pharm 4 anti-infectives

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mthompson17
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225151
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pharm 4 anti-infectives
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2013-06-27 17:45:18
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pharmacology nursing antimicrobials
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Anti-infectives - Moore
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  1. Drugs for TB are used for _____ or ______ disease.
    prophylaxis

    active
  2. Ppl at increased risk for TB?
    healthcare, prison workers, immunocompromised
  3. What TB meds can cause optic neuritis?
    • 1. isoniazid
    • 2. ethambutol
  4. 5 meds used for TB?
    • STRIPE
    • STreptomicin
    • Rifampin
    • Isoniazid (INH)
    • Pyrinzinamide
    • Ethambutol
  5. 3 circumstances where prophylaxis for TB is indicated?
    • 1. in immunocompromised ppl who have induration with PPD of >5mm
    • 2. in high-risk workers who have induration >10mm
    • 3. in anyone who has induration >15mm
  6. What are the 4 first-line drugs for TB?

    Why are these first line?
    • You could catch TB on a crowded PIER:
    • Pyrazidamide
    • Isoniazide/INH   
    • Ethambutol
    • Rifampin



    they are effective with manageable toxicities
  7. Which med may be used for TB or leprosy?
    rifampin
  8. How are TB meds given?

    Why?
    combination therapy to prevent resistance
  9. If a pt is taking fluconazole & there is no indication of a candidiasis infection what should nurse do?
    check if they are immunocompromised for some reason
  10. Precautions with TB pt?
    N-95 mask
  11. When is a pt able to go home from hospital after TB infection?
    after 3 negative sputum tests
  12. 5 second-line drugs for TB?
    • 1. aminoglycosides
    • 2. cycloserine
    • 3. ethionamide
    • 4. fluroquinolones
    • 5. para-aminosalicylic acid
  13. Test results in a pt that will receive TB prophylactic Tx?
    will have positive PPD & negative chest X-ray
  14. Length of therapy for TB prophylaxis? (not active disease)
    6 to 9 months in normal pt

    12 months in immunocompromised
  15. What drug has multiple drug interactions esp. with HIV meds?
    rifampin - IV drug users inject amp -> HIV
  16. EX of immunocompromised pt?
    AIDS, steroid use (arthritis pt)
  17. 3 test that confirm active TB?
    • PosItivie:
    • 1. PPD
    • 2. AFB - sputum smear test
    • 3. chest X-ray
  18. Drug therapy for pt with active or reactivated TB?
    multi drug therapy required for 6 to 24 months
  19. 2 phases in the Tx of active TB & their goal?
    • 1. induction phase - get sputum to test negative/non-infectious
    • 2. continuation phase - eliminate all intracellular bacilli
  20. Therapy during the induction phase of active TB Tx?
    will get 3 or 4 drugs
  21. Standard of care for induction phase of TB Tx determined by?
    DOTS - Direct Observed Tx:  short course
  22. Therapy during the continuation phase of TB Tx?
    minimum of 2 drugs
  23. Memory help for isoniazid/INH?
    • I - Interactions with tyramine & histamine
    • N - Neuropathy (peripheral & optic)
    • H - Hepatotoxicity

