy is the most common adverse effect of isoniazid. It results from a vitamin B6 deficiency, which is corrected by taking oral supplements. Symptoms include numbness and tingling in the fingers and toes.
Omeprazole side effects
O-meprazole O-steoporosis Long term use: risk of bone loss. 3 months or more - HYPOMAGNESEMIA (tremor, muscle cramps, seizure). Supplement with calcium and magnesium. Report diarrhea - may be c diff Headache, abdominal pain, nausea, diarrhea. Risk of rebound acid hypersecretion.
When performing a skin test for penicillin allergy, the nurse will do what? (Select all that apply.) Inject a tiny amount of the allergen subcutaneously. Observe for a local allergic response. Have epinephrine readily available. Have respiratory support readily available. Administer diphenhydramine [Benadryl] as the first-line agent should anaphylaxis occur.
Observe for a local allergic response. Have epinephrine readily available. Have respiratory support readily available. Injection of test dose is intradermal First line agent is epinephrine
A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? Omeprazole [Prilosec] Famotidine [Pepcid] Misoprostol [Cytotec] Ranitidine [Zantac]
Omeprazole [Prilosec] Omeprazole causes irreversible INHIBITION of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine BLOCK histamine2 receptors on parietal cells
A patient who has an infection with Mycobacterium leprae (leprosy) has been prescribed rifampin [Rifadin]. The nurse identifies which dosing schedule as most effective for this drug? Two times per day Every other day Once every 2 weeks Once per month
Once per month Rifampin is the most effective agent for treating leprosy. A single dose kills more than 99.9% of viable M. leprae. Monthly administration is effective, and this dosing schedule minimizes adverse effects. also for prophylaxis of meningitis caused by H. influenzae
loperamide
Opioid derivative Imodium Decreases peristalsis, increases transit time through GI tract. Increases absorption of water and sodium from feces. ADRs: cardiac arrest/arrhythmia. Drowsiness, constipation. Anticholinergic effects: dry mouth, lightheadedness, urinary retention, sedation, dizziness. Contraindicated for advanced hepatic disease, glaucoma Excess dosage can cause CNS effects similar to morphine. Atropine discourages abuse. For OD, treat with naloxone. Give up to 16 mg per day (4 mg initial, then 2 mg doses) - stop after 48 hours if symptoms persist. Replace fluids with electrolyte solution (esp. potassium). Avoid caffeine (diuretic and increases motility)
bisacodyl administration timing
Oral - Effective in 6-12 hours; administer at bedtime to take effect next day. Suppository - effective in 15-60 minutes. Do not give just before meals or at bedtime.
ondansetron contraindications
Oral formulation contraindicated with PKU. Not for use with apomorphine (severe hypotension) or congenital long QT syndrome. Contraindicated with SSRIs, SNRIs, tricyclic antidepressants, MAOIs, fentanyl, lithium, buspirone. Risk of serotonin syndrome.
The nurse is aware that which treatments are used in nonpregnant women to treat bacterial vaginosis? (Select all that apply.) Oral metronidazole Vaginal metronidazole Penicillin G Tetracycline Azithromycin [Zithromax]
Oral metronidazole Vaginal metronidazole In nonpregnant women, bacterial vaginosis can be treated orally with metronidazole, or intravaginally with metronidazole or clindamycin.
administration of omeprazole
Orally, once daily before breakfast. Food reduces absorption.
famotidine nursing considerations
PROLONG EFFECTS by taking with or just after meals or at bedtime. AVOID smoking, alcohol, aspirin, NSAIDs
A history of allergy to which substance is a contraindication to the use of ipratropium/albuterol [Combivent]?
Peanuts (cross-allergy with soy)
Most commonly prescribed medication
Penicillin
penicillin
Penicillin G most commonly Rx'd weakens bacterial cell wall, causing lysis and cell death. Most common drug allergy, but safest available otherwise. For strep, meningitis, syphylis Cross-allergy to all penicillins, cross-sensitive to cephalosporins
The nurse identifies which statements about penicillins as true? (Select all that apply.) Penicillins are the safest antibiotics available. The principal adverse effect of penicillins is allergic reaction. A patient who is allergic to penicillin always has a cross-allergy to cephalosporins. A patient who is allergic to penicillin is also allergic to vancomycin, erythromycin, and clindamycin. Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired.
