N3050 Exam #3 Study Guide PDF

N3050 Exam #3 Study Guide General principles of antimicrobial therapy Why don’t antibiotics damage human cells in an effort to kill bacteria?: selective by targeting bacterial components like cell walls which human cells don’t have Broad spectrum antibiotics before culture/sensitivity results are b...

N3050 Exam #3 Study Guide General principles of antimicrobial therapy Why don’t antibiotics damage human cells in an effort to kill bacteria?: selective by targeting bacterial components like cell walls which human cells don’t have Broad spectrum antibiotics before culture/sensitivity results are back  When/why do we do this?: used before because we’re trying to control the infection while waiting for identification of pathogen  When should cultures be obtained?: before initiating antibiotic therapy Superinfection  What causes it?: when med kills good and bad bacteria leading to opportunistic infections  What are some common ones?: c diff and thrush Educating patients/family about antimicrobial therapy  What do we tell every patient about their antimicrobial therapy prescription?: finish med course/ don’t skip doses because if you don’t finish or you skip doses bacteria can become resistant Combination antibacterial therapy  Antimicrobial effects of combination therapy: synergistic effects, prevention of resistance and report symps  Indications for combination therapy: serious infections, TB, prevention of resistance Antibiotics: Penicillins (penicillin G, methicillin, amoxicillin – common penicillin names): ampicillins  Basic mechanism of action: inhibits bacterial wall synthesis making bacteria wall hard to close  Adverse effects: liver disease, kidney disease and allergy  Allergy – what does it look like? How is it treated?: hives, angioedema, SOB, throat closing , epinephrine  Patient teaching: finish med course, call 911 for allergy / superinfections Cephalosporins: Cefazolin  Basic mechanism of action: inhibits bacterial wall synthesis, surgical prophylaxis  Adverse effects – recognizing them and intervening: allergy ( related to penicillin), possible kidney damage, superinfections  Patient teaching: finish med course and drink tons of fluids Vancomycin  Basic mechanism of action: weakens bacterial cell wall  Pharmacokinetics – IV vs. oral dosing: Iv (give slowly), PO( monitor renal function and trough level)  Adverse effects: renal toxicity, red man syndrome, ototoxicity  Minimizing adverse effects: give IV slowly, monitor contraindications  Interactions: DON’T TAKE WITH NSAIDS OR ASPIRIN Tetracyclines  Adverse effects: allergy, GI upset, superinfections, photosensitivity, and tooth discoloration  Minimizing adverse effects: wear sunscreen, stay covered, take with a glass of water  Interactions: DON’T TAKE WITH METALLIC COMPOUNDS AND ORAL CONTRACEPTIVES  Patient teaching: wear sunscreen, stay covered, take with glass of H2O and finish med course Aminoglycosides (Gentamicin)  Basic mechanism of action: penetrates cell membrane and kills it  Adverse effects: peripheral neuropathy, nephrotoxicity, ototoxicity  Minimizing adverse effects: monitor peak and trough levels  Patient teaching: finish med course   Sampling for peak and trough levels – when is each done?: peak is done after dose , trough is before next dose is administered Sulfonamides  Basic mechanism of action: inhibits growth and replication  Adverse effects: hypersensitivity (stevens johnson syndrome), GI upset, jaundice, headache)  Minimizing adverse effects  Allergy: steven Johnson syndrome (painful red rash and blisters)  Interactions: digoxin Trimethoprim/sulfamethoxazole (Bactrim)  Uses: UTI ( e.coli), pneumocystis jiroveci ( common in HIV)  Adverse effects: steven johnson, renal, skin, GI , hematologic  Minimizing adverse effects: encourage fluids! Treatment regimens for TB – latent, active, and drug resistant  How is each treated:: all treated