Pharmacology III

Card Set Information

Pharmacology III
2012-03-30 00:26:00

exam 3 antibiotics, antiviral, antituburcular, vitamins, minerals
Show Answers:

  1. What do antivirals do?
    —KILL VIRUSES by inhibiting their ability to replicate, so the body’s immune system can destroy the virus
  2. What are some viruses antivirals work against?
    • —CMV—
    • HSV
    • —HIV
    • —Influenza A (flu)
    • —RSV- resp. syncytial virus
  3. what viruses does Acyclovir work against
    • HSV 1 and 2—
    • Chickenpox
    • Shingles
  4. what does CRIXIVAN do?
    • Treatment for advanced HIV— *
    • Taken in combo with other antivirals
    • Increases CD4 count
  5. What does RIBAVIRIN do
    • Used to treat severe LRI caused by RSV—
    • MAY cause fetal toxicity!
    • Inhilation nasally or orally
  6. what does RIBAVIRIN do?
    Inhilation nasally or orally
  7. What do AZT, RETROVIR, ZERIT do?
    • —For HIV treatment
    • —May cause bone marrow suppression, if so, HIV clients would need a different medication
    • COMBIVIR is a combo drug
  8. What to assess when on these meds?
    • —ALL labs
    • —Bone marrow suppression
    • —VS—
    • Allergic reactions
    • —Is the drug working- decreased HSV, increased CD 4 counts, etc—
    • —Some can cause dizziness- SAFETY education—
  9. what do pt's taking immuno-supression drugs need to do?
    avoid crowds
  10. What do you have to wear when treating / assessing pts on antiviral drugs?
    GLOVES!!! Especially with topical’s and infected clients
    the bacteria that causes TB!

    —The bacteria becomes dormant or walled off by fibrous or calcified tissue—

    TB is a slow growing organism

    —There has been a resurgence of the disease
  12. Is TB aerobic or anaerobic
    It is an aerobic bacillus that requires a lot of O2 to grow —
  13. What areas are affected by TB
    • —Highly oxygenated areas:
    • —Lungs —
    • Growing ends of the bones
    • —Brain
    • —Kidney
    • —Liver
    • —Genitourinary tract
  14. what is TB transmitted from
    • Human,
    • cows,
    • birds
  15. How is TB transmitted?
    • —Conveyed in DROPLETS
    • —Expelled by infected people or animals by sneezing, coughing
    • —Inhaled by the host
  16. Does TB affect all people that inhale it?
  17. —who does TB affect?
    —Those immuno-supressed by CA, chemo, HIV/AIDS are common hosts that are affected and this can be deadly
  18. what are the antitubercular drugs



  19. what is a Primary antitubercular drugs
  20. properties of INH- (ISONIAZIDE)
    • —Can be used for the prophylaxis of or the sole agent for the treatment of active TB
    • —
    • Metabolized via the liver —
  21. Can cause blood sugars to increase
  22. properties of ETHAMBUTOL-
    Used for the treatment of active TB— *

    Used in combo drugs with rifampin, streptomycin, INH —

    Not used in children under 13

    —Can cause optic neuritis- loss of vision
  23. properties of RIFAMPIN
    • Antibiotic—*
    • Works against mycobacterium, Meningococcus and leprosy—

    Can turn urine, feces, saliva, skin, sputum, sweat, tears- orangish-brown! * EDUCATE… —

    Oral contraceptives are ineffective when on Rifampin
  24. properties of STREPTOMYCIN
    aminoglycocide antibiotic

    —Used only in combination because it can cause toxicity

    —Review this medication in your information about antibiotics!!
  25. Nursing Assessment TB
    • a medical history
    • —
    • LFT’s (liver function test) due to hepatic toxicity risks- especially in ETOH’ers and the elderly

    • —Neuro assessment- can cause peripheral neuropathies on INH – check for numbness and tingling- lets discuss a neurovascular assmt. —
    • —Take all meds as ordered and all meds thoroughly
  26. How do you prevent the spread of TB?
    Careful hand washing, covering the mouth with cough/sneeze, may require isolation from the pub
  27. What labs do yo asses for antitubercular drugs
    CBC, HGB, HCT- INH can cause hematolgic disorders

    —BUN, Cr, UA, possibly a 24 hour collection?

