Pharm Study Guide

NUR 2300 Final Exam Study Guide - Antibiotics & Antimicrobials (Ch. 42–49)

Allergic Reactions

  • True Allergic Reaction (Penicillins)

    • Anaphylaxis Signs:

    • Wheezing

    • Bronchospasm

    • Swelling of the face/lips/tongue

    • Hives

    • Itching

    • Hypotension

    • Dyspnea

    • Management: Stop the drug, maintain airway, administer epinephrine.

Photosensitivity

  • Antibiotics that cause Photosensitivity:

    • Tetracyclines (e.g., doxycycline)

    • Fluoroquinolones (e.g., ciprofloxacin, levofloxacin)

    • Sulfonamides (e.g., TMP-SMX / Bactrim)

Serum Level Monitoring

  • Antibiotics requiring peak and trough levels (nephro/oto-toxic):

    • Vancomycin

    • Aminoglycosides (e.g., gentamicin, tobramycin, amikacin)

    • Monitor for: Kidney toxicity (increased creatinine), Ear toxicity (tinnitus, vertigo, hearing loss).

Signs of Organ Toxicity

  • Early Signs:

    • Kidney: Increased creatinine, decreased urine output

    • Liver: Increased AST/ALT, jaundice, RUQ pain, dark urine.

Food and Drug Interactions

  • Foods/Drinks to Avoid with Certain Antibiotics:

    • Tetracyclines: No milk, antacids, iron (binds calcium/iron leading to decreased absorption)

    • Metronidazole: No alcohol (can cause severe vomiting/cramping)

    • Fluoroquinolones: Avoid antacids/dairy (decreased absorption)

    • Macrolides (erythromycin): Avoid food (decreased absorption) unless GI upset is severe.

Color Changes in Body Fluids

  • Drugs that cause unusual body fluid colors:

    • Rifampin (TB): Orange/red tears, urine, sweat

    • Nitrofurantoin: Brown urine

    • Metronidazole: Dark urine (brown).

Unique Side Effects

  • Medications with Notable Side Effects:

    • Fluoroquinolones: Tendonitis/tendon rupture

    • Rifampin: Orange fluids

    • Metronidazole: Metallic taste, dark urine

    • Tetracyclines: Teeth staining, photosensitivity.

Hydration Needs

  • Antibiotics requiring increased hydration:

    • Sulfonamides (TMP-SMX) → crystalluria

    • Acyclovir (antiviral, same principle)

    • Fluoroquinolones (increased risk of kidney crystals).

Tendon Issues and Flushing Syndrome

  • Antibiotics Associated with Tendon Rupture:

    • Fluoroquinolones (e.g., ciprofloxacin, levofloxacin)

  • Medications causing “Red Flushing” when infused too quickly:

    • Vancomycin → Red Man Syndrome (not allergic; slow the infusion).

Crystalline Formation in Urine

  • Drugs causing crystals in urine, requiring increased fluids:

    • Sulfonamides (Bactrim/TMP-SMX)

Antifungals & Antivirals (Ch. 50–52)

Notorious Antifungal

  • Amphotericin B:

    • Known for nephrotoxicity; causes symptoms such as fever, chills, hypotension.

Hepatotoxic Antifungals

  • Azoles:

    • Ketoconazole, fluconazole: Require liver lab monitoring.

Fluid Intake for Antivirals

  • Antivirals needing increased fluid intake for kidney protection:

    • Acyclovir/Valacyclovir → crystalluria requires increased fluid intake

    • Ganciclovir (also known to be renal toxic).

Food Interference with Antivirals

  • Acyclovir: Food does not impact absorption.

  • Oseltamivir (Tamiflu): Can be taken with food to prevent GI upset.

  • Zidovudine (HIV): Food is not required.

Pain Meds, NSAIDs, Opioids (Ch. 56–60)

Opioids

  • Most Dangerous Side Effect of Opioids:

    • Respiratory depression.

