pharmocology test 3

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pharmocology test 3
2012-03-29 09:34:55
pharmocology test

pharmocology test 3
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    • Fat soluble vitamin
    • Derived from animal fats found in dairy products (butter and milk), eggs, meat, liver and fish liver oils.
    • “Provitamin A” (carotenes)- found in plants- green/yellow veggies and yellow fruits
    • Used as a dietary supplement in a Vit. A deficiency
    • Required for the growth of teeth and bones, night vision and normal vision
    • Can be used to help treat acne, Psoriasis, Night blindness, needed for nursing/ pregnant women and infants
    • OD management = levels >25,000 U/kg = 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
    • Fat soluble vitamin
    • Needed for the proper utilization of calcium and phosphorus in the body
    • Natural Vitamin D = THE SUN!!
    • Obtained via Fish oils, salmon, sardines, FORTIFIED milk, bread and cereal, animal liver, tuna, eggs and butter
    • Needed for the normal calcification of the bone
    • In supplement form for deficiency
    • Given to clients with hypoparathyroidism
    • Long-term deficiency can cause infantile rickets- bone malformation, osteomalacia
    • OD management = hyoertension, weakness, HA, anorexia, n/v, bone pain, metallic taste. Lower dietary intake of D and stop the supplements
    • Fat soluble vitamin
    • Dietary sources = fruit, grains, cereal, veggies, wheat germ, eggs, meat and chicken
    • Is an antioxidant- to fight off cancer
    • Vitamin E deficiency typically only seen in INFANTS , especially premature infants) causing edema and irritability
    • Used to treat a deficiency
    • Fat soluble vitamin
    • Found in green leafy veggies and milk
    • Vital in the synthesis of blood coagulation factors that take place in the liver
    • Deficiency can be sue low dietary intake or from broad spectrum antibiotics because there is some stored Vit. K in the intestine (and antibiotics can inhibit the flora in the intestine)
    • Vitamin K is used for the reversal of increased coagulation to aid in clotting of the blood
    • Toxicity is primarily limited to newborns- hemolysis of RBC’s can occur, replacement of blood products is indicated
  5. VITAMIN B1- (THIMINE) water soluble vitamin
    • Available in whole grains, liver and beans
    • Deficiency = Wernicke’s Encephalopathy
    • From poor diet, liver disease, alcoholism, breastfeeding/pregnancy
    • GI tract, cardiovascular system, PNS depend highly on thiamine
    • Found in green leafy’s, eggs, nuts, meat and yeast
    • Essential for tissue respiration and to maintain erythrocyte integrity
    • Deficiency can cause- skin, oral and corneal changes
    • Alcoholism is a common cause of deficiency, liver disease or malignancy
    • Large doses can cause the urine to turn yellow-orange
    • Found in meat, wheat, yeast, beans, liver
    • Deficiency- various psychotic s/s, erythema and dryness of the skin, oral/vaginal/urethral lesions, Diarrhea and bloody diarrhea
    • Also an anti-hyperlipidemic agent- lowers cholesterol and triglyceride levels
    • Needed for the breakdown of stored glycogen to usable glucose
    • May cause GI distress and pruritis with continual usage
    • Supplements not for the client with DM, gout, hepatic dysfunction and active
    • Give with milk or food to decrease GI upset
    • Needed for fat and carbo metabolism and protein synthesis
    • Needed for growth, cell replication, hematopoesis
    • Found in animal food origins (liver, kidney, meat, shellfish and dairy)
    • Deficiency can cause GI lesions, neuro symptoms and megoblastic anemia
    • Present in alcoholics, chronic hemorrhage and poor diet
    • Side effects = itching, diarrhea and fever
    • Present in fruits and juices, tomatos, cabbage, cherries and liver
    • Deficiency = scurvy (gingivitis, bleeding gums/loss of teeth, anemia, bone lesions, delayed healing of soft tissue and bone)
    • Needed for tissue repair, maintenance of bone and teeth and capillaries
    • Enhances the absorption of iron
    • Can lessen the severity of the common cold!
