Patho/Pharm Exam 1

doxycycline - drug class

tetracyclines

doxycycline - mode of action

inhibit protein synthesis, bacteriostatic, bactericidal, broad spectrum

doxycycline - uses

acne, skin infections, respiratory infections, urinary infections, anthrax, E. coli, MRSA, clostridium, chlamydia, pneumonia, staphylococcus species, H. pylori

doxycycline - side effects

discoloration of permanent teeth/nails, photosensitivity, headache, GI distress

doxycycline - adverse reactions

superinfection, hypertension, hyperglycemia, pancreatitis, esophageal ulceration

LT: Stevens-Johnson syndrome

doxycycline - contraindications

breastfeeding, pregnancy, children, limit dairy

gentamicin sulfate - class

aminoglycosides

gentamicin sulfate - mode of action

inhibit bacterial protein synthesis, bactericidal

gentamicin sulfate - uses

IM or IV, blepharitis, conjunctivitis, endocarditis, bacteremia, sepsis, respiratory, intraabdominal, bone/joint, skin, and UTIs, gram-negative E. coli, pseudomonas aeruginosa, Salmonella, Staphylococcus, and streptococcus

gentamicin sulfate - side effects

tinnitus, photosentivity, CNA effects, GI, rash, elevated liver enzymes

gentamicin sulfate - adverse reactions

peripheral neuropathy, neurotoxicity, laryngeal edema, hearing loss, ototoxicity, hypokalemia, hypomagnesemia, hyponatremia, hypocalcemia, hyperbilirubinemia, azotemia, superinfection

gentamicin sulfate - contraindications

renal disease, neuromuscular disorders, electrolyte imbalance, dehydration, hearing impairment, tinnitus, pregnancy, breastfeeding

ciprofloxacin - drug class

fluoroquinolones

ciprofloxacin - mode of action

inhibits the enzyme DNA gyrase, which is needed for bacterial DNA synthesis, bactericidal effect, broad spectrum

ciprofloxacin - uses

anthrax, sinusitis, prostatitis, typhoid fever, STIs, skin, bone/joint, intraabdominal, urinary, and respiratory, otitis media/externa, gram positive and negative bacteria

ciprofloxacin - adverse reactions

neurotoxicity, GI bleeding, tendon rupture, tenditinitis, superinfection, hearing loss, pancreatitis, hematuria

LT: anaphylaxis, angioedema, blood dyscrasias, stevens-johnson syndrom, hepatic/renal failure, dysrhythmias, cardiac/respiratory arrest, suicidal ideation

ciprofloxacin - contraindications

peripheral neuropathy, pregnancy, breastfeeding, children

calcium - normal values

8.6-10.2 mEq/L

calcium - uses

electrolyte replacement

calcium - side effects

nausea/vomiting, constipation, pain

calcium - adverse effects

ECG changes, renal failure, cardiac arrest

calcium - caution

IV infiltration (tissue necrosis), can enhance digoxin effects

potassium - normal values

3.5-5

chloride - normal values

96-106

potassium chloride - uses

electrolyte replacement

potassium chloride - side effects

nausea, vomiting, diarrhea

potassium chloride - adverse reactions

hyperkalemia, cardiac dysrhythmias

potassium chloride - caution

must be diluted if given IV

causes of edema

increase in capillary hydrostatic pressure, decrease in plasma oncotic pressure, increase in capillary permeability, lymph channel obstruction

high salt intake, kidney disease, congestive heart failure

hypotonic IV fluids

0.45% saline

0.225% saline

0.33% saline

5% dextrose in water D5W (turns hypo)

isotonic IV fluids

lactated ringer’s solution (LR)

5% dextrose in water D5W (starts iso)

