Pharmacology Test One

Methods of Antimicrobial Action

* destroying the cell wall in bacteria
* inhibiting the conversion of an enzyme unique for a particular bacterium’s survival
* impairing protein synthesis in the bacteria’s ribosomes
* disrupting bacterial synthesis or function of DNA and RNA
* inhibiting viral replication

narrow spectrum antibiotics

only a few bacteria are sensitive

broad spectrum antibiotics

wide variety are sensitive

bactericidal medications

kills the micro-organism

bacteriostatic medications

prevents growth of micro-organism but the phagocytic cells actually destroy the bacteria

Which antimicrobials can cause harm in developing fetus by crossing over to the placenta

* sulfonamides
* gentamicin
* tetracyclines

antibiotics that destroy the bacterial cell wall

\-penicillins

\-cephalosporins

\-carbopenems

\-vancomycin

**penicillins**

\-first derived from mold on bread or fruit

\-kill wide range of bacteria, considered a beta-lactam antibbiotic

\-often combined with other drugs for maximum effectiveness

\-common side effects: rash, itchy skin

\-may also be allergic to cephalosporins and imipenem-cilstatin (cross sensitivity)

select prototype medication of penicillin

penicillin G potassium, a narrow spectrum medication for IM or IV use

what are the narrow-spectrum penicillins

* penicillin G benzathine for IM use
* penicillin V for PO use

what are the broad-spectrum penicillins

* amoxicillin for PO use
* amoxicillin-clavulanate for PO use
* ampicillin for IV or PO use

what are the antistaphylococcal penicillins

nafcillin for IV or IM use (nafcillin, oxacillin)

what are the antipseudomonal (extended spectrum) penicillins

* ticarcillin-clavulanate for IV use
* piperacillin-tazobactam for IV use

therapeutic uses of penicillin

* treats infections due to gram-positive cocci (pneumonia, meningitis, infectious endocarditis, and pharyngitis)
* treats infections due to gram-negative cocci (meningitis)
* kills spirochetes which causes syphilis
* can be used prior to dental procedures

complications of penicillins

==allergies, anaphylaxis== - because of cross-senstivity, being allergic to one penicillin should be considered allergic to all penicillins

* interview clients for prior allergy
* observe for allergic reaction for 30 min following parenteral administration

==renal impairment==

* monitor kidney function and I&O

==hyperkalemia and dysrhythmias== - due to high doses of penicillin G potassium

==hypernatremia== (IV ticarcillin-clavulanate)

* monitor cardiac status and electrolyte levels

contraindications/precautions with penicillin

* history of severe allergic reactions to penicillin, cephalosporins, or imipenem
* use cautiously in clients with kidney dysfunction

interactions with penicillin

* do not mix penicillin and aminoglycosides in the same IV solution because penicillin inactivates the aminoglycoside
* probenecid delays the excretion of penicillin

client education while taking penicillins

* complete the entire course of therapy
* use additional contraceptive method as penicillins cause a decrease in effectiveness

**cephalosporins**

\-Bactericidal (destroys cell wall)

\-High Therapeutic Index (safe)

5 generations of cephalosporins (CEF, CEPH)

* first generation: cefazolin (Ancef), cephalexin (Keflex)
* second generation: cefaclor, cefotetan
* third generation: ceftriaxone (Rocephin), cefotaxime
* fourth generation: cefepime (Maxipime)
* fifth generation: ceftaroline - only cephalosporin that is effective against MRSA

each subsequent generation of cephalosporins are

* more likely to reach CSF
* less susceptible to destruction by beta-lactamase
* more effective against gram-negative organisms and anaerobes

why are cephalosporins only administered IV or IM

because of a decreased absorption from the GI tract

complications with cephalosporins

==allergy, hypersensitivity, anaphylaxis, possible cross-sensitivity to penicillin==

* indication includes urticaria, rash, hypotension, dyspnea
* question client about history of allergy to a penicillin or another type of cephalosporin
* acceptable for use in clients who have mild PCN allergy

==bleeding tendencies -== from cefotetan and ceftriaxone

* monitor prothrombin and bleeding times
* administer parenteral vitamin K

==thrombophlebitis -== with IV infusion

* observe injection site for findings of phlebitis
* rotate sites
* administer as a dilute intermittent infusion or slowly over 3-5 min and in a dilute solution for bolus dosing