Penicillins are the safest antibiotics available. The principal adverse effect of penicillins is allergic reaction. Penicillins are normally eliminated rapidly by the kidneys but can accumulate to harmful levels if renal function is severely impaired.
Famotidine
Pepcid HISTAMINE H2 antagonist Treats GASTRIC & duodenal ulcers, heartburn, GERD, aspiration pneumonia, Zollinger-Ellison, mastocytosis Blocks histamine receptors in stomach responsible for acid secretion. increases stomach pH, lowers hydrogen Prolonged effect when given with or just after meals/at bed time Take as directed even if symptoms decrease . Avoid smoking, alcohol, aspirin, NSAIDs. Increases levels of WARFARIN, phenytoin, lidocaine, theophylline
sympathomimetics
Phenylephrine Pseudoephedrine Can cause irritability and anxiety Mimic effects of SNS. Activate alpha receptors on nasal blood vessels - vasoconstriction, causes shrinkage of swollen membranes, followed by nasal drainage. Topical administration - rapid, intense vasoconstriction Oral - delayed/prolonged Rebound congestion develops when topical agents are used more than a few days. With prolonged use, congestion becomes progressively worse. Limit topical use to 3-5 days. Not for chronic rhinitis. Most common ADR: CNS excitation - restlessness, irritability, anxiety, insomnia. Can cause widespread vasoconstriction (more likely with oral agents) - hazardous in HTN or CVD. Due to potential for abuse, some products are being reformulated to phenylephrine instead of pseudoephedrine - not very effective (extensive first pass metabolism) avoid caffeine, do not take at bedtime. Contraindicated for pts with HTN (vasoconstrictor)
A patient is receiving the protease inhibitor (PI) amprenavir [Agenerase]. Which laboratory results would the nurse evaluate as indicators of adverse effects of this medication? (Select all that apply.) Plasma cholesterol level Serum transaminases Cardiac enzymes Blood glucose level Creatinine level
Plasma cholesterol level Serum transaminases Blood glucose level All PIs cause hyperglycemia and diabetes, and patients should be instructed to report symptoms of polydipsia, polyphagia, and polyuria. In addition, PIs can increase serum levels of transaminases and should be used with caution in patients with chronic liver disease. Cholesterol should be measured for elevation caused by the use of PIs that results in a risk of cardiovascular events.
A patient is admitted to the hospital with a medical diagnosis of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). When taking the patient's history, a nurse recognizes which information as the most important? Plays a contact sport and is an athlete Currently resides in a long-term care facility Did not complete the last course of antibiotics Had gallbladder surgery in the previous month
Plays a contact sport and is an athlete CA-MRSA is transmitted by skin-to-skin contact and by contact with contaminated objects, such as sports equipment and personal items. It is seen in young, healthy people without recent exposure to healthcare facilities, which is one of the biggest risk factors for CA-MRSA.
A nurse should associate which factors with the pathophysiology of peptic ulcer disease? (Select all that apply.) Poor submucosal gastric blood flow Presence of Zollinger-Ellison syndrome Reduced stomach production of bicarbonate Increased synthesis of prostaglandins Gastrointestinal (GI) tract colonized with Haemophilus influenzae
Poor submucosal gastric blood flow Presence of Zollinger-Ellison syndrome Reduced stomach production of bicarbonate
patient is receiving amphotericin B. The nurse identifies which medication as useful in preventing adverse effects of amphotericin B? Furosemide [Lasix] Insulin Vitamin K Potassium
Potassium Renal injury from amphotericin B may cause severe hypokalemia. Serum potassium levels should be monitored more frequently and potassium supplements given to correct low plasma levels.
A patient who is receiving an aminoglycoside (gentamicin) has a urinalysis result with all of these findings. Which finding should a nurse associate most clearly with an adverse effect of gentamicin? White blood cells (WBCs) Glucose Ketones Protein
Protein Aminoglycoside-induced nephrotoxicity usually presents as acute tubular necrosis. Symptoms of concern are protein in the urine, dilute urine, and elevation of the serum creatinine and blood urea nitrogen (BUN) levels.
