Pharmacology Final Review: Antibiotics, Penicillin, Contraceptives

Antibiotics and Infections

• Too much antibiotic use can cause an overgrowth of flora, leading to yeast infections, secondary infections, or superinfections
• Antibiotics are often given with antifungals to avoid superinfections, and are contraindicated for breastfeeding mothers

Penicillin

• Common side effect of penicillin is diarrhea
• Patients with cephalosporin allergy may also be allergic to penicillin

Culture Sensitivity

• Taking a culture of a bacteria to determine what type it is and what it reacts to/what can kill it
• Broad-spectrum medications are given initially, while narrow-spectrum medications are given once the organism is identified

Oral Contraceptives

• Ineffective if taken while on antibiotic therapy
• Smoking is contraindicated

Assessment

• The nurse's FIRST step when there is any change in a patient's status is to ASSESS

Injection Methods

• Z-track method is used for intramuscular injections

Sulfa Drugs

• Photosensitivity: stay out of the sun
• Drink plenty of fluids
• Lowers blood sugar

Aminoglycosides

• Monitor BUN and creatinine levels

Fluoroquinolones

• Also known as Cipro, can cause tendon damage after 18-30 days of use
• Take with food to reduce stomach discomfort
• Patient education:
  • Drink plenty of fluids to dilute harmful effects
  • Avoid dairy products and juices containing calcium
  • Avoid sun exposure
  • Not recommended for patients under 18 years old
• Monitor for numbness, tingling in hands and/or feet, and tendonitis
• Note: Cipro and Levaquin are both fluoroquinolones and should not be administered together

TB Treatment

• Treatment duration: 1 year for active TB, 6 months for exposure
• Monitor for changes in vision

Antifungals

• Suffix: -azoles

Anti-TB Drugs

• Isoniazid (INH) is a common drug used for TB treatment

Viral Infections

• Antivirals are virustatic, but not virucidal, meaning they stop viral reproduction but don't kill viruses
• Used to treat HIV and prevent viral replication

HIV Infections

• Instruct patients to continue taking HIV medications even after pregnancy
• HIV medications affect the liver
• Monitor for changes in vision

Insulin

• Regulates sugar, fat, and protein, primarily sugar, at the cellular level
• Always check blood sugar before insulin administration
• Regular insulin works fast, NPH insulin works slow, and Lispro insulin works rapidly

Diabetes

• Signs of undiagnosed diabetes: darkening skin patches, increased thirst, urination, and hunger
• Complications of poorly managed diabetes: frequent thirst, urination, fruity breath, and increased infections
• Three P's of diabetes: polydipsia, polyuria, and polyphagia

Antidepressants

• Take 10-14 days to work
• Contraindicated in patients with vision problems
• Monitor for muscle twitching
• Never abruptly stop taking antidepressants

Bipolar Disorder

• Lithium is the main drug used for treatment
• Monitor for weakness, lethargy, and sodium levels
• Avoid excessive exercise

Antianxiety Medications

• Buspirone binds to serotonin and dopamine receptors
• Common benzodiazepines: Xanax, Ativan, Valium, and Klonopin

Sedatives

• Relax patients to sleep
• Usually used for insomnia

Anticonvulsants

• Monitor sodium levels
• Oxcarbazepine is given in a patch

Analgesics

• Given to relieve pain
• Can change patient's perception of pain or reduce painful stimuli

Mental Health

• Mental health drugs can affect the brain and nervous system
• Never abruptly stop taking antidepressants
• Monitor for suicidal thoughts
• Avoid mixing classes of medications

Pharmacology

• Always check for allergies before administering medications
• Rotate injection sites
• Make sure to check the 9 rights of drug administration
• Document time and place of administration
• Drink plenty of water with enteric-coated capsules
• Vials: push air into before withdrawal
• EpiPens: teach patients around age 5
• Injection site for 6-month-old: upper thigh### Infections and Antibiotics
• Tuberculosis (TB) is transmitted through the air (airborne droplets) and treated for 1 year for active cases and 6 months for exposure.
• Antifungal medications have the suffix "-azoles".
• Ringworm treatment involves griseofulvin (generic) or Grifulvin V (Trade), which affects the liver and may cause urine discoloration.
• Diarrhea is a common side effect of pinworm anthelmintic treatment.

Viral Infections

• Antivirals are virustatic, not virucidal, meaning they stop viral reproduction but don't kill viruses.
• Pregnant women should avoid contact with RSV (respiratory syncytial virus).
• Zorivax (Trade) or acyclovir (generic) should not be taken with dairy products.
• Tamiflu (Trade) or oseltamivir (generic) can only be taken within 24-48 hours of flu symptom onset.

Diabetes

• Insulin regulates sugar, fat, and protein, primarily sugar, at the cellular level.
• Always check blood sugar before insulin administration.
• The three P's of Diabetes are: Polydipsia (increased thirst), Polyuria (increased urination), and Polyphagia (increased hunger).
• Regular insulin works fast and is short-acting, while NPH insulin works slow and is long-acting.

