Patho Quiz 1

inflammation, infection, COVID, UTI, HIV, cardiac 1 MEDS ONLY

NSAID

non-steroidal anti-inflammatory drugs

NSAID med names

aspirin, ibuprofen

aspirin indications

fever, anti-inflammation, analgesic - pain

aspirin action

* irreversible, non-selective inhibitor of COX (1,2)
* Anti-inflammatory
* Antipyretic

aspirin side effects

GI - gastritis, dyspepsia, ulcers, bleeding, renal impairment, allergy

aspirin nursing consideration

* enteric coating may not prevent GI bleeding
* Administer with food
* avoid alcohol ingestion with meds

ibuprofen indication

fever, pain, anti-inflammation

ibuprofen action

* non-selective inhibitor of COX (1/2)
* anti-inflammatory
* antipyretic

ibuprofen side effects

GI - gastritis, dyspepsia, ulcers, bleeding

Antipyretic only

acetaminophen

antipyretic med names

NSAID

antipyretic only (not anti-inflammatory drug)

Acetaminophen indications

fever, pain

acetaminophen actions

decrease prostaglandin synthesis in the CNS

acetaminophen side effects

few - liver toxicity in high regular doses

antibiotic affecting cell wall synthesis

1. beta-lactam
2. non-beta-lactam

Penicillin + beta-lactamase inhibitor indications

* Therapeutic: used for gram positive bacteria
* Prophylactic: used to prevent bacteremia in selected populations at risk for endocarditis, such as people with artificial or damaged heart valves

Penicillin + beta-lactamase inhibitor / Generation b-lactam antibiotics actions

affect cell wall synthesis

Penicillin + beta-lactamase inhibitor side effects

* Allergy
* GI – diarrhea, dyspepsia
*  Renal impairment can cause penicillins to accumulate to toxic levels
* Suprainfections possible

Generation beta-lactam antibiotics med names

Cephalosporins - 4 generations

* each starts with CE

Generation b-lactam antibiotics indications

* Similar to penicillins in structure and activity
* To avoid the development of resistant populations of bacteria, __third and fourth generations should be reserved for serious infections__!

Generation b-lactam antibiotics side effects

* Risk of increased bleeding with warfarin because of interference with Vitamin K metabolism
* Allergy
* GI upset: diarrhea and pseudomembranous colitis
* can promote clostridium difficile suprainfection

Generation b-lactam antibiotics nursing considerations

Cephalosporins are contraindicated for patients with a history of allergic reactions to cephalosporins or of severe allergic reactions to penicillins.

Vancomycin (non-b-lactam) indications

* A potentially toxic antibiotic __only used to treat serious infections__.
* Can be used in treating gram+ infections (in those with PCN allergy)
* Oral preparation can be used for bowel infections, particularly *Clostridium difficile* (a suprainfection) – topical to GI system, not absorbed by the bloodstream

Vancomycin (non-b-lactam) actions

affect cell wall synthesis

Vancomycin (non-b-lactam) side effects

* Irritating to the vein, causing thrombophlebitis (use large vein and change site often
* Rapid infusion can cause “red man syndrome”

bacteriostatic antibiotics

antibiotics that inhibit protein synthesis

tetracyclines med names

* Tetracycline
* Doxycycline
* Minoclycline

tetracyclines indications

Agents of choice for  *Chlamydia* and rickettsial diseases (Rocky Mountain spotted fever)

Used in acne, periodontal disease.

tetracyclines actions

Bind to the 30S ribosomal subunit

Broad spectrum but resistance has developed

tetracyclines side effects

\*Discoloration of developing teeth

\*GI distress (epigastric burning, cramps, nausea, vomiting, diarrhea)

\*Photosensitivity

tetracyclines nursing considerations

Bind to calcium in developing teeth and form a discolored area > don’t give to pregnant women (will only affect baby teeth) or children below 8 years.

macrolides med names

Azithromycin (Zithromax)

Erythromycin

Clarithromycin (Biaxin)

macrolides indications

Gram-positive and some gram-negative bacterias

macrolides side effects

IV erythromycin, clarithromycin and azithromycin are corrosive to veins

Some forms of erythromycin are corrosive to the GI tract and can cause erosive esophagitis

macrolides nursing considerations

Erythromycin and clarithromycin are __strong inhibitors__ of cytochrome P450

Drug-drug interactions

Alternative to penicillin in those with PCN allergy

 D__ilute in large quantities of fluid and infused slowly into a large vein__.