Omeprazole
Proton pump inhibitor Priolosec Most effective for suppressing acid secretion. 1 30 mg oral dose decreases acid by 97% in two hours. Treats gastric/duodenal ulcers, prolonged dyspepsia, GERD, erosive esophagitis, Z-E Inhibits H+/K+/ATPase system in parietal cells to inhibit acid production. 8 week treatment maximum - maintain lowest dose for shortest time possible. Not for prophylaxis. Take orally once daily before breakfast. Contraindicated with rilpirivine, atazanavir, ketoconazle. Can increase levels of warfarin, phenytoin, diazepam. FOOD reduces absorption. Interferes with clopidogrel.
A nurse is assessing the effects of antimicrobial therapy in a patient with pneumonia. The nurse should establish which outcomes when planning care? (Select all that apply.) Potassium level of 4 mEq/dL Reduction of fever Sterile sputum cultures Oxygen saturation of 98% Elastic skin turgor Incorrect
Reduction of fever Sterile sputum cultures Oxygen saturation of 98%
The nurse identifies which statements about frequent urinary tract reinfections as true? (Select all that apply.) Reinfections are considered frequent if the individual has three or more a year. Prophylactic therapy should continue for at least 2 months. If reinfection is associated with sexual intercourse, the risk can be reduced by instructing the patient to void after intercourse. Single-dose nitrofurantoin 50 mg taken 1 hour before intercourse has been found to reduce the rate of reinfection. If a symptomatic episode occurs, the standard therapy for acute cystitis should be used.
Reinfections are considered frequent if the individual has three or more a year. If reinfection is associated with sexual intercourse, the risk can be reduced by instructing the patient to void after intercourse. If a symptomatic episode occurs, the standard therapy for acute cystitis should be used. Prophylactic therapy should continue for at least 6 months. Single-dose trimethoprim/sulfamethoxazole, taken after intercourse, has been found to reduce the risk of reinfection.
Promethazine ADRs
Respiratory depression local tissue injury - extravasation leads to necrosis/gangrene extrapyramidal reactions anticholinergic side effects
A patient has been diagnosed with respiratory syncytial virus. The nurse anticipates administration of which drugs? (Select all that apply.) Ganciclovir Oseltamivir Ribavirin (inhaled) Palivizumab Entecavir
Ribavirin (inhaled) Palivizumab
ondansetron
Serotonin antagonist Zofran For nausea/vomiting due to chemo/radiation or post-op Blocks 5-HT3 serotonin receptors in chemoreceptor trigger zone in the brain and on nerve terminals of afferent vagal nerves to stomach and small intestine. ADRs: serotonin syndrome, torsade de pointes, Stevens Johnson syndrome. Headache, dizziness, constipation, diarrhea For chemo - give IV slowly, over 15 minutes, 30 minutes before chemo treatment, then 4 and 8 hours post. For anesthesia, give one hour before induction, post-op and every eight hours PRN. 1-2 hours before radiation, every 8 hours PRN. Montor for dizziness, avoid driving, ambulate slowly.
Which finding does the nurse expect when assessing a male patient with secondary syphilis? Heart valve and aortic damage Skin lesions and flulike symptoms Red, protruding, painless sore on the penis Thin, watery urethral discharge
Skin lesions and flulike symptoms Two to 6 weeks after emergence of the primary lesion (a chancre, which is a hard, red, protruding, painless sore at the urethra of the penis), secondary syphilis develops. Symptoms of secondary syphilis result from the spread of Treponema pallidum by way of the bloodstream and manifest as skin lesions, along with flulike symptoms and enlarged lymph nodes. Heart valve and aortic damage may develop with tertiary syphilis.
________ indicates complete destruction of all microorganisms
Sterilization
Penicillin treats:
Strep, meningitis, syphillis
ADR: constipation Use caution in patient with swallowing difficulty For active duodenal ulcers
Sucralfate
trimethoprim-sulfamethoxazole
Sulfonamide Potentiative effects Prevents synthesis of FOLIC ACID - interferes with DNA protein synthesis Treats UTI (e.coli), LISTERIA , pertussis, SHIGELLOSIS , p. jirovecii 1st CHOICE for uncomplicated cystitis/recurrent UTI Not for patients with sulfa allergy, on loop/thiazide diuretics, ACE or ARB, infants under two months or pregnant women past 32 weeks - KERNICTERUS (bilirubin deposits in brain)
The nurse should question an order for glucocorticoids in the treatment of a patient with what? Systemic fungal infection Diabetes mellitus Myasthenia gravis Glaucoma
Systemic fungal infection
montelukast dosage instructions
Take once daily in evenings. For EIB, take two hours prior to activity, next dose 24 hours later.
