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56 Cards in this Set
- Front
- Back
Factors that effect outcome of therapy
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1.Identify the microorganism (by symptoms or cultures)
2.Select the proper antibiotic (Sensitivity) 3.Site of infection 4.Other drugs the patient is receiving 5.Renal and liver function of the patient |
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Problems in therapy
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1.Toxicity to the patient (Nurse must be alert to signs of toxicity)
2.Allergy 3.Suprainfection. —Arise during therapy, difficult to treat More likely with broad spectrum — they kill normal bacteria (Ex. Tetracycline can cause Candida) |
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Misuse in Therapy
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Antibiotics for viruses
Discontinue drug too soon Self medication with old or unused portions |
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Factors related to failure
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1.Inadequate blood levels of the treatment drug
2.Too short a period of drug treatment 3.Selection of the wrong treatment agent 4.Resistance to the antimicrobial by the pathogen 5.Failure to use combination drug treatment when indicated 6.Delay in treatment 7.Inadequate body defenses within the host 8.Concomitant or previous treatment by a drug agent antagonist to the action of the antimicrobial 9.Adverse reaction in the host, which requires discontinuation of treatment 10.Noncompliance of patient |
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Nursing care Assessment
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Fever, purulent drainage
Increase WBC, signs of inflammation Check culture Monitor V.S. History of exposure Pre-existing medical condition History of allergy |
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Nursing care Teaching
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Review benefits and side effects
Take as long as prescribed. Do not share or save. Take at evenly spaced intervals Review restrictions; i.e. refrigeration, take with/without food Check drug incompatibilities Tongue may darken, not significant Oral contraceptives may not be effective during therapy No alcohol (disulfiram effect) |
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Nursing care Intervention
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Timing is important
Give IV s slowly Usually orals given between meals Dispose of carefully to minimize environmental dispersion Cultures taken before therapy Watch for adverse reactions |
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Sulphonamides
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Pharmacodynamics Bacteriostatic.
Prevents microorganism growth by inhibiting the production of folic acid in bacterial cells. Interacts with PABA. Pharmacokinetics Absorbed readily from the GI tract Lipid soluble. - < "^y< ^ Lo >V Distributed readily into body tissues and fluids Metabolized by the liver Solubility in urine and rate of excretion enhances by drinking a full glass of water. Prototype: Bactrim (Septra) (Sulfamethoxazole/Trimethroprim) |
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Sulphonamides p2
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Uses:
Primarily urinary antiseptics Secondary: Wide range of gram neg and gram pos bacteria Adverse reactions Common: Allergy (rash, fever, Stevens Johnson Syndrome, anaphylaxis, aplastic anemia, hemolytic anemia) Crystallizes in kidneys Long term therapy can lead to Vit K deficiency and aplastic anemia Can cause hypoglycemia, suppress thyroid hormones, impair liver function, decrease male fertility Potentiates the effect of Warfarin (Coumadin) Trimethoprim can cause bone marrow depression |
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Sulphonamides p3
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Contraindications and Precautions
Easily crosses the placental barrier and is in breast milk Do not give Bactrim while pregnant (Can use Macrodantin for UT1 until close to term) Not used in neonates Nursing considerations Take with ample fluids (Drink 1500 ml per day) Monitor I & O Monitor renal function Notify M.D.: decreased urinary output, hematuria, flank pain, rash, unable to consume adequate oral fluids, Hematologic reaction (sore throat, pallor, purpura, jaundice, weakness). Some yellow orange urine and skin discoloration not harmful. i'hotosensitivity (Wear sunscreen) |
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Penicillins
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Pharmacodynamic
Inhibits bacterial enzyme called transpaptidase Inhibits cell wall synthesis Osmosis causes explosion of the cell Exposed bacteria are killed directly by the antibiotic or the host's immune system Drugs prevent formation of new cell walls, therefore, are effective against actively multiplying bacteria. Microorganisms develop penicillinases which render the drug inactive. |