==renal insufficiency==

==pain with IM injection==

* administer deep into a large muscle mass (ventrogluteal site)

==antibiotic-associated pseudomembranous colitis==

* observe for diarrhea
* risk for developing clostridium difficile

contraindications/precautions with cephalosporins

* do not use in clients who have a history of severe allergic reactions to penicillins or cephalosporins
* use cautiously in clients with renal impairment and bleeding tendencies

interactions r/t cephalosporins

* disulfiram reaction (intolerance to alcohol) occurs with simultaneous use of alcohol and either cefotetan or cefazolin
* probenecid delays renal excretion
* calcium and ceftriaxone should not be administered together

client education with cephalosporins

* take oral cephalosporins with food
* complete the entire course of therapy
* store oral cephalosporin suspensions in a fridge

Carbapenems (PENEMS)

\-broadest antibacterial action of any antibiotic to date

\-often reserved for complicated infections in acutely ill patients

types of carbapenem medications

* imipenem-cilastatin for IM or IV use
* meropenem for IV use
* ==-ertapenem==

complications r/t carbapenems

==allergy, hypersensitivity, possible cross-senstivity to penicillin or cephalosporins==

* monitor for signs of dyspnea, rash, pruritus
* question client carefully about allergy to a penicillin or other cephalosporin

==GI upset-== (nausea, vomiting, diarrhea)

* monitor I&O

==superinfection==

* because it’s so broad spectrum and kills lots of body’s good bacteria
* monitor for indications of colitis (diarrhea), oral thrush, black furry overgrowth on the tongue, and vaginal yeast infection

contraindications/precautions r/t carbapenems

* imipenem-cilastatin is pregnancy risk category C medication
* use cautiously in client who have renal impairment

interactions r/t carbapenems

imipenem-cilastatin can reduce blood levels of valproic acid leading to possibly seizures; avoid use together

Vancomycin

\-Treatment of choice for MRSA, and other gram-positive infections, C. diff

\-monitor trough blood levels ( to make sure it isn’t at toxic levels)

\-may cause ototoxicity and nephrotoxicity

\
Considerations:

\-INFUSE CAREFULLY (60 min infusion)

\-Red Man’s Syndrome

* decreased BP & flushing of neck, face, or torso, and urticaria
* If this condition occurs, decrease the IV infusion rate or stop it if that’s an option

\-antihistamine

\-IV hydration

\-assess IV site because it can cause necrosis of veins

way to remember which cause ototoxicity

\-MYCIN (mice have big EARS)

COMPLETE APPLICATION QUESTIONS IN ATI BOOK

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Antibiotics which impair protein synthesis

\-tetracycline

\-macrolides

\-aminoglycosides

tetracyclines (-CYCLINE)

==-deoxycycline (Vibramycin)==

==-minocycline (Minocin)==

==-demeclocycline==

therpeutic uses of tetracyclines

* acne vulgaris (topical and oral)
* periodontal disease (topical)
* rickettsial infections (typhus fever, Rocky mountain spotted fever)
* infections of the urethra or cervix due to Chlamydia trachomatis
* brucellosis
* pneumonia
* lyme disease
* anthrax
* GI infections due to H. pylori

complications r/t tetracyclines

==GI discomfort==

* monitor for nausea, vomiting, diarrhea
* avoid taking at bedtime to reduce the risk of esophageal ulceration

==yellow or brown tooth discoloration, hypoplasia of tooth enamel==

==hepatotoxicity -== (lethargy, juandice)

* avoid high daily doses IV

==photosensitivity -== (intense sunburn)

==superinfection==

* pseudomembranous colitis (diarrhea), yeast infections of the mouth, pharynx, vagina, bowels