  • Signs of Opioid Overdose:

    • Pinpoint pupils

    • Slow/shallow breathing

    • Decreased level of consciousness/unresponsive.

  • Antidote for Opioid Overdose:

    • Naloxone.

  • Management of Transdermal Patches:

    • Remove in cases of overdose

    • Before MRI

    • If skin irritation or rash develops.

Acetaminophen

  • Contraindications:

    • Patients with liver disease

    • Chronic alcohol users.

  • Maximum Daily Dose:

    • 4 g/day (some instructors recommend 3 g/day).

  • Organ Injured in Overdose:

    • Liver.

NSAIDs

  • Major Risks Associated with NSAIDs:

    • Bleeding

    • GI ulcers

    • Kidney injury.

  • Population at Highest Risk:

    • Elderly

    • Patients on anticoagulants

    • History of ulcers or GI bleeding

    • Concurrent corticosteroid use.

  • Classic Sign of Aspirin Toxicity:

    • Tinnitus.

  • Drug Interactions Increasing Bleeding Risk:

    • Anticoagulants (warfarin, heparin)

    • Antiplatelets (e.g., clopidogrel)

    • Other NSAIDs.

  • Drug Raising Uric Acid and Worsening Gout:

    • Aspirin.

Antiemetics, Antineoplastics, Chemotherapy (Ch. 53–55, 58)

Antiemetics

  • Medication causing Extrapyramidal Symptoms (EPS):

    • Metoclopramide (Reglan): EPS symptoms include lip smacking, rigidity, tremors.

  • Medication affecting Heart Rhythm/QT Issues:

    • Ondansetron (Zofran).

  • Antiemetics Used During Chemotherapy:

    • Ondansetron

    • Metoclopramide

    • Dexamethasone (steroid)

    • Aprepitant.

Chemotherapy Essentials

  • Key Lab to Monitor During Chemotherapy:

    • Neutrophils (ANC) → indicates infection risk (WBC count is insufficient; ANC is key).

  • Neutropenic Precautions:

    • Avoid:

    • Fresh flowers

    • Raw fruits/vegetables

    • Crowds

    • Sick individuals

    • Yard work, litter box cleaning

    • Rectal temperatures/suppositories.

  • Immediate Reporting Signs of Complications:

    • Fever (>100.4F)

    • Bleeding/bruising

    • Shortness of breath

    • Mouth sores preventing eating

    • Uncontrolled vomiting

    • Signs of dehydration.

Additional High-Yield Questions (From All Chapters 42–60)

High-Risk Adverse Reactions

  • Antibiotic causing Serotonin Syndrome with SSRIs:

    • Linezolid (Zyvox): Concurrent use with SSRIs can result in hypertensive crisis/serotonin toxicity.

  • Classic Sign of Salicylate Toxicity:

    • Tinnitus (may also include hyperventilation and metabolic acidosis).

  • Drugs Causing Photosensitivity:

    • Tetracyclines

    • Fluoroquinolones

    • Sulfonamides.

Vitamin & Supplement Needs

  • TB Drug Requiring Specific Vitamin:

    • Isoniazid (INH): Administer Vitamin B6 (pyridoxine) to prevent peripheral neuropathy.

Hydration Emphasis

  • Medications Requiring Increased Fluid Intake:

    • Sulfonamides → crystalluria

    • Acyclovir → kidney stones

    • Fluoroquinolones → crystals

    • Methotrexate → toxicity prevention

    • Allopurinol → prevention of kidney stones.

Opioid Administration

  • Priority Assessment Before Administering IV Morphine:

    • Check the respiratory rate (hold the dose if RR < 12).

Patches & Proper Handling

  • Fentanyl Patch Management:

    • Do NOT:

    • Cut the patches

    • Heat the patches (e.g., hot baths, heating pads)

    • Flush the patches down the toilet.

    • Do:

    • Dispose in the designated sharps/destruction box or as per facility policy

    • Apply to clean, hairless skin

    • Fold and secure patches before discarding in an appropriate container.