Ciprofloxacin drug interactions
Take six hours before or 2 hours after: Al or Mg-antacids Iron, zinc, sucralfate, calcium (milk/dairy products etc) Toxicity w: theophylline, warfarin, tinidazole (so not metal)
codeine patient advice
Take with food Increase fluid intake OD can be fatal; naloxone can reverse.
To promote treatment adherence in a patient with tuberculosis, the nurse will include which interventions? (Select all that apply.) Use a single medication, to keep the treatment simple. Teach the patient about intermittent-dose therapy. Teach the patient about the need for long-term treatment. Use a signed consent form to enhance patient compliance. Directly watch the patient take the medication.
Teach the patient about intermittent-dose therapy. Teach the patient about the need for long-term treatment. Directly watch the patient take the medication In patients with TB, nonadherence is the most common reason for treatment failure, relapse, and increased medication resistance. Because treatment is necessary for at least 6 months, directly observed therapy (DOT) is a standard of care, as is intermittent dosing. Multiple medication regimens are needed to prevent drug resistance. Education about the length of treatment and the regimen is essential to compliance.
What is the minimum bactericidal concentration (MBC)? The lowest concentration of an antibiotic needed to suppress bacterial growth completely The lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9% The lowest concentration of an antibiotic needed to produce effects The lowest dose of an antibiotic needed to eradicate bacteria
The lowest concentration of an antibiotic needed to reduce the number of bacterial colonies by 99.9%
Which of the following statements about promethazine are true? (Select all that apply.) The preferred route of parenteral dose is intramuscular. The medication should be administered through a largebore IV. The medication should be given by IV push only. The medication should be given in a concentration of 25 mg/mL or less. This medication can cause severe tissue injury.
The preferred route of parenteral dose is intramuscular. The medication should be administered through a largebore IV. The medication should be given in a concentration of 25 mg/mL or less. This medication can cause severe tissue injury.
Tiotropium onset
Therapeutic effects begin in 30 minutes, peak in 3 hours, persist for 24 hours Once daily dosing; plateaus after ~8 days
A patient has received a toxic dose of an antihistamine. It is most important for the nurse to assess the patient for what?
Toxicity associated with antihistamines can produce CNS stimulation, and seizures may result.
Trimethoprim/Sulfamethoxazole treats:
UTI p. jirovecii pertussis shigellosis listeria
Which are examples of the PROPER use of antibiotic therapy? (Select all that apply.) Using surgical drainage as an adjunct to antibiotic therapy Treating a viral infection Basing treatment on sensitivity reports Treating fever in an immunodeficient patient Using dosing that results in a superinfection
Using surgical drainage as an adjunct to antibiotic therapy Basing treatment on sensitivity reports Treating fever in an immunodeficient patient
Isoniazid can cause peripheral neuropathy by depleting what?
Vitamin B6
Pencillin mechanism of action
Weakens cell wall, causing lysis and death (bactericidal)
A nurse administering flu vaccines at an annual clinic should recognize that which individuals should be vaccinated, as recommended by the Advisory Committee on Immunization Practices (ACIP)? (Select all that apply.) Women who will be pregnant during flu season All children 6 months and older and older adults Those who report severe allergy to chicken eggs Those who have a history of Guillain-Barré syndrome Those 6 months to 18 years old receiving aspirin therapy
Women who will be pregnant during flu season All children 6 months and older and older adults Those 6 months to 18 years old receiving aspirin therapy
The nurse is aware that laxatives are contraindicated in patients with which of the following? (Select all that apply.) Abdominal pain Diverticulitis Constipation Bowel obstruction Pregnancy
abdominal pain Diverticulitis Bowel obstruction
tetracycline treats:
acne chlamydia brucella LYME anthrax MYCOPLASMA pneumonia h. PYLORI TYPHUS
Hydrate the client as ordered during and for 2 hr following IV infusion of _____
acyclovir
avoid scratching the application site hydrate by IV after infusion. OTC lotions may interfere with efficacy
acyclovir
loperamide contraindicated conditions
advanced hepatic disease glaucoma
antifungals
amphotericin -azoles -fungins flucytosine
antidiarrheals (mech of action)
anti-infectives and drugs used to correct malabsorption Opioids - most effective. Decrease intestinal motility, slow intestinal transit. Allows more time for absorption of fluid and electrolytes. Decreases secretion of additional fluid into GI tract. Slowing of peristalsis undesired in infectious diarrhea.