    • OD can cause n/v, HA and abdominal cramps and can cause renal stones
    • Oral supplement mixed in 6 oz water or juice
    • Educate the client that they may have an increase in urination
  10. CALCIUM- minerals
    • Most abundant mineral element in the human body = approximately 2% of the total body weight
    • Highest concentration in the bones and teeth
    • Milk and dairy
    • Deficiency can cause osteomalacia, muscle cramps and osteoprosis (esp. in postmenapausal women), and Rickets to name a few
    • Toxic levels = hypercalcemia, nausea, constipation and anorexia, ** Cardiac irregularities!!
    • Hypercalcemia and clients on Digoxin DO NOT MIX = serious cardiac dysrythmias
    • Calcium supplements IM or IV can be costic to the skin causing burning, cellulits of the tissue
    • Calcium can “Chelate” (bind) to tetracycline
    • Interacts with a lot of meds- Dig, epinephrine, coumadin, calcium channel blockers, etc…
    • Calcium supplements are contraindicated in clients with HYPERcalcemiaa dn in those with bone tumors
    • IV calcium- client should remain recumbent for at least 15 minutes after IV
    • infusion- helps to decrease risk of cardiac arrest. Give very slowly IV and have crash cart available…
    • If IV calcium extravasates- stop infusion immediately. The Dr. may order “procaine” to reduce vasospasms and dilute the effects of calcium in surrounding tissue
    • Oral calcium should be given 2-3 hours AFTER a meal
  11. MAGNESIUM- minerals
    • Associated with energy metabolism
    • Required for muscle contraction and nerve physiology- produces and anticonvulsant effect
    • Hypomagnesia can be due to alcoholism, long-term IV feedings, hyperthyroid, diabetic ketoacidosis, diuretics and malabsorption
    • May cause mental disturbances, cardiovascular disturbances and neuromuscular impairment
    • Hypermagnesia can occur in clients with renal dysfunction that take large amounts of antacids because they contain magnesium
  12. PHOSPHORUS- minerals
    • Dietary deficiency is RARE because phosphorus is in many foods
    • May become deficient due to malabsorption, acute diarrhea or vomiting, hepatic disease, long-term use of aluminum or calcium antacids
    • Important for the maintenance of teeth and bones
    • Side effects of supplemental treatment is GI disturbance- n/v/d.
    • Antacids can reduce the oral absorption of phosphorus
  13. LABS AND ELECTROLYTES need to be monitored before, duringand after vitamin or mineral supplement therapy!
    • Medical history- renal insufficiency, cardiac disease, GI bleeding, intestinal obstruction
    • VS need to be monitored during supplement therapy
    • Moniutor 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
    Needed for intra and extra-cellular body fluid electrolytes
  15. peak-
    • drawing the serum blood levels after the drug is administered as it distributes rapidly and reaches its peak in therapeutic range
    • •Labs for the Peak are drawn about one hour after the infusion finished.
  16. Therapeutics The highest serum level of free or unbound drug in a Pt based on a dosing schedule, which is usually measured ±1⁄2 hr after an oral dose of a drug.
  17. trough-
    • •This is the lowest drug level that is needed to reach therapeutic range.
    • •If trough is > 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.
    • •In general, a trough is usually drawn one hour prior to start infusion
  18. Antivirals
    • —KILL VIRUSES by inhibiting their ability to replicate, so the body’s immune system can destroy the virus
    • —CMV
    • —HSV
    • —HIV
    • —Influenza A (flu)
    • —RSV- resp. syncytial virus
  19. antivirals
    • 1) Acyclovir-
    • —For HSV 1 and 2
    • —Chickenpox
    • —Shingles

    • 2) CRIXIVAN-
    • —Treatment for advanced HIV
    • —Taken in combo with other antivirals
    • —Increases CD4 count
    • 3) RIBAVIRIN- Used to treat severe LRI caused by RSV
    • —MAY cause fetal toxicity!
