UNITS 4&5
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UNITS 4&5

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Questions and Answers

Which side effect is most commonly associated with Bupropion?

  • Orthostatic hypotension
  • Blurred vision
  • Weight loss (correct)
  • Drowsiness

    • What is a significant complication of Duloxetine that requires monitoring in children and adolescents?

  • Dry mouth
  • Sedation
  • Suicidal thoughts (correct)
  • Weight gain

    • Which drug requires a washout period before introducing other medications due to its potential for hypertensive crisis?

  • Phenelzine (correct)
  • Duloxetine
  • Amitriptyline
  • Methylphenidate

    • What is a notable contraindication for the use of Atomoxetine?

    <p>Renal impairment</p> Signup and view all the answers

    Which of the following medications is likely to cause extrapyramidal symptoms (EPS)?

    <p>Haloperidol</p> Signup and view all the answers

    Which condition is not a common complication of Tricyclic antidepressants (TCAs)?

    <p>Hypertension</p> Signup and view all the answers

    Which neurotransmitter is primarily involved in regulating nerve and muscle coordination?

    <p>Acetylcholine</p> Signup and view all the answers

    What is a significant characteristic of Generalized Anxiety Disorder (GAD)?

    <p>Symptoms persisting for 6 months or longer</p> Signup and view all the answers

    Which class of drugs is commonly associated with the potential for physical dependence?

    <p>Benzodiazepines</p> Signup and view all the answers

    What effect do SSRI antidepressants generally have?

    <p>Restore serotonin levels at synapses</p> Signup and view all the answers

    Which of the following disorders is characterized by compulsive behaviors such as hand washing or counting rituals?

    <p>Obsessive-Compulsive Disorder</p> Signup and view all the answers

    Which neurotransmitter is primarily associated with inhibiting nerve activity?

    <p>GABA</p> Signup and view all the answers

    What is a key consequence of using Monoamine Oxidase Inhibitors (MAOIs) without dietary precautions?

    <p>Elevated blood pressure</p> Signup and view all the answers

    What is the primary approach of non-pharmacological management for anxiety disorders?

    <p>Addressing the underlying cause</p> Signup and view all the answers

    Which of the following is true regarding the use of antidepressants in treating anxiety?

    <p>SSRIs are preferred for their lower side effects.</p> Signup and view all the answers

    Which of the following is a complication associated with SSRI medications?

    <p>Serotonin syndrome</p> Signup and view all the answers

    What is the primary pharmacological action of benzodiazepines?

    <p>Potentiating the effects of GABA</p> Signup and view all the answers

    What is a significant contraindication for the use of Buspirone?

    <p>Recent use of MAOIs</p> Signup and view all the answers

    Which side effect is commonly associated with sertraline?

    <p>Serotonin syndrome</p> Signup and view all the answers

    Which statement about benzodiazepines is accurate?

    <p>They are preferred for treating anxiety and insomnia.</p> Signup and view all the answers

    What complication can result from taking Zolpidem?

    <p>Sleepwalking and nocturnal eating</p> Signup and view all the answers

    What is advised when discontinuing long-term benzodiazepine use?

    <p>Discontinue over weeks to months to prevent withdrawal</p> Signup and view all the answers

    Which of the following symptoms indicates a need to monitor for serotonin syndrome?

    <p>High blood pressure with confusion</p> Signup and view all the answers

    What effect does Fluoxetine have regarding serotonin in the brain?

    <p>Inhibits the reuptake of serotonin</p> Signup and view all the answers

    What is a critical nursing consideration when administering lorazepam?

    <p>Monitor respiratory rate closely</p> Signup and view all the answers

    What is a significant risk associated with the administration of isoniazid in patients?

    <p>Neurotoxicity and B6 deficiency</p> Signup and view all the answers

    Which statement correctly describes the mechanism of action of Amphotericin B?

    <p>Binds to ergosterol in fungal cell membranes</p> Signup and view all the answers

    What is the primary alternative treatment for superficial fungal infections?

    <p>Topical Nystatin</p> Signup and view all the answers

    Which is a common complication of using Amphotericin B for systemic fungal infections?

    <p>Hypokalemia</p> Signup and view all the answers

    Which protozoan infection is specifically caused by Plasmodium?

    <p>Malaria</p> Signup and view all the answers

    What is the primary effect of Chloroquine in treating malaria?

    <p>Helps reduce elevated body temperature</p> Signup and view all the answers

    What is the main therapeutic action of penicillins?

    <p>Disrupts bacterial cell wall</p> Signup and view all the answers

    Which type of antibiotic is primarily effective against Gram-negative organisms?

    <p>Cephalosporins</p> Signup and view all the answers

    What adverse effect is most commonly associated with tetracyclines?

    <p>Permanent tooth discoloration</p> Signup and view all the answers

    Which of the following classes of antibiotics is most likely to cause ototoxicity?

    <p>Aminoglycosides</p> Signup and view all the answers

    What is a key nursing consideration when administering fluoroquinolones?

    <p>Monitor for signs of tendonitis</p> Signup and view all the answers

    Which antibiotic is not recommended for use in patients with severe renal disease?

    <p>Gentamicin</p> Signup and view all the answers

    What serious complication can occur with rapid administration of Vancomycin?

    <p>Red man syndrome</p> Signup and view all the answers

    What critical monitoring parameter is necessary for patients on aminoglycosides?

