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Pharmacology Ch 38, 39, 42

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antimicrobial
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eliminates living organisms that are pathogenic (cause diseases)
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culture & sensitivity
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should be done before antibiotic therapy (unless Save Your Life with Broad Spectrum, then switch after results back) urine, sputum, blood, throat, or wound
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3 classes of antibiotics
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antibacterial antifungal antiviral
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Nursing Process pre medication assessment
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Hx of current infection (vitals, s&s, site and description) Past hx Allergies Med hx Physical examination Lab and Dx tests (liver and kidney excretion)
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Antibacterials adverse reactions, anaphylactic reactions, treatment of,
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rash, pruritus, hives, superinfection, organ toxicity bronchospasm, laryngeal edema, cardiac arrest antihistamine, epinephrine, bronchodilator
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Nursing Process for Antimicrobial Therapy
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premedication assessment meal timing for absorption: with meals or without > fluids, drink, hydrate, IV fever down, site clearing, WBC down, n/v, diarrhea reaction—get better or worse after couple days=hypovolemia C Diff, secondary infection allergy=anaphylaxis tinnitus, dizziness, lab changes, platelets, photosensitivity neuro: drowsy, confused, numbness take all.
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Broad Spectrum
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effective against gram – and gram + examples: tetracycline, cephalosporins, zosyn, SMZ-TMP
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Narrow Spectrum
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primarily effective against one bacteria type examples: penicillin, erythromycin
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Antibacterial Resistance Use Contact Precautions
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MRSA methicillin resistant staph. aureus VREF vancomycin resistant enterici faecium VRSA vancomycin resistant staph. aureus ESBI extended spectrum beta lactamases: tx with Carbepenems, then leads to CRE carbepenem resistant enterobactriaceae=can only tx with tigecycline
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sulfamethoxazole + trimethoprim (SMZ-TMP) Sulfonamides:
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Bactrim, Septra stop the bacteria from making folic acid, which leads to cell death, used for: UTI, otitis media, side effects: photosensitivity, mild n/v report: rash, seizures, bone marrow, liver > fluid intake to 2000mL/day monitor CBC and renal AVOID antacids 1hr before and 2hr after meals can give IV over 90 minutes can increase!!! hypoglycemics, coumadin, methotrexate, dilantin
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Penicillins
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Amoxicillin/Amoxil inhibit cell wall synthesis, ear infections, pneumonia, meningitis, uti, syphilis, gonorrhea. Adverse Effects: renal toxic, raises potassium=arrhythmias, Stephen Johnsons. monitor for bleeding. increase fluids, take 1 hour before, or 2 hours after meals. oral contraceptives less effective while taking cillins.
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Cephalosporins related to penicillins, watch allergy potential
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1st generation effective against gram + microorganisms *Cefazolin:Ancef 2nd and 3rd generation increased activity against gram – *Cefaclor: Ceclor; Ceftriaxone:Rocephin 4th generation is broad spectrum *Cefepime: maxi-time 5th generation *Ceftaroline: good against MRSA #all infuse over 30 minutes: BID, QID #renal and liver toxic #Side Effects: GI, yeast, clotting, no alcohol, interferes with Oral Contraceptive function USE OTHER FORM FOR MONTH
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Carbapenems
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the broadest antibacterial agent to date *Imipenem/Cilastatin (Primaxin), also meripenem, dorapenem #bone, endocarditis, UTI, abdominals, sepsis Adverse Effects:seizures, confusion, hallucinations, Cdiff
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Macrolides
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Azithromycin/Zithromax; Erythromycin, Clarithromycin *inhibit protein synthesis; bacteriostatic and bactericidal Broad Spectrum; for gram – and gram + and cocci. *Respiratory, GI, skin, soft tissue #Long half-life, once a day Side Effects: n/v, diarrhea, hepatotoxic, ototoxic %increases effect of cyclosporin, digoxin, coumadin, theophylline Oral Contraceptives ineffective
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Tetracyclines
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tetracycline hydrochloride, doxycycline, demeclocyline, minocycline Inhibit protein synthesis *Broad Spectrum #Treat VDs, UTIs, URIs, pneumonia, meningitis, acne Side Effects: n/v, diarrhea. Affected by dairy products CNS toxicity, hepatotoxicit, stain teeth, photosensitive
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Aminoglycosides
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gentamicin, neomycin, amikacin, tobramycin *Inhibit protein synthesis against Gram – organisms: Ecoli, salmonella, pseudomonas, enterobacter #nephro and ototoxic peak and trough
