Pharm 2 Exam 3

what are some examples of health care acquired infections (nosocomial infections)?

MRSA- methicillin resistant S. aureus

VREF- vancomycin resistant enterococcus faecium

VRSA- vancomycin resistant s. aureus

what is a superinfection?

a secondary infection when normal flora is killed

* can also be known as C-Diff

what are the signs of a superinfection?

high fever, thrush (yeast) in mouth, may have sores, and respiratory distress

what do we use for anaphylaxis?

epinephrine

what should you teach a patient that is sexually active using an antibiotic?

teach the patient to use an alternative method of birth control--as the use of antibiotics with oral contraceptives can decrease the effectiveness of birth control

is diarrhea an allergic reaction to antibiotic use?

NO; it is a side effect

what spectrum is a basic penicillin?

narrow-spectrum

what are some examples of basic penicillins?

penicillin G. and V.

what spectrum is an aminopenicillin?

broad-spectrum

what are some examples of aminopenicillins?

amoxicillin, ampicillin, amoxicillin/clavulanic acid (Augmentin)

what spectrum is penicillinase-resistant penicillins?

narrow-spectrum

what are some examples of penicillinase-resistant penicillins?

dicloxacillin, nafcillin, and oxacillin

what spectrum are extended-spectrum penicillins?

broad-spectrum

what are some examples of extended-spectrum penicillins?

piperacillin-tazobactam (Zosyn)

what can penicillin affect in older adults

\*\*may affect renal function in older adults

what are penicillins often combined with?

beta lactam inhibitors to stop the bacteria from inactivating the PCN and overcoming bacterial resistance

what medications interact with cephalosporins?

\- **alcohol -- disulfiram reaction**

- cefotetan may increase the effects of aminoglycosides, salicylates, and warfarin

what spectrum are the macrolide antibiotics?

broad spectrum

what are the macrolide antibiotics?

erythromycin and azithromycin

what are the side effects of macrolide antibiotics?

anaphylaxis, superinfection, headaches, conjunctivitis, GI distress, C-Diff, **ototoxicity**, hepatotoxicity, phlebitis with IV use, **transient hearing loss with high dose therapy**

when giving azithromycin by IV , what should you monitor?

liver function tests

monitoring the IV site

ototoxicity (tinnitus)

cardiac functions (EKG)

what is an example of a lincosamide?

clindamycin

what should you monitor with clindamycin ?

bowel movements

what antibiotic has the most **severe** risk of putting a patient at risk for C Diff after prolonged use?

Clindamycin

what can lincosamides given IV rapidly cause?

EKG changes, hypotension, and cardiac arrest

GIVE SLOWLY

what are some examples of glycopeptides?

vancomycin

what are the side effects of glycopeptides?

Thrombophlebitis, ototoxicity, renal toxicity, **Red Man Syndrome**

what drug is red man syndrome specific to?

it is a result of vancomycin being rapidly infused; can also cause SEVERE hypotension

SLOW the infusion if this happens and continue monitoring the pt. BP

what is the preferred mediation for MRSA and C-Diff?

Vancomycin

what type of IV is preferred for glycopeptides?

PICC or central line-- hard on the veins

what is stevens-johnson’s syndrome?

toxic epidermal necrolysis

* a disorder that causes painful blisters and lesions on the skin and mucous membranes and can cause severe eye problems

why was telithromycin removed from the market?

removed due to reports of liver toxicity

what spectrum are tetracyclines?

broad-spectrum

what are the side effects of tetracyclines?

anaphylaxis, superinfection, photosensitivity, C-Diff, permanent teeth staining, stomatitis, glossitis, and GI distress

* **do not give to children**

what are the drug-food interactions seen with tetracyclines?

\- antacids and dairy products decrease absorption

\- oral contraceptives are less effective when taken

\- risk of nephrotoxicity if given with aminoglycosides

why is it important that tetracyclines be thrown out as soon as they are expired?

the drug breaks down into a toxic by-product

what are the aminoglycosides?

gentamicin, amikacin, neomycin, streptomycin, and tobramycin

how are aminoglycosides typically given?

IV or IM because the medication cannot be absorbed in the GI tract

what are the interactions seen with aminoglycosides?

\- penicillins decrease effectiveness

\- increases action of warfarin

\- risk of ototoxicity increases when given with ethacrynic acid (loop diuretic)

what should you monitor for when giving aminoglycosides?

peak and trough levels; especially for children and elders

what should you do if penicillin is concurrently prescribed with an aminoglycoside?

give the penicillin FIRST

what bacteria does tobramycin target?

gram-negative bacteria

what are the fluoroquinolones?

ciprofloxacin and levofloxacin

what side effects are seen with fluoroquinolones?

anaphylaxis, superinfection, photosensitivity, GI distress, C-Diff, headache, dizziness, insomnia, blurred vision, nightmares, tendonitis, and **TENDON RUPTURE**

what can fluoroquinolones increase?

liver enzymes--does NOT affect the kidneys

what is the black box warning for fluoroquinolones?

* tendonitis
* tendon rupture
* peripheral neuropathy
* CNS effects

\

what are the sulfonamides?

sulfasalazine and trimethoprim-sulfamethoxazole

what are sulfonamides used to treat?

otitis media, meningitis, malaria, and respiratory/urinary tract infections

**MOST effective in treating UTI’s**

what is common with sulfonamides?

cross sensitivity

what should be assessed when giving sulfonamides?

