Nur 326: Test 4

Front 1

Diuretics are tx for 4 major conditions:

Back 1

Heart Failure
Neuro trauma
Hypertension
Renal Failure

Front 2

What is the "chemist" of the body?

what does it control?

Back 2

The Nephron

It controls pH and electrolytes

Front 3

3 Functions of the Nephron:

Back 3

glomerular filtration
tubular reabsorption
tubular secretion

Front 4

4 classes of diuretics:

Back 4

Thiazides
Loop Diuretics "-mide"
Potassium Sparing Diuretics
Osmotic Diuretics

Front 5

Drug given if brain swells to rapidly decompress whole brain:

Back 5

Mannitol

Front 6

Brand name of Mannitol

Back 6

Osmitrol

Front 7

Pharmacologic class of Mannitol

Back 7

Osmotic Diuretic

Front 8

What are the indications for Mannitol?

Back 8

-Used primarily for closed head injury (helps reduce ICP)
-Used for burns
-Used for oliguria and anuria
-prevents acute renal failure
-given with chemo toxic agent, Cisplatin

Front 9

Side effects of Mannitol

Back 9

dehydration and edema

Front 10

What does Mannitol do?

Back 10

- flushes toxins out of the kidneys
-Keeps fluid moving through the nephron

Front 11

Burnt muscles release:

Back 11

toxins (myoglobin) which clog the nephrons in the kidneys

Front 12

What kind of needle do you use to drawl up Mannitol and why?

Back 12

Filter needle
bc it is a very large particle drug. It is very thick.

Front 13

How should Mannitol be pushed?

Back 13

VERY SLOW bc it is a very thick drug

Front 14

What is the Generic name of HCTZ?

Back 14

Hydrochlorothiazide

Front 15

Therapeutic classes of HCTZ:

Back 15

diuretic
antihypertensives

Front 16

Diuretics are tx for 4 major conditions:

Back 16

Heart Failure
Neuro trauma
Hypertension
Renal Failure

Front 17

What is the "chemist" of the body?

what does it control?

Back 17

The Nephron

It controls pH and electrolytes

Front 18

3 Functions of the Nephron:

Back 18

glomerular filtration
tubular reabsorption
tubular secretion

Front 19

4 classes of diuretics:

Back 19

Thiazides
Loop Diuretics "-mide"
Potassium Sparing Diuretics
Osmotic Diuretics

Front 20

Drug given if brain swells to rapidly decompress whole brain:

Back 20

Mannitol

Front 21

Brand name of Mannitol

Back 21

Osmitrol

Front 22

Pharmacologic class of Mannitol

Back 22

Osmotic Diuretic

Front 23

What are the indications for Mannitol?

Back 23

-Used primarily for closed head injury (helps reduce ICP)
-Used for burns
-Used for oliguria and anuria
-prevents acute renal failure
-given with chemo toxic agent, Cisplatin

Front 24

Side effects of Mannitol

Back 24

dehydration and edema

Front 25

What does Mannitol do?

Back 25

- flushes toxins out of the kidneys
-Keeps fluid moving through the nephron

Front 26

Burnt muscles release:

Back 26

toxins (myoglobin) which clog the nephrons in the kidneys

Front 27

What kind of needle do you use to drawl up Mannitol and why?

Back 27

Filter needle
bc it is a very large particle drug. It is very thick.

Front 28

How should Mannitol be pushed?

Back 28

VERY SLOW bc it is a very thick drug

Front 29

What is the Generic name of HCTZ?

Back 29

Hydrochlorothiazide

Front 30

Therapeutic classes of HCTZ:

Back 30

diuretic
antihypertensives

Front 31

Pharmacologic Class of HCTZ:

Back 31

Thiazide

Front 32

Indications of HCTZ:

Back 32

Mostly commonly used diuretic
Used mostly to control HTN and bloating

Front 33

Side Effects of HCTZ

Back 33

-hypokalemia
-hyponatremia
-hypo-magnesemia
-hypochloremic alkalosis
-hypercalcemia
-hypocalciuria
- dehydration
-hyperglycemia
-hyperuricemia

Front 34

What diuretic is the most potent to drop potassium levels?

Back 34

HCTZ

Front 35

What should use eat to keep potassium levels up while on HCTZ?

