EXAM 4!!!

Upper Respiratory- Diphenhydramine, class, action, uses, admin, SE, NI

-Antihistamine (1st gen)

-blocks histamine response in small vessels and nerves- like benadryl

-Allergic reactions, motion sickness, insomnia, nasal congestion

-PO or IV

-SEDATION, dry mouth (decreased sludge), constipation

• do not mix with alcohol (increases CNS depression), drink fluids/hydrate, not advised in older populations because of sedating effects, INCREASED RISK OF FALLS!!

Loratadine & Cetirizine- class, action, uses, admin, SE, NI

• antihistamine (2nd gen)

• blocks histamine response in small vessels and nerves

• allergic reaction, motion sickness, nasal congestion

• PO ONLY!!!!

• less sedative effects than diphenhydramine

• drink plenty of fluids, stay hydrated

Pseudoephedrine- class, action, SE, NI

• decongestant- MAKE METH- sudafed

• reduces inflammation of the nasal membranes

• increased bp (HTN), nervousness, agitation, increased glucose, tachycardia

• avoid caffeine as it can increase SE, use with caution in elderly patients and cardiac patients

Nasal Decongestants- MOA, examples, SE, NI

• shrink engorged nasal mucous membranes and relieve nasal stuffiness

• Ex: oxymetazoline (Afrin spray), phenylephrine, ephedrine

• Available over the counter

• Can cause rebound congestion with repeated use because of the very rapid absorption of drug through mucous membranes followed by more rapid decline in therapeutic activity. Can lead to dependance.

• teach patients to use for no more than 3 days

Nursing considerations:

Daily limit of acetaminophen of <3000 mg/day, and look for codeine because it can cause respiratory depression and addiction!!! Phenylephrine can raise BP!!

Lower Respiratory- Dextromethorphan- class, action, uses, admin, SE, NI

• Non-opioid Antitussives

• works on the CNS to suppress cough

• OTC liquid

• some sedation, potential for abuse, few side effects overall

• assess for productive cough vs non-productive cough, ensure patient’s report use of medication to MD/PharmD

Benzonate- class, MOA, admin, SE

• Non-opioid antitussive- need to be prescribed!!!

• thought to work by anesthetizing or numbing the cough receptors

• Oral pearls

• Not many SE and is a great prescription option

Guaifenesin- class, MOA, admin, SE, NI

• Expectorants (break up mucus- mucimex)

• increases hydration of the respiratory tract, which is needed for ciliary clearance and reducing the viscosity of mucus, thins; facilitates mucus removal- pulls fluid to break up mucus

• Orally- OTC product

• very few SE

• take with a glass full of water, HYDRATE, report use to MD/PharmD, for short term use!!! GLUG GLUG GLUG

Acetylcysteine- class, action, uses, admin, SE, NI

• mucolytics

• thin secretions

• acute/chronic pulmonary disorders (COPD) with large amount of secretions, cystic fibrosis.

• oral, IV, inhalation

• bronchospasm, dizziness, drowsiness, hypotension, tachycardia

• oral and IV form are for acetaminophen toxicity, oral medication smells like ROTTEN EGGS, encourage fluid intake, antidote for acetaminophen overdose!!

Albuterol- class, action, admin, SE, NI

• Beta-2 Agonists (short acting beta agonist- SABA)

• causes RAPID bronchodilation

• inhalation, rapid acting “rescue inhaler”, nebulizer & inhaler form

• tachycardia, tremors, palpitations

• check pulse & report increase of 20/30 beats per minute, used as needed for wheezing

Salmeterol- action, admin, SE

• causes bronchodilation, used for maintenance treatment of COPD and asthma and used in conjunction with oral corticosteroids

• inhaled, long acting (LABA); not to be used for acute treatment, for chronic!! often prescribed BID or daily- LONG TERM

• headache, sore throat, tachycardia, and tremors (with bronchodilation)

Terbutaline- class, action, admin, SE, NI

• selective beta 2 agonist

• causes bronchodilation for long term control of asthma

• PO

• can cause uterine relaxation (injection used to delay premature labor), uncontrollable shaking/tremors, dizziness, drowsiness, headache, nausea, sweating

• instruct patients on proper inhaler usage, report continued symptoms of SOB or wheezing, only use when other therapies aren’t working- old medication not used as much anymore

Nursing interventions for bronchodilators:

• assess for wheezing, cough, sputum production, decreased breath sounds. Watch breathing pattern (short, shallow, fatigued, etc.)

