Unit 7 Medication

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harstanner
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108328
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Unit 7 Medication
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2011-10-15 21:46:31
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Unit Medication
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Unit 7 Medication
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  1. – no current accepted medical use
    (Heroin, marijuana, LSD, amphetamines)
    Schedule I
  2. – current accepted medical use, high abuse, no TO, cannot be refilled (Cocaine, codeine, demerol, dilaudid, morphine, amphetamines, barbiturates)
    Schedule II
  3. - current accepted medical use, moderate
    dependence, can be refilled x5, none after 6 months
    (Opium, vicodin, tylenol with codeine, amphetamines, barbiturates)
    Schedule III
  4. - current accepted medical use, low dependence, can be refilled x5, none after 6 months (example Darvocet, librium, valium, barbiturates)
    Schedule IV
  5. - current accepted medical use, limited dependence, can be refilled, may not require prescription (Donnagel, lomotil, robitussin)
    Schedule V
  6. occur most often at points of transition in care: admission to hospital, transfer from one department to another, discharge to home or another facility
    Medication errors
  7. because of their potentially toxic nature, they require special care when prescribing, dispensing, and/or administering
    High alert medications
  8. Bacteria that stains purple
    Gram Positive bacteria
  9. Thick cell wall and outer capsule
    –Streptococcus
    –Staphylococcus
    –Enterococcus
    –Listeria
    Gram Positive bacteria
  10. Bacteria that stains red
    Gram negative bacteria
  11. More complex cell wall and 2 membranes
    Gram negative bacteria
  12. More difficult to treat
    –Salmonella
    –E.coli
    –Pseudomonas
    –Neisseria meningitidis
    Gram negative bacteria
  13. the administration of antibiotics based on the practitioners judgment of the pathogens most likely to be causing an apparent infection
    Empiric therapy
  14. –Broad spectrum antibiotics started
    •Aminoglycosides
    •Quinolones
    •2nd and 3rd generation cephalosporins
    Empiric therapy
  15. the administration of antibiotics based on known results of culture and sensitivity testing identifying the pathogen causing infection
    Definitive therapy
  16. –Narrow spectrum antibiotic
    •Penicillins
    •Vancomycin
    •Macrolides
    Definitive therapy
  17. antibiotics taken before anticipated exposure to an infectious organism in an effort to prevent the development of infection
    Prophylactic antibiotic therapy
  18. –After joint replacement or heart valve surgery when going to the dentist
    –30 minutes before surgery starts
    Prophylactic antibiotic therapy
  19. An infection occurring during antimicrobial treatment for another infection
    Superinfection
  20. a secondary microbial infection that occurs in addition to an earlier primary infection
    Superinfection
  21. •Examples:
    –Vaginal yeast infection d/t atbx. use
    –Development of c.diff after atbx.
    –Development of viral pneumonia during treatment of bacterial pneumonia
    Superinfection
  22. Patients often expect/demand an atbx. Rx even when they don’t show signs of bacterial infection
    Overprescribing of antibiotics
  23. reason why many treatable bacterial infections are resistant to atbx therapy
    Overprescribing of antibiotics
  24. 2nd reason: patients don’t finish prescribed atbx
    Overprescribing of antibiotics
  25. •Only medication used:
    –Sulfamethoxazole with trimethoprim (SMX-TMP)
    (Bactrim, Septra, co-trimoxazole
    Sulfonamides
  26. •Broad spectrum
    •Contraindications: sulfa allergy, pregnancy
    Sulfonamides
  27. •Used in treatment of UTI, URI, & staph. aureus
    Sulfonamides
  28. •Adverse effects:
    –N/V/D, photosensitivity, HA, cough
    Sulfonamides
  29. •Interactions:
    –Sulfonylureas
    –Phenytoin
    –Warfarin
    –Oral contraceptives
    Sulfonamides
  30. •Derived from mold
    Penicillins
  31. •4 subgroups based on structure and type of bacteria they kill
    Penicillins
  32. •Indications
    –Pneumonia
    –Pharyngitis (strep)
    –Syphillis (entercoccal)
    –Gonorrhea (entercoccal)
    •Contraindications
    –Drug allergy******
    Penicillins
  33. PCN
    Penicillin
  34. •Adverse Reaction
    –Urticaria, pruritis, N/V/D, anxiety, depression, lethargy

    •Interaction
    –Oral contraceptives, NSAIDS, warfarin
    PCN
  35. •Nursing Interventions
    –Observe for s/sx allergic reaction

