Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
95 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
PROTOTYPE:
hepatitis B vaccine (Engerix-B, Recombivax HB) |
MOA: Vaccine, to provide active immunity.
PU: Individuals at risk for exposure to hep B virus AE: pain and inflammation at injection site, transient fever or fatigue |
|
|
|
PROTOTYPE:
interferon alpha-2a (Roferon-A) |
MOA: enhances or stimulates immune system to remove antigens; suppresses growth of cancer cells.
PU: remove hair-cell leukemia, chronic hep C infection, or malignant melanoma (Unlabeled use: hep B; AIDS-related Karposi's, immunostimulant) AE: Flu-like syndrome in 50%, headache, nausea, vomiting, diarrhea; anorexia, depression, suicidal ideation; long term use: immunosuppression, hepatotoxicity, neurotoxicity |
|
|
|
PROTOTYPE:
cyclosporine (Neoral, Sandimmune) |
MOA: inhibit helper T cells
PU: transplant recipients AE: 75% pt experience reduction of urine flow; infections, tremor, hypertension, elevated hepatic enzymes |
|
|
|
PROTOTYPE:
NSAIDs (Advil, Motrin, others) |
MOA: inhibit of prostaglandin synthesis
PU: musculoskeletal disorders such as RA and osteoarthritis; mild to moderate pain, reduction of fever, primary dysmenorrheal pain AE: nausea, heartburn, epigastric pain, dizziness |
|
|
|
PROTOTYPE:
prednisone (Meticorten) |
MOA: being metabolized to an active form of glucocorticoid
PU: treatment of inflammation AE: long-term therapy may result in Cushing's syndrome. |
|
|
|
PROTOTYPE:
acetaminophen (Tylenol) |
MOA: to reduce fever by direct action at level of hypothalamus and dilation of peripheral blood vessels; enables sweating and dissipation of heat
PU: to relieve pain and reduce fever, no antiinflammatory actions AE: possible liver damage; less gastric irritation than aspirin, does not affect blood coagulation (inhibits warfarin, coumadin) ANTI: N-acetylcysteine IV (Acetadote, Mucomist) |
|
|
|
PROTOTYPE:
penicillin G (Pentids) |
MOA: to kill bacteria by disrupting their cell walls - bacteriocidal
PU: as drug of choice against streptococci, pneumococci, staphylococci organisms that do not produce penicillinase; also choice for most gonorrhea and syphilis AE: BROAD spectrum; diarrhea, nausea, vomiting, superinfections, anaphylaxis |
|
|
|
PROTOTYPE:
ceftotaxime (Claforan) |
CEPHALOSPORIN
MOA: to act with BROAD-spectrum activity against gram-negative organisms PU: for serious infections of lower respiratory tract, CNS, GU system, bones, blood, joints AE: hypersensitivity, anaphylaxis, diarrhea, vomiting, nausea, pain at injection site |
|
|
|
PROTOTYPE:
tetracycline HCL (Achromycin, others) |
TETRACYCLINE
MOA: effective against broad range of gram-positive and -negative organisms PU: chlamydiae, rickettsiae, mycoplasma AE: superinfections, nausea, vomiting, epigastric burning, diarrhea, discoloration of teeth, photosensitivity; TOXIC when outdated |
|
|
|
PROTOTYPE:
erythromycin (E-Mycin, Erythrocin) |
MACROLIDE
MOA: to act as spectrum similar to that of penicillins; also to be effective against gram-positive bacteria PU: Bordetella pertussis (whooping cough) and Corynebacterium diphtheriae, most gram-positive bacteria AE: nausea, abdominal cramping, vomiting; most severe is hepatotoxicity |
