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Test One

Test One

by Rann-Hads, Feb. 2016

Subjects: Pharmacology

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149 Cards in this Set

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	Four Drug Sources	Plants, Animals, Minerals, Chemicals (Synthetic)
	Chemical Name	Describes chemical composition ie. N-acetyl-para-aminophenol
	Generic Name	Name used in official drug compendiums to list drugs ie. Acetaminophen
	Trade Name	Drug has a registered trade mark and official owner ie. Tylenol
	Pharmacokinetics	The study of drug distribution rates between various body compartments after a drug has entered the body Includes absorption, distribution, metabolism, and excretion
	Absorption	The movement of a drug from its site of administration into the bloodstream for distribution to the tissues Factors that affect - route, food or fluids, dosage, rate of blood flow to the small intestines, acidity in the stomach, status of GI motility
	First Pass Effect	Reduces bioavailability to less than 100% A PO drug that is absorbed from the intestine must pass through the liver before it reaches systemic circulation If the drug is metabolized in the liver, some of the active drug will be inactivated before it can reach circulation and its site of action This happens every time the pt takes the meds IV route is 100% bioavailable
	Routes	Enteral, Parenteral, Topical, Transdermal, Inhalation
	Enteral	Oral ingestion of the drug Also includes sublingual (under the tongue) and buccal (cheek/gums)
	Parenteral	By injection Fastest route Also includes subcutaneous, intradermal, intramuscular, and intravenous
	Topical	Application of medications to the body surfaces
	Transdermal	Drug patch
	Inhalation	Delivered to the lungs as tiny drug particles
	Distribution	The transport of a drug in the body by the bloodstream to its site of action Once it has entered the bloodstream (circulation), it's distributed throughout and also begins to be eliminated by the organs that metabolize and excrete (liver, kidneys) Highly vascularized areas receive drug first (heart, liver, kidneys, brain) Areas of slower distribution are muscles, skin, fat
	Drug-Drug Interaction	When one drug decreases or increases the response of another concurrently given drug Includes OTC medications
	Metabolism	The biological transformation of a drug into an inactive metabolite (a more soluble compound) - also known as biotransformation Primary organ responsible is the liver Factors that can alter metabolism are genetics, diseases, the concurrent use of other meds, age
	Excretion	The process of elimination of drugs from the body Primary organ responsible is the kidney (also liver and bowel) Most are excreted through urine but also from the lungs, salivary and mammary glands, skin, sweat, and intestinal tract
	Factors Affecting Drug Action	Dosage Route Drug-Drug Int. Pathology Genetics Age Weight Gender Ethnicity Activity Level
	Drug Action	Refers to the chemical changes the drug produces
	Drug Effect	Combination of biological, physical, and psychological changes that take place in the body as a result of the drug action
	Therapeutic Effect	Desired effect, or reason the drug was administered
	Side Effects	Additional effects on the body that are not part of the goal of the drug therapy Can be harmless, mildly annoying, or dangerous
	Requirements for Proper Administration	Knowledge of drug effects Observation of the results in the pt
	Drug Allergy	An abnormal response that occurs because a person has developed antibodies against a particular drug Histamine is released and is responsible for the symptoms we can see Milk reactions can occur immediately, hours, days or weeks after a drug is administered Severe reactions (can be fatal) usually begin within minutes and require immediate attention
	Toxicity	The drugs ability to poison the body An overdose of medication - the amount given was too great for size, age, condition
	Adverse Reactions	Unexpected, unintended, and undesired responses to drugs
	Idiosyncratic Reaction	Abnormal or peculiar reactions to certain drugs Thought to be caused by an abnormal metabolism of drugs as a result of enzyme deficiency Pt may over or under react