    •Patient Teaching
    –Complete
    the prescription
    Penicillin
  36. s/sx
    signs and symptoms
  37. •Amoxicillin (Amoxil)
    •Ampicillin
    •Nafcillin
    •Penicillin V potassium (Pen-Vee K)
    •Piperacillin/tazobactam (Zosyn)
    Ticarcillin/clavulanate (Timentin
    Type of penicillin
  38. Broad spectrum antibiotic, chemically similar to penicillin
    Cephalosporins
  39. Allergic reaction to PCN may have a cross sensitivity to ___________
    cephalosporins
  40. Adverse effects: diarrhea, cramps, rash, pruritis,
    redness, edema

    Interactions: alcohol, antacids, iron, oral
    contraceptives
    Cephalosporins
  41. •First Generation
    –cefazolin (Ancef)
    –cephalexin (Keflex)
    Cephalosporin
  42. •Second Generation
    –cefoxitin (Mefoxin)
    –cefuroxime (Ceftin)
    Cephalosporin
  43. Third Generation (penetrate blood-brain barrier)
    –ceftriaxone (Rocephin)
    –ceftazidime (Fortaz)
    Cephalosporin
  44. •Fourth Generation
    –cefepime (Maxipime)
    –cefdinir (Omnicef)
    Cephalosporin
  45. •Indications
    –Upper and lower respiratory tract infections, syphilis, Lyme disease, gonorrhea, Listeria
    Macrolides and Ketolides
  46. Absorption enhanced when taken on an empty stomach
    -Gastric irritation (take with food or snack)

    •Contraindications
    –Drug allergy
    Macrolides and Ketolides
  47. •Adverse Effects
    –Palpitations, chest pain, HA, vertigo, N/V/D, rash, tinnitus

    •Interactions
    –Enhances effect and possible toxicity
    (Carbamazepine, cyclosporine, digoxin, theophyliine and warfarin)
    Macrolides and Ketolides
  48. •Azithromycin (Zithromax)
    •Clarithromycin (Biaxin)
    •Dirithromycin- rarely used
    •Erythromycin (E-mycin)
    4 main macrolide antibiotics
  49. •Telithromycin (Ketek)
    •Derived from erythromcyin A
    -Use is limited d/t associated with liver damage
    Ketolides
  50. Indications: Anthrax, Gonorrhea, syphilis, Lyme disease, chlamydia, acne
    Tetracyclines
  51. •Contraindications
    –Drug allergy
    –Children under 8, pregnant, nursing
    Tetracyclines
  52. •Adverse Effects
    –Discoloration of permanent teeth
    –Retard fetal skeletal growth
    –Photosensitivity
    –Diarrhea
    –Rash
    Tetracycline
  53. •Interactions
    –Anticoagulants, oral contraceptives
    –Reduced absorption if taken with

    •Antacids, antidiarrheal drugs, dairy products or iron preparations anticoagulants
    Tetracycline
  54. •Demeclocycline (Declomycin)
    •Doxycycline (Doryx)
    •Tigecycline (Tygacil)
    Tetracycline
  55. •Used for virulent infections
    –MRSA
    –VRE
    Aminoglycosides
  56. •Not given orally-poor absorption
    –Exception: neomycin
    Aminoglycosides
  57. •Common drugs
    –Amikacin, gentamicin, neomycin and tobramycin
    Aminoglycosides
  58. •Monitored with blood levels (Peak and Trough)
    –Nephrotoxicity
    –Ototoxicity
    Aminoglycosides
  59. •Contraindications
    –Known drug allergy
    –Infants, pregnancy, & lactation unless life-threatening
    Aminoglycosides
  60. •Adverse Effects
    –Duration of therapy short as possible
    –HA, vertigo, rash, fever, neuromuscular paralysis
    Aminoglycosides
  61. •Interactions
    –Nephrotoxicity increases with use of

    •Vancomycin, cyclosporine and amphotericin B
    –Ototoxicity increases with use of
    •Loop diuretics
    –Reduce the level of vitamin K – intestinal flora is destroyed from med
    •Warfarin
    Aminoglycosides
  62. Potent, broad-spectrum antibiotic
    Fluoroquinolones
  63. •Indications
    –Complicated UTI
    –Commonly used for Respiratory, skin, GI, bone, joint infections and STD’s
    Fluoroquinolones
  64. •Contraindications
    –Drug allergy
    Fluoroquinolones
  65. –Ciprofloxacin (Cipro)

    –Levofloxacin (Levaquin)
    Fluoroquinolones
  66. –Therapeutic blood levels

    –Red man syndrome
    Vancomycin (Vancocin)
  67. –Tyramine containing foods (aged cheese or wine, soy suace, smoked meats) can interact and raise BP
    Linezolid (Zyvox)
  68. –Avoid alcohol for 24 hours before and 36 hours after Flagyl
    Metronidazole (Flagyl)
  69. Nitrofurantoin
    Macrodantin
  70. –Not compatible with saline or heparin (D5W only)

    –Adverse effects at infusion site
    Quinupristin & dalfopristin (Synercid)
  71. Clindamycin
    Cleocin

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