    Sputum Cultures throughout treatment course—
  28. What education should you give pts taking antitubercular drugs?
    —Medication administration- no skipping and no doubling up

    —Side effects of medications—

    Labs for follow ups

    —Disease transmission—Isolation precautions—

    Hand washing—

    —MEDIC ALERT TAGS for meds
  29. Do you need to report TB to CDC ?
  30. FUNGI
    yeast/mold. Some are in the normal flora of the skin, mouth, intestines, vagina
  31. YEAST
    single-celled fungi that bud and can be useful organisms
  32. MOLD
  33. What is infection caused by fungus called?
  34. HOW is the host infected by fungus?
    • —Inhaled- fungal “spores” are airborne
    • —Implanted -under skin
    • —Ingested- orally
  35. Who is in the population infected by fungus?
    ——Long term antibiotic clients

    • Those who are imunosupressed- they are more susceptible to developing fungal infections.
    • —-Transplant patients that are on immunosuppressive therapy
    • —-HIV/AIDS
    • —-CA r/t to chemo therapy
    • —
  36. What is —Vag candidiasis?
    yeast infection: pregnant women, women with DM, women on antibiotics, women on oral contraceptives—
  37. What can taking Corticosteroids cause?
    can result in colonization of candida albicans- THRUSH-
  38. in what population is Thrush common in ?
    common in newborns and and the immunocompromised
  39. Antifungal Drugs
    —Have the ability to kill or inhibit the growth of fungi
  40. What do you use to treat Systemic fungal infections with?
  41. What do you use to treat CRYPTOCOCCAL MENINGITIS with?
    —Fluconozole or “Diflucan”- it penetrates the CSF
  42. what can you use to treat oropharyngeal and esophageal candida
    amphotericin B and Diflucan

    —However… there are a lot of side effects!
  43. What can you use topical NYSTATIN AND MYCOSTATIN for?
    diaper rash and vaginal candidiasis
  44. What forms can NYSTATIN AND MYCOSTATIN come in?
    —Oral and topical- ointment, powder, spray, vaginally
  45. side effects of Ampho-B
    can easily cause hepatotoxicity, neurotoxicity, renal toxicity,

    Resp difficulties, cardiac dysrythmias, fever, chills, malaise and hypotension
  46. side effects of Diflucan
    • cause N/V/D
    • increased AST
    • ALT
  47. Nursing Assessment for antifungal

    • —
    • Assess all lab values- AST/ALT, kdney function, WBC’s and RBC’s

    —May have cardiovascular effects- cardiac enzymes, P, Bp, EKG

    —Weight gain in Ampho-B clients should not exceed >2 lbs per week- if so… call Dr.—
  48. what population group need to be cautious when taking antifungal?
    Great caution in the pregnant or lactating woman

    — Caution in lupus clients—
  49. What are some things you have to education the pt about when taking antifungal?
    If using the medication for a vaginal infection- abstain from sexual intercourse

    —Partner may need to be treated as well—

    —Medication administration- no skipping and no doubling up—

    Continue medication even if menstruating

    Side effects of medications

    —Labs for follow ups—

    Disease transmission

    —Isolation precautions—Hand washing
    able to kill organisms and are used on non-living objects to destroy any organisms
    ONLY inhibit growth of microorganisms, but do NOT necessarily kill them and applied only to living tissue
  52. where can antiseptics be used?
    —Mucous membranes and skin
  53. What do antiseptics come in?
    —In soaps, such as pre-surgical scrubs when the skin will be incised
  54. What forms do antiseptics come in?
    —Topicals, ointments, mouthwashes, douches
  55. What are some effects of antiseptics
    —Some can cause skin irritation if in contact with skin such as dryness, burns
  56. What do Antiseptic Agents do?
    —Kills microorganisms- bacteria, fungi and viruses
  57. What are some Antiseptic Agents?
    • —Isopropyl alcohol (rubbing alcohol)- antiseptic —
    • —
    • Aldehyde (Cidex) - mostly disinfectant-

    Hibiclens- surgical scrub antiseptic

    —Chlorine compounds (Dakin’s sol)-

    —Iodine- —

    Hydrogen peroxide-
  58. What does Aldehyde (Cidex) do?
    causes burns to skin easily, sterilizes equip
  59. What does Chlorine compounds (Dakin’s sol)- do?
    only partially active against fungi- athletes foot
  60. What does Iodine do?
    kills all forms of microorganisms and SPORES
  61. What does Hydrogen peroxide do?
    can be used to irrigate wounds,

    used first for some surgeries,

    but can also cause skin irritation
  62. how do you apply —Creams and ointments antifungals?
    use a sterile q-tip or sterile gauze
  63. Pt education for antifunals
    —Patient education, have the client verbalize and return demonstrate, give written instructions

    —Teach and USE good hand washing—

    FOLLOW Dr. orders carefully!

    Document all teaching done!
  64. Peak
    drawing the serum blood levels after the drug is administered as it distributes rapidly and reaches its peak in therapeutic range

    highest safe level of medication
  65. When are labs for peaks drawn?
    about one hour after the infusion finished.
  66. Trough
    •This is the lowest drug level that is needed to reach therapeutic range.
  67. What should you do if trough is less than normal?
    • the patient is at risk for adverse effects.
    • Therefore, the doctor should expand the time interval before ordering the next dose or decrease drug dose.
  68. When is a trough drawn?
    usually one hour prior to start infusion
  69. What microorgainsms?
    Microorganisms are both internal and external

    They can be harmful to humans or they can live without interference and even be he
  70. How are we able to fight infection?
    •We are able to fight of infections caused by microorganisms that invade the body because of the existence of host defenses
  71. How can people get an infection?
    If the microorganisms invade the body that is not at it’s optimum health level- infection occurs

    prior rheumatic fever!