0.9% NS

hypertonic IV fluids

3% saline

dextrose 10% in water D10W

dextrose 5% in 0.9% NS D5NS

dextrose 5% in 0.45% NS D51/2NS

calcium - functions

bone and teeth formation

transmission of nerve impulses

muscle contraction

hypocalcemia

<8.6 mEq/L

causes: inadequate dietary intake, inadequate intestinal absorption

effects: increased neuromuscular excitability, twitching of mouth, intestinal cramping, hyperactive bowel sounds

severe: convulsions and tetany

hypercalcemia

>10.2 mEq/L

causes: hyperparathyroidism, bone metastases, steroids, multiple fractures

effects: fatigue, muscle weakness, impaired renal function, kidney stones

hypokalemia

<3.5 mEq/L

effects: depends on severity, skeletal muscle weakness, cardiac dysrhythmias

hyperkalemia

>5.0 mEq/L

effects: depends on severity

mild: increased neuromuscular irritability, tachycardia, intestinal cramping, nausea, and diarrhea

severe: muscle weakness, loss of muscle tone, numbness, tingling, paralysis

hyponatremia

<135 mEq/L

sodium loss or water gain, decreased osmolality

causes: vomiting, diarrhea, renal failure, heart failure

effects: muscle weakness headaches, confusion

hypernatremia

>145 mEq/L

sodium gain or water loss, increased osmolality

effects: tachycardia, hypertension, agitation, seizures, coma, thirst, dry sticky mucous membranes, flushed

phosphate - normal values

2.4-4.4 mEq/L

phosphate - functions

provides energy for muscle contraction

acid base balance

hypophosphatemia

<2.4 mEq/L

causes: intestinal malabsorption related to vit D

signs/symptoms: muscle weakness, tremors, paraesthesia, bone pain

hyperphosphatemia

>4.4 mEq/L

causes: acute and chronic renal failure, chemotherapy

effects: calcification of soft tissues with prolonged condition, muscle weakness, tachycardia, nausea, diarrhea, abdominal cramps

magnesium - normal values

1.5-2.5 mEq/L

magnesium - functions

increases neuromuscular excitability - cardiac contractions

absorbed in intestines

eliminated in kidneys

hypomagnesemia

<1.5 mEq/L

causes: malnutrition, malabsorption syndroms, alcoholism

effects: behavioral changes, irritability, increased relfexes, tachycardia, digoxin toxicity

hypermagnesemia

>2.5 mEq/L

causes: renal insufficiency or failure, antacids and laxatives

effects: skeletal smooth muscle contraction, loss of deep tendon reflexes, nausea and vomiting

