Carbamazepine (Tegretol) can sometimes show subtherapeutic range due to what?
Carbamazepine auto-induces metabolism, leading to lower levels despite good compliance<\/p>\n\n\n\n
What are the black box warnings for Carbamazepine?
Dermatologic reactions<\/p>\n\n\n\n
What lab test should be ordered for patients on Carbamazepine?
CBC every 3-4 months because it can cause decreased WBC, decreased platelets, and trouble with RBC<\/p>\n\n\n\n
What kind of teaching needs to be done with families of patients who have seizure disorders?
Prevention is important, patient safety is important, Do NOT abruptly stop taking medication.<\/p>\n\n\n\n
Ethosuximide (Zarontin), an anti-seizure medication can cause what?
Blood dyscrasias<\/p>\n\n\n\n
Patients taking Topiramate need to be monitored for what electrolyte imbalance?
Decreased sodium bicarb leading to hyperchloremic metabolic acidosis<\/p>\n\n\n\n
Topiramate treats seizures and what is one common side effect?
Normal side effect is weight loss, especially in higher dose patients<\/p>\n\n\n\n
A child on Topiramate that wants to play sports should monitor what?
Don’t get overheated. Topiramate may affect his ability to sweat in the heat.<\/p>\n\n\n\n
What should a pregnant patient be told about taking Valproate (Depakote)?
It is a known teratogen and category X medication. It should not be used in the first trimester, it may be restarted in second trimester.<\/p>\n\n\n\n
What patient population should tricyclic antidepressants be used cautiously in?
Heart Disease patients<\/p>\n\n\n\n
Phenelzine (Nardil) is a MAOI. What teaching needs to be done with this medication?
He should not use serotonergic drugs like Imitrex. Also, this class of medication interacts with yogurt, sour cream, soy sauce, etc.<\/p>\n\n\n\n
Phenelzine (Nardil) may cause what if there is an interaction with known contraindicated foods?
Hypertensive crisis<\/p>\n\n\n\n
What are the side effects of tricyclic antidepressants?
Anticholinergic type effects like dry mouth, sedation, constipation, increased appetite, blurred vision, tinnitus, euphoria, mania<\/p>\n\n\n\n
How long does it take for SSRIs to take effect
2-6 weeks<\/p>\n\n\n\n
SSRIs may cause what onset of action symptoms?
Nausea, but this will usually resolve in a week.<\/p>\n\n\n\n
What is one thing you should not do with SSRIs?
Drink alcohol<\/p>\n\n\n\n
What should happen when going off an SSRI?
Wean slowly, do not stop abruptly<\/p>\n\n\n\n
What medications would a patient with depression and anxiety respond well to?
Buspar and an SSRI combined
Celexa (Citalopram)
Lexapro (Escitalopram)<\/p>\n\n\n\n
Why should you combine an SSRI with Buspar?
Buspar augments the SSRI and is a good combo for anxiety and depression<\/p>\n\n\n\n
What is a first line drug for mild to moderate generalized anxiety disorder?
Buspirone<\/p>\n\n\n\n
How fast does Celexa start to demonstrate effects?
Improved appetitie and concentration in 1-2 weeks.<\/p>\n\n\n\n
What is a major drug to treat bipolar disease?
Lithium<\/p>\n\n\n\n
Blood levels need to be monitored with Lithium because why?
Lithium has a narrow therapeutic range so it is important to recognize toxicity<\/p>\n\n\n\n
What are symptoms of lithium toxicity?
Drowsiness and Nausea<\/p>\n\n\n\n
What dietary teaching needs to be done with patients taking lithium?
Salt intake needs to be consistent<\/p>\n\n\n\n
What are the side effects of SSRIs (selective seratonin reuptake inhibitor)?
N\/V, dizziness, light headedness, dry mouth, increased sweating, weight changes, agitation, sexual side effects.<\/p>\n\n\n\n
What are the side effects of SNRIs (serotonin norepinephrine reuptake inhibitor)
Headache, somnolence, dizziness, insomnia, nervousness, dry mouth, constipation, abnormal ejaculation, anorexia\/weight loss, elevated BP<\/p>\n\n\n\n
What are the side effects of MAOIs?
Insomnia, anxiety, agitation, dizziness, headache, restlessness, hypotension, dry mouth, blurred vision, constipation<\/p>\n\n\n\n
What Benzo has the greatest likelihood of dependence?
Xanax \/alprazolam<\/p>\n\n\n\n
What receptors do Benzos act on?
Enhances the neurotransmitter GABA (gamma-aminobutyric acid) receptors<\/p>\n\n\n\n
What result do Benzos have on the body?
sedative
hypnotic
anxiolytic
anticonvulsant
muscle relaxer<\/p>\n\n\n\n
What are long acting Benzos prescribed for?