|
|
|
PROTOTYPE:
gentamicin (Garamycin) |
AMNIOGLYCOSIDE
MOA: to act as broad-spectrum, bacteriocidal antibiotic PU: serious urinary, respiratory, nervous, or GI infections; often used in comb with other antibiotics, used parenterally or as drops for eye infections AE: ototoxicity, nephrotoxicity |
|
|
|
PROTOTYPE:
ciprofloxacin (Cipro) |
FLUOROQUINOLONE
MOA: to inhibit bacterial DNA gyrase; affects bacterial replication and DNA repair PU: for respiratory infections, bone and joint infections, GI infections, ophthalmic infections, sinusitis, prostatitis AE: nausea, vomiting, diarrhea, phototoxicity, headache, dizziness, ruptured Achilles common |
|
|
|
PROTOTYPE:
trimethoprim-sulfamethoxazole (Bactrim, Septra) |
SULFONAMIDE
MOA: to kill bacteria by inhibiting bacterial metabolism of folic acid PU: for UTI, Pneumocystitis carinii pneumonia, shigella infections of small bowel, acute episodes of chronic bronchitis AE: skin rashes, nausea, vomiting, agranulocytosis, thrombocytopenia |
|
|
|
PROTOTYPE:
cyclophosphamide (Cytoxan) |
ALKYLATING AGENT (chemo)
MOA: attaches to DNA and disrupts replication PU: to treat wide variety of cancers, including Hodkgin's, lymphoma, multiple myeloma, breast cancer, ovarian cancer AE: immunosuppressant effects, thrombocytopenia; nausea, vomiting, diarrhea, anorexia; alopecia, hemorragic cystitis ANTI: prophylactic antimicrobials, platelet transfusion, hemopoietic growth factor |
|
|
|
PROTOTYPE:
methotrexate (Folex, Mexate, others) |
ANTIMETABOLITES (chemo)
MOA: blocks synthesis of folic acid (Vitamin B9) to inhibit replication PU: to treat choriocarcinoma, osteogenic sarcoma, leukemias, head and neck CA, breast CA, lung CA AE: fatal bone marrow toxicity at high doses, hemorrhage and bruising, low platelet counts, nausea, vomiting, anorexia, GI ulceration, intestinal bleeding ANTI: Leucovorin (folinic acid), alkalinize urine to protect kidneys from toxicity, prophylactic antimicrobials, platelet transfusions, hemopoietic growth factor |
|
|
|
PROTOTYPE:
doxorubicin (Adriamycin) |
ANTITUMOR ANTIBIOTICS
MOA: attaches to DNA; distorts helical structure and prevents normal DNA and RNA synthesis PU: solid tumors of the lung, breast, ovary, bladder, and for various leukemias and lymphomas AE: CARDIOTOXICITY, dysrhythmias; irreversible heart failure, lower blood-cell counts; nausea, vomiting ANTI: prophylactic antimicrobials, platelet transfusions, hemopoietic growth factor. |
|
|
|
PROTOTYPE:
tamoxifen (Nolvadex) |
HORMONES/HORMONE ANTAGONISTS
MOA: blocks estrogen receptors on breast CA cells. PU: clients with breast CA; also for high risk clients to prevent disease AE: nausea and vomiting; assoc. with increased risk of endometrial CA and thromboembolic disease; hot flashes, fluid retention, vaginal discharge common |
|
|
|
PROTOTYPE:
vincristine (Oncovin) |
MOA: cell-cycle-specific (M-phase) agent that kills CA cells by preventing their abilities to complete mitosis
