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Exam 2 Pharmacology Review: Chapters 7-13

• Exam 2 Pharmacology Review includes 10 math questions.

Fluoroquinolones

• Fluoroquinolones carry a Black Box Warning for tendon rupture, specifically the Achilles tendon.

Patient Receving IV Antibiotics and Shortness of Breath

• Dyspnea from IV infusion can occur

ATI Pharm Book CH 44 PG 362 - Nursing Administration

• Instruct patients to report any allergic response findings (dyspnea, skin rash, itching, and hives).
• Administer IM injections cautiously to avoid injecting into a nerve or artery, which can cause sensory/motor dysfunction or neurotoxicity.

Nursing Administration - Client Education

• Take penicillin V, amoxicillin, and amoxicillin-clavulanate with meals.
• Other penicillins should be taken with 8 oz of water 1 hour before or 2 hours after meals.
• Complete the entire course of therapy, even if manifestations resolve.
• Use an additional contraceptive method when taking penicillins, as they can decrease effectiveness.

Dyspnea During Infusions

• Stop the infusion if a patient has dyspnea during an infusion.
• Elevate the head of the bed.
• Listen to lung sounds, and call the providers.
• Prioritize A (Airway), B (Breathing), C (Circulation).

Minimizing Aminoglycosides Adverse Effects

• Black Box warning for Aminoglycosides is ototoxicity and nephrotoxicity.
• Monitor for serum drug levels
• Peak and Trough levels are required.
• Aminoglycosides can result in elevated trough levels.
• Trough levels should be gathered before the next medication dose to prevent overdosing.

ATI Pharm Book CH 45 PG 370 - Nursing Administration

• Most aminoglycosides, like gentamicin and streptomycin (IM only), are parenteral.
• Neomycin formulations: oral and topical.
• Tobramycin has an inhalation formulation.
• Acquisition of aminoglycoside levels are based on dosing schedules.
• With once-a-day dosing, only trough levels need measuring.
• Divided doses, 30 min after administration of aminoglycoside IM or IV infusion completion, measure the peak.
• Divided doses, right before the next dose, measure the trough.
• Client education should include completing the entire course of antimicrobial therapy, even if manifestations resolve sooner.

Antiprotozoal Medications

• Flagyl (metronidazole) can cause a metallic taste in the mouth.

Common Antiprotozoal Agents

• Metronidazole (Flagyl, MetroGel, or Noritate) treats amebiasis, trichomoniasis, giardiasis, and anaerobic bacteria including C. diff.
• Tinidazole (Tindamax) treats trichomoniasis, giardiasis, and amebiasis.
• Adverse effects of antiprotozoal medications include CNS effects, headache, dizziness, ataxia, loss of coordination, peripheral neuropathy, GI effects, changes in liver function, superinfections, and metallic taste.

ATI Pharm Book CH 47 PG 381 - Complications

• GI discomfort includes nausea, vomiting, dry mouth, and metallic taste.
  • Instruct the clients to observe for effects and notify the provider and take medication with meals to reduce adverse effects
• Darkening of urine is a harmless effect of metronidazole.
• Neurotoxicity, CNS effects includes numbness of extremities, ataxia, and seizures
  • Instruct the clients to notify the provider if manifestations occur and stop metronidazole
• Pseudomembranous colitis
  • Discontinue use of the medication if this happens
  • Monitor and report fever, diarrhea, abdominal pain, or bloody stool.

Gentamicin Toxicity

• Signs and symptoms of gentamicin toxicity are tinnitus and dizziness.

Aminoglycosides

• Aminoglycosides are used to treat serious infections and require peak and trough levels.
• Use cautiously in pregnancy and with kidney dysfunction.
• Black Box Warning for Aminoglycosides is ototoxicity and nephrotoxicity.
• Other adverse effects: bone marrow depression and GI effects.

ATI Pharm Book CH 45 PG 371

• A nurse should monitor Gentamicin IV, an adverse effect of this medication includes vertigo, hematuria, or paresthesia of the hands and feet, urticaria, rash, and pruritus. Also Muscle weakness and respiratory depression,

ATI Pharm Book CH 45 PG 369 & 370 - Complications

• Ototoxicity from aminoglycosides includes cochlear damage (hearing loss) and vestibular damage (loss of balance).
  • Monitor for tinnitus, headache, hearing loss, nausea, dizziness, and vertigo and complete baseline audiometric studies (hearing tests); stop aminoglycoside if manifestations occur.
  • Notify the provider if tinnitus, hearing loss, or headaches occur.
• Nephrotoxicity from aminoglycosides is due to high total cumulative doses.
  • This can result in acute tubular necrosis (proteinuria, casts in the urine, dilute urine, elevated BUN and creatinine).
  • Monitor I&O, BUN, and creatinine; report hematuria and cloudy urine.
  • Intense neuromuscular blockade resulting, causing respiratory depression and muscle weakness: closely monitor use for clients who have myasthenia gravis, clients taking skeletal muscle relaxants, and clients receiving general anesthetics.
• Hypersensitivity with aminoglycosides: Rash, pruritus, paresthesia of hands and feet, urticaria; monitor for allergic effects.

