Podcast
Questions and Answers
Which of the following pathogens is a virus?
Which of the following pathogens is a virus?
What is a common symptom indicating a potential sepsis trigger?
What is a common symptom indicating a potential sepsis trigger?
Which antiinfection agent is known to target bacterial cell walls and is similar to penicillins?
Which antiinfection agent is known to target bacterial cell walls and is similar to penicillins?
What is a significant side effect to monitor when using tetracyclines?
What is a significant side effect to monitor when using tetracyclines?
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Which of the following is NOT a fungus-related pathogen?
Which of the following is NOT a fungus-related pathogen?
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What is the usual duration for the continuation phase of tuberculosis treatment using Isoniazid and Rifampin?
What is the usual duration for the continuation phase of tuberculosis treatment using Isoniazid and Rifampin?
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Which adverse effect is most commonly associated with Isoniazid treatment?
Which adverse effect is most commonly associated with Isoniazid treatment?
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Which of the following should be avoided when administering Isoniazid?
Which of the following should be avoided when administering Isoniazid?
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What is a nursing consideration when a patient is receiving antibiotics?
What is a nursing consideration when a patient is receiving antibiotics?
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What test is typically used to diagnose tuberculosis?
What test is typically used to diagnose tuberculosis?
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Which medication is primarily indicated for managing agitation and anxiety in a dying patient?
Which medication is primarily indicated for managing agitation and anxiety in a dying patient?
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Which medication is most effective in minimizing death rattle?
Which medication is most effective in minimizing death rattle?
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What is the potential consequence of administering isotonic IV fluids to an actively dying patient?
What is the potential consequence of administering isotonic IV fluids to an actively dying patient?
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Which of the following medications is NOT an appropriate choice for managing nausea in a dying patient?
Which of the following medications is NOT an appropriate choice for managing nausea in a dying patient?
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Which laxative is considered the most comfortable for an actively dying patient?
Which laxative is considered the most comfortable for an actively dying patient?
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What is the main action of NRTIs in the treatment of HIV?
What is the main action of NRTIs in the treatment of HIV?
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Which of the following is classified as a protease inhibitor?
Which of the following is classified as a protease inhibitor?
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What is the goal of antiretroviral therapy for patients infected with HIV?
What is the goal of antiretroviral therapy for patients infected with HIV?
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Which drug is an example of an integrase inhibitor?
Which drug is an example of an integrase inhibitor?
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Which markers should be established as baseline before initiating antiretroviral therapy?
Which markers should be established as baseline before initiating antiretroviral therapy?
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What potential toxicity should be monitored during antiretroviral therapy?
What potential toxicity should be monitored during antiretroviral therapy?
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What is the primary therapeutic class of acyclovir?
What is the primary therapeutic class of acyclovir?
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What adverse effect is possible with intravenous administration of acyclovir?
What adverse effect is possible with intravenous administration of acyclovir?
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What is a primary nursing consideration during antiretroviral therapy?
What is a primary nursing consideration during antiretroviral therapy?
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Which medication is specifically mentioned for managing mild to moderate pain?
Which medication is specifically mentioned for managing mild to moderate pain?
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What side effect is associated with Non-Nucleoside Reverse Transcriptase inhibitors (NNRTIs) such as doravirine?
What side effect is associated with Non-Nucleoside Reverse Transcriptase inhibitors (NNRTIs) such as doravirine?
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Which parasitic infection is most common in the US?
Which parasitic infection is most common in the US?
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What type of pain management medication is acetaminophen particularly relevant for?
What type of pain management medication is acetaminophen particularly relevant for?
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Which side effect can occur from overdose of acetaminophen?
Which side effect can occur from overdose of acetaminophen?
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What is the goal of medication for end-of-life care?
What is the goal of medication for end-of-life care?
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Which medication is known to potentially cause serotonin syndrome?
Which medication is known to potentially cause serotonin syndrome?
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Study Notes
Antiinfections
- Pathogens include bacteria (TB, pneumonia, cellulitis, bronchitis, STDs, UTIs, traveler's diarrhea, URIs), viruses (hepatitis, HIV, shingles, flu, COVID, norovirus, herpes simplex), fungi (candidiasis, pneumocystis pneumonia, histoplasmosis), and parasites (tapeworms, lice, mosquitoes, bedbugs, scabies).