    <p>Peak and trough serum levels</p> Signup and view all the answers

    Which drug class is commonly used to treat severe infections caused by Gram-positive bacteria, including MRSA?

    <p>Glycopeptides</p> Signup and view all the answers

    Which statement accurately describes the pathogenicity of an organism?

    <p>It denotes how infectious an organism is.</p> Signup and view all the answers

    What is the primary distinction between gram-positive and gram-negative bacteria?

    <p>Gram-positive bacteria retain a stain, indicating a thick cell wall.</p> Signup and view all the answers

    Which pathogen is commonly associated with causing tuberculosis?

    <p>Mycobacterium Tuberculosis</p> Signup and view all the answers

    What characterizes the acute stage of infection?

    <p>Peak symptoms with maximum impact on the host.</p> Signup and view all the answers

    Which class of anti-infective agents is designed to inhibit the replication of bacteria rather than killing them?

    <p>Bacteriostatic</p> Signup and view all the answers

    What is a significant consequence of widespread antibiotic use?

    <p>Development of drug-resistant bacterial strains.</p> Signup and view all the answers

    Which of the following best defines virulence?

    <p>The degree to which a pathogen can cause disease.</p> Signup and view all the answers

    Which of the following bacterium is known to cause urinary tract infections?

    <p>E. Coli</p> Signup and view all the answers

    What is the role of selective toxicity in anti-infective therapies?

    <p>To selectively damage bacterial cells while sparing human cells.</p> Signup and view all the answers

    Which of the following statements about the prodromal stage of disease is accurate?

    <p>The disease can still be transmitted even if symptoms are mild.</p> Signup and view all the answers

    Which of the following antibiotics requires monitoring for hepatotoxicity due to its potential side effects?

    <p>Ciprofloxacin</p> Signup and view all the answers

    What characteristic is most concerning when administering Metronidazole?

    <p>It is known to cause crystalluria if patients are not well-hydrated.</p> Signup and view all the answers

    Which drug is most likely to cause red man syndrome if administered too rapidly?

    <p>Vancomycin</p> Signup and view all the answers

    Which class of antipsychotics is likely to cause extrapyramidal symptoms?

    <p>Conventionals like Phenothiazines</p> Signup and view all the answers

    What key nursing consideration should be taken when managing a patient on opioid withdrawal treatments like Methadone?

    <p>Monitor for signs of severe respiratory depression.</p> Signup and view all the answers

    Which medication is noted for causing a risk of retinopathy and potential vision loss?

    <p>Chloroquine</p> Signup and view all the answers

    Which of the following drugs is known for potential nephrotoxicity?

    <p>Amphotericin B</p> Signup and view all the answers

    In the management of schizophrenia, which antipsychotic is recognized for a significant risk of weight gain and metabolic complications?

    <p>Risperidone</p> Signup and view all the answers

    Which of the following is an accurate statement concerning the treatment of HIV as it progresses to AIDS?

    <p>The patient may remain asymptomatic even after transitioning to AIDS.</p> Signup and view all the answers

    Study Notes

    Unit 5 - Nervous System

    • Chemical Transmission Nerves communicate with other nerves/effectors through the release of neurotransmitters.

    • Neurotransmitters are released from the presynaptic nerve and act on the postsynaptic effector cell, either exciting or inhibiting it.

    • Important Neurotransmitters

      • Norepinephrine influences mood, alertness, and arousal
      • Acetylcholine plays a role in nerve/muscle coordination
      • Dopamine aids in impulse coordination
      • GABA inhibits nerve activity
      • Serotonin regulates mood, sleep, appetite, and cognition

    • Types of Anxiety Disorders

      • Generalized Anxiety Disorder (GAD) characterized by persistent worry, anxiety, and physical symptoms for at least six months
      • Panic Disorder involves sudden episodes of intense fear and physical symptoms (lasts for less than 10 mins)
      • Phobias are persistent fears of specific objects or situations that trigger intense anxiety
      • Social Anxiety Disorder marked by fear of social situations and scrutiny
      • Obsessive-Compulsive Disorder (OCD) involves recurrent, intrusive thoughts (obsessions) that cause anxiety and repetitive behaviors (compulsions) to alleviate the anxiety.
      • Post-Traumatic Stress Disorder (PTSD) developed after experiencing a traumatic event, typically characterized by flashbacks, nightmares, avoidance of triggers, and heightened arousal.

    • Neural Systems: Anxiety and Wakefulness

      • The limbic system plays a crucial role in emotional expression, learning, and memory.
      • The limbic system sends signals to the hypothalamus which orchestrates physiological responses to stress.
      • Stress triggers the fight-or-flight response, stimulating the autonomic nervous system.
      • The reticular formation modulates arousal, wakefulness, and sleep-wake cycles via the reticular activating system (RAS), a network in the brainstem important for consciousness.

    • Non-Pharmacological Management for Anxiety

      • Addressing the cause of the anxiety is critical
      • Counseling can provide coping mechanisms and therapies like CBT (Cognitive Behavioral Therapy)
      • Meditation and mind-body techniques can help manage anxiety symptoms
      • Herbal remedies offer potential support, although their efficacy is not always scientifically proven.