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Penicillins p2
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Pharmacokinetics
Absorbed p.o., depends on gastric and intestinal pH, best absorbed with no food. Distributed in lungs, liver, kidney, muscle, bone and placenta Metabolized by the liver (short V% life: 30-72 min unless another drug (probenicid, procaine, benzathine) added to prolong serum concentration Excreted by kidneys |
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Penicillins p3
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Uses
Penicillin resistant staph infections (When resistance to Methicillin occurs then there is also resistence to other penicillins and most other antibiotics — MRSA). Absorbed better parenterally Adverse Reactions Allergy : Skin rash to anaphylaxis. Can occur within 10 min. Treat with epinephrine. (3-5% of population) Direct toxicity is low except in neonates GI distress with oral PCN (N/V, diarrhea) Contains enough Na and K to alter electrolytes |
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Penicillins p4
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Contraindications and Precautions
Use caution in patients with decreased renal function Interacts with several drugs: decrease effect of oral contraceptives and aminoglycosides Nursing considerations Administer aminoglycoside at least an hour apart from PCN Observe for 30 minutes after administration Have epinephrine, corticosteroids, antihistimines available Monitor Na and K levels Watch for suprainfection — oral and/or vaginal Candida Advise patient on oral PCN to take on empty stomach Give around the clock Teach signs and symptoms of sensitivity Teach backup birth control if on oral contracrptives |
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Cephalosporins
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Pharmacodynamics
Similar properties to PCN and therefore have cross sensitivity Four generations: 1. Act primarily against gram pos organisms. Give if allergic to penicillin. Examples: Cefzolin (Ancef), Cephalexin (Keflex), Cephadrine (Velosef). 2. For polymicrobial infections: diabetic foot ulcers, nosocomial infections. Slightly extended activity against gram neg organisms Examples: Cefaclor (Ceclor), Ceftin, Cefuroxime (Zinacef) 3. For gram neg organisms (Pseudomonas) Distributed to CNS Watch for pseudomembranous colitis Examples: Cefoperazone (Cefobid), Cefotaxime (Claforan), Ceftazidime (Fortaz), Ceftriaxone (Rocephin). 4. For UTI due toKlebsiella, skin and soft tissue infections, staph and strep, pneumonia. Example: Cefepime (Maxipime) |
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Cephalosporins p2
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Pharmacokinetics
Half life twice as long as PCN Excretion kidney Most are given IM or IV Prototype: Rocephin Uses Gram neg organisms plus all from Gen 1 & 2. GiveifallergictoPCN. Adverse reactions Pseudomembranous colitis (Abd pain, diarrhea) Pain at injection site IV phlebitis GI irritation — diarrhea Contraindications and Precautions Nephrotoxic when given with other nephrotoxic drugs: i.e. Gentamycin |
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Cephalosporins p3
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Nursing considerations
IM is painful. Mix with Xylocaine to give IM Teach patient about hypersensitivity reactions Teach s /s suprainfection Take oral drug with food Avoid alcohol Monitor BUN and Creatinine levels |
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Tetracycline
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Pharmacodynamics
Wide range of action for Gram pos. and Gram neg. and organisms not responsive to other drugs. Interferes with protein synthesis by microbial ribosomes Gains access to interior of cell by passive diffusion Bacteriocidal and bacteriostatic Classified as either short acting, intermediate acting or long acting |
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Tetracycline p2
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Pharmacokinetics
Absorbed from the doudenum Absorption impaired by food, dairy products, calcium, magnesium and aluminum laxatives and antacids Distributed widely in body tissues Stored in liver, spleen, bone marrow, bone, and dentin* *Concentrates in new bone and tooth formation and permanently discolors teeth |
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Tetracycline p3
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Uses
Infections from Rikettsia (Rocky Mtn Spotted Fever), tularemia, brucellosis, Chlamydia Management of Acne vulgaris and amebiasis Adverse reactions N/V, abdominal distress, diarrhea Rash to anaphylaxis Suprainfections Staph enterocolitis — bloody diarrhea Contraindications and Precautions Not recommended for nursing mothers and children under 8 years old May be toxic to liver and kidneys Decreases effectiveness of oral contraceptives Can sunburn easily Delays blood coagulation |
