NR 293 Final Exam Questions and answers + rationales

bacteriostatic

drugs that do not kill the bacteria, but slows their growth

culture and sensitivity

take a blood culture so we can determine where the bacteria is growing; sensitivity report determines the best treatment

antibiotic combos

Additive

potentiative

antagonisitic

empiric therapy

treatment of an infection before specific culture information has been obtained

definitive therapy

antibiotic therapy tailored to treat organisms identified with cultures

prophylactic therapy

treatment with antibiotics to prevent an infection, as in intraabdominal surgery or after trauma

MOA of sulfonamides

Bacteriostatic

inhibit bacterial growth

prevent bacterial synthesis of folic acid

uses of sulfonamides

Gramp positive and negative, broad spectrum

respiratory tract infections

infections of the small bowel

UTIs: enterobacter, ecoli, klebsiella, proteus vulgaris, staphylococcus aureus

contraindications of sulfonamides

drug allergy

pregnant women

infants younger than 2 months

potassium

oral contraceptives (ineffective)

Adverse effects of sulfonamides

mild to moderate rash

photosensitivity

GI distress

stomatitis

crystalluria

fatigue

depression

headache

dizziness

blood dyscrasias

Steven Johnsons syndrome

renal failure

hyperkalemia

prototype for sulfonamides, and administration

sulfamethoxazole combined with trimethropim

Administered IV, PO, Topical

patient education/ nursing interventions for sulfonamides

Pt. Education:

take with a full glass of water

increase fluid intake

report sore throat, bruising, bleeding

avoid direct sunlight

Nursing interventions:

push fluids

Monitor CBC

signs of bleeding (liver damage)

check for superinfection

beta lactam penicilins MOA

safest class

bacteriocidal

inhibition of bacterial cell wall synthesis

uses of penicillins

strep

staph

pneumonia

meningitis

skin, bone, and joint infections

stomach infections

blood and valve infections

gas gangrene

tetanus

anthrax

sickle cell anemia in infants

broad spectrum penicillin

bacteriocidal

ecoli

salmonella

influenza

adverse effects of penicillin

allergy most common

rash

pruritus

fever

anaphylaxis

lowered WBC, RBC, platelet count

GI upset

patient education for penicillins

side effects

bleeding

increase fluid intake

take with food

drugs for penicillin

broad spectrum:

amoxicillin

combination:

piperacillin plus tazobactam (zosyn)

give 3 times a day infused over 4 hours or every 6 hours infused over 1 hour

cephalosporins MOA

largest class

interfere with bacterial cell wall synthesis, bind to the same penicillin binding proteins

uses of cephalosporins

treatment of gram positive and negative anaerobic bacteria

mostly gram negative

patients who cannot tolerate the less expensive penicillins

respiratory infections

urinary infections

skin infections

bone and joint infections

genital infections

contraindications of cephalosporins

may cause cross allergy potential with penicillin

adverse effects of cephalosporins

weakness

pruritus

GI distress

high doses can cause

bleeding

seizures

nephrotoxicity

patient education of cephalosporins

side effects

administration

monitor kidney function with 1st generation

drugs for cephalosporins

first generation

Cefazolin (ancef)

not effective for beta lactase

gram positive bacteria

may cause kidney toxicity

macrolides MOA

broad spectrum

inhibit protein synthesis

binds reversibly to 50S ribosomal subunits of microbes

uses of macrolides

whooping cough

legionnaires disease

Hpylori

streptococcus

influenza

mycoplasma pneumonia

generic use:

respiratory

GI tract

skin

soft tissue

adverse effects of macrolides

tinnitus

ototoxicity

mild GI distress

diarrhea

abdominal pain

superinfectionm

hepatotoxicity

patient education/ nursing interventions

Patient education:

finish full regimen

monitor hepatic function

food-drug interactions (fruit juices)

take on empty stomach

Nursing interventions:

monitor hepatic function

bleeding, bruising, dark tea looking urine, jaundice

drugs for macrolides

we do not need peak or troughs for

Azithromycin (Zithromax, Zpack)