Back 35

Eat bananas and drink OJ

Front 36

Pharmacologic class of Lassix?

Back 36

Loop Diuretic

Front 37

Where do Loop Diuretics work?

Back 37

works in the Loop of Henle

Front 38

Generic name of Lassix

Back 38

Furosemide

Front 39

What drugs end in -mide?

Back 39

Loop Diuretics

Front 40

Dont give to a patient with a potassium level of less that 3.5

Back 40

Lassix

Front 41

Never push faster tat 10 mg/min

Back 41

Lassix

Front 42

What will Lassix do to the 8th cranial nerve?

Back 42

It will dehydrate the auditory nerve and will cause loss of hearing.

Front 43

Use acute, but not chronic care

Back 43

Lassix

Front 44

Indications of Lassix

Back 44

-Most effective, rapid-acting diuretic: good to get out of acute trouble, do not give chronically (will cause Hypokalemia)
-inhibits Na+ and Cl- reabsorption in ascending limb of loop of henle

Front 45

Side effects of Lassix

Back 45

-hypokalemia
-hyponatremia
-hypo-magnesemia,
-hypochloremic alkalosis
-hypocalcemia
-hypercalciuria
- dehydration
-hyperglycemia
-hyperuricemia

Front 46

What should you restrict while on Lassix?

What should you replace?

Back 46

Dietary Sodium

Potassium

Front 47

Generic name of Aldactone

Back 47

Spironolactone

Front 48

Pharmacologic Class of Aldactone

Back 48

Potassium-Sparing Diuretic

Front 49

Indications of Aldactone

Back 49

decreases sodium reabsorption and potassium excretion

Front 50

Side effect of Aldactone

Back 50

hyperkalemia

Front 51

What does Aldactone hold onto?

What does it lose?

Back 51

Potassium

Water

Front 52

What can you use to monitor potassium?

Back 52

Use an EKG and monitor the T wave

Decreased T wave = Decreased K
Increased T wave = Increased K

Front 53

After taking diuretics, a gain or loss of 2.2 lbs (1kg) indicates:

Back 53

a gain or loss of 1000 ml of fluid

Front 54

Dilute urine indicates:

Back 54

excessive fluid intake or fluid and electrolyte imbalances due to rapid diuresis

Front 55

Concentrated urine may indicate:

Back 55

oliguria or decreased fluid intake

Front 56

How many times daily should you check B/P when diuretic therapy is initiated?

Back 56

2-4 times

Front 57

Drugs that increase effects of diuretics:

Back 57

-Aminoglycoside antibiotics will have an increase the ototoxicity of loop diuretics
- Antihypertensive agents will add to the hypotensive side effect of diuretics
- Corticosteriods will increase the chance of Hypokalemia

Front 58

Drugs that decrease effects of diuretics:

Back 58

-NSAIDs cause retention of water and sodium
-Oral contraceptives cause retention of water and sodium
-Vasopressors

Front 59

Aerobic

Back 59

needs O2

Front 60

Anaerobic

Back 60

Does not like nor need O2

Front 61

Bactericidal

Back 61

kills

Front 62

Bacteriostatic

Back 62

slows

Front 63

Broad spectrum

Back 63

broad range of microbes are susceptible to it

Front 64

Narrow Spectrum

Back 64

small range of microbes are susceptible to it

Front 65

Superinfection

Example of superinfection:

Back 65

when you get an infection from killing off normal flora with antibiotics used for a previous infection.

Ex. Yeast infection after sore throat

Front 66

Cross-resistance

Back 66

if you are allergic to one drug you are more likely to be allergic to others

Front 67

Most likely age group to develop an infection:

Back 67

Aliens and peds under 6

Front 68

What type of infections have the greatest kill ratio?

Back 68

Airborn infections

Front 69

What do you have to have to have normal immunity?

Back 69

your normal unique bacteria

Front 70

What does your normal bacteria help make?

Back 70

Vitamin K

Front 71

MRSA

Back 71

methicillin resistant staphlococci aureus

Front 72

MRSA is resistant to

Back 72

ALL penicillians

Front 73

Drug of choice to treat MRSA

Back 73

Vancomycin

Front 74

The Physiology of a fever

Back 74

pathogen (produces pyrogens)-> causes neutrophil to releases interleuki-> interleukins go into blood stream-> blood travels to hypothalamus in brain (thermostat)-> resets the thyroid gland-> increases rate of ATP production (causes fever). Then WBC is activated, comes back to pathogen, and fights it.