PU: treatment of Hodgkin's and non-Hodgkin's; leukemias, Kaposi's, Wilms' tumor; bladder CA, breast CA AE: NERVOUS SYSTEM TOXICITY, numbness and tingling in limbs; muscular weakness, loss of neural reflexes, pain, paralytic ileus, constipation, alopecia ANTI: suppportive therapy, Leucovorin |
|
|
|
PROTOTYPE:
diphenhydramine (Benadryl) |
H1 Receptor Antagonist (Antihistamine)
MOA: histamine (H1) receptor blocker (1st Gen) PU: to treat minor symptoms of allergy and common cold AE: drowsiness; occasionally, paradoxical CNS stimulation and excitability; anticholinergic effects (dry mouth, tachycardia, mild hypotension); may cause photosensitivity |
|
|
|
PROTOTYPE:
fexofenadmine (Allegra) |
H1 Recep. Antagonist (Antihistamine)
MOA: histamine (H1) receptor blocker (2nd Gen) PU: reduces severity of nasal congestion, sneezing, tearing of eyes; most effective when taken before symptoms develop AE: drowsiness (less than 1st Gen), headache, upset stomach |
|
|
|
PROTOTYPE:
oxymetazoline (Afrin) |
DECONGESTANT
MOA: stimulates alpha-adrenergic receptors in sympathetic nervous system; causes arterioles in nasal passages to constrict; dries mucous membranes PU: to treat nasal congestion AE: rebound congestion when oxymetazoline is used for longer than 3 to 5 days; minor stinging and dryness in nasal mucosa may be experienced. |
|
|
|
PROTOTYPE:
fluticasone (Flonase) |
INTRANASAL GLUCOCORTICOIDS
MOA: decreases local inflammation in nasal passages, thus reducing nasal stuffiness PU: to treat seasonal allergic rhinitis AE: nasal irritation, epistaxis |
|
|
|
PROTOTYPE:
dextromethorphan (Benylin) |
ANTITUSSIVES
MOA: acts in medulla to inhibit cough reflex PU: as component in most OTC severe cold and flu preparations AE: dizziness, drowsiness, GI upset |
|
|
|
PROTOTYPE:
salmeterol (Serevent) |
BETA-ADRENERGIC AGONIST (asthma)
MOA: selectively binds to beta-2-adrenergic receptors in bronchial smooth muscle to cause bronchodilation PU: prevention of exercise-induced bronchospasm; best suited for management of chronic asthma; not indicated for termination of acute bronchospasm AE: headaches, throat irritation, nervousness, restlessness, tachycardia |
|
|
|
PROTOTYPE:
ipratropium bromide (Atrovent) |
ANTICHOLINERGIC
MOA: causes bronchodilation by blocking cholinergic receptors in bronchial smooth muscle PU: used to prevent bronchoconstriction, NOT for acute asthma exacerbation (local effects) AE: dry mouth or throat, GI distress, headache, coughing, anxiety |
|
|
|
PROTOTYPE:
zafirlukast (Accolate) |
LEUKOTRIENE MODIFIER
MOA: prevents airway edema and inflammation by blocking leukotriene receptors in airways PU: for prophylaxis of persistent, chronic asthma AE: headache, nausea, diarrhea |
|
|
|
PROTOTYPE:
beclomethasone (Beclovent, Beconase, Vancenase, Vanceril) |
GLUCOCORTICOID (antiinflammatory)
MOA: acts by reducing inflammation PU: to decrease frequency of asthma attacks; also for allergic rhinitis, should not be used to terminate asthma attacks in progress AE: oropharyngeal candidiasis |
|
|
|
NOTES
Active immunity |
Body makes antibodies
-natural -artificial: vaccines, toxoids |
|
|
|
NOTES
Passive immunity |
Someone else does the work to make antibodies (i.e. mom to baby, antibody shot); short lived.