• assess frequency of symptoms, timing, and number of times per week a rescue inhaler (albuterol) is needed

• assess for altered mental status that could result from hypercapnia or hypoxia

• ask pt to show their inhaler (make sure not empty) and demonstrate use

• ensure patients understand what each inhaler is intended to do and understands the importance of compliance with maintenance inhalers

• QUIT SMOKING and provide resources for quitting when pt is ready

• educate on spacer use, advise asthma patients to wear a medical bracelet, show pt how to measure their pulse to monitor for SE, educate patients to avoid environmental exposures that could cause symptoms

• patients should have written asthma plans for how manage symptoms as they worsen

Inhaled anticholinergics- uses, SE, NI

• for COPD

• Ipratropium (short acting muscarinic SAMA)

• Tiotropium (long acting muscarinic- LAMA)

• Inhaled (nebulizer or metered dose inhaler) often ipratropium combined with albuterol “duo neb” for best effect

• same as anticholinergic (DECREASED SLUDGE) dry mouth, blurred vision, headache, change in taste

• encourage hydration, avoid patients with narrow angle glaucoma

Theophylline- class, action, admin, SE, NI

• methylxanthines (Xanthine derivative)

• bronchodilation

• ORALLY- requires therapeutic drug monitoring (5-15 mcg/mL), can also be given rectally or IV (aminophylline)

• tachypnea, restlessness, nausea, diarrhea, toxicity includes dysrhythmias and seizures

• monitor levels periodically or with side of toxicity, increase risk for toxicity with certain antibiotics and caffeine

Montelukast- class, action, uses, admin, SE, black box warning, NI

• Leukotriene Receptor Antagonist (LTRA)

• decreases secretions, airway edema and promotes bronchodilation

• prevent bronchospasm in mild asthma. Used for long-term treatment of asthma; NOT for ACUTE ATTACKS

• Oral (once daily dosing)

• headache, dizziness, fatigue

• BLACK BOX: FOR SUICIDAL IDEATION/MOOD CHANGES

• educate about possible mood changes, should not be given in patient with lactose allergy

Drugs for hematological system- anemia drugs and other blood disorders-Epoetin Alfa- action, admin, SE, NI, black box

• erythropoietin stimulating agent (increases hemoglobin and hematocrit when transfusion is not optimal), used for pt with renal failure and cancer most commonly

• IV and SUBQ, DO NOT shake vial, HGB must be <11

• HTN, fever, headache, pruritus, rash, nausea, vomiting, arthralgia, injection site reaction, potential thrombosis especially when given to patient with HGB >11

• monitor iron stores to ensure adequate response is possible, monitor BP, monitor H&H, monitor for signs of blood clots

• BLACK BOX: warning for increase risk of death when given to target a hemoglobin >11 g/dL

Iron- foods that impair and enhance iron absorption

• Enhance: orange juice, veal, fish, ascorbic acid

• Impair: eggs, corn, beans, cereal products containing phytates (avoid dairy group)

• Dietary sources: meats, certain vegetables, and grains

• Stored in the liver, spleen, and bone marrow

• Oxygen carrier in hemoglobin and myoglobin, essential mineral

• Dietary iron must be converted by gastric juices before it can be absorbed

Supplemental Iron- enteral and parenteral

• may be given as a single drug or as part of a multivitamin preparation

• Enteral- ferrous sulfate (contraindicated in patients with ulcerative colitis, peptic ulcer disease, liver disease, and other GI disorders)

• Parenteral- Iron dextran (INFeD)-high risk of adverse reaction

-Iron sucrose (Venofer)

Adverse effects of Iron

• most common cause of pediatric poisoning deaths

• causes nausea, vomiting, diarrhea, cramps, constipation, pain, GI problems, black tarry stools!!