Treatment of anxiety<\/p>\n\n\n\n
What are short acting Benzos prescribed for?
Treatment of insomnia<\/p>\n\n\n\n
What would be a good medication to prescribe for panic disorder?
Diazepam (Valium)<\/p>\n\n\n\n
What is a anorexiant medication to treat obesity?
Phentermine<\/p>\n\n\n\n
What is a precaution with Phentermine?
Anorexiants may cause tolerance and should only be used for 6 months<\/p>\n\n\n\n
What medications or herbals should be avoided with Phentermine? Why?
SSRIs and St. Johns Wort\u2026the combination may cause serotonin syndrome<\/p>\n\n\n\n
Phentermine releases what two chemicals?
Epinephrine and norepinephrine<\/p>\n\n\n\n
Epi and norepi causes what to break down?
Fat cells to break down stored fat<\/p>\n\n\n\n
What are Signs and symptoms of seratonin syndrome?
Headache, agitation, mental confusion, hallucinations, coma<\/p>\n\n\n\n
What are autonomic effects that you can get from seratonin syndrome?
Shivering, sweating, hyperthermia, vasoconstriction, tachycardia, nausea, diarrhea<\/p>\n\n\n\n
What factors place a patient at risk for developing antimicrobial resistant organisms?
Inappropriate use of antibiotics
Children less than 2 years of age
Adults older than 65 yrs of age
Patients who do not finish their antibiotic regimen<\/p>\n\n\n\n
What are appropriate antibiotics to prescribe to pregnant women and children?
PCN or Cephalosporins
(Amoxicillin, or Augmentin)<\/p>\n\n\n\n
Which antibiotics inhibit cell wall synthesis?
Beta-lactam antibiotics
Vancomycin<\/p>\n\n\n\n
Why is clavulanate added to Amoxicillin?
Clavulanate is a Beta-lactam inhibitor. This increases the spectrum of action and is effective at preventing amoxicillin-resistant bacteria that produce Beta-lactamase<\/p>\n\n\n\n
What type of antibiotics should be avoided in children and pregnant women?
Tetracycline, fluoroquinolones<\/p>\n\n\n\n
What is a normal side effect of amoxicillin?
Diarrhea and it is recommended to continue to take the medicine, drink lots of water, and take probiotics daily, eat yogurt<\/p>\n\n\n\n
The American Heart Association recommedations for prophylaxis antibiotic use prior to dental care are\u2026<\/p>\n\n\n\n
What antibiotic is used for dental appointments?
Amoxicillin 2 gm for adults
50mg\/kg in children<\/p>\n\n\n\n
What should fluoroquinolones be reserved to treat?
Community acquired pneumonia in patients with comorbidities and Hospital acquired pneumonia<\/p>\n\n\n\n
What is the black box warning for fluoroquinolones?
It may cause tendon ruptures. Specifically of the achilles tendon.<\/p>\n\n\n\n
What medication can be affected with the use of fluoroquinolones?
Warfarin because fluoroquinolones displace the flora of the gut and displaces warfarin from albumin and interferes with metabolism by the P450 system.<\/p>\n\n\n\n
Why are tetracyclines not recommended in pregnancy and in children less than 8 yrs of age?
They can cause staining of teeth, and cause problems with bone growth.<\/p>\n\n\n\n
What population can tetracyclines like minocycline be used on? And patients who use it might develop what?
Adolescents. It may cause psuedotumor cerebri, drug-induced lupus and hepatitis, skin photosensitivity, tinnitus, fatty liver<\/p>\n\n\n\n
Tetracycline should be avoided with what foods and medications?
Calcium ions
milk, yogurt, or other dairy products
Methotrexate<\/p>\n\n\n\n
What drug interactions should be avoided when taking levaquin?
It is a fluoroquinolone, so do not take with coumadin or corticol steroid use.<\/p>\n\n\n\n
Gentamycin is known to cause what?
Ototoxicity and hearing loss<\/p>\n\n\n\n
Which medications interact with Linezolid?
Linezolid is a MAOI, so it should not be used with other MAOIs, pethidine, or demerol because of the risk of seratonin syndrome.<\/p>\n\n\n\n
What are the food restrictions while taking linezolid?
Tyramine rich foods such as pork, aged cheese, alcohol, smoked or pickled foods.<\/p>\n\n\n\n
What is the treatment for Lymes Disease?
Doxycycline 100mg PO BID x 21 days<\/p>\n\n\n\n
What vitamin can prevent peripheral neuropathy from isoniazid?
Vitamin B 6 (Pyridoxine)<\/p>\n\n\n\n
What should you monitor before prescribing valacyclovir?
Renal function. Patients should drink lots of water while on this medication.<\/p>\n\n\n\n
Which medication would be appropriate for Influenza A?
Oseltamivir, if started within the first 48 hours<\/p>\n\n\n\n
Name 3 things ta Rifampin is prescribed for?
