pharm exam 1

Nystatin

Nystatin

swish liquid in mouth then swallow

for thrush, candidiais infection

polyene

Griseofulvin

tinea infections
4-12 months

Antifungal drug groups

polyenes, azoles
very expensive and limited drugs

Purine nucleosides

interferes with the steps of viral DNA synthesis
acyclovir (Zvirax)

(shingles)

Metronidazole (Flagyl)

paraisitic infection
-helicodbacter pylori (H. pylori)-projectile vomit
aovid alchohol, can cause antabuse reaction (flushing, sweating, throbbing H/A, N/V, tachycardia, arrhythmia

pregancy category B

Antimalarial drugs

often given as a phrophylactic measure (travel)
long 1/2 life
GI side effects, take with food
can cause renal and liver impairment, no alcohol

fluconazole (Diflucan)

yeast
PO, IV, (Topical, vaginal- bedtime )
itching, STDs
systemic = IV
antibiotics kill good flora, yeast can then colonize

Azole drug group

fungi=tinea

difficult to treat because of thick coats
antifungals or antimycotic agents

Amphoterincin B

severe infections
causes hypotension, hypokalemia, hypomagnesemia
monitor VS every 30 min
increase fluids, monitor urine output

administer IV

polyene

How much urine should I put out in an hour

30 ML

hypotension

low blood pressure

hypomagnesemia

low magnesium

thrombocytopenia

low platelets

Isoniazid

take on empty stomach
follow complete regiment
collect sputum early in AM
report numbness, tingling, burning
Oral, IM
inhibits bacterial cell wall synthesis
antacids decrease absorption
alcohol increases risk of neurpoathy and hepatoxicity

hepatoxicity

liver toxicity

nephrotoxicity

kidney toxicity

Neurimindase inhibitors

flu
take within 48 hours of symptoms or wont work
oseltamivir phosphate (Tamiflu)
zanamivir (Relenza)

TB

most common symptom- coughing up blood
clients at risk-HIV patients, immunocomprimsed patients
single drug therapy-ineffective
multidrug therapy more effective
first line drugs- isoniazid (INH)
more effective than 2nd line and less toxic

rhabdomyolysis

myoglobin gets stuck in kidney

adherence

adherence to regimen is major concern

HAART

highly active antiretroviral therapy - decrease viral load

anaerobic

can live w/o oxygen

Antibacterial drugs

treat bacteria
bacteriostatic -stops growth
bactericidal-kills bacteria

gentamicin

class: Aminoglycoside (think mean)

action:inhibits protein synthesis

uses: gram neg aerobic microorganisms, severse systemic infections, e.coli, proteus pseudomonas

adverse effects: n/v, rash, peripheral neuropathy, tinnitus, ototoxicity, nephrotoxicity

CI: renal impairment, neuromuscular disorders, pregnancy, hypersensitivy

nursing: check culture and sensitivity, monitor peak/trough, monitor urine output, BUN, creatinine , give IM or IV, administer IV slow

dissolution

disolving
enteric coated- do not chew or break in 1/2
tablet- disintegration- dissolution

Pharmacokinetics

1. absorption -process of time that occurs between when a drug enters the body and the time it enters the blood stream
2. distribution -once a drug enters the bloodstream it is ready to travel through the body fluids to its site of action
3. metabolism -liver, a series of chemical reactions that alter and convert drugs into water-soluble compounds
excretion - kidney

onset of action

the time it takes to reach the minimum effective concentration (MEC) after a drug is administered

hepatic first pass

drug passes to liver first
after oral intake - to intestinal lumen - to liver via portal vein

excretion

kidney- main route

peak

highest blood or plasma concentration

trough

lowest plasma concentration

drug order components

1. patients name
2. date and time order written
3. medication name
4. medication dose
5. route of administration
6. frequency of administration
7. signature
8. TO (telephone order ) or VO (verbal order)

trade name

capitalized

medication orders

patient name , full name of med, dose, route, frequency, time, date, signature of provider

subjective data

what patient says

objective data

measureable data

rights of drug administration

1. right patient
2. right dose
3. right time
4. right drug
5. right route
6. right documentation
7.right reason
8. clients right to refuse

chlorquine HCL (Aralen HCL)

Antimalarial
moa: increase ph in malaria parasite, inhibits growth
causes: agranulocytosis (low neutrophil)
hypotension, ECG changes, thrombocytopenia

