IV Therapy and Pharmacology Quiz

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Questions and Answers

What is the primary mechanism by which valacyclovir inhibits viral replication?

Acting as a guanosine analogue to halt viral DNA elongation (correct)

Directly disrupting the viral membrane structure

Inhibition of viral protein synthesis

Incorporation into the growing viral RNA chain

Which of the following is a serious but less common side effect associated with valacyclovir?

Headache

Diarrhea

Kidney problems (correct)

Nausea

When selecting an IV insertion site, which factor should be avoided?

A site distal to a previous puncture

An area with extensive scarring (correct)

A vein that feels firm to the touch

An extremity that is opposite to a side of mastectomy

What is the purpose of using a tourniquet during IV therapy?

To engorge the veins for better visibility Signup and view all the answers

Which statement accurately describes the potential risk of fluid overload in patients receiving IV fluids?

It can exacerbate congestive heart failure (CHF). Signup and view all the answers

What are common signs and symptoms indicating infiltration of an IV line?

Pain, swelling, coolness, and numbness at the site Signup and view all the answers

Which statement regarding the use of first-generation cephalosporins is true?

They are primarily used to treat infections caused by gram-positive bacteria. Signup and view all the answers

What are the main consequences of excessive fluid accumulation in the body?

Increased workload on the heart and pulmonary congestion Signup and view all the answers

What is the primary action of cephalosporins as antibiotics?

Interfering with bacterial cell wall synthesis Signup and view all the answers

What potential side effect must be monitored for during intravenous bolus administration?

Fluid overload with crackles in the lungs Signup and view all the answers

Which of the following intravenous fluids is considered hypotonic and can cause fluid shifts into cells?

0.45% normal saline Signup and view all the answers

In which situation is intravenous acyclovir most commonly indicated?

For severe cases of genital herpes requiring hospitalization Signup and view all the answers

Which intervention is NOT appropriate when administering IV potassium replacement?

Administer potassium as an IV push Signup and view all the answers

What are the adverse effects associated with the use of crystalloid solutions for fluid replacement?

Peripheral edema and dilution of plasma proteins Signup and view all the answers

Which sign would NOT be expected in a patient suffering from cellulitis at an IV insertion site?

Well-defined borders of redness Signup and view all the answers

Which of the following first-generation cephalosporins is commonly used for surgical prophylaxis?

Cefazolin Signup and view all the answers

What serious adverse effect is associated with cephalosporin antibiotics?

Seizures Signup and view all the answers

Which type of penicillin is generally used to treat infections caused by gram-negative bacteria?

Broad-spectrum penicillins Signup and view all the answers

What is a common side effect shared by both penicillins and tetracyclines?

Gastrointestinal upset Signup and view all the answers

Which statement is true about penicillinase-resistant penicillins?

They decrease the effectiveness of live virus vaccines. Signup and view all the answers

What consequence may arise from using broad-spectrum penicillins with allopurinol?

Increased risk of developing a skin rash Signup and view all the answers

When should tetracyclines be avoided in patients?

In pregnant women and children under 8 years Signup and view all the answers

Which of the following is a common side effect of erythromycin?

Esophagitis Signup and view all the answers

What is a primary therapeutic use of TMP-SMX?

Acute otitis media Signup and view all the answers

Why are second-generation antihistamines less likely to cause sedation?

They do not readily cross the blood-brain barrier. Signup and view all the answers

What is a serious consequence of prolonged use of macrolides?

Ototoxicity and hearing loss Signup and view all the answers

What is a notable risk associated with tetracycline use that limits its application?

Increased mortality risk according to FDA boxed warning Signup and view all the answers

Which of the following is NOT a typical side effect associated with TMP-SMX?

Hypocalcemia Signup and view all the answers

Which macrolide can be administered intravenously for treatment?

Erythromycin Signup and view all the answers

Which specific patient assessment factors are crucial for evaluating itching?