TB, leprosy, legionella<\/p>\n\n\n\n
What are the adverse effects for Isoniazid?
Hepatotoxicity and peripheral neuropathy<\/p>\n\n\n\n
What are the main side effects of Doxycycline?
Mainly GI upset. Take with food. Can cause photosensitivity, Stephens Johnson syndrome, and toxic epidermal necrosis<\/p>\n\n\n\n
What is the difference between oral and I.V. Vanco?
Oral is given for C-Diff as it goes right to the site of infection. I.V. vanco is given for MRSA infections and needs to be administered through a picc line or central line because it is toxic to veins.<\/p>\n\n\n\n
What is the mechanism of action for Azithromycin?
It inhibits bacterial protein biosynthesis and prevents peptidyl transferase from adding to the growing peptide attached to the transfer RNA to the amino acid. It also inhibits ribosome ranslation.<\/p>\n\n\n\n
Which class of antibiotics block bacterial protein production?
Bacteriostatic antibiotics: Tetracyclie, Sulfonamides, Macrolides, Clindamycin, Ethambutol, Nitrofuantoin, Novobiocin, tigecycline, oxazolidinone<\/p>\n\n\n\n
What labs need to be monitored for long term antifungal therapy with ketoconazole?
AST, ALT, Phosphatase, bilirubin<\/p>\n\n\n\n
What teaching should be done with Flagyl?
Do not consume alcohol in any form with this medication<\/p>\n\n\n\n
Which antihelmintic is used to treat parasitic worms?
Mebendazole, and agromectin
and ivermectin to treat true parasites<\/p>\n\n\n\n
What antifungal can be used topically?
Clotrimazole<\/p>\n\n\n\n
What medication treats scabies and lice?
Ivermectin and permethrin cream<\/p>\n\n\n\n
Rifampin is used to treat what?
TB<\/p>\n\n\n\n
Side effects of rifampin?
Joint pain because it can precipitate gout and it is hepatotoxic.<\/p>\n\n\n\n
IF patients are hypersensitive to Sulfa, what other medications will they be sensitive to?
Loop Diuretics, thiazide diuretics, and sulfonylureas<\/p>\n\n\n\n
Sulfa antibiotics can cause what?
Stephen Johnsons Syndrome and toxic epidermal necrolysis<\/p>\n\n\n\n
Nurs 615 pharm exam 2 questions and answers
Nurs 615 pharm exam 2 questions
Nurs 615 pharm exam 2 pdf
Nurs 615 pharm exam 2 answers
Nurs 615 pharm exam 2 answer key<\/p>\n\n\n\n
NURS 615 Pharm Exam 2 MegaReview Study Guide latestNURS 615 Pharm Exam 2 Mega Review Study GuideLaw-Ham Pharm Exam 2 ReviewKnow every drug that is on the PowerPoint \u2013 have a one-line mechanism of action on a table for each drug and understand it, as well as how and where it worksCarbamazepine (Tegretol) \u2013 is an anticonvulsant = thought to affect Na+ channels to slow spread of abnormal activity\u2022SE = decreases body\u2019s production of blood cells, rare reports of aplastic anemia and agranulocytosis, can cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis\u2022Should get a CBC Q3-4 months (watch for WBC count in particular)\u2022Carbamazepine is a strong inducer of hepatic enzymes\/metabolism and can lead to lower levels\u2022Do NOT stop taking abruptly, has a shorter half-life w\/repeated usesTopiramate (Topamax) \u2013 is for tx of epilepsy, seizures, migraine prophylaxis\u2022Blocks sodium channels or potentiate GABA\u2022Peaks 2 hours after oral admin, mostly eliminated via urine\u2022Can cause \u2193 Na bicarb levels which can lead to hyperchloremic metabolic acidosis\u2022Serum bicarbonate should be monitored at baseline and periodically\u2022Can cause ocular syndrome (acute myopia and glaucoma) \u2013 should inform provider immediately if pt experiences eye pain or blurred vision\u2022Rare side effect is oligohidrosis (\u2193sweating) and hyperthermia\u2022Can increase the risk of suicidal behavior\/ideation, cause weight reduction\u2022Should NOT be discontinued abruptly\u2022Is a pregnancy category D and can increase risk of cleft lip\/palate in infantsLevetiracetam (Keppra) \u2013 antiepileptic, does NOT affect GABA, does inhibit burst firing and spread of seizure activity\u2022Mostly cleared through renal system, is not extensively metabolized\u2022Absolute contraindication is sensitivity to the drug\u2022At increased risk for suicidal thoughts and depression, behavioral changes, somnolence, fatigue, dizziness, muscle coordination difficulties\u2022Potential for withdrawal seizures if keppra is stopped abruptly\u2022Safer med for seizures in children and pregnancyValproate (Depakote) \u2013 is an anticonvulsant, for tx of bipolar disorder and mania also \u2022Blocks GABA uptake into presynaptic neurons\u2022SE = GI distress, heartburn, CNS depressant\u2022Is a pregnancy category X, known teratogen, may only be taken after the 1st trimester if necessary, bur should recommend switching to different anticonvulsant like Keppra NURS 615 Pharm Exam 2 Mega Review Study GuideEthosuximide (Zarontin) \u2013 tx for seizuresNURS 615 Pharm Exam 2 Mega Review Study Guide\u2022Should be monitored for blood