Prototypes

Chapter 33: Inflammation & Fever

• NSAIDs: Ibuprofen
  
  

  • Adverse Effects:

    • GI upset (dyspepsia, nausea, vomiting, ulcers), bleeding risk, kidney problems, increased risk of cardiovascular events (especially with long-term use).

  • Contraindications:

    • Hypersensitivity to ibuprofen or other NSAIDs.

    • History of GI bleeding or ulcers.

    • Severe kidney or liver disease.

    • Aspirin triad (asthma, nasal polyps, and sensitivity to aspirin).

    • Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.

  • Nursing Implications:

    • Assess for pain level and inflammation before and after administration.

    • Monitor for GI upset, bleeding signs (black tarry stools), and renal function.

    • Advise patients to take with food to minimize GI upset.

    • Educate about potential interactions with other medications (e.g., anticoagulants, aspirin).

• Corticosteroids: Prednisone
  
  

  • Adverse Effects:

    • Increased risk of infection, hyperglycemia, fluid retention, weight gain, mood changes, osteoporosis (long-term use), adrenal suppression (with prolonged use), Cushing's syndrome (with long-term, high-dose use).

  • Contraindications:

    • Systemic fungal infections.

    • Live virus vaccinations (while on immunosuppressive doses).

  • Nursing Implications:

    • Monitor blood glucose, blood pressure, and weight.

    • Assess for signs of infection.

    • Taper dose gradually to avoid adrenal insufficiency.

    • Provide patient education about side effects and the importance of not abruptly stopping the medication.

• Antipyretic/Analgesic/Centrally Acting COX Inhibitor: Acetaminophen (Tylenol)
  
  

  • Adverse Effects:

    • Generally well-tolerated.

    • Rare but serious: Liver damage (especially with overdose or in patients with liver disease).

  • Contraindications:

    • Severe liver disease.

    • Hypersensitivity to acetaminophen.

  • Nursing Implications:

    • Assess pain and fever.

    • Monitor liver function tests (especially in patients with liver disease or taking high doses).

    • Educate patients about the maximum daily dose (4 grams for adults) to avoid liver toxicity.

    • Advise patients to avoid alcohol while taking acetaminophen

Chapter 33: Inflammation & Fever

• NSAIDs: Ibuprofen  

  • Purpose: To reduce pain, inflammation, and fever. Commonly used for conditions like headaches, muscle aches, arthritis, menstrual cramps, and fever.  

• Corticosteroids: Prednisone  

  • Purpose: To suppress inflammation and the immune response. Used for a wide range of conditions, including allergic reactions, asthma, autoimmune diseases (like rheumatoid arthritis), and inflammatory bowel disease.  

• Antipyretic/Analgesic/Centrally Acting COX Inhibitor: Acetaminophen (Tylenol)  

Purpose: To reduce pain and fever.
It is often used for headaches, muscle aches, and fever. Unlike NSAIDs, it has minimal anti-inflammatory effects. 

Chapter 35: Antibacterials

• Penicillin: Penicillin G
  
  

  • Adverse Effects:

    • Allergic reactions (ranging from mild rash to anaphylaxis), diarrhea, nausea, vomiting.

  • Contraindications:

    • Known penicillin allergy.

  • Nursing Implications:

    • Assess for allergies before administration.

    • Monitor for signs of allergic reaction (rash, itching, hives, difficulty breathing).

    • Have emergency equipment readily available in case of anaphylaxis.

    • Culture the infection site before starting therapy if possible.

• Cephalosporins: Cefazolin
  
  

  • Adverse Effects:

    • Similar to penicillins (allergic reactions, GI upset).

    • Pain at injection site.

  • Contraindications:

    • Hypersensitivity to cephalosporins.

    • Cross-sensitivity may occur in patients with penicillin allergies.

  • Nursing Implications:

    • Assess for allergies (including penicillin allergy).

    • Monitor for signs of allergic reaction and superinfection (e.g., thrush, C. difficile infection).

• Tetracyclines: Tetracycline
  
  

  • Adverse Effects:

    • GI upset, photosensitivity (sun sensitivity), tooth discoloration (in children), effects on bone growth (in children).

  • Contraindications:

    • Pregnancy and breastfeeding.

    • Children under 8 years old.

  • Nursing Implications:

    • Advise patients to take on an empty stomach (1 hour before or 2 hours after meals).

    • Avoid dairy products, antacids, and iron supplements, as they can interfere with absorption.

    • Educate patients about photosensitivity and the need to use sun protection.

• Macrolide: Azithromycin
  
  

  • Adverse Effects:

    • GI upset (nausea, vomiting, diarrhea), QT prolongation (can lead to a rare but serious heart rhythm problem).

  • Contraindications:

    • History of QT prolongation or taking other medications that prolong the QT interval.

    • Liver disease (with some macrolides).

  • Nursing Implications:

    • Monitor for GI upset and cardiac rhythm changes.

    • Advise patients to report any palpitations or irregular heartbeat.

• Aminoglycosides: Gentamicin
  
  

  • Adverse Effects:

    • Nephrotoxicity (kidney damage), ototoxicity (hearing loss and balance problems).

  • Contraindications:

    • Known hypersensitivity to aminoglycosides.

    • Pre-existing kidney disease (use with caution).

  • Nursing Implications:

    • Monitor kidney function (BUN, creatinine) and hearing.

    • Peak and trough levels may be monitored to ensure therapeutic levels and minimize toxicity.

