pharm exam 3-updated

antimicrobial medications

used to treat or prevent infection, necessary when host defense mechanisms are not enough to get rid of infection

host defense mechanisms

-intact skin and mucuous membranes

-various anti infective secretions

-coughing, swallowing

-phagocytic cells

-immune processes

-inflamm processes

lab identification of pathogens

-Used to identify bacteria causing infection

-Gram stain: shows bacteria appearance under microscope (results ~24 hrs)

-Culture & Sensitivity: grows microbes to find exact bacteria + best antibiotic (~48 hrs)

-Broad-spectrum antibiotics may be started while waiting for results

-Best samples: sputum, urine, blood

-Important: collect cultures before starting antibiotics

characteristics of antimicrobials

-broad spectrum-covers large range of different infection

-narrow spectrum-very specific

-bactericidal-kills bact. (ex; bleach, purple wipes)

-bacteriostatic-prevents bact from growing (ex: ammonia, lysol wipes, fridges)

antimicrobial MOA

-act on specific target in pathogen and impair/impede growth of bact

-inhibition of bact wall synthesis, inhibition of protein synthesis or production of abnormal bact. proteins, disruption of microbial cell membranes, inhibition of reproduction of organisms, inhibition of cell metabolism and growth

common ADRS of all antimicrobial therapy

nausea, vomiting, diarrhea, yeast/superinfection

beta lactam antibacterials

-include penicillins, cephlasporines, carbapenems, monobactams

-all contain beta lactam ring

-inhibit synthesis of bacterial cell wall causing cell death

penicillins

-prototye-amoxcicilin

-watch out for penicillin allergies, ppl with this also tend to be sensitive to all beta lactams

cephalosporins

-derived from fungus

-all start with "cefa"

carbapenems

-inhibit synthesis of bact. cell walls by binding with penicillin binding proteins

-all end with "penem"

monobactams

-active against many strains that are ATB resistant

aminoglycosides

-prototype-gentamicin

-narrow spectrum antibiotic

-penetrate bact. cell walls, preventing synthesis of proteins necessary for function/replication

-given by IV only/reserved for hospitalized pts

-used for serious systemic infection

-ADR: ototoxicity (accumulate in high concentrations)

-asses effectiveness by peak and trough (assess how well kidneys are metabolizing and secreting drug)

-keep pts well hydrated and use caution if pt is on diuretics

Fluoroquinolones

-prototype-ciprofloxacin

-derived from quinolone (addition to quinolone structure)

-interfere with bacterial DNA enzyme synthesis

-well absorbed orally

-contraindications: hypersensitivity, children under 18, achilles tendon rupture

tetracyclines

-tetracycline

-penetrate microbial cells inhibiting protein synthesis

-cover wide range of illnesses

-often used for long term acne

-do not give to pregnancy women and children under 8 yrs (can discolor tooth enamel and depress bone growth)

sulfonamides

-prototype-sulfamethoxazole

-inhibit dihydropteroate synthase, a key enzyme in bact. folic acid synthesis pathway

-halt multiplication of new bact. and do not kill fully formed bact.

-trimethoprim-sulfamethoxazole-use for utis

-can be used for other things too

urinary antiseptics

-prototype-nitrofurantoin- has multi targeted disruption on DNA/RNA synthesis, protein synthesis, and cell wall formation

-bactericidal bc of local effects produced by high concentration levels in renal tubules and urine/only used for utis

-urine PH important (also with sulfs)

macrolides

-prototype-erythromycin and azithromycin

-give for upper resp infection in adult pop, soft tissue infection, can be penicillin substitute

-contraindications: hypersensitivity, pre existing liver disease, myasthenia gravis, MOA: inhibits bacterial protein synthesis

metronidazole (miscellaneous anti infective agents)

-antibiotic and antiprotozoal medication

-inhibits protein synthesis by interacting with DNA, and causes loss of helical DNA structure and strand breakage

-wide range of uses; ex is c difficile colitis

-avoid alc and miralax (stool softener)

-be careful with sodium levels/diet bc it can cause hypertension

vancomycin

-alters membrane permeability, inhibits RNA synthesis, and blocks late cell wall synthesis in susceptible bacteria.