dyscrasia (an abnormal condition or dx of the blood)Antiepileptics block transmission, raise the seizure threshold, so that the patient will not peak over the seizure threshold and have a seizure.Anticonvulsants in terms of monitoring (most common side effects, most serious side effects) \u2013 know that they are all monitored with blood work for their levels so that is a similarity amongst them\u2022Carbamazepine \u2013 CBC \u2013 Causes agranulocytosis so be watching the white count in particular although there is other bone marrow suppression as well\u2022What do you monitor? \u2013 TSH because the med can affect the thyroid\u2022Never want anyone to d\/c suddenly, must be weaned off\u2022Talk to patients about safety \u2013 driving limitations, may have to report patient to DMV if they are having active seizures\u2022Oral health can be affected by anti-seizure meds and extra trips to the dentist may be requiredNeurotransmitters\u2022GABA \u2013 calming\u2022Acetylcholine \u2013 muscle action, thought and learning<\/strong>*If a specific drug is listed on the PowerPoint, know all about it.\u2022All these drugs are listed on the PowerPoint\u2022SeizureoTopiramate \u2013 topamaxoCarbamazepine \u2013 TegretoloValproate \u2013 DepakoteoLevetiracetam \u2013 Keppra\u2022MAOIo Phenelzine \u2013 Nardil\u2022AnxiolyticsPhentermine (Adipex-P) \u2013 used for obesity, stimulating satiety centers\u2022Should only be used short-term (6 months or less)\u2022DO NOT mix w\/ SSRIs or St. John\u2019s Wart (Serotonin Syndrome), or w\/ MAOIs (HTN crisis)Lithium\u2014 tx of choice for manic-depressive (bipolar) illness, \u2193 severity\/frequency of mania\u25aaReplaces Na+ during depolarization in neurons = stops transmission of electrical impulses\u25aaInversely proportional to Na+ — \u2193Na+ = \u2191Lithium \u2191Na+ = \u2193Lithium\u25aaLithium Toxicity can occur = drowsiness, nausea, course tremors, diarrhea, confusion, stupor\u25aaNOT to be used in renal pts, children under 12, or pregnant women\u25aaPt education = avoid dehydration, eat a diet with consistent Na+ levels <\/p>\n\n\n\n Document continues below <\/p>\n","protected":false},"excerpt":{"rendered":" Carbamazepine (Tegretol) can sometimes show subtherapeutic range due to what?Carbamazepine auto-induces metabolism, leading to lower levels despite good compliance What are the black box warnings for Carbamazepine?Dermatologic reactions What lab test should be ordered for patients on Carbamazepine?CBC every 3-4 months because it can cause decreased WBC, decreased platelets, and trouble with RBC What kind […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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NURS 615 Pharm Exam 2 Mega Review Study GuideAntidepressants \u2013 SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram)
NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022SSRI blocks the reuptake of serotonin which keeps it present in the synapse for longer, so you get more effect from it\u2022All of the antidepressants, whether a drug family or specific drug, you need to know and understand that drugand mechanism of action\u2022Common side effects of SSRIs \u2013 weight gain, sometimes weight loss, anticholinergic effects like dry mouth and constipation, nausea, vomiting, sexual side effects \u2013 diminished, delayed or absent orgasm, premature ejaculation, decreased libido\u2022Nausea can occur when first starting SSRI, but will resolve in a week or so\u2022With citalopram, appetite and concentration improve in the first 1-2 weeks, works quickly\u2022Interacts w\/ MAOIs\u2022SSRIs \u2013 serotonin syndrome \u2013 HA, hallucinations, shivering, agitation, sweating, high body temperature, tremor, hyperreflexia, dilated pupils, nausea, diarrhea\u2022DO NOT stop abruptly or miss doses = serotonin withdrawal \u2013 can see this in shorter acting SSRI\u2019s when peopleforget to take them (paroxetine is the shortest acting), sertraline and citalopram can also happen but not as quickly as paroxetine.\u2022Serotonin withdrawal syndrome \u2013 tremulous, paresthesia\u2019s, nausea, vomiting, sweatingSNRIs\u2022Effect and block the reabsorption of norepinephrine \u2013 norepi effects specifically the sympathetic nervous system and also has serotonergic effects\u2022Sevilla, Cymbalta, etc. names of drugs\u2022An initial tx for depression w\/ symptoms of fatigue, sleeping all the time, and lack of motivation\u2022Side effects \u2013 headaches, nausea, somnolence, dry mouth, anticholinergic things, palpitations, hypertension, and hyperhidrosis (excessive sweating).TCAs (amitriptyline, nortriptyline, imipramine, trimipramine)\u2022Effect brain chemicalsoSerotonin \u2013 5htoNoradrenaline\/norepinephrineoActs on Histamine and Acetylcholine\u2022This group of medications has the highest anticholinergic effects \u2013 