• Liquid oral preparations may stain teeth

• Injectable forms cause pain upon injection

• likelihood of adverse reaction

• Can be toxic- causes dehydration for n/v, fluid in lungs??, change in LOC

Nursing Considerations for Iron Administration

• Teach about foods that decrease and enhance absorption

• Give small test dose with 1st IV dose with Iron Dextran

• IV dose can cause orthostatic hypotension (IV infusion over 2.5-3.5 hours)

• Test storage safety to avoid children taking iron

• Take liquid form through a straw to avoid staining tooth enamel

• Take between meals and not with antacids to maximize absorptions

Folic Acid- passage, uses, NI

• water-soluble, B-complex vitamin, essential for erythropoiesis

• Folic acid deficiency, give during pregnancy to prevent neural tube defects

• Look for natural sources in nutrition and give with food

Cyanocobalamin (Vitamin B12)- uses, admin, NI

• treats pernicious anemia and other megaloblastic anemias

• IM, orally, intranasally to treat B12 deficiency

• Usually administered by deep IM injection monthly

Filgrastim- action, uses, admin, SE, NI

• stimulates the increased production of WBC’s

• patients with neutropenia or decreased WBC’s especially patients receiving chemo

• SQ or IV

• bone pain and injection site pain (bc it stimulates bone marrow to produce blood cells) (Give NSAIDs)

• Monitor WBC (should increase) and bone pain and treat as needed

Coagulation Modifier Drugs (drugs that effect clotting)- HIGH RISK MEDS

Drugs that affect coagulation are some of the most dangerous drugs used today

Anticoagulants- for?

Antiplatelet- for?

Thrombolytic- for?

Antifibrinolytic/hemostatic- for?

• inhibits the action/formation of clotting factors, prevent clot formation

• inhibit platelet aggregation (cluster/clumping of platelets) and prevent platelet plugs

• Lyse (break down) existing clots

• promote blood coagulation

Anticoagulants (focus on lab, antidote, high risk)

• antithrombotic drugs

• no direct effect on blood clot that is already formed

• PREVENTS intravascular thrombosis by decreasing blood coagulability

• Used prophylactically to prevent- clot formation (thrombus) and an embolus (dislodged clot)

Enoxaparin (Lovenox)- action, admin, SE- Low Molecular Weight Heparins (LMWH)

• given to prevent clot formation in immobile patients

• generally give SUBQ in the abdomen (weight based), rotate sites

• bruising at injection site, generalized bleeding (less likely than most others)

• Antidote: Protamine Sulfate!!!

Heparin- action, admin, SE, antagonist, NI (help be a pro)

• prevents clots, high risk of clot formation

• IV drip (highest risk), SUBQ injection, IV flush (goal is to keep a clot from forming in the IV line), weight based medication in IV form- for DVT

• Hemorrhage, Leukopenia, HIT: heparin-induced thrombocytopenia

• Antagonist/antidote: Protamine Sulfate

Nursing Considerations:

• Frequent monitoring of PTT for IV drip, check stools for occult blood/dark tarry stools, high risks associated with invasive procedures

• obtain a thorough history- peptic ulcer disease, CVA, TBI, hemophilia increase risk of bleeding.