amphotericin B
antifungal amphotericin - TERROR on the body. Nephrotoxic. Creatinine over 1.3 = bad kidney. Urine 30 mL or less = kidneys in distress. For most systemic mycoses, cryptococcal meningitis infusion reaction: fever, chills, HA for 1-3 hrs after initiation. Give test dose; pretreat w/ diphenhydramine & acetaminophen Phlebitis is common, rotate sites ADRs: renal damage, hypokalemia. Drug remains in tissues as long as one year post-treatment. Labs: monitor K+ level, kidney labs Highly toxic - reserved for life-threatening infections.
Glucocorticoid for long term management of _____ and acute _____ exacerbation
asthma, COPD
montelukast labs
baseline liver function
montelukast mechanism of action
blocks action of leukotrienes which decreases smooth muscle contractions and inflammation, prevents EDEMA and BRONCHOSPASM
anticholinergic side effects
blurred vision photophobia dry mouth urinary retention tachycardia decreased bowel motility (constipation) increased intraocular pressure forgetfulness/confusion
A patient is taking oral theophylline for maintenance therapy of stable asthma. A nurse instructs the patient to avoid using which substance to prevent a complication?
caffeine
avoid _____ with albuterol
caffeine
Caution for diabetics taking albuterol
can cause hyperglycemia tremor side effect (also side effect of hypoglycemia)
codeine ADRs
can suppress respiration orthostatic hypotension slows CNS constipation sedative
loperamide ADRs
cardiac arrest/arrhythmias drowsiness anticholinergics: dry mouth constipation urinary retention
Notify provider re: _____ when taking albuterol
chest pain high heart rate
Severe ADRs: seizure, ICP, suicidal thoughts, hepatoxicity, anaphylaxis, c diff Drink 1500-2000 mL/day Decrease caffeine use
ciprofloxacin
Drugs contraindicated for MG patients
ciprofloxacin gentamicin glucocorticoids
aminoglycoside mechanism of action
disrupts protein synthesis (bactericidal)
ADR: diarrhea, throat irritation, rash
docusate
Delay bisacodyl one hour following:
drinking milk or taking antacids (can dissolve enteric coating)
Most common tiotropium ADR
dry mouth (anticholinergic)
fluticasone ADRs
dry mucous membranes epistaxis sore throat headache (dries out intranasal area)
Tetracycline
e.g. doxycycline Broad-spectrum Bacteriostatic - suppress growth but don't kill bacteria. Treats acne, typhus, chlamydia, brucella, mycoplasma pneumonia, lyme, anthrax, h. pylori Causes discoloration of developing teeth. Photosensitivity: intense sunburn Fungal overgrowth Do not take with milk or antacids, iron or magnesium supplements. Decreases contraceptive efficacy. Take on empty stomach with 8 oz of water. Remain upright after administration. Rarely first choice drug - increasing resistance.
To minimize risk of Vancomycin, do the following
ensure serum trough levels are drawn monitor serum creatinine levels
Report palpitations/fainting spells, mouth pain with white patches, vaginal discomfort contraindicated for hypokalemia, hypomagnesemia given as eye ointment to neonates
erythromycin
ampicillin
first broad-spectrum penicillin. effective against gram-negative bacteria (increased ability to penetrate gram negative cell envelope) in addition to gram-pos. Most common side effects are rash and diarrhea, which occur more often with ampicillin than any other penicillin.