    isoniazid - no antacid & take on empty stomach
  24. What is the most common cause of multi-drug resistant TB (MDR-TB)?
    inadequate drug therapy due to pt non-adherence
  25. What should be assessed prior to the admin of isoniazid?
    • 1. liver function tests
    • 2. Hx of liver disease or alc/drug use
  26. Action of isoniazid?
    disrupts cell wall synthesis
  27. Route of admin for isoniazid?
    IM, oral, IV
  28. When is isoniazid used for TB?
    always included in Tx regimen unless there is a resistance to it
  29. Isoniazid bactericidal or bacteriostatic?
    both
  30. Black box warning for isoniazid?
    hepatotoxic
  31. 2 common AE of isoniazid?
    • 1. hepatotoxicity
    • 2. peripheral neuropathy
  32. 4 important nursing responsibilities with isoniazid?
    • 1. prevent liver damage
    • 2. prevent peripheral neuropathy
    • 3. prevent food/drug interactions
    • 4. assess for pre-existing conditions
  33. 3 ways to minimize the potential for hepatitis with isoniazid use?
    • 1. assess for pre-existing hepatic disease
    • 2. assess for drug/alcohol use
    • 3. baseline liver function tests (LFTs) & serial LFTs during Tx
  34. What is the cause of peripheral neuropathy in isoniazid pt?
    isoniazid increases excretion of vitamin B6/pyridoxine -> peripheral neuropathy
  35. 3 ways to prevent peripheral neuropathy in isoniazid pt?
    • 1. teach pt to report s/s
    • 2. give vitamin B6/pyridoxine supplement
    • 3. routine eye exams for optic neuritis
  36. Interactions with isoniazid?
    tyramine foods & histamine foods
  37. Foods that contain histamine?
    tuna, yeast
  38. Education for pt taking isoniazid?
    • 1. take u.d. & why important to adhere
    • 2. explain alc/diet restrictions
    • 3. s/s of hepatotoxicity & peripheral neuropathy
    • 4. importance of eye exams
  39. 2 considerations for admin of isoniazid?
    • 1. take on empty stomach - 1 h before or 2 h after a meal
    • 2. avoid taking with antacids
  40. Memory help for rifampin?
    Rifampin = my fam

    they all drink/do drugs- hepatotoxiciy & multiple drug interactions

    Marisa has contact lenses and Leanne takes pyridium b/c she has UTI (discolors contacts & bodily fluids)

     they take ABX wrong so there is increased risk for mult. drug resistance

  41. Action of rifampin?
    inhibits RNA synthesis
  42. 2 uses for rifampin?
    TB & leprosy
  43. AE of rifampin?
    similar to isoniazid/INH esp hepatotoxiciy
  44. Teaching for pt taking rifampin?
    can discolor body fluids & stain contact lenses
  45. What antifungal med is extremely nephrotoxic?
    amphotericin B
  46. Why is rifampin ass. with many drug interactions?

    Important consideration?
    inducer of P450 enzyme system

    determine other drug therapy regimens esp. HIV meds
  47. Risk ass. with use of rifampin?
    risk of MDR-TB r/t pt non-adherence
  48. Potential adverse effects of ethambutol?
    optic neuritis  

    Ethambutol - Ethan has bad eyesight
  49. Assessment/monitoring for ethambutol pt?
    • 1. need eye exams
    • 2. monitor for change in vision color or acuity
  50. Potential AE of pyrazinamide?
    • 1. hepatoxicity
    • 2. arthralgias
    • 3. GI
    • 4. photosensitivity

    • Memory: pyrazinamide - pyro=fire
    • Pyro is photosensitive.  She meant to use sunblock but used arthritis cream  instead (arthralgias).  She thought you were supposed to eat it so she ate it & it damaged her liver & upset her stomach.
  51. 3 types of systemic fungal infections?
    • 1. aspergillosis
    • 2. cryptococcosis
    • 3. histoplasmosis
  52. Where is aspergillosis?

    Who gets it more often?
    soil or water

    immunocompromised
  53. Where can cryptococcosis infect?
    CNS/meningitis, lungs, disseminated
  54. Where does histoplasmosis infect?

    Where does is come from?

    s/s?
    lungs usually but can be other organs

    bird/bat droppings 

    flu-like s/s, chest pain, fever, weight loss
  55. What med can cause peripheral edema when given IV?
    metronidazole
  56. 2 types of superficial myoces?
    • 1. dermatophytic
    • 2. mucous membrane
  57. 2 types of mucous membrane superficial myoces?
    • 1. tinea
    • 2. candidiasis
  58. 6 polyene antifungal drugs?
    Many Funguses Can Annihilate A Nose.

    • Micafungin
    • Flucytocine
    • Caspofungin
    • Amphotersin B
    • Anidulafungin
    • Nystatin
  59. What will usually be in the name of a polyene antifungal drug?
    fungin
  60. How is nystatin taken?
    swish and swallow qid
  61. Amphotercin B memory help?
    amphotercin = ampho-terrible

    • Golden Poison Dart Frog
    •  
    • Ampho found a poisonous frog while picking mushrooms.  The terrible frog bit her in an artery.  Its poison damaged her kidneys and liver & she bled so much from her artery that she got electrolyte imbalances and pancytopenia.  At the hospital she received meds through a central line via pump but still experienced an infusion reaction so the nurse brought her a blanket.
  62. Med that should not be taken with grapefruit juice, pomegranate juice, or alcohol?
    Saquinavir
  63. 4 types of fungal infections that may be Tx with amphotercin B?
    • 1. aspergillisus
    • 2. candida
    • 3. cryptococcus
    • 4. histoplasma
  64. Action of amphotericin B?

