Regis University (Pharmacology I, Exam 4) Anti-infective, Anti-inflammatory, Anti-rheumatic and pain management

What is cyclooxygenase?

Also known as prostaglandin G/H synthase, it's the first prostaglandin synthetic pathway

What labs should you monitor with aminoglycosides?

BUN Creat Urine output

Indications for Sulfonamides?

Bacteriostatic with wide range of coverage against gram-positive and gram-negative bacteria. Stops growth by inhibiting folate.

How do antivirals work?

*Do not cure patients of the virus. Used to relieve symptoms and decrease recurrence rate

How does metronidazole (flagyl) work and what is a possible side effect?

*Dual activity against bacteria and parasites *May cause dark or reddish brown discoloration of urine

Name 2 basic types of Antibiotics

1. Bacteriostatic drugs Inhibit growth of bacteria. 2. Bactericidal drugs Kill bacteria.

A nurse prepares to reinforce instructions to a client who is taking allopurinol (Zyloprim). The nurse plans to include which of the following in the instructions? 1. Instruct the client to drink 3000 mL of fluid per day. 2. Instruct the client to take the medication on an empty stomach. 3. Inform the client that the effect of the medication will occur immediately. 4. Instruct the client that, if swelling of the lips occurs, this is a normal expected response.

1. Instruct the client to drink 3000 mL of fluid per day. Rationale: Allopurinol (Zyloprim) is an antigout medication used to decrease uric acid levels. Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with or immediately following meals or milk to prevent gastrointestinal irritation. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or she should contact the health care provider because this may indicate hypersensitivity.

What should you educate you pt's on who are taking tetracyclines?

1. Not to eat dairy, antacids, tums or vitamins containing iron because these interact and block the absorption of the drug. 2. Use SUN BLOCK due to incr. photosensitivity.

A client with human immunodeficiency virus is taking nevirapine (Viramune). The nurse should monitor for which adverse effects of the medication? Select all that apply. 1. Rash 2. Hepatotoxicity 3. Hyperglycemia 4. Peripheral neuropathy 5. Reduced bone mineral density

1. Rash 2. Hepatotoxicity Rationale: Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitors (NRTI) that is used to treat HIV infection. It is used in combination with other antiretroviral medications to treat HIV. Adverse effects include rash, Stevens-Johnson syndrome, hepatitis, and increased transaminase levels. Hyperglycemia, peripheral neuropathy, and reduced bone density are not adverse effects of this medication.

Teaching for a patient redceiving a prescription for ciprofloxacin (Cipro) should include (Select all that apply): 1. Report unusual heel, lower leg or calf pain or difficulty walking. 2. Avoid taking the medicine with milk products and antacids. 3. Limit vitamin C, both dietary and oral vitamin forms. 4. Take her pill with an antihistamine to avoid side effects

1. Report unusual heel, lower leg or calf pain or difficulty walking. 2. Avoid taking the medicine with milk products and antacids

In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses? Select all that apply. 1. Symptom control during periods of emotional stress 2. Normal white blood cell counts, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy 5. Inflammation and irritation at the injection site 3 days after injection is given 6. A low-grade temperature upon rising in the morning that remains throughout the day

1. Symptom control during periods of emotional stress 2. Normal white blood cell counts, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy Rationale: Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection.

A client is admitted to the hospital with complaints of back spasms. The client states, "I have been taking two or three aspirin every 4 hours for the past week and it hasn't helped my back." Aspirin intoxication is suspected. Which of the following complaints would indicate aspirin intoxication? 1. Tinnitus 2. Constipation 3. Photosensitivity 4. Abdominal cramps

1. Tinnitus Rationale: Mild intoxication with acetylsalicylic acid (aspirin) is called salicylism and is commonly experienced when the daily dosage is higher than 4 g. Tinnitus (ringing in the ears) is the most frequently occurring effect noted with intoxication. Hyperventilation may occur because salicylate stimulates the respiratory center. Fever may result because salicylate interferes with the metabolic pathways involved with oxygen consumption and heat production. Options 2, 3, and 4 are incorrect.

Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations

1. Tinnitus Rationale: Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism

Ibuprofen (Advil) is prescribed for a client. The nurse tells the client to take the medication: 1. With 8 oz of milk 2. In the morning after arising 3. 60 minutes before breakfast 4. At bedtime on an empty stomach

1. With 8 oz of milk Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be given with milk or food to prevent gastrointestinal irritation. Options 2, 3, and 4 are incorrect.

