Podcast
Questions and Answers
What is the primary mechanism by which sulfonamides exert their antibiotic effect?
What is the primary mechanism by which sulfonamides exert their antibiotic effect?
- Interference with bacterial protein synthesis
- Inhibition of bacterial cell wall synthesis
- Direct destruction of bacterial DNA
- Prevention of folic acid synthesis (correct)
Which of the following is a common indication for the use of sulfonamide antibiotics?
Which of the following is a common indication for the use of sulfonamide antibiotics?
- Treatment of pneumonia
- Treatment of fungal infections
- Treatment of urinary tract infections (correct)
- Treatment of viral infections
What strategy can be implemented to minimize the risk of crystalluria associated with sulfonamide therapy?
What strategy can be implemented to minimize the risk of crystalluria associated with sulfonamide therapy?
- Limiting fluid intake
- Increasing fluid intake (correct)
- Administering the drug on an empty stomach
- Administering sodium bicarbonate
Which common bacterial genera are typically categorized as gram-positive?
Which common bacterial genera are typically categorized as gram-positive?
How do penicillins achieve their bactericidal effect on susceptible bacteria?
How do penicillins achieve their bactericidal effect on susceptible bacteria?
A patient reports an allergic reaction to amoxicillin characterized by throat swelling and hives. Which antibiotic class should be avoided due to potential cross-reactivity?
A patient reports an allergic reaction to amoxicillin characterized by throat swelling and hives. Which antibiotic class should be avoided due to potential cross-reactivity?
A patient taking warfarin concurrently with penicillin requires close monitoring due to the increased risk of:
A patient taking warfarin concurrently with penicillin requires close monitoring due to the increased risk of:
Which of the following cephalosporins is commonly used intravenously or intramuscularly for surgical prophylaxis?
Which of the following cephalosporins is commonly used intravenously or intramuscularly for surgical prophylaxis?
Which generation of cephalosporins is known for its increased activity against Gram-negative bacteria, including the ability to penetrate the blood-brain barrier effectively?
Which generation of cephalosporins is known for its increased activity against Gram-negative bacteria, including the ability to penetrate the blood-brain barrier effectively?
A patient develops acute alcohol intolerance while on antibiotic therapy. Which class of antibiotics is most likely responsible for this reaction?
A patient develops acute alcohol intolerance while on antibiotic therapy. Which class of antibiotics is most likely responsible for this reaction?
What is the primary mechanism of action of macrolide antibiotics on bacteria?
What is the primary mechanism of action of macrolide antibiotics on bacteria?
Which of the following is a frequent adverse effect associated with erythromycin, a macrolide antibiotic?
Which of the following is a frequent adverse effect associated with erythromycin, a macrolide antibiotic?
Why is tetracycline use generally avoided in children under 8 years of age?
Why is tetracycline use generally avoided in children under 8 years of age?
Which of the following instructions should be given to a patient prescribed tetracycline?
Which of the following instructions should be given to a patient prescribed tetracycline?
What interaction occurs when tetracyclines are administered concurrently with dairy products or antacids containing calcium, magnesium, or aluminum?
What interaction occurs when tetracyclines are administered concurrently with dairy products or antacids containing calcium, magnesium, or aluminum?
What serious adverse effect is associated with aminoglycoside antibiotics, necessitating careful monitoring of drug levels?
What serious adverse effect is associated with aminoglycoside antibiotics, necessitating careful monitoring of drug levels?
Why are aminoglycosides poorly absorbed via the oral route?
Why are aminoglycosides poorly absorbed via the oral route?
For which type of infection are quinolones typically NOT recommended in children under 18 years of age?
For which type of infection are quinolones typically NOT recommended in children under 18 years of age?
Patients taking quinolones are advised to avoid concurrent use of antacids or supplements containing which minerals?
Patients taking quinolones are advised to avoid concurrent use of antacids or supplements containing which minerals?
What potentially serious adverse effect is associated with quinolone antibiotics, necessitating patient education about signs and symptoms?
What potentially serious adverse effect is associated with quinolone antibiotics, necessitating patient education about signs and symptoms?
What is the primary use of vancomycin?
What is the primary use of vancomycin?
A patient receiving intravenous vancomycin develops flushing, rash, and itching, primarily on the face, neck, and upper torso. Which of the following is the most likely cause?
A patient receiving intravenous vancomycin develops flushing, rash, and itching, primarily on the face, neck, and upper torso. Which of the following is the most likely cause?
What is the MOST appropriate nursing intervention to prevent nephrotoxicity in a patient receiving aminoglycoside therapy?
What is the MOST appropriate nursing intervention to prevent nephrotoxicity in a patient receiving aminoglycoside therapy?
Which characteristic of the bacterial cell structure is the basis for classifying bacteria as either gram-positive or gram-negative?
Which characteristic of the bacterial cell structure is the basis for classifying bacteria as either gram-positive or gram-negative?
A patient is diagnosed with pneumonia and prescribed an antibiotic. Prior to initiating antibiotic therapy, what action is MOST important for the nurse to take?
A patient is diagnosed with pneumonia and prescribed an antibiotic. Prior to initiating antibiotic therapy, what action is MOST important for the nurse to take?
A patient is receiving an antibiotic for a skin infection. The patient reports having diarrhea since starting the medication. What intervention should the nurse implement FIRST?
A patient is receiving an antibiotic for a skin infection. The patient reports having diarrhea since starting the medication. What intervention should the nurse implement FIRST?
If a patient who is prescribed a sulfonamide reports abdominal cramps, stomach pain, diarrhea, or severe or worsening rash, what is the correct nursing instruction?
If a patient who is prescribed a sulfonamide reports abdominal cramps, stomach pain, diarrhea, or severe or worsening rash, what is the correct nursing instruction?
A women asks if she can take all the antibiotics prescribed with juice rather than water, what is the nurses BEST response?
A women asks if she can take all the antibiotics prescribed with juice rather than water, what is the nurses BEST response?
A patient has been prescribed penicillin, what is the nurses BEST response prior to administration.
A patient has been prescribed penicillin, what is the nurses BEST response prior to administration.
A nurse is caring for a patient on cephalosporins, what is the MOST important teaching the nurse should educate the patient about?
A nurse is caring for a patient on cephalosporins, what is the MOST important teaching the nurse should educate the patient about?
Your patient is prescribed Macrolides, what education point about the medication is MOST important?
Your patient is prescribed Macrolides, what education point about the medication is MOST important?
Your patient is prescribed Tetracyclines, what are the MOST important points for the nurses to educate on?
Your patient is prescribed Tetracyclines, what are the MOST important points for the nurses to educate on?
What signs and symptoms would the nurse monitor to identify if antibiotic therapy has been therapeutic for their patient?
What signs and symptoms would the nurse monitor to identify if antibiotic therapy has been therapeutic for their patient?
Why is serum drug monitoring an essential component of aminoglycoside therapy?
Why is serum drug monitoring an essential component of aminoglycoside therapy?
In a clinical trial, a novel antibiotic demonstrates effectiveness against Pseudomonas aeruginosa but is rapidly inactivated by beta-lactamases. Which strategy would MOST effectively preserve the antibiotic's efficacy?
In a clinical trial, a novel antibiotic demonstrates effectiveness against Pseudomonas aeruginosa but is rapidly inactivated by beta-lactamases. Which strategy would MOST effectively preserve the antibiotic's efficacy?
The Minimum Inhibitory Concentration (MIC) of an antibiotic is described by which statement?
The Minimum Inhibitory Concentration (MIC) of an antibiotic is described by which statement?
What is the primary reason behind the emergence and spread of antimicrobial-resistant organisms?
What is the primary reason behind the emergence and spread of antimicrobial-resistant organisms?
What is the essential action a nurse must take before initiating an antibiotic therapy protocol?
What is the essential action a nurse must take before initiating an antibiotic therapy protocol?
Which of the following factors does NOT typically influence a patient's susceptibility to infection?
Which of the following factors does NOT typically influence a patient's susceptibility to infection?
Which characteristic of bacteria is MOST crucial in guiding the selection of an appropriate antibiotic therapy?
Which characteristic of bacteria is MOST crucial in guiding the selection of an appropriate antibiotic therapy?
The primary strategy for preventing healthcare-associated infections (HAIs) is:
The primary strategy for preventing healthcare-associated infections (HAIs) is:
An antiseptic is primarily used to:
An antiseptic is primarily used to:
Before beginning antibiotic therapy, what is the rationale for culturing the suspected areas of infection?
Before beginning antibiotic therapy, what is the rationale for culturing the suspected areas of infection?
Which statement BEST describes definitive antibiotic therapy?