    Streptococcus is present in the body and don’t cause any harm, BUT… under certain circumstances they can cause “endocarditis” in the client with damaged heart valves due to
  72. when should you assess for antibiotics
    before, during and after therapy
  73. What is Emperic therapy?
    The antibiotic selection is based on the type of microorganism and which med will work the best-
  74. What should be done before Empiric therapy?
    the organism should be cultured and identified
  75. what can be done if microorganism is ID'd in emperic therapy?
    • the lab can then run a “susceptibility”
    • - which shows which antibiotic works the best
  76. When can Antibiotics be given PROPHYLACTICLLY?
    times where the likelihood of microorganism invasion is high as in before a procedure (surgery)

  77. What is THERAPEUTIC RESPONSE in antibiotic use?
    when there is a decrease in s/s of infection
  78. What is SUB-THERAPEUTIC RESPONSE in antibiotic use?
  79. what is TOXIC levels in antibiotic use
    when the serum antibiotic levels are too high
    when antibiotics completely destroy the normal bacterial flora- this permits other bacteria and fungi to take over and cause an infection

    example: vaginal yeast infection
  81. Interactions with antibiotics
    • ‘FOOD-DRUG
    • interactions- as in milk or cheese and tetracycline (causes decreased levels of tetra), or antacids and quinolone antibiotics (decreases the absorption of the antibiotic).
  82. HOST FACTORS with antibiotics
    factors that pertain to the infected client that can interfere with antibiotic therapy such as, age, allergies, liver and kidney function, pregnancy, site of infection
  83. Some antibiotics
    • •Sulfonamides
    • Penicillins






    Miscellaneous antibiotics- in a class of their own!
  84. Sulfonomides (Sulfas)
    One of the first groups of antibiotics

    Sulfonamides DO NOT destroy bacteria, but inhibit their growth
  85. Where do sulfas achieve very high concentration?
    in the kidneys, through which they are eliminated
  86. What are sulfas primarily used for?
    • Used primarily for UTI’s caused by
    • : Enterobacter, E.Coli, Klebsiella, Proteus Mirabilis and
    • Vulgaris and Staph aureus
  87. What are sulfas used for?


    Chron’s disease

    rheumatoid arthritis
  88. What are sulfa's a DRUG OF CHOICE for?
    Pneumocystis carinii (common in HIV and AIDS clients)

    Xanthomonas maltophilia
  89. How is the greatest effectiveness achieved with sulfas
    if you combine a sulfonamide and a non-sulfonimide
  90. How should you give Sulfas
    with plenty of fluids to prevent crystalluria
  91. What are some Side effects and interactions of sulfas
    •Usually a delayed reaction

    • Rash,
    • Stevens-Johnson Syndrome
    • Renal and hepatic,
    • GI and hematologic complications- may be fatal (there are so much more, but this is an overview
  92. Interactions of Sulfas
    : Oral anticoag’s

    Urinary acidifi
  93. What is Bactrim used for?
    •Used for UTI’s

    Pneumo. carinii pneumonia

    Otitis media



    Used prophylactically for HIV clients
  94. What are Septra & Septra DS
    •Sulfamethoxazole and trimethoprim combination
  95. What are Septra & Septra DS used for?
    Ear infections



  96. What is Pediazole used for
    used on the urinary tract

    • Used for otitis media in children
    • and available in oral suspension

    Used primarily for children
  97. How well is Pediazole tolerated?
    Tolerated fairly well unless and allergy
  98. What are Penicillins derived form
    Derived form fungus or mold found on bread and fruit

    AKA “beta-lactams”
  99. What do penicillins work against?
    Kill a wide variety of gram positive and some gram negative bacteria•
  100. how does penicillin work?
    PCN works by inhibiting bacterial wall sythesis

    PCN’s only inhibit the wall synthesis of bacteria cells, not the other cells in the body
  101. What are somem microorganisms killed by PCN?