Anti-helmintic drugs

parasitic worms
ivermectin- one dose
happens a lot in kids
treat whole household
change sheets, underwear, bedclothes daily

hypokalemia

low potassium

acyclovir (Zovirax)

treats herpes simplex 1 (cold sore), herpes zoster(shingles) , genital herpes (herpes simplex 2), CMV (cytomegalovirus)
adverse effects: H/A, dizziness, N/V/D, lethargy, tremors
life threatening: neuropathy, nephrotoxicity, thrombocytopenia, seizures

adverse reaction: urticaria, anemia, gingival hyperplasia ( overgrowth of gum tissue around the teeth)

if patient has chronic kidney disease, need smaller dose

Antitubercular drugs

phase 1 : 2 months
phase 2: 4-7 months

zidovudine (Retrovir)

pregnant women- to prevent mother to baby transmission of HIV
start during pregnancy or can start during labor

AIDS

caused by HIV

categories of drug action

1. stimulation
2. depression
3. replacement
4. inhibition or killing organism
5. irritation

sympathetic

fight or flight
adrenergic drugs-stimulate sympathetic nervous sytem

parasympathetic

rest and digest
cholinergics- stimulate the parasympathetic nervous system

aerobic

requires oxygen

bioavailability

% of the administered drug dose that reaches the systemic circulation

metabolism

liver primary site

route of administration

sublingal- SL under tongue
buccal- in cheek
oral- PO
transdermal
inhalations
instillation
enteral
suppository
parenteral
intravenous
subcutaneous
intramuscular

generic name

lowercase

nursing process

1. assessment
2. nursing diagnosis
3. planning
4. intervention/ implementation
5. evaluation

Viruses

WBC count remain NORMAL

antiretroviral agents

fusion protein inhibitors
integrase inhibitors
CCR5 antagonist
NRTIs
NNRTIs
PI

steven johnson syndrome

very painful
red/pink spots
systemic
caused by vancomycin and bactrim

HIV stages four F's

flu like
feeling fine
falling count
final
1. primary infection
2. latency phase
3. Aids phase

theraputic index

it measures the margin of safety of a drug. a low theraputic index is higher risk for drug error

loading dose

large initial dose

neurotransmitters

chemical messengers that travel between neurons, stimulates the receptor site, and brings aboout a response

ligands

neurotransmitters, hormones, and medications that can bind to receptors in the ANS

signal transduction

cascade of intracellular events that occur when receptors located on target tissues are stimulared by ligand

agonist

works with drug

antagonist

works against drug

epinephrine:adrenaline

class: sympathomimetic

actions: stimulates alpha- and beta- adrenergic receptors

uses: anaphylaxis, bronchospasm, cardiogenic shock, cardiac arrest , severe asthma

contraindications: cardiac dysrhythmias, hypertension, hyperthyroidism

adverse reactions: palpitations, tachycardia, hypertension, n/v, dyspnea, h/a, insomnia, agitation, tremors, nervousness

life threatening: ventricular fibrillation, myocardial infarction, pulmonary edema

drug interaction: beta-blockers, decrease epinephrine action. Digoxin, causes cardiac dysrhythmias

nursing interventions: monitor vital signs, urine output, monitor IV site for infiltration

albuterol (Proventil)

class: beta-2 agonist

treats bronchospasms, asthma, bronchitis, COPD

moa: acts on beta2 receptors to relax airway smooth muscle to promote bronchodilation

adverse reaction: tremors, nervousness, restlessness, dissiness, h/a, tachycardia, HTN, seizures, palpitation, cardiac dysrhythmias

nursing interventions: record vital signs, monitor ECG for dysrhythmias, report signs of adverse reaction, avoid dose close to bedtime, check blood sugar

adrenergic blockers effect on receptors

Alpha 1- vasodilation, decreased blood pressure, reflex tachycardia. pupil constriction, reduces contraction of smooth muscles in bladder, neck, and prostate