the highest amount of dry mouth and constipation\u2022People who have BPH, glaucoma, urinary problems should not take this medication due to the degree ofanticholinergic effect\u2022Should be prescribed cautiously in patients with heart disease\u2022Can behave like class 1 antiarrhythmics = terminate Vfib, \u2193 heart contractility, increase collateral blood flow to ischemic heart muscles\u2022SE = anticholinergic, sedating, increased appetite, tinnitus, nausea, as well as cardiac conduction disordersincluding a prolonged QT interval with this drug \u2013 a baseline EKG is imperative before starting on this medication. Tardive dyskinesia (movement), neuroleptic malignant syndrome\u2022If you ever put someone on this for their depression, understand that in the first few weeks they can have increased suicidal ideation\u2022An overdose of TCAs is fatal; whereas, with the SSRIs it isn\u2019t
NURS 615 Pharm Exam 2 Mega Review Study GuideBuspirone (full agonist, serotonin) but can also be an antagonist\u2022Full agonist for the presynaptic 5ht1 receptor<\/p>\n\n\n\n
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NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022If someone has too much serotonin, it will act as an antagonist\u2022Or if they do not have enough serotonin, it will act as an agonist in the post synaptic\u2022Structure similar to clozapine which is an atypical antipsychotic\u2022Pt with anxiety and depression may respond to buspirone and an SSRI combined\u2022Is an appropriate first-line drug for mild to moderate generalized anxiety disorder\u2022Works well for anxiety and has a synergistic effect with SSRI for someone who has a resistant type of depression that needs an extra boost\u2022Will compete for metabolism site w\/ antipsychotics (Haldol)MAOI Inhibitors\u2022Phenelzine (Nardil)\u2022Parmate\u2022Marplan\u2022Not used often and are not popular due to the amount of adverse effects\u2022MAO \u2013 irreversibly inactivates the enzymes that metabolize NE, serotonin, and dopamine therefore increasing bioavailability of each so you get a longer serotonin, norepi effect such as more energy as well as a better mood)\u2022Adverse effects: tardive dyskinesia\u2022Do not mix with other substances (other MAOI\u2019s)\u2022Do NOT eat foods containing tyramine (aged cheese\/meats, alcohol) as these can cause symptoms of HTN crisis (increased BP, tachycardia, HA, dizziness, sweating, tremors) which requires immediate tx\u2022Do not mix well with other things so they need to be two weeks separated from anything else (assuming this isspecifically referring to other antidepressants)\u2022When starting new antidepressant, wean patient off this medication. Pt must be off of this medication at least two weeks before starting another antidepressantBenzodiazepines \u2013 binds to GABA receptors to inhibit the neurotransmitter release\u2022Alprazolam, Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam\u2022Effect\/binds to GABA receptors \u2013 which is sedating, acts as anticonvulsant, muscle relaxant, helps with alcohol withdrawal\u2022Tend to be very habituating \u2013 be aware of this and limit prescribing, CNS depressant\u2022If you have to put a patient on a benzo, try to choose something that is longer acting so that patient does not need to redose constantly. Longer acting benzo example is klonopin\u2022Short and intermediate acting benzos to tx insomnia, long-acting benzos to tx anxiety\u2022An appropriate drug to initially tx panic disorder is diazepam (Valium)\u2022CAUTION IN PRESCRIBING, alprazolam (Xanax) has greatest likelihood of rapid dependenceInsomnia Meds\u2022Familiarize yourself with what it means to utilize sleep hygiene and be sure your clients are using that.\u2022Meds should only be for short term or occasional use because you want the patient to develop their own sleep patterns and not become dependent upon a pill to go to sleep at night.\u2022Ambien \u2013 non-benzo type of sleep aid \u2013 works within the GABA receptors but non-benzo \u2013 considered to work ata benzo booster site.\u2022Temazepam \u2013 benzodiazepine sleep aid \u2013 has same side effects as other benzos Anti-infective
NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022Antibiotics is a broad term for a lot of things including antibacterial, antifungals, antiprotozoal, anthelmintic, and antiviral
NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022Classified as gram positive or gram negativeoGram positive bacteria have no capsule \u2013 have a thick peptidoglycan wall which stains purpleoGram negative bacteria have a capsule that protects the cell peptidoglycan wall from staining so it will show as pink\u2022Also classified by shape \u2013 i.e. flagellated, spirilla, cocci\u2022Classified by oxygen useoAnaerobes \u2013 cannot grow in the presence of oxygenoAerotolerant – most bacteria that cause humans to be sick. They can survive for 72 hours in the presence of oxygen, even though they may not usually, and they may not grow in oxygenoMost human flora is anaerobic deep within our bodies.\u2022Anti-infective work in the following waysoCell walls \u2013 anoFolic Acid metabolism \u2013oProtein synthesis inhibitors at 30s and 50s ribosomal subunitoMUST KNOW EACH ANTIBIOTICS FAMILIES MECHANISM OF ACTION<\/em><\/strong>*\u2022Bacteriostatic vs bactericidaloBacteriostatic \u2013 stop bacteria from reproducing but do not kill it = utilized in people who have an intact immune system that is able to go in and kill the bacteria as long as it is not reproducingoBactericidal \u2013 wipes out the bacteria = the bad and the good which is where C. Diff and other things come from\u2022What effects antibiotic efficacy?oPeople\u2019s immune function \u2013 people with poor immune function may need bactericidal or higher levels of antibiotics\u25aaDiabetic\u25aaSteroids\u25aaChemotherapy\u25aaAsplenia (absence of normal spleen function)\u25aaHx. Of previous infections\u25aaElderly\u25aaForeign bodies – catheters, artificial joints, valves, and shunts = may need to be removed if possible, in order for patient to be properly treated\u25aaAutoimmune disease \u2013 autoimmune drugs lower ability to fight infectionoAlteration in Distribution\u25aaNot high enough albumin level\u25aaOverweight\u25aaUnderweight \u2013 emaciated or cachectic (physical wasting)\u25aaRenal function decreased\u25aaAnything that can affect kinetics needs to be thought about in relation to antibiotic efficacy\u2022Bacteria cause resistance byoBreaking down beta lactam ringoOr breaking down whatever the drug is consisting of and inactivating itoPenicillin has things added to prevent the bacteria from breaking down the beta lactam ringoReduce bacterial efflux pumps or change the influx of it so it cannot work as welloAlter the binding site so the medicine cannot exert its action\u2022Every antibiotic drug class has resistant organisms that influence prescribing decisions\u2022Common resistant organismsoMRSA
NURS 615 Pharm Exam 2 Mega Review Study Guide\u25aaCommunity acquired\u2022Acquired from locker rooms, jails, prisons, gymnasiums, livestock handlers who handle animals who handle antibiotics
NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022Outpatient treatment options can be trimethoprim sulfa or doxycycline\u25aaHospital acquired \u2013 much more difficult to treat\u2022Requires extensive antibiotics that we do not use often such as vancomycin, linezolid, daptomycin, maybe even imipenem\u2019s and combinations of these things\u25aaThese occur in sicker patients who already have some bacterial resistance issuesoVRE (Vancomycin-Resistant Enterococci)\u25aaNatural enterococcus in GI tract and female genital tract\u25aaIn weakened immune systems it can cause infection\u25aaTreatment is with penicillin-cephalosporin combos, aminoglycosides\u25aaVery difficult to treat\u2022Who is affected by antibiotic resistance?oDaycares \u2013 children are more likely to be exposed to pathogens from other childrenoReview the slide and be familiar\u2022Mentioned being familiar with drugs on the slides again \u2013 understand broad vs. narrow spectrum, bactericidal vs. bacteriostatic, common indications for use, concern or contraindications, interactionsBoth PCNs and Cephalosporins contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms = why there is often cross-sensitivity and cross-resistance btw the two.PCNs and Cephalosporins are generally regarded as safe to prescribe to children, but Fluoroquinolones and Tetracyclines are to AVOIDED in childhood.The beta-lactam ABX (PCNs and Cephalosporins) and Vancomycin inhibit bacterial cell wall synthesis.Penicillins\u2022Bactericidal\u2022Inhibit cell wall synthesis\u2022Usually used for strep throat and upper respiratory types of things \u2013 otitis media\u2022Some pneumonias \u2013 amox-clavulanate used for this as it is a beta-lactamase inhibitor which increases its efficacy against amoxicillin-resistant bacteria \u2013 *Augmentin\u2022Maybe meningitis\u2022Valve infections\u2022Blood infections\u2022Abdominal\u2022Sensitive infections \u2013 bacteria that are sensitive to it\u2022SAFEST DRUG for pregnancy (UTI) and pediatrics \u2013 AUGMENTIN\/AMOXICILLIN\u2022Amoxicillin \u2013 risk for anaphylaxis \u2013 cross sensitivity with cephalosporin risk up to 25%oIf you cannot find something other than a cephalosporin to treat somebody with allergic reactions to penicillin\u2019s, go with a higher generation cephalosporin. Higher generations have a little bit less crossover with penicillinoSome anaphylactic risk comes from previous exposure with mold spores\u2022Remember that penicillin\u2019s and cephalosporins