only take for 5 days due to its long half life

administer antacids 2 hours before or after on an empty stomach with full glass of water

tetracyclines MOA

broad spectrum

inhibit protein synthesis

uses of tetracyclines

acne

Rocky Mountain spotted fever

typhus

cholera

lymes disease

peptic ulcers Hpylori

contraindications of tetracyclines

drug allergy

children under 8

pregnancy category D, fetal growth/develeopment

milk

antacids

iron

decrease effect of oral contraceptives

increases effect of digoxin

adverse effects of tetracycline

discoloration of teeth

retard fetal skeletal development if taken during pregnancy

photsensitivity

alteration of intestinal and vaginal flora

reversible bulging fontanelles in neonates

thrombocytopenia

heolytic anemia

hepatotoxicity (IV or high doses)

nephrotoxicity (outdated meds)

GI distress

patient education of tetracyclines

use sunblock

store out of light/heat

good oral hygeine

food-drug interactions

labs

administration times

drugs for tetracyclines

tetracycline (achromycin)

administer 1-2 hours after meals

aminoglycosides MOA

prevent protein synthesis in bacteria

uses of aminoglycosides

serious gram negative bacteria:

ecoli

serratia

proteus

psuedomonas

mycobacteria

some protozoans

common category to treat klebsiella

combined with penicillin, cephalosporins, or vancomycin for enterococcal infections

may be given to sterilize bowel prior to surgery

contraindications for aminoglycosides

renal patients

adverse effects of aminoglycosides

nephrotoxicity

ototoxicity:

hearing impairment

dizzy

loss of balance

persistant headache

ringing in ears

possible deaf

superinfection

photosensitivity

anaphylaxis

GI distress

rash

patient education/nursing interventions for aminoglycosides

Pt. education

monitor hearing

use sunblock

lab work

nursing interventions

monitor drug levels

monitor serum levels

drugs for aminoglycosides

gentamicin (garamycin)

if GI can not absorb, give IV

give deep into leg muscle IM

withhold if peak levels are above normal range

quinolone (fluroquinonlones) MOA

broad spectrum (bacteriocidal)

destroy bacteria by altering their DNA, interfere with bacterial enzymes DNA gyrase and topoisomerase

uses of quinolones

wide variety of gram negative and selected gram positive (strep, salmonella)

complicated UTIS

respiratory infections

skin infections

GI infections

bone and joint infections

STIS

food poisoning

anthrax (ciprofloxacin treats)

contraindications of quinolones

drug allergy

children under 18

caffeine and caffeine like drugs such as theophylline (increase serum levels)

calcium, magnesium, iron, or zinc (reduce absorption of quinolones by as much as 90%)

adverse effects of quinolones

rash

uritcaria

tinnitus

heamturai

photosensitivty

GI upset

superinfection

tendon inflammation or rupture (achilles, increase risk: less than 60 years old and taking corticosteroids)

patient education on quinolones

increase fluid intake to more than 2 liters

food drug interaction s

drugs for quinolones

ciprofloxacin (cipro)

levofloxacin (levaquin)

bacteria resistant to quinolones

pseudomonas aeruginose

Staph auereus

pneumonococcus

enterococcus

enterobacteriacae, including ecoli

Nitrofurantoin (macrodantin) MOA

bacteriostatic or bactericidal depends on dose

uses of nitrofurantoin

gram positive and negative bacteria:

ecoli

staph aureus

klebsiella

enterbacter

UTI is the primary use

contraindications of nitrofurantoin

impaired renal function

adverse effects of nitrofurantoin

anorexia

nausea vomit

diarrhea

abdominal pain

rust/brown color urine

rash

pulmonary reactions:

dyspneal

chest pain

fever

cough

hepatotoxicity

metronidazole (flagyl) uses

amebiasis

anaeorbic bacteria

respiratory infections

bone infections

skin infections

CNS infections

C.diff

adverse reactions of metronidazole

anorexia

nausea

diarrhea

headache

dry mouth

metallic taste

bone marrow suppression

contraindications of metronidazole

oral anticoagulants

hypoprothombinemia

alcohol (deathly sick if they drink)

