Patho Pharm Exam 2

Beta-lactam antibiotics

Beta-lactam antibiotics

ampicillin (penicillin); cefazolin (cephalosporins)

Alternatives to penicillin

clindamycin, erythromycin, azithromycin, carithromycine, tetracycline

action of beta-lactam antibiotics

inhibit bacterial cell wall synthesis

use of cephalosporins

new generations more effective against gram - and resistant bacteria

adverse effects of penicillin

hypersensitivity/allergic reaction

BBW penicillin

cardiopulmonary arrest/death if give IM med through IV route

cephalosporin AEs

hypersensitivity/allergic reaction; superinfection; bleeding tendencies

contraindications of penicillins

hypersensitivity; cross-allergenicity; caution in liver or renal disease

contraindications in cephalosporins

allergy to penicillin; allergic reaction to cephalosporins

Nursing implications for penicillin

culture and sensitivity test first, many meds/herbs interact, don’t take with OJ/acidic fluids; take at even spaced interventals; monitor BUN/creatinine

What meds must be taken on an empty stomach?

penicillin, tetracycline, sulfonamides, Loratadine/claritin

What meds must be taken with food?

cephalosporins, fluoroquinolones, prednisone

Nursing implications for cephalosporins

cross-sensitivity to penicillin; don’t take with antacids; if diarrhea - stop and report to provider, high risk pseudomembraneous colitis; IV infusion; administer slowly to avoid thrombophlebitis; check for signs of bleeding

adverse effects of gentamicin/aminoglycosides

hypersensitivity; streptomycin: parathesia of extremities; BBW: nephrotoxicity, ototoxicity, may be permanent; neurotoxicity

adverse effects of fluoroquinolones/ciprofloxacin

achilles tendon rupture (joint/cartilage damage); tendinitis

contraindications for aminoglycosides

caution in elderly and pt with renal disease

What meds must have peak and trough levels monitored?

Aminoglycosides, vancomycin

What meds must have liver and renal function monitored?

penicillin, tetracycline

contraindications for fluoroquinolones

caution in renal disease; don’t use in children <18 years old

nursing implications for aminoglycosides

monitor peak and trough levels; decrease toxicity by once daily dosing, dose no more than 10 days (repeated doses over course of months increase risk for AEs)

nursing implications for fluoroquinolones

don’t take same time as dairy products, antacids, multivitamins, calcium, iron, zinc, other minerals; stop and report achilles heel tendon discomfort

What meds require avoiding sun exposure?

fluoroquinolones, tetracycline, sulfonamides, diphenhydramine

Adverse effects of tetracycline

delayed growth in children, discoloration of teeth, enamel hypoplasia <8 years old

adverse effects of sulfonamides

low BS in diabetes, high potassium (monitor closely in pt with heart disease)

contraindications for tetracycline

children or breastfeeding; renal impairment, pregnancy

contraindications for sulfonamides

renal failure, pregnancy, children; causes kernicterus in fetus/infants - high bilirubin toxic to nervous system

nursing implications for tetracycline

diarrhea can indicate serious suprainfection - report to provider; don’t take at bedtime or with dairy products, antacids, or iron (take 2 hr before or 4 hr after); if acne, may develop superinfection (yeast) due to eradication of normal flora; decreases effect of oral contraceptives

nursing implications for sulfonamides

ask about sulfa allergy - cross sensitivity with thiazide/furosemide (diuretics), sulfonylureas; decreases effect of oral contraceptives; monitor BS in diabetics, potassium, CBC in pt with blood disorder; assess renal function before administering; assess for improvement in UTI symptoms

1st option for c. diff treatment

metronadizole

2nd option for c. diff treatment

vancomycin (stronger, more AEs)

macrolides

erythromycin, azithromycin, clarithromycin

adverse effects of erythromycin

hepatotoxicity, colitis, ototoxicity, confusion

adverse effects of clindamycin

nausea, vomiting, colitis

adverse effects of metronidazole

metallic taste (sensory alteration); dry mouth, low WBC, cancer risk

adverse effects of vancomycin

infusion reaction - red man syndrome; nephrotoxicity; ototoxicity

contraindications of erythromycin

liver disease, breastfeeding, meds metabolized by CYP enzymes

contraindications of clindamycin

caution in liver impairment

contraindications of metronidazole

pregnancy; caution in CNS, blood, liver disorders

contraindications of vancomycin

allergy to corn/corn products (dilutant/dextrose in IV similar to sugar in corn); renal impairment

nursing implications for erythromycin

avoid grapefruit; don’t take with antacids; take at regularly spaced intervals; decreases effect of oral contraceptives

nursing implications for clindamycin

colitis (severe) - stop med, report, stool sample for WBC, mucus, blood, c. diff; don’t refrigerate liquid suspension

nursing implications for metronidazole

stop alcohol use; good oral care - hard candy or sugarless gum for dry mouth; urine may be dark/reddish brown (med dark color excreted in urine)

nursing implications for vancomycin

IV: give very slowly (over 1-2 hr) to avoid red-man syndrome; monitor peak and trough levels; allergy to corn

what meds have renal function monitored?