Mental Health

• Antidepressants take 10-14 days to work and are contraindicated in patients with vision problems.
• Never abruptly stop taking antidepressants, as they affect the brain and nervous system.
• Benzodiazepines are used for short-term anxiety and have a high addiction potential.
• Narcan (Trade) or naloxone (generic) is the antidote for narcotics.

Medication Administration

• Always rotate injection sites.
• Transdermal patches should be applied with gloves on to prevent skin absorption.
• Check the 9 rights of drug administration: right patient, right medication, right dose, right route, right time, right reason, right documentation, right response, and right evaluation.
• High alert drugs are medications that can cause harm if administered in error.

Additional Notes

• Hormone replacement therapy for menopause can cause breast tenderness, bleeding, fluid retention, headache, weight gain, and acne.
• Thyroid medications should be taken lifelong, and breastfeeding is not recommended.
• Anti-thyroid medications require liver function monitoring and eye color checks.
• Lactulose is used to clear out toxins and reduce ammonia levels in the blood for patients with liver disease.

Nursing Interventions

• For loop diuretics, give in the AM, administer slowly via IV to prevent hypotension, and monitor sodium and potassium levels.

• For antacid therapy, take with meals or soon after, and at bedtime.

• For Reglan (metoclopramide), take on an empty stomach, 30 minutes before meals, and monitor for constipation, diarrhea, hypotension, hypertension, bradycardia, tachycardia, dry mouth, and drowsiness.### Subcutaneous Injections

• Nitroglycerin is administered through a patch or orally (up to 3 tabs, 5-minute intervals) and should not be stopped abruptly.

Angina

• Unstable angina occurs when symptoms are present at rest, while stable angina occurs when symptoms are triggered by physical activity.

Transdermal Patch

• Wear gloves when applying a transdermal patch and only apply to closed wounds.

Parenteral Medication

• Instruct patients to sit up and rinse their mouth after using a meter dose inhaler to prevent thrush.

IV Drugs

• IV drugs are administered directly into the vein using a syringe through a needleless port or saline lock.
• Preparation involves medication reconciliation or dilution.

Medication Administration

• Do not crush capsules.
• Stay in the room and observe the patient taking medication.
• Swallow capsules whole.
• Administer eyedrops 5 minutes apart, in the conjunctival sac.

Enteric Coated Tablets

• Teach patients to drink plenty of water, not to crush or chew, and avoid taking antacids with enteric coated tablets.

IM Injections

• For a 6-month-old, administer IM injections in the thigh (vastus lateralis muscle) using the z-track method.

EpiPen

• EpiPen can be administered through clothing, in the thigh.

IV Pumps

• If an IV pump is not flowing correctly, check for clamps, kinks, or site issues.

NG Tubes

• To prevent harm, elevate the bed, check for placement by testing pH, and drink water when inserting the NG tube.

Infections

• Secondary infections occur during or after treatment for another infection.
• Urinalysis is used to determine a UTI.

Antibiotics

• Penicillin side effects include nausea, vomiting, diarrhea, rash, abdominal pain, and urticaria.
• Antibiotics can reduce the effectiveness of contraceptives.
• Cephalosporin should not be given to patients allergic to penicillin.
• Tetracycline teaching points: avoid sun, no alcohol.
• Gentamicin is an aminoglycoside antibiotic that kills bacteria or prevents growth.
• Bactrim (sulfa drug) teaching points: drink water to prevent crystal formation.
• Fluoroquinolones teaching points: drink 2L of water per day.

TB and HIV

• TB is an airborne precaution.
• Patients with HIV must continue taking medications if they become pregnant.

Antihistamines

• Watch for: BP, bulging eyes.

Inhaled Anti-Inflammatory

• Side effects: thrush, cough, sore throat.

Cromolyn Sodium

• Used for exercise-induced inhalation.

Pediatrics

• Infants are most at risk for overdosing.

Thiazides

• Reduce blood pressure by increasing fluid loss to urine, leading to decreased extracellular fluid and plasma volume, resulting in diminished venous return, increased renin release, reduced cardiac output, and decreased blood pressure.

Lasix

• Teaching points: drink water to avoid fluid restriction.

Prostate Health

• Prosguards help maintain a healthy prostate and relax men's muscles to urinate.
• Use protection when sexually active.

Statin Drugs

• Cholesterol drug, take at night, no alcohol, no grapefruit juice.

Loop Diuretics

• Take potassium with Lasix to prevent loss of potassium.
• Nursing actions: assess vital signs, watch for decreased blood pressure, signs of dehydration, monitor weight loss, check potassium levels, give in the morning, and teach patient to notify if experiencing signs of weakness, muscle cramping, numbness or tingling, or irregular heartbeat.

Phenazopyridine

• Check liver (ALT/AST) before administration, and do not give to patients with liver problems.

Antihistamines

• Treat allergy symptoms by blocking the effects of histamine.