SULFA allergies

DO NOT give when pregnant

what are the nitroimidazoles?

metronidazole (Flagyl)

what are nitroimidazoles primary use?

C-Diff - first choice!

what occurs with nitroimidazoles when taken with alcohol?

disulfiram-reaction -- flushing, throbbing headache, visual disturbances, confusion, dyspnea, N/V, tachycardia, syncope, and circulatory collapse

what are the carbapenems?

meropenem, ertapenem, imipenem/cilastatin (Primaxin) \n

what are carbapenems used for?

serious or life-threatening infections, especially nosocomial

how are carbapenems given?

IM: deep muscle due to painful injections

IV: reconstitute and dilute; infuse on a pump over 45-60min

\*monitor renal and liver function

what antibiotics should be taken on an empty stomach?

MTF- macrolides, tetracyclines, and fluoroquinolones

when taking what antibiotics should you avoid the sun?

FTS- fluoroquinolones, tetracyclines, and sulfonamides

wear sunscreen

what drugs have cross sensitivity?

the 3 C’s

peniCillins, cephalosporins, and carbapenems

CHECK for allergies!

what is a first generation antihistamine?

diphenhydramine (Benadryl)

AND cyproheptadine (Periactin)

what are the second generation antihistamines?

azelastine (nasal spray)

cetirizin (Zyrtec)

fexofenadine (Allegra)

loratadine (Claritin)

desloratidine

levocetirizine

what is the main difference between the first and second generation antihistamines?

the second generation antihistamines are less sedating

what side effects are seen with first generation antihistamines?

anticholinergic effects -- DRY

what are antihistamines used to treat?

allergic rhinitis, allergic conjunctivitis, urticaria, angioedema, insomnia, motion sickness, and antiemetic

what can diphenhydramine be used to help with?

EPS of parkinson's disease

what can cyproheptadine be used to treat?

serotonin syndrome, cushing's disease, vascular headaches, and anorexia nervosa -- due to anti-serotonin qualities

what interaction is seen with loratadine?

\

serious cardiac affects are seen when taken with macrolides, fluconazole, cimetidine, ciprofloxacin, and clarithromycin

what are antihistamines contraindicated with?

asthma and glaucoma

what must you do when administering IV benadryl?

push VERY SLOW

what is the best option for a patient with asthma?

second generation drug like Cetirizine (Zyrtec)

what are the decongestants?

oxymetazoline, phenylephrine, pseudoephedrine, and tetrahydrozoline

who should proceed with extreme caution with decongestants?

patients with hypertension, cardiac disease, hyperthyroidism, and diabetes

what should you teach a patient that is taking a topical decongestant?

limit nasal spray use to 3-5 days -- longer will result in **rebound nasal congestion**

what are the antitussives?

benzonatate, codeine, and dextromethorphan

what are antitussives used to treat?

cough

what is the most widely used antitussive?

dextromethorphan -- better antitussive activity, non-sedating, and does not cause respiratory depression or addiction

what are antitussives contraindicated with?

MAOIs, SSRIs, and COPD

what is codeine used to treat?

\

intractable coughing

what should you avoid with codeine?

MAOIs, alcohol, sedatives, and phenothiazines

what are the side effects seen with codeine?

constricted pupils, hypotension, seizures, brady/tachycardia, stupor, and respiratory depression

what should you encourage with all antitussives?

deep breathing exercises

what is an example of an expectorant?

guaifenesin

what do expectorants do?

* Increases production of respiratory tract fluids
* Reduces the thickness, adhesiveness, and surface tension of mucous making it easier to clear from the airways

what should you take guaifenesin with?

a full glass of water to loosen mucus -- watch hydration status if vomiting or diarrhea

what is acetylcysteine used to treat?

acetaminophen overdose; IV/PO

\* may be used intranasally/nebulizers to decrease thickness of mucous -- used 5 minutes after bronchodilators

what is dornase alpha used to treat?

used for patients with cystic fibrosis to decrease congestion -- digests DNA in thick sputum

what side effects are seen with dornase alpha?

sore throat, hoarseness, voice changes, and cough

what are the short-acting bronchodilators?

albuterol (inhaler), levalbuterol, and terbutaline

what are short-acting bronchodilators used for?

rescue inhalers used for relief of symptoms and preventative for exercise-induced asthma

what are the long-acting bronchodilators?

albuterol (syst) , formoterol, salmeterol, olodaterol, and aformoterol

how are long-acting bronchodilators used?

administered on a schedule -- used for patients with nocturnal symptoms

DO NOT use as a rescue inhaler

what interactions are seen with bronchodilators?

\- increases glucose levels

\- may decrease bronchodilation with betablockers

how long in between puffs should you wait to give?

2 minutes

in what order do you take a bronchodilator and steroid?

use the bronchodilator first and steroid last -- wait 5 minutes in between

EX. albuterol then fluticasone

what are the anticholinergic inhalers?

ipratropium and tiotropium (powder inhaler)

what are anticholinergic inhalers used for?

used primarily with COPD to prevent wheezing, difficulty breathing, chest tightness, and coughing -- can also be used for rhinorrhea

what are the methylxanthines?

aminophylline, theophylline, and caffeine

what are methylxanthines used to treat?

breathing disorders -- caffeine is used to treat neonatal apnea

what must you monitor with methylxanthines?

theophylline levels, VS, and I&O

what interactions are seen with methylxanthines?

smoking decreases half life