Duration, location, progression, and medication history Signup and view all the answers

What type of infections can TMP-SMX effectively treat?

Acute urinary tract infections and MRSA infections Signup and view all the answers

What is the primary route of administration for cefazolin?

Parenteral (IV or IM) administration Signup and view all the answers

What effect do second-generation antihistamines typically have on cognitive function?

No effect on cognition Signup and view all the answers

What is the role of antihistamines in treating allergic conditions?

They block histamine receptors to alleviate symptoms Signup and view all the answers

Which of these is a significant risk factor for susceptibility to Malignant Hyperthermia (MH)?

History of muscular dystrophies Signup and view all the answers

Which statement accurately describes malignant hyperthermia?

It is a genetic disorder triggered by specific anesthetic agents. Signup and view all the answers

What symptoms are early indicators of malignant hyperthermia?

Increased end-tidal carbon dioxide and tachycardia Signup and view all the answers

What is a guideline for dosing cefazolin for adults?

1-2 grams IV every 8 hours Signup and view all the answers

Which condition is NOT typically treated with antihistamines?

Bacterial infections Signup and view all the answers

Which is a severe potential complication of untreated malignant hyperthermia?

Multi-organ failure and death Signup and view all the answers

Study Notes

Valacyclovir Mechanism of Action

Valacyclovir is an antiviral prodrug metabolized to acyclovir.
Acyclovir is a guanosine analogue inhibiting viral DNA polymerase.
It prevents herpes simplex virus (HSV) and varicella zoster virus (VZV) replication.
Valacyclovir mimics a normal DNA building block, causing chain termination.
This mechanism suppresses active viral infections and reduces symptoms.

Valacyclovir Side Effects

Common side effects include headache, nausea, vomiting, diarrhea, abdominal pain, dizziness, rash, and elevated liver enzymes.
Less common, but serious side effects include kidney problems, confusion, agitation, seizures, coma, and blood disorders (e.g., thrombocytopenia).
A black box warning exists for valacyclovir.

Safe IV Insertion Sites

Avoid joint flexion areas.
Never use extremities on the same side as a mastectomy, dialysis shunt, or AV fistula.
Avoid infected areas, extensive scarring, burns, or surgical sites.
Avoid the CVA paralysis side and extremities with prior infiltration, extravasation, or phlebitis.
Avoid sites distal to previous punctures.
Finding a vein often requires feel rather than sight.
Warm compresses and having the arm hang downward can be helpful.
Use a tourniquet 6-8 inches above the intended site.
Massage the vein as needed.
Clench the patient's fist as needed.
Bevel the needle upward and insert towards the heart.
Do not tie the tourniquet in a knot.
Extension tubing with a cap connects to the IV catheter.

IV Fluids

Expand intravascular volume.
Correct fluid and electrolyte imbalances.
Compensate for problems affecting fluid & electrolytes.
Fluid overload can cause congestive heart failure (CHF).
D5W (dextrose 5% in water) replaces lost fluids and provides carbohydrates.
D5W treats low blood sugar (hypoglycemia), insulin shock, and dehydration.
D5W supports nutritional needs for those unable to eat.

IV Flow Rates

Gravity flow: Check hourly rates.
Volume control pump
Sigma pump
Alaris pump

Cellulitis Clinical Findings

Inflammation of loose connective tissue around the insertion site.
Caused by poor aseptic technique.
Treated with antibiotics.
Red, swollen area spreads outwardly.
Warmth, tenderness, and swelling are observed.
Key signs include redness, warmth, swelling, pain, possible fever, and spreading redness.

IV Medication Administration Reasons

Maintain/restore fluid and electrolyte balance.
Provide patient nutrition/calories.
Administer medications.
Administer blood products.
Provide a diagnostic lab testing avenue.