    -Staphylococcus species
  102. What are some side effects of PCN
    •Most common side effect- rash, itching, dermatitis and Stevens Johnson Syndrome

    •10% are life-threatening and 10% or fatal

    •May cause GI upset- N/V/D, Bone marrow suppression, Increased ALT and AST, convulsions
  103. What do you need to asses for with PCN

    Check for hypersensitivity
  104. what are some drugs PCN interacts with
    NSAIDS- provides more free/active PCN

    Oral contraceptives- decreases contraceptive efficiency

    Rifampin- may inhibit the killing activity of PCN

    Coumadin- may decrease the effect of coumadin
  105. what groups sould Natural PCN, PCN G, PCN V not be used on
    •Not used in newborns
  106. When should PCN be taken
    Give 1 hour before food and 2 hours after food
  107. What should Oral PCN not be taken with?
    sodas or caffiens, fruit or tomato juice- decreases effectiveness
  108. What are Penicillinase resistant penicillins ?
    antibiotics, which are not inactivated by the penicillinase enzyme.
  109. These can resist the breakdown of the PCN destroying enzyme commonly produced by staphylococci
  110. what is penicillinase?
    enzyme some bacteria produce that destroys the beta-lactam ring of the antibiotic,

    Making the penicillin ineffective
  111. what drugs are penicillinase RESISTANT PCN-

    - Nafcillin,

    • -oxacillin,
    • -dicloxacillin
  112. what is MRSA?
    a staphylococcus aureus RESISTANT to PCN
  113. Amino PCN
    •Amoxicillin- Best for ears, nose, throat, GU tract, bladder, skin

    Also used to fight gonnorhea

    Ampicillin- available po and IV

    These all work best on gram negative bacteria
  114. What is a gram – bacteria?
    When gram staining- Gram Negative bacteria does not retain crystal violet dye

    • - E. Coli, Salmonella, Pseudomonas, Ghonnorhea,
    • Neisseria Meningitis
  115. What is a gram+ bacteria?
    • Gram Positives- do retain the dye and appear blue or purple under the microscope
    • - Staphylococcus, Streptococcus, Enterococcus
  116. What is drugs are Extended Spectrum PCN


  117. how is Extended Spectrum PCN given?
    All IV except Carbenicillin (po)
  118. What are Cephalosporins?
    •Related to PCN ( beta lactams)

    Can destroy a broad spectrum of bacteria
  119. What are Cephalosporins effective against?
    many gram positives, some gram negatives and some anaerobes
  120. What are cephalosporins not effective agains?
    NOT active against fungi or viruses
  121. what are the 4 generations of cephalosporins?
    Generation 1 = best for gram positive coverage, with little coverage for gm. neg

    Generation 2 & 3 = better for gram negative coverage, but have some gram positive fighting properties

    4th generation = greater activity on gram positives than 3rd generation, but also cover gram negatives as well

    •“CEFEPIME” (4th generation)
  122. Side effects of cephalosporins?
    May cause diarrhea, abdominal cramps, redness, edema, and pruritis

    If one is allergic to PCN, may be allergic to cephalasporins (“cross-sensitivity”)•

    • ONLY if a client has an anaphylactic reaction to PCN, then they should not be given cephalasporins
    • -Consult physician
  123. What are some 1st generation Cephalosporins?
    Ancef, Kefzol, Keflex
  124. 1st generation Cephalosporins?
    Good for gm + coverage

    Little coverage for gm
  125. What does giving 3rd generation cephalosprin cause
  126. Who can 1st generation Cephalosporins be given to?
    to children as well as adults
  127. how can 1st generation Cephalosporins be administered


  128. what are some Second Generation cephalosprin drugs

    Zinacef (does not kill anaerobes)


  129. Second Generation cephalosprin drugs properties
    better coverage for gram negative bacteria

    •Good for gm + and better gm – coverage than gen.1

    Kills anaerobes

    Used extensively for prophylaxis before surgery and abdominal and colorectal operations due to the fact that it kills many organisms that reside there

    Only IV
  130. Third Generation cephalosprin drugs properties
    HAS better GI absorption than the others*

    Better activity against gram negatives


    Has a very long half-life and can be given once daily IV/IM
  131. What does giving 3rd generation cephalosprin IM do?
    Given IM- causes pain, medication is thick!!

    Usually ok to massage after IM
  132. What are some 3rd Generation Cephalosprin drugs
    • Suprax
    • Claforan
    • Fortaz
    • Tazadime
  133. What are Fortaz & Tazadime good for?
    for hard to cover Pseudomonas
  134. how are 3rd Generation Cephalosprin eliminated?
  135. How are 3rd Generation Cephalosprin administered?
    • IM
    • IV
  136. OK for children- careful use though
  137. what do all 3rd Generation Cephalosprin work well on?
    hospital-acquired infections!
  138. What are some 4th Generation Cephalosprin?
    CEFEPIME (Maxipime), Cefron
  139. 4th Generation Cephalosprin
  140. What are 4th Generation Cephalosprin good for
    • complicated and uncomplicated
    • -UTI’s,
    • -skin infections,
    • -pneumonia