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Quinolones
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ciprofloxacin/Cipro; levofloxacin, ofloxacin gram + and gram – bacteria and anaerobic Hepatotoxic, neurotoxic and renal toxic **Increase fluid intake >2000ml/day #increases effect of oral hypoglycemics
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Lincosamides
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clindamycin/cleocin; lincomycin/lincocin *Inhibit bacterial protein synthesis, treat gram – Side Effects: rash, GI, Cdiff, colitis, anaphylactic shock Drug Interactions
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Metronidazole
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flagyl antibacterial: pseudomonas, sepsis GI Side Effects: flushing, sweating, severe h/a, slurred speech avoid alcohol dark urine, reddish brown EKG changes
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Glycopeptide
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vancomycin/vancocin; aztreonam Destroys bacterial walls 1st choice for MRSA also good for C-diff ototoxic, nephrotoxic Peak and Trough redman syndrome and < bp, tachycardia, Stevens-Johnson syndrome if infused too fast!!!
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Polyene Amphotericin B
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treats severe fungal infections *binds to fungal cell membranes IV over 2-6 hours Side Effects: flushing, fever, chills, h/a, GI distress, dyspnea, pseudomembranous colitis, paresthesia, thromboplebitis Increase fluids
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Polyene Nystatin/mycostatin
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oral, topical increases permeability of fungal cell membrane Fungistatic, Fungicidal *Swish and Swallow Gargle for throat
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Azoles Fluconazole/diflucan
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treats candidiasis, cryptococcosis, histoplasmosis Oral, IV, Vaginal, Topical No more > 200mg/hour Side Effects: n/v, anorexia, rash, h/a, cramps. hepatotoxic
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Antiprozoal
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atovaquone/mepron treat mild to moderate pneumocystis carinii pneumonia Oral
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Echinocandins
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caspofungin/cancidas treats Candida, Asperfillosis IV
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What are the big 3 side effects associated with antimicrobial therapy?
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nausea vomiting diarrhea Obtain thorough hx regarding new or existing health issues, as well as determine how soon after starting therapy the symptoms began.
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TMP-SMZ is used to treat which conditions?
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UTIs, otitis media, bronchitis, pneumonia, rheumatic fever, and burns
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administering vancomycin to a client, monitor for
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adequate hearing, appropriate IV rate, Stevens-Johnson syndrome, hypotension and tachycardia, redness of the face, neck and chest
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high priority nursing intervention for patient taking cefepime/maxipime
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monitor for signs and sx of a superinfection
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pt taking peperacillin-tazobactam (Zosyn) nursing interventions most appropriate?
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specimen to lab for C&S before antibiotic therapy is started instruct client to take entire prescribed drug monitor for sx of superinfection, including stomatitis and vaginitis
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What is the priority assessment data for a client prescribed antibiotic therapy?
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allergies
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Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)?
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“Apply sunscreen or wear protective clothing when outdoors.”
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Which adverse effect can result if tetracycline is administered to children younger than 8 years of age?
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Permanent discoloration of the teeth
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A client who is allergic to penicillin is at increased risk for an allergy to which drug?
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Cefazolin sodium (Ancef)
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When planning care for a client receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention?
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Encourage fluid intake of 2000 to 3000 mL/day.
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When administering a nonsteroidal antiinflammatory drug and a penicillin drug together, the displacement of the penicillin antibiotic from the protein-binding sites will result in which effect?
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Increased free drug in blood
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During antibiotic therapy, the nurse will assess the client for a condition that may occur because of the disruption of normal flora. The nurse knows this as what condition?
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Superinfection
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A client prescribed azithromycin (Zithromax) expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse’s best response?