    • —Inhilation nasally or orally
    • —For HIV treatment
    • —May cause bone marrow suppression, if so, HIV clients would need a different medication
    • —COMBIVIR is a combo drug
  20. What to assess when on these meds: antiviral
    • —ALL labs
    • —Bone marrow suppression
    • —VS
    • —Allergic reactions
    • —Is the drug working- decreased HSV, increased CD 4 counts, etc
    • —GLOVES!!! Especially with topical’s and infected clients
    • —Some can cause dizziness- SAFETY education
    • —If immuno-supression- avoid crowds
  21. Antitubercular Agents
    • MYCOBACTERIUM TUBERCULOSIS is the bacteria that causes TB!
    • —It is an aerobic bacillus that requires a lot of O2 to grow
    • —Highly oxygenated areas affected:
    • —Lungs
    • —Growing ends of the bones
    • —Brain
    • —Kidney
    • —Liver
    • —Genitourinary tract
    • Human, cows, birds
  22. Antitubercular Agents-How is it transmitted?
    • —Conveyed in DROPLETS
    • —Expelled by infected people or animals by sneezing, coughing
    • —Inhaled by the host
    • —TB does not infect all people that inhale this!
    • —So who dies it affect?
    • —The bacteria becomes dormant or walled off by fibrous or calcified tissue
    • —TB is a slow growing organism
    • —Those immuno-supressed by CA, chemo, HIV/AIDS are common hosts that are affected and this can be deadly
    • —There has been a resurgence of the disease
  23. Antitubercular Agents- The Drugs
    • 1)INH- (ISONIAZIDE)-a primary anti-TB drug
    • —Can be used for the prophylaxis of or the sole agent for the treatment of active TB
    • —Metabolized via the liver
    • —Can cause blood sugars to increase
    • 2) 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
    • 3) 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
    • 4) STREPTOMYCIN- aminoglycocide antibiotic
    • —Used only in combination because it can cause toxicity
    • —Review this medication in your information about antibiotics!!
  24. Antitubercular Agents- Nursing Assessment
    • —OF
    • COURSE- a
    • medical history

    • —LFT’s 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.
    • —CBC, HGB, HCT- INH can cause hematolgic disorders
    • —BUN, Cr, UA, possibly a 24 hour collection?
    • —Sputum Cultures throughout treatment course
    • —Take all meds as ordered and all meds thoroughly
    • —Careful hand washing, covering the mouth with cough/sneeze, may require isolation from the public
    • education-—Medication administration- no skipping and no doubling up
    • —Side effects of medications
    • —Labs for follow ups
    • —Disease transmission
    • —Isolation precautions
    • —Hand washing
    • —CDC reporting and follow-ups
  25. Antifungal
    medications- What are we treating?
    • —FUNGI = yeast/mold.Some are in the normal flora of the skin, mouth, intestines, vagina
    • —YEAST = single-celled fungi that bud and can be useful organisms
    • —MOLD = Multi-cellular
  26. Infection and transmission
    • —INFECTION caused by fungus is called “MYCOSIS”
    • —HOW is the host infected?
    • —Inhaled- fungal “spores” are airborne
    • —Implanted -under skin
    • —Ingested- orally
  27. Who is in the population infected?
    • —Those who are imuno-supressed- they are more susceptible to developing fungal infections.
    • —Who are these people?
    • —Transplant patients that are on immunosuppressive therapy
    • —HIV/AIDS
    • —CA r/t to chemo therapy
    • —Corticosteroids- can result in colonization of candida albicans- THRUSH- common in newborns and and the immunocompromised
    • —Long term antibiotic clients
    • —Vag candidiasis- yeast infection: pregnant women, women with DM, women on antibiotics, women on oral contraceptives
    • —What about our friends from other countries?