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Tetracycline p4
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Nursing considerations
Inspect mouth daily for candiasis Teach alternate birth control Recommend sunscreen Take on an empty stomach with eight ounces of water Avoid dairy products and antacids |
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Aminoglycosides
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Streptomycin was developed at the same time as penicillin and sulfonamides Pharmacodynamics
Prevents protein synthesis in cell wall membranes by binding irreversibly to ribosomal subunits with the pathogens. It gets into the cell rather than on the cell wall. Bacteriocidal Pharmacokinetics Poorly absorbed in the GI tract. Given p.o. to reduce intestinal floral prior to GI surgery, for acute intestinal infections, and for hepatoencephalopathy. Rapidly absorbed IM or IV. Does not cross blood brain barrier. Does not bind to plasma protein. Metabolized in the liver. Goes unchanged to the kidneys where it is excreted. Is active drug in the urine. May cause tubule damage. Not in bile. Plasma half life 2-4 hours. Bacterial resistance possible. |
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Aminoglycosides
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Uses
Moderate to serious infections. Control of gram pos. and gram neg. aerobic bacilli Adverse reactions Renal toxicity 8th cranial nerve damage with high and/or prolonged therapy Can lead to permanent deafness Neuromuscular blockade if given immediate post-op. Mixes with general anesthetics and muscle relaxants to cause respiratoiy difficulty and irregular heartbeat. Shows little allergic potential but if allergic to one aminoglycoside can be allergic to others. |
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Aminoglycosides p2
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Contraindications and Precautions
Do not give immediately post op. Potentiates warfarin Administer at least two hours apart from penicillin Avoid sequential use of different aminoglycosides due to residuals left from previous drugs. Nursing considerations Monitor kidney function Monitor peak and trough levels Monitor for tinnitis, nausea, decreased equillibrum Monitor for oliguria Monitor urinalysis for casts or protein Administer 2 hours apart from other antibiotics |
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Quinolones
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Pharmacodynamics
Interferes with DNA replication Pharmacokinetics Well absorbed p.o. Highly protein bound Distributed to body secretions, lymph, peritoneal fluid, csf, bone, skin, muscle, cartilage, and fat Metabolized in the liver. Excreted through the kidneys ( 40-50% is excreted unchanged in urine). Halflife4hours |
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Quinolones p2
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Uses
Gram neg. and Gram pos. organisms. Lower urinary and respiratory tract infections, skin, bone, joint, and infectious diarrhea. Adverse reactions Most disappear with discontinuation of the drug GI discomfort, h.a., restlessness, syncope, photosensitivity, blurred vision Contraindications and Precautions May damage cartilage — do not give to children. Do not give with antacids Take with a full glass of water Do not give with probenecide — decreases excretion Nursing considerations Safety precautions for those exhibiting CNS reactions |
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Macrolides
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Pharmacodynamics Bacteriostatic Inhibits protein synthesis Effective against similar spectrum as penicillin Give if allergic to penicillin
Pharmacokinetics Primarily given p.o. Absorbed in the small intestine. Partially destroyed by gastric acidity (Has coating— do not crush) Best given on an empty stomach but ok with food Distributed to most body tissues except CSF Metabolized in liver excreted in the bile. Some of the drug is reabsorbed in the large intestine. |
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Macrolides p2
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Uses
Give if allergic to penicillin. Drug of choice for diphtheria, Legionaire's disease and relapsing UTI's Adverse reactions Abd. discomfort. Transient deafness in the real impaired Contraindications and Precautions Caution in patients with biliary and/or hepatic disease (OK with renal disease). Decreases theophyllin clearance Nursing considerations Teach patient s/s of cholestatic/ hepatic disease |
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Miscellaneous Antibiotics
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Pharmacodynamic