A client with rheumatoid arthritis is taking acetylsalicylic acid (aspirin) on a daily basis. Which medication dose should the nurse expect the client to be taking? 1. 1 g daily 2. 4 g daily 3. 325 mg daily 4. 1000 mg daily

2. 4 g daily Rationale: Aspirin may be used to treat the client with rheumatoid arthritis. It may also be used to reduce the risk of recurrent transient ischemic attack (TIA) or brain attack (stroke) or reduce the risk of myocardial infarction (MI) in clients with unstable angina or a history of a previous MI. The normal dose for clients being treated with aspirin to decrease thrombosis and MI is 300 to 325 mg/day. Clients being treated to prevent TIAs are usually prescribed 1.3 g/day in two to four divided doses. Clients with rheumatoid arthritis are treated with 3.6 to 5.4 g/day in divided doses. *Eliminate options 1 and 4 because they are alike*

When should Colchicine be discontinued?

If GI symptoms develop

A nurse is caring for a client with severe back pain, and codeine sulfate has been prescribed for the client. Which of the following would the nurse include in the plan of care while the client is taking this medication? 1. Restrict fluid intake. 2. Monitor bowel activity. 3. Monitor for hypertension. 4. Monitor peripheral pulses.

2. Monitor bowel activity. Rationale: While the client is taking codeine sulfate, an opioid analgesic, the nurse would monitor vital signs and monitor for hypotension. The nurse should also increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency (codeine can cause constipation). The nurse should monitor respiratory status and initiate breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication

A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of the following should be included in the list of instructions? 1. Restrict fluid intake. 2. Maintain a high fluid intake. 3. If the urine turns dark brown, call the health care provider (HCP) immediately. 4. Decrease the dosage when symptoms are improving to prevent an allergic response.

2. Maintain a high fluid intake. Rationale: Each dose of sulfisoxazole should be administered with a full glass of water, and the client should maintain a high fluid intake. The medication is more soluble in alkaline urine. The client should not be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause urine to turn dark brown or red. This does not indicate the need to notify the HCP.

A client has been taking isoniazid (INH) for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing: 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation

2. Peripheral neuritis Rationale: A common side effect of the TB drug INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are incorrect.

Colcrys (colchicine) is prescribed for a client with a diagnosis of gout. The nurse reviews the client's medical history in the health record, knowing that the medication would be contraindicated in which disorder? 1. Myxedema 2. Renal failure 3. Hypothyroidism 4. Diabetes mellitus

2. Renal failure Rationale: Colchicine is contraindicated in clients with severe gastrointestinal, renal, hepatic or cardiac disorders, or with blood dyscrasias. Clients with impaired renal function may exhibit myopathy and neuropathy manifested as generalized weakness. This medication should be used with caution in clients with impaired hepatic function, older clients, and debilitated clients. *Note that options 1, 3, and 4 are all endocrine-related disorders: Myxedema=Hypothyroidism*

What are Sulfonamides used to treat?

UTI OM Bronchitis Malaria UC Chlamydia Norcardosis GC Enterobacter Pseudomonas

Nitrofurantoin (Macrobid, Furadantin) is used for what?

UTI's Uncomplicated, acute UTI's and symptomatic bacteriuria during pregnancy

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen? 1. "My ulcer will heal because these medications will kill the bacteria." 2. "These medications are only taken when I have pain from my ulcer." 3. "The medications will kill the bacteria and stop the acid production." 4. "These medications will coat the ulcer and decrease the acid production in my stomach."

3. "The medications will kill the bacteria and stop the acid production." Rationale: Triple therapy for Helicobacter pylori infection usually includes two antibacterial drugs and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production

A health care provider instructs a client with rheumatoid arthritis to take ibuprofen (Motrin). The nurse reinforces the instructions, knowing that the normal adult dose for this client is which of the following? 1. 100 mg orally twice a day 2. 200 mg orally twice a day 3. 400 mg orally three times a day 4. 1000 mg orally four times a day

3. 400 mg orally three times a day Rationale: For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose is 400 to 800 mg three or four times daily

Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin neutral protamine Hagedorn (NPH) insulin daily. Which of the following prescription changes does the nurse anticipate during therapy with the prednisone? 1. An additional dose of prednisone daily 2. A decreased amount of daily Humulin NPH insulin 3. An increased amount of daily Humulin NPH insulin 4. The addition of an oral hypoglycemic medication daily

3. An increased amount of daily Humulin NPH insulin Rationale: Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. Therefore the other options are incorrect.