    Disadvantage?
    causes fungal cell permeability (punches holes in it) -> causes fungal cell death

    also damages host cells
  65. Amphotericin B is used to treat ______ & potentially _____ systemic infections.
    progressive

    life threatening
  66. 5 potential adverse effects of amphotericin B?
    • 1. hepatotoxicity
    • 2. nephrotoxicity
    • 3. electrolyte disturbances
    • 4. pancytopenia - leukocytopenia, anemia, & thrombocytopenia
    • 5. infusion reactions
  67. Interventions for infusion reactions caused by amphotericin B?
    warm blankets & diversions
  68. What is the best way to give amphotericin B parenteral?
    give through central line with filter via pump!
  69. How should amphotericin B be given if central line is not an option?
    should have at least 2 IV's & rotate sites with each admin

    use PUMP!
  70. Nursing assessments/monitoring for pt on amphotericin B?
    • 1. pancytopenia - CBC, H&H, s/s of bleeding or infection
    • 2. monitor drug interactions
    • 3. kidney damage - I&O, creatinine, hydration
    • 4. electrolytes
    • 5. liver function & s/s of liver damage
  71. Coadministration of amphotericin B?
    avoid coadmin if possible
  72. What should be done prior to the first dose of amphotericin B?
    admin a test dose & monitor for infusion reaction
  73. When will infusion reaction with amphotericin B usually occur?
    w/in first 15 min of admin
  74. Nursing interventions for pt taking amphotericin B?
    • 1. blankets/diversions for infusion reactions
    • 2. maintain hydration
    • 3. Educate pt about reaction potential
  75. How should ALL antifungals be admin?
    VERY SLOW over 2 to 6 h
  76. What antifungal drug is similar in structure to amphotericin B?
    nystatin
  77. Uses for nystatin?
    Tx topical, vaginal, & oral fungal infections
  78. Why is nystatin not used for systemic fungal infections?
    poor GI absorption & toxicity
  79. Nystatin oral troches admin?
    dissolved in mouth - don't chew or swallow
  80. Antifungal drugs end with _____.
    azole
  81. 3 antifungal drugs?
    • 1. fluconazole/Diflucan
    • 2. itraconazole/Sporanox
    • 3. ketoconazole/Nizoral
  82. 3 uses for fluconazole?
    1. Tx esophageal, oropharyngeal, & vulvovaginal candidiasis

    2. Tx systemic infections

    3. prophylaxis for immunocompromised pt esp HIV with CD4 <200
  83. 3 potential adverse effects of fluconazole?
    • 1. GI disturbances
    • 2. HA & dizziness
    • 3. mildly elevated liver enzymes

    Conazole had the flu.  She had GI upset & was throwing up so hard she got a HA & was very dizzy.  She took so much tylenol for her HA that she had elevated liver enzymes.
  84. Action of acyclovir?
    competes for position in DNA chain of herpes virus then terminates DNA synth.
  85. Use for acyclovir?
    • use for herpes viruses ONLY:
    • 1. herpes simplex I & II
    • 2. herpes zoster/shingles
    • 3. epstein-barr virus
    • 4. cytomegalovirus/CMV
  86. 2 routes of admin for acyclovir?
    topical, oral
  87. 2 goals of acyclovir Tx?
    • 1. shorten outbreak
    • 2. extend time b/t outbreaks
  88. What drugs should not be given with pre-existing eye diseases?
    anti-malarials:  hydroxychloroquine & chloroquine
  89. Memory help for acyclovir?
    Acyclovir has anorexia.  She was riding her bicycle so long that she got dehydrated & light-headed.  She ran her bike into a water fountain  & landed on her head.  She hit it so hard she had a seizure.  When she woke up her head & abd hurt so bad she took 8 tylenol with 8 oz of water which caused her to have liver and kidney damage.
  90. Med that can cause thrombophlebitis?
    metronidazole
  91. Why may nephrotoxicity occur with acyclovir?
    • can cause crystallization
  92. 3 common AE of acyclovir?
    • 1. HA
    • 2. GI: NV, anorexia, abd pain
    • 3. light headed
  93. 2 serious AE of acyclovir?
    nephrotoxicity & neuro/seizures
  94. Teaching for acyclovir pt?
    • 1. 8 - 8 oz glasses of water per day
    • 2. prevent spreading
    • 3. Wear gloves & wash hands before & after application of topical
    • 4. Protect from light & moisture - don't store in bathroom
  95. 2 topical antivirals?
    • 1. abreva
    • 2. denavir
  96. Abreva?
    OTC topical Tx for herpes simplex I/oral herpes
  97. Denavir?