    Also used commonly for pseudomonas
  141. What can most 4th Generation Cephalosprin do?
    cross the blood brain barrier so good also for Meningitis
  142. What should Tetracyclines not be given for? Why?
    •NOT given with milk or any dairy products, antacids, iron salts or iron preparations due to reduction of oral absorption of the tetracycline
  143. What do Tetracyclines have a strong affinity for?
    They have a strong affinity for calcium- so… NOT used on clients under 8, pregnant women, nursing moth
  144. How do Tetracyclines work?
    inhibit the protein synthesis in susceptible bacteria-
  145. What are Tetracyclines used for?
    • Chlamydia,
    • Rickettsia( Rocky Mt. Spotted Fever),
    • Mycoplasms (Myco Pneumonia)
    • Also useful in Lyme disease
    • Syphillus
    • SIADH
    • Gonorrhea
    • •USED ALSO FOR A SCLEROSING AGENT for pleural effusion treatment
  146. What do Tetracyclines cause?
    cause inflammation that causes fibrosis in the lungs-
  147. What happens when Tetracyclines are instilled into the pleural space of the lungs
    causing scar tissue, reducing fluid accumulation
  148. What kind of pts are Tetracyclines useful for?
    clients with pleural or pericardial effusions caused by metastatic tumors, thoracentesis, thoracostomy tubes

    When the med is instilled into the pleural space of the lungs- causing scar tissue, reducing fluid accumulation
  149. What are some side effects of Tetracyclines?
    • Can discolor teeth in fetus and children
    • Can retard fetal skeletal development if taken during pregnancy
    • Can cause photosensitivity
    • Can cause candida –superinfection in the intestinal flora
    • Diarrhea
    • •Pseudomembranous colitis*
    • Can alter vaginal flora
    • Can cause reversible bulging fontanels in neonates
    • Can precipitate thrombocytopenia
    • Can cause coagulation irregularities and hemolytic anemia
    • Can exacerbate systemic lupus
  150. what must you evaluate with Tetracyclines?
    • •BUN
    • Depending on the dose- can elevate serum levels
    • monitor liver function
  151. What are some Tetracycline drugs?
    • –DECLOMYCIN- used for SIADH…
    • –DOXYCYCLINE- Vibramycin-
  152. Properties of Declomycin
    most likely to cause photsensitivity
  153. Wht are properties of Doxycycline (Vibramycin)?
    well absorbed from GI tract

    highly lipid soluble

    • used for Bacillus anthracis (anthrax)
    • Chlamydia trachomatis
  154. What can Tetracycline interfere with?
    • •antacids
    • birth control pills
    • antibiotics like penicillin
    • some multivitamins
    • Warfarin (coumadin)
  155. Properties of Aminoglycocides?
    • •Have POOR oral absorption, except for NEOMYCIN-
    • These drug require PEAKS and TROUGHS for serum drug levels
  156. There is a narrow therapeutic index
  157. What are Aminoglycocides used for?
    • •Used for Serratia (common bug in human waste, also in some hospital acquired infections)
    • E.Coli,
    • Proteus,
    • Klebsiella
    • Used to decontaminate the GI tract when given orally
  158. What can Aminoglycocides cause?
    • can cause toxicity
    • Generally reserved for more life-threatening infections
  159. What other medications are Aminoglycocides often used with?
    Vanco, PCN, Cephalasporins for synergy
  160. What are some side effects of Aminoglycocides
    • •Ototoxicity causing hearing loss resulting in s/s such as:
    • Renal failure causing s/s of:
    • Increased BUN and Creatinine,
    • Proteinuria
  161. What should Aminoglycocides not be given with?
    • LASIX,
    • neuromuscular blockers,
    • oral anticoagulants
  162. What population should take Aminoglycocides with extreme caution ?
    • •The elderly,
    • newborns
    • premies
    • those with renal dysfunction
  163. What can Aminoglycocides do?
    can cross the placenta and be harmful to the fetus and can cross into breast milk
  164. Aminoglycocide drugs
  165. What is the peak and trough for GENTAMYCIN/TOBRAMYCIN?
    • •peaklevel = 5-12 ug/ml
    • •Trough = <2 ug/ml
  166. How can GENTAMYCIN be administered?
    • IM
    • IV
    • ointment for optic use
    • topically as well for burns and skin infections
  167. What are the peaks and troughs for AMIKACIN
    • Peak = 20-35 ug/ml
    • Trough = <10 ug/ml
  168. What are Quinolones?
    • •Broad spectrum antibiotics
    • Used very commonly if no history of allergy or adverse reactions** Can cause colonization with MRSA and C-Diff
  169. How do Quinolones work
    They KILL bacteria and alter their DNA so they can replicate vs. inhibiting the growth
  170. What are Quinolones used for
    Active against gram positive and gram negative bacteria
  171. What can Quinolones cause?
    ** Can cause colonization with MRSA and C-Diff
  172. What are some side effects of Quinolones?
    • •HA,
    • blurred vision
    • Depression
    • Convulsions
    • Nausea,
    • constipation
    • Elevated liver enzymes
    • Oral candidiasis
    • Pseudomembranous colitis
    • Rash
    • Fever
  173. What are Cipro, Levaquin, Floxin used for?
    • KILLS pseudomonas
    • •Kills some anaerobics-
    • Lower resp. tract infections
    • Bone and joint infections
    • Infectious diarrhea
    • UTI’s
  174. What forms do Cipro, Levaquin, Floxin come in?
    • •IV
    • po,
  175. What was the 1st Macrolide
    • •EES (Erythromycin)
    • Zithrom
    • x, Biaxin
  176. what are Macrolide used for?
    • • Strep Pyogenes (Group A beta-hemolytic strep)
    • Upper and Lower resp infections caused by haemophilus influenzae
    • Lyme disease
    • Ghonnorea and chlamydia and mycoplasmas
  177. what do Macrolide do?
    •They irritate the GI tract, thus causing GI motility- a benefit for those with decreased GI motility
  178. What are some side effects of Macrolide?
    • •There are many- most effect the GI tract
    • Can cause CP and palpitations
    • HA,
    • vertigo
    • N/V/D,
    • jaundice
    • Rash,
    • thrombophlebitis (flush) at the IV site
    • Hearing loss
    • problems with liver=> tinnitis or leuroigloss
  179. What is an allergic reaction to Macrolide?
    flush at IV site and all over
  180. What are some intereactions of Macrolide?
    If on theophyline: can decrease the clearance of the theo, increasing the serum levels

