baddies only pharm 2 exam

ceftriaxone (ceftrisol/rocephin)

3rd generation cephalosporin antibiotic

broad spectrum

ceftriaxone treats

respiratory, skin, intraabdominal, joint, bone, urinary, biliary and genital infections

otitis media

p aeruginosa

ceftriaxone side effects

anorexia, NVD, headache, rash

ceftriaxone adverse reactions

dysgeusia (distorted taste), GI distress, nephrotoxicity

(seizure, anaphylaxis, superinfection, bleeding)

ceftriaxone nsg/edu

advise pt to ingest buttermilk/yogurt/ or an acidophilus supplement to prevent superinfection of the intestinal flora

take w/ food

report signs of superinfection

monitor IV patency: IV med is painful to the vein, run over 30 sec

avoid alcohol

amoxicillin (amoxil)

broad spectrum penicillin (aminopenicillin antibiotic)

gram-positive and gram-negative bacteria

amoxicillin treats

otitis media, sinusitis

(respiratory, skin, intraabdominal, urinary tract, and gynecologic infection)

amoxicillin side effects

NVD, tongue discoloration, stomatitis, glossitis

amoxicillin adverse reactions

superinfection, prolonged bleeding, anaphylaxis, seizure, C diff associated diarrhea (CDAD)

amoxicillin nsg/edu

unaffected by food, patient can take whenever

assess for allergic reaction, have epi

when giving: take culture

take entire prescription

monitor for superinfection and liver labs

narrow spectrum

effective against ONE bacteria type (ex. penicillin, erythromycin for gram positive)

broad spectrum

effective against gram-negative and gram-positive

(ex. tetracycline 3rd and 5th gen cephalosporin)

-frequently used when offending microorganism has not yet been identified by culture and sensitivity (sepsis)

azithromycin (zithromax)

macrolide antibiotic

used against most gram positive and some gram negative bacteria

azithromycin treats

upper and lower respiratory tract infections

STIs, uncomplicated skin infections

(THRO: "throat")

azithromycin side effects

blurred vision, headache, NVD, tinnitus, fatigue

azithromycin adverse reactions

hepatotoxicity (when taken in high dose w/ other hepatotoxic drug, but can be reversible when discontinued)

anaphylaxis, superinfection, CDAD

azithromycin nsg/edu

assess for liver dysfunction w/ labs (elevated liver enzyme levels and jaundice)

antacids may reduce azithromycin peak levels when taken at the same time

-administer antacids 2 hours before or 2 hours after azithromycin

teach to report any superinfections

what is red man syndrome and how do you avoid this condition

occurs when there is a TOXIC EFFECT OF VANCOMYCIN

vancomycin (glycopeptide that is effective against MRSA)

it is not an allergic reaction, it occurs due to histamine release if GIVEN TOO QUICKLY

-must adminster over an hour

s/sx: severe hypotension, tachycardia, tingling, red blotching of face/neck/chest and extremities

to treat: stop or slow down infusion, administer antihistamine or IV fluids if hypotensive 10mg/min

doxycycline (vibramycin)

tetracycline antibiotic

broad spectrum antibiotic

H PYLORI! MRSA

doxycycline treats

MRSA

severe acne, gingivitis, skin/respiratory/urinary infection

doxycycline side effects

NVD, discoloration of permanent teeth/tongue/nails, abdomen pain, headache, glossitis, stomatitis

doxycycline adverse reaction

superinfection, anaphylaxis, CDAD, ototoxicity/hepatotoxicity/nephrotoxicity

doxycycline nsg/edu

should NOT be taken w/ magnesium, aluminum, antacids, milk products containing calcium or iron-containing drugs

peds patients younger than 8 years of age DO NOT GIVE (teeth discoloration)

advise pt to use sunblock and protective clothing during sun exposure (photosensitivity)

inform female pt who are considering pregnancy to avoid --> teratogenic

have backup oral contraceptive

gentamicin (gentak)

aminoglycoside antibiotic

mostly against gram negative E coli or pseudomonas species

gram positives can be resistant to it

gentamicin treats

SERIOUS bacterial infections of respiratory, skin, urinary, bone, joint, intraabdominal infections