A postoperative client has received a dose of naloxone hydrochloride for respiratory depression shortly after transfer to the nursing unit from the postanesthesia care unit. After administration of the medication, the nurse checks the client for: 1. Pupillary changes 2. Scattered lung wheezes 3. Sudden increase in pain 4. Sudden episodes of diarrhea

3. Sudden increase in pain Rationale: Naloxone hydrochloride is an antidote to opioids and may also be given to the postoperative client to treat respiratory depression. When given to the postoperative client for respiratory depression, it may also reverse the effects of analgesics. Therefore, the nurse must check the client for a sudden increase in the level of pain experienced. Options 1, 2, and 4 are not associated with this medication

A nurse reinforces discharge instructions to a postoperative client who is taking warfarin sodium (Coumadin). Which statement, if made by the client, reflects the need for further teaching? 1. "I will take my pills every day at the same time." 2. "I will be certain to avoid alcohol consumption." 3. "I have already called my family to pick up a Medic-Alert bracelet." 4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."

4. "I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated." Rationale: Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

A client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken on a frequent daily basis for relief of generalized discomfort. The nurse reviews the client's laboratory results and determines that which of the following indicates toxicity associated with the medication? 1. Sodium of 140 mEq/L 2. Prothrombin time of 12 seconds 3. Platelet count of 400,000 cells/mm3 4. A direct bilirubin level of 2 mg/dL

4. A direct bilirubin level of 2 mg/dL Rationale: In adults, overdose of acetaminophen (Tylenol) causes liver damage. Option 4 is an indicator of liver function and is the only option that indicates an abnormal laboratory value. The normal direct bilirubin is 0 to 0.4 mg/dL. The normal platelet count is 150,000 to 400,000 cells/mm3. The normal prothrombin time is 10 to 13 seconds. The normal sodium level is 135 to 145 mEq/L.

Should PCN be taken with or without food?

All PCN should be taken on an empty stomach. Amoxicillin absorption has no regard for meals

A nurse notes that a client is receiving lamivudine (Epivir). The nurse determines that this medication has been prescribed to treat which of the following? 1. Pancreatitis 2. Pharyngitis 3. Tonic-clonic seizures 4. Human immunodeficiency virus (HIV) infection

4. Human immunodeficiency virus (HIV) infection Rationale: Lamivudine is a nucleoside reverse transcriptase inhibitor and antiviral medication. It slows HIV replication and reduces the progression of HIV infection. It also is used to treat chronic hepatitis B and is used for prophylaxis in health care workers at risk of acquiring HIV after occupational exposure to the virus. *Note the letters "-vir" in the trade name for this medication*

A nurse is assisting in preparing to administer acetylcysteine (Mucomyst) to a client with an overdose of acetaminophen (Tylenol). The nurse prepares to administer the medication by: 1. Administering the medication subcutaneously in the deltoid muscle 2. Administering the medication by the intramuscular route in the gluteal muscle 3. Administering the medication by the intramuscular route, mixed in 10 mL of normal saline 4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw

4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw Rationale: Because acetylcysteine has a pervasive odor of rotten eggs, it must be disguised in a flavored ice drink. It is consumed preferably through a straw to minimize contact with the mouth. It is not administered by the intramuscular or subcutaneous route. *Knowing that the medication is a solution that is also used for nebulization treatments will assist you to select the option that indicates an oral route*

Phenazopyridine hydrochloride (Pyridium) is prescribed for a client for symptomatic relief of pain resulting from a lower urinary tract infection. The nurse reinforces to the client: 1. To take the medication at bedtime 2. To take the medication before meals 3. To discontinue the medication if a headache occurs 4. That a reddish orange discoloration of the urine may occur

4. That a reddish orange discoloration of the urine may occur Rationale: The nurse should instruct the client that a reddish-orange discoloration of urine may occur. The nurse also should instruct the client that this discoloration can stain fabric. The medication should be taken after meals to reduce the possibility of gastrointestinal upset. A headache is an occasional side effect of the medication and does not warrant discontinuation of the medication

Meperidine hydrochloride (Demerol) is prescribed for the client with pain. Which of the following would the nurse monitor for as a side effect of this medication? 1. Diarrhea 2. Bradycardia 3. Hypertension 4. Urinary retention

4. Urinary retention Rationale: Meperidine hydrochloride (Demerol) is an opioid analgesic. Side effects of this medication include respiratory depression, orthostatic hypotension, tachycardia, drowsiness and mental clouding, constipation, and urinary retention.