• No allergy or history of HIT

• Monitor aPTT levels at the appropriate interval and adjust heparin as prescribed or per protocol (monitor platelets, hemoglobin, and hematocrit)

• examine mouth, nose, urine, and skin for new bleeding or bruising

• examine risk of bleeding and need for frequent lab draws to the pt and check stools for occult blood (blood you can’t see)

• normal PTT values is 1.5-2.5 seconds

Warfarin Sodium- action, admin, antagonist, SE, NI

• blocks clot formation, used in high-risk clot situations (for pts on post-op orthopedic and A-fib)- use acetaminophen with this instead of aspirin for pain

• Oral form only so lots of pt ed

• Antagonist/ antidote: Vitamin K

• Hemorrhage, Hepatitis, Leukopenia

Nursing Implications:

• monitor INR (lab that says how quickly you dissolve blood clots) frequently (want range of 2-3→ lower is increased risk for clotting, higher is increased risk of bleeding)

• take dose at same time daily and DO NOT double up for missed dose

• monitor for signs of bleeding (occult blood, new bruising, bleeding when brushing teeth) coffee ground emesis

• check CBC periodically and take 5-7 days to reach effect

• avoid large amounts of food with Vitamin K (green leafy vegetables steady intake)- steady diet!!

• high risk in pregnancy

Clopidogrel- action, admin, SE, NI

• antiplatelet agent and often used in short term after cardiac procedure- for DVT

• Oral/give loading dose (one higher dose for the first administration)

• GI irritation, bleeding, thrombocytopenia

• stop 5-7 days prior to invasive procedure (since it increases bleeding time), monitor for bleeding, monitor CBC, can give with food if needed to prevent GI irritation

Alteplase or t-PA- action, admin, SE, NI

• thrombolytic, give to breakdown an existing clot (for ischemic stroke/for thrombolytic stroke)

• IV only with CLOSE monitoring (in ICU) one time IV or dose

• HEMORRHAGE, hypotension, rash- HIGHEST RISK

Nursing Implications:

• evaluate medical history and meds for CI to alteplase (if someone had surgery/fall recently, they probably have a clot somewhere, you don’t want to break up clots that are doing what we want them to) ex: active bleeding, aneurysm, CVA recently, recent surgery, recent trauma, brain trauma or tumor, severe uncontrolled HTN (SBP > 185), active anticoagulant given (warfarin at home, now they took both and had a stroke!!)- warfarin takes 3 days to have a therapeutic effect, so you can take heparin until warfarin is therapeutic. can take with recent use of acetaminophen, not if you have HTN, had spinal surgery, or recent warfarin use

• ensure vital signs monitoring for HTN or hypotension/tachycardia that might indicate bleeding, nosebleed

• no foley/NG tube for 24 hours if possible→ can cause tissue damage

• check EKG for reperfusion dysrhythmia if MI was indication

Drugs for GI issues- for the colon, lower GI: Orlistat- action, uses, admin, AE, admin, Education

• inhibits fat absorption in small & large intestine, non-stimulant anorexiant

• for weight loss

• OTC ORAL medication

• flatulence, rectal incontinence, oily stools (bc fat is passing through and out), cholelithiasis, abdominal/rectal pain, hepatitis, pancreatitis, nausea

• take with meals, report use to provider, report adverse reactions to provider, decrease fat intake, fatty/oily stools very common

Antidiarrheals- NI (donnatal, diphenoxylate, lactobacillus)

• many over the counter, we want to stop the stool

• rule out infections or obstruction before giving, instruct patients to report long term use (OTC meds), monitor hydration status (take plenty of fluids), watch for nutritional/electrolyte imbalance

Donnatal- class, action, SE

• anticholinergic (decreased SLUDGE)

• slow peristalsis by reducing contractions/smooth muscle tone of GI tract, drying effect

• Potential for systemic anticholinergic effects

Diphenoxylate- class, action, SE

• Opioid

• reduce bowel motility (peristalsis), reduce pain associated with diarrhea, longer absorption of water/electrolytes/nutrients

• pancreatitis

Lactobacillus- class, action, pt ed

• Probiotic (OTC, herbal)

• suppress growth of diarrhea-causing bacteria and reestablish flora that normally resides in intestines

• found in foods like yogurt, good for diarrhea associated with antibiotics, lots of forms available

Laxatives- AE, NI

• bloating, cramping, malnutrition, can cause decrease absorption of some medications (when you force things to the colon, it can inhibit nutrients)

• rule out infections or obstruction before giving (acute abdomen, appendants, impaction- is there abdomen firm or is there any pain)