    • Insomnia

      • Short-term insomnia: typically caused by stress, diet, lifestyle disruptions, or caffeine/alcohol consumption.
      • Long-term insomnia: persists for 30+ days, can be a symptom of depression, mood disorders, or chronic pain.
      • Non-pharmacological intervention for insomnia is the first line of treatment.

    Anxiolytic Drugs - Treatment of Anxiety and Insomnia

    • Anxiolytic Drugs aim to restore balance in neurotransmitter levels, particularly serotonin and norepinephrine.

    Classes of Anxiolytic Drugs

    - **Antidepressants** 
    - **SSRIs** (Selective Serotonin Reuptake Inhibitors): commonly used due to fewer side effects, potential for suicidal ideation should be monitored.
    - **TCAs** (Tricyclic Antidepressants): not recommended for individuals with cardiac issues, pregnancy categories C & D, potential for serious side effects.
    - **MAOIs** (Monoamine Oxidase Inhibitors): rarely used, strict dietary restrictions (tyramine in aged foods) due to high risk of severe reactions (hypertensive crisis).

- **Benzodiazepines** 
    - **Schedule IV drugs:** considered relatively safe, higher margin of safety compared to barbiturates, mostly administered orally (PO). 
    - **Parenteral (IV) Routes**:  monitor closely, use with caution, risk of respiratory depression.

- **Barbiturates**  
    - **Schedule II drugs:**  higher risk of dependence and abuse, rarely prescribed due to serious adverse effects and potential for life-threatening withdrawal.

- **Non-Barbituate, Non-Benzodiazepine CNS Depressants**
    - Act on dopamine and GABA receptors, depending on specific medication. 
    - **Buspirone** (atypical anxiolytic): used for panic disorder, OCD and PTSD 
    - **Zolipidem** (nonbenzodiazepine, nonbarb):  facilitates GABA, short-term insomnia (7-10 days)

    Anxiolytic Drugs - Specific Agents

    Antidepressants

    • Escitalopram (Lexapro)

      • PC: SSRI
      • A&U: increases serotonin levels at the synapse
      • Complications: Serotonin Syndrome, Neuroleptic Malignant Syndrome (NMS)
      • Interactions: MAOIs (serotonin syndrome), alcohol, St. John's Wort (serotonin syndrome)
      • N/C: avoid use within 14 days of MAOIs, reduced doses for renal/hepatic impairment, dose increments should be spaced at least 1 week apart, not for children under 12 years old.

    • Paroxetine

      • PC: SSRI
      • A&U: selectively inhibits serotonin uptake
      • Complications: Nausea, diaphoresis, tremor, fatigue, drowsiness, sexual dysfunction, weight gain, GI bleeding, serotonin syndrome, bruxism, postural hypotension
      • N/C: Report any sexual dysfunction, monitor for bleeding, use mouthguards for bruxism, engage in regular exercise, sit before standing, discontinue gradually, pregnancy category D, compliance is crucial (up to 4 weeks for therapeutic effect)

    Benzodiazepines

    • Lorazepam

      • TC: Sedative-hypnotic
      • PC: Benzodiazepine
      • A&U: Enhances the effects of GABA, used as pre-anesthetic
      • Complications: Drowsiness, sedation, amnesia (high doses), weakness, disorientation, sleep disturbances, blood pressure changes, blurred vision, nausea/vomiting
      • Interactions: CNS depressants, sedation-producing herbs (kava, valerian).
      • N/C: IV administration requires close monitoring of respiratory rate, have airway and resuscitation equipment readily available, pregnancy category D.

    • Diazepam

      • TC: Sedative-hypnotic
      • PC: Benzodiazepine
      • A&U: Enhances the action of GABA, used in alcohol withdrawal, seizure disorders, and muscle spasms.
      • Complications: Paradoxical Response (opposite therapeutic effects), CNS depressants, respiratory depression, nausea/vomiting, anorexia, toxicity, physical dependence
      • Interactions: CNS depressants
      • N/C: Take with food, avoid hazardous activities, taper off over weeks to months, pregnancy category D.

    Non-Benzodiazepine, Non-Barbiturate CNS Depressants

    • Busprirone

      • TC: Atypical Anxiolytic
      • PC: Non-Barb Anxiolytic
      • A&U: Binds to serotonin receptors, used for panic disorders, OCD, PTSD
      • Complications: Dizziness, nausea, suicidal ideation, headache, lightheadedness
      • Interactions: MAOI antidepressants (discontinue 14 days before starting), St. John's Wort, grapefruit juice.
      • N/C: Effects are not immediate, dependency is less likely, doesn't cause sedation or intensify effects of other CNS depressants, monitor and report SI, increase fluids and fiber for constipation.

    • Zolipidem

      • TC: Sedative-hypnotic
      • PC: Nonbenzodiazepine, nonbarb, CNS depressant
      • A&U: Facilitates GABA, short-term insomnia management (7-10 days).
      • Complications: Daytime sedation, dizziness, depression (with suicidal ideation), adverse neuropsychiatric effects (hallucinations, sleepwalking, nocturnal eating)
      • Contraindications: Not specified in your text.
      • Interactions: CNS depressants.
      • N/C: Rapid onset, administer immediately before bedtime.

    • Melatonin

      • A&U: helps to fall asleep faster, aids in insomnia related to disrupted circadian rhythms.
      • Complications: Nausea, headache, dizziness.

