Nclex: Pharm--Antibiotics Antivirals

Front 1

Name the generations of Cephalosporins.

Back 1

Keflex: Cephalexin Sodium (1st generation)
Ceftin: Cefuroxime (2nd)
Claforan: Cefotaxime (3rd)
Maxipime: Cefepime (4th)

Front 2

What are the most important side effects to watch for when administering cephalosporins?

Back 2

Rash, anorexia, hypersenstivity (rash, pruritis, fever), N/V diarrhea, GI Pain.

Front 3

What is important patient teaching for cephalosporins?

Back 3

Advise client to hydrate, notify health care provider if experiencing diarrhea.

Front 4

What antibiotic is contraindicated if a patient is allergic to penicillins?

Back 4

Cephalosporins.

Front 5

What are 1st generation cephalosporins and what are they used for commonly?

Back 5

Keflex: Cephalexin

Used in severe infections: respiratory, GI, GU, endocarditis and meningitis

Front 6

What are the 2nd generation cephalosporins and what are they used to treat?

Back 6

Ceftin: Cefuroxime

Used in serious infections: speticemia, lower respiratory, bone, joint, skin and UTI.

Front 7

What are the 3rd generation Cephalosporins and what are they used to treat?

Back 7

Claforan: Cefotaxime sodium.

Used for serious infection: lower respiratory, bone, joint, CNS (meningitis), gonorrhea.

Front 8

What are the 4th generation cephalosporins and what are they used to treat?

Back 8

Maxipime: Cefepime.

Used in serious infecitons: pneumonia, urinary, GI

Front 9

What are the main side effects to watch for when administering Tetracycline?

Back 9

Epigastric discomfort, diarrhea, heartburn and photosensitivity.

Others: N/V, suprainfection( C. difficile), abdominal cramping.

Front 10

What are Tetracyclines used for?

Back 10

Chlamydia, Rocky Mountain Spotted Fever, Acne

Other:Rickettsial Disease, uncommon infections, tropical intestinal infections, peptic ulcer disease, sinusitis, cystitis, lyme disease, periodontal disease.

Front 11

What patient teaching is necessary for Tetracyclines?

Back 11

-Take on an empty stomach.
-Antacids, milk products and iron supplements should not be consumed until at least 2 hours after dose was taken.
-Wear sunscreen and protective clothing.

Front 12

What precautions should be considered when giving tetracyclines?

Back 12

-Do not give to children (<11 yr) or pregnant women.
-May cause staining of developing teeth.

Front 13

What is the action of Cephalosporins?

Back 13

-Interfere with bacterial cell wall synthesis.
-Cell weakens, swells, bursts, and dies as a result of increased osmotic pressure.
-BROAD SPECTRUM

Front 14

What is the action of Tetracyclines?

Back 14

-Bacteriostatic, broad spectrum.
-Suppresses bacterial growth and replication, but do not kill the bacterial cells outright.

Front 15

What is the action of Metronidazole (Flagyl)?

Back 15

-Direct trichomonacidal and amebicidal activity against Trichomonas baginalis, Entamoeba histolytica, Clostridium difficile, and Giardia lamblia.

Antibacterial against anaerobic bacteria, gram-negative anaerobic bacilli and clostridia.

Front 16

What are the uses of Metronidazole (Flagyl)?

Back 16

-Trichomoniasis, intestinal amebiasis and antibiotic-asssociated colitis.

THESE Invaders:
Entamoeba histolytica, Giardia lamblia, Trichomoniasis, intestinal amebiasis, H. Pylori (peptic ulcers), Gardnerella.

Front 17

What is an important direction to give patients taking Metronidazole (Flagyl)?

Back 17

No alcohol products 48 after treatment. This includes mouthwash, aftershave, deodorant and bath splashes.

Front 18

What side effects should be watched for for Metronidazole (Flagyl)?

Back 18

Headache, dry mouth, fatigue, metallic/bitter taste, GI distress, N/V.

Front 19

What is important patient teaching for the use of Metronidazole?

Back 19

-No cologne, aftershave, bath splases, or do not ingest alcohol products to avoid a disulfiram-type reaction (eg: flushing, nausea, projectile vomiting, palpitations, tachycardia, psychosis)
-Mothers should wait 3 days after last dose of drug to resume breast-feeding
-Harmless darkening of the urine may occur.

Front 20

What is Isoniazid (INH)?

Back 20

Antituberculosis Agent.

Front 21

What is the action of Isoniazid

Back 21

Bacteriostatic to "resting organisms" and bactericidal to actively dividing organisms. Interferes with biosynthesis of bacterial protein, nucleic acid and lipids.

Front 22

What test is important to do while the patient is on Isoniazid and why?

