PHARM FINAL PT. 1 (copy)

how is bacteria killed through disruption of the bacterial cell wall?

rigid bacteria wall stops growing, causing the wall to become more permeable, allowing water to rush into the bacteria and destroy it

how is bacteria killed through inhibition of an enzyme unique to bacteria?

it stops folic acid from being synthesized, which is a vital enzyme bacteria needs to survive

how is bacteria killed through disruption of bacterial protein synthesis?

DNA replication is stopped, causing the bacteria to stop growing

what is a narrow antibiotic?

specific to a gram negative or gram positive bacteria, it can directly target bacteria and is more effective

what is a broad-spectrum antibiotic?

kill both gram positive and gram negative bacteria, so you don't want a patient to remain on this long term

what is a bactericidal antibiotic?

lethal -> it will kill the bacteria

what is bacteriostatic antibiotic?

stops replication so bacteria cannot grow and spread

what is antibiotic resistance?

when an antibiotic will not work on someone

what is microbial resistance?

bacteria gets smart and evolves

how does conjugation cause microbial resistance?

when you don't take full course of antibiotics, only some of the bacteria dies and the other portion will become resistant

how does increased antibiotic use cause resistance?

antibiotics are in the food that we eat so the our bodies can develop a memory of it

how does healthcare-associated infections cause resistance?

if you do not wash hand between patients, you can pass resistant microbes between patients

what is a superinfection?

an infection caused from antibiotic usage, because an antibiotic knocks out good and bad bacteria

when someone arrives to the hospital and you suspect them of a bacterial infection, what are the steps to be taken?

1. collect culture and send it to lab
2. start broad-spectrum antibiotic
3. switch patient to narrow antibiotic once positive culture has been obtained

what is a drug susceptibilty test?

tests different antibiotics on patient's specimen to determine what antibiotics the patient is sensitive (it will kill it) and resistant to

when would you use a drug susceptibility test?

the infection isn't improving with current antibiotic

how can the immune system impact antibiotic therapy?

the immune system still fights bacteria on an antibiotic, so if you have a week immune system, you need to be on a stronger antibiotic

how can the site of infection impact antibiotic therapy?

the antibiotic needs to be able to get to the site of infection (BBB, skin, etc.)

how can allergies impact antibiotic therapy?

if someone is allergic to an antibiotic, don't administer it or any other drug in the family

how can genetics impact antibiotic therapy?

some antibiotics work differently on different ethnicities

what is prophylactic drug use?

take antibiotic even though you do not currently have an infection, but are at risk for one

why are people administered prophylactic antibiotics for surgeries/procedures?

incisions cause increased risk for infection

why are people administered prophylactic antibiotics for bacterial endocarditis?

patient with cardiac issues getting dental procedure done must be on antibiotics- this reduces the risk of them getting bacterial endocarditis

why are people administered prophylactic antibiotics for UTI's?

if you have chronic UTI's, do prevent them (ex. someone with a large prostate)

why are people administered prophylactic antibiotics in relation to STI's?

person who has partner with STD can take to prevent getting it from partner

why will you not prescribe an antibiotic for a viral infection?

it will not treat it- only works on bacteria

why will you not prescribe an antibiotic for an unknown fever?

if it is the only symptom the patient is experience, it doesn't mean it is a bacterial infection, and could be viral

why is improper dosing a consideration for antimicrobial drugs?

you want to ensure the drug can reach MEIC (minimum effect inhibitory concentration) so it can kill bacteria

what must you ensure before giving a patient an antibiotic?

their infection is bacterial

how might you know if an antibiotic is working?

decreased WBC
decreased fever
symptoms reduce

what is the difference between palliative care and hospice?

palliative care helps a patient with a chronic disorder optimize quality of life to prevent suffering
hospice care is end of life care directed at patients who have 6 months to a year left to live

all _______ care is _______, but not all ________ is ________

1. hospice
2. palliative
3. palliative
4. hospice

how would you assess pain for a terminally ill patient who may not be able to verbalize well?