• instruct patients to report long term use (OTC meds)

• monitor fluid and electrolyte balance (take plenty of fluids) watch for imbalance

Gentle Laxatives: Methylcellulose and Docusate (Colace)- SE and NI for both

Methylcellulose: bulk forming, action is to act like fiber does naturally, absorb water into intestine, distend bowel to initiate reflex bowel activity

Docusate (Colace): Emollients (softens things), MOA: stool softeners, lower, surface tension of GI fluid to absorb more water into stool, common for people on opioids

• SE minimal for both

• NI: report chronic use to provider, drink plenty of water, assess consistency and amount of stool, can be used for prevention of constipation and treatment of constipation, takes a few days to work→ for prevention!!!

Stimulant Laxatives: Bisacodyl (Dulcolax)- action, admin, SE and Senna- action, use, SE

Bisacodyl:

• stimulated peristalsis and increase water in intestines

• PO, rectal suppository

-low dose: constipation often caused by opioid use

-high dose: whole bowel evacuation prior to endoscopic exam

• cramping with high dose

Senna:

• stimulates peristalsis and increase water in intestines

• acute constipation

• can cause abdominal pain, can cause dependency

Hyperosmotic Laxatives- action, Glycerin, Lactulose

• increases fecal water content, increases peristalsis and evacuation in large intestine

• Glycerin- increases water content and peristalsis

• Lactulose- used to reduce ammonia levels (hepatic encephalopathy), liquid form, watch since its an aggressive laxative!!! monitor fluid balance and ammonia levels (decreases ammonia by excreting it). will have a large lipidy poop!!!

Hyperosmotic Laxatives- Polyethylene Glycol 3350 (GoLYTELY)- uses, NI

• before diagnostic/surgical bowel procedures (colonoscopy) to cleanse bowels

• instruct pt to take as directed, drink plenty of electrolyte rich fluids while taking this, typically comes in a large volume, often cause nausea in patients, powder mixed into fluid (Gatorade, sometimes tastes bad)

IBS- Alosetron- action, SE, NI

• increases firmness in stool and decrease urgency and frequency of bowel movements; used for IBS with diarrhea

• constipation, bowel obstruction/perforation

• do not use if already constipated, high risk for GI issues so clients must sign a treatment agreement, assess bowel sounds (note absent bowel sounds), assess for consistency and frequency of bowel movements, only take for 4 weeks but need close follow up with provider

Lubiprostone- action, SE, NI

• increases fluid secretion in the intestine to promote motility; used for IBS and constipation #LUBEthatbowel

• diarrhea

• take medication with food and monitor fluid and electrolyte status

Acyclovir- class, uses, admin, SE, NI

• antivirals

• treats herpes simplex virus infections (1 or 2)

• IV, PO, or Topical Routes, can be very irritating to the vessels

• headaches, nausea, diarrhea, fatigue, burning when applied topically

• Encourage fluids, monitor for improving lesions→ make sure lesions are going away

Tenofovir/emtricitabine combo taken together (PREP)- class, route, NI

• Preexposure prophylaxis (PrEP)

• antiviral

• given prophylactically to those at high risk for HIV and up to 90% effective for preventing a person from getting HIV when used correctly.

• PT ED: adherence to med is key. PrEP is much less effective when it is not taken consistently

Oseltamivir- class, uses, admin, SE, NI

• antivirals

• Flu A & B

• Oral- best to be started within 24-48 hours of symptoms!!!! can be used for prophylaxis treatment

• nausea, vomiting, headache

• start within 2 days of symptoms and it should reduce the course of illness

Isoniazid- class, uses, admin, SE, black box!!!, NI

• Selective Antituberculosis

• Treatment of TB both latent and active. This is the most common and widely used anti-TB drug

• Neurotoxicity: especially peripheral neuropathy, hepatotoxicity

• BLACK BOX: possible hepatitis!!!