  28. Antifungal Drugs
    • —Have the ability to kill or inhibit the growth of fungi
    • —Systemic fungal infections treated with AMPHO-B
    • —TREATMENT of CRYPTOCOCCAL MENINGITIS = Fluconozole or “Diflucan”- it penetrates the CSF
    • —Both amphotericin B and Diflucan can treat oropharyngeal and esophageal candida
    • —However… there are a lot of side effects!
    • —NYSTATIN AND MYCOSTATIN- TOPICAL for diaper rash and vaginal candidiasis
    • —Oral and topical- ointment, powder, spray, vaginally
  29. Antifungal Drugs-Side Effects
    • •Ampho-B can easily cause hepatotoxicity, neurotoxicity,
    • renal toxicity,
    • -Resp difficulties, cardiac dysrythmias, fever, chills, malaise and hypotension
    • —Diflucan can cause N/V/D, increased AST and ALT
  30. Antifungal Drugs-Nursing Assessment
    • —Allergies
    • —Great caution in the pregnant or lactating woman
    • —Caution in lupus clients
    • —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.
    • —If using the medication for a vaginal infection- abstain from sexual intercourse
    • —Partner may need to be treated as well
    • —Continue medication even if menstruating
    • —EDUCATE!
  31. Antifungal Drugs- Education
    • —Medication administration- no skipping and no doubling up
    • —Side effects of medications
    • —Labs for follow ups
    • —Disease transmission
    • —Isolation precautions
    • —Hand washing
    • —DISINFECTANTS- able to kill organisms and are used on non-living objects to destroy any organisms
    • —ANTISEPTICS- ONLY inhibit growth of microorganisms, but do NOT necessarily kill them and applied only to living tissue
  33. Antiseptics
    • —Mucous membranes and skin
    • —In soaps, such as pre-surgical scrubs when the skin will be incised
    • —Topicals, ointments, mouthwashes, douches
    • —Some can cause skin irritation if in contact with skin such as dryness, burns
  34. Antiseptic Agents
    • —Isopropyl alcohol- antiseptic
    • —Kills microorganisms- bacteria, fungi and viruses
    • —Aldehyde (Cidex) - mostly disinfectant- causes burns to skin easily, sterilizes equip
    • —Hibiclens- surgical scrub antiseptic
    • —Chlorine compounds (Dakin’s sol)- only partially active against fungi- athletes foot
    • —Iodine- kills all forms of microorganisms and SPORES
    • —Hydrogen peroxide- can be used to irrigate wounds, used first fro some surgeries, but can also cause skin irritation
  35. Antiseptic Agents- Nursing Assessment
    • —Assess the condition of the skin before, during and after treatment and document
    • —Some of these preps can cause damage to the healthy tissue!
    • —Check hydration of the skin
    • —Drug allergies?
    • —Iodine, seafood allergies?
    • —Use standard precautions/protect your skin
    • —Creams and ointments = use a sterile q-tip or sterile gauze
    • —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!
  36. Infection
    • •We are able to fight of infections caused by microorganisms that invade the body because of the existence of host defenses
    • •Microorganisms are both internal and external
    • •They can be harmful to humans or they can live without interference and even be helpful
    • •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 prior rheumatic fever!
    • •If the microorganisms invade the body that is not at it’s optimum health level- infection occurs.
  37. Principles of antibiotics
    • •Assessment before, during and after therapy
    • •The antibiotic selection is based on the type of microorganism and which med will work the best- “EMPERIC THERAPY”
    • •BEFORE empiric therapy, the organism should be cultured and identified
    • •If it is identified, the lab can then run a “susceptibility”- which shows which antibiotic works the best
    • •Antibiotics can also be given “PROPHYLACTICLLY” – as in before a procedure (surgery) where the likelihood of microorganism invasion is high
    • •THERAPEUTIC RESPONSE – when there is a decrease in s/s of infection
    • •TOXIC levels- when the serum antibiotic levels are too high
  38. Superinfection
    • 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
  39. Interactions (review)
    • •There can also be a ‘FOOD-DRUG and DRUG-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).