Which statement BEST describes definitive antibiotic therapy?
A patient shows a therapeutic response to antibiotic therapy, what would the nurse assess?
A patient shows a therapeutic response to antibiotic therapy, what would the nurse assess?
Which of the following adverse effects is MOST indicative of a superinfection?
Which of the following adverse effects is MOST indicative of a superinfection?
Which of the following instructions is MOST appropriate for a patient prescribed a sulfonamide regarding fluid intake?
Which of the following instructions is MOST appropriate for a patient prescribed a sulfonamide regarding fluid intake?
What is the MOST important instruction to give a patient who is prescribed penicillin?
What is the MOST important instruction to give a patient who is prescribed penicillin?
A patient receiving cephalosporins should be educated about the potential for:
A patient receiving cephalosporins should be educated about the potential for:
Which of the following is the MOST appropriate recommendation for a patient taking macrolides to minimize gastrointestinal upset?
Which of the following is the MOST appropriate recommendation for a patient taking macrolides to minimize gastrointestinal upset?
A patient prescribed tetracycline should be instructed to:
A patient prescribed tetracycline should be instructed to:
What is the rationale for measuring both peak and trough drug levels in patients receiving aminoglycosides?
What is the rationale for measuring both peak and trough drug levels in patients receiving aminoglycosides?
Which of the following is the MOST concerning adverse effect associated with quinolone antibiotics that warrants immediate discontinuation of the drug?
Which of the following is the MOST concerning adverse effect associated with quinolone antibiotics that warrants immediate discontinuation of the drug?
How do macrolides exert their bacteriostatic effect on susceptible bacteria?
How do macrolides exert their bacteriostatic effect on susceptible bacteria?
What is a key difference between bactericidal and bacteriostatic antibiotics?
What is a key difference between bactericidal and bacteriostatic antibiotics?
What is the primary reason why tetracyclines are contraindicated in children younger than 8 years of age?
What is the primary reason why tetracyclines are contraindicated in children younger than 8 years of age?
A nurse is caring for a patient receiving aminoglycoside therapy. What signs or symptoms should the nurse monitor to detect potential ototoxicity?
A nurse is caring for a patient receiving aminoglycoside therapy. What signs or symptoms should the nurse monitor to detect potential ototoxicity?
Which of the following statements BEST describes 'prophylactic therapy' with antibiotics?
Which of the following statements BEST describes 'prophylactic therapy' with antibiotics?
Which antibiotic class is known for its potential to cause a disulfiram-like reaction when a patient consumes alcohol?
Which antibiotic class is known for its potential to cause a disulfiram-like reaction when a patient consumes alcohol?
What is the primary mechanism by which beta-lactam antibiotics, such as penicillins and cephalosporins, exert their effect on bacteria?
What is the primary mechanism by which beta-lactam antibiotics, such as penicillins and cephalosporins, exert their effect on bacteria?
A patient receiving vancomycin intravenously begins to develop flushing and itching, particularly on the face and upper torso. What condition do these signs and symptoms correlate with?
A patient receiving vancomycin intravenously begins to develop flushing and itching, particularly on the face and upper torso. What condition do these signs and symptoms correlate with?
A patient has been prescribed a quinolone antibiotic. What should the nurse emphasize to the patient regarding potential adverse effects??
A patient has been prescribed a quinolone antibiotic. What should the nurse emphasize to the patient regarding potential adverse effects??
What is the primary mechanism by which sulfonamides exert their antibacterial action?
What is the primary mechanism by which sulfonamides exert their antibacterial action?
Why is it essential to obtain appropriate cultures from infection sites before initiating antibiotic therapy?
Why is it essential to obtain appropriate cultures from infection sites before initiating antibiotic therapy?
What is the most important nursing consideration when administering intravenous vancomycin to a patient to prevent 'red man syndrome'?
What is the most important nursing consideration when administering intravenous vancomycin to a patient to prevent 'red man syndrome'?
Which of the following instructions should be given to a patient prescribed tetracycline to minimize its adverse effects and interactions?
Which of the following instructions should be given to a patient prescribed tetracycline to minimize its adverse effects and interactions?
What is the underlying mechanism behind the broad-spectrum antibacterial activity observed in quinolone antibiotics?
What is the underlying mechanism behind the broad-spectrum antibacterial activity observed in quinolone antibiotics?
A women is prescribed a tetracycline, what is the MOST important reason the nurses would advise them not to take this medication if they are pregnant?
A women is prescribed a tetracycline, what is the MOST important reason the nurses would advise them not to take this medication if they are pregnant?
A patient is prescribed oral vancomycin for antibiotic-induced colitis. What unique aspect of oral vancomycin's action makes it suitable for this condition?
A patient is prescribed oral vancomycin for antibiotic-induced colitis. What unique aspect of oral vancomycin's action makes it suitable for this condition?
A patient is prescribed clarithromycin while also taking warfarin. What potential interaction should the nurse monitor for, and why?
A patient is prescribed clarithromycin while also taking warfarin. What potential interaction should the nurse monitor for, and why?
A patient with a known penicillin allergy is prescribed cefprozil, a second-generation cephalosporin. What is the MOST important nursing intervention?
A patient with a known penicillin allergy is prescribed cefprozil, a second-generation cephalosporin. What is the MOST important nursing intervention?
What is the PRIMARY reason that aminoglycosides are administered parenterally (e.g., intravenously or intramuscularly) rather than orally?
What is the PRIMARY reason that aminoglycosides are administered parenterally (e.g., intravenously or intramuscularly) rather than orally?
Which of the following is the MOST appropriate instruction for a patient taking tetracycline to minimize the risk of esophageal irritation?
Which of the following is the MOST appropriate instruction for a patient taking tetracycline to minimize the risk of esophageal irritation?
Imagine you are a seasoned infectious disease specialist tasked with formulating a novel antibiotic stewardship program for a large hospital network. As the lead, which strategy would likely yield the MOST significant impact in curbing the rise of multi-drug resistant organisms?
Imagine you are a seasoned infectious disease specialist tasked with formulating a novel antibiotic stewardship program for a large hospital network. As the lead, which strategy would likely yield the MOST significant impact in curbing the rise of multi-drug resistant organisms?
A patient develops Clostridium difficile infection (CDI) following a course of broad-spectrum antibiotics. After a round of oral vancomycin, the CDI recurs. Given the challenges in treating recurrent CDI, which emerging therapeutic strategy holds the MOST promise?
A patient develops Clostridium difficile infection (CDI) following a course of broad-spectrum antibiotics. After a round of oral vancomycin, the CDI recurs. Given the challenges in treating recurrent CDI, which emerging therapeutic strategy holds the MOST promise?
What is the MOST critical action to prevent antimicrobial resistance in hospitals?
What is the MOST critical action to prevent antimicrobial resistance in hospitals?
What is the MOST likely reason why a patient with a localized skin infection is not responding to an oral antibiotic?
What is the MOST likely reason why a patient with a localized skin infection is not responding to an oral antibiotic?
A patient is prescribed an antibiotic known to cause photosensitivity. What crucial advice should the nurse provide?
A patient is prescribed an antibiotic known to cause photosensitivity. What crucial advice should the nurse provide?
A patient is prescribed both probenecid and penicillin. What is the intended effect of this drug combination?
A patient is prescribed both probenecid and penicillin. What is the intended effect of this drug combination?
What is the PRIMARY rationale for administering a loading dose of an antibiotic?
What is the PRIMARY rationale for administering a loading dose of an antibiotic?
Which of the following is the MOST appropriate way to assess for ototoxicity in a patient receiving aminoglycosides?
Which of the following is the MOST appropriate way to assess for ototoxicity in a patient receiving aminoglycosides?
Besides Penicillins and Sulfonamides, which other antibiotic class is MOST frequently associated with allergic reactions?
Besides Penicillins and Sulfonamides, which other antibiotic class is MOST frequently associated with allergic reactions?
Which statement accurately describes the action of a 'static' antibiotic?
Which statement accurately describes the action of a 'static' antibiotic?
A patient is prescribed a drug, and the nurse checks, upon assessment, that it is a 'cidal agent'. What does that mean for the action of this drug?
A patient is prescribed a drug, and the nurse checks, upon assessment, that it is a 'cidal agent'. What does that mean for the action of this drug?
Which of the following factors could be MOST impactful in the incidence of infection?
Which of the following factors could be MOST impactful in the incidence of infection?
What is the MOST significant difference between antiseptics and disinfectants?
What is the MOST significant difference between antiseptics and disinfectants?
What is the PRIMARY reason for obtaining a specimen for culture and sensitivity testing prior to starting antibiotic therapy?