    Admin?
    Rx Tx for herpes simplex II

    requires multiple applications throughout the day:  wear gloves & wash hands before and after admin
  98. 4 antivirals that Tx influenza?

    What type of influenza does each Tx?
    • 1. amantadine - A
    • 2. rimantadine - A
    • 3. tamiflu - A & B
    • 4. Relenza - A & B

    "dines" are A only
  99. If a med has ivir at the end it is an _____ med.
    antiviral
  100. Uses for tamiflu?

    Admin?
    Tx & prophylaxis for influenza type A & B

    give w/in 48 h of onset
  101. 4 AE of tamiflu?
    • 1. N/V
    • 2. bronchitis      
    • 3. insomnia
    • 4. vertigo 

            

    Influenza had insomnia b/c she was sick with bronchitis.  She took a lot of cold medicine that made her have vertigo and she got very nauseated.
  102. Therapy for HIV & AIDS?
    HAART - Highly Active AntiRetroviral Therapy
  103. 5 drugs that Tx HIV & AIDS?
    • PENNN
    • 1. Protease inhibitors
    • 2. Entry inhibitors
    • 3. Nucleoside Reverse Transcriptase Inhibitors
    • 4. Nonnucleoside Reverse Transcriptase Inhibitors
    • 5. Nucleoside Reverse Transcriptase Inhibitors
  104. How are HAART drugs admin?

    Action?
    combo of 3 to 4 drugs

    inhibit enzymes, replication, etc. to decrease progression
  105. Action of retrovir?
    inhibit reverse transcriptase

    reverse transcriptase is an enzyme produced by HIV virus that allows it to form viral DNA w/in human cell
  106. Route of admin for retrovir?
    oral and parenteral
  107. Retrovir memory help?
    Retro is a hippy who likes to shoot up acid that he learned to make from milk (lactic acidosis)  The milk in his blood is killing all of his blood cells (bone marrow suppression) & the fat from the milk is building up in his liver and making his pancreas very tired (liver damage/fatty liver, pancreatitis, fatigue).  He is always running from his hallucinations so he has muscle pains & tingling (peripheral neuritis) & he is wasting away.
  108. 7 serious AE of retrovir?
    • 1. lactic acidosis with hepatic steatosis
    • 2. bone marrow suppression
    • 3. hepatotoxicity
    • 4. muscle pain/myopathy
    • 5. peripheral neuropathy
    • 6. wasting
    • 7. pancreatitis
  109. 3 Black Box Warnings for retrovir?
    • 1. hematologic toxicities r/t bone marrow suppression
    • 2. myopathy
    • 3. lactic acidosis
  110. What causes lactic acidosis & pancreatitis with retrovir?
    altered fat & protein metabolism
  111. What type of drug is retrovir?
    NRTI for HIV
  112. 4 things to educate retrovir pt about?
    • 1. need low-fat diet
    • 2. adherence to therapy & why important
    • 3. warn about serious AE
    • 4. follow up for blood monitoring
  113. Admin of retrovir?
    admin 1 h before meals - will get 600mg per day BID-TID
  114. NNRTIs compared to NRTI/retrovir?
    less powerful & less toxic

    only effective against HIV-1
  115. Action of NNRTIs?
    inhibit reverse transcriptase enzyme
  116. Prototype NNRTI?
    Sustiva
  117. Admin of sustiva?
    tk 1 time per day hs on an empty stomach

    used as polytherapy
  118. Common AE of sustiva?
    • 1. dizziness
    • 2. impaired concentration
    • 3. insomnia
    • 4. abnormal dreams
    • 5. hallucinations

    • sustiva- sustenance - When Sustiva takes adipex she does not want to take sustenance.  Adipex gives her insomnia & abnormal dreams and she gets dizzy and has impaired concentration if she doesn't eat.  She hallucinated that she saw a doughnut & ate poison which caused hepatotoxicity.  When they gave her meds at the hospital she had a Stevens Johnson syndrome reaction.
  119. When is sustiva admin?

