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61 Cards in this Set
- Front
- Back
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Narrow-Spectrum (Penicillinase Sensitive)
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Penicillin G
Penicillin V |
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Narrow-Spectrum(Penicillinase Resistant/Antistaphyoloccal)
Nafcillin |
Oxacillin and Dicloxacillin
Methicillin |
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Broad-Spectrum(Aminopenicillins)
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Ampicillin
Amoxicillin |
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Extended-Spectrum (Antipseudonomal)
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Ticarcillin
Piperacillin |
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2nd Generation antihistamines: what is appropriate for a patient with allergic rhinitis
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The second generation antihistamines minimize side effects (drowsiness) that are commonly seen with the first generation antihistamines. This is due to the fact that the second generation antihistamines do not easily cross the BBB. There are six second generation antihistamines that are approved for seasonal allergic rhinitis. These drugs are Azelastine (nasal spray), Cetirizine, Levocetirizine, Fexofenadine, Lortadine, and Desloratadine.
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Benedryl and Chlor-Trimeton and Nolahist
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first generation H1 antagonists. Sedation is the number one adverse effect. Some nonsedating CNS effects are dizziness, fatigue, coordination problems (elderly), paradoxical excitation, GI upset (N&V, loss of appetite, constipation, diarrhea). Some drug interactions are alcohol and CNS depressants. These drugs are contraindicated in pregnant women during 3rd trimester, nursing mothers, and newborn infants. These drugs are administered by mouth. Benedryl is an antihistamine with the ability to suppress cough only at doses the produce prominent sedation (the usual dose is 25 mg every 4 hours). This drug would be used during a mild allergic reaction because it decreases dilation of small blood vessels and it decreases itching and edema.
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Astelin and Clarinex
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second generation H1 antagonists. They do not cause as much sedation because they are poor at crossing the BBB. Astelin is a nasal-spray. This drug works by blocking the release of histamine and other mediators from mast cells. It is used to treat allergic or vasomotor rhinitis. This should not be combined with alcohol. Clarinex is used to treat seasonal allergic rhinitis, perennial allergic rhinitis, and chronic idiopathic urticaria. It does not have any significant drug interactions but if the dose is increased the chance for drowsiness can increase. The first dose should be decreased with liver and renal impairment.
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What is a unique feature of ASA, not found in other COX inhibitors?
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Aspirin (ASA) is the only COX inhibitor the irreversibly inhibits COX. As a result, the effects of Aspirin persist until cells can make more COX.
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Aspirin and surgery?
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To minimize blood loss, pts. need to discontinue using high dose aspirin 1 week before a scheduled surgery. There is no need to discontinue low dose aspirin before a low risk surgery (dental, cataract).
No high dose aspirin at least one week before surgery (7-10days) |
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Risks of COX 2 inhibitors? (Celebrex/ Celecoxib; Rofecoxib, Valdecoxib)
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Contra-indicated in patients usnig Warfarin/ Heparin. Lessens the effects of Diauretics (Loop) . Can increase Lithium levels. Caution with P450 Inhibiting drugs. Renal impairment, and increase risk of MI, stroke & other cardiovascular events.
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Acetaminophen overdose is treated how?
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Acetylcystene (Mucomyst) by IV or orally.
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Glucocorticoids and increased stress? What would you expect?
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Because of adrenal suppression, patients taking glucocorticoids long term require increased doses during times of stress. Once glucocorticoid use has ceased, supplemental doses are required until recovery of adrenal function is complete. If glucocorticoid levels are insufficient, hypotension & hypoglycemia occurs. Glucocorticoids suppress inflammatory and immune responses and increase urinary excretion of potassium.
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Risks involved in pts on high dose glucocorticoids?
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Risk involved in patients on high dose glucocorticoids include adrenal insufficiency, osteoporosis, increased vulnerability to infection, muscle wasting, thinning of the skin, fluid volume excess and electrolyte imbalance, glucose intolerance, and, possibly, peptic ulcer disease.
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Best time to administer steroids?