interferon alfa ADRs
flu-like symptoms (50% of patients) - symptoms diminish with continued treatment neuropsych effects (depression, suicidal thoughts) fatigue, thyroid dysfunction, heart damage, alopecia (interferon - influenza)
Increase_____ with bisacodyl
fluid intake (to prevent dehydration)
Greatest benefit when taken daily (not PRN/acute) for perennial rhinitis. May take 2-3 weeks to take effect
fluticasone
full effect takes 2-3 weeks Use nasal decongestant if nares are blocked. Use humidifier . contraindicated with recent live virus vaccination, systemic fungal infection, candida use caution in patients with diabetes, PUD
fluticasone
ondansetron dosing considerations
for chemo: give IV slowly over 15 minutes, 30 minutes before treatment, then four and eight hours post for anesthesia: give one hour before induction, post-op and every 8 hours PRN
interferon alfa
for chronic HBV, former preferred treatment with ribavirin for HCV blocks viral entry into cells, synthesis of viral mRNA ADR: flu-like syndrome (incidence ~50%). Symptoms diminish with continued therapy Neuropsych effects: depression/suicidal thoughts Fatigue, thyroid dysfunction, heart damage, alopecia
ADR: ataxia contraindicated for pregnancy
gentamicin
________ are used to kill all microorganisms
germicides
Give ____ in combination with a LABA for management of COPD (not adequate alone)
glucocorticoids
QVAR/beclomethasone diproprionate Budesonide Fluticasone (flonase) are all ____
glucocorticoids
azithromycin ADRs / tests to monitor
heptatoxic - liver labs can prolong QT interval - watch ECG
albuterol ADRs
hyperglycemia angina tachycardia heart palpitations tremor (fades over time)
ADR: cardiac arrest, long QT interval, torsades, constipation Patient teaching: suck on hard candy contraindicated for diarrhea due to poisoning, GI bleed use caution with prostatic hypertrophy therapeutic use for decreasing ileostomy effluent
immodium
Expectorants
improve the ability to cough up mucus from the respiratory tract. e.g. guaifenisin, also acetylcysteine (for serious CF-induced mucous, also antidote to acetaminophen overdose)
sucralfate patient advice
increase fluid and fiber intake to reduce constipation report GI bleeding signs Take on an empty stomach, best at bedtime
Slowing of peristalsis undesired in:
infectious diarrhea
Most effective treatment of seasonal/allergic rhinitis
intranasal glucocorticoids
bisacodyl works by:
irritating intestinal mucosa
ADRs: liver failure, peripheral neuropathy monitor for DRESS (fever, rash, lymphadenopathy, facial swelling)
isoniazid
If IM form of _____ contains crystals, warm it to room temperature before using.
isoniazid
Infants/pregnant women not given trimethoprim/sulfamethoxazole due to:
kernicterus (bilirubin deposit in brain)
erythromycin treats:
legionella strep chlamydia diphtheria mycoplasma pneumonia pertussis
montelukast
leukotriene modifier (blocks receptors) Singulair Assists in decreasing inflammation/bronchoconstriction. Normally prescribed as adjunctive therapy. Patient may be able to reduce steroid usage. For treatment of allergic rhinitis, asthma, EIB. Obtain baseline liver function (ALT) Slight risk of suicidal thoughts Once daily dosing in evenings - decreases nocturnal awakenings Available as tablets or oral granules. For EIB usage, take two hours prior to activity with the next dose 24 hours later. SABA is preferred.
trimethoprim/sulfamethoxazole contraindicated meds
loop/thiazide diuretics ACE-i's, ARBs
magnesium sulfate
low-dose therapy indicated for preterm labor. high doses cause hypothermia and paralytic ileus, PE.
erythromycin
macrolide bacteriostatic (bactericidal at high doses) treats: legionella, pertussis, diphtheria, chlamydia, strep, mycoplasma pneumonia CAUSES prolonged QT interval Ototoxic at high doses other side effects: GI upset, rash
contraindicated in breastfeeding
macrolides erythromycin cephalosporins -azole antifungals
Alcohol MUST be avoided during treatment and three days afterward with this drug
metronidazole (Flagyl)
sulfasalazine nursing considerations
monitor stool for intact pills yellow-orange coloring to skin
can cause suicidal ideation, contraindicated for acute asthma exacerbation
montelukast
Promethazine alternatives
most widely used antiemetic in young children despite adverse side effects injury risk lower IM than IV If IV is necessary, infuse through large-bore, free-flowing line at 25 mg/mL or less, at 25 mg/min or less. Safer alternative: ondansetron
ADR: teeth staining in liquid form. Dark urine, pulmonary distress Take with food or milk. Contraindicated for jaundice due to gallbladder disease.
