wk3pharm PDF - Learning Objectives

Learning Objectives, Chapter 18, Drug Therapy With Beta-Lactam Antibacterial Agents 1. Describe general characteristics of beta-lactam antibiotics. Derive name from beta-lactam ring, which is part of their chemical structure Intact ring is essential for antibacterial activity. Specific enzymes ca...

Learning Objectives, Chapter 18, Drug Therapy With Beta-Lactam Antibacterial Agents 1. Describe general characteristics of beta-lactam antibiotics. Derive name from beta-lactam ring, which is part of their chemical structure Intact ring is essential for antibacterial activity. Specific enzymes can disrupt the ring. Inactivate mechanism of action Major mechanism of action in acquiring resistance Characteristics widely differ Include Penicillins Cephalosporins Carbapenems Monobactams 2. Discuss the penicillins in relation to effectiveness, safety, spectrum of antibacterial activity, mechanism of action, indications for use, administration, observation of patient response, and teaching of patients. 3. Recognize the importance of questioning patients about allergies before the initial dose of all drugs, especially penicillins. 4. Describe characteristics of beta-lactamase inhibitor drugs. 5. Give the rationale for combining a penicillin and a beta-lactamase inhibitor drug. 6. Discuss the cephalosporins in relation to effectiveness, safety, spectrum of antibacterial activity, mechanism of action, indications for use, administration, observation of patient response, and teaching of patients. 7. Discuss the carbapenems in relation to effectiveness, safety, spectrum of antibacterial activity, mechanism of action, indications for use, administration, observation of patient response, and teaching of patients. Broad-spectrum, bactericidal beta-lactam antimicrobials, Inhibit synthesis of bacterial cell walls by binding with penicillin-binding proteins,Four medications 8. Discuss the one monobactam drug in relation to effectiveness, safety, spectrum of antibacterial activity, mechanism of action, indications for use, administration, observation of patient response, and teaching of patients. Active against gram(−) bacteria Active against many strains that are ATB resistant Does not cause kidney damage or hearing loss (as can aminoglycosides) Indications for use Urinary tract, skin/skin structures, lower respiratory tract, intra-abdominal, and gynecologic infections, septicemia 9. Implement the nursing process when caring for patients receiving beta-lactam antibacterials. Perioperative use Children Older adults Abnormal kidney function Hepatic impairment Patients with critical illness Home care Learning Objectives, Chapter 19, Drug Therapy With Aminoglycosides and Fluoroquinolones Aminoglycosides Widely used to treat serious gram(−) infections for many years Gentamicin (prototype) Fluoroquinolones Synthesized through an addition to quinolone structure Quinolones are older drugs originally used for treatment of UTIs only. Ciprofloxacin (prototype) 1. State the rationale for the increasing use of single daily doses of aminoglycosides. 2. Discuss the importance of measuring serum drug levels during aminoglycoside therapy. 3. Describe measures to decrease nephrotoxicity and ototoxicity with aminoglycosides. 4. Identify characteristics of aminoglycosides and fluoroquinolones in relation to effectiveness, safety, spectrum of antimicrobial activity, indications for use, administration, and observation of patient responses. 5. Recognize factors influencing selection and dosage of aminoglycosides and fluoroquinolones. 6. Describe characteristics, uses, adverse effects, and nursing process implications of aminoglycosides and fluoroquinolones. 7. Discuss principles of using aminoglycosides and fluoroquinolones in abnormal kidney function and critical illness. 8. Recognize the importance of the judicious use of aminoglycosides and fluoroquinolones to decrease the rate of antibiotic resistance. 9. Implement the nursing process in the care of patients receiving aminoglycosides and fluoroquinolones. Learning Objectives, Chapter 21, Drug Therapy With Macrolides and Miscellaneous Anti- Infective Agents 1. Describe the characteristics and specific uses of macrolide anti-infective agents. Widely distributed into body tissues and fluids Bacteriostatic or bactericidal Depending on drug concentration in infected tissues Effective against gram(+) cocci USED for: Hepatic impairment/Critical illness Respiratory tract and soft tissue infections Penicillin substitute for hypersensitivities Prophylaxis Rheumatic fever, gonorrhea, syphilis, pertussis, and chlamydial conjunctivitis in newborns Treatment for other infections Legionnaires disease, GU infections, bacterial sinusitis, 2. Identify the prototype and describe the action, use, adverse effects, contraindications, and nursing implications of macrolides. Azithromycin/Clarithromycin/Fidaxomicin Erythromycin (prototype) Adverse effects: hard on the liver/ Hypersensitivities/Preexisting liver disease/Myasthenia gravis 3. Describe the action, use, adverse effects, contraindications, and nursing implications of miscellaneous anti-infective agents. 4. Implement the nursing process in the care of patients being treated with macrolides and miscellaneous anti-infective agents. Learning Objectives, Chapter 22, Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease 1. Describe the characteristics of tuberculosis and Mycobacterium avium complex. Infectious disease usually affecting lungs but may affect,Lymph nodes, pleurae, bones Joints, kidneys, GI tract Pathogenic bacilli Multiply slowly; may lie dormant for years Resist phagocytosis; develop drug resistance Commonly occurs in many parts of the world Estimated one-third world’s population affected; approximately equal to 1.5 million died in 2020 Infection decreased to low level Most new cases occur in foreign-born immigrants. Large numbers with inactive/latent infection 2. Describe the characteristics of latent, active, and drug-resistant tuberculosis. Four phases of initiation and progression lies dormant in the body Transmission Primary infection Latent tuberculosis infection (LTBI) Active tuberculosis 3. Describe drug therapy for tuberculosis, including the rationale for multiple-drug therapy. Major concern to public health and infectious disease authorities LTBI Increase in drug-resistant infections Mutations Biologic adaptation Development of resistance attributed to Poor patient compliance with anti-TB drug therapy Development of new strains within patients who are immunocompromised which are then transmitted Identified in India, China, Russia Major concern in those with HIV Multidrug-resistant tuberculosis (MDR-TB) Resistant to most effective medications available Extensively drug-resistant TB (XDR-TB) Rare, first reported in 2006 and now reported in six continents Resistant to second-line medications No effective drugs for treatment Major concern for those with HIV Extensively drug-resistant TB (XDR-TB) (cont.) Factors contributing to development Delayed diagnosis Delayed determination of medication efficacy May take several weeks Lack of adequate diagnostic laboratories 4. List the action, uses, adverse effects, contraindications, and nursing implications of first-line antitubercular drugs. CDC, American Thoracic Society (ATS), and Infectious Disease Society of America (IDSA) emphasize, Expanded efforts to identify and treat LTBI,Techniques for TB control among specific populations , Children and adolescents, foreign-born persons, HIV(+), homeless persons, Specific facility residents (prisons, etc.) 5. Describe how second-line antitubercular drugs are added to drug regimens to treat multidrug-resistant tuberculosis. 6. Describe the drugs used to prevent or treat Mycobacterium avium complex. 7. Discuss ways to increase adherence to antitubercular drug therapy regimens. 8. Implement the nursing process in the care of patients undergoing drug therapy for tuberculosis.