	Tolerance	The need for increasingly larger doses of a drug to produce the same effects ie. opiates, alcohol, tobacco
	Synergism	When two drugs given together produce a more powerful response than each given seperately
	Potentiation	One drug increases the effect of the other drug ie. sedatives + alcohol = sedatives stronger possibly fatal
	Antagonism	Two drugs inhibit or cancel each other out ie. Maalox should not be given with oral tetracycline
	Onset	The time it takes for the drug to elicit a therapeutic response
	Peak Effect	The time it takes for a drug to reach its maximum therapeutic response
	Duration of Action	The length of time that a drug concentration is enough to elicit a therapeutic response
	Peak Level	Highest blood level of a drug
	Trough Level	Lowest blood level of a drug
	Plateau or Steady State	State in which the amount of drug removed by elimination is equal to the amount absorbed with each dose
	Half-Life	The time it takes for one half of the original amount of a drug in the body to be removed and is a measure of the rate at which drugs are removed from the body After about 5 half-lives the drug is considered removed from the body
	Absorption and Distribution changes with aging:	Slower blood circulation Slower absorption or oral meds through intestines
	Factors related to Aging	Heart pumps less efficiently Stomach and intestines have fewer digestive enzymes Peristalsis is weaker Heart and brain compete for blood supply causing more drugs to end up there which can lead to abnormal reactions Metabolism is affected because of reduced capacity of the liver Drugs tend to stay in effect longer and can build up causing a cumulative effect (toxic) Excretion affected by reduced blood circulation to the kidneys which can cause build ups Body looses its ability to balance the systems Usually meds are prescribed in lower doses and less frequently to prevent toxicity Disease affact drug actions
	Acute Therapy	Intensive drug therapy; short period of time
	Maintenance Therapy	Does not eradicate problems but prevents progression
	Supplemental Therapy	Something the body requires but cannot make itself ie. insulin administration
	Palliative Therapy	Goal is to make pt as comfortable as possible
	Supportive Therapy	Providing fluids and electrolytes to prevent dehydration for a pt with influenza
	Prophylactic Therapy	Antibiotics given prior to surgery to prevent post op infection Preventative measures
	Pregnancy Considerations	First trimester is the period of greatest danger for all drug-induced developmental defects Drugs diffuse across the placenta There are Pregnancy Safe categories
	Breastfeeding	Infants are at risk for exposure to drugs consumed by the mother
	Pediatric Considerations	Absorption - gastric pH is less acidic and emptying is slowed; topical is faster through the skin; IM is faster and irregular Skin is thin and permeable Stomach lacks acid to kill bacteria Lungs lack mucus barriers Body temps are poorly regulated and dehydration occurs easily Liver and kidneys are immature, impairing drug metabolism and excretion
	Geriatric Considerations	Use of OTC meds - if their doc does not "listen" or "believe" they stop telling them what they are taking Polypharmacy - the use of four or more meds
	Drug Regulations	Regulated by the Canadian Food and Drug Inspection Agency (FDA) Narcotics are under RCMP jurisdiction Only licensed pharmacists can dispense meds Only physicians, dentists, and NPs can prescribe meds
	Analgesics	Meds that relieve pain without causing loss of consciousness Also referred to as "painkillers"
	Pain	Pain is whatever the pt says it is It exists whenever the pt says it does It is an unpleasant sensory and emotional experience associated with actual or potential tissue damage Pain is a personal and individual experience Tissue injury causes release of substances that stimulate nerve endings, starting the pain process
	Acute Pain	Sudden onset Usually subsides once treated
	Chronic Pain	Lasting more than 6 months Persistent or recurring Often difficult to treat
	Analgesics	Interfere with the process of pain transmission and recognition
	Analgesic Action	Either effect the brain itself or interfere with the ability of pain receptors around the body to send pain messages to the brain