Front 75

Ways to reduce resistance

Back 75

-Avoid broad spectrum drugs
-Collect specimens before therapy
-Give organism specific drugs
-Dont use just for fever alone
- Follow CDC recommendations
- Consult with specialists

Front 76

3 Indications for use of Antimicrobial Drugs

Back 76

-Prophylactic therapy
-Empiric Therapy
-Organism specific

Front 77

Prophylactic Therapy

Back 77

-Manditory before invasive procedures including dental work if patient has a mechanical part
-Important for people who travel outside the US especially to subtropical areas and 3rd world countries

Front 78

Empiric Therapy

Back 78

therapy given with infection is indicated by physical assessment
It is looks and acts like and infection treat it like one.

Front 79

A person who is immunosuppressed cannot...

Back 79

raise a fever.

Front 80

A fever of 100.4 in an immunosuppressed patient is like...

Back 80

a fever of 105 in a normal person

Front 81

Decreased fever

Back 81

Fungal infection

Front 82

Action of Sulfonamides on bacterial cells

Back 82

block synthesis of components necessary for cell metabolism and growth

Front 83

Action of Penicillins, cephalosporins, and vancomycin on bacterial cells

Back 83

inhibit formation of cell walls

Front 84

Action of Fluoroquinolones on bacterial cells

Back 84

inhibit DNA gyrase, an enzyme required for reproduction

Front 85

Actions of Aminoglycosides, macrolides, ketolides, tetracycline, linezolid, and quinupristin/dalfopristin on bacterial cells

Back 85

bind to ribosomes and inhibit production of essential proteins

Front 86

Labs to consider in Anti-microbial infections

Back 86

WBC count-> acute infection or Leukemia

Creatinine-> Male: 1.78-2.32 ml/s
Female: 1.45-1.78 ml/s

BUN-> 10-20 mg/dl

Front 87

Some antibiotics are nephrotoxic so...

Back 87

give enough meds to kill the bug but not enough to kill the kidneys

Front 88

Why dont you mix antibiotics and diuretics?

Back 88

bc diuretics remove water from the blood which can lead to antibiotic toxicity

Front 89

What group do you not give fluoroquinilones?
what is the exception to the rule?

Back 89

Do not give to children bc Fluoroquinilones (Cipro) will cause joint damage

exception to children with cystic fibrosis

Front 90

Tetracyclines contraindicated in:

Back 90

children under 8 and pregnancy

Front 91

Side effect of Tetracyclines:

Back 91

will turn teeth permanently gray

Front 92

Penicillins and Cephlasporins should be used cautiously in:

Back 92

Neonates bc they are excreted more slowly. Use caution.

Front 93

What toxicities do aminoglycosides cause?

Back 93

Nephrotoxicity and ototoxicity in any client.
Use extreme caution in neonates because of the lack of maturity of their renal system.

Front 94

Aminoglycosides should only be saved for:

Back 94

patients infected with MRSA

Front 95

What are the Beta-Lactam Antibacterials?

Back 95

-Penicillins
-Cephalosporins
-Carbapenems
-Monobactams

Front 96

Beta-Lactam Antibacterials_____ in the bacterial cell.

Back 96

Inhibit synthesis of bacterial cell wall by binding to PBPs in the cell membrane

Front 97

Penicillins (PCN) prototype

Back 97

Penicillian G potassium (Pfizerpen)

Front 98

Penicillin IM and IV solutions are__.

Back 98

NOT interchangeable

Front 99

Drug of choice for gonorrhea

Back 99

Penicillin (but has started to become resistant)

Front 100

Indications for Penicillin:

Back 100

-bactericidal action against susceptible bacteria: most gram +, some gram (-) such as meningitis and gonorrhea, and some anaerobic bacteria and spirochetes.

Front 101

-stephen johnson’s syndrome
-rashes
-allergic rxns such as anaphylaxis
-serum sickness
-seizures
-N/V/D
- epigastric distress
Are all Side Effects of what drug?

Back 101

Penicillin

Front 102

How long should you hold someone after giving a dose of penicillin?