    Mood Disorders

    • Depression involves an imbalance of NT’s in brain regions associated with cognition and emotion.
      • Major Depressive Disorder: Diagnostic Criteria - depressive symptoms for at least two weeks.
        • Symptoms include: sleeping too much or too little, fatigue, abnormal eating patterns, vague physical symptoms, poor concentration, indecisiveness, feelings of despair, death preoccupation, social avoidance, lack of interest, and delusions/hallucinations.
      • Situational Depression arises from specific life events.
      • Postpartum Depression (PP) may be less noticeable.
      • Seasonal Affective Disorder (SAD) "seasonal depression"
      • Psychotic Depression
      • Assessment and Treatment:
        • Assess physical and psychological factors, self-treatment behaviors (drugs/alcohol).
        • Evaluate for suicidal ideation and symptoms.
        • Treatment focuses on antidepressants, psychotherapy, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS)

    Antidepressants

    • SSRI's (Selective Serotonin Reuptake Inhibitors): commonly prescribed, target serotonin reuptake, often associated with sexual dysfunction and weight gain.
      • Serotonin Syndrome is a risk factor and monitored closely: hyperpyrexia, hypertension, confusion, diaphoresis.

    Atypical Antidepressants

    • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors):

      • Duloxetine
        • PC: SNRI
        • A&U: Treats major depression by blocking reuptake of norepinephrine and serotonin
        • Complications: Risk for suicidal ideation in children & adolescents, sexual dysfunction, serotonin syndrome, withdrawal syndrome, nausea/vomiting, anorexia, hypertension, tachycardia, dizziness, blurred vision, bronchitis
        • Interactions: MAOIs, NSAIDs, alcohol and CNS medications, St. John's Wort.
        • N/C: Monitor weight and food intake, vital signs, taper the dose.

    • NDRIs (Norepinephrine-Dopamine Reuptake Inhibitors):

      • Bupropion:
        • PC: NDRI
        • A&U: depression and aid in smoking cessation.
        • Complications: Nausea, vomiting, anorexia, weight loss, seizures, headaches, dry mouth, GI distress, constipation, increased heart rate, hypertension, restlessness, insomnia
        • Contraindications: Seizure history, eating disorders.
        • N/C: Monitor weight and food intake, be cautious in patients prone to seizures.

    TCA's (Tricyclic Antidepressants)

    • Treatment for major depressive disorder

      • Imipramine:
        • A&U: Blocks reuptake of serotonin and norepinephrine
        • Complications: Sedation, drowsiness, blurred vision
        • Interactions: CNS depressants, St. John's Wort
        • N/C: Compliance is key - 2-3 weeks for effects to appear, discontinue gradually.

    • Amitriptyline

      • A&U: Blocks norepinephrine and serotonin reuptake
      • Complications: Orthostatic hypotension, decreased seizure threshold, sedation
      • N/C: Change positions slowly, avoid hazardous activities, closely monitor patients with seizure disorders.

    MAOI's (Monoamine Oxidase Inhibitors)

    • Phenelzine
      • A&U: Irreversible inhibition of MAO, used for depression.
      • Complications: Constipation, dry mouth, hypertensive crisis
      • Contraindications: Foods with tyramine
      • N/C: Requires washout periods (2-3 weeks) before introducing other meds, abrupt discontinuation can cause rebound hypertension, avoid tyramine-containing foods (wine).

    Complementary and Alternative Therapies

    • St. John's Wort: inhibits serotonin reuptake (similar to SSRIs), potential for Serotonin Syndrome if combined with other serotonergic meds.

    Bipolar Disorder

    • Characterized by episodes of depression and mania

      • Mania: a state of high psychomotor activity, distractibility, and elevated mood.
      • Diagnosis: Manic symptoms for at least one week.

    • Mood Stabilizers - Lithium Carbonate

      • A&U: Acute mania, manages depression.
      • Complications: Lithium toxicity, renal toxicity, polyuria (excessive urination), thirst.
      • Contraindications: Renal dysfunction, sodium depletion, dehydration.
      • Interactions: Diuretics.
      • N/C: Maintain adequate hydration, monitor for toxicity, monitor sodium levels, weigh daily to track fluid balance.

    ADHD

    • Diagnosis usually made by age 12
      • Symptoms are characteristic of inattention, behavioral control issues, restlessness.
      • Contributing Factors: Genetic predisposition, alcohol or drug exposure during pregnancy, high lead levels.

    Medications for ADHD

    • Stimulants: help improve focus.

      • Methylphenidate
        • PC CNS stimulant
        • A&U: activates the reticular activating system, reduces impulsivity and enhances focus.
        • Complications: Nervousness, insomnia, irregular heartbeat, hypertension, diminished appetite (anorexia), liver toxicity, dependence
        • N/C: Schedule II drug, monitor weight weekly, administer early in the day (before 4 pm), evaluate for continuous medication need or drug holidays, do not discontinue abruptly.

    • Non-CNS Stimulants

      • Atomoxetine
        • PC: Non-CNS stimulant
        • A&U: Treats ADHD
        • Complications: Appetite suppression, weight loss, hepatoxicity.
        • N/C: Schedule meals to avoid weight loss, therapeutic effect may take up to 3 weeks, monitor liver function.

    Psychoses

    • Schizophrenia

      • Overactive dopamine pathways in basal nuclei

      • High risk for suicide.