	Analgesic Antipyretics	Some analgesics also have anti-fever properties They are often combines with narcotic analgesics or sedatives in prescription pain relievers ie. Tylenol with codeine
	Narcotics	A large group of analgesics Along with pain relief, bring a euphoria, a sense of calm, and therefore are often abused ie. Morphine, Demerol, Codeine, Oxycodone
	Opioid Analgesics	Very strong pain relievers that contain opium, derived from the opium poppy or chemically related to opium 20 different alkaloids available from the opium plant but only 3 are useful clinically: Morphine (pain reliever) Codeine (pain reliever) Papaverine (muscle relaxant) The body has its own natural pain relievers that stimulate opioid receptors known as endorphins (endogenous morphine)
	Opioids - Main Use	To alleviate moderate to severe pain Often given with adjuvant analgesic agents to assist the primary agents with pain relief NSAIDs, antidepressants, anticonvulsants, corticosteroids
	NARCAN	Naloxone Hydrochloride Used for complete or partial reversal of opioid-induced respiratory depression Works as a blocking agent to the opioid drugs Also used in suspected overdose
	Opioid - Other Indications	Opioids are also used for: Couch center suppression Treatment of diarrhea Balanced anethesia
	Opioid - Contraindications	Known drug allergy Severe asthma or other respiratory insufficiency Elevated intracranial pressure Pregnancy
	Opioid - Side Effects	Euphoria CNS depression Nausea and vomiting Respiratory depression Urinary retention Diaphoresis and flushing Pupil constriction (miosis) Constipation Itching
	Opioid Tolerance	A common physiologic result of chronic opioid treatment Results in larger dose of opioid required to maintain the same level of pain control or relief Is expected with long-term opioid treatment and should not be confused with psychological dependence/addiction
	Opioid Physical Dependence	The physiologic adaptation of the body to the presence of an opioid With physical dependence, when the drug is stopped abruptly, withdrawal symptoms may result such as increased pulse, rebound pain, hypertension, and mental agitation Is expected with long-term opioid treatment and should not be confused with psychological dependence/addiction
	Opioid Psychological Dependence	A pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief (feeling/euphoria)
	Opioids - Nursing Implications	Oral forms should be taken with food to minimize gastric upset Withhold dose and contact Dr if there is a decline in the pts conditions or if VS are abnormal, especially if respiratory rate is less than 12 BPM Constipation is common and may be prevented with adequate fluid and fiber intake Instruct pt to follow directions for admin carefully, and to keep a record of their pain experience and response to treatments Pts should be instructed to change positions slowly to prevent orthostatic hypotension
	Non-Opioid Analgesics	Acetaminophen - most common Analgesic and antipyretic effects Available OTC and in combination products with opioids Causes pain impulses to be blocked Indicated for mild to moderate pain, fever, and as an alternative for those who cannot take aspirin products Maximum daily dose for healthy adults is 4000 mg/day Be aware of the acetaminophen content of other meds taken by pt (ie. Neocitrin) Dangerous interactions may occur is taken with alcohol Should not be taken if pt has liver dysfunction or possible liver failure
	Analgesics Nursing Implications	Before beginning therapy, perform a thorough history regarding allergies and use of other meds, including alcohol, health history, and medical history - presence of liver disease Obtain baseline vitals and I&O Assess for potential contraindications and drug interactions Perform a thorough pain assessment, including pain intensity and character, onset, location, description, precipitating and relieving factors, type, remedies, and other pain treatments Assessment of pain is considered a "fifth vital sign" Be sure to medicate pts before the pain gets severe to provide adequate analgesic and pain control Have pt rate pain using a pain scale 30 mins before and after pain meds Pain management includes pharmacologic and nonpharmacologic approaches; be sure to include other interventions Pts should not take other meds or OTC meds without checking with their Dr Instruct pt to notify Dr for signs of allergic reaction or adverse effects Advise overdose/overuse/misuse can cause liver damage