Inhibit bacterial protein synthesis. Inhibits binding of ribosomes Bacteriostatic and/or bacteriocidal depending on drug concentration and microorganism susceptibility Effective against aerobic Gram pos cocci and some Gram neg. Natural and acquired resistance exists Pharmacokinetics Well absorbed from the GI tact. OK with food Distributed in many tissue. Does not cross blood brain barrier. Crosses placenta and breast milk. Metabolized in the liver and excreted in the kidneys |
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Miscellaneous Antibiotics p2
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Uses
Septicemic infections: Skin, soft tissue, respiratory and intra-abdominal systems, chronic bone and joint disease. Adverse reactions Diarrhea Pseudomembranous colitis caused by overgrowth of clastridium difficile |
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Miscellaneous Antibiotics p3
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Contraindications and Precautions
Caution in patients with liver disease Caution with patients with myasthenia Gravis due to neuromuscular properties. Nephrotoxic, neurotoxic, neuromuscular blocking properties — use with caution in concurrent use of similar acting drugs Nursing considerations IM may be painful Teach patient to report diarrhea |
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Purine Nucleoside Group
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Pharmacodynamics
Converts viral enzyme and terminates DNA chain of virus Only effective against actively replicating viruses. Pharmacokinetics Topical — Minimal percutaeous absorption Poorly absorbed p.o. Extensive distribution Minimally metabolized in the liver Excreted unchanged by the kidneys Half life: 2.5 hours |
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Purine Nucleoside Group p2
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Uses
Herpes simplex, genitalis, and zoster. CMV, RSV, Influenza A Adverse reactions Well tolerated. Common effects are GI upset, lightheadedness and HA. Contraindications and Precautions Caution in pregnancy and breast feeding Caution with renal disease and preexisting neurologic disorder Nursing considerations Monitor regime for other nephrotoxic drugs Examine for active lesions (drugs not effect bacterial lesions) Drug is expensive Give with a full glass of water at regular intervals |
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Pyrimidine Nucleoside Group
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Pharmacodynamics
Incorporates into viral DNA and stops building process Active against HIV, Ebstein Barr, and Hep B. Pharmacokinetics Rapidly absorbed p.o. 1 hour half life. Crosses blood brain barrier. Rapidly metabolized in the liver Excreted inactive by the kidneys |
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Pyrimidine Nucleoside Group p2
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Uses
Treating HIV in children and adults Preventing transmission to fetus in HIV pregnant women Guidelines for starting therapy are controversial and constantly changing. Adverse reactions Anemia, granulocytopenia, and thrombocytopenia.(bone marrow depression) GI upset Myopathy including cardiomyopathy CNS — HA, seizures, somnolence, parasthesias, .agitation, insomnia |
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Pyrimidine Nucleoside Group p3
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Contraindications and precautions
Contraindicated during the first 14 weeks of pregnancy Contraindicated in neonates up to 3 months Caution in patients with preexisting bone marrow depression, folic acid and vit B12 deficiencies. Caution in patients with renal or hepatic disease Mothers with HIV are encouraged not to breast feed Nursing considerations Assess for hypersensitivity, pregnancy, hepatic and renal disease. Assess for other drugs that are myelosuppressive Monitor lab results Teach that patient on this drug can still transmit HIV Take 1 hour before meals and avoid fatty foods Expensive |
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Antitubercular Primary Drugs (First line Drugs)
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Pharmacodynamics
Isoniazid, Rifampin, ethanbutol, pyrazinamide, and streptomycin are first line drugs. Bacteriocidal and bacteriostatic Disrupts the cell wall Pharmacokinetics P.O. or IM. Absorbed from GI tract rapidly Distributed to all fluids and tissues and crosses blood brain barrier Metabolized in liver to inactive state 75% excreted in urine. The rest is feces, saliva, and sputum |
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Antitubercular Primary Drugs (First line Drugs) p2
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Uses
Treat or prevent TB and other mycobacterial infections Unlabeled use —severe tremors of multiple sclerosis Adverse Reactions Hepatitis, jaundice Peripheral neuropathy Contraindications and Precautions Interacts with antiseizure drugs, alcohol, aluminum based antacids, benzodiazepines, ketoconazole, meperidine, anti coagulants. Contraindicated with acute hepatic disease Caution with alcoholics Caution with diabetics and those with seizure disorders |