Findings Priority

• Airway should be the priority finding in a patient, then breathing, then circulation

Cephalosporins

• Cephalosporins have prefix "cef-" and are similar to penicillin.
• Take caution with patients allergic to penicillin.
• Adverse effects include pseudomembranous colitis, GI effects, nephrotoxicity, and disulfiram-like reactions.

Cephalosporins - Information

• Cephalosporins are similar to penicillins and have 5 generations.
• Each new generation = more likely to reach CSF, more effective
• Use cautiously with patients with penicillin allergies due to increasing resistance.
• Adverse effects: pseudomembranous colitis, GI effects, nephrotoxicity, and disulfiram-like reactions.

ATI Pharm Book CH 44 PG 362 - Complications

• Cephalosproins cause an allergic reaction, hypersensitivity, anaphylaxis, and possible cross sensitivity to penicillin.
• if signs of allergy are apparent stop adminstering cephalosporins.
• Question clients carefully about a history of allergy to a penicillin or another cephalosporin, and notify the provider if present.
• Acceptable for use with clients who have mild PCN allergies.

Allergic to Penicillin

• Verify medications and make sure the patient is not allergic to one type of penicillin, as they are allergic to all types.

Culture and Sensitivity

• Culture and Sensitivity should be performed before deciding which antibiotics to give a patient.

Considerations Before Starting Anti-Infective Therapy

• Identify correct pathogen with C & S.
• Select correct drug that causes least complications and that is most effective.

ATI Pharm Book CH 43 PG 357

• Technicians apply the aspirate to a culture medium, where colonies of the microorganism grow over several days.
• A culture is preferable when a gram stain does not yield a positive identification.
• Obtain specimens for culture prior to treatment with antimicrobials and collect fluid for culture carefully to prevent contamination.

ATI Pharm Book CH 43 PG 359

• Nurse is implementing a plan of care for a client who has a wound infection.
• It's essential to obtain a wound specimen for culture before initiating antibiotic therapy.

ATI Pharm Book CH 43 PG 359

• Nurse teaching a client who has manifestations of a urinary tract infection.
• The nurse should instruct the client that a urine culture is needed to determine which microorganism is causing the infection.

Someone is taking ciprofloxacin to treat an infection, Provide which education

• Black box warning: tendon rupture
• Avoid sun exposure

Fluoroquinolones

• Fluoroquinolones (levofloxacin and ciprofloxacin) treat UTIs, respiratory, skin and ophthalmic infections, and prevent anthrax.
• Use cautiously in pregnancy and during lactation.
• Adverse effects: CNS and GI effects.
• Carry a black box warning for tendon rupture, bone marrow depression, and phototoxicity/sunburn.
• Avoid antacids.

IV Vancomycin

• Monitor the patient's ABCs when administering IV Vancomycin: Airway, Breathing, Circulation.

Vancomycin

• Vancomycin treats C. diff and MRSA and is highly toxic with potential side effects.
• Side effects include renal failure, ototoxicity, superinfections, and "red man syndrome".
• Therapeutic Range - Peak & Troughs should be monitored

Clients Pneumonia What Should We Do Before Abx

• A wound infection a specimen for culture should be obtain

ATI Pharm Book CH 43 PG 357

• Technician apply the aspirate to a culture where microorganism grow.
• Culture is preferable when gram stain does not yield a positive identification.
• Nurses should obtain specimens for culture prior to use and the nurses must collect if for contamination.

Rifampin

• when taking rifampin, it discolors body fluids.

Antimycobacterials

• Antimycobacterials (isoniazid, pyrazinamide, ethambutol, rifampin, and daps) treat TB/leprosy; they are acid fast and used in combination.
• Use cautiously if the patient has renal/hepatic failure and is teratogenic.
• Adverse effects: hepatotoxic, discolors body fluids, hyperglycemia, and pseudomembranous colitis.