      • Symptoms:

        • Positive: hallucinations, delusions, paranoia
        • Negative: Apathy, lack of motivation, alogia (poverty of speech), anhedonia (lack of pleasure), social withdrawal.

      • Pharmacotherapy: Does not cure schizophrenia, symptoms in remission only while taking med. Common side effects include Extrapyramidal Symptoms (EPS)

    Typical Antipsychotics

    • Phenothiazines:

      • Chlorpromazine
        • A&U: Blocks dopamine and serotonin receptors
        • Complications: EPS, NMS (Neuroleptic Malignant Syndrome), sedation, sexual dysfunction.
        • N/C: Therapeutic effect takes 8 weeks, parenteral forms available, withdraw gradually.

    • Nonphenothiazine:

      • Haloperidol
        • A&U: Blocks postsynaptic dopamine receptors, EPS common in older adults, highly potent.
        • Complications: Less sedative than other antipsychotics, EPS, NMS
        • N/C: Do not discontinue abruptly, injectable form considered if oral therapy is not followed.

    Atypical Antipsychotics:

    • Fewer EPS effects, treats both positive and negative symptoms.
      • Risperidone
        • A&U: Blocks dopamine, serotonin, and alpha-adrenergic receptors.
        • Complications: Weight gain, hyperglycemia, hypertriglyceridemia, EPS
        • N/C: Compliance is critical.

    Substance Use Disorder

    • Addiction: an overwhelming urge to use a substance despite serious consequences.

      • Physical Dependence: alcohol, sedatives, nicotine
      • Psychological Dependence: cannabinoids
      • Withdrawal Syndrome: when a physically dependent individual abruptly stops using the substance.

    • Medications to support withdrawal: benzodiazepines

    • Delirium Tremens: alcohol withdrawal syndrome characterized by tremors, vomiting, tachycardia, fever, hypertension.

    • Treatment for Alcohol Abuse: Aversion therapy

    • Cocaine Withdrawal: dilated pupils, nose bleeds, sniffing, tachycardia, seizures, hypertension, hyperthermia, hallucinations, anxiety/agitation, anorexia

    • Opioid Withdrawal: Agitation, insomnia, flu-like symptoms, yawning, sweating.

      • Treatment: Methadone substitution, clonidine, buprenorphine

    • Varenicline: medication to reduce nicotine dependence.

    Infection

    • Pathogens must bypass many body defenses to infect an individual
    • Pathogenicity is how infectious an organism is. Some infectious organisms are only infectious in certain parts of the body
    • Virulence is how well something can produce a disease
    • Production of toxins - some bacteria can make toxins that cause illness
      • Ex. → e.Coli

    Bacterial Infections

    • Gram-positive bacteria have thick cell walls and stain purple. They are killed with penicillin by driving medication through the thick cell wall
      • Examples: Staphylococci, Streptococci, Enterococci
    • Gram-negative bacteria have thinner cell walls and stain pink. They do not have thick cell walls.
      • Examples: Bacteroides, E.Coli, Klebsiella, Pseudomonas, Salmonella
    • Cell Shapes:
      • Rod Shape: Bacilli
      • Sphere: Cocci
      • Spirals: Spirilla

    Common Bacterial Infections

    • Chlamydia Trachomatis: is the most common STI. It causes venereal disease and eye infections
    • E.Coli: causes UTIs, traveler's diarrhea, and meningitis in children
    • Mycobacterium Tuberculosis: causes TB
    • Streptococcus: causes pharyngitis, pneumonia, skin infections, septicemia

    Stages of Infection

    • Incubation Period: The pathogen is replicating without producing recognizable symptoms. You don't feel sick
    • Prodromal Stage: Initial appearance of symptoms in the host. The symptoms may be vague.
    • Acute Stage: The maximum impact of the infectious process. You are VERY SICK!
    • Convalescent Period: Containment of the infection, resolution of associated symptoms.

    Anti-Infective Medications

    • The main goal of anti-infective medication is to assist the body in eliminating the pathogen.
    • Bactericidal: Kills bacteria
    • Bacteriostatic: Prevents bacteria from replicating
    • Selective Toxicity: Antibacterial medications target bacterial cell walls or biochemical pathways that are distinct from human cells. This reduces harm to human cells

    Antibiotic Resistance

    • Bacteria can quickly divide (exponential division) and make errors that lead to drug resistance
    • Antibiotic use promotes the development of drug-resistant bacterial strains.
    • Unwarranted or widespread use of antibiotics leads to higher numbers of antibiotic-resistant strains.
    • MRSA and VRE are examples of antibiotic resistant strains

    Strategies to Reduce Antibiotic Resistance

    • Use the right drug for the right culture
    • Restrict antibiotic use
    • Take the full length of the therapy
    • Finish the entire course of antibiotics.

    Culture and Sensitivity Testing

    • This helps identify the specific pathogen.
    • May take several days or weeks to complete
    • Tests which antibiotics work best
    • Start with broad-spectrum antibiotics if a severe infection is suspected. After lab testing, change to narrow-spectrum drugs.