-natural -artificial -antitoxin -antivenin -immune globulins |
|
|
|
NOTES
Two methods to achieve active immunity: |
1 - get a disease and survive
2 - become immunized against a disease |
|
|
|
NOTES
Three types of vaccines: |
1 - killed microbes (needs booster)
2 - attenuated (weakened) microbes 3 - toxoids (modified bacterial toxins) |
|
|
|
NURSING PROCESS FOCUS
Clients receiving Hepatitis B vaccine |
ASSESS: obtain complete health history, assess cardiopulmonary fx, assess for active infection
IMP: -provide immunization schedule to client (3 IM injections) -monitor for allergic response (anaphylaxis possible) -discuss reliable birth control (vaccine can cause birth defects) -report any signs of allergic response ASAP -avoid pregnancy for 3 months after admin |
|
|
|
NOTES
Immune Globulin Preparations |
-provide passive immunity following exposure to hepatitis; no memory cells produced --> lasts only 2-3 wks
|
|
|
|
NOTES
Interferons |
-slows spread of viral infections and enhances the activity of leukocytes
-Two major class: -interferon alpha (leukemia, AIDS, hep b/c) -interferon beta (MS, granulomatous disease, severe osteoporosis |
|
|
|
NOTES
Interleukins |
-used to treat renal CA
-stimulate platelet production in immunosuppressed clients -promotes inflammation |
|
|
|
NURSING PROCESS FOCUS
Clients receiving immunostimulant therapy |
ASSESS: labwork (CBC, electrolytes, liver enzymes), obtain weight/vitals--esp BP
IMP: -monitor for leukopenia, neutropenia, thrombocytopenia, anemia, increased liver enzymes (drugs can cause bone marrow suppression and liver damage) -Monitor blood glucose levels (may increase in pt with pancreatitis) -monitor for change in mental status (causes or aggravates neuropsychiatric disorders) *immediately report unusual bleeding or jaundice! -avoid crowds and people with infections -avoid activities that can cause bleeding or impaired skin integrity -pt monitor BP and pulse every day -report palpitations immediately |
|
|
|
NOTES
4 types of immunosuppressants: |
-glucocorticoids
-antimetabolites -antibodies -calcineurin inhibitors |
|
|
|
DEFINE CLASS
Glucocorticoids |
inhibit inflammation; used for SHORT-term therapy of severe inflammation. Ex: prednisone
|
|
|
|
DEFINE CLASS
Antimetabolites |
inhibit aspects of lymphocyte replication. Ex: sirolimus (Rapamune)
|
|
|
|
DEFINE CLASS
Antibodies |
created in other species to fight human T cells. Ex: infliximab (Remicade)
|
Ex:
-muromonab-CD3 (Orthoclone OKT3) prevents rejection of kidney, heart, and liver transplants; depletes bone marrow of T cells prior to marrow transplant. -basiliximab (Simulect) and daclizumab (Zenapax) prevent acute rejection of kidney transplants |
|
|
DEFINE CLASS
Calcineurin inhibitors |
Bind to calcineurin and disrupt T cells. Ex: cyclosporine (Neoral)
|
|
|
|
*****
Cyclooxygenase-1 (COX-1) |
location: present in all tissues
fx: protects gastric mucosa, supports kidney function, promotes platelet aggregation, regulates smooth muscle tone in blood vessels and bronchial tree inhibition by meds: UNDESIRABLE - increases risk of gastric bleeding, gastric upset, and kidney failure |
*****
Watch for bleeding and monitor renal function |
|
|
*****
Cyclooxygenase-2 (COX-2) |
location: present at sites of tissue injury
fx: mediates inflammation, sensitizes pain receptors, mediates fever in the brain. inhibition by meds: DESIRABLE - results in suppression of inflammation |
*****
more specific than COX-1 |
|
|
*****
5 fundamental steps of inflammation: |
-Vasodilation (redness, heat)
-Vascular permeability (edema) -Cellular infiltration (pus) -Thrombosis (clots) -Stimulation of nerve endings (pain) |
|
|
|
CHEM MEDIATORS INFLAMMATION
bradykinin |
present in an inactive form in plasma and mast cells; vasodilator that causes pain; effects are similar to those of histamine
|
|
|
|
CHEM MEDIATORS INFLAMMATION
complement |
series of at least 20 proteins that combine in a cascade fashion to neutralize or destroy an antigen
|
|
|
|
CHEM MEDIATORS INFLAMMATION
histamine |
stored and released by mast cells; causes dilation of blood vessels, smooth-muscle constriction, tissue swelling, and itching
(BOOK) |
-key chemical mediator in inflammation
-stored in mast cells -initiates inflammatory response -directly stimulates pain receptors -release of histamine produces vasodilation; capillaries become "leaky" and cause tissue swelling -responsible for symptoms of anaphylaxis (bronchioles fill with fluid) (NOTES) |
|
|
CHEM MEDIATORS INFLAMMATION
leukotrienes |
stored and released by mast cells; effects are similar to those of histamine
|
|
|
|
CHEM MEDIATORS INFLAMMATION
prostaglandins |
present in most tissues and stored and released by mast cells; increase capillary permeability, attract white blood cells to site of inflammation, and cause pain
|
|
|
|
*****
Because some penicillin preparations contain high levels of ______ and ______ ________, monitor for ______ and ______ prior to and during therapy. |
sodium
potassium salts hyperkalemia hypernatremia |
|
|
|
*****
Primary goal of antibiotic therapy: |
kill enough bacteria, or to slow the growth of infection, so that natural body defenses can overcome the invading agent.
