Bunny Pharm Flashcards - NUR 310 Weeks 1-3

Gentamicin: drug class?

Aminoglycoside. Route: IM, IV

Gentamicin (Aminoglycoside): why give it & how does it work?

WHY: Serious aerobic Gram-negative infections (e.g., E. coli). HOW: Blocks $30\text{S}$ protein synthesis; bactericidal

Gentamicin (Aminoglycoside): how do I give it?

• IM/IV only • Culture before the 1st dose • Peak & trough levels; keep hydrated

Gentamicin (Aminoglycoside): side effects, expected vs. urgent?

EXPECTED: GI upset, headache. URGENT (report): • Ototoxicity: tinnitus, hearing loss, dizziness • Nephrotoxicity: decreased urine output, increased BUN/creatinine

Gentamicin (Aminoglycoside): safety risks?

• Avoid in kidney disease, hearing impairment, pregnancy • With cephalosporins: higher nephrotoxicity risk • Older adults & infants at higher risk

Gentamicin (Aminoglycoside): patient education?

• Report ringing in ears, hearing change, dizziness, decreased urine • Finish the full course

Carbapenems: drug class?

Carbapenem. Route: IV, IM

Carbapenems (Carbapenem): why give it & how does it work?

WHY: Serious/life-threatening infections (sepsis, multidrug-resistant). HOW: Blocks cell wall; bactericidal, broad spectrum

Carbapenems (Carbapenem): how do I give it?

• IV/IM • Culture before the 1st dose • Check beta-lactam allergy & seizure history

Carbapenems (Carbapenem): side effects, expected vs. urgent?

EXPECTED: GI upset, headache, rash. URGENT (report): • Seizures • C. diff (bloody or watery diarrhea) • Bone marrow suppression

Carbapenems (Carbapenem): safety risks?

• Contraindicated with PCN/cephalosporin allergy • Lowers valproic acid levels, which can cause seizures • Monitor BUN/creatinine

Carbapenems (Carbapenem): patient education?

• Report diarrhea or bloody stools • Finish the full course

Cephalosporins: drug class?

Cephalosporin (beta-lactam). Route: PO, IM, IV

Cephalosporins (Cephalosporin): why give it & how does it work?

WHY: Many infections; ceftriaxone (3rd gen) for meningitis, gonorrhea, severe pneumonia. HOW: Beta-lactam; each higher generation has more Gram-negative coverage & brain penetration

Cephalosporins (Cephalosporin): how do I give it?

• PO with food; IV slowly (ceftriaxone IV/IM only) • Culture before the 1st dose • Ceftriaxone: never with IV calcium

Cephalosporins (Cephalosporin): side effects, expected vs. urgent?

EXPECTED: Diarrhea, nausea, rash. URGENT (report): • Anaphylaxis • C. diff • Bleeding (cefotetan)

Cephalosporins (Cephalosporin): safety risks?

• PCN allergy cross-reactivity • Alcohol causes a disulfiram-like reaction (cefotetan) • With aminoglycosides: higher nephrotoxicity risk; with warfarin: higher bleeding risk

Cephalosporins (Cephalosporin): patient education?

• Take with food • Report bloody diarrhea, bruising or bleeding • Anaphylaxis: call 911

Levofloxacin: drug class?

Fluoroquinolone. Route: PO, IV

Levofloxacin (Fluoroquinolone): why give it & how does it work?

WHY: Bacterial infections, severe UTI, anthrax exposure. HOW: Blocks bacterial DNA enzymes; bactericidal

Levofloxacin (Fluoroquinolone): how do I give it?

• PO/IV; IV over $60\,\text{min}$, alone in the line • Antacids/sucralfate: $2\,\text{h}$ after or $6\,\text{h}$ before

Levofloxacin (Fluoroquinolone): side effects, expected vs. urgent?

EXPECTED: N/V/D, dizziness, headache; Photosensitivity. URGENT (report): • Achilles tendon rupture • Seizures, hepatotoxicity, C. diff

Levofloxacin (Fluoroquinolone): safety risks?

