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organism that con cause diseas
- Basic Shapes: bacilli-rod, cocci-spherical, spirilla
- Ability to use O2: aerobic-with, anaerobic-without
- Staining characteristics: gram positive, gram negative
ability of organism to cause infection
ability of a microbe to produce disease when present in minute numbers
ability of pathogen to replicate rapidly
AKA: antibacterial, antimicrobial, antibiotic
acquired in hospital
Anti-infective drug actions
- Affects: structure, metabolism, or life cycle
- Goal is to eliminate pathogen.
slow growth of bacteria
inhibition of: cell wall synthesis, DNA synthesis, RNA synthesis, Protein sysnthesis, and Folic acid synthesis.
Antibiotic Resistance occurs when:
- ...pathogen acquires gene for bacterial resistance by:
- producing enzyme that deactivates antiinfective drug.
- changing cellular permeability to prevent drug from entering cell.
- altering transport systems to exclude drug from active transport into cell.
- altering binding sites on membranes.
- variations in biochemical processes or biochemicals.
- mutation of genetic material.
- Not caused by but worsened by overprescription.
Prevent Emerging Resistance by:
- Infection control.
- Right drug for right bug.
- Rx only when medically necessary.
- Advise patient to take full course of treatment.
- Teach patient drug is for specific infection that they have now.
Tetracycline Discharge teaching:
- Take with food to avoid gastric upset
- Do not take with milk or iron supplements
- Alternate birth-control should be used while taking
- Permanent mottling and discoloration of teeth in children less than 8 years of age
- Do Not get pregnant
AE of Aminoglycosides
- Ototoxicity: Hearing loss may occur after therapy is completed.
- Nephrotoxicity: Neuromuscular function may also be impaired.
What needs to be done before prescribing an antibiotic?
A culture needs to be taken to make sure the right drug is picked for the right bug!
Most common side effect of antibiotics
Beta lactamase inhibitors in combonation with antibiotics
- Beta lactamase/penicillinase=enzyme secreted secreted by some bacteria that splits the beta-lactam ring. Makes most bacteria become resistant to antibiotics.
- when beta lactamase inhibitors combine with penicillin it protects the pen molecule from destruction.
Cell Cycle specific
targets a specific spot in the cell cycle
Cell cycle non specific
does not target a specific spot in the cells cycle, can target 2 or more spots
- red/orange body fluids
- AE: hepatoxicity
Pathophysiology of Viral Infection
- cannot replicate on its own, has to have host cell
- attaches to and enters host cell
- uses host cell's energy to synthesize protein DNA, and RNA.
- Difficult to kill b/c live inside cell.
- drug of choice for treatment of initial and recurrent episodes of HSV-1, HSV-2, and VZV.
- Oral, topical, and parenteral forms
Isoniazid SE management
- Anti-TB drug
- avoid foods containing tyramine, can increase toxicity.
- take on empty stomach, 2-3hrs before eating.
- admin deep IM, and rotate sites
- Depletes vitamin B5= neuropathy
- AE: peripheral neuropathy, hepatoxicity
Amantadine (Symmetrel)- active only against influenza A; used prophylactically and to reduce symptoms.
the point at which the drug has reached it's greatest therapeutic effect.
point at which the drug has reached it's lowest therapeutic effect
Vancomycin, nursing considerations/AE
- Nursing considerations: used only for severe infections after bacteria have b/c resistant to safer antibiotics; Most effective treating MRSA; hearing must be evaluated frequently during treatment due to ototoxicity; nephrotoxicity = uremia. If given rapidly through IV can cause red-man syndrome.
- AE: red-man syndrome, hypotention w/flushing and red rash, superinfections, generalized tingling after IV admin, chills fever, skin rash, hives, hearing loss, and nausea.
Nursing considerations prior to Quinine therapy for malaria
- treatment most successful if started immediately after symptoms are recognized.
- Cinchonism(tinnitus, ototoxicity, vertigo, fever, visual impairment), hypothermia, coma cardiovascular collapse, agranulocytosis.
Metronidazole (Flagyl) patient teaching
no cutting or crushing, swallow whole on an empty stomach; do not take if pregnant (pregnancy cat B); interacts with oral anticoagulants; drug can elevate lithium levels;
Amphotericin B(systemic antifungal) nursing considerations
- infuse slowly b/c cardiovascular collapse may result.