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Glucocorticoids should be administered before 9:00 AM. Why? Because this helps minimize adrenal insufficiency and mimics (sort of) the burst of glucocorticoids released naturally by the adrenals each morning.
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Steroid Discontinuation
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To minimize expression of adrenal insufficiency when glucocorticoids are discontinued, doses should be tapered very gradually. Abrupt termination of long-term therapy may result in adrenal crisis. A Glucocorticoid should not be continued for life unless it is taken because of adrenal gland removal.
Following glucocorticoid withdrawal, supplemental glucocorticoids are needed at times of stress until adrenal function has fully recovered. |
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Contraindications to use of glucocorticoids?
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Some contraindications for the use of glucocorticoids are patients with systemic fungal infections and patients recieving live virus vaccines (MMR, oral polio, small pox vaccine). Use with caution on pediatric or pregnant/breast feeding patients.
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Proper use of an MDI--patient teaching
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MDI- Metered-dose inhaler- Used for oral administration. Patient teaching= Place up to mouth. Begin to inhale just prior to drug administration, continue slow inhalation. Hold breath and count to 10. When 2 puffs need to be taken there should be a 1 minute interval between the first and second puff. The puffs should not be taken in rapid succession. This use of a spacer is used to increase delivery of a drug to the lung and decrease deposition of drug on the oropharyngeal mucosa. Rinse mouth.
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How to you dose albuterol and an inhaled glucocorticoid? What is the purpose of each? How and when used?
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Inhaled glucocoriticoid dosing=highly individualized, determined by trial and error, for long time use=smallest effective amount, increased in times of stress, and wean off gradually. Purpose= anti-inflammatory, prevent exacerbation of illness and slow disease progression. Used orally or inhaled. Best if 2/3 given in morning and 1/3 given in the evening.
Albuterol dosing=used to abort on-going attack. Not to be used for long term prohylaxis. Used for bronchodilation. Inhaled or taken orally depending on type of medication before exercise or to abort on-going attack. When two different inhalers are used concurrently, it is best to wait 5 minutes between the two. |
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Azmacort/inhaled steroids-patient teaching?
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f. With inhaled therapy in premenopausal women: bone loss is possible, although much lower than the amount caused by oral steroids. To minimize bone loss, patients should use the lowest dose possible, ensure adequate intake of calcium and vitamin D, and participte in weight-bearing exercies. Teach pts to ensure adequate intake of calcium and vitamin D, and to participate in weight bearing exercise.
g. Prolonged therapy may increase the risk of cataracts and glaucoma • **Remember Rinse mouth after each use, Use spacer, If on PO steroids, overlap with inhaled steroid due to prolonged onset of action, Take after Beta Agonist; wait a few minutes after use of Beta 2 agonist, then use inhaled steroid, Take on regular basis, not PRN, Avoid OTC meds (like cough syrups which can cause tachycardia) , Using a beta 2 agonist first, increases penetration of the inhaled glucocorticoid to the lungs. |
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27. Adverse effects of long term steroids/long term inhaled steroids?
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i. Can be severe with long-term, hi dose oral tx (adrenal suppression, osteoporosis, hyperglycemia, and others)
ii. Can slow growth in children & adolescents, but do not decrease adult height iii. Prolonged therapy may increase the risk of cataracts and glaucoma iv. Prolonged therapy with oral glucocorticoids: adverse effects –adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and in young pts, suppression of growth. Following withdrawal of oral glucocorticoids (or transfer to inhaled glucocorticoids), several months are required for recovery of adrenocortical function. Throughout this time, all patients—including those switched to inhaled glucocorticoids—must be given supplemental oral or IV glucocorticoids at times of severe stress. |
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Theophylline? Adverse effects? Why? Seizures? Precautions.