    They are highly protein bound- so they bind to the albumin in the blood.

    If other drugs are highly protein bound, there will be competition = free drug in the circulation = prolonged drug effect (remember?)
  181. Where are Macrolide metabalized?
    • Metabolized in the liver
    • •NOT in the client with liver disease - can cause jaundice
  182. What are some Macrolide drugs?
  183. Where are Macrolide metabolixd
  184. How should you take EES?
    •Take on an empty stomach to increase absorption
  185. What does EES cause?
    •Causes GI upset•So take after or with food = less absorption = educate!
  186. What are some properties of Zithromax and Biaxin?
    •Have less GI irritation

    NOT with food- affects absorptioin-- educate
  187. What can Zithromax and Biaxin be taken for?
    • Can be used for both upper and lower resp tract infections
    • Can be used for skin infections
  188. What are some properties of Zithromax?
    • Zithromax has excellent tissue penetration and long duration of action-
    • has a long diration QD dosing
  189. Miscellaneous Antibiotics
    • PRIMAXIN (Imipenem and MERREM)
    • Zyvox
    • Vancomycin
  190. what is CLINDAMYCIN used for?
    Used for chronic BONE infections
  191. what is PRIMAXIN used for?
    Used for bone infections and bacterial endocardiitis
  192. What are some side effects of PRIMAXIN
    seizures, especially in the elderly and the renally impaired
  193. What is Zyvox used for?
    Used to treat VREF- Vancomycin resistant enterococcus faecium or VRE!

    OK for the treatment of skin infections and hospital acquired pneumonias- including MRSA as well as CAP
  194. What can Zyvox do?
    •Can decrease platelets
  195. What needs to be monitored when taking Zyvox?
    •Careful monitoring of platelets
  196. What is Vancomycin used for?
  197. What happens if pt takes Vancomycin often?
  198. What are the peaks and trough s of Vancomycin?
    • •PEAK = 18-26 ug/ml
    • TROUGH = 5-10 ug/ml
    • NARROW therapeutic window
  199. What mixes with Vancomycin?
  200. WHat toxicity can Vancomycin cause?
    • ototoxicity = watch for ringing in the ears / ear problems
    • nephrotoxicity= keep eye on kidney
  201. how long do you infuse IV Vancomycin?
    Vanc always for 1hour or more IV
  202. Nursing process
    • * Cultures and Sensitivities FIRST!!
    • * All labs and serum levels where indicatedMonitor I&O
    • (can mess with kidneys)
    • WBC’s to assess antibiotic effectiveness
    • VS, especially temp
    • List of all meds, including OTC’s
    • Monitor for allergic reactions, especially with PCN