Back 102

90 min supervised

Front 103

How is Penicillin doesed?

Back 103

By weight and kidney function

Front 104

Best way to administer IM penicillin is...

Back 104

Deep in either the gluteal of vatus lateralus muscles. drug is very thick and painful

Front 105

When should penicillin be given?

Back 105

1 hour before meal or 2 hours after and not with acidic juice

Front 106

Piperacillin and Tazobactam combination drug

Back 106

Zosyn

Front 107

Pharmacological class of Zosyn

Back 107

Extended spectrum penicillin

Front 108

Side effects of Zosyn

Back 108

-stephen johnson's syndrome
-seizures
-pseudomembranous colitis
-rashes
-hypokalemia
-hypersensitivity such as anaphylaxis
-serum sickness

Front 109

Zosyn is contraindicated in people with

Back 109

Penicillin allergies

Front 110

Indications for Cephalosporins

Back 110

-Active gram-
-Surgical prophy
-Skin/soft tissue
-bones/joints
-Respiratory
-GU
-Septicemia
-brain and spinal cord

Front 111

Ist generation cephalosporin

Back 111

cephalexin

Front 112

Brand name of cephalexin

Back 112

Keflex

Front 113

Indications for Keflex

Back 113

-surgical prophy for implants
-gram -
- low level drug

Front 114

Side Effects of Keflex

Back 114

-stephen johnsons syndrome
-seizures
-pseudomembranous colitis
-N/V/D
-rashes
-allergic reactions such as anaphylaxis
-serum sickness

Front 115

What do you take with Keflex?

Back 115

Milk or food to prevent stomach upset

Front 116

All Cephalosporins are cross sensitive to

Back 116

Penicillin and could cause an allergic reaction

Front 117

2nd Generation Cephalosporin

Back 117

Cefaclor

Front 118

Brand name of Cefaclor

Back 118

Ceclor

Front 119

Indications for Cefaclor

Back 119

-Flu
-gram- and anaerobic microbes
-E.coli from raw meat

Front 120

Give Cefaclor when:

Back 120

the stomach is either empty or full

Front 121

Do not take Cefaclor with

Back 121

antacids containing magnesium or aluminum, or with pepcid, tagamet, or Zantac because these decrese absorption

Front 122

3rd Generation Cephalosporin

Back 122

Cefotaxine

Front 123

Brand name of 3rd generation Cephalosporin

Back 123

Claforan

Front 124

What does the 3rd generation Cephalosporin Cetaflaxine penetrate?

Back 124

The blood brain barrier

Front 125

4th generation Cephalosporin:

Back 125

Cefepime

Front 126

Brand name of 4th generation cephalosporin:

Back 126

Maxipime

Front 127

What is Cefepime saved for and why?

Back 127

Saved for septic shock bc of potency and cost (as much as $5000 for 1 IV dose)

Front 128

Pharmacological class of Meropenem

Back 128

Carbapenem

Front 129

Brand name of Meropenem

Back 129

Merrem

Front 130

Indications for Meropenem both on and off label

Back 130

on label: treatment of intra-abdominal infections and bacterial meningitis
Skin and skin structure infections

Off-label: Febrile neutropenia
Hospital acquired pneumonia and sepsis

Front 131

Side effects of Meropenem

Back 131

Seizures
Apnea
Pseudomembranes colitis
Anaphylaxis

Front 132

Meropenem interacts with what drug

Back 132

Probenecid: decreases renal excretion and increases blood levels when given together

Front 133

Aminoglycoside drugs

Back 133

-Amikacin
-Gentamicin

Front 134

Brand name of Amikacin (aminoglycoside)

Back 134

Amikin

Front 135

Indication for Amikacin

Back 135

used to treat serious infections only

Front 136

Side effects of Amikacin

Back 136

-Vesicant
-Red Man's syndrome
-If infused to quickly can cause paralysis because it is neurotoxic
-Nephrotoxicity
-Ototoxicity
-Stephen Johnson's Syndrome
-Suprainfection- Cdiff

Front 137

What should be checked before Amikacin is given (IM or IV)?