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. GI: N /V, diarrhea, insomnia, with increasing bld levels
i. CNS: nervousness/anxiousness ii. CV: tachyarrhythmias/angina/dysrythmias iii. •Should a patient develop serious toxicity accompanied by seizures, the priority of care is patient safety, along with airway, breathing and circulation (ABCs). iv. •Toxicity is related to theophylline levels. Adverse effects are uncommon at plasma levels below 20 mcg/mL. At 20 to 25 mcg/mL, relatively mild reactions occur (eg, nausea, vomiting, diarrhea, insomnia, restlessness). Serious adverse effects are most likely at levels above 30 mcg/mL and could include tachycardia and dysrhythmias. A priority nursing assessment is to assess drug levels. At the first indication of toxicity, administration of theophylline should cease. f. Drug Interactions: many; P450 effects . Caffeine: (a methylxanthine) can intensify affects of theophylline in CNS and heart i. Phenobarbital, phenytoin and rifampin can reduce theophylline levels ii. Cimetidine and the fluoroquinolone antibiotics (Cipro) can elevate theophylline levels g. Fatal drug interaction: Halothane (an anesthetic drug) h. Contraindicated for patients with untreated seizure disorders or peptic ulcer disease i. Use caution in patients with heart disease, liver or kidney dysfunction, or severe hypertension. |
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Montelukast (Singulair): use/maximum effects/interactions?
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• Antihistamine - Sympathomimetic combination
• Leukotriene Antagonist - Blocks Leukotriene receptors • Uses: Seasonal Allergic Rhinitis - Leukotrienes cause nasal congestion; so by blocking leukotriene receptors, montelukast (Singulair) relieves nasal congestion. • Also used for asthma - decreases inflammation, bronchconsrtiction, edema, mucous secretion, recruitment of eosinophils - not for quick relief of an asthma attack, but for prophylaxis an dmaintenance therapy of asthma. • Interactions - Montelukast undergoes metabolism by hepatic P450 enzymes. If taken with phenytoin ( P450 inducer), can decrease levels of montelukast. • Maximum effects: Develop within 24 hours of the first dose, so are not immediate. As monotherapy, montelukast is less effective than glucocorticoids. Some drugs for treating allergic rhinnitis: |
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Intranasal sympathomimetics: use, adverse effects, teaching.
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• Relieves stuffiness in allergic rhinntis. The vasoconstriction on the nasal blood vessels shrinks the swollen membranes followed by nasal drainage.With topical administration, vasoconstriction is rapid and intense with minimal side effects.
• Rebound congestion can occur when intranasal sympathomimetics are used for prolonged periods, requiring the patient to increase the frequency of doses.This can be stopped by not abruptly withdrawing the decongestant. Discontinue the drug in one nostril at a time to to decrease rebound congestion. Limit the sprays or drops to 3 to 5 days.Not appropriate for people with chronic rhinnitis. |
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Guaifenesin: indication; method of action
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Guaifenesin (Mucinex, Humibid)
• Indication/Method of action o Expectorant o renders cough more productive by stimulating the flow of respiratory tract secretions • Does NOT increase the effects of antibiotics, relieve pain from cough, or dry up secretions • May need higher dose for this drug to be effective • Not effective in asthma |
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Suprainfection
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NEW infection that appears during the course of treatment for a primary infection
o New infection develops when antibiotics eliminate the inhibitory influence of normal flora, thereby allowing a second infectious agent to flourish o More likely with pts receiving broad-spectrum agents Caused by drug-resistant microbes, so difficult to treat Ex. Oral thrush = manifestation of a suprainfection |
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Nosocomial Infection
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Infections acquired in hospitals
-Most difficult to treat -Can reduce risk by removing invasive lines/devises ASAP and encouraging vaccinations |
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Community Acquired infection
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Infection acquired outside the hospital or present on admission
- Most often involve H. influenzae or Streptococcus pneumonia |
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Antiobiotic resistance
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• Microbe becomes resistant to antibiotic, NOT the patient
• Contributing factors include: Widespread use of antibiotics, esp. broad spectrum drugs o Drug works on bacteria prescribed for transient organisms, other pathogens & normal flora. o Normal flora become suppressed & nutrients support growth of organism resistant to effects of the antibiotic o Resistant organism become the predominant strain o Resistant organisms can cause superinfection o Interrupted/inadequate drug treatment o Patient stops taking the medication too early o Type of bacteria: gram-positive and gram-negative bacteria are producing more antibiotic resistant strains o Type of infection: o Lower respiratory tract infections o Infections associated with cystic fibrosis o Infections associated with osteomyelitis These infections are difficult to treat as they reoccur, involve gram-negative or resistant organisms, and/or involve anatomic areas that drugs do not penetrate well. • Condition of the host o Malnourished o Severely ill (ICU pts) o Immunosuppressed o Mechanically ventilated (VAP and HAP) Location or settings o Critical Care Units o Large teaching hospitals Occurs in most human pathogens These infections require more toxic/expensive drugs Leads to prolonged illness, hospitalization, and increased mortality rates |
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Antibiotic administration – nursing interventions/priority interventions/patient history
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• Use measures to prevent/minimize spread of infection.