    when givning IM -deep muscle / rotate frequently/ can be given w/ lidicane to ease pain
  203. Some other antibiotic nursing process
    • •Assess injection sites for heat, swelling, hematoma
    • Assess IV site frequently for s/s of phlebitis
    • •ETOH with some cephalasporins can cause “antabuse-like” symptoms**** -
    • (get nauseous if takesip of ETOH) ALL abx. for the FULL course to prevent resistance
    • Educate medic alert bracelets for allergies
    • ALL abx, for 6-8 oz of water for better absorption
  204. Fever of unknown origin
    • •Expect to be assessing just about everything
    • Full physical assessment
    • Check IV sites
    • Check injection sites
    • Any welling or erythema or edema anywhere?
    • Check all drains and tubes
    • Check all wounds, pressure ulcers
    • What about recent surgeries? Any hardware?
  205. What are some fat soluable vitamins
    • VITAMIN A- (Retinol)
  206. What is Vitamin A derived from?
    animal fats found in dairy products (butter and milk), eggs, meat, liver and fish liver oils.
  207. What is “Provitamin A” (carotenes) found in?
    found in plants- green/yellow veggies and yellow fruits
  208. What is Vitamin A used for
    • Vit . A deficiency
    • Can be used to help treat acne,
    • Psoriasis,
    • Night blindness,
    • needed for nursing/ pregnant women and infants
  209. What is Vitamin A required for?
    • Required for the growth of teeth and bones,
    • night vision
    • normal vision
  210. What are the highest safe levels of Vitamin A?
    OD management = levels >25,000 U/kg
  211. What are some s/s of Vitamin A toxicity?
    • irritability,
    • vertigo,
    • delirium,
    • vomiting/diarrhea
    • In infants = can cause increase in cranial pressure = bulging fontanels
    • Skin may start peeling after a few weeks and erythema may occur
  212. What is Vitamin D needed for?
    Needed for the proper utilization of calcium and phosphorus in the body
  213. In what foods can Vitamin D be obtained?
    • Fish oils, salmon, sardines,
    • FORTIFIED milk, bread and cereal,
    • animal liver
    • tuna
    • eggs
    • butter
  214. What is Vitamin D needed for?
    • Needed for the normal calcification of the bone
    • Vitamin D deficiency
    • Given to clients with hypoparathyroidism
  215. What does long term deficiency of Vitamin D cause?
    • infantile rickets- bone malformation
    • osteomalacia
  216. What can an OD of Vitamin D cause?
    • hyoertension
    • weakness
    • HA
    • anorexia
    • n/v
    • bone pain
    • metallic taste
  217. What can be done for OD of Vitamin D
    Lower dietary intake of D and stop the supplements
  218. What are some dietary sources of Vitamin E
    • fruit
    • grains
    • cereal
    • veggies
    • wheat germ
    • eggs
    • meat
    • chicken
  219. What can Vitamin E fight off?
  220. What is usually the only population Vitamin E deficiency is seen in?
    INFANTS , (especially premature infants)
  221. What can Vitmain E defiency cause?
    • edema
    • irritability
  222. What foods is Vitamin K found in?
    • green leafy veggies
    • milk
  223. What does Vitamin K vital for?
    the synthesis of blood coagulation factors that take place in the liver
  224. What can cause Vitamin K defiency?
    • low dietary intake
    • broad spectrum antibiotics because there is some stored Vit. K in the intestine (and antibiotics can inhibit the flora in the intestine) Vitamin
  225. Where is some Vitamin K stored?
    in the intestine
  226. What is Vitamin K used for?
    reversal of increased coagulation to aid in clotting of the blood
  227. What is usually the only population that gets Vitamin K toxicity?
  228. What can Vitamin K toxicity cause?
    - hemolysis of RBC’s
  229. How is Vitamin K toxicity treated?
    replacement of blood products
  230. What are the WATER SOLUBLE VITAMINS
    • VITAMIN B 12
  231. What foods is Vitamin B1 found in?
    • whole grains
    • liver
    • beans
  232. What does Vitamin B1 deficiency cause?
    Wernicke’s Encephalopathy
  233. What causes Vitamin B1 defiency?
    • poor diet
    • liver disease
    • alcoholism
    • breastfeeding/pregnancy
  234. What depends highly on Vitamin B1 ?
    • GI tract
    • cardiovascular system
    • PNS
  235. What is another name for Vitamin B1?
  236. What is another name for VITAMIN B 2
  237. What is Riboflavin found in?
    • green leafy’s,
    • eggs,
    • nuts,
    • meat
    • yeast
  238. What is Riboflavin essential for?
    • tissue respiration
    • to maintain erythrocyte integrity
  239. What can Riboflavin deficiency cause?
    • skin,
    • oral
    • corneal changes
  240. What are causes of Riboflavin defiency?
    • Alcoholism
    • liver disease
    • malignancy
  241. What can large doses of Riboflavin cause?
    the urine to turn yellow-orange
  242. What is another name for VITAMIN B3?
  243. What foods can Niacin be found in?
    • meat,
    • wheat,
    • yeast,
    • beans,
    • liver
  244. What can Niacin deficiency cause?
    • various psychotic s/s,
    • erythema
    • dryness of the skin,
    • oral/vaginal/urethral lesions, Diarrhea and bloody diarrhea
  245. What is Niacin
    • water soluable vitamin
    • anti-hyperlipidemic agent