Beta 1- reduces cardiac contractility, decreases pulse

Beta 2- bronchoconstriction, inhibits glycogenolysis

Nonselective beta blocker

propranolol HCL (Inderal)

selective beta blockers

metoprolol tartrate (Lopressor) and atenolol (Tenormin)

atenolol (Tenormin)

class: beta 1 blocker

uses: treat HTN, angina pectoris, myocardial infarction

adverse effect: drowsiness, dizziness, fainting, N/V/D, cool extremities, depression

adverse reaction: bradycardia, hypotension, heart failure, dysrhythmias, pulm edema

caution: renal dysfunction, asthma , COPD, diabetes mellitus

pregnancy category C

Contraindication: sinus bradycardia, heart block, cardiogenic shock

nursing interventions: report AE, rise slowly, monitor urine output, comply with med schedule, monitor mood changes, monitor vitals, pulse less than 60 HOLD

anticholinergics

dries secretions, treats bradycardia, parkinsons disease, motion sickness, overactive bladder, irritable bowel disease, asthma and COPD

direct acting cholinergic agonist

located in smooth muscles

metoclopramide (Reglan)- increase gastric emptying

pilocarpine (Pilocar)- contstict pupils

bethanechol chloride (Urecholine)- increase urination

indirect acting cholinergic drugs

also called cholinesterase (ChE) inhibitors, and acetylcholinesterase (AChE) inhibitors

moa: inhibits cholinesterase enzyme

adverse effects: increased GI motility, bradycardia , miosis, bronchial constriction, increase urination

contraindications: intestinal and urinary obstruction

anticholinergics

block parasympathetic

anticholinergics: atropine

class: anticholinergics

used as preoperative med to decrease salivation, increase pulse, dilate pupils

mechanism of action: inhibition of acetylcholine by occupying the receptor

contraindicated in glaucoma and obstructive GI disorder

adverse effect: dry mouth and skin, H/A, blurred vision, photophobia, palpitations, urinary retention, constipation

adverse reaction: tachycardia, hyperthermia, delirium

life threatening: coma, paralytic ileus, ventricular fibrillation

nursing interventions: monitor vital signs, urine output, bowel sounds, monitor safety, provide mouth care, avoid hot environments, avoid alcohol, cigarettes, caffeine, wear sunglasses in bright light

Atropine overdose

hot as a hare(increased temp, decreased sweating), mad as a hatter(confusion, delirium), red as a beet(flushed face, tachycardia), dry as a bone (decreased secretions, thirsty)

pancytopenia

low count of all blood cells

protease inhibitors

moa: inhibits HIV protease, results in noninfectious immature HIV particles

prototype: Saquinivir mesylate (Invirase)

contraindications: use with ergot alkaloids can cause ergot toxicity, hepatic impairment, conditions that cause QT prolongation

AE: N/V/D, peripheral neuropathy,depression, anxiety, rash , pancytopenia, chest pain, hyperglycemia

nursing interventions: monitor liver enzymes and CBC, monitor ECG for QT prolongation, give with meals to improve absorption

integrase inhibitors

MOA: blocks integrase to prevent virus replication

prototype : Raltegravir (Isentress)

must be used in conjunction with HAART for patients with resistance to other regimes

AE: n/v/d, headache, fever, adbominal pain

adverse reaction: rhabdomyolysis

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

MOA: prevent viral replication by binding with reverse transcriptase

given in combination with other antiretrovirals

major disadvantage: prevalence of NNRTI-resistant viral strains and low genetic barries of NNRTIs for development of resistance

prototype: efavirenz (Sustiva)

AE: dizziness, headache, depression , fever , fatigure ,skin rash

Adverse reaction: steven johnson syndrome

contraindications: liver impairment, hypersensitivity, pregnancy category D

nursing interventions: monitor for rash, monitor liver enzymes

nucleoside reverse transcriptase inhibitors NRTIs

moa: block reverse transcriptase needed for viral replication

uses: slow progression, prevent transmission to fetus

prototype: zidovudine (Retrovir)

used in combination with 2 or more antiretrovirals

AE: anemia, neutropenia, n/v/d/ , headache, malaise, hepatomegaly

adverse reaction: lactic acidosis

nursing interventions: monitor CBC and liver enzymes, monitor for lactic acidosis, monitor for opportunistic infections

neutropenia

decreased neutrophils

hepatomegaly

enlargement of liver

fusion protein inhibitors

moa: inhibitis fusion of the virus to the host cell which prevents HIV cell entry

prototype: enfuvirtide (Fuzeon)

expensive

used in combo with 3-5 other agents

ae: inj site reactions (sub-q), rash, fatigure, diarrhea, nausea

nursing interventions: administer subcutaneoulsy

can use upper arm, abdomen, thigh

CCR5 antagonist

moa: prevents the interaction of HIV-1 and CCR5 that is needed for HIV to enter the cell

prototype: Maraviroc (Selzentry)

may lead to drug induced hepatotoxicity after one month of use

used in combination with other meds

ae: cough, fever, rash, HTN, dizziness, anxiety, depression

CI: liver and kidney impairment

nursing interventions: high fat food enhances absorption, monitor liver enzymes, BUN, CrCI