What is the PRIMARY reason for obtaining a specimen for culture and sensitivity testing prior to starting antibiotic therapy?
A patient receiving a beta-lactam antibiotic develops a rash, pruritus, and angioedema. Which action is MOST important?
A patient receiving a beta-lactam antibiotic develops a rash, pruritus, and angioedema. Which action is MOST important?
A patient is prescribed empiric antibiotic therapy. What statement BEST explains this type of treatment?
A patient is prescribed empiric antibiotic therapy. What statement BEST explains this type of treatment?
Besides the intended purpose of addressing the primary infection, what is the MOST common adverse effect associated with nearly ALL antibiotics?
Besides the intended purpose of addressing the primary infection, what is the MOST common adverse effect associated with nearly ALL antibiotics?
A patient is taking warfarin and is newly prescribed Tetracycline. What is the nurses NEXT priority?
A patient is taking warfarin and is newly prescribed Tetracycline. What is the nurses NEXT priority?
A microorganism has developed resistance to multiple antibiotic classes. What term is used best describe this organism?
A microorganism has developed resistance to multiple antibiotic classes. What term is used best describe this organism?
A patient with a known penicillin allergy is prescribed amoxicillin for a respiratory infection. Upon realizing this error, what is the nurse's FIRST action?
A patient with a known penicillin allergy is prescribed amoxicillin for a respiratory infection. Upon realizing this error, what is the nurse's FIRST action?
A patient develops new oral thrush (candidiasis) after completing a course of broad-spectrum antibiotics. This is an example of what?
A patient develops new oral thrush (candidiasis) after completing a course of broad-spectrum antibiotics. This is an example of what?
A researcher isolates a bacterial strain with a mutation that renders its ribosomes completely insensitive to tetracycline. This bacterium also has a mutation that introduces the ability to transport tetracycline, but only out of the cell, at rapid rate, independently of normal cellular transport mechanisms. If this bacteria gains the ability to transfer this trait to other bacteria, which statement assesses the difficulty correctly?
A researcher isolates a bacterial strain with a mutation that renders its ribosomes completely insensitive to tetracycline. This bacterium also has a mutation that introduces the ability to transport tetracycline, but only out of the cell, at rapid rate, independently of normal cellular transport mechanisms. If this bacteria gains the ability to transfer this trait to other bacteria, which statement assesses the difficulty correctly?
Why are viruses challenging to eradicate with drug therapy?
Why are viruses challenging to eradicate with drug therapy?
Which characteristic is crucial for antiviral drugs to effectively combat viral infections?
Which characteristic is crucial for antiviral drugs to effectively combat viral infections?
What is the primary action of most antiviral drugs currently available?
What is the primary action of most antiviral drugs currently available?
Which of the following best describes an opportunistic infection?
Which of the following best describes an opportunistic infection?
Why are long-term prophylaxis and anti-infective drug therapy often required for opportunistic infections?
Why are long-term prophylaxis and anti-infective drug therapy often required for opportunistic infections?
Acyclovir (Zovirax) is the medication of choice for the treatment of:
Acyclovir (Zovirax) is the medication of choice for the treatment of:
Which formulation of acyclovir is appropriate for treating severe viral infections?
Which formulation of acyclovir is appropriate for treating severe viral infections?
Ganciclovir is commonly used in the treatment of infections caused by which virus?
Ganciclovir is commonly used in the treatment of infections caused by which virus?
What is a key difference between oseltamivir and zanamivir in treating influenza?
What is a key difference between oseltamivir and zanamivir in treating influenza?
For which patient population is the inhaled form of ribavirin (Virazole) typically used?
For which patient population is the inhaled form of ribavirin (Virazole) typically used?
How is HIV most commonly transmitted?
How is HIV most commonly transmitted?
What is the estimated risk of HIV transmission to healthcare workers via percutaneous (needle-stick) injuries?
What is the estimated risk of HIV transmission to healthcare workers via percutaneous (needle-stick) injuries?
What is the primary goal of highly active antiretroviral therapy (HAART) in treating HIV?
What is the primary goal of highly active antiretroviral therapy (HAART) in treating HIV?
Fusion inhibitors, a class of antiretroviral drugs, work by what mechanism?
Fusion inhibitors, a class of antiretroviral drugs, work by what mechanism?
Which nursing action is most important in preventing the spread of viral infections?
Which nursing action is most important in preventing the spread of viral infections?
Which instruction is MOST crucial for patients starting antiviral medications?
Which instruction is MOST crucial for patients starting antiviral medications?
Acyclovir is used to treat infections caused by which type of virus?
Acyclovir is used to treat infections caused by which type of virus?
A patient with a confirmed diagnosis of influenza has been prescribed oseltamivir. What education should the nurse provide regarding the timing of treatment?
A patient with a confirmed diagnosis of influenza has been prescribed oseltamivir. What education should the nurse provide regarding the timing of treatment?
A patient is prescribed enfuvirtide (Fuzeon) for HIV. Which route of administration is specific to this medication?
A patient is prescribed enfuvirtide (Fuzeon) for HIV. Which route of administration is specific to this medication?
Which vaccination strategy is MOST likely to confer lifelong immunity?
Which vaccination strategy is MOST likely to confer lifelong immunity?
What is the primary difference between the prevention strategies offered by toxoids versus vaccines?
What is the primary difference between the prevention strategies offered by toxoids versus vaccines?
What is the purpose of adding aluminum salts (alum) to some vaccines?
What is the purpose of adding aluminum salts (alum) to some vaccines?
What is the key characteristic of inactivated vaccines?
What is the key characteristic of inactivated vaccines?
Why is the hepatitis B vaccine recommended for all children shortly after birth?
Why is the hepatitis B vaccine recommended for all children shortly after birth?
Which statement is most accurate regarding the influenza vaccine, FluMist Quadrivalent?
Which statement is most accurate regarding the influenza vaccine, FluMist Quadrivalent?
Why is it important to get an influenza vaccine each year?
Why is it important to get an influenza vaccine each year?
What is the key rationale behind assessing a patient's underlying disease and medical history before beginning antiviral therapy?
What is the key rationale behind assessing a patient's underlying disease and medical history before beginning antiviral therapy?
What is the MOST important hygiene practice to teach patients when they are prescribed antiviral medications?
What is the MOST important hygiene practice to teach patients when they are prescribed antiviral medications?
A patient with herpes zoster is prescribed acyclovir. What should the nurse emphasize regarding the start of treatment?
A patient with herpes zoster is prescribed acyclovir. What should the nurse emphasize regarding the start of treatment?
A patient taking antiviral medication reports experiencing varied side effects. What is the nurse's most appropriate action?
A patient taking antiviral medication reports experiencing varied side effects. What is the nurse's most appropriate action?
What should the nurse monitor to evaluate if a patient's antiviral therapy is effective?
What should the nurse monitor to evaluate if a patient's antiviral therapy is effective?
Artificial active immunization functions by which statement?
Artificial active immunization functions by which statement?
Imagine a virus evolves within a human population, rendering it resistant to all existing antiviral medications. The virus exhibits an extremely high mutation rate, and scientists hypothesize it hijacks the host cell's DNA repair mechanisms to further accelerate its replication cycle. What is the most likely strategy to combat this virus's spread?
Imagine a virus evolves within a human population, rendering it resistant to all existing antiviral medications. The virus exhibits an extremely high mutation rate, and scientists hypothesize it hijacks the host cell's DNA repair mechanisms to further accelerate its replication cycle. What is the most likely strategy to combat this virus's spread?
A novel retrovirus has been discovered. Preliminary studies reveal that it relies on a unique host cell surface receptor, 'HRX,' for entry, and upon entry, it rapidly silences key antiviral defense genes. Furthermore, it integrates its genetic material at seemingly random locations within the host genome, making it highly difficult to predict integration sites. If the goal is to prevent widespread infection using insights of currently available medications, which is the MOST promising avenue for immediate research and development?
A novel retrovirus has been discovered. Preliminary studies reveal that it relies on a unique host cell surface receptor, 'HRX,' for entry, and upon entry, it rapidly silences key antiviral defense genes. Furthermore, it integrates its genetic material at seemingly random locations within the host genome, making it highly difficult to predict integration sites. If the goal is to prevent widespread infection using insights of currently available medications, which is the MOST promising avenue for immediate research and development?
What is a primary challenge in developing effective antiviral drugs?
What is a primary challenge in developing effective antiviral drugs?
Which statement accurately describes the mechanism by which non-HIV antiviral drugs work?
Which statement accurately describes the mechanism by which non-HIV antiviral drugs work?