- Antiinfection agents either kill the pathogen or stop its reproduction.
Sepsis Triggers
- Elevated white blood cell count (WBC)
- Fever, chills, weakness, fatigue
- Elevated lactic acid
- Hypotension
- Tachycardia
- Hypercapnia
- Hypoxia
- Inflammation
- Positive blood cultures
Sepsis Treatment
- Fluid resuscitation is the priority.
- Obtain blood cultures immediately.
- Initiate broad-spectrum antibiotics within one hour.
- Iatrogenic sepsis examples for UTI and abdominal infections include Zosyn/Tazobactam 3.375g q8h and Vancomycin 15mg/kg q12h.
- For pneumonia, add Levofloxacin 750mg IV q24h.
- For simple sepsis or community-acquired pneumonia, Ceftriaxone (Rocephin) 1g IV q24h, plus Doxycycline 100mg IV q12h or Levofloxacin 750mg IV q24h.
- Narrow treatment is adjusted based on culture results and sensitivities.
Four Basic Mechanisms of Antibiotic Action
- Interference with bacterial cell wall synthesis (penicillins, cephalosporins)
- Inhibition of bacterial protein synthesis (aminoglycosides, tetracyclines)
- Interruption of nucleic acid synthesis (fluoroquinolones)
- Interference with bacterial metabolism (sulfonamides, trimethoprim)
Knowing Antibiotics
- Some antibiotics are bactericidal, while others are bacteriostatic.
- Broad-spectrum antibiotics are effective against both gram-positive and gram-negative bacteria.
- No antibiotics are effective against viruses.
- Avoid giving IV antibiotics concurrently with antacids.
- Monitor for allergic reactions (rash, hives), especially after the first dose.
- Metronidazole (Flagyl) is unique in treating protozoal infections.
Classes of Antibiotics
- Penicillins (Ampicillin, Amoxicillin)
- Cephalosporins (Cephalexin, Cefepime, Ceftriaxone)
- Tetracyclines (Doxycycline, Tetracycline)
- Macrolides
- Aminoglycosides
- Fluoroquinolones (Ciprofloxacin, Levofloxacin)
- Sulfonamides (Bactrim, Septra, Sulfasalazine)
Treating Tuberculosis
- Mycobacterium tuberculosis is slow-growing.
- It commonly infects the lungs.
- Treatment involves intensive and continuation phases.
- Latent TB treatment is 9 months of Isoniazid (INH).
- Active TB requires a 6-12-month treatment regimen combining Isoniazid, Rifampin, Pyrazinamide, and Ethambutol.
- Diagnostic methods include Mantoux skin test, Quantiferon tests, sputum culture, and CXR.
Isoniazid (INH)
- Route: Oral (PO) and intramuscular (IM) injection (rare).
- Administration: avoid giving it within two hours of antacids (aluminum).
- Adverse effects include peripheral numbness, tingling, and hepatotoxicity.
- Contraindicated with disulfiram.
- Consider concurrent pyridoxine (vitamin B6) administration. Monitor liver enzymes regularly.
- Complete the full treatment course.
Adverse Effects of Antibiotics
- Severe allergic reactions (anaphylaxis)
- Severe watery/bloody diarrhea (Clostridium difficile infection)
- Stomach cramps
- Yeast infections (mouth or vagina)
Nursing Care for Patients on Antibiotics
- Verify allergies before starting antibiotics.
- Monitor vital signs (especially temperature).
- Watch for adverse reactions in the first two hours.
- Maintain adequate hydration.
- Provide patient teaching about the medication dose, schedule, and possible side effects.
- Offer probiotics (yogurt) with oral antibiotics to maintain the gut flora.
- Consider sensitivities if antibiotic doesn't work, consider changing to another antibiotic.
- Inquire about any OTC medications, or contraceptives and monitor accordingly.