|
|
|
|
NOTES
Signs of inflammation |
-swelling
-pain -warmth -redness |
|
|
|
NOTES
Histamine can produce its effects by interacting with two different receptors: |
H1 receptors
H2 receptors |
|
|
|
NOTES
H1 Receptors |
-Found in vascular smooth muscle, in bronchi, and on sensory nerves.
-Stimulation results in itching, pain, edema, vasodilation, bronchoconstriction -characteristic symptoms of inflammation and allergy |
|
|
|
NOTES
H2 Receptors |
-located in stomach
-stimulation results in secretion of hydrochloric acid |
|
|
|
NOTES
Inflammation relief inhibits either the: |
-leukotriene pathway
-prostaglanding pathway OR both |
|
|
|
NOTES
Nonsteroidal anti-inflammatory drugs |
-primary drugs for treatment of mild to moderate inflammation
-include aspirin, ibuprofen, and COX-2 inhibitors -all have about the same efficacy -all are analgesics and antipyretics -side effects vary |
|
|
|
NOTES
First generation NSAIDs |
COX-1 inhibitors
-dyspepsia, heartburn, epigastric distress, nausea -GI bleeding -mucosal lesions (erosions or ulcerations) |
|
|
|
NOTES
Second generation NSAIDs |
COX-2 inhibitors
-more specific in their action -reduce GI distress -serious side effects: -cardiac arrhythmias -heart attack -stroke -renal failure (reduced creatinine clearance first sign) [informed consent important --> Celebrex, Mobic] |
|
|
|
*****
COX-1 and COX-2 inhibitor precautions |
Do NOT take if:
-have or had stomach ulcers and bleeding -have had asthma -have had an allergic response to aspirin or sulfa -have severe kidney problems -have severe liver problems -pregnant |
Monitor kidney function and I&O
|
|
|
NOTES
Aspirin |
-treats inflammation by inhibiting both COX-1 and COX-2
-readily available, inexpensive, effective -large doses needed to relieve severe inflammation -ADVERSE effects: irritate digestive system, may cause bleeding, salicylism. |
*****Effects of inhibiting BOTH COX-1 and COX-2:
-more stomach acid -difficulty blood clotting -lower renal blood flow -suppresses inflammation, pain, fever |
|
|
NOTES
Ibuprofen |
-alternative to aspirin
-inhibits COX-1 and COX-2 |
*****Effects of inhibiting BOTH COX-1 and COX-2:
-more stomach acid -difficulty blood clotting -lower renal blood flow -suppresses inflammation, pain, fever |
|
|
NOTES
COX-2 inhibitors |
-newest and most controversial class
-no inhibition of COX-1; does not affect blood coagulation; does not irritate digestive system -Celebrex only remaining COX-2 inhibitor |
-Vioxx and Bextra removed from market; Vioxx found to double risk of heart attack and stroke.