    Common Adverse Effects of Antibiotic Use

    • Secondary Infections (Superinfections)

    Host Factors that Influence Infections

    • Immunosuppression (different diseases like HIV/AIDS)
    • Site of infection: (CNS, intracellular)
    • Allergies to certain drugs
    • Age
    • Pregnancy
    • Genetics

    Types of Antibiotics

    Penicillins

    • Due to bacterial resistance, many different types of penicillins are now available.
    • Penicillins primarily work on Gram-positive bacteria.
    • Prototype: Penicillin G
    • Therapeutic Class: Antibacterial
    • Pharmacologic Class: Penicillin
    • Action and Use: Disrupts cell walls, effective against bacteria that do not produce penicillinase.
    • Complications: N/V/D, superinfections, anaphylaxis
    • Contraindications: Hypersensitivity in PCN class, severe renal disease
    • Interactions: If on potassium-sparing diuretic = hyperkalemia. Decreases oral contraceptives effectiveness. Take at least an hour apart from aminoglycosides.
    • Nursing Considerations: Observe for possible reactions, allergy identification bracelet.

    Cephalosporins

    • Contains a beta-lactam ring
    • Bactericidal: Inhibits cell wall synthesis.
    • 5 Generations: First-generation through fifth-generation cephalosporins (each generation has a broader spectrum of activity)
    • Prototype: Cefazolin
    • Therapeutic Class: Antibacterial
    • Pharmacologic Class: First-gen cephalosporin
    • Action and Use: Attach to penicillin-binding proteins to inhibit bacterial cell wall synthesis.
    • Complications: Rash, diarrhea, superinfections, seizures (rare)
    • Contraindications: Severe Renal Disease (BUN/CR/I&O)
    • Interactions: Alcohol = disulfiram reaction (violent puking)
    • Nursing Considerations: Clients should not consume alcohol.

    Tetracyclines

    • Bacteriostatic: Slows and inhibits growth, does not kill on contact. Needs to be taken for a longer period to be effective.
    • Inhibits bacterial protein synthesis.
    • Prescribed for Mountain Spotted Fever, typhus, cholera, Lyme disease, peptic ulcers caused by H.pylori, Chlamydial infections
    • Complications: GI/Gastric distress (take with food), photosensitivity (avoid sunlight), permanent teeth discoloration (yellow or brownish color) - cannot be given to children under 8 or pregnant women (affects fetal bone growth), hepatotoxicity
    • Prototype: Tetracycline
    • Therapeutic Class: Antibacterial
    • Pharmacologic Class: Tetracycline
    • Action and Use: Broad-spectrum against gram-positive and gram-negative bacteria.
    • Complications: Superinfections, N/V/D, epigastric burning, teeth discoloration, photosensitivity
    • Contraindications: Pregnancy, children under 8, renal/hepatic impairment
    • Interactions: Milk products, iron supplements, magnesium-containing laxatives, decrease oral contraceptives
    • Nursing Considerations: PO (short half-life: QID), Take with food and a full glass of water. IM is painful, Preg cat D.

    Macrolides

    • High doses can be bactericidal
    • Effective against both gram-positive and gram-negative bacteria (broad spectrum)
    • Used for whooping cough, Legionnaire's disease
    • Treatment for Listeria, Chlamydia, Neisseria, Legionella
    • Mild GI upset, diarrhea, abdominal pain, superinfections
    • Prototype: Erythromycin
    • Therapeutic Class: Antibacterial
    • Pharmacologic Class: Macrolide
    • Action and Use: Inhibits protein synthesis, often used for patients who cannot tolerate PCN
    • Complications: N/V, abdominal cramping, hearing loss, vertigo, dizziness, cardiotoxic
    • Interactions: Anesthetics, anticonvulsants increase toxicity. St. John's Wort decreases sensitivity
    • Nursing Considerations: Empty stomach with a full glass of water, no juices before or after.

    Aminoglycosides

    • Bactericidal: Used for bad infections
    • Inhibits protein synthesis
    • Reserved for serious systemic infections caused by aerobic gram-negative organisms. (E. coli, Serratia, Proteus, Klebsiella, Pseudomonas)
    • Administered parenterally; poorly absorbed from the GI tract.
    • Permanent ototoxicity and nephrotoxicity
    • Prototype: Gentamicin
    • Therapeutic Class: Antibacterial
    • Pharmacologic Class: Aminoglycoside
    • Action and Use: Broad-spectrum
    • Complications: Rash, N/V, fatigue, ototoxicity; nephrotoxicity
    • Contraindications: Impaired renal function
    • Nursing Considerations: Only IV and IM. Withhold drug if peak serum level lies above the normal range of 5-10 mcg/mL.

    Fluoroquinolones

    • Bactericidal
    • Stops DNA synthesis by inhibiting two bacterial enzymes.
    • Mostly gram-negative
    • Preferred drug against UTIs
    • Well absorbed orally; once or twice a day
    • N/V/D, dysrhythmias, hepatotoxicity, increased risk of tendinitis and tendon rupture (Achilles tendon). Report pain and swelling in the leg
    • Prototype: Ciprofloxacin (Cipro)
    • Therapeutic Class: Antibacterial
    • Pharmacologic Class: Fluoroquinolone
    • Action and Use: Inhibits bacterial replication and DNA repair.
    • Complications: N/V/D, phototoxicity, headache, dizziness
    • Interactions: Antacids, ferrous sulfate, sucralfate decrease absorption.
    • Nursing Considerations: Can be administered with food to diminish adverse GI effects. Observe and report pain, swelling, and redness at the Achilles tendon site. Monitor for tendinitis and tendon rupture, especially in patients 60 and over or those who have had a transplant.