-glycopeptide antibiotic

-helps fight bact in intestine if given orally

-be careful w GI disorder pts (same with metro)

-decrease wbc count/surpress immune response

red man sydrome_devolps rash if given rapidly

characteristics of latent, active, and drug-resistant tuberculosis

-latent-TB bact present but inactive, no s/s or contagious but can become active later

-active-TB active and multiplying, contagious, bad cold like symptoms, requires multi drug treatment

-drug resistant-TB bact resistant to standard TB drugs, harder/longer to treat

Isoniazid

-primary agent for tb-treat latent, active and drug resistant TB infection when possible

-inhibits mycolic acid synthesis, interferes with cell wall synthesis and produces bactericidal effect

-oral med

-best taken on empty stomach and with no alcohol. -hepatoxic-monitor AST and ALT

rifamycin-rifampin (used interchangeably)

-other primary tb agent

-inhibit bacterial DNA dependent RNA polymerase

-given PO

-can cause orange discoloration of bodily secretions

clinical manifestations of viruses

-fever, headache, cough, malaise, NV, muscle pain, diahhrea, insomnia, photophobia (may vary with virus/tissue involved)

-wbc count remains normal (5-10k)

-start therapy early for best effects

acyclovir (antiviral drugs)

-treat HSV and VCV (varicella zoster virus) -inhibit viral replication but does not eliminate viruses from tissue, treat fever blisters

amantadine

same moa as acylovir?, inhibits viral replication of flu A

neuraminidase inhibitors

-inhibit viral infection

-prototype-oseltamivir

fungal infections

-can be mild/superficial (skin, hair, nails) or life threatening/systemic (mainly in immunosuppressed)

-recognized through blood culture

-ppl at risk are immunocompromised, diabetics, organ transfusions, substance use, hospitalized pts, overuse of broad spectrum antibiotics

-most anti fungal medication targets fungal cell membrane/disrupt structure/function

polyenes

-prototype-amphotericin B

-IV only, use only when yeast in blood

-binds with ergosterol and disrupts cell membrane

-ADR: transfusion reaction, pretreat with diphenhydramine, acetaminophen/aspirin or antiseptics

-other prototype is nyastain, which can be taken as suspension pill, powder, and cream; same MOA (yeast not in blood)

azoles

-prototype-fluconazole

-end in "azole"

-inhibit ergosterol synthesis, used for yeast infection

-metroniazole not a azole

parasites

-scabies and pediculosis-parasitic infections of the skin, itching is main symptom

Scabicides

-prototype-permethrin, can be topical or hair

-paralyze nervous system of parasites,only kills live lice and not eggs

-effective against all stages of insect growth, particularly larvae

Ivermectin

-works through many mechanisms to kill targeted parasites

-PO

hydantoins (anti seizure medication)

-prototype-phenytoin

-stabilizes neuronal membrane by delaying influx of sodium ions into neurons and preventing excitability caused by excessive stimulation

-half life around 8-60 hrs (once a day dosing)

-ADR: sedation, sleepiness, confusion, gingival hyperplasia

-serum drug level 10-20 mcg/ml

-implications-Na level, CBC, Liver test, give slowly via IV with inline filter for initial dose

carbamazepine

-prototype-carbamazepine

-works on sodium channels

-serum drug level 5-12 mcg/dl

-implications-na levels, CBC/WBC, LFTs

barbiturates

-prototype-phenobarbital

-depress CNS by inhibiting conduction of impulses in ascending reticular activating system which depresses cerebral cortex and cerebellar function

-ADR: CNS depression (super sedating), cognitive impairment w sedation, Steven-Johnson syndrome

Benzodiazepines

-prototype-diazepam

-antidepressants, antiepiliptics, skeletal muscle relaxants

-used for treatment of severe recurrent conclusive seizures and status epilepticus

-give during seizure

status epilepticus

-life threatening emergency where seizures recur every few minutes or last more than 30 minutes; get them to the ground in recovery position, nothing in mouth, note any twitching, call 911

-antiseizure drugs prevent seizures from occurring, during actual seizure give lam or pam causing CNS depression,

drugs typically abused (substance use disorder)

-CNS depressants (alc, anti anxiety meds (benzos; antidote is flumazenil)

-sedative hypnotic agents

-opioid analgesics (antidote naloxone)

-CNS stimulants (cocaine, metam, methyl, nicotine)

-mind altering drugs (weed, ectasy)

characteristics of drug dependence

-Craving the drug

-Compulsive drug-seeking behavior

-Physical dependence (withdrawal symptoms if drug use decreased or stopped)

-Psychological dependence (unpleasant symptoms occur when the drug is stopped)

drug therapy for drug dependency

-alc withdrawal-benzos (chlordiazepoxide)

-alc sobriety maintenance- enzyme inhibitors (disulfiram)

-opoid abuse-opoid agonists and antagonists

rapid acting vs long acting insulin

-rapid-lispro/aspart/glulisine. rapid onset, short duration of action, starts to work in 15 mins, peaks in 2.5 hrs, lasts 5 hrs, used as bolus (body secretes large amounts of insulin after eating), pump uses rapid acting only but also gives basal