A patient asks why they need a flu shot every year, what is the nurses' BEST response?
A patient asks why they need a flu shot every year, what is the nurses' BEST response?
Which of the following is an example of a viral infection that may require long-term prophylactic anti-infective drug therapy?
Which of the following is an example of a viral infection that may require long-term prophylactic anti-infective drug therapy?
Which of the following viral illnesses is commonly associated with the herpes simplex virus type 1 (HSV-1)?
Which of the following viral illnesses is commonly associated with the herpes simplex virus type 1 (HSV-1)?
A patient is diagnosed with shingles. The patient asks how soon will treatment subside the effects, what is the nurses' BEST response?
A patient is diagnosed with shingles. The patient asks how soon will treatment subside the effects, what is the nurses' BEST response?
What is the primary use of amantadine hydrochloride?
What is the primary use of amantadine hydrochloride?
A patient is prescribed acyclovir, the patient asks about the route administration for this medication, what should the nurse respond?
A patient is prescribed acyclovir, the patient asks about the route administration for this medication, what should the nurse respond?
Which of the following is a key characteristic that antiviral drugs must possess to be effective?
Which of the following is a key characteristic that antiviral drugs must possess to be effective?
Which of the following statements best describes the use of ribavirin?
Which of the following statements best describes the use of ribavirin?
Which of the following is the MOST common route of HIV transmission?
Which of the following is the MOST common route of HIV transmission?
What is the approximate risk of HIV transmission to a healthcare worker following a needle-stick injury?
What is the approximate risk of HIV transmission to a healthcare worker following a needle-stick injury?
Which outcome indicates effective treatment with antiviral medications?
Which outcome indicates effective treatment with antiviral medications?
How do fusion inhibitors work within the antiretroviral medication class?
How do fusion inhibitors work within the antiretroviral medication class?
What type of virus does ganciclovir treat?
What type of virus does ganciclovir treat?
Which class of biological antimicrobial drugs is designed to stimulate the production of a specific antibody, providing protection against future exposure to toxin-producing bacteria?
Which class of biological antimicrobial drugs is designed to stimulate the production of a specific antibody, providing protection against future exposure to toxin-producing bacteria?
How does artificial active immunization work to protect against infectious diseases?
How does artificial active immunization work to protect against infectious diseases?
Why are vaccinations with live bacteria or viruses generally considered to provide lifelong immunity?
Why are vaccinations with live bacteria or viruses generally considered to provide lifelong immunity?
What is the primary purpose of adding aluminum salts (alum) to certain vaccines?
What is the primary purpose of adding aluminum salts (alum) to certain vaccines?
How do toxoids work to protect against diseases like diphtheria and tetanus?
How do toxoids work to protect against diseases like diphtheria and tetanus?
What is the general approach to addressing adverse effects associated with antiretroviral drugs?
What is the general approach to addressing adverse effects associated with antiretroviral drugs?
A novel virus replicates via a previously uncharacterized mechanism involving direct modification of host cell microRNA (miRNA) to suppress innate immune responses, allowing unchecked viral replication initially. After integrating itself, it directly expresses a protein that inhibits a key enzyme crucial for both DNA replication and repair. Which therapeutic strategy is most likely to yield immediate benefits?
A novel virus replicates via a previously uncharacterized mechanism involving direct modification of host cell microRNA (miRNA) to suppress innate immune responses, allowing unchecked viral replication initially. After integrating itself, it directly expresses a protein that inhibits a key enzyme crucial for both DNA replication and repair. Which therapeutic strategy is most likely to yield immediate benefits?
What distinguishes 'natural passive immunity' from other forms of immunization?
What distinguishes 'natural passive immunity' from other forms of immunization?
Which strategy would be MOST effective to curb the spread of a newly discovered virus that exhibits rapid mutation rates and integrates into host cell DNA, combined with a unique mechanism of immune evasion involving alteration of host cell surface receptors, making it difficult for antibodies to bind?
Which strategy would be MOST effective to curb the spread of a newly discovered virus that exhibits rapid mutation rates and integrates into host cell DNA, combined with a unique mechanism of immune evasion involving alteration of host cell surface receptors, making it difficult for antibodies to bind?
What is the MOST important nursing action to prevent the spread of viral infections?
What is the MOST important nursing action to prevent the spread of viral infections?
In which specific zone of the stomach are the cells of the gastric gland located, where they play a primary role in acid control?
In which specific zone of the stomach are the cells of the gastric gland located, where they play a primary role in acid control?
What is the direct physiological effect of stimulating muscarinic receptors (M3) with acetylcholine on parietal cells?
What is the direct physiological effect of stimulating muscarinic receptors (M3) with acetylcholine on parietal cells?
Pepsin, a proteolytic enzyme that breaks down proteins in the stomach, is activated by which mechanism?
Pepsin, a proteolytic enzyme that breaks down proteins in the stomach, is activated by which mechanism?
What is the primary physiological role of prostaglandins in the stomach lining?
What is the primary physiological role of prostaglandins in the stomach lining?
Which dietary and lifestyle factor is LEAST likely to stimulate secretion by parietal cells, leading to increased hydrochloric acid production?
Which dietary and lifestyle factor is LEAST likely to stimulate secretion by parietal cells, leading to increased hydrochloric acid production?
How does raising gastric pH by one point from 1.3 to 2.3 through antacid use affect gastric acidity?
How does raising gastric pH by one point from 1.3 to 2.3 through antacid use affect gastric acidity?
What is the primary mechanism of action of antacids in providing relief from acid-related disorders?
What is the primary mechanism of action of antacids in providing relief from acid-related disorders?
Which of the following conditions would be considered a contraindication for the use of antacids?
Which of the following conditions would be considered a contraindication for the use of antacids?
Which of the following is a notable characteristic of sodium bicarbonate as an antacid?
Which of the following is a notable characteristic of sodium bicarbonate as an antacid?
Why are aluminum salts often combined with magnesium-based antacids?
Why are aluminum salts often combined with magnesium-based antacids?
Which of the following antacids might a provider recommend for a patient with renal disease?
Which of the following antacids might a provider recommend for a patient with renal disease?
What is the MOST significant consideration for a patient taking calcium-based antacids long-term, especially concerning acid rebound?
What is the MOST significant consideration for a patient taking calcium-based antacids long-term, especially concerning acid rebound?
How do H2 antagonists work to reduce gastric acid secretion?
How do H2 antagonists work to reduce gastric acid secretion?
For a patient taking both an H2 receptor antagonist and an antacid, what instruction should the nurse provide to optimize the effectiveness of both medications?
For a patient taking both an H2 receptor antagonist and an antacid, what instruction should the nurse provide to optimize the effectiveness of both medications?
What is the primary mechanism by which proton pump inhibitors (PPIs) decrease gastric acid production?
What is the primary mechanism by which proton pump inhibitors (PPIs) decrease gastric acid production?
In addition to treating GERD and erosive esophagitis, what other condition are PPIs commonly used for?
In addition to treating GERD and erosive esophagitis, what other condition are PPIs commonly used for?
Why might a patient on long-term PPI therapy be predisposed to Clostridium difficile infection?
Why might a patient on long-term PPI therapy be predisposed to Clostridium difficile infection?
A patient is taking a PPI, phenytoin, and diazepam. What potential drug interaction should the nurse monitor for?
A patient is taking a PPI, phenytoin, and diazepam. What potential drug interaction should the nurse monitor for?
Sucralfate is prescribed to a patient. What is the MOST important instruction the nurse should provide?
Sucralfate is prescribed to a patient. What is the MOST important instruction the nurse should provide?
The following is a list of medications: Aluminum hydroxide, Calcium carbonate, Magnesium hydroxide, Sodium bicarbonate. If each of the four antacids were available at the same cost, to the same patient, which would MOST greatly increase the risk of metabolic alkalosis?
The following is a list of medications: Aluminum hydroxide, Calcium carbonate, Magnesium hydroxide, Sodium bicarbonate. If each of the four antacids were available at the same cost, to the same patient, which would MOST greatly increase the risk of metabolic alkalosis?
Flashcards
Antimicrobial Resistance (AMR)
Antimicrobial Resistance (AMR)
The ability of microbes to resist the effects of antimicrobial medications.
Microorganisms
Microorganisms
Microbes present externally and internally that have the ability to be harmful or beneficial.
Gram Stain Procedure
Gram Stain Procedure
A categorization method using dye to classify bacteria by cell wall structure.