• Wash hands thoroughly and often. Foam in/out. • Support natural defense mechanism. • Keep patients skin clean and dry. • Treat all body fluids as infectious. • Implement isolation procedures appropriately. • Prevent spread of respiratory infections (cough sneeze etiquette). • Assist with pulmonary hygiene measures. • Sterile technique for dressing changes. • Minimize spread of infections (get flu vaccine). • Monitor temps, WBCs • Monitor intake/output • Assist patient in using drugs safely (teaching) |
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Antibiotics and patient teaching
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Patients should complete prescribed course of antibiotic treatment, even though symptoms may abate before the full course is over.
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Purpose of antibiotic combination therapy
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Although combinations of antibiotics should generally be avoided, they are appropriate in some situations, including (1) initial treatment of severe infections, (2) infection with more than one organism, (3) prevention of resistance, (4) decreased toxicity, and (5) an infection in which combination therapy can greatly enhance antibacterial effects. (Treatment of tuberculosis).
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Potentiative
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giving the two together has a greater effect than either given alone.
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Additive
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response is one in which the antimicrobial effect of the combination is equal to the sum of the effects of the two drugs alone
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How to reduce incidence of nosocomial infection (CDC recommendations)
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• Prevent Infection
1. Vaccinate 2. Get the catheters out • Diagnose and Treat Infection 3. Target the pathogen 4. Access the experts • Use Antimicrobials Wisely 5. Practice antimicrobial control 6. Use local data 7. Treat infection, not contamination 8. Treat infection, not colonization 9. Know when to say “no” to vancomycin 10. Stop treatment when infection is cured or unlikely • Prevent Transmission 11. Isolate the pathogen 12. Break the chain of contagion |
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Desensitization Process
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administer small doses every hour in increasing doses until the full therapeutic dosage has been achieved
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Safety Interventions
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Epinephrine and facilities for respiratory support should be kept in a place where immediately available incase of a reaction.
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UTIs and medications indicated
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• most common infection, that may only colonize in urine or may infect other tissues of the urinary tract
o classified according to location o referred to complicated and uncomplicated complicated- occur in males and females and associated to a predisposing factor such as calculi, prostatic hypertrophy, indwelling catherters, or in impediment in urine flow Uncomplicateed- occur mostly in women of child-bearing age and are not associated with any predisposing factors • Medications indicated o Sulfonamides, Trimethoprim, Penicillins, Aminoglycosides, Cephalosprorins, Fluoroquinolones urinary tract antiseptics |
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Cross allergy: Penicillins and cephalosporins
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Patients allergic to penicillins have about a 1% risk of cross-reactivity with cephalosporins. Therefore, cephalosporins can be used with minimal concern in patients with a mild penicillin allergy; however, they should not be administered to patients with a history of a severe reaction to penicillin, such as anaphylaxis.
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Cefotetan and drug interactions (warfarin)
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Cefotetan promotes bleeding and therefore caution is needed if this drug is combined with other agents that promote bleeding such as anticoagulants, thrombolytics, NSAIDS, and other antiplatelet drugs. Cefotetan can also induce a state of alcohol intolerance. If a patient takes this drug and drinks alcohol, a disulfram-like reaction can occur. cefotetan—cause bleeding tendencies and disulfiram-like reactions. Patients should be monitored for signs of bleeding: bruising, bleeding gums, blood in urine. Bleeding tendencies should be carefully monitored for in patients who are also taking warfarin (Coumadin).