ATI PHARM BOOK CH 47 PG 380

• Discoloration of body fluids which client should know this is normal
• There will be an Orange color of urine, saliva, sweat, and tears.
• Jaundice you need to monitor liver function

TB Medication

• Nursing education including:
  • Treatment is 6-9 months
  • It is used in combination -Acid fast
  • use caution if patient have renal problems -AE- Hepatotoxic -It also includes body fluids -Pseudomembranous colitis -Causes hyperglycemia

Antitubercular Medication

• treatment must be continued for 6 months to 2 years
• initial phase (induction phase) and the second phase(work towards eleminating any other pathogens
• Treatment varies depending on medication

Prophylactic antibiotic

• Who should receive the treatment

1. STI
2. orthpedic surgery 3.prosthetic heart value

Medications for Herpes Zoster

• Medications for herpes zoster include cidofovir, acyclovir (Sitavig, Zovirax), famciclovir, foscarnet (Foscavir), ganciclovir (Cytovene), valacyclovir (Valtrex), valganciclovir (Valcyte), or medications ending in -Vir.
• All is short is antiviral medications that are used to treat herpes

Nursing in a providers office.

• Herpes Zoster you should anticipate Acyclovir is needed.
• It is antiviral to treat herpes

Lab Test TB

• When taking TB medication, lab test to take is AST to see how effect the liver is working.

Antimycobacterial Medications

• Antimycobacterial medications (isoniazid, pyrazinamide, ethambutol, dapsone, and rifampin) treat tuberculosis (TB) and leprosy.
• Use with caution in patients with renal or hepatic failure and if teratogenic.
• These agents may cause hepatotoxicity and discolor body fluids and they may also result in hyperglycemia or pseudomembranous colitis.

ATI Pharm Book CH 47 PG 380 - Complications

• Discoloration occurs with body fluids, so expect an orange color in urine, saliva, sweat, and tears.
• Hepatotoxicity (jaundice, anorexia, and fatigue); monitor liver function and avoid alcohol.
• Mild GI discomfort includes anorexia, nausea, and abdominal discomfort; abdominal discomfort is mild and doesn't require action.
• Pseudomembranous colitis: monitor and report fever, diarrhea, abdominal pain, or bloody stool; discontinue the medication if manifestations occur.

ATI Pharm Book CH 47 PG 380 - Contraindications/Precautions and Interactions

• Rifampin is Pregnancy Risk Category B and should be used cautiously in clients who have liver dysfunction.
• Isoniazid is contraindicated for clients who have liver disease, is used cautiously in older clients, and those who have diabetes mellitus or alcohol use disorder.
• Isoniazid, Pyrazinamide, Ethambutol, and Rifapentine are Pregnancy Risk Category C.
• Rifampin accelerates metabolism of warfarin, oral contraceptives, protease inhibitors, and non-nucleoside reverse transcriptase inhibitors (NNRTIs) for HIV, resulting in diminished effectiveness.
• HIV medications doses increased often which is monitored through PT and INR.
• To avoid hormones advice client use non-hormonal form or contraception
• Concurrent use with isoniazid and pyrazinamide to increase risk for hepatotoxicity
  • Instruct clients to avoid alcohol consumption
  • Monitor liver function.

Aids Oral Infection

• Someone with AIDS is at risk with an oral condition known as Candidiasis

Antiprotozoal

• Protozoal infections can occur due to
  • insect bites like maleria -trihomoniasis

The Flu

• A patient who has the flu need -vir

ATI PHARM BOOK CH 48 PG 385 - Antivirals

• Acyclovir and ganciclovir prevent viral DNA reproduction, are used to herpes simplex / varicella-zoster viruses.
• Ganciclovir treats cytomegalovirus (CMV); preventative therapy given to clients who have HIV/AIDS, organ transplants, and other immunocompromised states.
• Interferon alfa-2b and lamivudine treat hepatitis B & C.
• Oseltamivir treats influenza A & B.
• Ribavirin treats respiratory syncytial virus, hepatitis C, and influenza (unlabeled use).
• Boceprevir and telaprevir are protease inhibitors that treat hepatitis C virus.

Malaria Prevention

• Malaria prevention includes taking chloroquine for infections from the U.S 1-2 weeks before exposure, during exposure, and then 4 weeks after exposure.
• Chloroquine resistance is becoming a problem; treatment is combined with an antibiotic.

Maleria Teaching

• A teaching that can be taught to a patients begin a patient with maleria with a prophylatic therapy

Amoxicillin medication for client

• Take it with food so no stomach occur

Common Virus

• Virus cannot live on our own they need energy to activate. It is hard to kill because its already in our cells.

Start drug on treatment.

• A client who has the flu need treatment 2 days prior

Oral anticoagulant

• When are you going to monitor Increase in effects to the oral client.

Malaria Drug Therpay

• What of the side effects Visial Disturbances

Antitubercular Drugs

• Monitor if they'll take this type of drugs
• Monitor if oral contraceptive works while they take this drugs

Herpes Zoster

• The sing and sysmptoms to look for are
• Painful lesions following nerve pathway

Broakd Spectrum

When you dont know the bug