    Why?
    give at night to decrease CNS s/s
  120. Education for pt taking sustiva?
    • should not drive until know how it affects them
    • take hs
  121. Most potent anti-HIV drugs?
    protease inhibitors (PIs)
  122. Activity and admin of protease inhibitors (PI)?
    they have activity against both HIV I & II and are used as polytherapy
  123. Prototype protease inhibitor drug (PI)?
    saquinavir
  124. Memory help for saquinavir?
    • Saquinavir is an indian.  She went riding on her buffalo (hump) & decided to eat some chocolate-covered bacon.  She ate so much that she got sick to her stomach and developed insulin resistance.  She felt so sick she fell off her buffalo and got a headache.  She developed hyperlipidemia and even had fat deposits in her liver.  She could not sleep because she was so upset about all the fat in her body, because she knew it would increase her risk for pancreatitis and cardiovascular problems so she got up and drank some grapefruit and pomegranate juice with vodka.  (should not be taken with grapefruit or pomegranate juice or with alcohol)
  125. Most common adverse effects of saquinavir?
    • 1. deposits of fat/buffalo hump
    • 2. GI upset
    • 3. insulin resistance
    • 4. HA
    • 5. hyperlipidemia
    • 6. fat deposits in liver
    • 7. hepatotoxicity
    • 8. insomnia
  126. 2 most serious AE of saquinavir?
    • 1. cardiovascular problems
    • 2. pancreatitis r/t fat probs
  127. Pt education with saquinavir?
    • 1. low-fat & chol. foods
    • 2. limit alcohol consumption r/t liver damage
    • 3. do not take with grapefruit or pomegranate juice or with garlic
    • 4. Take with small frequent meals to help with GI upset.
  128. Effect of taking garlic, grapefruit juice, or pomegranate juice with Saquinavir?
    can lower med levels
  129. Action of entry inhibitors/fusion inhibitors?
    inhibits HIV from binding to, fusing with, & entering the human cell
  130. Prototype entry/fusion inhibitor?
    Fuzeon
  131. Admin of fuzeon?
    SQ in 12 h intervals/bid
  132. Most common AE of fuzeon admin?
    injection site reactions

    fuzeon - med fuses with the skin & irritates it
  133. Most serious AE of fuzeon admin?
    bacterial pneumonia

    fuzeon - pneu-mon-ion
  134. 4 pt education for pt taking fuzeon?
    • 1. rotate injection sites to increase absorption and decrease irritation
    • 2. how to reconstitute & admin
    • 3. use of asceptic technique
    • 4. monitor for s/s of infection
  135. Anti-parasitic drug that Tx protozoan infections?
    metronidazole/Flagyl
  136. 6 things that may be Tx with metronidazole?
    • BAT TAG
    • Bacterial vaginosis
    • Amebiasis
    • Trichamoniasis
    • Toxoplasmosis
    • Antibiotic-associated pseudomembranous colitis
    • Giardiasis
  137. Admin of metronidazole PO?
    should give with meals to decrease GI s/s & bad taste ass. with med
  138. Admin of metronidazole IV?
    give slowly over 1 h
  139. 2 things to monitor when give metronidazole IV?
    • 1. thrombophlebitis s/s
    • 2. s/s of peripheral edema
  140. Memory help with metronidazole?
    Metronidazole - Metro-fell-in-a-hole