Back 137

-Dosage checked by 2 RNs
-Dosage by weight based formula
-Lab work: BUN and Creatinine
- Hydration

Front 138

Brand name of Gentimacin (aminoglycoside)

Back 138

Garamycin

Front 139

Geremycin saved for

Back 139

MRSA

Front 140

Fluoroquinilones

Back 140

Ciprofloxin
Levofloxin

Front 141

Brand name of Ciprofloxin

Back 141

Cipro

Front 142

Indications for Cipro

Back 142

-Drug of choice for chemical warfare (soliders carry on them)
- Penicillin resistant gonorrhea
-MDR-TB

Front 143

-Do not give to children under 18 yrs of age unless they have CF bc it will cause joint damage

Back 143

Side Effect of Cipro

Front 144

Drug that causes a paradoxic rxn. when giving to diabetic causes refractory hypoglycemia (hard to turn around) [or hyperglycemia in type II]

Back 144

Cipro

Front 145

Black box warning: ____ and ____ given together will cause V-Tach

Back 145

Fluoroquinilone and Amnioderone

Front 146

Fluoroquinilones interfer with what on the bacterial cells

Back 146

DNA synthesis

Front 147

Fluoroquinilones should be given with ____but not with____(meals are not regarded)

Back 147

With= 2-3 quarts of fluid daily to flush out kidneys

Not With:antacids w/ Mg or Al, or with Fe, Ca, or Zn at the same time or for several hours before or after a dose.

Front 148

Pharmocologic class of Doxycycline

Back 148

Tetracycline

Front 149

Brand name of Doxycycline

Back 149

vibramycin

Front 150

Tetracycline (doxycycline) indicated in

Back 150

-acne
-UTI
-penicillin allergies (much weaker than penicillins and cephlasporins)

Front 151

Tetracycline side effects

Back 151

-photo-sensitivity! Do not go to tanning bed! Will get 2nd-3rd degree burns
-N/V/D
-skin rash
-perineal itching

Front 152

Do not give this drug with dairy. Give 1hr ac or 2 pc. Give with at least 8oz of water

Back 152

Tetracycline

Front 153

How do you treat Red Man's Syndrome?

Back 153

Give Benadryl and fluids
Slow rate of drug infusion

Front 154

Brand name of Doxycycline
Trimethoprim-sulfamethoxazole

Back 154

Bactrim

Front 155

Pharm class of Bactrim

Back 155

Folate antagonist sulfonamides

Front 156

Therapeutic class of Bactrim

Back 156

Anti-infectives
Antiprotozoals

Front 157

Bactrim is most often used in

Back 157

UTIs
also used in prophylaxis (after sex)

Front 158

Major side effect of Bactrim

Back 158

Photosensitivy
can get 2nd and 3rd degree burns from the tanning bed

Front 159

What do you give Bactrim with

Back 159

A full glass of water to esophagitis

Front 160

Bactrim effects what part of the bacterial cell

Back 160

blocks synthesis of necessary component for cell metabolism and growth

Front 161

Urinary tract analgesic

Back 161

Pyridium

Front 162

Generic name for Pyridium

Back 162

Phenazopyridine

Front 163

Pyridium is used as a_____ it does nothing to ______.

Back 163

-urinary antiseptic: used for burning and to numb the urethra.
-It does nothing to the organism (bacteria)

Front 164

Pyridium's side effects

Back 164

Turns all secretions orange

Front 165

How long should you use pyridium?

Back 165

no longer than 48 hrs so as not to cover up other more serious problems

Front 166

Azithromycin Brand name

Back 166

Zithromax

Front 167

Azithromycin Pharm class

Back 167

Macrolide

Front 168

Azithromycin Therapeutic class

Back 168

Atypical TB Medication

Front 169

What drug can cause explosive diarrhea for 4-7 days?

Back 169

Azithromycin

Front 170

3 Common uses for Azithromycin

Back 170

-used prophy in people with penicillin allergy with an implant (ex. mitral valve prolapse take it before you have invasive procedures)
-For infections of the Respiratory Tract
-used in combo to tx MAC

(most commonly used antibiotic)

Front 171

What symptoms would you look for when giving Azithromycin which might indicate that the drug is causing liver damage?

Back 171

N/V/D
Abdominal cramping pain
jaundice
dark urine
tiredness

Front 172

Where do macrolides work in the bacterial cell?

Back 172

in the ribosomes

Front 173

Metronidazole: Brand name

Back 173

Flagyl

Front 174

Flagyl treats what kind of bacteria?