    Sulfonamides and Urinary Antiseptics

    • Bacteriostatic
    • Active against a broad spectrum of bacteria.
    • Inhibits the synthesis of folic acid
    • Used against UTIs
    • Complications: Crystals in urine (need to increase fluid intake to prevent crystals). N/V. Fatal blood abnormalities (monitor CBCs).
    • Prototype: Trimethoprim-sulfamethoxazole.
    • Therapeutic Class: Antibacterial
    • Pharmacologic Class: Sulfonamide
    • Action and Use: Used for UTIs. Inhibits folic acid synthesis
    • Complications: N/V, crystalluria, oliguria, renal failure, blood dyscrasias, photosensitivity
    • Contraindications: Renal impairment
    • Interactions: Increases methotrexate toxicity
    • Nursing Considerations: Administer oral doses with a full glass of water.

    Glycopeptide

    • Treatment for severe infections from gram-positive bacteria.
    • Used after bacteria become resistant to other medications.
    • Treat MRSA infections.
    • Complications: Ototoxicity, nephrotoxicity, Red Man Syndrome, hypotension, flushing, red rash in the face, neck, trunk, or upper body. Superinfection
    • Prototype: Vancomycin
    • Therapeutic Class: Antibacterial
    • Pharmacologic Class: Glycopeptide
    • Action and Use: Treats severe infections from gram-positive bacteria. Used for treatment when bacteria is resistant to other medications.
    • Complications: Ototoxicity, nephrotoxicity, Red Man Syndrome, hypotension, flushing, red rash in the face, neck, trunk, or upper body. Superinfection
    • Nursing Considerations: Monitor peak and trough levels.
    • If vancomycin is administered quickly, the risk of "Red Man Syndrome" increases.

    General Nursing Considerations for Antibiotics

    • All prototype antibiotics are processed by the liver. Monitor LFTs, ALT, AST, etc.
    • Steven-Johnson Syndrome: Report inner/outer skin burning.

    Tuberculosis

    • Latent TB: Can be reactivated if the immune system is suppressed.

    • Active TB: Invades the lungs and can spread to bones. Activates the body's immune defenses.

    • Treatment must continue for 6-12 months.

    • At least two (sometimes 4+) antibiotics are used: Isoniazid, rifampin, pyrazinamide, and ethambutol.

    • Prototype: Isoniazid.

    • Therapeutic Class: Anti-TB drug

    • Pharmacologic Class: Mycolic acid inhibitor

    • Action and Use: First-line treatment for TB. Bactericidal and bacteriostatic.

    • Complications: Neurotoxicity, rash, fever, convulsions, dizziness, memory loss, various psychoses

    • Contraindications: Severe hepatic problems

    • Interactions: Alcohol increases the risk of hepatotoxicity

    • Nursing Considerations: Take on an empty stomach, 1 hour after or 2 hours before meals. Preg Category C

    • Can cause B6 deficiency, causing neurological problems. Monitor CNS health.

    • May cause hyperglycemia.

    Fungal Infections

    • Fungal medications target ergosterol in the plasma membrane of fungi.
    • Inhalation of spores, handling contaminated soil. Can grow slowly. Symptoms may appear months after exposure.
    • Rarely transmitted through contact.
    • Superficial Fungal Infections: Localized to the scalp, skin, nails, mouth, vagina, etc. Treatment is topical.
    • Systemic Fungal Infections: Internal organs (lungs, brain, GI system), can affect multiple systems, aggressive oral or parenteral anti-fungal medications
    • Amphotericin B: preferred drug for systemic fungal infections, serious side effects

    Amphotericin B

    • Prototype: Amphotericin B
    • Therapeutic Class: Antifungal
    • Pharmacologic Class: Polyene
    • Action and Use: Broad-spectrum
    • Complications: Fever, chills, vomiting, headache, phlebitis, nephrotoxicity, hypokalemia, cardiac arrest, hypotension, dysrhythmias, ototoxicity
    • Contraindications: Renal impairment
    • Interactions: MANY, refer to a drug guide
    • Nursing Considerations: Infuse slowly via IV, risk for CV collapse. Administer premedication to decrease the risk of hypersensitivity. Months of pharmacotherapy may be required. Call if BUN is greater than 40 or Cr is greater than 3

    Fluconazole

    • Prototype: Fluconazole
    • Therapeutic Class: Antifungal
    • Action and Use: Interferes with the synthesis of ergosterol. Prevent most infections from reaching the CNS.
    • Complications: N/V/D. Steven-Johnson Syndrome (with immunosuppression)
    • Contraindications: Pre-existing kidney disease.

    Nystatin

    • Prototype: Nystatin
    • Therapeutic Class: Superficial Antifungal
    • Pharmacologic Class: Polyene
    • Action and Use: Binds to sterols in the fungal cell membrane.
    • Complications: Topical: Minor skin irritation; PO: N/V/D.
    • Contraindications: None.
    • Nursing Considerations: Topical or PO. Too toxic for parenteral administration.

    Protozoan Infections: Malaria

    • Protozoa are single-celled organisms
    • Malaria: Caused by Plasmodium
    • Mosquitoes suck blood, inject Plasmodium, multiplies in the liver, transforms into progeny, infects RBCs, which rupture.