Classes of Antiretrovirals
- Nucleoside/Nucleotide reverse transcriptase inhibitors (NRTIs) (Abacavir, Trizivir, Biktarvy)
- Non-nucleotide reverse transcriptase inhibitors (efavirenz, etravirine, nevirapine)
- Protease inhibitors (Atazanavir, Lopinavir)
- Entry inhibitors (Maraviroc)
- Integrase inhibitors (Biktarvy, Dolutegravir)
- Combination therapy is necessary for HIV-infected patients
Pharmacotherapy with Antiretrovirals
- Establish baseline CBC, BMP, CD4, viral load, liver, and kidney studies.
- Monitor for concurrent infections.
- Monitor for hepatic, renal, and neurotoxicity.
- Monitor glucose and lipid levels.
- Emphasize adherence to the drug regimen.
- Assess for body image issues.
- The therapy goal is to reduce viral load and prevent opportunistic infections.
NRTIs
- Abacavir, Emtricitabine, Lamivudine, Zidovudine
- Inhibit the HIV enzyme that makes copies of itself.
Prototype Drug: Acyclovir
- Therapeutic class: antiviral for herpesviruses
- Pharmacologic class: nucleoside analog
- Treatment for herpes viruses, prevents viral DNA synthesis, decreases duration and severity of episodes.
- May reduce frequency of herpes recurrences (does not cure)
- Adverse effects can occur with IV administration: nephrotoxicity and neurotoxicity, and resistance can develop.
Nursing Considerations during Antiretroviral Therapy
- Monitor kidney and liver function, heart function
- Manage side effects (skin rash, weight gain, fever, fatigue, joint pain, headache, eye swelling).
- Patient education.
- Teach patients about managing HIV medications as a required lifetime treatment.
- Monitor for side effects and complications.
- Genetic testing before initiation, especially for NRTIs such as Trizivir or Ziagen.
- Avoid non-nucleoside reverse transcriptase inhibitors (NNRTIs) like doravirine in patients with mental illness.
Parasites
- Protozoa (malaria, dysentery, giardiasis); Malaria is a serious worldwide disease with significant mortality and morbidity.
- Helminths (wormlike creatures); Examples: tapeworms, roundworms, Enterobius vermicularis (pinworm).
- Arthropods (ticks, lice, mites); can be vectors for other diseases like bubonic plague.
Pharmacotherapeutic Management of Pain
- Pain is a sensory or emotional experience
- Opioid analgesics include Morphine, Codeine, Hydrocodone, Fentanyl, Oxycodone, Methadone, Tramdol.
- Non-opioid analgesics include Acetaminophen (for mild-moderate pain and fever) and Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ASA, Ibuprofen, Naproxen.
- Antidepressants (Duloxetine, Amitriptyline)
- Antiepileptics (Gabapentin, Pregabalin)
- Local anesthetics (lidocaine patch)
Side Effects of Pain Medications
- Opioids: respiratory suppression, sedation, mental instability, abnormal EKG
- NSAIDs: GI upset
- Lidocaine: arrhythmias, seizures, loss of consciousness
- Duloxetine: serotonin syndrome, tachycardia, seizures, coma
- Acetaminophen: overdose can cause liver damage
Medications for End-of-Life Care
- Goal: palliative care, managing anxiety and pain.
- Medications like morphine sulfate, acetaminophen, haloperidol, lorazepam, atropine sulfate, bisacodyl, and antidepressants.
End-of-Life Quiz Questions
- Specific question about which medications are appropriate for a patient experiencing symptoms in end-of-life.
Febrile Actively Dying Patient Needs
- Acetaminophen (PR or PO) is suggested.
Haloperidol Use
- For agitation and anxiety
Impending Death and Anxiety
- Lorazepam, diazepam, xanax, and clonazepam as appropriate.
Gurgling Breathing Sounds
- Sublingual atropine drops
Death Rattle Management
- Atropine
Dyspnea and Air Hunger Management
- Morphine Sulfate
Nausea Management in Dying Patients
- Ondansetron, Prochlorperazine, Metoclopramide (excluding Dronabinol)
Comfortable Laxative for Dying Patients
- Bisacodyl suppository
IV Fluids for Actively Dying Patients
- Contraindicated, May prolong suffering; Isotonic fluids are preferred.
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Description
Test your knowledge on pathogens, antibiotics, and nursing considerations in pharmacology. This quiz covers various types of infections, their treatments, and the implications for patient care in clinical settings. It is essential for nursing students and healthcare professionals to understand these concepts.