	NSAIDs	Non-Steroid Anti-Inflammatory Drugs Large and chemically diverse group of drugs with the following properties: Analgesic Anti-inflammatory Antipyretic Anti-rheumatic Salicylates also have antiplatelet activity (inhibit platelet aggregation/clotting) They relieve pain, headache, and inflammation by blocking the chemical activity of enzymes Blocking this chemical activity limits inflammatory effects
	NSAIDs Indications	Analgesia (mild to moderate) Antigout effects - acute gout (Gout-uric acid crystals in blood) Anti-inflammatory effects Antipyretic effects Relief of vascular headaches Platelet inhibition (ASA) Osteoarthritis, RA, Juvenile RA Various bone, joint, and muscle pain Dysmenorrhea (difficult periods)
	NSAIDs - Salicylates	Aspirin Antithrombotic Effect: used in the treatment of MI and other clotting disorders
	NSAIDs - Antigout	Gout: condition that results from inappropriate uric acid metabolism Uric acid crystals are deposited in tissues and joints resulting in pain Allopurinol, Colchicine, Probenecid
	NSAIDs - Side Effects	Gastrointestinal Heartburn, epigastric distress, nausea GI bleeding Mucosal lesions (erosions or ulcerations) Renal Reductions in creatinine clearance May result in renal failure Cardiovascular Pulmonary edema
	NSAIDs - Salicylate Toxicity	Adults: tinnitus and hearing loss Children: hyperventilation and CNS effects; arise when serum levels exceed 300 mcg/mL Tinnitis (ringing in the ears) is a classic sign of aspirin toxicity
	NSAIDs - Nursing Implications	Before beginning therapy, assess for conditions that may be contraindications to therapy, especially GI lesions or peptic ulcer disease and bleeding disorders Perform lab studies as ordered (cardiac, renal, liver studies, CBC, platelet count) Perform a med history to assess for potential drug interactions (alcohol, heparin, etc) Salicylates are NOT to be given to children under age 12 because of the risk of Reye's syndrome (a serious illness the can affect the brain and liver) Often better tolerated with food, milk, or an antacid to avoid stomach irritation Explain to pts that therapeutic effects may not be seen for 3-4 weeks Pts should watch closely for occurrence of any unusual bleeding, such as in the stool Enteric coated tablets should not be crushed or chewed
	Cholinergics	Drugs that stimulate the PNS AKA parasympthomimetics
	Anticholinergics	Drugs that oppose the action of the PNS
	Adrenergics	Drugs that stimulate the SNS Either promote the release of adrenaline and noradrenaline or mimic their effects
	Sympatholytics	Drugs that lyse or inhibit the SNS AKA beta-blockers
	Cholinergic Drug Uses	Reduce intraocular pressure (IOP) in pts with glaucoma Treat GI and bladder disorders, Alzheimer's, and excessive dry mouth Used to stimulate the intestine and bladder
	Cholinergic Drug Contraindications	GI or GU tract obstruction Bradycardia Hyperthyroidism Epilepsy Parkinson's Hypotension COPD
	Cholinergic Drug Side Effects	Over stimulation of the PNS could result in bradycardia, headache, dizziness, convulsions, increased secretions, N&V, bronchospasms SLUDGE: salivation, lacrimation (tears), urinary incontinence, diarrhea, GI cramps, emesis
	Cholinergic Drug Nursing Implications	Watch for GI upset Blurred vision Decreased pulse Low BP SOB (shortness of breath) Urinary frequency VS and I&O
	Cholinergic Drug Teaching	Take as ordered Space doses evenly Call Dr is increased muscle weakness, abdominal cramps, diarrhea, dyspnea Do not break, crush, or chew sustained release tabs Change position slowly, wear med alert
	Anticholinergics Action	Cholinergic blockers Action: they block a cholinergic effect which allows the SNS to dominate (blocks actions of Acetylcholine) May have similar effects as adrenergics Major Action Sites: respiratory tract, heart, GI tract, bladder, eye and exocrine glands
	Anticholinergics Use	Decrease intraocular pressure (IOP) Increase bladder tone and peristalsis Promote muscle contractions Mild dementia