    Chloroquine

    • Prototype: Chloroquine
    • Therapeutic Class: Antimalarial drug
    • Pharmacologic Class: Heme complexing agent
    • Action and Use: Effective in treating the erythrocytic stage but not against latent Plasmodium. Can reduce a high fever.

    Antibiotic Spectrum and Opportunistic Infections

    • Broad Spectrum Antibiotics can open the door to opportunistic pathogens like yeast
    • Narrow Spectrum Antibiotics used when individual is very ill, targets specific pathogens
    • Incubation Period - Patient may transmit disease before showing symptoms
    • Prodromal Stage - Initial symptoms emerge
    • Acute Stage - Peak of symptoms
    • Convalescent Stage - Healing occurs, but patient may still be contagious
    • Acquired Resistance - Treatment plan must be followed completely
    • Antibiotic Usage Best Practices - Treat with broad spectrum initially, then narrow down to target pathogen

    Penicillin

    • Gram Positive antibiotic
    • Impairs Effectiveness of Birth Control
    • Can cause Anaphylaxis, ask about history of reactions

    Cephalosporins

    • Similar to Penicillin
    • Cell Wall Inhibition
    • Cross-Reactivity with Penicillin Allergies

    Tetracyclines

    • Take with Food
    • Impairs Birth Control
    • Liver Toxicity
    • Sunburn Risk
    • Avoid Milk (Interferes with Absorption)
    • Monitor Kidney Function
    • Fetal Bone Malformations (Pregnancy Risk)

    Erythromycin

    • Broad Spectrum
    • Empty Stomach
    • Full Glass of Water

    Gentamicin

    • Ototoxicity (Hearing Loss)
    • Nephrotoxicity (Kidney Damage)
    • Monitor Kidney Function

    Ciprofloxacin

    • Achilles Tendon Rupture
    • Hepatotoxicity
    • Report Leg Pain and Swelling
    • Gram Negative antibiotic

    Trimethoprim-Sulfamethoxazole

    • Sulfamethoxazole Allergy
    • Bad for Bladder
    • Bad for Blood
    • Hydrate to Prevent Crystal Formation
    • Reduced Platelet Production

    Vancomycin

    • Nephrotoxicity
    • Ototoxicity
    • Red Man Syndrome (Rapid Infusion)
    • IV Administration Only
    • MRSA Treatment

    Isoniazid

    • Hepatotoxicity
    • B6 Supplement (Nerve Function)
    • Tingling or Spasms in Hands/Feet (Sign of Hepatotoxicity)

    Amphotericin B

    • Potent Antifungal (Ergosterol)
    • Kidney Damage (Increased BUN and Creatinine, Potassium)
    • Severe Fungal Infections

    Fluconazole

    • Antifungal
    • Yeast Infections

    Chloroquine

    • Antimalarial
    • Retinopathy
    • Blindness Risk

    Metronidazole

    • Diverticulitis
    • Review Side Effects

    HIV/AIDS

    • Protease Inhibitors (-Vir ending)
    • High Viral Load (Active Infection)
    • Low CD4 Count (Under 200) - Transition from HIV to AIDS
    • Acyclovir - Broad Spectrum Antiviral

    Schizophrenia

    • Delusions - False Beliefs
    • Hallucinations - Perceiving Stimuli Not Present
    • Illusions - Misinterpreting Real Stimuli
    • High Non-Compliance Rate
    • Pharmacotherapy - Management of Symptomatic Relief
    • Extrapyramidal Symptoms - Adverse Effects of Medications

    Conventional Antipsychotics

    • Phenothiazines
    • Dopamine and Serotonin Blockade

    Chlorpromazine

    • Neuroleptic Malignant Syndrome (Life-Threatening)

    Haloperidol

    • Acute and Chronic Psychotic Disorders
    • 50x More Potent Than Chlorpromazine
    • Do Not Discontinue Abruptly
    • Long-Acting Injections for Non-Compliance

    Risperidone

    • Blocks Type 2 Serotonin, Dopamine, and Alpha 2 Adrenergic Receptors
    • Schizophrenia and Bipolar Treatment
    • Complications - Weight Gain, Hyperglycemia, Hypertriglycerides, Fatigue, Nausea, Dizziness, Visual Disturbances, Fever, Orthostatic Hypotension.
    • Therapeutic Effect Takes Weeks

    Opioid Withdrawal

    • Agitation
    • Insomnia
    • Flu-Like Symptoms
    • Rhinorrhea
    • Yawning
    • Sweating
    • Abdominal Cramps
    • Diarrhea

    Treatment of Opioid Withdrawal

    • Methadone Substitution
    • Respiratory Depression Risk

    Nicotine

    • Highly Addictive
    • Nicotine Patches
    • Remove Patches Before Leaving Hospital

    Methylphenidate

    • Schedule II Drug
    • New Prescription Required

    Key Adverse Effects

    • Metronidazole - Review Adverse Effects
    • Amphotericin B - Review Adverse Effects
    • Erythromycin - GI upset, Full Glass of Water, Empty Stomach

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    Explore the complexities of the nervous system in Unit 5. Learn about neurotransmitter functions, their impacts on mood and behavior, and the types of anxiety disorders. This quiz will test your knowledge on how these elements interact and influence each other in human physiology.

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