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Antitubercular Primary Drugs (First line Drugs) p3
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Nursing considerations
Given for 6 to 12 months Assess for hepatic disease and alcoholism, DM and seizure disorders Teach to refrain from foods rich in tyramine: Cheese, dairy products, beef or chicken liver, beer and ale, red wine, avocados, bananas, figs, raisins, caffeine, and chocolate. |
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Secondary Drugs (Second line drugs)
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Less effective and more toxic than first line drugs
Pharmacodynamics PAS — Similar to sulfonamides -inhibits synthesis of folic acid Cycloserine— bacteriostatic, inhibits cell wall synthesis Kanamycin — aminoglycoside Pharmacokinetics PAS — p.o., Well absorbed, distributed to body tissues and fluids, metabolix=zed in the liver and excreted in urine as inactive form. Cycloserine — p.o.. Same as PAS Kanamycin — IM or IV. See aminoglycosides Uses Treat TB |
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Secondary Drugs (Second line drugs) p2
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Adverse Reactions
PAS — GI disturbances. Poorly tolerated by adults Cyclserine — anxiety, depression, confusion, seizures, peripheral neuropathy, hepatotoxicity Kanamycin — See aminoglycosides Contraindications and Precautions PAS used primarily as a substitute for ethambutol in pediatric patients Nursing considerations PAS tablets loose effectiveness if exposed to sunlight, extreme heat, or moisture. Advise patients not to store in kitchen or bathroom. Pyrodoxine may prevent neurotoxic effects of cycloserine |
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Other
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Pharmacodynamics
Inhibits protein synthesis Pharmacokinetics P.O., Absorbed readily. Widely distributed. Metabolized in lever. Excreted in urine bile and feces. Uses Used for prevention and spread of mycobacterium avium complex (MAC) in HIV patients Used for treating active MAC |
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Other p2
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Adverse Reactions
Well tolerated Rash, GI disturbances, neutropenia Contraindications and Precautions Liver enzyme inducer — decreases blood levels of other drugs Nursing considerations Imparts a harmless brown orange discoloration to urine, saliva and tears. Soft contact lenses may be permanently stained Teach patient about decreased blood levels of other drugs; i.e. oral contraceptives |
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Antifungal Polyenes
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Pharmacodynamics
Binds to membrane sterols in fungal cell membranes causing them to leak and die. Damage to host cells can occur. Pharmacokinetics P.O. for GI fungal infections and IV for other sites including intrathecal for CNS infections. Limited distribution into body fluids. Metabolism unknown. Initial half life of 24 hours followed by second elimination phase of 15 days |
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Antifungal Polyenes p2
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Uses
Anti fungal agent used to treat progressive and potentially fatal systemic fungal or protozoal infection. Adverse Reactions "Amphoterrible" Nephrotoxic Infusion reactions: ha, chills, fever, rigors, hypotension, bronchospasm, N/V Electrolyte imbalances, anemia, leukopenia, thrombocytopenia. Ventricular fibrillation, seizures, cardiac arrest |
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Antifungal Polyenes
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Contraindications and Precautions
Do not administer with other nephrotoxic drugs. Monitor electrolytes closely Nursing Considerations Complete a baseline assessment of renal and cardiac condition Keep well hydrated Administer test dose to determine hypersensitivy Extra blankets, diversion therapy, warm fluids Administer pre-treatment drgs as ordered; such as hydrocortisone, meperidine, and ibuprofen. Use cental line if possible with in-line filter Accurate I & O. VS q 15 min during first dose. |
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Azole Antifungal drugs
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Pharmacodynamics
Alters fungal cell membrane to cause leakage and death Pharmacokinetics Oral and IV Rapid Gl absorption Widely distributed to tissues and fluids Elimination is renal; 60-80% excreted in urine unchanged Uses Wide spectrum antifungal activity Drug of choice for oralpharangeal, esophalgeal, and vulvovaginal candiasis Fungal prophylaxis for immunocornpromised patients Alternative to amphotericin |
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Azole Antifungal drugs p1