• can have many drug interactions, decrease alcohol intake, take 2 hours apart from antacids

Rifampin- class, use, admin, SE, NI

• Antituberculosis

• TB

• PO on empty stomach

• Elevated LFT, rash and GI distress, flu-like symptoms, causes red & orange discoloration of body fluids

• monitor liver function, instruct patients about body fluid color change, rifampin can cause urine, saliva, tears, and sweat to be a red-orange-brown color.

Pyrazinamide- use, SE, NI

• used in combo with other TB drugs

• GI distress, malaise, arthralgias, hepatotoxicity, photosensitivity

• uric acid may be elevated, so monitor in patients with gout and monitor liver function

Ethambutol- NI/Pt ed

Do not give with antacids (alters absorption), monitor renal function, notify provider of changes in vision or the inability to see green

TB treatment

• monotherapy ONLY for latent disease- isoniazid for 6-9 months (may contribute with rifampin)

• 3-4 drugs for active disease, needed for subpopulations of M. tuberculosis within the body and to prevent resistance, all TB drugs of focus today are given PO

• shortest duration possible is 6 months (up to 18-24 months), patients feel better before then, so close monitoring to ensure completion, 5 days per week, twice weekly, and weekly regimens are alternatives to improve compliance

• “DOT” direct observation therapy needed at times

Nystatin- class, uses, admin, NI

• antifungal

• candidiasis

• suspension, swish and swallow, given 4 times daily for oral candidiasis (thrush), powder best for candidiasis of moist areas (skin folds, diaper rash), nystatin cream for topical candidiasis when powder not used

• warn patients of bitter taste and potential nausea with oral suspension

Amphotericin B- class, admin, SE, NI

• broadest antifungal agent available- treats many type of fungi

• IV, multiple formulations to reduce toxicities

• INFUSION REACTIONS- fever, chills, rigors, arthralgias, hypotension (almost all patients get these!). Pre-medicate 30-60 min before with acetaminophen, diphenhydramine, and meperidine (if rigors only)

• May cause acute kidney injury, hypokalemia, hypomagnesemia, sodium loading with normal saline before and after dose, monitor renal function, urine output, and electrolytes daily while inpatient

Fluconazole- class, admin, other info?

• antifungal

• oral and injectable

• very broad antifungal with a better side effect profile than amphotericin B

• Even a single dose can be effective for vaginal candidiasis

• Has excellent bioavailability; almost all of the dose administered is absorbed into circulation

Metronidazole- class, uses, SE, NI

• antiprotozoals (has broad antibacterial activity)

• #1 drug to treat C-diff, STIs

• severe GI upset with alcohol; new rash (Steven Johnson’s syndrome- MED EMERGENCY). normal: dark urine and metallic taste. Disulfiram- like reaction due to concurrent alcohol use

• Avoid ETOH (alcohol) during and 3 days post and take with a full glass of water

Hydroxychloroquine- class, uses, SE, Pt ed

• antimalarial

• malaria treatment and prevention- from med missions

• EPS, rashes

• avoid sun exposure, contraindicated in pregnancy, visual field changes, optic neuritis, and psoriasis

Glucocorticoids (raise blood sugar so watch diabetes!!)- Prednisone- action, admin, SE

• reduces inflammation by reducing inflammatory and immune response

• Oral: intermediate acting

• Weight gain & increased appetite, increased blood sugar, mood changes, bone loss, decreased immune response, trouble sleeping

Methylprednisolone- action, admin, SE

• reduces inflammation by reducing inflammatory and immune response

• IV: intermediate acting

• Weight gain & increased appetite, increased blood sugar, mood changes, bone loss, decreased immune response, trouble sleeping

Fluticasone- action, admin, SE

• reduces inflammation by reducing inflammatory & immune response

• Inhaled

• fewer systemic side effects, can cause yeast growth in mouth (thrush) so RINSE AND SPIT after use!!!