vancomycin

what meds have liver function monitored?

macrolides, metronidazole

What meds can be “on call”?

cephalosporins

humoral-mediated immunity

B lymphocytes from bone marrow create antibodies and Igs; produces plasma cells and memory cells

cell-mediated immunity

T lymphocytes from thymus gland create cells that help with immunity: helper T cells, cytotoxic t cells, suppressor t cells, and memory t cells

Are humoral and cell-mediated immunity part of innate or adaptive immunity?

adaptive

active immunity

specific immunity to antigen through exposure with infection or by immunization

passive immunity

transferred from another source; short term (weeks-months)

Natural passive immunity

from IgG antibodies passed from mother to baby

artificial passive immunity

injection of antibodies/Igs after exposure

IgM

first Ig made by newborn; floats around intravascular serum; newborn production levels rise after 6 days, at adult level after 1 year

IgA

second most common Ig; body secretions; passed onto newborn through breastmilk; newborn starts to develop after 13 days

IgD

in serum; differentiation of B cells

IgG

most abundant; blood, lymph, interstitial body fluids; crosses placenta; mother transfers during fetal development and newborn continues production after birth

IgE

allergic response; parasitic infections

alloimmunity

human to human; immune response in presence of cells from another person (blood transfusion, skin graft, etc)

angioedema

fluid in subq tissues and mucous membranes; life-threatening if in larynx, upper airway, tongue

Type I hypersensitivity

IgE; response to allergens in environment; asthma, allergic rhinitis, atopic dermatitis/eczema

Type II hypersensitivity

IgG, IgM; cytotoxic hypersensitivity; antibody-mediated inflammation; blood transfusion reactions, autoimmune disorders

Type III hypersensitivity

IgG, IgM; antigens bind to form large antigen-antibody complexes in vessels that accumulate in tissues; ex: drug reactions, autoimmune disorders (rheumatoid arthritis)

Type IV hypersensitivity

delayed; symptoms 24-48 hours after exposure; may last days-weeks; antigen specific T cells activated by cytokines for specific immune reactions; ex: positive TB reaction, contact dermatitis (poison ivy/oak), reaction to transplanted organs, hair dyes, metals, cosmetics, latex

moderate symptoms of anaphylaxis

bronchospasms, dyspnea, cough, wheezing

severe symptoms of anaphylaxis

cyanosis, hypotension, dysphagia, abd cramping, V, D, seizures, cardiac arrest, coma, anaphylactic shock

action of epinephrine

bronchodilation and vasoconstriction (raise BP); inhibit release of chemical mediators from mast cells that cause hypersensitivity reaction

Administration of epinephrine

0.3-0.5mg given subq in lateral thigh; hold in place at 90 degrees for 10 sec, massage for 10 sec

Pt position if allergic reaction occurs

supine with legs elevated to promote blood flow to major organs

Adrenal insufficiency/addison’s disease

unable to produce cortisol; take corticosteroid for remainder of life; need higher dose for any type of stress (surgery, anxiety, illness)

goal of prednisone

smallest dose to relieve symptoms to tolerable level for shortest amount of time

action of prednisone

mimics cortisol; lowers immune response and inflammation

AEs of prednisone

cushing’s syndrome: buffalo hump on back of neck, thin fragile skin with striae, edema, muscle wasting, moon face

contraindications of prednisone

hypersensitivity; caution in liver, renal disease, immune suppression, peptic ulcer, diabetes

nursing implications for prednisone

Alternate daily therapy for maintenance therapy: double dose every other day to decrease AEs; give between 6-9am (when body naturally makes cortisol); monitor fluid retention - weight gain >5lb/week; reduce risk for infection

action of antihistamines

antagonize action of histamine; do not cure problem or lower release of histamine; block H1 receptors

1st generation antihistamine

benadryl; diphenhydramine

2nd generation antihistamine

cetirizine (zyrtec); loratadine (claritin); selectively binds to peripheral H1 receptors, not CNS, to decrease drowsiness

use of diphenhydramine

prevent/treat blood transfusion reactions; prevent reaction to contrast dyes used in diagnostic tests; allergic rhinitis, hypersensitivity disorders, angioedema, urticaria, poison ivy

use of cetirizine/loratadine

Allergic rhinitis, atopic dermatitis, pruritis, asthma, allergies

AEs of diphenhydramine

sedation; in older adults - confusion, unsteady, dizzy, orthostatic hypotension; Anticholinergic effects: cant see, pee, dries you up

AEs of cetirizine/loratadine

Dizziness, headache, N, V, fatigue

contraindications of diphenhydramine

pregnancy, BBW for some children; Beer’s list for older adults

contraindications for zyrtec/claritin

hypersensitivity; caution with other sedating drugs

nursing implications for diphenhydramine

25 mg in 1 min, 50 mg in 2 min; no more than 1 antihistamine at a time; safety: driving, machinery; check alcohol/other meds that cause sedation

nursing implications for zyrtec/claritin

long acting-take once/day; assess for AEs, assess for therapeutic effects/relief of symptoms