|
|
|
NOTES
NSAIDs implementation |
-obtain baseline kidney and liver-function tests, CBC
-monitor bleeding time with long-term admin -assess for changes in pain, reduct. in temp and inflammation -assess for GI bleed, hepatitis, nephrotoxicity, hemolytic anemia, salicylate toxicity -use cautiously in elderly => potential for increased bleeding -aspirin contrandicated in pediatric clients (under 12-14) --> REYE'S |
Reye's syndrome:
-increased intracranial pressure, massive accumulation of lipids in the liver |
|
|
NOTES
Glucocorticoids |
-effective for short-term treatment of acute inflammation
-if on long-term dose-->d/c gradually, alternate-day dosing, keep dose low,Cushing's may result -serious ADVERSE effects -can mask infections |
*****Assess for infection priot to administration of glucocorticoids.
HOLD and call: fever, low CBC, etc. |
|
|
NOTES
Antipyretic drug implementation |
-assess developmental status, origin of fever, assoc. symptoms
-baseline lab data necessary to assess kidney and liver status -acetaminophen antipyretic of choice for fevers -aspirin contraindicated for pediatric clients -motrin contraindicated before 1 y.o. |
Determine appropriate formulation or route: clients who are vomiting = suppository; young children = flavored elixirs
Acetaminophen: contraindicated in clients with significant liver disease; inhibits warfarin metabolism; may result in bleeding |
|
|
*****
Reduce ASA intolerance: |
Crushed, dissolved in water = faster absorption, reduces time in GI tract
|
|
|
|
*****
pathogenicity |
ABILITY of an organism to cause infection.
|
|
|
|
*****
virulence |
MEASURE of disease-producing potential
|
|
|
|
NOTES
Nosocomial infection |
Hospital acquired infection
|
|
|
|
NOTES
Multiple antibiotic drug therapy can be used: |
-when multi-organisms cause infection
-for treatment of tuberculosis -for treatment of HIV |
|
|
|
*****
Superinfections |
-occurs when too many host flora are killed by an antibiotic..
-pathogenic microorganisms have chance to multiply -opportunistic: take advantage of suppressed immune system -signs and symptoms include diarrhea, bladder pain, painful urination, or abnormal vaginal discharge |
|
|
|
NOTES
Host factors that influence choice of antibiotics: |
-immune system status
-local conditions at infection site -allergic reactions -age -pregnancy status -genetics |
|
|
|
NOTES
Antibacterial agents |
-penicillins
-cephalosporins -tetracyclines -macrolides -aminoglycosides -fluroquinolones -miscellaneous |
|
|
|
CLASS
Penicillins (-cillin) |
-bacteriocidal
-most effective against gram-positive bacteria -kill bacteria by disrupting cell wall with beta-lactam ring -some penicillins are rapidly destroyed in the stomach --> p.o. not effective; given IM or IV |
-assess previous drug reactions to penicillin
-avoid cephalosporins if allergic ***monitor for hyperkalemia and hypernatremia -monitor cardiac status, including ECG changes |
|
|
NOTES
enzyme allowing bacteria to be resistant to penicillin |
-beta-lactamase or penicillinase.
-potassium clavulanide inhibits penicillin; combined with penicillin -new penicillins are penicillinase-resistant (oxacillin and cloxacillin) -combination drugs with beta-lactamase inhibitors (clavulanate, sulbactam, tazobactam) |
|
|
|
*****
Adverse effects of penicillin |
-one of safest classes of antibiotic
-allergy most common side effect; anaphylaxis can happen on first dose -if client allergic to penicillin, avoid cephalosporins (possible cross-sensitivity) -other adverse effects: -skin rash -decreased RBC, WBC, platelet counts **Monitor first and second dose closely for allergic reaction |
If allergic to penicillin, but prescribed cephalosporin --> HOLD, call doc
|
|
|
CLASS
Cephalosporins |
-similar in structure and function to penicillins
-have beta-lactam ring; are bacteriocidal -widely prescribed anti-infective class -more than 20 cephalosporins available -cross-sensitivity with penicillins (5-10% of population) -classified by generations |
treats infections of:
skin, bone, heart, blood, respiratory tract, GI tract, urinary tract |
|
|
NOTES
generations of cephalosporins |
First (oldest): bacteria producing beta-lactamase are resistant
Second: more potent, broader spectrum, more resistant to beta-lactamase Third: longer duration of action (side effects longer), even broader spectrum, resistant to beta-lactamase Fourth: effective against organisms that are resistant to earlier generations |
Third and fourth capable of entering CSF.
