Pharm Test 2 (Tb)

Front 1

Tuberculosis
-Mycobacterium tuberculosis

Transmission:
(2)

Back 1

-Person to person
-Inhaled infected aerosol (by inhaling infected sputum, or by coughing, sneezing)

Front 2

**Principal cause underlying the emergence of resistance is

Back 2

inadequate drug therapy (treatment may be too short, dosage may be too low, patient adherence)

Front 3

Goal of TB treatment: (2)

Back 3

Eliminate symptoms
Prevent relapse

Front 4

TB - Two phases

Back 4

-Induction phase
Eliminate active tubercle bacilli
-Continuation phase
Eliminate intracellular “persisters”

Front 5

TB Medications

-Typically utilizes 2 or more

Back 5

antibiotics (test)

Front 6

TB typically has multiple resistances to drugs

A _____ is needed with C/S to determine most effective meds to administer

Back 6

sputum specimen

Front 7

Induction phase: lasts

what drugs are used?

Back 7

2 months
Daily therapy –RIPE
Isoniazid test
Rifampin test
Pyrazinamide
Ethambutol

Front 8

Continuation phase: how many months

Daily or biweekly therapy
includes what 2 meds?

Back 8

4 months

Isoniazid
Rifampin

Front 9

Isoniazid (INH) [Laniazid]

tell me about this medication?

Bactericidal or Bactererstatis

Back 9

Primary agent to treat TB

Bactericidal – it’s a killer

Front 10

Isoniazid (INH) [Laniazid]

Adverse effects – what system does it affect

Back 10

affects nervous system. Too much medication can lead to toxicity. Toxicity can lead to seizure.

Front 11

Isoniazid (INH) [Laniazid]

adverse reactions
(4)

Back 11

-Peripheral neuropathy results from (pyridoxine, vitamin B6) Dose dependent
-Hepatotoxicity: due to production of toxic metabolites
-Optic neuritis
-Anemia

Front 12

Isoniazid (INH) [Laniazid]

Nursing considerations
what do we need to monitor (3)

Back 12

-CBC
-Monitor patients Liver function test
-Monitor for S/S of liver inflammation
----Anorexia, fatigue, nausea, skin color changes, RUQ pain

Front 13

Isoniazid (INH) [Laniazid]

Drug interactions: (2)

Back 13

Phenytoin (Dilantin)

ETOH, Rifampin & pyrazinamide :

Front 14

Isoniazid and Phenytoin (Dilantin)

Interferes with:

Signs of phenytoin excess include

Back 14

Interferes with metabolism causes increase levels of dilantin


ataxia and incoordinaiton
Monitor dilantin levels

Front 15

Isoniazid and ETOH, Rifampin & pyrazinamide :

increase risk of ______ secondary to ______

Back 15

risk of hepatotoxicity secondary to metabolite accumulation (patients should be encouraged to reduce or eliminate alcohol intake)

Front 16

Rifampin [Rifadin]

Broad spectrum antibiotic
Uses (5)

Back 16

-Tuberculosis
-Leprosy
-Haemophilus influenzae – common bacteria that causes bronchitis and nose infections
-Legionella
-Neisseria meningitidis used prophylactically post exposure to men

Front 17

Rifampin is the best drug for meningits, why?

What are the interactions? (can increase the___)

Back 17

it can cross the BBB!

Can increase the metabolism of numerous drugs that utilize cytochrome P450 enzymes

Front 18

Rifampin and oral contraceptives

increases or decreases effectiveness of birth control pill

Back 18

decreases

Front 19

Rifampin and Warfarin

inhibits

Back 19

Inhibits proper metabolism higher levels in circulating blood can lead to increased potential for bleeding to occur

Front 20

Rifampin

Adverse reactions (2)

Back 20

Hepatotoxocity- Alcoholics and patients with liver disease are predisposed


Fluid Alterations: pt ed. Turns secretions red
, sweat, saliva, tears red/brown, semen, vaginal secretion. Contacts will become stained by aqueous humor of eye

Front 21

Ethambutol [Myambutol]

Bacteriostatic or Bacteriocidial

Uses:

Adverse effects (3)

Back 21

Bacteriostatic

Uses: tuberculosis

Adverse effects
Optic neuritis
Allergy
Hyperuricemia

Front 22

Ethambutol [Myambutol]

Mycobacterium avium Complex Infection

(Prophylaxis) --what 2 drugs

can be confused with TB
so you need a:

Back 22

Azithromycin
Clarithromycin

you need a sputum specimen)

Front 23

Latent TB -what is it

Back 23

A person who has the bacteria present, but are not experiencing symptoms and/or do not know that they have been exposed.

Front 24

Pts at risk for latent progressing to active:

Back 24

-HIV positive patients
-IV drug users
-Immunosuppresive meds (prednisone)
-Anyone who has received an organ transplant

Front 25

Metronidazole Flagyl
Action:

Bactericidal against _____ bacteria only

examples

Back 25

anaerobic

CNS infections
bone-joint infections
abdominal organ infections
vaginal infections (gardnerella)

Front 26

Metronidazole Flagyl


Absorbed in the _____

Reacts with DNA of bacteria & converts it to

Back 26

small intestine

Flagyl’s active form

Front 27

Metronidazole Flagyl


Used for women who

Back 27

has PID (pelvic inflammatory disease) whatever bacteria you had in vagina got into the cavity.