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? A) Naloxone (Narcan) B) Acetylcysteine (Mucomyst) C) Methylprednisolone (Solu-Medrol) D) Protamine sulfate

A) Naloxone (Narcan) Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

Superinfection

AKA secondary infection. Emergence of microorganism growth when natural protective flora are destroyed by an anti infective drug.

Nursing Implications of Antibiotics regarding cultures.

ALWAYS get a culture done BEFORE beginning antibiotic therapy!

Name an Antiviral, used with AIDS S/E: Anemia, paresthesias, agranulocytosis Teach pts to strictly comply with dosing schedule

AZT

What decreases the effectiveness of Amoxicillin and Dicloxacillin?

Acidic fruits or juices

Name a Antiviral S/E: Headache, seizures, diarrhea Slows progression of symptoms, does not prevent transmission, check LFTs and renal test

Acyclovir

Aminoglycosides are primarily used to treat?

Aerobic gram negative infections

Gentamicin Tobramycin Amikacin Are what TYPE of antiinfective agent?

Aminoglycosides

What medication would you prescribe to a pt with valve disease prior to a dental procedure as a prophylaxis?

Amoxicillin!!

Describe the unique analgesic/anti-inflammatory efficacy of ketorolac (Toradol):

Analgesic w/ minimum anti-inflammatory effects. As an analgesic it's as effective as morphine without respiratory depression, tolerance, dependence and abuse.

Which teaching has highest priority for the client taking azithromycin (Zithromax)? A. Instruct the client to use sunblock and protective clothing during sun exposure. B. Instruct the client to store the drug out of light and extreme heat. C. Inform parents that children younger than 8 years should not take the drug, to avoid teeth discoloration. D. Instruct the client to report any loose stools or diarrhea

Answer: D. Rationale: The client should be instructed to report loose stools or diarrhea because of possible pseudomembranous colitis.

What is the most noteable adverse effect of Clindamycin (Cleocin)?

Antibiotic associated diarrhea and pseudomembranous colitis. Broad spectrum antibiotics alters the normal colonic flora to allow overgrowth of C. Difficile= badness!! Drug usually stopped. Candida- a superinfection is also common with clindamycin.

Use of Opioid Antagonists such as Naloxone (Narcan)

Antidote for opiate overdoses; Reverse effects of opiates, including respiratory depression, sedation, hypotension; Respiratory distress, respiratory depression.

Nursing Interventions - Cephalosporins

Assess for allergy; perform C&S before therapy; assess renal and liver function; administer IV over 30 min b.i.d.-q.i.d.; monitor for superinfection; keep out of reach of children

Cautions with COX 2 Inhibitors

Avoid during third trimester of pregnancy.

What pregnancy category is Azithromycin (Zithromax)?

B

Clindamycin (Cleocin) is a __________ spectrum antibiotic?

Broad spectrum

Doxycycline (Vibramycin) is a _________ spectrum antibiotic.

Broad spectrum

Levofloxacin (Levaquin) is a ________ spectrum antibiotic.

Broad spectrum

Nitrofurantoin (Macrobid, Furadantin) is a _________ specturm antibiotic?

Broad spectrum

Trimethroprim-sulfamethoxalazole(TMP/SMX, Septra) is a _________ spectrum antibiotic?

Broad spectrum

Caffeine/ergotamine aka

Cafergot

Name a COX 2 inhibitor and what type of drug is it?

Celecoxib (Celebrex), an NSAID

Only COX 2 inhibitor drug

Celecoxib (Celebrex).

Name 2 Cephalosporins S/E: Incr risk of bleeding, superinfections, thrombophlebitis IV Take with food, avoid alcohol, CROSS ALLERGY: penicillins

Cephalexin, Ceftriaxone

Penicillin allergies cross over with what other antibiotic class?

Cephalosporins 5-10% of pts allergic to PCN are also allergic to cephalosporins

What is the most commonly used antibiotic class?