increased RR, sweating, uncomfortable/agitated

how would you assess dyspnea in a terminally ill patient?

struggling to breathe/unable to clean airway

what mental condition may you assess in a patient with a terminal illness?

anxiety, because death is scary!

what are the 3 nursing diagnosis for terminally ill patients?

reduce secretions, decrease anxiety, and decrease pain

what pain control measures do you implement with terminally ill patients?

opioids & non-pharm (massage/relaxation)

how should you implement opioids for a terminally ill patient?

every hour, set up PCA, morphine drop, transdermal patch if leaving the hospital

how should you implement non-pharm measures to reduce pain for terminally ill patient?

quiet environment, music, dim lights, back rub

when is it acceptable to give the patient a high dose of a medication?

terminally ill patients

what ineffective airway clearance measures do you implement with terminally ill patients?

scopolamine patch, glycopyrrolate-muscarinic blocker, and oxygen

how and why should you implement a scopolamine patch for a terminally ill patient?

placed behind the ear, dries secretions, can keep on for 3 days

how and why should you implement a glycopyrrolate-muscarinic blocker for a terminally ill patient?

robinin = masculine blocked and dryness occurs, administered IV

how and why should you implement oxygen for a terminally ill patient?

always if suffering, a little bit will keep them comfortable but not help them live

what and how do you implement measures to decrease death anxiety?

administer benzodiazepine IV and give with opioid and it will have sedative effects on the brain

what are the characteristics of fungal infections?

they are more complex and larger than bacteria and can be a superinfection (mild) or systemic (life-threatening)

what demographic of patients are at risk for fungal infections?

immunocompromised or long-term antibiotic users

what are the routes used to administer polyenes?

oral, IV, topical

why and how would you administer polyenes orally to a patient?

patients with thrush (fungal infection)

If it is just on the tongue -> swish and spit out the medication if it is down the throat -> swish and swallow the medication

why and how would you administer polyenes topically to a patient?

for fungal infections under skin flabs/fat
clean the skin, let it dry and they shake medication over area

why would you administer polyenes IV to a patient?

for patients experiencing a systemic infection (in the blood)

what is the distribution of polyenes?

tissues, not CNS

what are important nursing considerations when a patient is on polyenes?

it isn't compatible with a lot of drugs (check compatibility!) and keep the patient hydrated

what are important assessments for amphotericin B (polyene)?

advocate for a pic line
check vital signs every 15 minutes
check CBC and BMP because its hard on the bone marrow, electrolytes, and creatinine

what organ is amphotericin B hard on?

kidneys -> stay hydrated

what can you do to prevent amphotericin B infusion reactions?

premedicate with diphenhydramine, acetaminophen, hydrocortisone, and antiemetics

for patients on amphotericin B, what can you administer for rigors or chills?

meperidine

what broad-spectrum fungal infection antibiotic is given a lot?

itraconazole or the "azole" family

what organ is the "azole" family very hard on?

liver

what assessments should you make on a patient receiving anything in the "azole" family?

liver function tests
monitor for drug-drug interactions (throws off other drug levels)
cannot be pregnant or get pregnant
do not give to patients who suffer from heart failure (it relaxes the heart)

what are the ways to administer anything in the "azole" family?

topical (powder), IV, oral (pills)

what is a benefit of taking echinocandins?

less hard on liver & kidneys

what assessments should you take for a patient receiving echinocandins?

monitor for headache, fever, nausea, hypersensitivity
check and monitor IV site

what implementation might you need to take for patients on echinocandins who are experiencing side effects?

administer acetaminophen, antiemetics, or emergency protocol for anaphylaxis

what are the characteristics of viruses?

they evolve so much there is no long term immunity and they can spread through contact

what is the difference between herpes simplex 1 and 2?