lithium (increases levels)

how to administer metronidazole

topical: treats rosacea

combination: treat h pylori infection

vancomycin MOA

bacteriocicdal

inhibits cell wall synthesis

uses of vancomycin

gram positive bacteria

bone infection

skin infection

lower respiratory infection

MRSA (Most effective drug for MRSA)

adverse effects of vancomycin

flushing

hypotension

ototoxicity

nephrotoxicity

Steven Johnsons syndrome

red man syndrome (occurs, when rapid IV admin, large amounts of histamine are released and dace, neck, trunk of body turn red)

blood dycrasias

pseudomembranous colitis

nursing interventions for vancomycin

peak and trough levels are drawn after 3 doses

Labs (BUN, Cr)

monitor hearing

administer over 1-2 hours

nursing role for antibiotics

cultures prior to antibiotic therapy

monitor 1/2nd dose for allergy

monitor labs (kidney, liver, peak and trough)

increase fluids

check for superinfection (fever, perineal itching, cough, lethargy, unusual discharge)

educate patient to finish prescription even if they feel better

amphotericin B MOA

broad spectrum anti fungal medication

binds to ergosterol in fungal cell membranes

uses of amphotericin B

severe systemic infections

adverse effects of amphotericin B

fever

rash

chills

hypotension

tachycardia

malaise

muscle and joint pain

anorexia

nausea and vomit

headache

hypokalemia

hypomagesemia

nephortoxicity

liver failure

anaphylaxis

MI

thombocytopenia

leukopenia

agranulocytosis

anemia

administration of amphotericin B

premedicate:

1st dose: 1 mg over 20-30 min

administer slowly via IV, can cause cardiovascular collapse

withhold if BUN is over 40mg

withhold if serum creatinine rises about 3mg

nursing interventions for amphotericin B

monitor labs Cr, BUN, ALK

AST and ALT may increase

K, Ca, Mg may decrease

premeditate with antipyretics, antihistamines, antiemetics and corticosteroids

monitor vital signs

promote hydration

liquid form of drug causes fewer side effects but is more expensive

antiviral acyclovir (Zovirax) MOA

prevents viral DNA synthesis

acyclovir uses

herpes virus

decreases duration and episodes

contraindications of acyclovir

renal impairment

adverse effects of acyclovir

PO:

nausea/ vomit

anorexia

headache

elevated hepatic enzymes

IV:

nephrotoxicity

neurotoxicity

patient education of acyclovir

start as soon as signs and symptoms begin

virus may be activated by stress, trauma, fever, sunlight, sex menstruation, immunosuppressive drugs

refrain from sex when you have visible lesion

drowsiness in older adults may increase fall risk

CNS depressants dose dependents

low: calms without inducing sleep

high: calms with sleep

main groups of CNS depressants: benzodiazepines MOA

depress CNS activity

affects hypothalamic, thalamic, and limbic systems of the brain:

calming effect

controls agitation and anxiety (panic attack)

reduce sensory stimuli. inducing sleep

induce skeletal and muscle relaxation

does not suppress REM sleep as much as baribiturates

does not increase metabolism of other drugs

what receptor is used for benzodiazepines?

GABA: gamma aminobutyric acid

uses or benzodiazepines

sedation

sleep induction

skeletal muscle relaxation

anxiety relief/ depression

acute seizure disorders

alcohol withdrawl

agitation relief

balanced anesthesia (before they give you actual anesthesia they will give this to you to calm you down)

side effects of benzodiazepines

headache, drowsiness, dizzy

cognitive impairement

vertigo

lethargy

fall hazard for older adults

hangover effect

toxicity and OD for benzodiazepines

somnolence

confusion

coma

diminished reflexes

contraindication of benzodiazepines

other CNS depressants (alcohol, opioids): hypotension and respiratory depression

azalea antifungals

verapamil

diltiazem

protease inhibitors

macrolide antobiotics

grapefruit juice

olanzapine

rifampin

overdose treatment of benzodiazepines

Flumazenil (romazicon)