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“This drug is like erythromycin with less gastrointestinal adverse effects.”
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In an effort to prevent superinfections of the GI tract such as Clostridium difficile, the nurse will instruct clients to eat which foods?
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Cultured dairy products such as yogurt
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Which statement best describes health care-associated infections?
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The infection was not incubating at the time of admission.
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Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.)
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Clients stop taking an antibiotic when they feel better. Antibiotics that are prescribed to treat a viral infection.
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antiseptic
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topical antimicrobial agent: chemical that inhibits the growth and reproduction of microorganisms without necessarily killing them “inhibit the growth of organisms on living tissue”
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disinfectant
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topical antimicrobial agent: chemical applied to nonliving objects to kill microorganisms
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aminoglycosides
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amikacin gentamicin tobramycin
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quinolones aka fluoroquinolones
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norfloxacin:Noroxin ciprofloxacin: Cipro levofloxacin: Levaquin moxifloxacin: Avelox gemifloxacin:Factive
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action of quinolones
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interruption of bacterial DNA replication
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The nurse will question the use of a fluoroquinolone antibiotic in a client already prescribed which medication?
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Amiodarone (Cordarone) Dangerous cardiac dysrhythmias are more likely to occur when quinolones are taken by clients receiving class Ia and class III antidysrhythmic drugs such as disopyramide and amiodarone. For this reason, such drug combinations should be avoided.
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When performing discharge teaching for a client prescribed oral linezolid (Zyvox) to treat methicillin-resistant Staphylococcus aureus (MRSA), the nurse should emphasize which important information?
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Avoid ingestion of foods containing tyramine. Hypertension may occur in clients consuming tyramine-containing foods such as aged cheese or wine, soy sauce, smoked meats or fish, and sauerkraut while taking linezolid.
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The nurse is planning care for a client prescribed once-daily IV gentamicin (Garamycin) therapy. When should the nurse schedule a trough drug level to be drawn?
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12 hours after completing the antibiotic infusion Trough serum drug levels should be drawn at least 8 to 12 hours after the medication is infused.
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Quinolones are a class of antibiotics known for several significant complications. Which are possible adverse effects with these drugs? (Select all that apply.)
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Tendon rupture Correct Prolongation of the QT interval Correct Abnormal cartilage development in children Correct Quinolones are not used in prepubescent children because of the risk of cartilage development issues. Quinolones may also cause a cardiac effect that involves prolongation of the QT interval on the electrocardiogram. The use of these medications can result in tendonitis or ruptured tendons in adults.
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problem of most concern for pt. about to receive anti fungal therapy?
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hepatic disease
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pt. receiving IV amphotericin B, expect to see which adverse effect?
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fever and chills
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anti fungal drug therapy, this issue contributes to many of the drug interactions
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cytochrome P-450 enzyme system
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nystatin lozenge for oral candidiasis, best practice instruction?
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dissolve the lozenge slowly and completely in your mouth
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receiving caspofungin, which serious adverse effects to look for?
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blood dycrasias, hypotension, hepatotxicity
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What conditions are considered contradictions for use of antifungal medications? (Select all that apply.)
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Liver failure Pancreatic failure *Drug allergy, liver failure, kidney failure, and porphyria (for griseofulvin) are the most common contraindications for antifungal drugs
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The nurse would question a prescription for voriconazole (Vfend) if the client was taking which medication?
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Quinidine Correct The nurse would question a prescription for quinidine because both voriconazole and quinidine are metabolized by the cytochrome P-450 enzyme system. The drugs will compete for the limited number of enzymes, and one of the drugs will end up accumulating.
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The nurse needs to know that major adverse effects are MOST common by which drug?
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Amphotericin B (Amphocin) the IV administration of amphotericin B is associated with a multitude of adverse effects.
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What is the MOST important action for the nurse to complete before administration of intravenous (IV) amphotericin B?
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Check for premedication prescriptions. Almost all clients given IV amphotericin B experience fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache. Pretreatment with an antipyretic, antihistamine, and antiemetic can minimize or prevent these adverse reactions.