Community-Acquired Infection
Community-Acquired Infection
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Health Care-Associated Infections
Health Care-Associated Infections
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Resistant Pathogens
Resistant Pathogens
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Handwashing
Handwashing
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Antiseptic
Antiseptic
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Disinfectant
Disinfectant
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Antibiotics
Antibiotics
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Empiric Therapy
Empiric Therapy
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Definitive Therapy
Definitive Therapy
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Prophylactic Therapy
Prophylactic Therapy
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Therapeutic Response
Therapeutic Response
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Subtherapeutic Response
Subtherapeutic Response
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Superinfection
Superinfection
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Antibiotic Resistance
Antibiotic Resistance
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Sulfonamides Action
Sulfonamides Action
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Sulfonamides Indications
Sulfonamides Indications
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Sulfonamides Adverse Effects
Sulfonamides Adverse Effects
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Inhibit synthesis of bacterial peptidoglycan cell wall
Inhibit synthesis of bacterial peptidoglycan cell wall
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Penicillin Mechanism
Penicillin Mechanism
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Bactericidal
Bactericidal
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Bacteriostatic
Bacteriostatic
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Penicillins uses
Penicillins uses
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First-Generation Cephalosporins
First-Generation Cephalosporins
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Cefoxitin (Mefoxin)
Cefoxitin (Mefoxin)
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Cefuroxime axetil (Ceftin)
Cefuroxime axetil (Ceftin)
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Third-Generation Cephalosporins
Third-Generation Cephalosporins
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Ceftriaxone Sodium
Ceftriaxone Sodium
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Fourth-Generation Cephalosporins
Fourth-Generation Cephalosporins
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Carbapenems
Carbapenems
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Imipenem/Cilastatin
Imipenem/Cilastatin
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Meropenem (Merrem)
Meropenem (Merrem)
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Macrolides Mechanisms
Macrolides Mechanisms
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Macrolides Indications
Macrolides Indications
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Macrolides Adverse Effects
Macrolides Adverse Effects
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Gram-negative and gram-positive organisms.
Gram-negative and gram-positive organisms.
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Tetracyclines
Tetracyclines
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Tetracyclines Adverse Effects
Tetracyclines Adverse Effects
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antibiotic use
antibiotic use
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Administer 180 mL of water
Administer 180 mL of water
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Take with 2 000 to 3 000 mL of fluid per 24 hours
Take with 2 000 to 3 000 mL of fluid per 24 hours
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Cephalosporin allergy
Cephalosporin allergy
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Avoid milk products
Avoid milk products
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Aminoglycosides toxitcities
Aminoglycosides toxitcities
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Quinolones
Quinolones
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Tendon Rupture
Tendon Rupture
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Metronidazole (Flagyl)
Metronidazole (Flagyl)
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Metronidazole (Flagyl)
Metronidazole (Flagyl)
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Vancomycin
Vancomycin
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Vancomycin
Vancomycin
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MRSA
MRSA
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Extended-spectrum ß-lactamases (ESBL)
Extended-spectrum ß-lactamases (ESBL)
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Viral Replication
Viral Replication
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Smallpox
Smallpox
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Sore throat and conjunctivitis
Sore throat and conjunctivitis
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Warts
Warts
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Influenza
Influenza
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Respiratory Infections
Respiratory Infections
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Gastroenteritis
Gastroenteritis
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HIV/AIDS
HIV/AIDS
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Herpes
Herpes
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Hepatitis
Hepatitis
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Antiviral Drugs
Antiviral Drugs
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Immunoglobulins
Immunoglobulins
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Opportunistic Infections
Opportunistic Infections
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Antiviral Drugs
Antiviral Drugs
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Antiretroviral Drugs
Antiretroviral Drugs
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HSV-1
HSV-1
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HSV-2
HSV-2
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HHV-3 (VZV)
HHV-3 (VZV)
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HHV-4
HHV-4
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HHV-5
HHV-5
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Hepatitis C
Hepatitis C
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Antiviral Mechanism
Antiviral Mechanism
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Antiviral Side Effects
Antiviral Side Effects
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amantadine hydrochloride
amantadine hydrochloride
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Acyclovir
Acyclovir
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Ganciclovir hydrochloride
Ganciclovir hydrochloride
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oseltamivir phosphate/zanamivir
oseltamivir phosphate/zanamivir
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Ribavirin
Ribavirin
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HIV Transmission
HIV Transmission
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HIV Overview
HIV Overview
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Reverse Transcriptase Inhibitors
Reverse Transcriptase Inhibitors
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Protease Inhibitors
Protease Inhibitors
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Fusion Inhibitors
Fusion Inhibitors
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Antiretroviral Drugs: enfuvirtide (Fuzeon)
Antiretroviral Drugs: enfuvirtide (Fuzeon)
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Antiretroviral Modification
Antiretroviral Modification
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Opportunistic Infections
Opportunistic Infections
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Nursing Implication
Nursing Implication
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Artificial Active Immunization
Artificial Active Immunization
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Natural Active Immunization
Natural Active Immunization
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Passive Immunization
Passive Immunization
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Immune response
Immune response
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Biological
Biological
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Toxoids
Toxoids
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Vaccines
Vaccines
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Influenza Vaccine
Influenza Vaccine
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Acid-Controlling Drugs
Acid-Controlling Drugs
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Stomach Zones with Glands
Stomach Zones with Glands
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Glands of the Cardiac Zone
Glands of the Cardiac Zone
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Parietal Cells
Parietal Cells
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Chief Cells
Chief Cells
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Mucous Cells
Mucous Cells
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Stomach Acidity (pH)
Stomach Acidity (pH)
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Antacids
Antacids
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Antacid Salts
Antacid Salts
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Antacids: Action
Antacids: Action
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H2 Antagonists Action
H2 Antagonists Action
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H2 Antagonists: Mechanism of Action
H2 Antagonists: Mechanism of Action
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Peptic Ulcer Disease
Peptic Ulcer Disease
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Proton Pump Inhibitors
Proton Pump Inhibitors
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Common PPI Medications
Common PPI Medications
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Stress-Related Mucosal Damage
Stress-Related Mucosal Damage
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Sucralfate
Sucralfate
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Cytoprotective Activity
Cytoprotective Activity
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Simethicone Uses
Simethicone Uses
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Antacid Combination
Antacid Combination
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Study Notes
Microbial Infection
- Microorganisms exist in the external and internal environments of our bodies
- They can either be harmful or beneficial
- Conditions can alter the impact of microorganisms, making them harmful
- Individuals typically maintain health and resist infectious microorganisms due to host defenses
- Physical barriers like skin and the respiratory mucosa protect against infections
- Physiological defenses such as gastric acid and antibodies in the stomach form immune factors
- Phagocytic cells (macrophages and polymorphonuclear neutrophils) play a role in immunity within the mononuclear phagocyte system
Bacteria
- Microbes contain organisms capable of infecting humans
- Bacteria, viruses, fungi, and protozoa can have different shapes
- Morphology describes the shape property of bacteria
- Bacteria are grouped according to common recognizable characteristics
- Gram staining is used to categorize bacteria
- Gram-positive organisms stain purple with gram staining
- Gram-negative organisms stain red with gram staining
- Gram staining guides the selection of antibiotic therapy
Infections
- Community-acquired infections are obtained by individuals without recent hospitalization or medical procedures within the past year, like dialysis, surgery or the insertion of a catheter
- Health care-associated infections can be contracted in a health care facility, occur more than 48 hours after admission, and may not have been present or incubating upon admission
- They are a leading cause of death in Canada and are often drug-resistant and virulent
- Examples of health are associated infections: Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and nosocomial infections.