nitrofurontoin
Respiratory symptoms with what drug? Acute: chills/fever, cough, lasts 2 to 4 days Subacute: cough, shortness of breath, lasts weeks to months and may be permanent
nitrofurontoion
patient instructions: take MG supplements. Therapeutic for hypersecretory disorders (i.e. Z-E)
omeprazole
contraindicated with apomorphine (severe hypotension) Monitor for severe diarrhea and dehydration Caution with liver dysfunction, recent abdominal surgery, children under 3
ondansetron
omeprazole onset
one 30 mg dose decreases acid by 97% in two hours
give vanco _____ for c diff
orally
polyethylene glycol
osmotic laxative MiraLax for chronic constipation nonabsorbable compound - retains water in intestinal lumen. Adverse effects: nausea, bloating, cramping, flatulence. High doses may cause diarrhea Dosage: 17 g, once per day, dissolved in 4-8 oz fluid. Effects may take 2-4 DAYS. Combo with electrolyte for bowel cleanse pre-procedure
polyethylene glycol mechanism of action
osmotic laxative nonabsorbable compound - retains water in intestinal lumen
do not use these two drugs in the same port
penicillin and aminoglycoside (gentamicin)
tetracycline ADRs
photosensitivity fungal overgrowth teeth staining
combine _____ with electrolyte solution as a bowel cleanse pre-procedure
polyethylene glycol (osmotic laxative)
_____ should not be taken with potassium-wasting diuretics
prednisone
do not take _____ with live virus vaccine
prednisone (glucocorticoid)
erythromycin ADRs
prolonged QT interval ototoxic at high doses GI upset rash (rate/rash)
sulfasalazine mechanism of action
prostaglandin inhibitor decreases intestinal inflammation immunosuppressive for Crohn's/colitis
Increase ______ with loperamide and avoid ______
replace fluids with electrolyte solution (incl potassium) avoid caffeine (diuretic/increases motility)
________ implies that contamination has been reduced to a level compatible with public health standards.
sanitization
ondansetron mechanism of action
serotonin antagonist. blocks serotonin receptors in CTZ in the brain and on nerve terminals of afferent VAGAL nerves to stomach and small intestine
ondansetron ADRs
serotonin syndrome torsade de pointes stevens-johnson headache, dizziness
senna
stimulant laxative Senokot, Ex-Lax Pink urine Prone to abuse
Bisacodyl
stimulant laxative for constipation due to opioid use, slow motility, pre-procedure. Irritates intestinal mucosa. Delay oral form one hour after drinking MILK or taking ANTACIDS (can dissolve the enteric coating) Increase fluid intake to prevent dehydration Do not give with GI obstruction, fissures, ulcerated hemorrhoids, fecal impaction, proctitis.
docusate
stool softener lower surface tension, allowing water into the feces take with full glass of water
Patient instructions: report fever/take OTC remedies; report rash/joint pain Contraindicated for folate deficiency, anemias, GI obstruction Monitor CBC
sulfasalazine
Amphotericin B treats:
systemic mycoses cryptococcal meningitis
Do not take ____ with milk, antacids, iron, magnesium
tetracycline
Expired drug can cause kidney infection. Do not give to children under 8. counterindicated for pregnancy, liver failure broad spectrum: syphilis, tetanus, cholera, anthrax
tetracycline
Alternative for penicillin allergies
tetracyclines quinolones aminoglycosides
ADRs of inhaled glucocorticoids
thrush, hoarseness (rinse mouth and use spacer)
Ciprofloxicin is given for:
travelers diarrhea severe infections (non-Staph)
give at least 1200-1500 mL of water per day. contraindicated for pregnant women, pharyngitis caused by GABHS, hyperkalemia, impaired creatinine clearance Monitor CBCs, urinalysis Therapeutic for chronic bronchitis, acute ear infections in children
trimethoprim-sulfamethoxazole
fluticasone nursing considerations
use humidifier pre-treat with decongestant if needed
Most widely used antibiotic in hospitals - for severe infection
vancomycin
Famotidine increases levels of:
warfarin phenytoin lidocaine theophylline
clindamycin
Bacteriostatic inhibitor of protein synthesis Effective on most anaerobic bacteria, and gram-positive aerobes. (Group A strep) ANTAGONIZES effects of erythromycin Used as alternative to penicillin, severe strep infection, topical for bacterial vaginosis POOR penetration to CSF/ does not cross BBB ADR: C diff
Clindamycin mechanism of action
Bacteriostatic. Inhibit protein synthesis.
