IV Therapy and Pharmacology Quiz

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.

National Patient Goals related to Safety and Preoperative Care

• 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.