Health Care–Associated Infections
- Serious pathogens include Klebsiella, Acinetobacter, and Pseudomonas aeruginosa often exhibit resistance to commonly prescribed antibiotics
- Gram-negative bacteria producing beta-lactamase can degrade common antibiotics
- Escherichia coli and Klebsiella pneumoniae are a common source of ESBL
- Carbapenemase-producing Enterobacteriaceae (CPE) are resistant to carbapenems
Health Care–Associated Infections: Prevention
- Handwashing is the most important prevention method
- Antiseptics, disinfectants and disinfectant agents are also important
- Disinfectants kill organisms used only on nonliving objects and are cidal agents
- Antiseptics inhibit growth of microorganisms, do not necessarily kill them, applied exclusively to living tissue, and considered static agents
Antibiotics
- Antibiotics are medications that treat bacterial infections
- Suspected infection areas should be cultured to identify the causative organism and potential antibiotic susceptibilities before treatment
Antibiotic Therapy
- Empiric therapy treats an infection before specific culture information is available
- Definitive therapy tailors antibiotic use once the organism is identified with cultures
- Prophylactic therapy uses antibiotics to prevent infection, such as before abdominal surgery or after trauma with administration occurring 60 minutes before surgery
Antibiotic Therapy: Response
- A therapeutic response shows a decrease in specific signs and symptoms of infection, with reduced fever, normal white blood cell count, and decreased redness, inflammation, drainage, and pain
- A subtherapeutic response shows no improvement in the signs and symptoms of infection
Antibiotic Therapy: Considerations
- Superinfections, pseudomembranous colitis (Clostridium difficile), secondary infections, and resistance can occur in patients taking antibiotics
- Antimicrobial stewardship programs such as the one created by Accreditation Canada in 2014 help to ensure effective usage
- Food-drug interactions and host factors, like patient specific allergies or pregnancy status can also alter treatment
Antibiotic Therapy: Host Factors
- Host factors include age, allergies, health conditions, pregnancy status, genetics, infection site, and host defenses
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency and slow acetylation are also important considerations
Antibiotic Classes
- Common antibiotic classes include Sulfonamides, Penicillins, Cephalosporins, Carbapenems, Macrolides, Quinolones, Aminoglycosides, and Tetracyclines
Antibiotic Therapy: Mechanisms of Action
- Antibiotics may act by interfering with cell wall synthesis, protein synthesis, or deoxyribonucleic acid (DNA) replication
- Antibiotics may act as a metabolite to disrupt critical metabolic reactions inside the bacterial cell
Actions of Antibiotics
- Bactericidal antibiotics kill bacteria
- Bacteriostatic antibiotics inhibit the growth of susceptible bacteria, eventually leading to bacterial death
Antibiotics: Sulfonamides
- Sulfonamides are one of the earliest antibiotic groups that inhibit bacteria growth rather than killing them
- Sulfonamides prevent synthesis of folic acid, which is required for synthesis of purines and nucleic acid
- Sulfonamides don't affect human cells or certain bacteria because they can use preformed folic acid
- Sulfonamides affect organisms that must synthesize their own folic acid; are often combined with another antibiotic.
Sulfonamides: Indications
- Sulfonamides are effective against both gram-positive and gram-negative bacteria
- They treat urinary tract infections caused by Enterobacter spp, Escherichia coli, Klebsiella spp, Proteus mirabilis, Proteus vulgaris, and Staphylococcus aureus
- Sulfonamides treat Pneumocystis jiroveci pneumonia, often through sulfamethoxazole/trimethoprim
- Sulfonamides are used in cases of upper respiratory tract infections
- SMX-TMP is used for outpatients with Staphylococcus infections due to community-acquired MRSA rates
Sulfonamides: Adverse Effects
- Sulfonamides have body system adverse effects like hemolytic and aplastic anemia, agranulocytosis, and thrombocytopenia
- Integumentary effects include photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, and epidermal necrolysis
- GI effects include nausea, vomiting, diarrhea, pancreatitis, and hepatotoxicity
- Other effects include convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria, and cough
Mechanism of β-Lactam Antibiotics
- Commonly used, they Inhibit the synthesis of the bacterial peptidoglycan cell wall leading to bacterial cell death
- Some bacterial strains produce the enzyme beta-lactamase
- This enzyme provides a mechanism for bacterial resistance to these antibiotics
- The enzyme can break the chemical bond between the carbon (C) and nitrogen (N) atoms in the structure of the beta-lactam ring
- When this occurs, all beta-lactam drugs lose their antibacterial efficacy
- Classes are limited to Penicillins, Cephalosporins, Carbapenems, and Monobactams
Penicillins
- Penicillins are a large group of chemically related antibiotics derived from mould (fungus)
- They are batericidal
- Types include natural penicillins, penicillinase-resistant penicillins, aminopenicillins, and extended-spectrum penicillins
Penicillins: Mechanism of Action
- Penicillins enter bacteria via the cell wall and bind to penicillin-binding protein
- Once bound, normal cell wall synthesis is disrupted, which results in cell lysis
- Penicillins only kill bacteria cells and do not kill other cells in the body
Penicillins: Indications
- Penicillins act to prevent and treat infections caused by susceptible bacteria
- They are effective against gram-positive bacteria, including Streptococcus spp, Enterococcus spp, and Staphylococcus spp
Penicillins: Contraindications
- Penicillins are usually safe and well tolerated
- Contraindications occur for known medication allergy or reaction to penicillins
- A lack of names ending in "cillin” (e.g., Clavulin®) can result in incorrect naming from trade brands, leading to administration to a patient with a penicillin allergy
Penicillins: Adverse Effects
- Penicillin allergies occur in 0.7-4% of cases, with affects such as urticaria, pruritus, and angioedema
- Patients that are allergic to penicillins have an increased risk of allergy to other ß-lactam antibiotics
- The potential for those allergic to penicillins to receive cephalosporins should be reviewed if they have a history of throat swelling or hives
- Common adverse effects include nausea, vomiting, diarrhea, and abdominal pain
- Many interactions with nonsteroidal anti-inflammatory drugs, oral contraceptives, and warfarin, among others
Cephalosporins
- The family of antibiotics can be broken down into first, second, third, fourth and fifth generations with varying usage guidelines
- Fifth generation are unused in Canada
- These are semisynthetic antibiotics structurally and pharmacologically related to penicillins that are Bactericidal and Broad spectrum
- The different classes target different Antimicrobial activity
Cephalosporins: First Generation
- First-generation cephalosporins have good gram-positive but poor gram-negative coverage
- They come in parenteral and oral forms with an emphasis of surgical and prevention with susceptible staphylococcal infections
- Cefazolin is administered intravenously (IV) or intramuscularly (IM) and cephalexin (Keflex) is available via Oral dosage
Cephalosporins: Second Generation
- Second-generation cephalosporins have good gram-positive, and improved gram-negative coverage
- Examples include cefaclor, cefoxitin, cefuroxime, and cefprozil
- Cefoxitin (Mefoxin®) is available in IV and IM forms for prophylactic use with abdominal/colorectal surgeries, and can also kill anaerobes
- Cefuroxime has an oral form (Ceftin®) can be used for surgical prophylaxis, and doesn't kill anaerobes
Cephalosporins: Third Generation
- Third-generation cephalosporins are the most potent group against gram-negative bacteria
- They are less active against gram-positive bacteria
- Examples include cefotaxime sodium, cefixime, cefpodoxime proxetil, ceftizoxime, ceftazidime, and ceftriaxone
- Ceftriaxone sodium is administered via, IV and IM, has a long half-life, once-a-day dosing, and is eliminated via the liver
- Ceftriaxone crosses the meninges easily and treats central nervous system infections
Cephalosporins: Fourth Generation
- Fourth-generation cephalosporins have broader spectrum than third-generation cephalosporins and are especially useful against gram-positive bacterial cases
- Fourth Generation options can treat uncomplicated and complicated urinary tract infections, such as cefepime hydrochloride (Maxipime®)
Cephalosporins: Adverse Effects
- Cephalosporins have similar effects to penicillins
- Mild diarrhea, abdominal cramps, rash, pruritus, redness, and edema have been identified
- There is a potential cross-sensitivity with penicillins if allergies exist
Carbapenems
- Display the broadest antibacterial action of all antibiotics
- Reserved for complicated body cavity and connective tissue infections for ill hospitalized patients
- Typically administered over 60 minutes
- May cause drug-induced seizure activity that can be reduced with proper dosage
Types of Carbapenems
- Imipenem/cilastatin (Primaxin®) is used to treat bone, joint, skin, and soft tissue infections and more, with Cilastatin which inhibits an enzyme that breaks down imipenem
- Meropenem (Merrem®)
- Ertapenem (Invanz®)
Macrolides
- Common macrolide medications include erythromycin (E-Mycin®), azithromycin (Zithromax®), clarithromycin (Biaxin®) , and fidaxomicin (Dificid®)
Macrolides: Mechanism of Action
- They prevent protein synthesis within bacterial cells and are considered bacteriostatic, leading to eventual bacterial death
- In high enough concentrations, macrolides may also be bactericidal
Macrolides: Indications
- Treat “strep” infections such as Streptococcus pyogenes
- Treat moderate upper and lower respiratory tract infections caused by Haemophilus influenzae
- Treat spirochetal infections like Syphilis and Lyme disease
- Treat Gonorrhea, Chlamydia, and Mycoplasma
Macrolides: Fidaxomicin Indications
- Fidaxomicin (Dificid) is the newest macrolide
- Fidaxomicin adverse effects: nausea, vomiting, and GI bleed
- It is indicated only for the treatment of C. difficile-associated diarrhea
- It is reasonably safe for use in pregnancy due to minimal absorption
Macrolides: Adverse Effects
- Gl effects, are frequently seen with erythromycin causing, nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia, heartburn, abnormal taste, etc.