- admin premedication to help decrease risk of infusion reaction.
- withhold if BUN exceeds 40mg/dL or serum creatinine rises above 3mg/dL.
- pregnancy cat B
- cations with renal impairment
- continue to monitor VS, esp. BP and pulse.
- use with digoxin increases risk digoxin toxicity
- renal toxicity and neurotoxicity
SE of anti cancer drugs for fast growing cells
- antineoplastic drugs are much more toxic to tissues and tumors with high growth fractions. Much higher success rate with fast growing cancer cells.
- suppresses bone marrow production
- hair loss
- leukopenia or neutropenia (low WBC)
- Thrombocytopenia (low platelet count)
- extreme nausea and vomiting, diarrhea
- alopecia(hair follicles damaged)
- opportunistic infections
- ulceration, bleeding of lips and gums
Growth Fraction definition
a measure of the number of cells undergoing mitosis in a tissue. Ratio of the number of replicating cells to number of resting cells.
the lowest pt to which the erythrocyte, neutrophil, or platelet count is depressed by a antineoplastic drug.
Absolute Neutrophil Count
The number of neutrophils present in a
MOA of Alkylating agents
- forming bonds or linkages to DNA, a process called alkylation.
- Alkylation changes shape of DNA dbl helix and prevents nucleic acid from completing normal cell division.
- induce cell death, or at least slows replication of tumor cells.
AE of Doxorubicin (Adriamycin)
- lower CBC
- acute nausea/vomiting
- hair loss
- most serious are dysrhythmias and hepatoxicity
- tendon rupture
- peripheral neuropathy, hepatoxicity, seizure, photosensitivity, superinfections
Cyclophosphamide ( Cytoxan), alkylating agent, AE
- bone marrow suppression
- stevens-johnson syndrome
- pulmonary toxicity
Handling antineoplastic/anticancer drugs
always wear gloves b/c are highly toxic and can abosrbed through skin.
Types of antibiotic therapy(before, during, after hospitalization)
Petit Mal Seizure (Absence)
- seen most in children
- lasts few seconds
Grand Mal Seizure (Tonic-clonic)
- intense muscle contraction (tonic) followed by alternating contractions and relaxation of muscles (clonic).
- aura preceding
- disorientation/deep sleep following
Phenytoin (Dialntin) levels are checked because...
...of the very narrow range between a therapeutic dose and a toxic dose, and patients varying significantly in their ability to metabolize it.
Stimulation of Adrenergic Receptor response
- alpha1, alpha2, beta1, beta2
- selective drugs stimulate only one type, others affect all.
- Norepinephrine (NE) is the neurotransmitter
Pain medication administration assessment
Always assess level of pain before administering
Assess what before administrating Digoxin
Pulse has to be at least 60 or up. Check by Apical for a full minute.
Angina vs Heart Attack
- Angina- chest pain
- Heart Attack- actual death of myocardial tissue
Severe SE of Lipitor (statin), for hyperlipidemia
rhabdomyolysis- breakdown of muscle fibers
Patient teachings for Immunosuppressant meds
- infection prevention
- avoid crowds
best way to determine immunity by vaccine or by having disease
immunosuppressed patients may receive agents to prevent illness, performed antibodies transferred or donated from one person to another, typically administered after the person has been exposed or is at high risk to exposure to illness.
...foreign proteins or inactive cells introduced to the body, result in production of memory cells, stimulates immune system for disease prevention.
Do vaccines have risk?
- all have some risk, but diseases they prevent can cause serious illness
- do not cause autism
Why do transplant patients have to take meds to dampen their immune system?
to prevent rejection of the new organ
Non specific immunity include:
epithelial lining of skin, GI membrane, and phagocytes
What labs should patient taking NSAIDS have monitored?
creatinine clearance, liver function, and CBC
Signs of inflammation:
swelling, warmth, and pain
What do Histamines do?
dilate vessels resulting in congestion and stuffiness
Common SE of anti inflamitory meds?
What can help prevent GI upset that's common with ASA?
What exam should patients taking DMARD meds (Plaquenll) have annually?