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C. difficile: cause; how to treat
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Clindamycin adverse effect is pseudomembraneous colitis (c. difficile). When a patient has C. difficle, characterized by profuse diarrhea, abdominal pain, and fever, you would expect Vancomycin (oral) or metronidazole (oral) to be ordered.
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Recognize a good alternative antibiotic to using penicillin
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Clindamycin
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Gentamicin: adverse reactions; indications; drug interaction
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Adverse reactions - same as all aminoglycosides - possible nephrotoxicity, ototoxicity (avoid use with ethacrynic acid), hypersensitivity reactions, neuromuscular blockade, muscle weakness, blood dyscrasias
Indications/uses - almost exclusively used for serious infections due to aerobic gram-negative bacilli; gentamicin also used effectively as opthalmalic solutions and ointments, as well as a treatment for cystic fibrosis Drug interactions - use w/caution in patients with renal impairment, pre-exsisting hearing impairment, myasthenia gravis; watch with patients receiving ototoxic drugs, nephrotoxic drugs, and neuromuscular blocking agents |
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Aminoglycosides: measurement of peak and trough levels/measurement; drug interactions; nephrotoxicity
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Peak levels must be high enough to cause bacterial kill, trough levels must be low enough to minimize toxicity.
Peak Draw: the level should be measured a 1/2 hour after IV infusion is complete OR an an hour after IM). Trough Draw: just prior to the next to dose (when using divided daily does) OR 1 hour before he next dose (when using a single daily dose). You want the draw to be very near 0 if it is not then the dose may need to be decreased so that a sustained high trough level is not maintained. A sustained high trough level can cuase ototoxicity DI’s: o Combining Aminoglycosides with Ethacyrnic acid (Edecrin) will increase risk of ototoxcity. o Concurrent therapy of Aminoglycosides with amphotericin B, cephalosporins, vancomycin, and aspirin will increase the risk of nephrotoxicity. o Concurrrent use of a neuromuscular blocking agent or general anesthetic with an aminoglycoside will increase risk of neruromuscular blockade. It can be reversed by an IV infusion of calcium gluconate. Nephrotoxicity: Aminoglycoside induced Nephrotoxicity is o related to the total cumulative dose, not elevated trough levels o generally reversible o usually manifests as acute tubular necrosis o manifested with symptoms of proteinuria, casts in urine, dilute urine, elevations in serum creatinine and BUN. |
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Sulfonamides: adverse reactions; drug interactions; pts with diabetes
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1. hypersensitivity reactions (photosensitivity and Steven Johnsons)- tell patients to wear sunscreen and protective clothing if in direct sun. Patients should be reminded to take med with food and report signs of nausea.
2. hemolytic anemia- 3. kernicterus - due to increased risk with youngins dont administer to an infant under 2 months of age or to a pregnant woman near term or to mothers who are breast feeding. 4. renal damage- to prevent tell pt. to drink 8-10 glasses of water /day. 5. Pts w/ Diabetes: Remind diabetic patients of the risk of hypoglycemia as sulfonamides can intensify the effects of oral hypoglycemic agents. They need to monitor their blood sugar levels carefully and make sure they know the s/s of hypoglycemia (anxiety, hunger, sweating, heart palpitations, seizures, double/blurred vision, confusion, and abnormal behavior.) |
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Red Man Syndrome
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flushing, rash, pruritus, urticaria, tachycardia, hypotension (these effects may result from the release of histamine) Tx with Vancomycin slowly infused over 1 hour or more.