- Azithromycin and clarithromycin are associated with fewer GI effects, longer duration of action, better efficacy, and better tissue penetration
Macrolides: Types
- Erythromycin is a commonly prescribed macrolide and its absorption is enhanced on an empty stomach but can result in significant stomach irritation
- Delayed-release capsules containing enteric-coated granules of the drug can have reduced blood levels if administered with a meal
- Azithromycin (Zithromax®) and clarithromycin (Biaxin®) are semisynthetic macrolide antibiotics with structural advantages over erythromycin with both better adverse effect profiles and better pharmacokinetic properties
- Azithromycin can reach high concentrations in infected tissues and have a long duration of action with or without food, where both oral and injectable form exist
Tetracyclines
- Examples of tetracyclines include doxycycline hyclate (Doxycin®, Vibramycin® etc), minocycline hydrochloride (Minocin®), and tigecycline (Tygacil®)
Tetracyclines: Indications
- Tetracyclines are wide spectrum and are Effective against gram-negative and gram-positive organisms, protozoa, Mycoplasma spp., Rickettsia spp., Chlamydia, syphilis, Lyme disease, acne, and others
Tetracyclines: Characteristics
- Tetracyclines are natural and semisynthetic
- Obtained from cultures of Streptomyces, bacteriostatic and can inhibit bacterial growth
- Act through Inhibiting protein synthesis, stopping many essential functions of the bacteria
Tetracyclines: Interactions
- Tetracyclines bind (chelate) to Ca+++, Mg++, and Al+++ ions to form insoluble complexes
- Dairy products, antacids, and iron salts reduce oral absorption of tetracyclines.
- Use should be avoided in children under 8 or in pregnant or lactating women, because tooth discoloration can result from the drug binding to calcium in the teeth
Tetracyclines: Adverse Effects
- These drugs exhibit strong affinity for calcium making them dangerous for those under 8 and during pregnancy
- Use in pregnancy can stunt fetal skeletal development
- Potential results include discoloration of permanent teeth
- Alteration of the intestinal flora
- May also cause Vaginal candidiasis, Gastric upset, Enterocolitis, and Maculopapular rash
Nursing Implications
- Before beginning therapy, assess for allergies, and perform tests on renal, liver, cardiac function
- Health history should be obtained to confirm the patients immune status
- Assess conditions that may be contraindications to antibiotic use or that may indicate cautious use
- Assess potential drug interactions
- Obtain cultures from appropriate sites before starting therapy
- Instruct patients to take antibiotics as prescribed and for the length of time prescribed.
- Watch for signs of superinfection: fever, irritation, cough, lethargy, or unusual discharge
- Each class of antibiotics has specific adverse effects and drug interactions that must be carefully assessed and monitored
- The most common adverse effects of antibiotics are nausea, vomiting, and diarrhea
- All oral antibiotics are absorbed better if taken with at least 180 mL of water
Nursing Considerations for Sulfonamides
- Take with 2 000 to 3 000 mL of fluid per 24 hours.
- Take oral doses with food.
- Encourage patients to immediately report worsening abdominal cramps, stomach pain, diarrhea, hematuria, severe or worsening rash, shortness of breath, and fever.
Nursing Considerations for Penicillins
- Take oral doses with water (not juices) because acidic fluids may nullify the drug's antibacterial action
- Monitor for allergic reaction for 30 minutes after administration
Nursing Considerations for Cephalosporins
- Assess for penicillin allergy because patients can have cross-allergy
- Give orally administered forms with food to decrease GI upset even though this will delay absorption
- Some drugs may cause a disulfiram (acute alcohol intolerance) reaction when taken with alcohol
Nursing Implications for Macrolides
- Macrolides are highly protein bound and will cause severe interactions with other protein-bound drugs
- The absorption of oral erythromycin is enhanced when the medication is taken on an empty stomach
- However, because of the high incidence of Gl upset, patients may have to eat to tolerate medication intake
Nursing Implications for Tetracyclines
- Avoid milk products, iron preparations, antacids, and other dairy products because of the chelation and drug binding that occur.
- Take all medications with at least 180 mL of fluid, preferably water.
- Because of photosensitivity, avoid sunlight and tanning beds.
- Monitor for therapeutic effects and adverse reactions such as improvements of signs and symptoms, return to normal vital signs, or negative results
Aminoglycosides
- Aminoglycosides are natural and semisynthetic are never administered orally due to poor absorption
- Potent antibiotics with serious toxicities exhibit bactericidal behavior by preventing protein synthesis
- Kill mostly gram-negative bacteria and some gram-positive bacteria
- Examples include gentamicin sulphate, streptomycin sulphate, tobramycin sulphate, amikacin sulphate, paromomycin sulphate, and neomycin sulphate
Aminoglycosides: Inidcations
- They are used to kill gram-negative bacteria including Pseudomonas spp., Escherichia coli, Proteus spp., Klebsiella spp. and Serratia spp
General Principles of Virology
- Viruses cannot replicate on their own
- Viruses must attach to and enter a host cell
- Viruses are much smaller than bacteria
- Viruses utilize the host cell's energy to synthesize protein, deoxyribonucleic acid (DNA), and ribonucleic acid (RNA)
- Viruses are difficult to kill because they live inside the cells
- Drugs that kill viruses may also kill cells
Viral Replication
Viral Illnesses
- Smallpox (poxviruses)
- Sore throat and conjunctivitis (adenoviruses)
- Warts (papovaviruses)
- Influenza (orthomyxoviruses)
- Respiratory infections (coronaviruses, rhinoviruses)
- Gastroenteritis (rotaviruses, Norwalk-like viruses)
- Human immunodeficiency virus (HIV) / acquired immune deficiency syndrome (AIDS) (retroviruses)
- Herpes (herpesviruses)
- Hepatitis (hepadnaviruses)
- Most viral illnesses are bothersome but survivable
- Effective vaccines have prevented some illnesses
- Effective drug therapy is available for a small number of viral infections
Antiviral Drugs
- Antiviral drugs kill or suppress viruses by destroying virions or inhibiting viral replication, and are controlled by current antiviral therapy
- Immunoglobulins are concentrated antibodies that attack and destroy viruses
- Viruses controlled by current antiviral therapy include Cytomegalovirus (CMV), Hepatitis viruses, Herpesviruses, HIV, Influenza viruses (“flu”), and Respiratory syncytial virus (RSV)
- Key characteristics of antiviral drugs: able to enter infected cells, interfere with viral nucleic acid synthesis or regulation, prevent the fusion process, and stimulate the body’s immune system
- Patients with competent immune systems respond the best to antiviral medications
- A healthy immune system works synergistically with drugs to eliminate or suppress viral activity
Antiviral Drugs: Opportunistic Infections
- Opportunistic infections occur in immunocompromised patients and would not normally harm an immunocompetent person
- Long-term prophylaxis and anti-infective drug therapy are needed
- Opportunistic infections cab be caused by viruses, fungi, bacteria, or protozoa
- Antiviral drugs treat infections caused by viruses other than HIV
- Antiretroviral drugs treat infections caused by HIV, the virus that causes AIDS
Herpes Simplex and Varicella-Zoster Virus Infections (Herpesviridae)
- Herpes simplex virus (HSV) 1 causes oral herpes
- HSV 2 causes genital herpes
- Human herpesvirus (HHV 3), also known as varicella-zoster virus (VZV) causes chickenpox and shingles
- HHV 4 is known as the Epstein-Barr virus
- HHV 5 is Cytomegalovirus (CMV)
- HHV 6 and HHV 7 are not especially clinically significant but affect immunocompromised patients
- HHV 8 causes Kaposi’s sarcoma
- HSV 2 (genital herpes) is highly transmissible and can cause neonatal herpes
- HHV 3 (VZV) (chickenpox) contains the varicella virus vaccine
- HHV 3 (VZV) (shingles) is painful and opioids can be used for pain control
- HHV 3 may lead to postherpetic neuralgias
- Acyclovir may speed recovery of HHV 3 if started within 72 hours of symptom onset, and the Zostavax® vaccine exists
Hepatitis C
- Hepatitis C is a leading cause of chronic liver disease and the most common reason for liver transplantation
- Ribavirin (Virazole®) is taken orally for treatment of hepatitis C
Antiviral Drugs (Non-HIV)
- Most current antiviral drugs block the activity of a polymerase enzyme that normally stimulates the synthesis of new viral genomes
- Used to treat non-HIV viral infections such as Influenza viruses, HSV, VZV, CMV, and Hepatitis A, B, C
- Adverse effects vary with each drug
- Healthy cells are often killed as well, resulting in serious toxicities
amantadine hydrochloride (Dom-Amantidine®)
- amantadine hydrochloride is an antiviral with a narrow spectrum, active only against influenza A, but most recent guidelines do not recommend its use to treat or to prevent influenza
- amantadine hydrochloride's Central nervous system effects: insomnia, nervousness, light-headedness