 Erythromycin and clarithromycin are __strong inhibitors__ of cytochrome P450 – administer with caution in patients taking drugs metabolized by these enzymes (statins and warfarin, among others).

clindamycin indications

Anaerobes and gram-positive aerobes

Reserve for serious infections

 Poor penetration of the brain.

clindamycin actions

Inhibits 50S ribosomal subunit

clindamycin side effects

Suprainfection with *Clostridium difficile*

clindamycin nursing considerations

IV infusion must be __SLOW__ (fatalities have occurred from too rapid infusion)

Bacteriocidals

aminoglycosides, fluoroquinolones

Aminoglycosides med names

Gentamicin

Tobramycin

Amakacin

Aminoglycosides indications

Good coverage of gram-negative bacteria: *Pseudomonas, Klebsiella, and Serratia*.

No activity against anaerobes.

Aminoglycosides actions

Bind to the 30S ribosomal subunit

Aminoglycosides side effects

ototoxic and nephrotoxic, inhibits neuromuscular transmission → respiratory depression

Sulfamethoxazole trimethroprim (aminoglycosides) indications

* Broad spectrum, including many gram negative and gram positive
* Used extensively for UTI,  *Pneumocystis jerovici* pneumonia

Sulfamethoxazole trimethroprim (aminoglycosides) actions

* Blocks bacterial enzymes that are important for the synthesis of the building blocks of DNA, RNA and proteins.
* __Combination of a sulfa drug (sulfamethoxazole)__ and an inhibitor of a bacterial enzyme called dihydrofolate reductase __(trimethoprim)__ - are synergistic in their activity. 

Sulfamethoxazole trimethroprim (aminoglycosides) side effects

Rash, including rare Stevens-Johnson syndrome

Sulfamethoxazole trimethroprim (aminoglycosides) nursing considerations

* Advise outpatients to consume 8 to 10 glasses of water per day.
* Advise patients to avoid prolonged exposure to sunlight, wear protective clothing, and apply a sunscreen to exposed skin.

Fluoroquinolones med names

Ciprofloxacin (Cipro)

Levofloxacin

Oxofloxacin

Fluoroquinolones indications

Active against aerobic organisms, most gram negative and some gram positive

Fluoroquinolones actions

Inhibit an enzyme (DNA gyrase) important in bacterial DNA replication

Fluoroquinolones side effects

*Candida* suprainfections, especially of the oropharynx

Methronidazole (fluoroquinolones) indications

Targets __anaerobic__ organisms, including parasites and bacteria:

*C. difficile and others*

Methronidazole (fluoroquinolones) actions

A prodrug that is activated only in anaerobic cells

Methronidazole (fluoroquinolones) side effects

* Cytochrome P450 interactions
* Darkening of the urine
*  CNS adverse effects
*  Caution during pregnancy, avoid during lactation

antibacterial drugs

* narrow spectrum antibiotics
* broad-spectrum antibiotics
* anti-mycobacterial drugs

antifungal drugs

target fungi/mold

antiviral drugs

antivirals, anti-retroviral

nitrate medication

* nitroglycerine
* isosorbide dinitrate

nitrate indication(s)

stable, variant, unstable angina, MI

nitrate action(s)

* dilates veins (keep in venous system = decrease cardiac demand) → reduced preload → decrease cardiac oxygen demand
* vasospastic angina → prevent vasospasm of coronary arteries
* stable angina vasodilator: decrease preload → decrease cardiac work

nitrate side effects

* headache (common)
* orthostatic hypotension
* reflex tachycardia secondary to decrease BP

nitrate nursing considerations

* assess HR, BP
* Route: patch
* NO ALCOHOL
* Slow position changes (orthostatic hypotension)
* headaches (common)
* remove patch at night (b/c decrease O2 demand)

nitrate & alcohol

hypotension

nitrate & heparin

decreased anticoagulation

nitrate & lithium

possible lithium toxicity

nitrate & fentanyl

severe hypotension, increase fluid requirements

Beta-blockers/antihypertensive medication names

Propranol__**ol**__

B-blocker indication(s)