Drug Antidotes

Heparin ⇄ Protamine sulfate
Acetaminophen ⇄ Acetylcysteine
Opioids ⇄ Naloxone
Warfarin ⇄ Vitamin K
Benzodiazepine ⇄ Flumazenil

Hypotonic IV Fluids

Hypotonic fluids move body water into cells.
Used to treat conditions with excess extracellular sodium or solutes.
Common hypotonic fluids: 0.45%, 0.33%, and 0.225% normal saline.
Contraindicated in dehydration, trauma, and intracranial pressure (ICP).

IV Potassium Replacement RN Interventions

Verify order, concentration, rate, and compatibility.
Assess kidney function and urine output before administration.
Continuously monitor cardiac rhythm.
Do not exceed 10 mEq/hr for non-monitored patients.
Inspect IV site hourly for extravasation or phlebitis.
Educate patients on hyperkalemia symptoms.
Never administer potassium as an IV push.
Dilute with 0.9% normal saline and use an infusion pump.
Document intake, output, potassium levels, and patient response.

Crystalloid Solutions Adverse Effects

Edema (peripheral and pulmonary).
Dilution of plasma proteins, reducing oncotic pressure.
Fluid overload from large volume infusions.
Short-lived effects, requiring prolonged infusions.
Electrolyte imbalances.
Symptoms of pulmonary edema: Dyspnea, tachypnea, crackles, restlessness, and hypertension.

Decreasing/Discontinuing IV Therapy Patient Cues

Infiltration/extravasation at the site.
Phlebitis.
Fluid overload symptoms (edema, crackles, jugular venous distention).
Electrolyte imbalances (hyper/hypokalemia).
Adverse reactions (fever, chills, rash).
Improvement in patient condition.
Patient refusal/inability to continue therapy.
Cellulitis around the IV site.
Air embolus (dyspnea, chest pain, hypotension, tachycardia, decreased LOC).

Genital Herpes Treatment

No cure, but antiviral medications manage outbreaks and reduce transmission.
Acyclovir, valacyclovir, or famciclovir for initial outbreaks.
Intravenous acyclovir for severe cases.
Episodic therapy speeds healing when promptly initiated.
Suppressive therapy reduces outbreak frequency but doesn't eliminate viral shedding.
Patient education on prevention, triggers, and support is crucial.

Intravenous Bolus Administration

Hypertonic solutions (e.g., 5% D5NS, D10W) for cerebral edema, hyponatremia, and others.
Monitor for fluid overload.
Vessels become more concentrated than cells, causing cell shrinkage with hypertonic solutions.
Hypotonic solutions (e.g., .45% NS, D5W) for hypernatremia, dehydration, DKA, and others.
Vessels become less concentrated, causing cell swelling with hypotonic solutions.
Monitor for fluid overload, edema, pulmonary fluid, and crackles.

Cephalosporins MOA and Side Effects

Interfere with bacterial cell wall synthesis by binding to penicillin-binding proteins.
Common side effects: headache, vomiting, dizziness, diarrhea, nausea, GI disruption, rash.
Serious side effects: seizures, kidney injury, hyperkalemia, and blood disorders.
Cross-sensitivity with penicillin allergies can occur in 1-4% of patients.
Indications: meningitis, pneumonia, UTI, sepsis, etc.

First-Generation Cephalosporins

Primarily treat infections caused by gram-positive bacteria (Staphylococcus, Streptococcus).
Limited activity against gram-negative bacteria.
Common indications: skin infections, surgical prophylaxis, respiratory tract infections, UTIs, bone/joint infections.
Examples: cefazolin, cephalexin, cefadroxil

Penicillins (Class)

Inhibit bacterial cell wall synthesis, causing cell lysis.
MOA: Bind to penicillin-binding proteins, interfering with peptidoglycan cross-linking.
Spectrum: Active against gram-positive organisms (Streptococcus) and some gram-negatives.
Administration: Oral and parenteral.
Assess for penicillin allergies.
Monitor kidney function and electrolytes (potassium).
Common adverse effects: gastrointestinal upset, rash, fever, superinfections.
Choose narrowest effective agent.. Complete the full course to prevent resistance