Cephlasporins

Tetracyclines - Nursing Interventions

Check C&S before drug therapy; administer 1 hr BEFORE or 2 hrs AFTER meals; monitor KIDNEY & LIVER function; store out of LIGHT and extreme HEAT; USE SUNBLOCK!; teach client to report superinfection; warn client to avoid milk, iron & antacid; use effective oral hygiene

Macrolides: Nursing Interventions

Check C&S before therapy, monitor liver enzymes, advise client to take full regimen, administer antacids 2 hr BEFORE or 2 hrs AFTER macrolides; give azithromycin 1 hr BEFORE or 2 hrs AFTER meals with FULL flass of water

Name 2 Fluoroquinolones S/E: Superinfections, hepatotoxicity Take on empty stomach, monitor liver function

Ciprofloxacin, Levofloxacin

HAART

Highly active antiretroviral thearpy involves drug combinations used to fight HIV and AIDS. Combinations and order in which they are given influence effectiveness. 3 or more drugs from at least 2 different classes fight HIV at different stages of replication.

Where is the cyclooxygenase-1 (COX-1) form located, and what normal functions does it serve?

Constitutively in most tissues, makes PGs that regulate physiologic processes "house keeping chores". Important for: platelets, gastric mucosa, kidneys, vascular endothelium

In a Culture and Sensitivity test, What does the culture tell us? AND what does the Sensitivity tell us?

Culture = What the organism is we are treating. Sensitivity = What antibiotic is going to be effective.

A patient has been prescribed tetracycline. When providing information regarding this drug, the nurse would be correct in stating that tetracycline A. Is classified as a narrow-spectrum antibiotic and only treats a few infections B. Is used to treat a wide variety of disease processes C. Has been identified to be safe during pregnancy D. Is contraindicated in children younger than 8 years

D. Is contraindicated in children younger than 8 years

A client w/ a history of migraine headaches arrives at the ER w/ a severe headache. In additon to an analgesic, the nurse is most likely to administer which drug? 1) Verapamil HCL (Isoptin) 2) Propranolol (Inderal) 3) Ergotamine tartrate (Ergomar) 4) Phenytoin (Dilantin)

Ergotamine tartrate (Ergomar). Ergotamine is used to abort migrane headaches. It is not recommended for prophylaxis b/c of side effects such as gangrene of the nose, seizures, nausea/vomiting and many others (3). Calcium channel blockers become effective several weeks after the therapy begins (1). Beta blockers are used prophylactically (2). Phenytoin is an antiepileptic drug that is not used to treat migraine headaches (4

Indicated for the termination of migraine headaches when the Triptans are ineffective.

Ergots

Name 3 Macrolide Antibiotics.

Erythromycin, Azithromycin and Clarithromycin

A client is taking piperacillin-tazobactam (Zosyn). What nursing interventions are most appropriate for this drug?

Extended-spectrum penicillin is not givin with an aminoglycoside as it may inactivate the aminoglycoside. Always perform a C&S PRIOR to giving antibiotic, client should take ENTIRE course of drugs prescribed to avoid drug resistance, clients should INCREASE fluid intake, symptoms of superinfection should always be monitored for all antibiotics.

What should you educate your pt on who is taking a PCN? (2)

FINISH ENTIRE COURSE OF TREATMENT!! If a female pt: warn that PCN will decrease effectiviness of oral contraceptives!

Side effects/adverse reactions to Macrolides. Examples:Erythromycin (E-Mycin), Clarithromycin (Biaxin, Biaxin XL), Azithromycin (Zithromax).

GI distress, tinnitus, Superinfection, Ototoxicity, hepatotoxicity.

Side effects/adverse effects of Fluoroquinolones (Quinolones)

GI upset, rash, urticaria, tinnitus, photosensitivity. Superinfection. Hematuria, crystalluria. Psudomembranous colitis

NSAIDs: Side Effects

GI upsets, dizziness, HA, bleeding, fluid retention

Name 2 Aminoglycosides S/E: Ototoxicity, nephrotoxicity Encourage fluids, small frequent meals

Gentamicin, Neomycin

Explain Gout What is Gout caused by? Explain what happens with gout? What is the goal in treating gout?

Gout is caused by overproduction or decreased excretion of uric acid. Crystals deposit into tissues and joint causing pain. Goal is to decrease symptoms/ prevent recurrence.

Caffeine/ergotamine side effects

Headache; tremors, convulsions; blood vessel contraction, with decreased circulation, esp. in limbs; toxic erotism: N/V, diarrhea, dizzines headache, mental confusion

Adverse effect of Macrolides on the body? what should be avoided?