	Anticholinergics Contradictions	Anesthetics Opioids Some antibiotics Magnesium Anti-arythmias or corticosteroids History of benign hypertrophic prostate Glaucoma Tachycardia MI, heart failure Hiatal hernia GI/GU obstruction Under 3 years of age
	Anticholinergics Nursing Implications	Watch for toxicity, myasthenic crisis (muscular debility or crisis - can lead to resp. failure), and respiratory difficulties Monitor VS and I&O SOme ppl are very susceptible to the effects of these drugs: infants, elderly, fair skinned, children with Down's syndrome, spastic paralysis, or brain damage
	Anticholinergics Side Effects	Increased heart rate CNS excitation Dysrhythmias Restlessness Irritability Disorientation Hallucinations Delirium Dilated pupils Increased IOP Decrease in: salivation, gastric secretions, motility, sweating, bronchial secretions, urinary retention
	Anticholinergics Teaching	Overdose can be life threatening Good oral care for dry mouth Safety in regards to blurred vision, driving, strenuous activity Dark glasses for light sensitivity Caution with OTC meds Elderly at risk for heat stroke Adequate fluid and salt intake
	Alpha Adrenergic Action	Alpha 1 adrenergic receptors are located on the tissue, muscle, or organ that the nerve stimulates (postsynaptic effector cells) Alpha 2 adrenergic receptors are located on the actual nerves (presynaptic nerve terminals) Basic response is vasoconstriction and CNS stimilation
	Beta Adrenergic Action	Beta 1 adrenergic receptors are located primarily in the heart (beta 1 = you have 1 heart) Beta 2 adrenergic receptors are located primarily in the smooth muscle of the bronchioles (beta 2 = you have 2 lungs), arterioles, and visceral organs Results in bronchial, GI, and uterine relaxation; Glycogenolysis (conversion of glycogen into glucose); and heart stimulation
	Adrenergic Agent Indicatons	Asthma Bronchitis Causes relief of nasal congestion Conjunctival congestion Dilates pupiles Supports CV system during cardiac failure or shock (epinephrine)
	Adrenergic Agent Contraindications/Interactions	Contraindicated with known drug allergy and severe hypertension Interactions with anesthetics, antidepressants, antihistamines, antihypertensices
	Alpha Adrenergic Agent Side Effects	Headache Restlessness Excitement Insomnia Euphoria Hypertension Tachycardia Palpitations Anorexia - loss of appetite Dry mouth N&V
	Beta Adrenergic Agent Side Effects	Stimulate CNS causing mild tremors Headache Dizziness Nervousness Increased pulse Sweating N&V Muscle cramps
	Adrenergic Agent Teaching	Gice pt instructions for proper use on inhalers including spacers if used to inhaled meds Overdosing leads to tachycardia and palpitations Inform Dr of respiratory difficulties May cause sputum to turn pink Rinse mouth after if given sublingual (under the tongue)
	Scopolamine	Anticholinergic Agent Preop control of secretions Motion sickness
	Detrol	Anticholinergic Agent AKA tolterodine overactive bladder
	Adrenergic Blocking Agents - Alpha Blockers	Action: block stimulation of the SNS Leads to: Vasodilation Decreased BP Miosis (pupil constriction) Suppressed ejaculation Some alpha blockers are used for their vasoconstriction properties to treat migraines Other alpha blockers cause vasodilation and treat high BP Both are alpha blockers but attract to different sites and cause different results
	Alpha Blocker Indications	Migraines - constrict dilated arterioles Post Partum Bleeding - stimulate the uterus to contract and cause vasoconstriction Hypertension Benign Prostatic Hyperplasia (BPH) - reduces urinary obstruction by reducing small muscle contraction of the bladder and prostate Raynaud's Disease - an exaggerated response to cold or emotions where fingers go white (pallor), then blue (cyanosis), then red (hyperemia) as blood flow returns Frostbite Adrenal Gland Turmor
	Alpha Blocker Contraindications	PVD (peripheral vascular disease) Hepatic and renal disease CAD (coronary artery disease) Peptic ulcers Sepsis
	Alpha Blocker Side Effects	Palpitations Orthostatic hypotension Tachycardia Edema Dysrythmias Chest pain Dizziness Headaches Drowsiness Anxiety Depression Vertigo Weakness Numbness Fatigue N&V Diarrhea Constipation Abdominal pain Incontinence Tinnitus Dry mouth Epistaxis (nose bleed)
	Alpha Blocker Nursing Implimentation	Avoid caffeine and stimulants due to irritability Safety with rising due to orthostatic hypotension
