PAIN, INFLAMMATION & INFECTION MEDS

isoniazid

• liver failure / toxicity (jaundice & RUQ pain) → report

• peripheral neuropathy → B6 deficiency

• N/V, CNS changes (dizziness)

• DRESS → rash, eczema, fever, swelling face

• take 6-9 months

• avoid antacids

• usually combined w/ rifampin

• STORY →

rifampin (anti TB)

• ADR - liver toxicity → monitor & report

• causes red/orange body fluids

• it can interact w/ birth control (non concetratives)

• must be taken for as long as prescribed (reinforce adherence to prevent resistance)

• STORY → my family & i were putting up our christmas pine tree. i then went to the restroom and urinated orange/red fluid. i got scared so i went to the doctor and they gave me meds to take for as long as prescribed. i had to stop taking my birth control with this med.

nystatin

• anti-fungal → for systemic and local fungal infections

• can cause infusion reaction → fever, chills, aches, tachycardia

• can cause hypotension

• can cause bone marrow suppression (anemia - not enough blood cells)

• can cause thrombophlebitis (inflammation of vein by blood clot)

• can cause renal/kidney toxicity (low potassium) → monitor lab/weight

• the topical form must be swished & swallow (treat infection in mouth)

• pre-medicate (diphenhydramine/acetaminophen)

• monitor IV site

• STORY → i was called stat in the hospital because one of my patients was having infusion reactions. they appeared with low BP because of bone marrow suppression (anemia). i ran to give them a topical med to swish & swallow. i also pre medicated them with acetaminophen & diphenhydramine. i monitored their labs & weight in case of renal toxicity and their IV site.

gentamycin

• can cause ototoxicity (tinnitus, vertigo (room spinning), hearing loss) → monitor & report

• can cause nephrotoxicity/kidney damage

• stay hydrated → report high dilute urine

• monitor peak/trough levels

• limit 10 or less days

• track I&Os / renal labs

• measure trough 30-60 min before administration of next dose

• STORY → i went to check my patients peak & trough level gentle at night so i wouldnt wake them up. when they woke up they said they felt ringing in ear (tinnitus) and like the room was moving (vertigo). i documented that this could be ototoxicity or nephrotoxicity. i checked their trough 30-60 mins before i gave them their med and gave them water (hydrated). i monitored I&Os and renal labs to make sure everything was okay and they could be discharge in 10 or less days.

vancomycin

• for MRSA, severe infections

• can cause nephrotoxicity (low urine output + high creatine)

• ototoxicity

• infuse SLOWLY

• monitor troughs

• assess kidney function

• STORY → when i was working at the hospital, i had a patient named mycin with severe MRSA infection. i noticed she had low urine output and elevated creatinine levels, indicating nephrotoxicity. i ensured the infusion was slow and monitored their trough levels closely while assessing kidney function to prevent further complications.

3 medications that carry risk for ototoxicity

• gentamycin

• vancomycin

• erythromycin

acetaminophen

• can cause hepatotoxicity (liver toxicity) → report RUQ pain/jaundice

• interacts w/ liver & alcohol drugs → avoid alcohol

• daily max → 4 grams - track total daily dose (OTC combos)

• STORY → i wasn’t feeling good so my mom gave me 4 grams of acetaminophen. she told me not to drink alcohol. I started to turn yellow and had RUQ pain. the doctor told me this could be hepatotoxicity.

salicylate (aspirin)

• is a non opioid analgesic that reduces platelet aggregation → commonly used to relieve pain and reduce inflammation

• can cause asthma

• salicylate intolerance

• reyes syndrome → avoid if under 18 y/o with viral illness

• bleeding/tinnitus = sign of toxicity → report

• stop 7 days pre-op

• take w/ food or milk

• monitor CBC, PT/INR, BUN/Cr

• STORY → me and sali were working late at the hospital. my under 18 y/o patient named reyes had asthma and fell when we was walking. i gave her a non-opioid to help with her injury and relieve her inflammation after the fall. she built tolerance to the medicine so i told her to stop taking it 7 days before her surgery.

morphine

• a opioid agonist → for pain (makes breathing slow)

• can cause respiratory depression → report dyspnea

• hypotension

• check RR & LOC before / after → hold if under 12 RR or low LOC

• cough suppression

• sedation/euphoria → report over sedation (caution w/ other sedatives)

• urinary retention

• n/v & constipation → FFF or laxatives

• keep naxolone + resuscitation at bedside

• dilute & push slow - TAPER

• high potential for abuse & dependence

• STORY → my patient was complaining of pain, so i gave her a morphine SLOWLY & diluted at night. it slowed her BP and gave her a sedation effect. i told her to report any signs of dyspnea. i checked her RR & LOC before giving it (12). i also gave it to her a night so she wont have to get up to go urinate (urine suppression). she woke up feeling n/v and constipated so i gave her fluids/fiber. i kept naxolone + resuscitation near in case she needed it. she wanted me to give her more since she felt relaxed (depended) so i slowly discontinued it.

naloxone

• opioid antagonist → reversal opioid (morphine) overdose (knocks opioid off) - helps w/ morphine overdose

• can cause ventricular arrhythmias

• withdrawals are expected (may need repeated dose)

• hypertension / tremors / vomiting

• monitor RR, O2 sat, LOC

• watch for abstinence syndrome

• reassess frequently (short half life)

• STORY → i accidentally gave my patient too much morphine. so i ran to give her naxolone to reduce the effect. she started having withdrawals so i monitored for abstinence syndrome, making sure she wasnt dependent on opioids. her blood pressure started going up and had abnormal heart rhythms (ventricular arrhythmias) so i monitored her vital signs (RR, O2, LOC) closely.

prednisone

• is a corticosteroid → suppresses cortisol (stress hormone), reduces inflammation, helps with pain

• can cause hyperglycemia → monitor glucose

• muscle weakness

• high risk for PUD (sores/ulcers in stomach)

• high risk for infection → monitor

• adrenal suppression (adrenal stop making cortisol) → monitor

• TAPER

• use caution w/ PUD, diabetic, immunocompromised patients

• STORY → the predsident was having pain, so i gave him costicosteroids to suppress the stress hormone and reduce inflammation. i monitored him closely to made sure he wasnt having adrenal suppression. he started to feel muscle weakness so i checked his glucose. turns out he had hyperglycemia. he was also at risk for infection since he was diabetic. he had many sore/ulcers (PUD) in his stomach so i stopped the medications slowly.

c diff

• the suprainfection caused by many antibiotics

• characterized by overgrowth of intestinal bacterial & bloody diarrhea

penincilin

• for bacterial infection

• can cause anaphylaxis (allergy) - type 1 hypersensitivity

• AIRWAY PRIORITY → give O2 + epinephrine

• STORY → penelope was having an allergic reaction so i gave her oxygen and epinephrine.