    • Metro fell in a hole and hit her head and her stomach. (GI upset)  She had a HA & was very dizzy from loss of blood (blood dyscrasias). She had a dry mouth so she began to drink some canadian mist she had in her purse even though she was pregnant. (no alcohol or pregnancy) When she was taken to the hospital they gave her IV fluids and some food, but the IV caused thrombophlebitis & peripheral edema & the food did not taste right so she didn't eat.
  141. Common AE of metronidazole?
    • 1. GI upset & anorexia
    • 2. CNS: HA & dizziness
    • 3. dry mouth
    • 4. thrombophlebitis & peripheral edema with IV admin
    • 5. altered taste
  142. Serious AE of metronidazole?
    blood dyscrasias
  143. Pt education with metronidazole?
    • 1. no alcohol & make sure other products don't contain alcohol
    • 2. can't use if pregnant
    • 3. take with meals
    • 4. s/s of blood dyscrasias
  144. Antimalarial drugs end with ____.
    quine
  145. 2 antimalarial drugs?
    • 1. chloroquine/Aralen
    • 2. hydroxychloroquine/Plaquenil
  146. Which antimalarial drug is less toxic?
    hydroxychloroquine
  147. 3 uses for antimalarial drugs?
    • 1. prophylaxis
    • 2. Tx acute attack
    • 3. prevention of relapse
  148. 2 things to consider when using antimalarials for prevention of relapse?
    • 1. identity of species
    • 2. geographic area of infection
  149. Memory help for antimalarial drugs:  chloroquine and hydroxychloroquine?
    Hydroxy & chloroquine are twins.  Hydroxy is blind(retinopathy), and she ran into chloroquine and broke her nose.  Chloroquine bled so much she got anemic & her blood pressure dropped.  Hydroxy was so upset about what she did that she thought she was going to throw up (GI upset), but she ate a meal(take with meals) and felt better.
  150. Major contraindication for antimalarial drugs?
    pre-existing eye disease like cataracts or retinopathy
  151. Common AE of antimalarial drugs?
    • 1. hypotension
    • 2. GI upset

    hydroxychloroquine sounds like hydrochlorothiazide & they both lower BP
  152. 2 serious AE of antimalarials?
    • 1. retinopathy
    • 2. aplastic anemia
  153. What does nurse need to know prior to admin of antimalarial drugs?
    Hx of eye disease or hypotension
  154. Pt education with antimalarials?
    • 1. change positions slowly r/t hypotension
    • 2. admin med on same day each week
    • 3. admin with meals to decrease GI effects
    • 4. potential for eye probs
    • 5. s/s of aplastic anemia
  155. Admin of antimalarials for prophylaxis?
    begin 1 to 2 wks before entering area & continue for 4 to 6 weeks after leaving the area
  156. Mebendazole memory help?
    Mebendazole climbed a tree (trematodes) & got infected with worms.  Her stomach was hurting and she felt dizzy.  She fell out of the tree and pooped her pants (diarrhea).  She had a horrible HA and was bleeding everywhere (blood dyscrasias.
  157. Antihelminthic drug?
    mebendazole/Vermox
  158. 3 types of helminths Tx by mebendazole?
    • 1. nematodes- round worms
    • 2. trematodes- flukes
    • 3. cestodes - tapeworms
  159. Common AE of mebendazole/anti-helminths?
    GI upset:  abd pain, diarrhea, dizziness, & HA
  160. Serious AE of mebendazole?
    blood dyscrasias
  161. 3 antihelminthics/mebendazole nursing considerations
    • 1. Tx entire family at same time
    • 2. encourage small, frequent meals to decrease GI effects
    • 3. educate pt to wash clothing and bed linens etc at the same time family is being Tx
  162. Prototype antiectoparasitic drug?
    permethrin/Elimite/Nix
  163. 7 uses for permethrin?
    • Many Fleas Like Biting My Tiny Cat
    • Mosquitos
    • Fleas
    • Lice/pediculosis
    • Biting flies
    • Mites/scabies
    • Ticks
    • Chiggers
  164. Route of admin for permethrin?
    topical
  165. Permethrin for Tx of lice?
    OTC 1%
  166. Permethrin for Tx of scabies?

    Consideration?
    Rx 5%

    need to Tx the whole family !
  167. 2 common AE of permethrin?
    • 1. skin irritation
    • 2. pruritis
  168. 3 pt education for permethrin?
    • 1. apply only u.t.
    • 2. keep out of reach of children and do not let them admin med
    • 3. do not leave on more than recommended time period

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