TB, tularemia, bactermia, septicemia, endocarditis, meningitis

aminoglycosides cannot be absorbed from GI or cross CSF; it crosses blood brain barrier in children but not in adults

gentamicin adverse reactions

ototoxicity, nephrotoxicity, neurotoxicity

gentamicin nsg/edu

assess hx related to renal or hearing disorder --> large doses can cause nephrotoxicity/ototoxicity

monitor urine output and encourage increased fluids

check therapeutic drug monitoring has been ordered for peak and trough

-blood levels should be drawn to 45-60 min after drug administration for PEAK and minutes before next drug dosing for TROUGH levels

gentamicin peak and trough

peak: 5-8mcg/ml

trough: less than 1-2 mcg/ml

peak monitoring

drug level is drawn AFTER medication admin

-known to the HIGHEST level in bloodstream

trough monitoring

drug level is drawn when drug its at its LOWEST in bloodstream

-right BEFORE the next scheduled dose is given

TMP-SMZ/ trimethoprim-sulfamethoxazole (bactrim, septra)

sulfonamide antibiotic

against gram negative bacteria that inhibits bacterial synthesis of folic acid

TMP-SMZ treats

90% effective against E coli

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

TMP-SMZ side effects

anorexia, stomatitis, glossitis, NvD, photosensitivity, rash

TMP-SMZ adverse reactions

crystallruia (advise pt to increase fluids)

hematuria

erythema multiforme (hypersensitivity reaction)

TMP-SMZ nsg/edu

increase fluids to prevent crystalluria (at least 2L/day)

records I/Os

observe for hematologic reactions that may lead to life threatening anemias

don't take w/ antacids

assess for superinfection, report bruising or bleeding

INH/ isoniazid

anti tubercular, antimycobacterial

INH treats

active TB infections, TB prophylaxis

-is given w/ vitamin B6 to decrease vitamin B deficiency and minimize peripheral neuropathy

INH adverse reactions

GI distress, paresthesia, ocular toxicity, hepatotoxicity, ototoxicity

rifapin turns body fluids orange--> soft contact lens may be permanently discolored!!

INH nsg/edu

admin 1 hr before or 2 hr after meal

give pyridoxine (vitamin b6) as prescribed w/ INH to prevent peripheral neuropathy

encourage eye exam for pt taking INH--> can cause optic neuritis

monitor hepatic function test LFTs

dont drink alcohol

tb test after 2-3 months after therapy will be negative

nystatin

antifungal (polyenes)

oral or topical meds since poor absorption in GI tract

nystatin treats

cutaneous and mucocutaneous infections

CANDIDA infections!!

nystatin adverse reactions

hypersensitivity reaction, stevens-johnson syndrome (skin reaction)

high dose: nephrotoxicity, hypokalemia, hypomagnesemia

nystatin nsg/edu

tell pt not to consume alcohol w/ antifungals

swish liquid then swallow

dont dilute with water

medication adherence

monitor urinary output, assess hepatic and renal function

acyclovir (zovirax)

herpes antiviral

acyclovir treats

herpes and varicella zoster virus

interfers w DNA synthesis

acyclovir adverse reactions

leukopenia, thrombocytopenia, granulocytopenia, coma, seizure

*nephrotoxicity

acyclovir nsg/edu

monitor CBC for leukopenia, thrombocytopenia, low Hgb, low Hct

check for superinfection

dilute drug as needed in appropriate amount of solution

why is multidrug therapy indicated for TB

combination therapy against active TB is MORE EFFECTIVE in eradicating infection

it decreases drug resistance and duration of treatment from 2 years to 6-9 months

metronidazole (flagyl)

antimicrobial peptide (AMPs)

metronidazole treats

trichomonas vaginalis, amebiasis, giardiasis, h pylori, rosacea

bacterial/parasitic infections

metronidazole side effects

NVD, dry mouth, metallic taste, headache

metronidazole adverse effect

seizure, aseptic meningitis, thrombocytopenia, toxic epidermal necrolysis

metronidazole nsg/edu

monitor liver function test

assess urine output

monitor LOC

check for superinfection

which antibiotic can be used to treat both parasitic and bacterial infection

AMPs (antimicrobial peptides)

ex. metronidazole

the proteins have broad activity to directly kill bacteria/yeast/fungi/virus/cancer cells

efavirenz (sustiva)

antiretroviral (nonnucleoside reverse transcriptase inhibitors/ NNRTIs)

the only NNRTI that penetrates CSF (causes neuropsychiatric symptoms)

efavirenz treats

HIV 1 infections

efavirenz adverse reactions

hepatotoxicity, neuropathy, stevens johnson syndrome, suicide

efavirenz nsg/edu

monitor CD4, rising viral load

assess psychosocial needs

edu adherence to meds

edu decrease risk of exposure to infection

teach safe sex practices

considerations for pregnant patients with HIV

TIMING of starting therapy: goal is to achieve maximal and sustained viral suppression during pregnancy to prevent perinatal transmission

transmission can occur during pregnancy/labor/delivery/breastfeeding

efaviranz can cause nerual tube defects in 1st 5-6 weeks of pregnancy

postexposure prophylaxis for occupational HIV exposure (needle stick injury)