1 = causes fever, blisters, cold sores on lips, mouth and face
2 = causes fever, blisters on genitals
*only way to differentiate is to perform a blood test*

what assessment findings are common in patients with herpes simplex?

lesions and pain (paresis (pins/needle feeling) and vesicles form and pop, causing more pain)

what is the action of acyclovir?

inhibits viral replication by suppressing synthesis of viral DNA so that the immune system can fight the virus off

what are the ways to administer acyclovir?

topical (limited impact but use ASAP if patient experiences numbness/tingling)
oral
IV (prophylactically to prevent herpes)

what organ can acyclovir be hard on?

kidneys -> monitor creatinine and keep moist

what are the adverse effects of acyclovir?

phlebitis (IV use)
nephrotoxicity (oral and IV use)

what is a key characteristic of valacyclovir?

it is a prodrug (doesn't start working until liver metabolizes it)

does acyclovir of valacyclovir have a greater bioavailability?

valacyclovir

what is an adverse effect of valacyclovir?

thrombotic thrombocytopenic purpura (decreased platelets to clotting happens if on it long-term)

what education should be given to a patient diagnosed with herpes simplex?

spreads very easily
avoid when pregnant (can pass it on to child)
incubation period of 2-12 days

what are characteristics of varicella-zoster virus (chicken-pox)?

highly contagious through contact (with lesions) or airborne

what are you at risk for if you get varicella-zoster virus (chicken-pox)?

reactivation of latent cells known as Shingles

what are the assessment findings with varicella-zoster virus (chicken-pox)?

lesions (crust over = not contagious), pain, fever

what are the guidelines of the varicella vaccination?

once age 1, get 1 dose and get the next dose at age 5/6

no one with a depressed immune system, allergy, or is pregnant should receive because it is a LIVE vaccine

what are the guidelines of the herpes zoster vaccination?

made for older people (around 50yr old)

2 doses - wait 2-6 months in-between

decreases effectiveness eventually

what drugs treat varicella?

acyclovir & valacyclovir (herpes-like infection)

which drug (acyclovir/valacyclovir) do patients typically go home on?

valacyclovir

what education should be given to a patient with varicella-zoster virus (chicken-pox)?

vaccination (especially children)

deadly if elderly get it

pain in the arm after receiving the vaccine is normal

can use calamine lotion to treat

gabapentin can also be prescribed

what are the key characteristics of CMV?

85% have it and don’t know

droplet precaution

lives dormant in most people

if transmitted during pregnancy, crosses BBB and fetus can have infection of brain, ears, and eyes

what population is at risk for CMV?

immunosuppressed

why are most people on drugs that treat CMV?

prophylactic

what are the routes used to administer ganciclovir?

oral, IV, gel (optic)

what organ(s) must be function to receive ganciclovir?

kidneys

what are the adverse effects of ganciclovir?

granulocytopenia (lower WBC counts), thrombocytopenia, trouble getting pregnant, teratogenic (permanent decrease in sperm count)

if you are prophylactically on ganciclovir, what should you be monitored for?

low WBC counts, especially neutrophils, as they can indicate an infection

what is the prodrug of ganciclovir?

valganciclovir → which means it has greater oral bioavailability

what is a adverse effect with valganciclovir?

thrombotic thrombocytopenic purpura

what are the characteristics of influenza?

highly contagious droplet precaution (gown and gloves)

characterized by chills, fever, cough, sore throat, headache, myalgia

when should you get the influenza vaccine?

every year

what assessments should you perform with a patient who may have or has influenza?

screening (swab the nose)

vital signs (increased temp, decreased O2, wheezy/course lungs)

what is the difference between the IV and nasal influenza vacccine?

nasal spray = live vaccine so DO NOT administer to pregnant women, immunosuppressed or children

IV = inactive

who should get the influenza vaccine?

everyone 6 months and older

high risk patients (pregnant, older age, chronic condition, immunocompromised)

what is influenza treated with and what effect does it have on the disease?

oseltamivir, reduced the number of days by 3 you will experience influenza symptoms (only really given in the first 12 hours of contraction)

if a patient was not prescribed oseltamivir, what education would you provide?

stay home and rest and stay hydrated

what are the adverse effects of oseltamivir?

SJS

toxic epidermal necrolysis

neuropsychiatric effects (wacky)