==dizziness, lightheadedness== (minocyclines)

contraindications/precautions with tetracyclines

* pregnancy risk category D
* avoid administration to children younger than 8 years and pregnant women
* use cautiously with liver and kidney disease

interactions r/t tetracyclines

* interactions with milk products, calcium and iron supplements, laxatives containing magnesium, and antacids causes formation of non-absorbable chelates, thus reducing the absorption of tetracyclines
* tetracyclines decrease the efficacy of oral contraceptives
* both minocycline and doxycycline increase the risk of digoxin toxicity

client education regarding tetracyclines

* take tetracyclines (except for minocycline) on an empty stomach with 8 oz. of water.
* dont take right before lying down because it increases the risk of esophageal ulceration
* tetracyclines should be administered at least 1 hr. before or 2 hrs. after ingestion of chelating agents
* complete the entire course of therapy
* utilize additional contraception

what are the types of macrolides

==-azithromycin (Zithromax)==

==-clarithromycin (Biaxin)==

==-erthromycin (E-mycin and others)==

what are the therapeutic uses of macrolides

* treats infections in people who have penicillin allergy against rheumatic fever and bacterial endocarditis
* treats legionnaire's disease, pertussis (whooping cough), and acute diphtheria
* treats chlamydia infections (urethritis, cervicitis), pneumonia, and strep infections

complications r/t macrolides

* GI discomfort (nausea, vomiting, epigastric pain)
* prolonged QT intervals - causing dysrhythmias and possible sudden cardiac death
* ototoxicity with high dose therapy - report hearing loss, vertigo, and tinnitus

contraindications/precautions with macrolides

* erythromycin and azithromycin are pregnancy risk category B
* liver disease and QT prolongation are contraindications

interactions r/t macrolides

* erythromycin inhibits the metabolism of antihistamines, theophylline, carbamazepine, warfarin, and digoxin, which can lead to toxicity
* verapamil, diltiazem, HIV protease inhibitors, antifungal medications, and nefazodone inhibit the metabolism of erythromycin, which can lead to toxicity and cause tachydysrhythmias and possible cardiac arrest

COMPLETE APPLICATION QUESTIONS IN ATI BOOK

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Urinary Tract Infections

\-sulfonamides and trimethoprim

\-fluroquinolones

\-urinary tact antiseptics

\-urinary tract analgesics

fluoroquinolones medications (-FLOXACIN)

\-ciprofloxacin (Cipro)

\-levofloxacin (Levaquin) ==(ADMINISTER SLOWLY)==

\-ofloxacin

\-moxifloxacin

\-gemifloxacin

fluoroquinolones pharmacologic and therapeutic uses

\-bactericidal; destroy bacteria by inhibiting an enzyme necessary for DNA replication

\-broad spectrum

\-treats complicated UTIs, respiratory, skin, GI, STDs

complications of fluoroquinolones

==GI discomfort== - nausea, vomiting, diarrhea

* tell client to take med with food (except dairy)

==Achilles tendon rupture== - special protein causes destruction of tendon

* observe for and report pain, swelling, and redness

==Superinfection== - thrush, vaginal yeast infection

==Photo-toxicity== - severe sunburn

contraindications/precautions r/t fluoroquinolones

* do not administer to children under 18 years old because of risk of achilles tendon rupture (children are still growing and more prone to rupture)
* Ciprofloxacin increases risk for C.diff as it destroys normal intestinal flora
* Ciprofloxacin can cause CNS issues (dizziness, headache, restlessness, confusion)
* pregnancy risk category C
* older adults tolerate fluoroquinolones well

interactions with fluoroquinolones

* cationic compounds (aluminum- or magnesium-containing antacids, iron salts, sucralfate, dairy products) decrease the absorption of ciprofloxacin
* plasma levels of theophylline can increase with concurrent use of ciprofloxacin
* plasma levels of warfarin can increase with concurrent use of ciprofloxacin

nursing administration of fluoroquinolones

* Ciprofloxacin is available in oral and IV formulations. Discontinue other IV infusions or use another IV site when administering cipro IV
* give lower dosages to those with kidney impairment
* administer cipro IV in a dilute solution SLOWLY over 60 min in a large vein
* for inhalation anthrax infection, give cipro every 12 hours for 60 days

antiprotozoal metronidazole (Flagyl)

\-acts against __anaerobic microbes__

* giardiasis and trichomoniasis

\-think of the GI tract!