Tetracyclines and Glycylcyclines Side Effects

Avoid in pregnancy, childhood (younger than 8).
Photosensitivity and GI/vaginal/blood-related effects (thrombocytopenia, anemia, coagulation issues).
Not to be used with warfarin or theophylline.
Common side effects: headache, dizziness, abdominal pain, nausea, vomiting, diarrhea, esophageal irritation, photosensitivity, skin rashes, injection site reactions.
Severe side effects: exfoliative dermatitis, Stevens-Johnson syndrome, anaphylaxis, superinfections.
Teeth discoloration, delayed bone growth in children can occur. Toxicity can occur.

Patient Assessment of Itching

Onset, location, progression, associated symptoms, potential triggers, relieving factors, medical history.
Localized or generalized? Constant or intermittent? Mild tickle or intense burning? Rashes, dryness, or lesions? Factors aggravating/relieving itching? Impact on daily life? Underlying conditions? Medications?

Cefazolin

First-generation cephalosporin antibiotic for various bacterial infections.
MOA: Effective against gram-positive organisms (Staphylococcus aureus, Streptococcus species).
Route: Parenteral (IV or IM).
Common uses: Surgical prophylaxis, skin infections, respiratory tract, UTIs, and bone/joint infections.
Typical dose: 1-2 grams IV every 8 hours (adjusted by renal function).
Adverse effects: hypersensitivity reactions, GI upset, site reactions, blood dyscrasias.
Contraindications: cephalosporin allergy, severe renal impairment.
Precautions: pregnancy, breastfeeding, elderly, anemia, or coagulation disorders, GI & renal disease.

Conditions Antihistamines Treat

Allergic rhinitis (hay fever), nasal allergies.
Urticaria (hives), allergic reactions.
Pruritus (itchy skin).
Common cold symptoms (sneezing, runny nose).
Motion sickness, vertigo, insomnia.
Parkinson's disease (anticholinergic effects).

Malignant Hyperthermia (MH)

Inherited disorder triggered by anesthetics (volatile gases, succinylcholine).
Characterized by hypermetabolic crisis, uncontrolled muscle contractions, rapidly increasing body temperature, acidosis, rhabdomyolysis.
Increased intracellular calcium levels in muscles trigger increased muscle metabolism.
Serum calcium and potassium increase.
Initial signs include increased end-tidal carbon dioxide; later, high body temperature.
Clinical features: muscle rigidity, tachycardia, tachypnea, hypoxemia, hypercarbia, unstable blood pressure, profuse sweating, dysrhythmias, hypotension, skin mottling, cyanosis, myoglobinuria.
Treated with dantrolene, supportive care (cooling, hyperventilation, electrolyte correction).

Second-Generation Antihistamines

Non-sedating antihistamines (loratadine, cetirizine, fexofenadine).
Less likely to cause sedation compared to older antihistamines.
Do not readily cross the blood-brain barrier.
Longer duration of action (once-daily dosing).
Some sedation can occur at higher doses.

Macrolide Antibiotics

Erythromycin, azithromycin, clarithromycin.
Treat gram-positive and gram-negative bacterial infections (respiratory, gastrointestinal, genitourinary tracts).
Erythromycin can be IV. Azithromycin has ophthalmic formulation.

Macrolide Side Effects

Common: headaches, rash, GI disturbances (diarrhea, abdominal pain, nausea, vomiting).
Disrupt intestinal flora, potentially causing Clostridium difficile infection (CDI).
Vaginitis, candidiasis, ototoxicity, prolonged QT interval, ventricular arrhythmias, hepatotoxicity, and rare hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis) are serious.