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Steven Johnsons Syndrome
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widespread lesions of skin and mucous membranes, fever, malaise, toxemia. (can be extremely dangerous)
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Hemolytic Anemia
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affects AA (African American) and Mediterannian patients (usually genetic deficiency). Red cell lysis can produce fever, pallor and jaundice
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Fosfomycin: indications; advantage
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Indications: UTI
Advantages: Single dose! For those that compliance might be an issue. |
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Rifampin: adverse reactions versus expected findings; indications for use
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The adverse effects of rifampin are hepatotoxicity, discoloration of bodily fluids, and GI disturbances. Hepatotoxicity is the adverse effect of most concern. Any signs of hepatitis should be reported to the prescriber while a patient is taking rifampin. Rifampin frequently imparts a red-orange color to urine, sweat, saliva, and tears and patients should be warned of this harmless effect. Rifampin is indicated for use in tuberculosis, leprosy, H. influenza, and Legionella.
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Why do we use multiple drugs in the treatment of TB? What is the typical course of therapy?
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Multiple drugs are used to treat TB because it minimizes the risk of drug resistance. A bacterium could develop resistance to one anti-TB agent but is unlikely that a bacterium would develop a resistance to two drugs. The organism must be sensitive to both of the TB agents employed.
A typical course of therapy has two phases: induction and continuation. The goal of the induction phase is to eliminate actively dividing tubercle bacilli. This phase lasts 2 months and consists of isoniazid, rifampin, pyrazinamide, and ethambutol. Dosing can be daily or 2-3 times a week. The goal of the continuation phase is to eliminate extracellular persisters. This phase generally lasts four months and consists of the drugs isoniazid and rifampin. These are also dosed daily or 2-3 times per week. |
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Ethambutol (Myambutol): effects/adverse effects; precautionary testing needed.
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Ethambutol is a bacteriostatic, first-line tuberculosis drug. It is always used as a part of a multidrug regimen. Ethambutol can produce dose-related optic neuritis, resulting in blurred vision, constriction of the visual field, and disturbances in color discrimination. Therefore, patients should be tested for visual acuity and red-green color perception prior to treatment and monthly thereafter. Since vision changes are hard to monitor in pediatric patients, ethambutol is not recommended for children under 8. Other adverse effects are allergic reactions, GI upset, confusion, and hyperuricemia leading to acute gouty arthiritis. Rarely patients experience peripheral neuropathy, renal damage, and thrombocytopenia
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Ciprofloxacin
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• Ciprofloxacin is approved for a wide variety of infections. Among these are infections of the respiratory tract, urinary tract, gastrointestinal (GI) tract, bones, joints, skin, and soft tissues. Also, ciprofloxacin is a preferred drug for preventing anthrax in people who have inhaled anthrax spores.
• Ciprofloxacin can induce a variety of mild adverse effects, including GI reactions (nausea, vomiting, diarrhea, abdominal pain) and central nervous system (CNS) effects (dizziness, headache, restlessness, confusion). Candida infections of the pharynx and vagina may develop as a result of treatment. • As with all the fluoroquinolones there is a risk of phototoxicity or tendon rupture • Ciprofloxacin can elevate levels of warfarin. The patient’s prothrombin time should be monitored and the dosage of warfarin should be reduced as appropriate. • Other drug interactions-- Absorption is reduced by cationic substances (antacids,iron salts, zinc salts, sucralfate, milk and other dairy); food should be avoided 6 hours before and 2 hours after Cipro; interacts with warfarin, theophylline, and azole antifungals |
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Levofloxacin
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• Adverse effects-- peripheral neuropathy, rhabdomyolysis (rapid breakdown (lysis) of skeletal muscle (rhabdomyo) due to injury to muscle tissue), tendon rupture, and phototoxicity
• Adminstered PO or IV • Absorption is reduced by cationic substances (antacids,iron salts, zinc salts, sucralfate, milk and other dairy) so patients should avoid if possible |
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Terbinafine and onychomycosis: patient teaching;
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Terbinafine is also known as Lamisil, this drug is active against dermatophytes and less active against Candida species, this is available in topical and oral treatments. Patients should be advised of signs of liver dysfunction (persistent nausea, anorexia, fatigue, vomiting, jaundice, dark urine, and pale stools) if they do appear then patient should discontinue use immediately and undergo an evaluation of liver function. Onychomycosis is used for a fungal infection of the nails. This can be treated with oral or topical therapies as well. Using either product will require for at least 3-6 months to help alleviate these issues. The topical treatment is safer and cheaper, but much less effective.