HIV transmisson

sexual contact, infected needles, blood to open mucus membrane , maternal fetal transmission, breastfeeding

red man syndrome

occurs with too rapid infusion-histamine release

Vancomycin

class: glycopeptide

actions: inhibits cell wall and RNA synthesis, fights gram positive

uses: oral for bacterial colitis, IV for serious infections-bone, skin, lower respiratory tract, MRSA

primary hospital setting

AE: chiils, dizziness, fever, rashes, n/v, thrombophlebitis at injection site

adverse reactions: ototoxicity, nephrpathy, steven-johnsons syndrome, severe hypotension, tachycardia, cardiac arrest, red man syndrome

contraindications: hypersensitivity, previous hearing loss, impaired kidney function and renal failure

erythromycin (Erythrocin)

class: macrolide

common: azithromycin

actions: inhibits protein synthesis

uses: respiratory infection, skin, soft tissue infection , chlamydia, ointment- newborns to treat chlamydial conjunctivitis

contraindications: hypersensitivity, hepatic dysfunction, pregnancy, lactation

adverse effects: N/V/D, anorezia, abd cramps, rash, tinnitus, pruritis

adverse reaction: secondary infections, hearing loss, anaphylaxis , hepatotoxicity

contraindication: hypersensitivity, hepatic dysfunction, lactation

nursing interventions for macrolide

check for allergies, check liver enzymes, report changes in skin color, can give antacids 2 hours before or 6 hours after med- not with food, can give with food if GI upset, contraceptives may have decreased effect, report s/s of secondary infections

sulfamethoxazole-trimethoprim (Bactrim)

class: sulfonamide

action: inhibit bacterial synthesis of folic acid. bacteriostatic (topical for burn related infections is bactericidal)

uses: fights gram neg, gram pos bacteria. Klebsiella, E.coli, Shigella enteritis. UTI, respiratory infection, otis media, treats infections r/t 2nd and 3rd degree burns

Contraindications: renal impairment, hypersensitivity, pregnancy

adverse effects: anorexia, n/v/d, rash, pruritis, hyperkalemia, fatigure, crystalluria, photosensitivity

life threatening: leukopenia, thrombocytopenia, increased bone marrow depression, aplastic anemia, stevn johnson syndrome and renal failure

crystalluria

developing crystals in urinary tract

leukopenia

low white blood cell count

tetracycline hydrochloride (Sumycin)

class: Tetracycline

actions: inhibits microbial growth by preventing protein synthesis

uses: gram pos and gram neg bacteria, fights helicobacter pylori, treats acne

common:doxycycline (Vibramycin)

ae: n/v/d, rash, urticaria, esophagitis, photosensitivity, hepatotoxicity, secondary infections

CI: liver disease, pregnancy, hypersensitivity, renail impairment

nursing interventions: wear suncreen, use non hormonal oral contraceptives, avoid giving to children under 8 due to permanent teeth discoloration or in pregnancy due to baby teeth discoloration of fetus, instruct client to report any s/s of a secondary infection

ciprofloxacin (Cipro)

class: Fluoroquinolone (quinolone)

action: interferes with enzymes needed for synthesis of bacterial DNA

uses: gram neg, some gram pos, bone and joint infections, bronchitis and pneumonia, gastroenteritis, uti, anthrax

adverse effect: N/V, rash, urticaria, tendonitis, photosensitivity, secondary infections

CI: renail impairment, pregnancy, and hypersensitivity

nursing interventions: hydration, monitor I and O, no antacids for 2 hours before or 6 hours after dose, report s/s of thrush, yeast, or C.diff, report any achilles tendon pain or edema, wear sunscreen

urticaria

hives

tendonitis

achilles tendon pain

tinnitis

ringing in ear

generations of cephalosporins

Generations of Cephalosporins

1. First Generation: Effective against gram-positive bacteria (e.g., Cephalexin, Cefazolin).

2. Second Generation: Broader spectrum, including some gram-negative bacteria (e.g., Cefuroxime, Cefoxitin).

3. Third Generation: Increased activity against gram-negative bacteria (e.g., Ceftriaxone, Ceftazidime).

4. Fourth Generation: Enhanced stability against beta-lactamases (e.g., Cefepime).

5. Fifth Generation: Effective against MRSA and resistant strains (e.g., Ceftaroline).