|
|
|
IMP/TEACH
Cephalosporin therapy |
-assess for presence or history of bleeding disorders (may reduce prothrombin levels)
-assess renal and hepatic function -avoid alcohol (disulfiram-like reaction with ETOH). -monitor for thrombophlebitis -monitor sterile abscess when given IM -monitor renal fx (should not be given if reduced renal fx) -monitor 1st and 2nd dose for allergic reaction |
-Run through IV slowly to reduce risk of thrombophlebitis
-sterile abscess possible with IM (pocket filled with antbiotic) -if reduced renal HOLD and call doc |
|
|
CLASS
tetracycline |
-some broadest spectrums of any antibiotic class
-large number of resistant bacterial strains -drugs of choice for only a few diseases (Rocky Mountain spotted fever, Typhus, cholera, Lyme disease, peptic ulcer disease caused by H. pylori, chlamydial infections) -inhibit bacterial protein synthesis with bacteriostatic effect. |
|
|
|
SIDE EFFECTS
tetracycline |
-photosensitivity
-permanent yellow-brown tooth discoloration in children -risk for superinfection high -pregnancy category D; effects linear skeletal growth of fetus and lactating child -TOXIC when outdated -decreases effectiveness of oral contraceptives -use caution in clients with impaired kidney or liver function |
-binds with calcium and iron to decrease absorption by up to 50%
-do not take with milk products, iron supplements, magnesium-containing laxatives, or antacids |
|
|
CLASS
Macrolides |
-Broad spectrum; effective against most gram-positive and gram-negative bacteria
-safe alternative to penicillin -inhibits protein synthesis by binding to bacterial ribosome -bacteriostatic at low dose; bacteriocidal at high doses -drug of choice for (RESPIRATORY) whooping cough, Legionnaire's disease, streptococcus, H. influenzae, mycoplasma pneumonia, chlamydia |
-may cause superinfections; otherwise no serious side effects or contraindications
-Multiple drug-drug interactions |
|
|
IMP/TEACH
Macrolides |
-assess for presence of respiratory infection
-examine client for history of cardiac disorders -monitor hepatic enzymes with certain macrolides, such as erythromycin estolate |
Adverse effects:
-nausea, abdominal cramping, vomiting. -most severe HEPATOTOXICITY |
|
|
CLASS
aminoglycosides |
-NARROW-spectrum drugs, bacteriocidal
-reserved for serious systemic infections caused by aerobic gram-negative bacteria (E. coli, serratia, klebsiella, pseudomonas) -inhibit bacterial protein synthesis -more TOXIC than most antibiotics -have potential to cause SERIOUS side effects, i.e. ototoxicity, nephrotoxicity, neuromuscular blockade ***-mycin or -micin |
|
|
|
IMP/TEACH
aminoglycosides |
-monitor for ototoxicity and nephrotoxicity
-hearing loss may occur after therapy has been completed -neuromuscular function may also be impaired; can lead to respiratory paralysis during anesthesia -increase fluid intake unless otherwise contraindicated, to promote excretion |
-narrow therapeutic range => peak and trough levels; do not give dose without trough level; HOLD until then
-signs of nephrotoxicity: -mucous threads in urine -increased protein in urine -increased BUN/creatinine levels |
|
|
CLASS
fluroquinolones |
-bacteriocidal and affect DNA synthesis by inhibiting bacterial enzymes
-all have activity against gram-negative pathogens -newer drugs in class have activity against gram positive microbes -now four generations; used for infections of respiratory system, GI and GU tracts, SKIN and SOFT TISSUE infections. |
|
|
|
ADVERSE EFFECTS
fluroquinolones |
-do not take with multivitamins or minerals such as calcium, magnesium, iron, or zinc ions; can decrease absorption up to 90%!