Hepatotoxicity Avoid Acetaminophens and alcohol

Nursing interventions with Sulfonamides (7)

Increase fluid intake Monitor renal function CBC Monitor for rash Superinfection Avoid during third trimester Avoid antacids.

What is the cyclooxygenase-2 (COX-2) form located, and what normal functions does it serve?

Induced at sites of tissue injury, mediates inflammation. Synthesize PGs that mediate inflammation, pain, and fever, constantly (constitutive) expressed in the brain and kidney

NSAIDs: Action

Inhibit prostagladin sysnthesis, Uses: arthritis, mild to moderate pain, fever

A client has developed active tuberculosis and is prescribed isoniazid and rifampin. Which should the nurse include in teaching the client about taking this drug?

Isoniazid should be given 1 hr BEFORE or 2 hr AFTER for better absorption. Periodic eye exams should be done as these drugs may cause visual disturbances. Compliance with drug regimen is essential to prevent drug resistance. Numbness, tingling, or burning of hands and feet should be reported. Rifampin may turn body fluids a harmless red-orange color.

What should you monitor with all antivirals?

LFT Kidneys- BUN, creat

Describe the benefits of celecoxib (Celebrex) compared to non-selective NSAIDs:

Less GI side effects

Vancomycin (Vancocin)- Clinical Uses

MRSA, serious infections G+ in beta-lactam allergic pts, MDR strains, endocarditis, or surgical prophylaxia in PCN allergy or cardiac surgery. Oral vanco for refractory C-diff (otherwise Flagyl is best for c-diff).

What is the most frequently used ABX if a patient has an allergy to PCN?

Macrolides

Erythromycin (E-mycin), Azithromycin (Zithromax), & Clarithromycin (Biaxin) are all what drug class?

Macrolides (protein synthesis inhibitors)

The nurse recognizes that opioid analgesics exert their action by interacting with a variety of opioid receptors. Drugs such as morphine act by activating:

Mu and kappa

Aminoglycosides are _________ spectrum antibiotics.

Narrow spectrum

What adverse effects should you look out for when giving aminoglycosides?

Nephrotoxicity & Ototoxicity

What drugs would you consider for first line treatment of uncomplicated UTIs?

Nitrofurantoin (Macrobid, Furadantin) or Septra

Beta-Lactam Antibiotic?

Penicillin

Allopurinol (Zyloprim) is used to:

Prevent uric acid production (usually to prevent recurrence of a gout attack)

What would you consider for a complicated UTI?

Quinolones (such as Levaquin)

Colchicine is used to:

Reduces inflammatory response of joints (most common, used for acute attack)

Antigout Drug - Colchicine - Contraindications

Severe renal, cardiac or GI problem - AVOID alcohol & caffeine

What should you educate your pt on who is taking Acyclovir (Zovirax)?

Stay hydrated because the drug can crystallize in the kidney

Often prescribed for the treatment of UTIs

Sulfonamides

Antitubercular Drugs - Nursing Interventions

Take INH 1 hr BEFORE meals or 2 hrs AFTER meals; must follow complete regimen, collect sputum early in am; take pyridoxine (Vit B6) to prevent peripheral neuropathy; check liver enzymes, CBC; need frequent eye examinations; report numbness, tingling (paresthesia), burning; use SUNBLOCK; avoid antacids

NSAIDs: Nursing Interventions

Take with food or after meals, monitor liver and renal function, use cautiously w/ ASA allergy, check for bleeding

The nurse realizes that the component of client goals for HAART therapy includes all of the following except:

The CD4+ count is as low as possible. Included client goals are: the viral load is undetectable, secondary infection does not occur and medication regimen is adhered to

What is the goal for drug therapy for gout?

To decrease symptoms/ prevent recurrence.

Caffeine/ergotamine Nursing considerations

Treatment of vascular headache; take at onset of pain/during prodromal stage to abort headache; lie down in darkened quiet room for several hours; Rx; Preg Cat X

Indicated for the treatment of migraine headaches and cluster headaches.

Triptans

How do Tetracyclines affect your teeth & bones?

Use during last half of preg- 8 yo may cause permanent discoloration (yellow, brown) teeth. Tetracyclines form a stable calcium complex in any bone-forming tissue. Dec fiula growth rate in premature infants when given the drug.

When is Clindamycin (Cleocin) indicated?