\-treatment and prophylaxis

\-H. pylori

\
Considerations:

\-dont use in patients w seizure disorders

\-Priority complication is Neurotoxicity which can cause numbness, ataxia, and seizures

\-GI discomfort

\-Darkening of urine

\-Interacts with alcohol

\-Most common adverse effects are headache, nausea, dry mouth, and an unpleasant metallic taste in the mouth

Anti-Fungals

\-systemic: candidiasis, aspergilosis, histoplasmos

\-superficial: ringworm, candida infection of the skin and nails

\-acts on cell membranes to cause cell death

\-fungistatic or fungicidal

* ==amphotericin B (IV)==
* ==nystatin (powder)==
* ==fluconazole (Diflucan)==

hallmark for HIV turning into AIDS

CD4 count (less than 200, then it is considered AIDS)

Viral infection, HIV, AIDS

\-alter viral reproduction

\-HAART: combination therapy

\-also treats adverse effects and to prevent secondary infectons, take meds

* **“virs” are for viruses**
* ==acyclovir==
* ==ganciclovir==
* ==ribacirin==

\-can also use oseltemivir (Tamiflu)

HAART (Highly Reactive AntiRetroviral Therapy)

\-For HIV

\-Uses 3-4 meds simultaneously

* reduces med resistance
* reduced adverse effects
* reduces dosages
* reduces amount of virus
* increases CD4 counts

Categories of HIV meds

\-Antivirals

\-Antiretrovirals

* fusion/ entry inhibitors
* CCR5 antagonists
* NRTIs
* NNRTIs
* protease inhibitors
* integrase inhibitors

MultiDrug Resistant Organisms

\-MRSA (methicillin resistant staphylococcus aureus)

\-VRE (vancomycin resistant enterococcus)

\-ESBL (extended spectrum beta lactamase)

\-KPC (klebsiella pneumoniae carbapenemase)

Nursing implications for all antibiotics

\-take ALL of antibiotics exactly as prescribed, they should not stop taking med early when they feel better

\-assess for signs + symptoms of superinfection:

* fever
* perineal itching
* cough
* lethargy
* unusual discharge
* preventing infection: WASH HANDS

which antibiotic should be used to treat meningitis in a patient allergic to Penicillin

\
cephalexin

amoxicillin

vancomycin

vancomycin

because patient is allergic to penicillin, which of the following drugs should be available in case of severe allergic reaction to antibiotic prescribed?

\
A. atropine

B. naloxone

C. epinephrine

D. neostigmine

C. epinephrine

IV vancomycin has been prescribed to treat the meningitis, when administering this drug IV, which of the following actions should the health care professional take? (select all that apply)

\
A. do not mix with other drugs

B. administer it rapidly via IV bolus

C. monitor IV insertion site for phlebitis

D. monitor vital signs during infusion

E. dilute the drug before administering

A. do not mix with other drugs (incompatible with a lot of drugs)

C. monitor IV insertion site for phlebitis

D. monitor vital signs during infusion

E. dilute the drug before administering

clients receiving vancomycin should be closely monitored for which

\
A. visual disturbances

B. hearing loss

C. perioral numbness

D. metallic taste

\

B. hearing loss

while receiving vancomycin, the client becomes flushed and warm. which of the following is indicative of an adverse reaction to vancomycin

\
A. muscle weakness

B. pupil change

C. ecchymosis

D. hypotension

D. hypotension (indicative of Red Man’s Syndrome)

nurse is caring for a client who has streptococcal pharyngitis and an allergy to penicillin. The nurse should give which drug

\
Nafcillin

Azithromycin

Cephalexin

Amoxicillin

Azithromycin

A nurse in a provider’s office receives a call from a client who is taking amoxicillin to treat resp. infection and reports rash and wheezing. what should you instruct the client to do?



A. wait 1 hour and contact provider if it doesn’t improve

B. skip today’s dose

C. call emergency services

D. take an NSAID

C. call emergency services

Patient is taking ciprofloxacin, when should they report to healthcare services?

when they have tendon pain

when administering oral erythromycin to a client with acute diptheria, a nurse should monitor for which of the following adverse effects?

\
hypothermia

blurred vision

constipation

cardiac dysrhythmias

cardiac dysrhythmias

patient is taking oral contraception and is about to start antibiotic, you should instruct them to do what

\
A. increase antibiotic dose

B. increase oral contraceptive dose

C. allow 2 hours between taking two drugs

D. use non-hormonal form of contraception

D. use non-hormonal form of contraception (like condoms)

Patient taking antibiotic has abdominal cramping and bloody diarrhea for several days. What should you instruct patient to do?

\
A. bring stool sample

B. take drug only once daily

C. use anti-diarrhea med

D. return to clinic for blood work

A. bring stool sample (to test for C. diff.)

pt has cefotetan IV to treat infection. IV site is warm, edematous, and painful to touch. Which of the following actions should the nurse take?