    • •HOST FACTORS = 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
  40. Sulfonomides (Sulfas)
    • •One of the first groups of antibiotics
    • •They achieve very high concentrations in the kidneys, through which they are eliminated
    • •Used primarily for UTI’s caused by: Enterobacter, E.Coli, Klebsiella, Proteus Mirabilis and Vulgaris and Staph aureus
    • •Used for URI’s
    • •DRUG OF CHOICE for: Pneumocystis carinii (common in HIV and AIDS clients) and Xanthomonas maltophilia
    • •Used also for Chron’s disease and rheumatoid arthritis
    • •Sulfonamides DO NOT destroy bacteria, but inhibit their growth
    • •Greater effectiveness is achieved if you combine a sulfonamide and a non-sulfonimide
    • •Give with plenty of fluids to prevent crystalluria
  41. Sulfonomides (Sulfas)-Side effects and interactions
    • •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)
    • Interactions:
    • •Oral anticoag’s
    • •Urinary acidifiers
  42. The Drugs: 1- Bactrim
    • •Used for UTI’s
    • •Pneumo. carinii pneumonia
    • •Otitis media
    • •bronchitis
    • •ghonnorea
    • •Used prophylactically for HIV clients
  43. 2- Septra & Septra DS
    • •Sulfamethoxazole and trimethoprim combination
    • •Ear infections
    • •UTI’s
    • •Bronchitis
    • •PCP
  44. 3- Pediazole
    • •Again used on the urinary tract
    • •Used for otitis media in children and available in oral suspension
    • •Used primarily for children
    • •Tolerated fairly well unless and allergy
  45. Penicillins
    • •Derived form fungus or mold found on bread and fruit
    • •AKA “beta-lactams”
    • •Kill a wide variety of gram positive and some gram negative bacteria
    • •PCN works by inhibiting bacterial wall sythesis
    • •PCN’s only inhibit the wall synthesis
    • of bacteria cells, not the other cells in the body
    • •Microorganisms killed by PCN:
    • -Streptococcus
    • -Enterococcus and
    • -Staphylococcus species
  46. Penicillins Side effects
    • •Most common side effect- rash, itching, dermatitis and Stevens Johnson Syndrome
    • •10% are life-threatening and 10% are fatal
    • •May cause GI upset- N/V/D, Bone marrow suppression, Increased ALT and AST, convulsions
  47. Penicillins Interactions
    • •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
  48. 1- Natural PCN, PCN G, PCN V
    • •Not used in newborns
    • •Check for hypersensitivity
    • •Give 1 hour before food and 2 hours after food
    • •Oral PCN should not be taken with sodas or caffiens, fruit or tomato juice- decreases effectiveness
  49. 2- Penicillinase RESISTANT PCN- METHACILLIN
    • •Penicillinase resistant penicillins are antibiotics, which are not inactivated by the penicillinase enzyme.
    • •Some bacteria produce the enzyme “penicillinase” that destroys the beta-lactam ring of the antibiotic,
    • •Making the penicillin ineffective
  50. The
    Drugs are:
    • •Nafcillin, oxacillin, dicloxacillin
    • •These can resist the breakdown of the PCN destroying enzyme commonly produced by staphylococci