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Itraconazole (Sporanox): what type of patient should not take this drug?
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Patients with heart failure, a history of heart failure, or other indications of ventricular dysfunction should be advised about the effects of this drug. This drug should only be used in patients with serious infections.
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What drug is indicated for the treatment of oral candidiasis?
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Topical agents such as nystatin, clotrimazole, and amphotericin B are generally effective. In an immunocompromised patient oral therapy with fluconazole or ketoconazole is usually required.
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Amphotericin B: adverse effects; monitoring; how can you mitigate the adverse effects; when administering this drug? How is drug administered?
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Adverse effects with this drug are infusion reactions, nephrotoxicity, hypokalemia, bone marrow suppression, which can result in normocytic, normochromic amenia. Infusion reactions can be minimized by changing peripheral venous sites often, administering amphotericin through a central vein, and pretreatment with heparin. To evaluate renal function testing kidney function should be performed every 3 to 4 days and intake and output should be monitored. Potassium levels and serum creatinine should be monitored often. Hematocrit determinations should be conducted to monitor red blood cell status.
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Valacyclovir (Valtrex): patient teaching; indications; administration; action
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Valacyclovir (Valtrex), a prodrug form of acyclovir, has three approved indications: (1) herpes zoster (shingles), (2) herpes simplex genitalis, and (3) herpes labialis (cold sores). It will not prevent recurrent infection, but it does help reduce the duration of pain and postherpetic neuralgia. It may be taken, PO with or without food, it does not need to be taken on an empty stomach. Patients do not need to avoid dairy products, nor do they have to take the medication at a certain time, like in the morning.After oral dosing, valacyclovir undergoes rapid absorption followed by rapid and essentially complete conversion to acyclovir. When acyclovir itself is given PO, bioavailability is only 15% to 30%. In contrast, when valacyclovir is given PO, the effective bioavailability of acyclovir is greatly increased—to about 55%
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Interferon: indication for use; adverse effects
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interferon alpha used for Hep B and Hep C viral infections; Adverse effects - Flu like syndrome(fever, fatigue, myalgia, headache and chills),frequently causes nueropsychiatric effects such as depression and suicide especially with large prolonged doses.Prolonged or high-dose therapy can cause fatigue, thyroid dysfunction, heart damage, and bone marrow suppression, manifesting as neutropenia and thrombocytopenia.
Other adverse effects include alopecia and GI effects: nausea, diarrhea, anorexia, and vomiting. Injection-site reactions (inflammation, bruising, itching, irritation) are common, especially with long-acting formulations. Also, interferon may induce or exacerbate autoimmune diseases, such as thyroiditis and autoimmune chronic hepatitis. |
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Influenza vaccine: who should receive; when does protection begin; contraindications to vaccine; protection if exposed;
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Influenza is caused by influenza viruses, of which there are two major types: influenza A and influenza B. Type A influenza viruses cause far more infections than type B influenza viruses (about 96% vs. 4%). The influenza viruses are highly variable and undergo constant evolution. Two types of influenza vaccine are available: inactivated influenza vaccine (administered by IM injection) and live, attenuated influenza vaccine (administered by nasal spray).
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Tamiflu: action; when to start; what does this drug do?
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oseltamivir (Tamiflu) and zanamivir—are active against influenza A and influenza B. When used to treat influenza, oseltamivir (Tamiflu) dosing must begin early – no later than 2 days after symptom onset and preferable much sooner. When treatment is started within 12 hours of symptom onset, symptom duration is reduced by more than 3 days; when started within 24 hours, symptom duration is reduced by less than 2 days. At a week after symptom onset, the medication will not significantly help to reduce symptoms. The medication will not prevent future episodes of influenza. Lab testing is not required before a prescription may be written for a patient. Antiviral effects derive from inhibiting neuraminidase, a viral enzyme required for replication and is effective against Influenza A and B.
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