• Avoid under $18$ & with myasthenia gravis • Higher tendon rupture risk: older adults and with corticosteroids • Increases warfarin effect; hypoglycemia with diabetes meds

Levofloxacin (Fluoroquinolone): patient education?

• Report tendon pain • Sunscreen; drink $1.5\text{--}2\,\text{L/day}$; less caffeine

Amoxicillin: drug class?

Penicillin. Route: PO, IM, IV

Amoxicillin (Penicillin): why give it & how does it work?

WHY: Common ear, throat & urinary infections. HOW: Blocks cell wall; bactericidal

Amoxicillin (Penicillin): how do I give it?

• PO/IM/IV at the start of meals • Ask about PCN allergy first • IV: watch $30\,\text{min}$ for allergic reaction

Amoxicillin (Penicillin): side effects, expected vs. urgent?

EXPECTED: N/V/D. URGENT (report): • Allergic reaction / anaphylaxis • Superinfection (yeast, C. diff)

Amoxicillin (Penicillin): safety risks?

• Contraindicated with beta-lactam allergy • Decreases oral contraceptive effectiveness • Caution in kidney impairment

Amoxicillin (Penicillin): patient education?

• Report bloody or watery diarrhea • Report mouth or vaginal infection • Use backup birth control

Piperacillin: drug class?

Penicillin (extended spectrum). Route: IV only

Piperacillin (Penicillin): why give it & how does it work?

WHY: Severe infections: sepsis, hospital-acquired pneumonia, Pseudomonas. HOW: Blocks cell wall; bactericidal

Piperacillin (Penicillin): how do I give it?

• IV only • Monitor WBC, BUN/creatinine, Na/K

Piperacillin (Penicillin): side effects, expected vs. urgent?

EXPECTED: Slides list only serious effects. URGENT (report): • Nephrotoxicity • Electrolyte imbalance • Thrombocytopenia (bleeding)

Piperacillin (Penicillin): safety risks?

• Contraindicated with beta-lactam allergy • Caution: kidney disease, heart failure • Older adults: watch bleeding & electrolytes

Piperacillin (Penicillin): patient education?

• Report bloody or watery diarrhea • Report mouth or vaginal infection

Trimethoprim-Sulfamethoxazole: drug class?

Sulfonamide. Route: PO, IV

Trimethoprim-Sulfamethoxazole (Sulfonamide): why give it & how does it work?

WHY: UTI, pneumonia, bronchitis, otitis media. HOW: Blocks bacterial folic acid synthesis

Trimethoprim-Sulfamethoxazole (Sulfonamide): how do I give it?

• PO/IV with food • Fluids $1,200\text{--}1,500\,\text{mL/day}$ • Monitor CBC & urinalysis

Trimethoprim-Sulfamethoxazole (Sulfonamide): side effects, expected vs. urgent?

EXPECTED: GI upset. URGENT (report): • Stevens-Johnson syndrome (rash) • Blood dyscrasias: fatigue, pallor, bruising, infection

Trimethoprim-Sulfamethoxazole (Sulfonamide): safety risks?

• Not in pregnancy, breastfeeding, or infants under $2\,\text{months}$ • Alcohol causes a disulfiram reaction; increases warfarin bleeding • Avoid in hyperkalemia

Trimethoprim-Sulfamethoxazole (Sulfonamide): patient education?

• Report rash/hives, bruising, fatigue • Drink plenty of fluids; no alcohol

Tetracycline: drug class?

Tetracycline. Route: PO, IM/IV only if PO not tolerated

Tetracycline (Tetracycline): why give it & how does it work?

WHY: 1st choice for chlamydia, syphilis, mycoplasma, anthrax; acne. HOW: Blocks protein synthesis; bacteriostatic

Tetracycline (Tetracycline): how do I give it?

• PO on an empty stomach ($1\,\text{h}$ before / $2\,\text{h}$ after meals) • Full glass of water; no dairy, iron, zinc or antacids • Not right before bed

Tetracycline (Tetracycline): side effects, expected vs. urgent?