albuterol mechanism of action
Beta2 adrenergic agonist. Acts in sympathetic nervous system, selectively active in bronchial smooth muscle
albuterol
Beta2-adrenergic agonist Acts in SNS with selective activation in BSM Bronchodilator - do not use more than 1/2x per week. Typically PRN as quick relief agent ADR: hyperglycemia, angina, tachycardia, heart palpitations, tremor (fades over time) Overdose can cause seizure Take prior to glutocorticoid (dilation effect first) Take immediately before exertion as EIB prophylactic Avoid caffeine Caution in patients with diabetes as tremor side effect also occurs during hypoglycemia Notify provider of chest pain, high heart rate.
When providing patient teaching for oral sulfonamide therapy, the nurse should instruct the patient to take the sulfonamide in what way? At mealtime, when food is available With soy or nonmilk products Between meals with a full cup of water On awakening before breakfast
Between meals with a full cup of water Oral sulfonamides should be taken on an empty stomach and with a full glass of water. To minimize the risk of renal damage, adults should maintain a daily urine output of 1200 mL.
Clindamycin ADR
C. diff
A nurse should recognize that which laboratory result is used as a major factor in deciding when antiretroviral therapy is indicated for a patient infected with HIV? Plasma HIV RNA assay CD4 T-lymphocyte count Western blot assay OraQuick Rapid HIV-1 Antibody Test
CD4 T-lymphocyte count The CD4 T-cell count is the principal indicator of how much immunocompetence remains when a patient is infected with HIV. It is used as a guide in the initiation, discontinuation, and resumption of medications for opportunistic infections.
ADR of sympathomimetics
CNS excitation - irritability, anxiety, restlessness, insomnia
Tiotropium treats:
COPD (off label for asthma)
A patient who is receiving an aminoglycoside develops flaccid paralysis and impaired breathing. Which medication does the nurse anticipate administering? Magnesium sulfate [Epsom salt] Potassium chloride [K-Dur] Sodium bicarbonate [Citrocarbonate] Calcium gluconate [Kalcinate]
Calcium gluconate Flaccid paralysis and impaired breathing are signs of impaired neuromuscular transmission, which may occur with aminoglycosides, especially if they are administered concurrently with a neuromuscular blocking agent.
The nurse identifies appropriate use of antimicrobials to prevent infection in which situations? (Select all that apply.) Cardiac surgery Recurrent urinary tract infections in women Anemia Treatment of fever of unknown origin Hysterectomy
Cardiac surgery Recurrent urinary tract infections in women Hysterectomy
A nurse instills 1% silver nitrate topically into the eyes of a neonate on delivery to prevent conjunctivitis caused by what? (Select all that apply.) Chlamydia spp. Gonorrhea Syphilis Bacterial vaginosis Herpes simplex type 2
Chlamydia spp. Gonorrhea Neonatal gonococcal infection is acquired through contact with infected cervical exudates during delivery and can cause blindness. A topical antibiotic should be instilled into both eyes after delivery. Infants born to women with a cervical chlamydial infection can acquire the infection during the birth process. These infants are at risk for conjunctivitis and pneumonia.
Which antiseptics should a nurse choose to prepare intact skin before an invasive procedure? (Select all that apply.) Chlorhexidine gluconate [Hibiclens] Ethanol (ethyl alcohol) Hydrogen peroxide Povidone-iodine [Betadine] Hexachlorophene
Chlorhexidine gluconate [Hibiclens] Ethanol (ethyl alcohol) Povidone-iodine [Betadine] Hydrogen peroxide and hexachlorophene can be caustic, causing burns of the skin or mucous membranes
The nurse identifies which host factor as the most important when choosing an antimicrobial drug? Age Competent immune function Genetic heritage Previous medication reactions
Competent immune function Only host defenses and site of infection are unique to antimicrobial choice
Omeprazole drug contraindications
Contraindicated with: rilpirivine atazonavir ketaconazole Increases levels of: warfarin phenytoin diazepam Interferes with clopidogrel (no prilosec & plavix)