Back 22

Liver function tests: this drug can cause drug-induced hepatitis.

Front 23

What needs to be watched for when taking Isoniazid (INH)?

Back 23

Epigastric distress, jaundice, peripheral neuritis (neuropathy).

Front 24

What are the important nursing teaching for a patient taking Isoniazid?

Back 24

-Take orally on an empty stomach 1 hour before and 2 hours after meals.
-Teach clients to reduce or eliminate consumption of alcohol to reduce risk of hepatotoxicity.

Front 25

What are the important nursing implications when administering Isoniazid?

Back 25

-Depletes vitamin B6 (pyridoxine) and will need supplementation during treatment.
-Peripheral neuritis, the most common adverse effect, is preceded by paraesthesias (eg. numbness, tingling, burning, pain) or the feed and hands.
-Antituberculosis treatment always involves 2 or more medications; INH is often combined with rifampin.

Front 26

What antibiotics are used in TB?

Back 26

STRIPE:
ST=Streptomycin
R=Rifampin
I= isoniazid
P= Pyrizinamide
E= ethambutol.

Front 27

Give examples of types of aminoglycosides?

Back 27

Garamycin, Amikacin, Neomycin, Tobramycin, Gentamicin and Amikin.

Front 28

What are the two prominent infections that aminoglycosides are used for?

Back 28

Serious infections: Meningitis and Peritonitis.

Front 29

What are the two most important adverse of aminoglycosides?

Back 29

Ear and Kidney Damage (Nephrotoxicity and Ototoxicity)

Front 30

What type of tests need to be done when administering aminoglycosides?

Back 30

PEAKS and TROUGHS

Front 31

What are common adverse effects of aminoglycosides?

Back 31

Nephrotoxicity, ototoxicity, tremors, urticaria, pruritus, rash.

Front 32

What is the action of aminoglycosides?

Back 32

-Bactericidal against a wide variety of gram negative bacteria (narrow spectrum) and certain gram-positive organisms.
-Disrupts bacterial protein synthesis.

Front 33

What type of infections are aminoglycosides used for?

Back 33

-Parenteral use for serious infections: GI, respiratory, GU. CNS, bone, skin and soft tissue (including burns)
-Topical application for primary and secondary skin infection.

Front 34

What adverse side effect can occur if a patient is taking skeletal muscle relaxants with aminoglycosides?

Back 34

Neuromuscular blockade leading to flaccid paralysis and fatal respiratory depression.

<>Anticipate antidote of IV calcium gluconate for treatment of neuromuscular blockade.

Front 35

What is important patient teaching when taking aminoglycosides?

Back 35

Report tinnitus, high-frequency hearing loss, persistent headache, nausea, dizziness, vertigo. (Be aware of loss of hearing!!--this is irreversible injury that can be caused by aminoglycosides)

Front 36

What are the types of antiretrovirals?

Back 36

Zidovudine [Azidothymidine -AZT]: reverse transcriptase inhibitor (terminates viral replication)

Efavirenz [Sustiva]--Nonnucleoside reverse transcripatse inhibitor. (Blocks enzyme activity)

Saquinavir mesylate [Invirase]--Protease inhibitor (inhibits and prevents maturation of HIV)

Front 37

How to antiretrovirals work?

Back 37

Search for the virus, interrupt and hider growth, but are unable to kill the virus totally. The retrovirus can take on different shapes and forms, which fools the antiviral agents.

Front 38

What is HAART?

Back 38

Stands for Highly Active Antiretrovial Therapy--in which the infection is a treatment that involves 3 or 4 drugs.

Front 39

Give an example of an retrovirus.

Back 39

HIV

Front 40

Describe HIV fusion inhibitor.

Back 40

Antiretroviral--Blocks the entry of virus into CD4-T cells.
--It is a new category with only one drug, Enfuvirtide [Fuzeon].
-Used when resistance to other medications occur.

Front 41

What are the most frequent side effects of antiretrovirals?

Back 41

NNRTI: CNS symptoms (dizziness, insomnia, drowsiness), Rash
PI: Hyperglycemia
HIV infusion inhibitor: Injection site reactions.

Front 42

What is important nursing teaching for clients taking antiretrovirals?

Back 42

+Take the full dose and complete treatment regimen.
+Report symptoms related to severe rash, CNS issues, diabetes, pneumonia.

Front 43

What is important to know about antiretrovirals and pregnancy?

Back 43

Pregnant women should receive antiretroviral therapy regardless of pregnancy status.

Front 44

What are the various antiviral medications?

Back 44

REMEMBER: VIR at the start, middle or end of the word means used for virus:

AcycloVIR, EfaVIRenz, InVIRase, EnfuVIRtide, RetroVIR, SaquinarVIR

Front 45

What two antibiotics need to be avoided in pregnant women?