Uses: infections of the bone, skin, joints, resp tract, and abdomen

Common Signs of Superinfection

Vaginal itching Diarrhea Change in cough or sputum White plaques in mouth

A client is admitted to the hospital with an acute gout attack. The nurse expects that which medication will be ordered to treat acute gout? a. colchicine b. allopurinol c. probenecid d. sulfinpyrazone

a. colchicine

Amoxicillin (Amoxil) is prescribed for a client who has a respiratory infection. The nurse is teaching the client about this medication and realizes that more teaching is needed when the client makes which statement? a."I should not take my medication with food." b."I will take my entire prescription of medication." c."I should report to the physician any genital itching." d."I should report to the health care provider any excess bleeding."

a."I should not take my medication with food."

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. b.) The dose of naloxone was inadequate. c.) The client is resistant to this drug. d.) The drug overdose is irreversible.

a.) The client did not use an opioid drug. If opioid antagonists (Naloxone) fail to reverse symptoms of respiratory depression quickly, the overdose was likely due to a non-opioid substance

Penicillin G (Pentids) has been prescribed for a client. Which nursing intervention(s) should the nurse include for this client? (Select all that apply.) a.Collect C & S prior to first dose. b.Monitor client for mouth ulcers. c.Instruct client to limit fluid intake to 1000 mL/day. d.Have epinephrine on hand for a potential severe allergic reaction.

a.Collect C & S prior to first dose. b.Monitor client for mouth ulcers. d.Have epinephrine on hand for a potential severe allergic reaction

A client is beginning isoniazid and rifampin treatment for tuberculosis. The nurse gives the client which instruction? a.Do not skip doses. b.Take the drugs t.i.d. with food. c.Take an antacid with the drugs to decrease GI distress. d.Take rifampin initially, and then begin isoniazid after 2 months.

a.Do not skip doses.

A client has been prescribed HAART therapy following a laboratory test that indicated an increasing viral load. The client reports that he's glad to have a choice of medications from which to choose so he will have an easier time with daily medications. What should the nurse's response include? a.Education about the importance of using multiple medications concurrently b.Written information about the scheduling of his medications with meals c.Support and encouragement for the client's readiness for treatment d.Guidelines for follow-up laboratory monitoring and clinic appointments

a.Education about the importance of using multiple medications concurrently

Sulfasalazine (Azulfidine) has been ordered for a client. The nurse knows that this drug is most effective against which organisms? a.Escherichia coli and Clostridium b.Neisseria gonorrhoeae and H. Influenzae c.Pseudomonas aeruginosa and Helicobacter pylori d.Enterococcus faecium and Staphylococcus aureus

a.Escherichia coli and Clostridium

The nurse is administering tetracycline (Vibramycin) to a client. Which would be appropriate teaching? a.Take sunscreen precautions when at the beach. b.Take an antacid or milk with the drug to prevent severe GI distress. c.Obtain frequent hearing tests for early detection of hearing loss. d.Obtain frequent eye checkups for early detection of retinal damage.

a.Take sunscreen precautions when at the beach.

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

A client taking isoniazid is worried about the side effects/adverse reactions. The nurse realizes that which is a common adverse reaction of isoniazid? a.Ototoxicity b.Hepatotoxicity c.Nephrotoxicity d.Optic nerve toxicity

b.Hepatotoxicity

The nurse enters a client's room to find that his heart rate is 120, his BP is 70/50, and he is flushed. Vancomycin (Vancocin) is running IVPB. The nurse interprets this as a severe adverse effect of "red man syndrome." What should the nurse do? a.Stop the infusion and call the laboratory. b.Reduce the infusion to 10 mg/min. c.Encourage the client to drink more oral fluids up to 2 L/day. d.Report to health care provider the onset of Stevens-Johnson syndrome.

b.Reduce the infusion to 10 mg/min

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? a.) Muscle relaxant b.) Acetaminophen c.) Narcotic analgesics d.) Ice packs

c.) Narcotic analgesics Injury to tissues produces nociceptor pain, which usually responds to conventional analgesic pain medications such as opiates or NSAIDS.