	Adrenergic Blocking Agents - Beta Blockers	Cardioselective or Beta 1 Blockers Action: Reduces myocardial stimulation Reduces heart rate Slows conduction through AV node Decreased myocardial oxygen demand Nonselective or Beta 2 Blockers Action: Same as above as well as block receptors on the bronchioles causing airways to narrow = SOB (shortness of breath)
	Beta Blocker Indications	Angina MI HTN Irregular heart beats or dysrhythmias Migraine headaches Glaucoma
	Beta Blocker Contraindications	Known drug allergies Heart failure Heart block; bradycardia Pregnancy Pulmonary disease Raynaud's Disease
	Adrenergic Blocking Agent Adverse Effects	Most are mild and diminish with time but can be serious if they are caused by abrupt withdrawal of the drug Can cause increased angina, MI, and may alter insulin requirements
	Adrenergic Blocking Agent Nursing Implications	Watch VS, GI upset, rash, larynx spasms, respiratory distress Never abruptly stop meds Avoid OTCs Avoid sudden changes in position
	Antibiotics	Medications used to treat bacterial infections A culture should be obtained to identify the organism to assist in antibiotic selection
	Empirical Therapy	Treatment of an infection before specific culture information has been reported or obtained
	Subtherapeutic Response	Signs and symptoms of infection do not improve
	Superinfections	A secondary infection that occurs in addition to an earlier primary infection Usually due to a weak immune system ie. yeast infections
	Bactericidal	Kill bacteria
	Bacteriostatic	Inhibit growth of susceptible bacteria, rather than killing them immediately Will eventually lead to bacterial death
	Sulfonamide	One of the first groups of antibiotics Action: Bacteriostatic - inhibits bacteria growth to kill Does not affect human cells or certain bacteria
	Sulfonamide Indications	Treatment of UTIs Pneumonia Upper respiratory tract infections Otis media
	Sulfonamide Side Effects	Blood - Anemia Integumentary - Photosensitivity, dermatitis, Stevens-Johnson syndrome GI - N&V, diarrhea, pancreatitis Other - Convulsions, nephrosis (kidney diease), headache, urticaria (skin rash)
	Sulfonamide Nursing Implications	Should be taken with at least 2000 mL of fluid per day unless contraindicated Due to photosensitivity, avoid sunlight and tanning beds These agents reduce the effectiveness of oral contraceptives Oral forms should be taken with food or milk to reduce GI upset
	Penicillin	Introduced in the 40s Action: Bacterialcidal - inhibits bacteria growth to kill Effective on a wide variety of bacteria Enter bacteria and attach to them Once attached, normal cell wall synthesis is disrupted Results in bacteria cell death Do not kill other cells in the body
	Penicillin Indications	Prevention and treatment of infections caused by susceptible bacteria such as gram-positive bacteria, Strepococcus, Enterococcus, Staphlyococcus
	Penicillin Adverse & Side Effects	Allergic reactions occur in a small percentage of cases causing urticaria (hives), pruritus (itchiness) 10% of allergic reactions are life threatening and 10% of these are fatal Common side effects are N&V, diarrhea, abdominal pain
	Penicillin Nursing Implications	Any pt taking a penicillin should be carefully monitored for an allergic reaction for at least 30 minutes after it's administered The effectiveness of oral penicillin is decreased when taken with caffeine, citrus fruit, cola, fruit, and tomato juice
	Cephalosporins	Derived from a fungus Structurally and pharmacologically related to penicillins - careful with allergies Bactericidal action Broad spectrum Divided into groups according to their antimicrobial activity
	Cephalosporins Use	Used for surgical prophylaxis (preventative) Upper respiratory infections (URIs) Otitis media Most have good gram-positive coverage Some have good gram-negative coverage Some are used to treat difficult organisms
	Cephalosporins Side Effects	Similar to penicillin
	Cephalosporins Nursing Implications	PO forms should be given with food to decrease GI upset - even though this will delay absorption Some of these agents may cause a reaction when taken with alcohol