Front 28

Metronidazole Flagyl

drug of choice for:

Back 28

c diff

Front 29

Metronidazole Flagyl

if given IV needs to be given how

Back 29

slowly over 1 hour

Front 30

Metronidazole Flagyl

Adv Rx & Nursing Considerations

GI-

What tests do we monitor?

Antabuse?

Back 30

GI: N/V diarrhea and upset stomach

GU: monitor Kidney function
Monitor K+ levels if client is having diarrhea

Antabuse-like reactions with alcohol violent projectile vomiting because flagyl reacts with it.

Front 31

Metronidazole Flagyl

-Pregnancy Category __
Not to be given during the

Back 31

B

1st trimester

Front 32

Metronidazole Flagyl

Drug interactions

Back 32

Warfarin:
Inhibits the inactivation of warfarin potentially can cause an increases INR = potential for hemorrhage

Front 33

Antifungal


Systemic mycoses (fungal)
Superficial mycoses (fungal)

mycoses means

Back 33

Antifungal

fungal

Front 34

Antifungal

Amphotericin B
-Drug of choice for:

Back 34

Broad spectrum
Fungicidal or fungistatic- Dose dependent
Highly toxic
Drug of choice for systemic fungal infections

Front 35

Amphotericin B

Administration
-how is it given?
-needs to have?
-how long does it take each infusion for it to be complete?

-how long is treatment take?
-what is it important to watch IV site for?

Back 35

IV
-Needs to have a inline filter
-Each infusion can take 6-8 hours to complete
-Tx can be as long as 6-8 weeks
-Important to watch IV site for extravasation

Front 36

Amphotericin B

Infusion reactions
Shake & bake:

what will you see
-what is it caused by:
-typically seen how many hours after infusion has been started?

what can you pre-treat them with?

Back 36

-Fever, chills, muscle tightening, nausea, H/A


-Caused by the release of cytokines from monocytes and macrophages

-Typically seen occurring 1-3 hrs after infusion started
-Pre-treat with Bendaryl & Tylenol

Front 37

Antifungal
-Amphotericin B

This drug is potentially contraindicated if the pt has


_____can occur 2° to kidney damage

Back 37

kidney insuffienceny (Nephrotoxicity)

hypokalemia

Front 38

Antifungal
-Amphotericin B

*Can be reversible*

Damage can be decreased by

Back 38

hydrating the patient with 1000cc of NS or more during the IV infusion of the drug.

Front 39

Amphotericin B
-Nursing considerations

What does the nurse have to monitor closely? how often?

Back 39

-Monitor VS q15 min then q1hr during infusion
(Watch P & B/P carefully)

Daily weights
(Monitor for fluid accumulation)

Front 40

Amphotericin B
-Nursing considerations

Labs:

Back 40

K+
BUN/Creat (kidney function tests)
Mg+
Na+
Liver function tests
CBC

Front 41

Ketoconazole Nizoral

Broad spectrum fungal agent
Fungistatic at __
Fungicidal at __

Back 41

Broad spectrum fungal agent
Fungistatic at low conc.
Fungicidal at high conc.

Front 42

Ketoconazole Nizoral

In order for these medications orally, stomach needs to be

Back 42

acidic environment for dissolution

Front 43

Drugs for Superficial Mycoses

Dermatophytic infections (e.g., ringworm)
Tinea pedis- on foot
Tinea corporis -on abdomen
Tinea cruris -groin crotch
Tinea capitis -on head

Back 43

Drugs:
Clotrimazole—topical
Griseofulvin—oral

Front 44

Whenever you hear tinea ---think

Back 44

fungal

Front 45

Ketoconazole Nizoral

Administration: (3)

when given PO, what does the nurse have to know?

Back 45

PO, topically, shampoo

When given PO, the patient needs to work up a good sweat.

Sweat carries antibiotic and the antibiotic has to dry on the skin because then it will kill the fungal infection

Let it dry on the skin for this drug to be effective.

Front 46

Ketoconazole Nizoral

Drug interactions (2)

Back 46

H2 blockers and antacids can decrease effects of the antifungal agent

Aminoglycosides: gentamicin; can increase the possibility of nephrotoxicity

Front 47

Miconazole Monistat

what is it:
what is it used for:

Back 47

Antifungal
Used for vaginal infections

Front 48

Fluconazole - is an oral med

Diflucan- begins working when:

Back 48

Diflucan 1 drug, begins working within 24 hours

Fungistatic

Vaginal Candidiasis
Oropharyngeal, esophageal, systemic

Front 49

Nystatin - Mycostatin

Treats (3)

Back 49

Oral candidiasis
Intestinal candidiasis
Topical & vaginal candidiasis