EXPECTED: GI upset, photosensitivity. URGENT (report): • Hepatotoxicity (jaundice) • C. diff

Tetracycline (Tetracycline): safety risks?

• Not for children under $8$ (tooth staining, bone growth) • Not in pregnancy or breastfeeding • Increases digoxin toxicity; decreases oral contraceptive effect

Tetracycline (Tetracycline): patient education?

• No milk with doses • Avoid sun; report pregnancy or jaundice

Azithromycin: drug class?

Macrolide. Route: PO, IV, Ophthalmic, Topical

Azithromycin (Macrolide): why give it & how does it work?

WHY: Legionnaires’, whooping cough, diphtheria; PCN-allergy alternative. HOW: Alters protein synthesis

Azithromycin (Macrolide): how do I give it?

• PO/IV/ophthalmic/topical; with food if GI upset • Check QT history, K+ & Mg++

Azithromycin (Macrolide): side effects, expected vs. urgent?

EXPECTED: N/V/D, abdominal pain. URGENT (report): • Dysrhythmias / QT prolongation • Ototoxicity • C. diff

Azithromycin (Macrolide): safety risks?

• Contraindicated: prolonged QT, low K+, low Mg++ • Increases digoxin, warfarin & theophylline levels • Older adults: QT risk

Azithromycin (Macrolide): patient education?

• Report palpitations or fainting • Report hearing loss or tinnitus

Acyclovir: drug class?

Antiviral. Route: PO, Buccal, Topical, IV

Acyclovir (Antiviral): why give it & how does it work?

WHY: Herpes, CMV, varicella-zoster. HOW: Blocks viral DNA replication

Acyclovir (Antiviral): how do I give it?

• IV: infuse slowly + hydrate during and $2\,\text{h}$ after • Gloves for topical

Acyclovir (Antiviral): side effects, expected vs. urgent?

EXPECTED: Topical: burning/itching; PO: GI upset, headache. URGENT (report): • IV nephrotoxicity • CNS toxicity • Phlebitis at IV site

Acyclovir (Antiviral): safety risks?

• Monitor BUN/creatinine • Caution: kidney disease, dehydration • Higher kidney risk with other nephrotoxic drugs

Acyclovir (Antiviral): patient education?

• Use condoms; yearly Pap if HSV-2 • Keep topical out of the eyes

Nystatin: drug class?

Antifungal. Route: PO (suspension), Topical

Nystatin (Antifungal): why give it & how does it work?

WHY: Candidiasis (yeast). HOW: Alters fungal cell wall; fungicidal

Nystatin (Antifungal): how do I give it?

• Shake, then swish as long as possible • Topical: clean, dry skin

Nystatin (Antifungal): side effects, expected vs. urgent?

EXPECTED: GI upset, skin irritation. URGENT (report): • Hypersensitivity

Nystatin (Antifungal): safety risks?

• Only contraindication: hypersensitivity

Nystatin (Antifungal): patient education?

• Nothing by mouth for $30\,\text{min}$ after a dose • Good oral hygiene; finish the course

Vaccines: drug class?

Vaccine (active immunity). Route: IM, Subcut, Intranasal

Vaccines (Vaccine): why give it & how does it work?

WHY: Prevent flu, measles/mumps/rubella, chickenpox. HOW: Antigens make the body produce its own antibodies (active immunity)

Vaccines (Vaccine): how do I give it?

• Flu shot (IIV) IM yearly; LAIV intranasal • MMR & varicella: subcutaneous, 2 doses

Vaccines (Vaccine): side effects, expected vs. urgent?

EXPECTED: Low fever, soreness/redness at the site. URGENT (report): • Anaphylaxis • Seizures

Vaccines (Vaccine): safety risks?

• Live vaccines (LAIV, MMR, varicella): not in pregnancy or immunocompromised • Egg allergy (some flu vaccines) • Delay after blood products or immunoglobulins

Vaccines (Vaccine): patient education?

• Ask “Could you be pregnant?” before a live vaccine • Get the flu vaccine yearly by the end of October

Rabies Immune Globulin: drug class?

Immune serum (passive immunity). Route: Infiltrated at wound, IM

Rabies Immune Globulin (Immune serum): why give it & how does it work?