**angina**, post MI, antiarrhythmic

B-Blockers action(s)

reduce PVR, decrease force of contraction, decrease HR, decrease rate of electrical conductions, reduce myocardial O2 demand

B-Blockers side effects

* HF, AV block, sinus arrest, bradycardia
* hypotension occurs 2nd to reduced CO
* asthma patients blocking beta2 receptors → bronchospasms

B-Blockers nursing consdierations

* assess apical BP, HR before admin
* notify HCP if

B-Blockers drug-to-drug interactions

contraindicated for patients with asthma, sinus, bradycardia

Calcium channel blocker med names

* nondihydropyridines (controlling HR)
* dihydropyridine (lower BP)

Calcium channel blocker indication(s)

stable, variant angina, antihypertensive

Ca+ channel blocker actions

* reduction of automaticity in the SA node → delay conduction through the AV → reduction of myocardial contractility
* arterial vasodilation
* decrease BP → decrease vascular resistance
* reduce myocardial O2 demand

Ca+ channel blockers side effects

* Cardiac: bradycardia, AV block, HF
* bradycardia → decrease HR > increase ventricular filling time > increase CA prefusion
* PV: hypotension
* GI: constipation
* Reflex tachycardia
* body response to drop in BP

Ca+ channel nursing considerations

* assess HR, BP
* Prolongs PR
* avoid grapefruit

Ca+ channel drug-to-drug interactions

increase risk of digoxin toxcity

Anti-platelet med names

aspirin (NSAID)

Anti-platelet indications

Thrombosis prevention:

* ischemic stroke
* TIA’s
* Chronic stable angina
* Unstable angina
* Coronary stenting
* MI - acute, previous, prevention

Anti-platelet actions

* suppress platelet aggregation
* irreversible suppression of COX - 7-10days
* prevent thrombus formation

Anti-platelet side effects

* GI bleeding
* Hemorrhagic stroke

Anti-platelet nursing considerations

* dose: 325mg PO → 81 mg/day (baby aspirin)
* enteric coating may not prevent GI bleeding

Anti-platelet drug-to-drug interactions

contraindication: recent GI bleed 6 weeks, CVA within 2 years, thrombocytopenia

Anti-coagulant med names

warfarin, heparin

Warfarin indications

* thromboembolism prevention: DVT, stroke (A. Fib and prosthetic heart valves)


* Reduce risk of TIA and MI

Warfarin actions

suppresses coagulation by decreasing the production of Vitamin K dependent clotting factors

Warfarin side effects

hemorrhage

Warfarin nursing considerations

* monitor INR goal: most 2-3
* PO: onset slow, half-life long, 1.5-2 days
* not useful in emergency
* plan to admin IV vitamin K for warfarin overdose slowly

Warfarin drug-to-drug interactions

increase/decrease anticoagulation effect (INR)

Heparin indications

* PE and DVT
* Prevent post-op DVT
* during open heart surgery and dialysis

Heparin actions

suppresses formation of fibrin

Heparin side effects

* hemorrhage
* spinal/epidural hematoma
* ITP - low platelets
* hypersensitivity

Heparin nursing consideration

* IV or SQ
* onset rapid, half life short, 1.5 hours
* IV: monitor PTT times (1.5-2x), platelet count, signs of bleeding closely
* plan to admin protamine sulfate for heparin overdose (antidote)

Complicated UTIs

doxycycline, ciprofloxacin, levoFLOXacin, azithromycin

Uncomplicated UTIs

sulfamethoxazole-trimethoprim

Allerigies to sulfamethoxazole trimethoprim/resistance to E. coli

nitrofurantonin macrocrystals

UTIs during pregnancy

nitrofurantonin macrocrytstals, amoxicillin, cephalexin

continous antimicrobial prophylaxis for chronic UTIs

sulfamethozazole-trimethoprim x nitrofurantonin macrocrystals