hydrostatic pressure

pushing pressure - heart

oncotic pressure

pulling pressure - albumin

ADME

absorption, distribution, metabolism, excretion

6 rights of med admin

patient

drug

dose

route

documentation

time

crystalloid

normal IV fluid

colloid

albumin, blood products

type of interactions

drug interactions

pharmacokinetic interactions

drug-laboratory interactions

drug-induced photosensitivity

alpha 1 receptors

vasoconstrict, increase BP, pupils dilate, bladder relaxesa

alpha 2 receptors

vasodilate, decrease BP

beta 1 receptors

increase heart contractibility, increase HR, increase BP

beta 2 receptors

bronchodilate, increase blood flow

adrenergic

SNS

cholinergic

PNS

CRH

corticoreleasing hormone

ACTH

adrenocorticotropic hormone

epinephrine - action

increases vasoconstriction, BP, HR, and cardiac output

promotes bronchodilation

epinephrine - uses

anaphylaxis, anaphylactic shock

bronchospasms, status asthmaticus

cardiogenic shock, cardiac arrest

epinephrine - side effects

cardiac dysrhythmias, palpitations

tachycardia, hypertension

dizziness, headache, paresthesias

agitation, restlessness, tremors

hyperglycemia, oliguria

epinephrine - classification

adrenergic agonist

atenolol - action

decreases HR and BP

atenolol - uses

hypertension

angina

acute MI

atenolol - side effects

depression

dizziness, drowsiness

erectile dysfunction

atenolol - classification

adrenergic antagonist

bethanechol - classification

parasympathomimetic/cholinergic agonist

bethanechol - use

treat non-obstructive urinary retention, neurogenic bladder

bethanechol - side effects

hypotension, diaphoresis, miosis

increased salivation and gastric acid

nausea, vomiting, diarrhea, abdominal cramps

LT: bronchospasms, wheezing

bethanechol - contraindications

bradycardia, hypotension, peptic ulcer

parkinsonism, hyperthyroidism

urinary tract obstruction

atropine - classification

anticholinergic, parasympatholytic, muscarinic antagonist

atropine - action

increase HR, promotes pupil dilation, decreases GI motility, spasms, peristalsis, salivary and gastric secretions

atropine - uses

reduce salivation

increase HR during bradycardia

atropine - side effects

dry mouth, dehydration, headache

blurred vision, photophobia

urinary retention, constipationat

atropine - adverse reactions

tachycardia, paradoxical bradycardia, angina, ileus, seizures

LT: dysrhythmias, laryngospasm, coma

benzotropine - classification

anticholinergic

benztropine - action

decreases involuntary movement, tremors, and muscle rigidity

benztropine - use

parkinsonism

benztropine - side effects

dry mouth/skin, headache

blurred vision, photophobia

tachycardia, ocular hypertension

urinary retention, constipation

tolterodine tartrate - classification

antimuscarinic, anticholingeric

tolterodine tartrate - action

increase HR, promotes pupil dilation, decreases GI motility, spasms, peristalsis, salivary and gastric secretions

tolterodine tartrate - uses

decrease urinary frequency, urgency, and nocturia not related to a UTI

overactive bladder syndrom (OBS)

tolterodine tartrate - side effects

drowsiness, dizziness, dry mouth and eyes, headache, blurred vision, confusion, diarrhea, abdominal pain, constipation, dyspepsia, dysuria, fatuge, weight gain, arthralgia, hallucinations, and urinary retention

tolterodine tartrate - adverse reactions

angioedema, chest pain, tachycardia, peripheral edema

LT: stevens-johnson syndrome

overactive bladder syndrome (OBS)

urgency, frequency, nocturia or urge incontinence; no UTI or other known pathology

involuntary detrusor muscle contractions, possible myogenic or neurogenic dysfunction

meds: diuretics, antidepressants, alpha agonists, beta antagonists, sedatives, analgesics

neurogenic bladder

lower urinary tract dysfunction caused by central or peripheral neurologic disorders; depends on the location of the neurologic lesion; effects bladder sensation and emptying

upper motor neuron lesions: detrusor hyperreflexia (OBS), detrusor-sphincter dyssynergia, increased bladder pressures, urgency and urge incontinence

lower motor neuron lesions: detrusor areflexia (atonic bladder), urinary retention, overflow incontinence, impaired bladder sensation

acute cystitis

lower UTI

E.coli, Staphylococcus saprophyticus, Klebsiella, Proteus, Pseudomonas

acute pyelonephritis

upper UTI

E. coli

trimethoprim and trimethoprim-sulfamethoxazole - classification

urinary antiseptics/antiinfectives and antibiotics

trimethoprim and trimethoprim-sulfamethoxazole - use

treat bacterial urinary infections

trimethoprim and trimethoprim-sulfamethoxazole - side effects

nausea, vomiting, diarrhea

anorexia, abdominal pain

renal failure, hyperkalemia, hyponatremia, hypoglycemia

C difficile-associated diarrhea

trimethoprim and trimethoprim-sulfamethoxazole - contraindications

hypersensitivity

hepatic or renal impairment

clients with lupus

solifenacin succinate - classification

urinary antimuscarinic, anticholinergic, bladder antispasmodic

solifenacin succinate - use

treat overactive bladder and urinary incontinence

solifenacin succinate - side effects

blurred vision, dizziness, fatigue, cough, pharyngitis, dry mouth

nausea, vomiting, abdominal pain, constipation, dyspepsia

cystitis, urinary retention, peripheral edema