can give you diarrhea, continue tx but recommend probiotics daily and yogurt helpso Kaopectate and some other things can be used after verifying that this is not a c. diff or bacterial overgrowth type of diarrheaCephalosporins NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022Note that the first generation usually has gram positive coverage\u2022By the time you get to the fifth generation, there is a lot of gram-negative activity NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022If you are wanting gram negative activity, do not choose cephalexin or cefazolin, you need to go to a different drug group altogether or something in a higher generation\u2022Widely distributed\u2022Renally excreted as is penicillin \u2013 if you have a patient that does not have a renal system that is working well, you may need to adjust your dosing and monitor the renal functions\u2022Generally a pretty safe drug\u2022Same adverse effects of penicillins; however, very uncomfortable at injection siteo Rocephin \u2013 often mixed with lidocaine to ease discomfort\u2022Mechanisms of resistance \u2013 also add a beta lactamase inhibitor type of medication to itoHas other mechanism of resistance such as\u25aaMaking bacterial cell wall impermeable to the antibiotic\u25aaEffecting the upregulation and the pumping in of the antibiotic\u2022If a client with strep pharyngitis is allergic to penicillin or cephalosporins then what do you use?o Macrolides \u2013 erythromycin or azithromycin \u2013 do not risk allergic reactionVancomycin\u2022Very toxic to the ear and the kidney\u2022Has gram positive coverage \u2013 particularly effective in IV form for staph aureus or MRSA infection\u2022Bactericidal \u2013 widely distributed and renally excreted \u2013 watch the kidneys\u2022Does not absorb well in GI tract so mostly given IV unless somebody has C. diff in which case we can give it PO because it will work topically\u2022Can cause phlebitis at IV site as well as nephro and ototoxicity\u2022Red Man syndrome if infused too rapidly \u2013 histamine type release and patient feels flushed, fever, chills, tachycardia, pruritis, paresthesia\u2019s \u2013 does not mean this is an allergic response, means we need to slow it downBacteriostatic ABX limit bacterial growth by interfering w\/bacterial protein production, DNA replication = Tetracyclines, Sulfonamides, Spectinomycin, Trimethoprim, Chloramphenicol, Macrolides, Lincosamides, Clindamycin, Ethambutol, Nitrofurantoin, Oxazolidinone.Tetracyclines\u2022Doxycylcine 100 mg PO Q12H or BID for 14-28 days depending\u2022If pt is on doxycycline for a chlamydia infection, recommend she use a back-up method of birth control (condom) since this med can \u2193 effectiveness of oral contraception\u2022Doxycycline can cause anorexia, N\/V, diarrhea = should take w\/food\u2022Tetracyclines such as Minocycline are safe to use in adolescents for the tx of acne\u2022If pt taking Minocycline complains of a HA, evaluate for pseudotremor cerebri\u2022Do not give to children less than age 8 because it effects bone growth as well as causing stained teeth\u2022Adverse effects = photosensitivity, lupus\/hepatitis, fatty liver, tinnitus, SJS (serious), TEN\u2022Can be inactivated by calcium ions, DO NOT give with an antacids or dairy (yogurt, milk) because that decreases the absorption\u2022BacteriostaticMacrolides, Azalides\u2022Bacteriostatic as a general rule, inhibits bacterial protein biosynthesis (peptidyl transferase), binds to the P site of the 50S ribosome subunit NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022Vary in excretion \u2013 stool and urine\u2022Cover some of the unusual or uncommon respiratory problems such as mycoplasma pneumonia, chlamydia pneumonia, Bordetella pertussis NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022There is a molecule with a macrolide ring on this drug\u2022Have been around a really long time so we are starting to appreciate problems with resistance now\u2022Azithromycin for sinus infection is not really used much more because of problems with resistance \u2013 gets to the ears and throat better as they are deeper in the body\u2022Azithromycin is a good abx for strep throat especially if pt has developed a rash\/rxn to PCN\u2022Besides causing significant GI upset, can cause acute hepatitis, rash, prolonged QT and malignant arrhythmias \u2013 serious side effects that need to be monitoring\u2022Given for upper and lower respiratory infections, uncomplicated skin infections\u2022STIsLincosamides\u2022Clindamycin \u2013 relative of erythromycin \u2013 binds like they do to the bacterial 50s ribosomes\u2022Bacteriostatic for certain bugs\u2022Works deep within the body\u2022Bactericidal for certain bugs\u2022If a bacteria is resistant to macrolides, it will be resistant to clindamycin as well\u2022If pt