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Adverse reactions
Diarrhea N/V abd pain, headache and dizziness Contraindications and precautions Drug interactions with anticoagulants, hydantoins, refampin, tolbutamide, cyclosporin, oral contraceptives, non-sedating antihistamines, hydrochlorthyiazide, theophylline, and zidvoudine. Nursing Considerations Assess for preexisting renal, hepatic disease or anemia Absorption not affected by food No alcohol Refrain form acetominophen Antiemetic or antidiarrheal can be given along with drug treatment Monitor I & O |
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Nystatin
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Pharmacodynamics
Similar to Amphotericin B Available in topical, vaginal and oral forms Not used for systemic infections Pharmacokinetics Local effect |
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Nystatin p2
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Uses
Candidasis of oropharyngel, cutaneous, mucocutaneous, and vulvovaginal Orally used to treat GI fungus "Swish and swallow" or "Swish and spit" Adverse reactions Hypersensitivity Mild transient N/V, diarrhea, and abdominal pain Vaginal irritation Contraindications and Precautions Some forms contain sucrose which can cause hyperglycemia in diabetics Nursing considerations Teach swish and swallow technique Teach about troche use —to allow troche to dissolve, do not chew or swallow |
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Antimalarial Chloroquine (Quinine)
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Pharmacodynamics
Interrupts synthesis of RNA and DNA Pharmacokinetics Absorbed rapidly in GI system Concentrates in erythrocytes, liver, spleen, kidney, lung, melinan-containing tissue, and leukocytes. Penetrates CNS Half life 70-120 hours. Excreted unchanged in kidney and feces |
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Antimalarial Chloroquine (Quinine) p2
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Uses
Prophylaxis and treatment of malaria, extra-intestinal amebiasis, rheumatoid arthritis, and discoid lupus, erythematosus. Adverse reactions Hypotension, cardiac changes, GI upset Potential hearing and visual problems Contraindications and Precautions Hypersensitivity Preexisting hearing or visual loss Caution with psoriasis Caution with alcoholics Caution in patients with GI disorders, blood dyscrasias, dental disease, and .neurologic disorders Nursing considerations Baseline assessment of vision, hearing, neurological disorers, liver and kidney disease. Assess for blood dyscrasias and skin disorders. Prophylaxis 2 weeks prior to going to an area with endemic malaria and continue for two weeks after. If dosing is weekly, take on same day each week Take with food to decrease Gl upset Take acetaminophen to decrease HA Avoid alcohol |
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Antiprotozoal Antiinfective
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Pharmacodynamics
Acts against anaerobic bacteria by inhibiting DNA synthesis Pharmacokinetics Oral, IV, or topical Distributed to tissue and fluids including CSF. Metabolized in the liver Adverse reactions N/V, dry mouth, altered sense of taste, anorexia, and abdominal pain. Contraindications and Precautions Disulfiram reaction in alcoholics Caution in patients with bone marrow depression Caution with hepatic dysfunction |
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Antiprotozoal Antiinfective p2
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Nursing considerations
No alcohol including OTC drugs that contain alcohol Sexual partner also needs to be treated for trichomonas. Discolored urine not harmful Administer with food to decrease GI upset Monitor for thrombophlebitis and CHF, oral candiasis and vaginal candiasis Monitor for peripheral neuropathy If treated for giardiasis , three clear stool specimens several days apart will determine success of therapy. |
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Antihelmintic Mebendazole (Prototype
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Pharmacodynamics
Selectively damages cytoplasmic microtubules in the absorptive and intestinal tract of the helminth but not the host. Pharmacokinetics Minimally absorbed by the GI tract Most is excreted in the feces Adverse reaction Rare due to poor absorption |
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Antihelmintic Mebendazole (Prototype p2
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Contraindications and Precautions Hypersensitivity
Caution with inflammatory bowel disease and hepatic disease Interacts with anticonvulsant drugs to decrease effect of Mebendazole Nursing considerations Collect stool specimens to ensure drug is therapeutic Monitor patient's contacts —helminthic infections are highly contagious Entire family may be treated Disinfect clothing and bedding Increase fluid intake |