Back 174

-Gram - bacteria
-Anaerobic
-Some gram +cocci

Front 175

What should you teach your patient not to use when taking Flagyl?

Back 175

NO ALCOHOL!

Front 176

Labs to check before giving Flagyl

Back 176

CBC
Liver function
Kidney function (BUN and Creatinine)

Front 177

Who should not be given Flagyl?

Back 177

-1st trimester pregnancy
-Use cautiously in patients with CNS or blood disorders

Front 178

Vancomycin Brand name:

Back 178

Vancocin

Front 179

CDC recommendations for Vancomycin use:

Back 179

Used sparingly to help decrease the spread of VRE

Front 180

Side Effects of Vancomycin use

Back 180

-Red man's syndrome
-Nephrotoxicity
-phlebitis
-Allergic rxn= Anaphylaxis

Front 181

How does Vancomycin effect the bacterial cell?

Back 181

Binds to the cell wall

Front 182

What 2 impairments should you use caution with when treating with Vancomycin?

Back 182

Hearing and renal

Front 183

How long does it take for a Mycobacterium culture to grow?

Back 183

30 days

Front 184

What is the main problem with TB?

Back 184

The lack of ability to diagnose within a timely manner

Front 185

Who are common carriers of TB?

Back 185

-HIV+
-Immigrants
- homeless

Front 186

If you do not comply to your TB treatment what can happen?

Back 186

You can be put in Jail

Front 187

Primary TB drug

Back 187

INH

Front 188

Generic name for INH

Back 188

Isoniazid

Front 189

How is IHN used?

Back 189

Alone for latent TB
In combination for active TB

Front 190

Rifampin is used for

Back 190

TB

Front 191

Rifampin brand name:

Back 191

Rifadin

Front 192

Used synergistically with INH

Back 192

Rifampin

Front 193

Major side effect of Rifampin

Back 193

Liver damage- dont use alcohol and look for S/S of hepatitis which include nausea, jaundice, dark urine, light stools

Front 194

Should you take Rifampin with meals?

Back 194

No, take either 1 hr ac or 2 hr pc

Front 195

Drug that causes red excretions

Back 195

Rifampin

Front 196

Drug used with resistant TB

Back 196

Pyrazinamide

Front 197

Pyrazinamide is contraindicated in

Back 197

Pregnancy

Front 198

Take TB drugs on a _ stomach unless_

Back 198

empty stomach unless stomach upset occurs than can be taken with food.

Front 199

TB drugs

Back 199

IHN
Rifampin
Pyrazinamide

Front 200

INH-Resistant TB

Back 200

6 months of rifampin,Pyrazinamide, and ethambutol

Front 201

Rifampin resistant TB

Back 201

18 months of INH and ethambutol or
9 months of IHN, Pyrazinamide, and streptomycin

Front 202

Labs to monitor for TB

Back 202

ALT
AST
Bilirubin

Front 203

HIV drugs

Back 203

ATZ
Viread
Rescriptor
Viracept
Fuzeon

Front 204

AZT Generic name

Back 204

Zidovudine

Front 205

Pharm class of AZT

Back 205

Nucleoside reverse transcriptase inhibitors

Front 206

Therapeutic class of AZT

Back 206

Anti-retroviral

Front 207

Side effects of all HIV drugs
(AT, Viread, Rescriptor, Viracept, Fuzeon)

Back 207

-Nephrotoxicity
-hepatotoxicity
- CNS and peripheral neurotoxicity
-Pancreatitis
-Bone marrow suppression
-Increase or decrease in the metabolism of other drugs
- GI upset

Front 208

Side effects of AZT

Back 208

-severe anemia
-granulocytopenia
-peripheral neuropathy
-pancreatitis
-liver problems

Front 209

Labs to monitor when taking AZT

Back 209

-monitor amylase labs for pancreatitis
-monitor liver tests like SGOT because of hepatic effects (metabolized in liver)

Front 210

Used in pregnancy and can lower chance of HIV transmission to fetus to <2-4% if given early enough

Back 210

AZT

Front 211

AZT action

Back 211

blocks reverse transcriptase action

Front 212

HIV drug that may be effective against Hep B

Back 212

Viread (or Tenofovir)