    •BUT… REMEMBER MRSA- this is a staphylococcus aureus RESISTANT to PCN
  51. 3- 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
  52. What is a gram – or gram + bacteria?
    • •When gram staining- Gram Negative bacteria does
    • not retain crystal violet dye
    • •E. Coli, Salmonella, Pseudomonas, Ghonnorhea, Neisseria Meningitis
    • •Gram Positives- do retain the dye and appear blue or purple under the microscope
    • •Staphylococcus, Streptococcus, Enterococcus
  53. 4- Extended Spectrum PCN
    • •Piperacillin, Carbenicillin, Ticarcillin
    • •All IV except Carbenicillin (po)
  54. Cephalosporins
    • •Related to PCN ( beta lactams)
    • •Can destroy a broad spectrum of bacteria
    • •Effective against many gram positives, some gram negatives and some anaerobes
    • •NOT active against fungi or viruses
    • •There are 4 generations:
  55. Generations 1-4
    • •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
    • •NOW a 4th generation = greater activity on gram positives than 3rd generation, but also cover gram negatives as well
    • •“CEFEPIME”(4th generation)
  56. Cephalosporins Side Effects
    • •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
  57. First Generation Drugs
    • Ancef, Kefzol, Keflex
    • •Good for gm + coverage
    • •Little coverage for gm -
    • •Can be given to children as well as adults
    • •IM and IV and po
  58. Second Generation
    • •Cefzil
    • •Zinacef (does not kill anaerobes)
    • •Mefoxin
    • •Cefotan
    • •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
  59. Third Generation
    • •HAS better GI absorption than the others
    • •Better activity against gram negatives
    • •ROCEPHIN-
    • •Has a very long half-life and can be given
    • once daily IV/IM
    • •Given IM- causes pain, medication is thick!!
    • •Usually ok to massage after IM
    • •Suprax
    • •Claforan
    • •Fortaz & Tazadime- Excellent for hard to cover Pseudomonas
    • •Eliminated renally
    • •IM/IV
    • •OK for children- careful use though
    • •All 3rd generations work fairly well on hospital-acquired infections!
  60. Fourth Generation
    • •CEFEPIME (Maxipime), Cefron
    • •Good for complicated and uncomplicated UTI’s, skin infections, and pneumonia
    • •Most can cross the blood brain barrier so good also for Meningitis
    • •Also used commonly for pseudomonas
  61. Tetracyclines
    • •NOT given with milk or any dairy products, antacids, iron salts or iron preparations due to reduction of oral absorption of the tetracycline
    • •They have a strong affinity for calcium- so… NOT
    • used on clients under 8, pregnant women, nursing mothers
    • •Tetracyclines- inhibit the protein synthesis in susceptible bacteria-
    • • Chlamydia, Rickettsia( Rocky Mt. Spotted Fever),
    • •Mycoplasms (Myco Pneumonia)
    • •Also useful in Lyme disease and
    • •Syphillus and SIADH
    • •Tetracyclines cause inflammation
    • that causes fibrosis in the lungs- seful 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
  62. Tetracyclines- Many Side Effects
    • •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
  63. Tetracyclines- A must to evaluate:
    • •BUN
    • •Depending on the dose- can elevate serum levels
    • •So how will this effect the renal system?
    • •How will this need to be taken into consideration for your renally impaired patient?
    • •Also monitor liver function!
  64. The
    • –DECLOMYCIN- used for SIADH…
    • –DOXYCYCLINE- Vibramycin-
    • •Used in Rocky Mt. Spotted Fever
    • •Chlamyida
    • •Mycoplasmas
    • •Gonorrhea
    • •USED ALSO FOR A SCLEROSING AGENT for pleural effusion treatment
    • May interfere with:
    • •antacids
    • •birth control pills
    • •other antibiotics like penicillin
    • •some multivitamins
    • •Warfarin (coumadin)
  65. Aminoglycocides
    • •Have POOR oral absorption, except for NEOMYCIN-
    • •Used to decontaminate the GI tract when given orally
    • •This drug can cause toxicity
    • •Generally reserved for more life-threatening infections
    • Used most commonly for:
    • •Used for Serratia (common bug in human waste, also in some hospital acquired infections)
    • •E.Coli,
    • •Proteus,