administered IV

drugs for benzodiazepines long acting

clonazepam (klonopin)

diazepam (valium) first benzo drug, varied uses including anxiety

drugs for benzodiazepines intermediate acting

alprazolam (xanax)

lorazepam (Ativan)

temeazepam (restoril):

used for sleep

induces sleep within 20-40 min

take 1 hour before bed

drugs for benzodiazepines short acting

eszophiclone (lunesta)

zolpidem (ambien)

nonbenzodiazepine zolpidem (ambien)

short acting

decrease daytime sleepiness

somnambulation

nonbenzodiazepine eszopiclone (lunesta)

provides full 8 hours of sleep

short acting

avoid taking if they do not plan to sleep for less than 8n hours

barbiturates MOA

habit forming, low therapeutic index

increases the action of GABA, which inhibits the nerve impulses traveling in the cerebral cortex

site of action: brainstem

drug effects of barbiturates

low doses: sedative

high doses: hypnotic, lowers respiratory rate

uses of barbiturates

sedatives

anticonvulsants

anesthesia for surgical procedures

adverse effects of barbiturates

vasodilation

hypotension

drowsiness

lethargy

vertigo

respiratory depression

cough

nausea/vomit

diarrhea/ constipation

agrunlocytosis

thrombocytopenia

reduced REM sleep

toxicity and OD of barbiturates

leads to respiratory depression and respiratory arrest, CNS depression (sleep to coma to death)

can be used therapeutically for uncontrollable seizures

treatment:

maintain adequate airway

assisted ventilation or oxygen therapy

push fluids

pressure support

activated charcoal to absorb drug via NG tube

drugs for barbiturates

pentobarbital (nembutal)

prevents tonic clonic seizures

prevents fever induced convulsions

treats hyperbilirubiemia in neonates

should not be used anymore as a sedative/hypnotic drug

uses of muscle relaxants

relieve pain associated with skeletal muscle spasms

management of spasicity of severe chronic disorders:

MS, cerebral palsy

central acting: similar to CNS depressants,

Direct acting: similar to GABA

adverse effects of muscle relaxants

euphoria

lighthead

dizzy

drowsiness

fatigue

muscle weakness

drugs for muscle relaxants

baclofen (lioresal) PO, inject

cyclogenzaprine (flexural)

reduce spasms followed by musculoskeletal injuries, side effect: sedation

nursing interventions for muscle relaxants

obtain baseline vitals, plush orthostatic BP

hypnotics must be given 30-60 min before bedtime

benzodiazepines cause REM rebound and a tired feeling the next day

avoid alcohol, and other CNS depressants

check previous meds including OTC

rebound insomnia: few nights after 3-4 regimen has been stopped

no smoking

assist with ambulation

safety: side rails up, bed alarms etc

CNS stimulants therapeutic uses

ADHD

anti narcoleptic

anorexiant

anti migraine

analeptic

CNS stimulants amphetamines MOA

mood elevation or euphoria

increased mental alertness/ work capacity

decreased fatigue/ drowsiness

prolonged wakefulness

relaxes bronchioles of smooth muscle

increases respiration

dilates pulmonary arteries

uses of CNS stimulants amphetamines

ADHD

narcolepsy

obesity

migraine

COPD

adverse effects of CNS stimulants amphetamines

palpitations

tachycardia

hypertension

angina

dysrhythmias

nervousness

restlessness

anxiety

insomnia

nausea/ vomit

diarrhea

dry mouth

increased urinary frequency

tends to speed up body systems

ADHD and narcolepsy drugs

methylphenidate (ritalin); schedule 4

modafinil (provigil); schedule 4

nursing interventions for CNS stimulants amphetamines

last dailym dose should be given 4-6 hours before bed to reduce insomnia

take 30-45 min before meals on empty stomach

drug holidays- providers taper off the drug to see S/S

parents should keep a journal to monitor response

monitor Childs growth/weight since these meds can stunt their growth

therapeutic response:

ADHD: decrease hyperactivity, increased attention span, and concentration

Narcolepsy: decrease sleepiness