    • Encourage adequate hydration.

• Fluoroquinolones: Ciprofloxacin
  
  

  • Adverse Effects:

    • GI upset, tendonitis and tendon rupture (rare but serious), QT prolongation, peripheral neuropathy.

  • Contraindications:

    • Hypersensitivity to fluoroquinolones.

    • Myasthenia gravis.

  • Nursing Implications:

    • Advise patients to report any tendon pain or swelling.

    • Monitor for signs of peripheral neuropathy (numbness, tingling).

    • Avoid administering with dairy products, antacids, or iron supplements.

• Sulfonamides: Trimethoprim-Sulfamethoxazole (TMP-SMX)
  
  

  • Adverse Effects:

    • Hypersensitivity reactions (including Stevens-Johnson syndrome, a severe skin reaction), GI upset, photosensitivity, bone marrow suppression.

  • Contraindications:

    • Hypersensitivity to sulfonamides.

    • Pregnancy (at term) and breastfeeding.

    • Infants younger than 2 months of age.

  • Nursing Implications:

    • Assess for allergies.

    • Monitor for skin rashes and other signs of hypersensitivity.

    • Encourage adequate fluid intake to prevent kidney problems.

Chapter 35: Antibacterials

• Penicillin: Penicillin G  

  • Purpose: To treat bacterial infections caused by susceptible organisms. Effective against a wide range of bacteria, including those that cause pneumonia, strep throat, and skin infections.  

• Cephalosporins: Cefazolin  

  • Purpose: Similar to penicillin, it treats a broad spectrum of bacterial infections. Often used for surgical prophylaxis (to prevent infections after surgery), respiratory tract infections, and skin infections.  

• Tetracyclines: Tetracycline  

  • Purpose: To treat a variety of bacterial infections, including acne, respiratory infections, and urinary tract infections. Also used for some sexually transmitted infections (STIs) and Lyme disease.  

• Macrolide: Azithromycin  

  • Purpose: To treat bacterial infections such as respiratory infections (pneumonia, bronchitis), skin infections, and some STIs. Often used for patients with penicillin allergies.  

• Aminoglycosides: Gentamicin  

  • Purpose: To treat serious bacterial infections, often those caused by gram-negative bacteria. Commonly used for sepsis, endocarditis, and complicated urinary tract infections.

• Fluoroquinolones: Ciprofloxacin  

  • Purpose: To treat a wide range of bacterial infections, including urinary tract infections, respiratory infections, skin infections, and some STIs.  

• Sulfonamides: Trimethoprim-Sulfamethoxazole (TMP-SMX)  

Purpose: To treat bacterial infections, including urinary tract infections, respiratory infections, and ear infections.
Also used for certain types of pneumonia and to prevent infections in people with weakened immune systems.  

Chapter 40: Asthma & COPD

• Beta2-Adrenergic Agonist: Albuterol
  
  

  • Adverse Effects:

    • Tachycardia, tremors, nervousness, palpitations.

  • Contraindications:

    • Hypersensitivity to albuterol.

    • Tachycardia or heart rhythm disturbances (use with caution).

  • Nursing Implications:

    • Monitor heart rate and rhythm.

    • Assess lung sounds before and after administration.

    • Provide patient education on proper inhaler technique.

• Anticholinergic: Ipratropium
  
  

  • Adverse Effects:

    • Dry mouth, blurred vision, urinary retention (especially in older men with prostate problems).

  • Contraindications:

    • Hypersensitivity to ipratropium or atropine.

    • Glaucoma (use with caution).

  • Nursing Implications:

    • Provide patient education on proper inhaler technique.

    • Advise patients about ways to manage dry mouth (e.g., sugar-free candy, frequent sips of water).

• Inhaled Corticosteroids: Beclomethasone
  
  

  • Adverse Effects:

    • Oral thrush (candidiasis), hoarseness, cough.

  • Contraindications:

    • Hypersensitivity to beclomethasone.

    • Systemic fungal infections.

  • Nursing Implications:

    • Instruct patients to rinse their mouth after each use to prevent oral thrush.

    • Monitor for signs of oral candidiasis.

    • Provide education on proper inhaler technique.

• Leukotriene Modifier: Montelukast (Singulair)
  
  

  • Adverse Effects:

    • Headache, mood changes (including suicidal ideation - rare but serious).

  • Contraindications:

    • Hypersensitivity to montelukast.

  • Nursing Implications:

    • Monitor for any mood changes or neuropsychiatric events.

    • Advise patients to report any unusual changes in behavior or mood to their healthcare provider.

Chapter 40: Asthma & COPD

• Beta2-Adrenergic Agonist: Albuterol  

  • Purpose: To relieve bronchospasm (the tightening of airways) in asthma and COPD. It is a quick-relief medication used to treat acute symptoms like wheezing and shortness of breath.

• Anticholinergic: Ipratropium  

  • Purpose: To relax the muscles around the airways, making it easier to breathe. Primarily used for maintenance treatment of COPD and occasionally for asthma.

• Inhaled Corticosteroids: Beclomethasone  

  • Purpose: To reduce airway inflammation in asthma and COPD. Used for long-term control and prevention of symptoms, not for acute attacks.  

• Leukotriene Modifier: Montelukast (Singulair)  

Purpose: To prevent asthma symptoms and to treat allergic rhinitis (hay fever). It blocks leukotrienes, which are chemicals that contribute to inflammation in the airways.