\
A. decrease rate of infusion

B. administer diphenhydramine

C. request another antibiotic

D. stop infusion

D. stop infusion

metronidazole to treat anaerobic infection. Nurse should recognize they should be cautious if patient has

\
seizure disorder

hearing loss

asthma

anemia

seizure disorder

pt is about to begin gentamicin, nurse should monitor which of the following

\
A. bowel function

B. peripheral pulses

C. urine output

D. level of consciousness

C. urine output (to watch for nephrotoxicity)

pt has bacterial meningitis. nurse should expect the provider to prescribe a drug from which of the following classes of antibiotics

\
first gen cephalosporins

third gen cephalosporins

monobactams

macrolides

third gen cephalosporins (can cross blood-brain barrier)

pt is taking itraconazole to treat fungal infection. nurse should instruct the client to report which adverse effect

\
tingling in hands and feet

joint swelling

swelling of hands and feet

excessive sweating

swelling of hands and feet , can indicate heart dysfunction

nurse is reviewing a clients prescriptions prior to administering gentamicin to treat systemic infection. nurse should clarify use of gentamicin with the provider if the client is taking which of the following drugs?

\
ethacrynic acid

diphenhydramine

acetaminophen

levothyroxine

\
ethacrynic acid (loop-diuretic)

Define the Endocrine System?

A complex system of hormone-secreting glands

Regulation of many bodily functions: growth, metabolism, sexual reproduction, responses to stress

Maintains homeostasis with a mechanism of feedback loops

What is Antidiruetic Hormone?

\*Posterior Pituitary Disorder

Vasopressin

Therapeutic uses of ADH?

* these hormones are used to treat DI
* ADH promotes reabsorption of water within the kidney through vasoconstriction

Route of Administration for Vasopressin?

* SQ
* IM
* IV

Complications of ADH?

Water Intoxication:

* Retention of too much water
* Clients should reduce fluid intake during therapy
* Report signs of sleepiness and pounding HA

Myocardial Ischemia:

* From excessive vasoconstriction of coronary arteries
* Manifestations include angina pectoris, coronary insufficiency, and MI
* Monitor ECG and BP

Contraindications/Precautions of Vasopressin?

* Contraindicated in clients who have CAD, decreased peripheral circulation, and chronic nephritis
* Use caution in clients who have renal impairment

Interactions with Vasopressin?

* Carbamazepine and tricyclic antidepressants can increase the antidiuretic action
* Concurrent use of alcohol, heparin, lithium, or phenytoin can decrease antidiuretic effects

Nurse should monitor what with administration of ADH?

Monitor VS (BP and HR), central venous pressure, I&O, specific gravity, BUN, creatinine, daily weight

Thyroid Hormone medication?

Levothyroxine

Levothyroxine?

* hormone replacement due to hypothyroidism
* IV use for myxedema coma
* complication from chronic over-treatment is bone loss
* needs yearly therapeutic blood levels: T4 and TSH

Thionamides medications?

* Methimazole
* Propylthiouracil (PTU)

Methimazole?

* Used for Hyperthyroidism
* Complications include hypothyroidism and client may be given a beta blocker to decrease tremors and tachycardia (propanolol)

PTU?

* Used for Hyperthyroidism
* Also used for emergent treatment of thyrotoxicosis

Radiopharmceutical medication?

Radioactive iodine

Radioactive Iodine?

* Used for Hyperthyroidism, Thyroid cancer, and Thyroid function tests
* Complications include radiation sickness, bone marrow depression, and hypothyroidism

Insulin is for?

Diabetes Mellitus

Rapid-Acting Insulin?

Lispro Insulin

* Onset: 15 to 30 min
* Peak: 0.5 to 3 hours
* Duration: 3 to 5 hours

Short-Acting Insulin?

Regular Insulin

* Onset: 0.5 to 1 hour
* Peak: 1 to 5 hours
* Duration: 6 to 10 hours

Intermediate-Acting Insulin?

NPH Insulin

* Onset: 1 to 2 hours
* Peak: 4 to 14 hours
* Duration: 14 to 24 hours

Long-Lasting Insulin?

Insulin glargine U-100

* Onset: 1 to 4 hours
* Peak: None
* Duration: 24 hours

What is U-500 strength?

Short-Acting: Regular Insulin