-most serious side effects dysrhythmias and liver failure -CNS disturbances affect 1-8% of clients -Do NOT use in children and pregnant or lactating women |
|
|
|
IMP/TEACH
fluroquinolones |
-monitor white blood count
-monitor clients with liver and renal dysfunction -teach that drugs may cause dizziness and lightheadedness; advise against driving or performing hazardous tasks during drug therapy -norfloxacin (Noroxin) may cause photophobia -teach that drug may affect tendons, especially in children |
***even though WBC is monitored, it cannot always be used to monitor for infection as the med affects the WBC count.
|
|
|
CLASS
sulfonamides |
-bacteriostatic and act by inhibiting folic acid
-broad spectrum -widespread use leads to resistance -used in a combination to treat UTIs -also used to treat pneumocystitis carinii and shigella -anti-inflammatory properties can help with RA and ulcerative colitis |
***teach client how to decrease effects of photosensitivity
-assess for anemia or other hematologic disorders -assess renal function; sulfonamides may increase risk for crystalluria -consume at least 1 L water/day; 3-4 L preferred -limit foods/meds that acidify urine (promotes crystals) -avoid sunlight and tanning beds -use alternate forms of birth control; reduce effectiveness of oral contraceptives |
|
|
ADVERSE EFFECTS
sulfonamides |
-generally safe
-serious adverse effects: -hypersensitivity (urticaria, Stevens-Johnson Syndrome -renal dysfunction (crystal development in urine) -hematologic changes (hemolytic anemia, aplastic anemia, thrombocytopenia) -photosensitivity -contraindicated in clients with a histoyr of hypersensitivity to sulfonamides (Stevens-Johnson) |
|
|
|
NOTES
Tuberculosis |
-caused by mycobacterium tuberculosis; cell wall resistant to anti-infectives
-body's immune response attempts to isolate pathogen by walling it off -tuberculosis may remain dormant in walled-off areas called tubercles -decreased immune system can give tuberculosis opportunity to become active |
-tubercles make it hard to treat
-1st positive = prophylactic drug response *****Do NOT test again after testing positive = skin reaction at injection site |
|
|
NOTES
Antituberculosis therapy |
-"Big guns"
-contraindicated for clients with history of alcohol abuse, AIDS, liver disease, or kidney disease -use caution for certain clients: -those with renal dysfunction -those who are pregnant or lactating -those with history of convulsive disorders -assess for gouty arthritis -some drugs interact with oral contraceptives -if taking isoniazid avoid foods containing tyramine -often given with B6 to reduce peripheral deficiency |
B6 to prevent peripheral neuropathy
|
|
|
NOTES
Long-term antituberculosis therapy |
-6-12 months of drug therapy
-needed to reach isolated pathogens in tubercles -therapy must be continued even if no symptoms -clients with multidrug-resistant infections require therapy for 24 months (C&S to determine) |
|
|
|
NOTES
multidrug antituberculosis therapy |
-2-4 antibiotics administered concurrently
-different combinations used during course of therapy: -necessary because mycobacterium grows slowly and is commonly resistant -therapy initiated with first-choice drugs -when resistance develops, second-choice drugs used (more toxic, less effective than first choice) |
-prophylaxis used to prevent disease in high-risk population
-close contacts and family members of recently infected tb clients -clients with AIDS -clients who are HIV-positive or are receiving immunosuppressant drugs |
