Patho Pharm Exam 2

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Beta-lactam antibiotics

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86 Terms

1

Beta-lactam antibiotics

ampicillin (penicillin); cefazolin (cephalosporins)

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Alternatives to penicillin

clindamycin, erythromycin, azithromycin, carithromycine, tetracycline

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action of beta-lactam antibiotics

inhibit bacterial cell wall synthesis

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use of cephalosporins

new generations more effective against gram - and resistant bacteria

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5

adverse effects of penicillin

hypersensitivity/allergic reaction

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BBW penicillin

cardiopulmonary arrest/death if give IM med through IV route

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cephalosporin AEs

hypersensitivity/allergic reaction; superinfection; bleeding tendencies

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contraindications of penicillins

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

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contraindications in cephalosporins

allergy to penicillin; allergic reaction to cephalosporins

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10

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

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11

What meds must be taken on an empty stomach?

penicillin, tetracycline, sulfonamides, Loratadine/claritin

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12

What meds must be taken with food?

cephalosporins, fluoroquinolones, prednisone

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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

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14

adverse effects of gentamicin/aminoglycosides

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

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adverse effects of fluoroquinolones/ciprofloxacin

achilles tendon rupture (joint/cartilage damage); tendinitis

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contraindications for aminoglycosides

caution in elderly and pt with renal disease

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17

What meds must have peak and trough levels monitored?

Aminoglycosides, vancomycin

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18

What meds must have liver and renal function monitored?

penicillin, tetracycline

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19

contraindications for fluoroquinolones

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

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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)

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21

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

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22

What meds require avoiding sun exposure?

fluoroquinolones, tetracycline, sulfonamides, diphenhydramine

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23

Adverse effects of tetracycline

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

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adverse effects of sulfonamides

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

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contraindications for tetracycline

children or breastfeeding; renal impairment, pregnancy

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contraindications for sulfonamides

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

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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

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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

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29

1st option for c. diff treatment

metronadizole

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30

2nd option for c. diff treatment

vancomycin (stronger, more AEs)

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macrolides

erythromycin, azithromycin, clarithromycin

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adverse effects of erythromycin

hepatotoxicity, colitis, ototoxicity, confusion

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adverse effects of clindamycin

nausea, vomiting, colitis

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adverse effects of metronidazole

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

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adverse effects of vancomycin

infusion reaction - red man syndrome; nephrotoxicity; ototoxicity

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contraindications of erythromycin

liver disease, breastfeeding, meds metabolized by CYP enzymes

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contraindications of clindamycin

caution in liver impairment

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contraindications of metronidazole

pregnancy; caution in CNS, blood, liver disorders

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contraindications of vancomycin

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

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nursing implications for erythromycin

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

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nursing implications for clindamycin

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

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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)

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43

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

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44

what meds have renal function monitored?

vancomycin

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45

what meds have liver function monitored?

macrolides, metronidazole

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46

What meds can be “on call”?

cephalosporins

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47

humoral-mediated immunity

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

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48

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

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49

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

adaptive

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50

active immunity

specific immunity to antigen through exposure with infection or by immunization

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51

passive immunity

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

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Natural passive immunity

from IgG antibodies passed from mother to baby

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artificial passive immunity

injection of antibodies/Igs after exposure

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54

IgM

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

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IgA

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

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IgD

in serum; differentiation of B cells

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IgG

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

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IgE

allergic response; parasitic infections

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alloimmunity

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

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angioedema

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

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Type I hypersensitivity

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

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Type II hypersensitivity

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

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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)

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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

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65

moderate symptoms of anaphylaxis

bronchospasms, dyspnea, cough, wheezing

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66

severe symptoms of anaphylaxis

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

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67

action of epinephrine

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

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68

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

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69

Pt position if allergic reaction occurs

supine with legs elevated to promote blood flow to major organs

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70

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)

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71

goal of prednisone

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

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72

action of prednisone

mimics cortisol; lowers immune response and inflammation

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73

AEs of prednisone

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

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contraindications of prednisone

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

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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

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76

action of antihistamines

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

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77

1st generation antihistamine

benadryl; diphenhydramine

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78

2nd generation antihistamine

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

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79

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

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80

use of cetirizine/loratadine

Allergic rhinitis, atopic dermatitis, pruritis, asthma, allergies

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81

AEs of diphenhydramine

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

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82

AEs of cetirizine/loratadine

Dizziness, headache, N, V, fatigue

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83

contraindications of diphenhydramine

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

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84

contraindications for zyrtec/claritin

hypersensitivity; caution with other sedating drugs

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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

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86

nursing implications for zyrtec/claritin

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

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