The client admitted with hepatitis B is prescribed Vicodin tabs 2 for treatment of pain. The appropriate nursing action is to: a.) Administer the drug as ordered. b.) Administer one tablet only. c.) Question the physician about the order. d.) Hold the drug until the physician arrives.

c.) Question the physician about the order. Vicodin is a combination drug of hydrocodone and acetaminophen. Acetaminophen can be hepatotoxic, and is contraindicated in liver disease

Celecoxib (Celebrex) is added to the treatment regimen of a client with arthritis. The nurse explains that the major advantage of this drug is: a.) The drug is less expensive. b.) The drug has no known side effects. c.) The drug has anti-inflammatory properties. d.) The drug's effectiveness is the same as opioids.

c.) The drug has anti-inflammatory properties. Celecoxib (Celebrex) has anti-inflammatory properties. It is not less expensive, has many side effects, and is less potent than opioids.

The nurse is teaching a client about sulfadiazine (Microsulfon). Which directive should the nurse include in the teaching? a.Avoid caffeine during sulfonamide treatment. b.Administer in 50 mL of fluid over 30 minutes. c.Avoid sulfonamides during the third trimester of pregnancy. d.Use an ultraviolet light to enhance drug effectiveness.

c.Avoid sulfonamides during the third trimester of pregnancy.

A client is receiving amoxicillin (Amoxil). The nurse knows that the action of this drug is by which process? a.Inhibition of protein synthesis b.Alteration of membrane permeability c.Inhibition of bacterial cell-wall synthesis d.Alteration of synthesis of bacterial ribonucleic acid

c.Inhibition of bacterial cell-wall synthesis

For the client who is crushing nitrofurantoin (Macrodantin) tablets, what should the nurse teach the client to do? a.Expect the urine to turn blue. b.Keep the urine acidic by drinking milk. c.Rinse the mouth after oral nitrofurantoin to avoid teeth staining. d.Take an antacid with oral nitrofurantoin to avoid gastrointestinal distress.

c.Rinse the mouth after oral nitrofurantoin to avoid teeth staining.

Fluoroquinolones (Quinolones) - Drugs

ciprofloxacin (Cipro); levofloxacin (Levaquin)

When a client does not appear for her routine clinic visit, the nurse calls to ask about the missed visit. The client says, "I really don't need to come any longer. I'm so thankful I no longer have HIV." The nurse finds that the laboratory results indicated an "undetectable" HIV viral load and that the client stopped her medication several weeks earlier. What is the nurse's best response? a. Inform the client that she must be seen immediately because the undetectable viral load indicates that her medication stopped working. b. Have the client reschedule the clinic visit. c. Congratulate the client on her treatment success. d. Educate the client about the continued need for her medications and ongoing laboratory monitoring.

d. Educate the client about the continued need for her medications and ongoing laboratory monitoring.

The nurse closely monitors the client taking lincosamides for which serious adverse effect? a. Seizures b. Ototoxicity c. Hepatotoxicity d. Colitis

d. colitis

A client has been prescribed cefaclor (Ceclor). The nurse knows what fact about this medication? a.It has a normal adult dose of 2 grams q6h. b.It has a common side effect of hypotension. c.It has an intramuscular administration route. d.It is used to treat respiratory infections.

d.It is used to treat respiratory infections.

The client complains about a burning sensation and pain when urinating. The nurse knows that which is an appropriate urinary analgesic? a.tolterodine (Detrol) b.oxybutynin (Ditropan) c.bethanechol (Urecholine) d.phenazopyridine (Pyridium)

d.phenazopyridine (Pyridium

Antiretroviral Agent Goals:

decrease VL to undetectable levels, preserve and increase # of CD4+ T cells, prevent resistance, have client in good clinical condition, prevent secondary infections and cancers

Antifungal Drug Types - Azoles

fluconazole (Diflucan); metronidazole (Flagyl)

NSAIDs: Names

ibuprofen, indocin, Naproxen, Celebrex, Tarodol

Disease-modifying antirheumatic drugs (DMARDs)

may influence the course of disease progression of rheumatoid arthritis (Arava, Cuprimine, Cytoxan, Rheumatrex, Ridaura)

Aminoglycosides - Side Effects/Adverse Reactions

photosensitivity; superinfection; ototoxicity (damage to inner ear); nephrotoxicity

Foods containing salicylates

prunes, raisins, licorice, curry and paprika

Fluoroquinolones (Quinolones) - Side Effects/Adverse Effects

rash, urticaria; tinnitus, photosensitivity; GI upset, pseudomembranous colitis (antibiotic related diarrhea, c-diff); superinfection; hematuria, crystalluria

Which teaching by the nurse has the highest priority for the client taking azithromycin (Zithromax)?

the client should be instructed to report loose stools or diarrhea because of possible pseudomembranous colitis.