Also include other antibiotics that one must be cautious about in pregnancy.

Back 45

Quinolones and Tetracyclines

The TWO QT's (cuties) say no to OBs.

<>MCAT:
-Metronidazole (in first trimester, category B in 2nd and 3rd timester)
-Cloramphenicol (Category C)
-Aminoglycosides (Caterogy C)

Front 46

What are the FDA pregnancy risk Categories?

Back 46

A: Remote risk of fetal harm
B: Slightly more risk than A
C: Greater risk than Category B
D: Proven risk of fetal harm; labeled as warming.
X: proven risk of fetal harm; labeled as contraindicated.

Front 47

What is the action of Ciprofloxacin (Cipro)?

Back 47

Inhibits DNA, inhibits enzymes in susceptible microorganisms, interfering with replication.
-It is bactericidal.

Front 48

What type of infections is Ciprofloxacin [Cipro] used for?

Back 48

Bacterial infection of the urinary, respiratory and GI tracts, as well as with bone, joint and ophthalmic infections.
<>Preferred drug treatment of inhaled anthrax
"For those hard to reach chronic bacterial infections"

Front 49

When should caution be takenfor administering Ciprofloxacin (Cipro)?

Back 49

Renal or CNS disorders. Seizures or those taking Theophylline.

Front 50

What adverse side effects should be monitored for for a patient on Ciprofloxacin (Cipro)?

Back 50

Can cause N/V, diarrhea, dyspepsia, constipation and flatulence, tendon rupture.
Heachaches, dizziness, restlessness and confusion.

Front 51

Who should not be administered Ciprofloxacin (Cipro)

Back 51

Individuals under the age of 18 should not be given Cipro.

Front 52

What should a patient be taught who will be on Ciprofloxacin [Cipro]?

Back 52

-avoid antacids, iron supplements and dairy products for at least 2 hours after taking medication.
-Teach client to report any tendon pain or inflammation.
-Adequate fluid intake is necessary, 6-8 glasses a day.

Front 53

What are important nursing implications for administering Ciprofloxacin (Cipro)?

Back 53

-Administer IV over 60 minutes.
-Dosage regimen for anthrax inhalation is over a 60-day period.

Front 54

What are the uses of Penicillin (PCN)

Back 54

Gonorrhea, UTI, pneumonia and other respiratory infections, Septicemia, Peritonitis, Meningitis.

Front 55

What are the adverse reactions of Penicillins (PCN)?

Back 55

GI distress, Oral or vaginal candidiasis, Generalized rash, Anaphylaxis.

Front 56

What is the mechanism of action of Penicillins?

Back 56

Bactericidal disrupts and weakens the cell wall, leading to cell lysis and death.

Front 57

What are the patient teaching instructions for Penicillins?

Back 57

Instruct client to check label with regard to administering with food.
-Instruct client to wear medication-alert bracelet if allergic to penicillin.

Front 58

What are the important nursing implications for Penicillins?

Back 58

-Monitor client for 30 minutes when given parenterally; administer epinepherine if anaphylaxis occurs.
-Collect any laboratory culture specimens before initiating penicillin therapy.
-Monitor for circulatory overload and bleeding tendencies when client receives ticarcillin and carbenicillin.

Front 59

Azithromycin (Zithromax) can be used to treat what?

Back 59

-Upper Respiratory tract bacterial infections: Pharyngitis, Tonsillitis
-Uncomplicated skin or skin structure infections
-Lower Respiratory Tract infections: Pneumonia, Mucobacterium avius complex (MAC), Exacerbations of COPD, Chlamydia.
Sexually Transmitted Diseases: Nongonoccocal urethritis, gonorrhea, chancroid in men.

Front 60

What is the mechanism of action of Azithromycin (Zithromax)?

Back 60

Azithromycin binds with ribosomal receptor sites in susceptible organisms to inhibit protein synthesis.

Front 61

What adverse reactions needs to be watched for with Azithromycin (Zithromax)?

Back 61

N/V, Diarrhea, abdominal pain and suprainfections.

Front 62

How is Azithromycin (Zithromax) packaged?

Back 62

It is packaged in a 7-day dose pack.

Front 63

What are important nursing implications for Azithromycin (Zithromax)?

Back 63

-Administer 1 hour before or 2 hours after food or antacids.
-Observe for development of signs of syprainfection.

Front 64

What is important patient teaching for Azithromycin (Zithromax)?

Back 64

-Take medication 1 hour before or 2 hours after food or antacids.
-Instruct to take prescribed course of therapy, although symptoms may improve or disappear.