TMP-SMX (Bactrim) Indications

Acute uncomplicated UTIs, acute otitis media, traveler's diarrhea, shigellosis, pneumonia, sinus infections (Streptococcus pneumoniae, Haemophilus influenzae).
First-line therapy for Pneumocystis jirovecii infections (immunocompromised).
Effective against methicillin-resistant Staphylococcus aureus (MRSA).
Oral administration; IV for serious infections and Pneumocystis jirovecii pneumonia.

TMP-SMX (Bactrim) Side Effects

Common: nausea, vomiting, abdominal pain, skin rash, dermatitis, urticaria, photosensitivity, crystalluria, hyperkalemia, blood dyscrasias, C-difficile.
Rare: Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, systemic lupus erythematosus, anaphylactic reaction.

Ondansetron Contraindications

Hypersensitivity to ondansetron.
Congenital long QT syndrome.
First trimester pregnancy.
Severe hepatic impairment.
Alcohol.
Hypokalemia, hypomagnesemia, bradyarrhythmias, conduction disturbances.
Concurrent use of QT-prolonging medications.
Phenylketonuria (oral disintegrating tablets).
Monitor for palpitations, confusion, and flushing.

Promethazine MOA

Phenothiazine derivative. Non-selective antagonist.
MOA: Antihistaminic, anticholinergic, and anti-dopaminergic effects.
Antihistaminic: Blocks H1 histamine receptors.
Anticholinergic: Blocks muscarinic acetylcholine receptors.
Anti-dopaminergic: Blocks dopamine D2 receptors.
Reduces secretions, decreases GI motility, and has potent antiemetic action.
Contraindications: hepatic impairment, bone marrow suppression, glaucoma, myasthenia gravis, children with Reye syndrome. Black Box Warning: High risk in pediatrics, older adults, and IV use.

Surgical Care Improvement Project (SCIP)

Aims to reduce surgical complications.
Core compliance measures: prophylactic antibiotics, timely catheter removal, and VTE prophylaxis.

Preoperative verification of documents (consent, allergies, medical history, lab results).
Marking the operative site and timed-out procedures (patient inclusion ).

TeamSTEPPS

System designed to improve communication and collaboration among healthcare providers.
Enhances patient safety and quality of care.

Epidural Catheter Safety Concerns

Risks include headache, hypotension, and infection.
Inadvertent dural puncture can cause cerebrospinal fluid leakage leading to hypotension or infection.
Respiratory depression could occur.
Monitor for hypotension, neurologic status, catheter site, and medication response.
Accurate sterile technique and frequent assessments help with prevention and early complication detection.

Spinal Headache and Blood Patch

Spinal headache, a common complication of spinal anesthesia, can be treated with bed rest, analgesics, hydration, and/or a blood patch.

Patient Safety Strategy to Prevent PE after Surgery

Peripheral vascular assessment.
Prophylactic drugs (e.g., enoxaparin).
Compression stockings, pneumatic compression devices, and leg exercises.

Street Drugs and Anesthesia

Street drugs alter responses to anesthesia.
Cross-tolerance may be observed, requiring higher anesthetic doses.
Monitor for altered anesthetic/analgesic effects.

Pulmonary Function Tests (PFTs)

Evaluate lung function measuring volumes and airflow rates.
Key measurements: FVC, FEV1, FEV1/FVC ratio, MVV, and diffusing capacity.
Results indicate obstructive/restrictive lung diseases.

Blood Type and Crossmatch Purpose

Ensure safe blood transfusions by preventing hemolytic reactions.
Blood typing identifies ABO and Rh antigens.
Crossmatch tests for recipient plasma antibodies against the donor's red blood cells.

Nursing Considerations for IV Antivirals

Dilute IV infusions according to guidelines.
Infuse slowly to prevent renal damage.
Encourage patient hydration to prevent crystalluria.
Monitor IV site frequently.

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Test your knowledge on IV therapy and the pharmacology of antiviral and antibiotic medications. This quiz covers various aspects such as drug mechanisms, side effects, and fluid management in clinical practice. Ideal for nursing students and healthcare professionals.