PEP regimen is initiated within 72 hours of event and continued for 4 weeks

dextromethorphan (robitussin)

antitussive

dextromethorphan treats

dry/nonproductive coughs, common cold

dextromethorphan adverse reactions

tachycardia, respiratory depression, psychosis

dextromethorphan nsg/edu

caution when giving to COPD, asthmatic, or pt with bronchitis

maintain adequate fluid, observe secretions

diphenhydramine (benadryl)

antihistamine

diphenhydramine treats

allergic rhinitis, pruritus, urticaria, common cold, sneezing, cough

prevent motion sickness

diphenhydramine interaction

increases CNS depression with alcohol and other CNS depressants

diphenhydramine side effects

drowsiness, dizziness, dry mouth, fatigue, urinary retention

diphenhydramine adverse effects

seizure, thrombocytopenia

diphenhydramine nsg/edu

give oral form w/ food to decrease gastric distress

warn pt to avoid driving and performing dangerous activities until stabilized on the drug

advise pt to avoid alc and other CNS depressants

use sugarless candy/gum/ice chip for dry mouth

albuterol (ventolin, proventil)

bronchodilator (selective beta adrenergic)

rapid onset, long duration w/ few side effects, better aerosol

albuterol treats

acute asthma, bronchospasm, bronchospasm prophylaxis

albuterol side effects

headache, rhinitis, excitability, tremor

albuterol adverse reactions

bronchospasm, palpitation, tachycardia

albuterol nsg/edu

tell pt proper use, may use spacer

assess for wheezing, decreased breath sounds, cough, sputum production

wear ID bracelet if has asthmatic attacks

tiotropium (spiriva)

anticholingeric bronchodilator

(long acting muscarinic antagonist causes pupil dilation and bronchodilation, increase HR and inhibit secretions)

tiotropium treats

maintenance of bronchospasms associated w/ COPD

tiotropium side effects

GI distress, dry mouth, urinary retention, insomnia, pharyngitis/sinusitis, HTN

tiotropium adverse reactions

seizure, palpitation, dysrhythmias, tachycardia, peripheral edema

tiotropium nsg/edu

dont give to glaucoma or urinary retention

assess wheezing, decreased breath sounds, cough sputum production

make sure pt hydrated

digoxin (lanoxin)

cardiac glycoside

digoxin treats

lowers heart rate, treats HF, atrial fibrillation

digoxin adverse reactions

bradycardia, cardiac dysrhythmias, delirium, blurred or yellow vision

digoxin nsg/edu

ascertain apical pulse rate before admin

monitor serum digoxin level: digitalis toxicity causes visual disturbances (halos), bradycardia, malaise

monitor serum potassium: report hypokalemia

assess signs of peripheral and pulmonary edema

nitroglycerin NTG

antianginal

promotes vasodilation, decreases preload and afterload

NTG treats

angina, MI, HTN, HF, pulmonary edema

NTG side effects

headache, hypotension, flushing

dizziness, weakness, syncope

NTG adverse reactions

orthostatic hypotension, MI, pulmonary edema

NTG nsg/edu

ask male pt if they are on sildenafil (viagra) since can cause severe hypotension

always get HR and BP prior to admin, monitor VS for orthostatic hypotension

position pt sitting/lying down when admin nitrate for the first time

admin under tongue for chest pains

acebutolol (sectral, pindolol)

antidysrhythmic (class II beta-adrenergic blocker)

BLOCKS BETA I ADRENERGIC

acebutolol treats

aids in the treatment of premature ventricular contractions, HTN

acebutolol adverse reactions

palpitations, bradycardia, hypotension, HF

acebutolol nsg/edu

do not stop abruptly: can cause palpitations

monitor VS for hypotension

avoid alcohol, caffeine, tobacco

signs and symptoms of digoxin toxicity and management

anorexia, NVD, bradycardia, dysrhythmias, blurred vision, visual disturbances (HALOS), confusion, delirium

antidote for digoxin toxicity

digoxin immune FAB (excretes digoxin in urine)

hydrochlorothiazide (microzide)

thiazide diuretic

(acts directly on arterioles to cause vasodilation, promotes water and sodium chloride excretion, not rec for severe renal dysfunction)

hydrochlorothiazide treats

HTN, peripheral edema due to HF, ascites, nephrotic syndrome

-increases urine output

hydrochlorothiazide adverse effects

hypotension, hyperglycemia, electrolyte imbalance, urticaria, hyperuricemia, HLD

causes loss of NA, K, and Mg but promotes Ca reabsorption

hydrochlorothiazide interactions

digoxin: thiazides can cause hypokalemia or hypercalcemia which enhances action of digoxin which can result in digitalis toxicity

hydrochlorothiazide nsg/edu

monitor VS and serum electrolytes

observe for s/sx of hypokalemia

suggest pt to take early MORNING to avoid sleep disturbance from nocturia

monitor daily weight and urine output