WHY: Rabies exposure in a non-immunized patient. HOW: Gives ready-made antibodies (passive immunity)

Rabies Immune Globulin (Immune serum): how do I give it?

• $20\,\text{IU/kg}$ once; into and around the wound, rest IM • Never the same syringe or site as the rabies vaccine

Rabies Immune Globulin (Immune serum): side effects, expected vs. urgent?

EXPECTED: Site pain or swelling, mild fever. URGENT (report): • Anaphylaxis: chest tightness, low BP, trouble breathing

Rabies Immune Globulin (Immune serum): safety risks?

• Contraindicated after a prior severe reaction to immune sera • OK in pregnancy and immunocompromised patients

Rabies Immune Globulin (Immune serum): patient education?

• Complete the rabies vaccine series • Report trouble breathing right away

Dextromethorphan: drug class?

Antitussive (non-opioid). Route: PO

Dextromethorphan (Antitussive): why give it & how does it work?

WHY: Dry, nonproductive cough. HOW: Suppresses the medulla cough center (non-opioid)

Dextromethorphan (Antitussive): how do I give it?

• PO; confirm the cough is nonproductive first

Dextromethorphan (Antitussive): side effects, expected vs. urgent?

EXPECTED: Drowsiness, dry mucous membranes, N/V. URGENT (report): • Respiratory depression • Serotonin syndrome with MAOIs

Dextromethorphan (Antitussive): safety risks?

• Not for patients who need to cough to clear the airway • With MAOIs: serotonin syndrome • Not for children under $6$

Dextromethorphan (Antitussive): patient education?

• No alcohol or CNS depressants; no driving • Cough over $7\,\text{days}$: see the provider

Pseudoephedrine: drug class?

Oral decongestant (alpha-adrenergic). Route: PO

Pseudoephedrine (Oral decongestant): why give it & how does it work?

WHY: Nasal congestion (cold, allergies). HOW: Alpha-adrenergic stimulation shrinks nasal membranes

Pseudoephedrine (Oral decongestant): how do I give it?

• PO, earlier in the day • Monitor BP, HR, glucose

Pseudoephedrine (Oral decongestant): side effects, expected vs. urgent?

EXPECTED: Restlessness, insomnia, headache. URGENT (report): • Hypertension, arrhythmias • Urinary retention

Pseudoephedrine (Oral decongestant): safety risks?

• Avoid in hypertension, CAD, glaucoma, diabetes, thyroid disease, BPH • With MAOIs: hypertensive crisis • Not for children under $6$

Pseudoephedrine (Oral decongestant): patient education?

• Read OTC labels (many contain it) • Report chest pain, severe headache, trouble urinating

Phenylephrine: drug class?

Topical (nasal) decongestant. Route: Intranasal

Phenylephrine (Topical decongestant): why give it & how does it work?

WHY: Nasal congestion. HOW: Alpha-adrenergic vasoconstriction of nasal membranes

Phenylephrine (Topical decongestant): how do I give it?

• Intranasal; $3\text{--}5\,\text{days}$ max

Phenylephrine (Topical decongestant): side effects, expected vs. urgent?

EXPECTED: Nasal burning, stinging, dryness. URGENT (report): • Rebound congestion • Hypertensive crisis with MAOIs

Phenylephrine (Topical decongestant): safety risks?

• Caution with cardiovascular disease • Contraindicated in infants

Phenylephrine (Topical decongestant): patient education?

• Don’t use longer than $3\text{--}5\,\text{days}$

Fluticasone: drug class?

Topical steroid decongestant (intranasal). Route: Intranasal

Fluticasone (Topical steroid decongestant): why give it & how does it work?

WHY: Allergic rhinitis. HOW: Steroid that blocks inflammation

Fluticasone (Topical steroid decongestant): how do I give it?

• Intranasal; teach spray technique

Fluticasone (Topical steroid decongestant): side effects, expected vs. urgent?

EXPECTED: Nasal burning, dryness, headache. URGENT (report): • Fungal (Candida) infection