  246. What can Niacin do?
    lowers cholesterol and triglyceride levels
  247. What is Niacin needed for?
    the breakdown of stored glycogen to usable glucose
  248. What can Niacin cause with continual usage?
    GI distress
  249. Who should not take Niacin suupplements?
  250. client with DM
    • gout,
    • hepatic dysfunction
  251. What should Niacin be given with?
    milk or food to decrease GI upset
  252. What is Vitamin B12 needed for?
    • fat and carbo metabolism
    • protein synthesis
    • for growth,
    • cell replication,
    • hematopoesis
  253. What is Vit B12 found in?
    animal food origins (liver, kidney, meat, shellfish and dairy)
  254. What can Vit B12 deficiency cause?
    • GI lesions,
    • neuro symptoms
    • megoblastic anemia
  255. What groups tend to get Vit B12 defiency?
    • in alcoholics,
    • chronic hemorrhage
    • poor diet
  256. What are some side effects of Vit B12 defiency?
    • itching,
    • diarrhea
    • fever
  257. What is Vit C found in?
    • in fruits
    • juices,
    • tomatos,
    • cabbage,
    • cherries
    • liver
  258. What does Vit C defiency cause?
  259. What are some symptoms of scurvy?
    • gingivitis,
    • bleeding gums/loss of teeth,
    • anemia,
    • bone lesions,
    • delayed healing of soft tissue and bone)
  260. What is Vit C needed for?
    • tissue repair,
    • maintenance of bone and teeth and capillaries
  261. What can Vit C do?
    • Enhances the absorption of iron
    • lessen the severity of the common cold
  262. What can an OD of Vit C cause?
    • n/v,
    • HA
    • abdominal cramps
    • can cause renal stones
  263. How are Vit C supplements usually taken?
    Oral supplement mixed in 6 oz water or juice
  264. What should edu should be given with Vit C supplements?
    they may have an increase in urination
  265. What are minerals needed for?
    Needed for intra and extra-cellular body fluid electrolytes
  266. What are some minerals?
    • Calcium
  267. What is Calcium?
    - Most abundant mineral element in the human body = approximately 2% of the total body weight
  268. Where is the highest concentration of Calcium found?
    • in the bones
    • teeth
    • Milk
    • dairy
  269. What can Calcium defiency cause?
    • osteomalacia,
    • muscle cramps
    • osteoprosis (esp. in postmenapausal women),
    • Rickets
  270. What can toxic levels of Calcium cause?
    • hypercalcemia,
    • nausea,
    • constipation
    • anorexia,
    • ** Cardiac irregularities!!
  271. WHat can hypercalcemia cause in pts on Digoxin
    serious cardiac dysrythmias Calcium
  272. What are some problems of Calcium supplements given IM or IV
    • can be costic to the skin
    • causing
    • burning,
    • cellulits of the tissue
  273. What can Calcium do?
    can “Chelate” (bind) to tetracycline
  274. What are some meds Calium can interact with?
    • Dig,
    • epinephrine,
    • coumadin,
    • calcium channel blockers,
    • lot of meds
  275. In what pts are Calcium supplements contraindicated for?
    • HYPERcalcemia
    • with bone tumors
  276. What should IV calcium clients do after IV infusion?
    remain recumbent for at least 15 minutes after IV infusion- helps to decrease risk of cardiac arrest.meal
  277. what should be done when giving Calcium via IV?
    • Give very slowly IV
    • have crash cart available
  278. WHat should be done if IV calcium extravasates?
    • stop infusion immediately.
    • The Dr. may order “procaine” to reduce vasospasms and dilute the effects of calcium in surrounding tissue
  279. When should oral Calcium be given
    should be given 2-3 hours AFTER a meal
  280. WHat is MAGNESIUM associated with?
    with energy metabolism
  281. WHat is MAGNESIUM required for?
    • Required for muscle contraction
    • nerve physiology- produces and anticonvulsant effect
  282. WHat can cause MAGNESIUM ( Hypomagnesia) defiency?
    • alcoholism,
    • long-term IV feedings,
    • hyperthyroid,
    • diabetic ketoacidosis,
    • diuretics
    • malabsorption
  283. What can MAGNESIUM defiency cause?
    • mental disturbances,
    • cardiovascular disturbances
    • neuromuscular impairment
  284. Who can get Hypermagnesia?
    clients with renal dysfunction that take large amounts of antacids because they contain magnesium
  285. How common is Phosphorus dietary defiecincy?
    RARE because phosphorus is in many foods
  286. What can cause Phosphorus defiency
    • malabsorption,
    • acute diarrhea or vomiting,
    • hepatic disease,
    • long-term use of aluminum or calcium antacids
  287. What is Phosphorus important for?
    maintenance of teeth and bones
  288. WHat are some side effects of Phosphorus supplemental treatment
    GI disturbance- n/v/d.
  289. What can antacids do to phosphorus
    reduce the oral absorption
  290. What needs to be monitored before, during and after vit/min supplement therapy
  291. What do you assess& monitored w/ vit/ min therapy?
    • Medical history- renal insufficiency, cardiac disease, GI bleeding, intestinal obstruction
    • VS during supplement therapy
    • WBC, RBC, H/H, and trace elements
    • Get a thorough medication history
    • Social history (a lot of these deficiencies are due to alcoholism)
    • Baseline EKG’s