-long acting-glargine. slower absorption, prolonged action, starts to work in 1 hr, no peak, lasts 24 hrs, acts like basal (constant secretion; little amounts), injections

-insulin opens cells and pulls glucose in

dosing of insulin

-t1d dosing-insulin based on current blood sugar; additional if over 150; correction amounts is usually 1 unit for every 30 over 150 or 1 unit for every 50 over 150

-t2d dosing-based on A1c

-count carbs to figure out how much they will dose

-based on age, nutrition, stress (raises sugar), exercise (lowers sugar)

complications of insulin treatment

-hypoglycemia-too much insulin taken/given. shaky, sweaty, nausea

-hyperglycemia-too less insulin. sleepy, 3ps, fruity breath smell

-long term: vision changes, ED, neuropathy, stroke etc;

orał hypoglycemics biguanide

-prototype-metformin

-increases use of glucose by muscle and fat cells, decreases hepatic glucose production, and decreases intestinal absorption of glucose

-used for type II

-ADR: lactic acidosis, GI upset

orał hypoglycemics sulfonyleuras

-prototype-gly

-increase secretion of insulin

-use for elevated serum glucose

-ADR: hypoglycemia;15 grams of carbs raises sugar 50 points

SGLTs inhibitors

-prototype-canaglifozin

-blocks reabsorption of glucose in the kidney, promotes excretion of excess glucose in urine; renal protective decreasing protein loss-like dieuretic

-use for elevated serum glucose

-ADR: may cause UTIS, urgency, flank pain

type I vs type II diabetes

-type 1-destroys pancreatic beta cells, cause 3 ps, weight loss, ketaacidosis

-type 2-insulin resistance and inappropriate insulin secretion, usually in obese ppl

patient teaching guidelines of insulin and oral hypoglycemics

-follow diet and exercise

-take meds as prescribed and correctly

-monitor blood glucose regularly

-regular blood sugar between 60-120, 7% elevated (average 154)

-review s/s of hypoglycemia and hyperglycemia

-test urine for ketones when blood sugar elevated (biproduct of muscle breakdown)

-observe and report complication

local anesthesia

-sensory stimulation transmitted through peripheral nerves is blocked only in restricted region of body

-lose movement/feeling but awake

local Anastasia routes

-topical-skin eye or mucus membranes; used to relieve pain

-infiltration-injected directly into the area (ex: dental surguring/suturing)

-nerve block-injected near a nerve to numb a larger specific area without affecting whole body

-intravenous regional-injected into vein to numb arm or leg

-epidural-given through catheter outside spinal cord to block pain; common in labor

-spinal-injected into spinal fluid to numb the lower body

amides (types of local anestethics)

-prototype-lidocaine

-less allergic reactions

-blocks sodium channels in nerve cells, stopping nerve signals and causing numbness. -epi added to prolong effects and decrease systemic effects

esters (types of local anesthetics)

-prototype-procaine

-more allergic reactions

-decreases influx of sodium into nerve cell and depresses depolarization

general anesthetics

-complete loss of sensation, consciousness, pain perception, and memory

Inhaled anesthetics

-implications: monitor vital signs+ pain, have pt cough and deep breathe to help get rid of anesthetic

nursing management for general anesthetics

-assess vitals; low bp and temp

-asses pain

-assess for n/v

-assess wound

-talking to them

cytoprotective agents (cancer drugs)

-reverse the effects of cytotoxic drugs

cytoprotective agents

-epoetin-stimulates bone marrow to produce red blood cells

-filgrastim-stimulates production, maturation, and activation of neutrophils

-pegfilgrastim-stimulates production, maturation, and activation of neutrophils (long acting version of filgrastim)

-oprevelkin-prevent thrombocytopenia

-sargrasmostin-use only for stem cell and bone marrow transplant

indicators of chemo

-leukopenia-wbc less than 3500 cells

-neutropenia-neutrophils less than 1500

-anemia- hbg less than 13.5 in males and less than 12 in females

-thrombocytopenia-platelets less than 150,000. -hematocrit less than 38.8 in males and 34.9 in females

-tachycardia and tachpnea

side effects of chemo

-n/v most common bc drugs target rapidly producing cells in GI

-alopecia

-anorexia

-mucositis-sores in mouth

-infection bc of low wbc

-pain also very common

toxicities of chemo

-bone marrow suppression

-stomatitis or mucostitis (sores)

-hyperuricimeia-elevation of uric acid bc we've killed a Loy of cells; use hydration/allopurinol which blocks conversion of hypoxanthine and xanthine to uric acid

-myelosurpression-bone marrow not making enough cells; may result in granulocytopenia and thrombocytopenia