with meds  Time frame for each: L (1 drug for 9 months or 2 drugs for 3 months) , A ( 4 drugs for 2 months or 2 drugs for 4 months)  Why so many drugs?: can be resistant Isoniazid (Nydrazid)  Basic mechanism of action: bactericidal messes with ability to build cell wall  Adverse effects: peripheral neuropathy, resistance, hepatotoxicity  Minimizing adverse effects: no alcohol, vit b6 if needed, liver monitoring  Interactions: inhibits drug metabolism: phenytoin and carbamazepine, increases risk of hepatotoxic: rifampin, pyrazinamide, rifambin  Patient education: finish med course Rifampin (Rifadin)  Basic mechanism of action: inihibits bacterial DNA, RNA, and protein synthesis  Adverse effects: hepatotoxicity and discoloration of bodily fluids  Minimizing adverse effects  Patient education: take med on empty stomach Ciprofloxacin (Cipro)  Basic mechanism of action: interacts with bacterial DNA synthesis  Adverse effects: allergy, photosensitivity, tendonitis, CNS effects and peripheral neuropathy  Minimizing adverse effects: don’t give to kids/older pts, metallic compound drugs/foods ( STEAK)  Patient education: sunscreen, tendon issues no antacids Metronidazole (Flagyl)  Basic mechanism of action: inhibits DNA synthesis killing cells  Uses – why is it used?: to treat C.diff and prevention of GI infection Erythromycin  Basic mechanism of action: inhibits microbial protein synthesis  Adverse effects: GI CNS effects, dysrhythmias, allergy, hepatotoxicity  Minimizing adverse effects  Patient education: how to take drug/ contraceptive effectiveness and symps to report Antivirals Acyclovir (Zovirax)  Basic mechanism of action: inhibits viral replication, suppresses DNA synthesis  Uses: herpes, varicella zoster, and shingles  Adverse effects: IV( phlebitis nephrotoxicity, neurotoxicity ) PO(n/v, diarrhea, headache, dizziness, malaise)   Minimizing adverse effects: rotate IV sites, monitor fluid balance, encourage fluids, creatine & BUN levels, topical: burning stinging Oseltamivir (Tamiflu)  timing: begin 2 days within of onset of symps, if started within 12 hours of onset reduces severity and length by 3 days  adverse effects: n/v, hypersensitivity reactions, nosebleeds HIV Drugs Zidovudine (Retrovir)  mechanism of action: inhibits DNA synthesis by mimicking substance virus needs installing faulty info and injuring cell  Adverse effects: anemia, thrombocytopenia, neutropenia, lactic acidosis and hepatic steatosis ( n/v, abdominal pain, malaise fatigue and anorexia)  Minimizing adverse effects: b12 supplement, monitor lactic acid levels and ABGS  Patient education: know symps and what to report Efavirenz: sustiva  mechanism of action: binds to HIV reverse transcriptase and disrupts it  Adverse effects: dizziness/headaches, insomnia/nightmares, ddelusions and depression, hallucinations  Minimizing adverse effects: discontinue drugs if symps occur  Patient education: can’t be pregnant so take 2 contraceptives Protease inhibitors  Mechanism of action: keeps virus from infusing with CD4 cells so it cant replicate it  Adverse effects: hyperglycemia ( 3ps : polydipsia, polyuria, polyphagia), fat maldistribution, hyperlipidemia, bone marrow decreases, neuropathy, depression, suicidal ideation, rash and pruritus)  Minimizing adverse effects: PO ( diabetic drugs, insulin, healthy diet, regular exercise, lipid lowering drugs  Interactions: shouldn’t be taken with PI ( grapefeuit juice, ketoconazoleketonazole, clarithromycin) , decrease PI ( rifampin, phenytoin and carbamazepine) loss of therapeutic effects ( st.johns wart, garlic and decrease levels of saquinavir), drugs levels are decreased (Cisapride, benzodiazepines, ergotamine, lovastatin, simvastatin, sildenafil, tadalafil, vardenafil)  Patient education: give injection, cleansing site and how to prevent infection by rotating sites Drugs for Allergies: Antihistamines Diphenhydramine: Benadryl  Adverse effects: drowsiness, anticholinergics side effects ( dry mouth, constipation, blurred vision and urinary retention)  Interactions: anything that makes you drowsy ( opioid), tricyclic antidepressants, mao inhibiters and alcohol use  Therapeutic uses: smaller allergies Fexofenadine: allegra  Adverse effects: headache, n/v, fatigue, drowsy if not take as prescribed  Interactions: alcohol, marijuana, oxycodone (drowsy)  Therapeutic uses: seasonal allergies, urticaria, cold and allergy symptoms, antacids can mess with absorption Promethazine: Phenergan  Adverse effects: can damage tissues around it if infiltrated , extrapyramidal side effects  Interactions  Therapeutic uses: antiemetic( nausea)   Difference between first and second generation antihistamines: 1 st gen passes blood brain barrier, 2nd target peripheral histamine receptors o Common uses: 1st ( contact dermatitis) 2nd (seasonal allergies) o Adverse effects: 1st drowsiness, fatigue, impaired alternes 2 nd ( headache n/v fatigue ) Epinephrine (epi pen)  Mechanism of action: vasoconstriction ( alpha 1), increased cardiac output and perfusion ( beta 1), open airways ( b2)  Adverse effects: HTN, increased HR, dysrhythmias, angina and increased glucose levels  Patient teaching: administration , care and keeping of pen and monitor glucose for diabetic patients Antidysrhythmics Prodysrhythmic effects of antidysrhythmic drugs Diltiazem (Cardizem)  How does it work? What is this drug used for?: SVT, rate control for A fib, slows conduction through decrease in calcium movement  Adverse effects: bradycardia, AV block, flushing and peripheral edema  Patient teaching: monitor pulse and BP, how to do it because of bradycardia Amiodarone (Cordarone)  What is it used for?: used for A fib/A flutter, V tach and fib, HR and contractability prolonged conduction  Adverse effects: CNS effects(dizziness, fatigue, tremors, and ataxia)  Interactions: beta blockers, anticoagulants, digoxin and phenytoin, pulmonary toxicity, hepatotoxicity, photosensitivity, vision changes  Patient teaching (what to watch for, what to report): signs of liver issues, manage vison changes, monitor cough dyspnea, crackles pleuritic angina cover up and wear sunscreen PREDNISONE - Action: Decreased inflammation - Uses: - Allergic reactions - Autoimmune diseases - Endocrine disorders - Neurologic conditions - Arthritis - Cancer: can help w/ retaining appetite - COPD and asthma - Adverse effects: - Adrenal insufficiency - Adrenal excess - CNS effects - Decreased immunity - Fluid and electrolyte imbalance - Blood glucose elevation - Skin issues - Osteoporosis - CAN CAUSE AN INCREASED RISK FOR INFECTIONS - CUSHING”S SYNDROME IS CAUSED BY STEROID OVERUSE - Contraindications: - Immunosuppression - Careful in kiddos: cause slowed growth and diminish eventual adult height with the exception of inhaled steroids for the treatment of asthma - Certain types of infections: Steroids are also not indicated when there is a systemic fungal infection, hepatitis B or varicella present – and itsn’t a great idea when treating someone with a resistant infection - Caution: - Kidney, liver, and GI issues ( GI ulcerations and kidney/liver disease) - Diabetes: due to the elevation of glucose levels - Nursing Responsibilities: - Monitor blood glucose, and other adverse effects - Monitor for improvement …. Signs will vary depending on why its being used - Pathophysiology vs. physiologic dosing: - Physiologic: it will likely be lifelong and extra doses during stress and illness will be needed - pathophysiology: they need to take it as prescribed and follow the taper down when discontinuing or they will go into cardiovascular collapse - Patient teaching: - Importance of taking as prescribed - What to watch out for: elevated pulse, low bp (dizziness, fatigue) - Diabetic patients – self monitoring: need to monitor their blood glucose levels even more carefully than normal -