Renal Medications- Nitrofurantoin- class, MOA/uses, SEs, NI/teaching

• nitrofuran antibiotic

• disrupts bacterial cell wall formation (breaks down the bacteria); treats lower urinary tract infections

• Myelosuppression, blood dyscrasias, nausea, possible irreversible peripheral neuropathy and FATAL hepatotoxicity (RARE)- available PO

• check baseline CBC, take at bedtime to decrease nausea, report signs of infection/bleeding, doses may need to be reduced in the older population

Phenazopyridine- action, SE, NI

• provides a local anesthetic to the urinary tract (NOT an antibiotic)

• GI discomfort, urine will turn orange/red color, PO

• urine can stain clothes, take after meals to minimize GI discomfort, patients can use cranberry juice to prevent UTIs but is not effective if UTI is present

Oxybutynin- class, action, SEs, NI

• Anticholinergic (antimuscarinic)

• prevents bladder spasms, decreasing incontinence, primarily used for over-active bladder (OAB), available PO and in transdermal patch (patch used for OAB)

• can have several anticholinergic side effects (dizziness, drowsiness, dry mouth, constipation, tachycardia), weight gain, orthostatic hypotension'

• inform patients to report urinary retention, notify provider of palpations, do not take if pt has a urinary obstruction or glaucoma

Tamsulosin and Doxazosin- action, uses, SE, NI

• relaxes smooth muscles of the bladder and prostate (helpful in BPH), can also cause vasodilation and lower BP

• BPH, Urinary retention, PO

• HYPOTENSION (given in older males so watch for erectile dysfunction), nasal congestion, sleepiness, problems with ejaculation

• Contraindicated in patients with known use of erectile dysfunction in drugs

• caution in patients with renal impairment, monitor BP/ caution with patients taking antihypertensives

Antibiotics (oral contraceptive effectiveness may be reduced by penicillins, take with food to decrease GI upset, obtain cultures before starting antibiotics)-

Penicillin antibiotics- class, admin, SE

• B-lactam antibiotic, examples: amoxicillin; piperacillin/tazobactam

• mostly oral, teach patients to take with food to decrease GI upset, IM loading dose may be given, PIPERACILLIN/TAZOBACTAM (IV FORM)

• cross sensitivity to all penicillins, monitor kidney function, GI upset, thrombocytopenia

Cephalosporins- drugs in this class, action, SE, NI

• Cefazolin (IM or IV), Cefaclor (PO), Cefepime (IM or IV)

• broad spectrum coverage

• can have cross sensitivity/allergy with severe PCN (penicillin) allergy, GI upset & risk for C.diff, kidney stones or gallstones

• take with food, add food with probiotics (yogurt), monitor kidney function, tell patient to report diarrhea (C. diff)

Sulfonamides- drugs in this class/admin, SE, NI

• Sulfamethoxazole/trimethoprim (IV or PO), Sulfadiazine (IV or PO)

• Hyperkalemia, hyponatremia, hypoglycemia, Steven Johnson Syndrome (MED EMERGENCY), rash, anaphylaxis (sulfa allergy), stomatitis, photosensitivity, diarrhea, nausea

• Monitor potassium levels and kidney function

Carbapenems- drugs in this class, action/uses, SE, NI

• Meropenem, Imipenem/cilostatin

• broad spectrum antibiotic (actually has the broadest antibacterial action of any antibiotic to date), pneumonia, sepsis, severe infections, IV only

• GI upset, seizures, rash

• Caution with patients with PCN allergy, renal impairment and those on valproic acid, monitor I&O if GI symptoms present

Monobactams- admin, SE

• Great for gram-negative coverage (ex: e.coli, klebsiella, pseudomonas)

• Aztreonam is the only monobactam antibiotic to be developed thus far, only available PO

• Commonly given to patients with known PCN allergy because of less cross-reactivity

• Rash, nausea, vomiting, diarrhea

Macrolides “Mycins”- drugs in this class, admin, SE, NI

• Azithromycin: IV or PO (tapered dosing) Erythromycin: PO

• GI upset, rash, QT prolongation, several drug interactions, azithromycin has fewer side effects than erythromycin

• Be sure they provide a thorough drug history, EKG prior to administration if cardiac history, take on empty stomach, monitor liver function