    • • Klebsiella
    • •Often used WITH:
    • - Vanco, PCN, Cephalasporins for synergy
    • May cause some serious side effects
    • •Ototoxicity causing hearing loss resulting in s/s such as:
    • •Renal failure causing s/s of:
    • •Increased BUN and Creatinine, Proteinuria
    • •DO NOT GIVE WITH LASIX, neuromuscular blockers, oral anticoagulants
    • •These drug require PEAKS and TROUGHS for serum drug levels
    • •There is a narrow therapeutic index
    • •The elderly, newborns and premies and those with renal
    • dysfunction should take these meds with extreme caution
    • •They can cross the placenta and be harmful to the fetus and can cross into breast milk
  66. The Drugs:
    • •Peak level = 5-12 ug/ml
    • •Trough = <2 ug/ml
    • •Available IM/IV and ointment for optic use
    • •Gentamycin can be used topically as well for burns and skin infections
    • •Peak = 20-35 ug/ml
    • •Trough = <10 ug/ml
  67. Quinolones
    • •Broad spectrum antibiotics
    • •They KILL bacteria and alter their DNA so they can replicate vs. inhibiting the growth
    • •Active against gram positive and gram negative bacteria
    • • Used very commonly if no history of allergy or adverse reactions
    • •** Can cause colonization with MRSA and C-Diff
  68. Quinolones Side Effects
    • •HA, blurred vision
    • •Depression
    • •Convulsions
    • •Nausea, constipation
    • •Elevated liver enzymes
    • •Oral candidiasis
    • •Pseudomembranous colitis
    • •Rash
    • •Fever
  69. Cipro, Levaquin, Floxin
    • •IV and po, KILLS pseudomonas
    • •Kills some anaerobics-
    • •Lower resp. tract infections
    • •Bone and joint infections
    • •Infectious diarrhea
    • •UTI’s
  70. Macrolides
    • •EES was the first one! (Erythromycin)
    • •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
    • •They irritate the GI tract, thus causing GI motility- a benefit for those with decreased GI motility
  71. Macrolides Side effects
    • •There are many- most effect the GI tract
    • •Can cause CP and palpitations
    • •HA, vertigo
    • •N/V/D, jaundice
    • •Rash, thrombophlebitis at the IV site
    • •Hearing loss
  72. Macrolides Interactions
    • 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?)
    • •Metabolized in the liver
    • •NOT in the client with liver disease
  73. The
    • •EES
    • •Take on an empty stomach to increase absorption
    • •Causes GI upset
    • •So take after or with food = less absorption = educate!
  74. Zithromax, Biaxin
    • •Have less GI irritation
    • • Can be used for both upper and lower resp tract infections
    • •Can be used for skin infections
    • •Zithromax has excellent tissue penetration and long duration of action- QD dosing
    • •NOT with food
  75. Miscellaneous
    • CLINDAMYCIN- Used for chronic BONE infections
    • PRIMAXIN (Imipenem and MERREM)- Side effect can include seizures, especially in the elderly and the renally impaired
    • •Used for bone infections and bacterial endocardiitis
    • Zyvox-•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
    • •Can decrease platelets
    • •Careful monitoring of platelets
    • •What population might be greatly effected?
    • Vancomycin •Antibiotic of choice for MRSA
    • •Oral vanc for C-Diff
    • •Used IV for staph in the bone and bloodstream
    • •If a client is frequently given vanc, can become resistant
    • •MUST do frequent vanc levels
  76. Vancomycin levels:
    • •PEAK = 18-26 ug/ml
    • •TROUGH = 5-10 ug/ml
    • •NARROW therapeutic window- huh?
    • •If toxicity = ototoxicity and nephrotoxicity
    • •Vanc always for 1hour or more IV…
  77. Nursing
    • * Cultures and Sensitivities FIRST!!
    • * All labs and serum levels where indicated
    • •Monitor I&O
    • •WBC’s to assess antibiotic effectiveness
    • •VS, especially temp
    • •List of all meds, including OTC’s
    • •Monitor for allergic reactions, especially with PCN
    • •When the abx. are given IM,
    • should be in a deep muscle, rotated frequently and some of them are mixed with lidocaine to ease pain
    • •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**** (discuss)
    • •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