- amantadine hydrochloride's Gastrointestinal effects: anorexia, nausea, others
acyclovir (Zovirax®)
- acyclovir is a synthetic nucleoside analogue used to suppress replication of HSV 1, HSV 2, and VZV
- acyclovir is often a medication of choice for treatment of initial and recurrent episodes of these infections either orally, topically, or parenterally
ganciclovir hydrochloride (Cytovene®, Valcyte®)
- ganciclovir hydrochloride is a synthetic nucleoside analogue of guanosine used to treat infection caused by CMV
- ganciclovir is taken orally and parenterally
- ganciclovir also treats CMV retinitis
- Similar drugs: valacyclovir hydrochloride and famciclovir are only taken orally and indicated for less severe infections
oseltamivir phosphate (Tamiflu) and zanamivir (Relenza)
- oseltamivir phosphate and zanamivir are active against influenza types A and B and reduce its length
- oseltamivir phosphate is taken only orally and causes nausea and vomiting
- zanamivir is inhaled and causes diarrhea, nausea, and sinusitis
- Treatment should begin within 2 days of influenza symptom onset
Ribavirin
- Ribavirin is a synthetic nucleoside analogue taken either orally or via nasal inhalation
- Ribavirin in inhaled form (Virazole) is used for hospitalized infants with respiratory syncytial virus infections
HIV and AIDS
- 36.9 million people worldwide are infected with HIV, which is a retrovirus
- HIV is transmitted by sexual activity, intravenous drug use, perinatal transfer from mother to child
- The risk for transmission to health care workers via percutaneous (needle-stick) injuries is currently calculated at approximately 0.3%
- Hand hygiene and standard precautions are extremely important
Four Stages of HIV Infection
- Stage 1: Asymptomatic infection
- Stage 2: Early, general symptoms of disease
- Stage 3: Moderate symptoms
- Stage 4: Severe symptoms, including AIDS-defining illnesses, often leading to death
- *World Health Organization model
Opportunistic Infections and HIV
- Infections caused by organisms that would not normally harm an immunocompetent person
- Common examples are individuals with cancer, organ transplant recipients, and individuals with AIDS
- Caused by other non-HIV viruses, bacteria, fungi, and protozoans
- Require long-term prophylactic anti-infective drug therapy
Antiretroviral Drugs
- Highly active antiretroviral therapy includes at least three medications
- These medications work in different ways to reduce the viral load
Antiretroviral Drugs
- Reverse transcriptase inhibitors Block activity of the enzyme reverse transcriptase, preventing production of new viral DNA
- Protease inhibitors inhibit the protease retroviral enzyme, preventing viral replication
- Fusion inhibitors inhibit viral fusion, preventing viral replication
- Entry inhibitors called CCR5 co-receptor antagonists now exist
- Integrase inhibitors now exist
Antiretroviral Drugs: Adverse Effects
- Numerous adverse effects vary with each medication
- Drug therapy may need to be modified because of adverse effects
- The goal is to find the regimen that will best control the infection while having a tolerable adverse effect profile
- Medication regimens change during the course of the illness
enfuvirtide (Fuzeon®)
- enfuvirtide (Fuzeon®) is a fusion inhibitor
- enfuvirtide (Fuzeon®) suppresses the fusion process whereby a virion is attached to the outer membrane of a host T cell before entry into the cell and subsequent viral replication
- enfuvirtide (Fuzeon®), in combination with other antiretroviral drugs, is used for treatment of HIV infection, and in combination with other standard antiretroviral drugs markedly reduced viral loads
- enfuvirtide (Fuzeon®) is currently available only in injectable form
Other Viral Infections
- Includes Avian influenza (“bird flu”), West Nile virus, Severe acute respiratory syndrome (SARS), and H1N1 influenza virus (“swine flu”)
Nursing Implications
- Before beginning therapy, thoroughly assess underlying disease and medical history, including allergies
- Assess baseline vital signs and nutritional status
- Assess for contraindications, conditions that may indicate cautious use, and potential drug interactions
- Be sure to teach proper technique for applying ointments, aerosol powders, and so on
- Emphasize handwashing to prevent site contamination and spread of infection
- Instruct patients to wear a glove or finger cot when applying ointments or solutions to affected areas
- Instruct patients to consult their prescribers before taking any other medication, including over-the-counter medications
- Emphasize the importance of good hygiene
- Inform patients that antiviral medications are not cures but do help to manage symptoms
- Instruct patients on the importance of taking these medications exactly as prescribed and for the full course of treatment and to to start therapy with antiviral medications at the earliest sign of recurrent episodes of genital herpes or herpes zoster
- Monitor adverse effects that are varied and specific to each drug
- Monitor therapeutic effects varied depending on the viral infection, and range from delayed progression of HIV infection and AIDS as well as a decrease in flulike symptoms, a decrease in the frequency of herpetic flare-ups, or a crusting over of herpetic lesions
Immunity
- Immune response: Antigens are foreign proteins from an invading organism
- Specific information is imprinted into a cellular “memory bank” of the immune system
- The body can then effectively fight any future invasion by that same organism by mounting an immune response
- Antibodies are immunoglobulin molecules that have antigen-specific amino acid sequences
- Immunoglobulin molecules: glycoprotein molecules synthesized by the humoral immune system for the purpose of destroying all substances that the body recognizes as foreign
Active Immunization
- Artificial active immunization: The body is clinically exposed to a relatively harmless form of an antigen that does not cause an actual infection
- The immune system is stimulated and “remembers” this antigen if subsequent exposures occur
- The antigen does not cause a full-blown infection
- Natural active immunization: A person acquires immunity by surviving the disease itself and producing antibodies to the disease-causing organism.
Passive Immunization
- Artificial passive immunization: administration of serum or concentrated immunoglobulins
- The inoculated person is given the substance needed to fight off the invading microorganism
- This type of immunization bypasses the host’s immune system
- Natural passive immunization: Antibodies are transferred from the mother to her infant in breast milk or through the bloodstream via the placenta during pregnancy
Biological Antimicrobial Drugs
- Biological antimicrobial drugs are used to prevent, treat, or cure infectious diseases and are also called biologicals
- Antitoxins and antisera exist
- Toxoids and vaccines are known as immunizing biologicals and target a particular infectious microorganism
Toxoids
- Toxoids are antigenic preparations of bacterial exotoxins
- They are detoxified with chemicals or heat and are weakened or “attenuated”
- Toxoids cannot revert back to a toxic form
- Toxoids stimulate the immune system to produce specific antibodies and create artificial active immune response
- Toxoids protect against future exposures (e.g., to toxin-producing bacteria that cause diphtheria and tetanus)
Vaccines
- Vaccines are suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms
- These slight alterations in the bacteria and viruses prevent the injected person from contracting the disease
- Vaccines also stimulate the production of antigens against a specific antibody
- Vaccinations with live bacteria or virus provide lifelong immunity
- Vaccinations with killed bacteria or virus provide partial immunity and require booster shots periodically
- Example: influenza and pneumonia vaccines
Inactivated Drugs
- Hepatitis B virus vaccine (inactivated) (Recombivax HB®, Engerix-B®) is a noninfectious viral vaccine containing hepatitis B surface antigen (HBsAg)
- Antigenic HBsAg is used to promote active immunity to hepatitis B infection in persons considered at high risk for potential exposure to the hepatitis B virus or HBsAg-positive materials (e.g., blood, plasma, serum)
- Recommended: all children (usually started shortly after birth) and adults with diabetes
Influenza Vaccine
- Needs to be given each year before influenza season begins
- Single most important influenza control measure
- FluMist Quadrivalent® is given intranasally, whereas the others are given intramuscularly or intradermally
- The National Advisory Committee on Immunization (NACI) recommends that all persons older than 6 months of age receive the influenza vaccine
- The influenza vaccine Fluad is specifically indicated for older adults (>65 years of age)
Other Vaccines
- Measles, mumps, and rubella virus vaccine (live)
- Meningococcal vaccine
- Pneumococcal vaccine, polyvalent and 13 valent
- Poliovirus vaccine (inactivated)
- Rabies virus vaccine
- Human papillomavirus vaccine
- Herpes zoster vaccine
- Varicella virus vaccine
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