	Carbapenems	Very broad spectrum antibacterial action Reserved for complicated body cavity and connective tissue infections May cause drug-induced seizure activity Used for treatment of bone, joint, skin, and soft tissue infections among others
	Monobactams	Primarily active against aerobic gram-negative bacteria ie. E. coli, Pseudomonas Bactericidal action Used for severe systemic infections and UTIs
	Macrolides Action	Prevent protein synthesis within bacterial cells causing bacteria to eventually die
	Macrolides Indications	Strep infections Mild to moderate URIs Lyme disease Gonorrhea, Chlamydia, Syphilis
	Macrolides Side Effects	GI effects - primarily with erythromycin N&V, diarrhea, hepatotoxicity (chemical driven liver damage), flatulence, jaundice, anorexia (loss of appetite) Newer agents have less side effects, longer duration of action, better efficacy, and better tissue penetration
	Macrolides Nursing Implications	These agents are highly protein-bound and will cause severe interactions with other protein-bound drugs The absorption of oral erythromycin is enhanced when taken on an empty stomach, but because of the high incidence of GI upset, many agents are taken after a meal or snack
	Tetracyclines	Action: Bacteriostatic (inhibit growth leading to death) Stop many essential function of the bacteria Dairy, antacids, and iron salts reduce absorption of tetracyclines
	Tetracyclines Indications	Wide spectrum Gram-negative, gram-positive, protozoa Mycoplasma, Chlamydia, syphilis, Lyme disease
	Tetracyclines Side Effects	Watch calcium levels Discoloration of permanent teeth and tooth enamel in children May retard fetal skeletal development if taken during pregnancy Alterations in intestinal flora may result in superinfection, diarrhea, colitis May cause vaginal yeast infections, GI upset, entercolitis (intestinal inflammation), rash
	Tetracyclines Nursing Imlications	Milk and dairy products, iron preparations, and antacids should be avoided All meds should be taken with 6-8 oz of fluid, preferably water Due to photosensitivity, avoid sunlight and tanning beds
	Aminoglycosides	Poor oral absorption - no PO forms Very potent antibiotics with serious toxicities Bactericidal action Kill mostly gram-negative - some gram-positive
	Aminoglycosides Indications	Often used in combination with other antibiotics Poorly absorbed through GI tract Given parenterally Exception: Neomycin - given PO or as an enema to decontaminate the GI tract before surgery
	Aminoglycosides Side Effects	Cause serious toxicities Headache, vertigo, paresthesia (pins & needles feeling) Skin rash, superinfections Fever, dizziness
	Aminoglycosides Nursing Implications	Monitor peak and trough blood levels to prevent nephrotoxicity (kidneys) and ototoxicity (ear) Symptoms of ototoxicity include dizziness, tinnitus, and hearing loss Symptoms of nephrotoxicity include proteinuria (high protein content in urine), increased BUN (blood urine nitrogen) and serum creatinine levels
	Quinolones	Excellent oral absorption but is reduced by antacids First oral antibiotics effective against gram-negative bacteria Action: bactericidal, alter DNA of bacteria causing death Effective against gram-negative and some gram-positive organisms Dose not affect human DNA
	QuinolonesIndications	Lower respiratory tract infections Bone and joint infections Infectious diarrhea Urinary tract infections Skin infections STIs Anthrax
	Quinolones Side Effects	CNS - headache, dizziness, fatigue, depression, restlessness GI - N&V, diarrhea, constipation, thrush, increased liver function studies Skin - rash, pruritus (severe itching), urticaria (hives), flushing, photosensitivity Other - fever, chills, blurred vision, tinnitus
	Quinolones Nursing Implications	Should be taken with at least L of fluid per day unless contraindicated Intake of alkaline foods and drugs (antacids, dairy, peanuts, sodium bicarbonate) should be limited
	Vancomycin	Natural bactericidal, destroys cell wall Treatment of choice for MRSA, and other gram-positive infections Must monitor blood levels to ensure therapeutic levels and prevent toxicity May cause ototoxicity (ear) and nephrotoxicity (kidneys) May cause Redman's Syndrome - decreased BP, flushing of neck and face 2 L/day of fluid unless contraindicated

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