begins to have frequent diarrhea w\/blood in it, assess pt for pseudomembranous colitis\u2022Adverse effects: nausea, vomiting, diarrhea \u2013 can cause c. diff diarrhea, metallic taste in mouth, dizziness,vertigo, hypotension, arrhythmias \u2013 if patient is having bad c. diff diarrhea from this med, that could bethe reason the patient offloads their metabolism and has arrythmiasOxazolidinones\u2022Linezolid \u2013oBacteriostatic although can be cidal against a few gram positivesoUtilized for the big bads \u2013 pneumonias and more complicated infections, VREs \u2013 not first drug of choiceoSHOULD NEVER BE USED within two weeks or concurrently with maoi d.t drug interactionsocauses BONE MARROW SUPPRESSION \u2013 MONITOR CBC can cause lactic acidosis so be concerned with acid base balances, optic and peripheral neuropathies\u25aaEspecially if used greater than 28 daysoHeadache and nausea also ADRsoOriginally developed as an MAOI, indirect acting sympathomimetic \u2013 giving an SSRI with this would cause serotonin syndrome and also interactions with tyramine rich foods (aged cheese, wines, etc.)Sulfonamides\u2022Sulfamethoxazole \u2013 often utilized with trimethoprim (Bactrim)\u2022Silver sulfadiazine \u2013 cream used in burns\u2022Bacteriostatic, highly protein bound and well distributed\u2022Effect folic acid so never use in somebody who has a folic acid deficit\u2022If pt has sulfonamide allergy, then they are cross-sensitive to loop\/thiazide diuretics and sulfonylureas\u2022Excreted via the kidneys so make sure this is prescribed in somebody with good kidney function\u2022Used to treat E. coli UTIs and occasionally strep pneumonia and pyrogens \u2013 used to be used for c. trachomatous\u2022Adverse effects \u2013 folate deficiency because it disrupts folic acid synthesis. Can also cause SJS or TEN so systemic reaction can occur (esp. w\/large doses). Glossitis, stomatitis, hepatitis \u2013 can cause transient jaundice, CNS effects\u2013 can suppress bone marrow, renal impairment NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022Contraindicated in people that are folate deficient or G6PD deficient (condition causing RBCs to break down in response to certain meds, infections, stressors) NURS 615 Pharm Exam 2 Mega Review Study Guideo People with G6PD deficiency are missing an enzyme needed for cellular processes \u2013 what happens is that you give a sulfonamide and the persons RBCs will hemolyze and they will develop an anemia and so forth\u2022Avoid in lactation and infants under 2 months because they are G6PD deficient just by being too new, also avoid in sulfa allergiesMacrobids\u2022Nitrofurantoin (Macrodantin)\u2022Used for urinary tract infections, also works well with kidney infections (basically goes directly to the kidneys) so it would be contraindicated in somebody with kidney disease\u2022Renally excreted\u2022Crosses the placenta\u2022Same effect as sulfa in terms of g6pd thoughFluoroquinolones\u2022One of the latest and greatest medications\u2022End in floxacin\u2022Bactericidal working on the bacterial DNA replication\u2022Work very well on inner anaerobe type of bacteria that live deep within us \u2013 Haemophilus, enterococcus, pseudomonas\u2022Save for the \u2018big bads\u2019 \u2013 pneumonias, things that could really hurt us, things that are resistant to all other typesof medications\u2022Fluoroquinolones should be reserved for tx of community-acquired PNA in pts w\/ comorbidities\u2022Can go where many other antibiotics cannot\u2022Avoid antacids, dairy, and iron within a few hours of taking this medication\u2022Understand that it does concentrate in the prostate and the kidneys \u2013 it is a good prostatitis medication for this reason\u2022Is renally excreted \u2013 alter dose and monitor functions with patients that have renal disease\u2022Not recommended in pregnancy or children under 18o Damage to cartilage \u2013 black box warning for tendon rupture even months after tx\u2013 elderly are the most susceptible\u2022Can prolong the QT intervaloKnow the patient\u2019s cardiac statusoKnow other medications that patient is on that also prolong the QT\u2022Know drug to drug interactions with fluoroquinolonesoWhat does fluoroquinolones and warfarin do? Enhances the effect of warfarinoWhat does fluoroquinolones and NSAIDs do?Aminoglycosides\u2022Gentamicin \u2022Amikacin \u2022Tobramycin \u2022Neomycin \u2022Things mostly systemically given \u2013 eye drops and ear drops most frequentoPoor GI absorption so IV drugoRenally excreted and concentrates in the kidneys as well as the inner ear which is why the issue with NURS 615 Pharm Exam 2 Mega Review Study Guidegentamicin and ototoxicity and hearing lossoAlso can cause renal problems (nephrotoxicity) so monitoring of hearing and renal functions incredibly necessary NURS 615 Pharm Exam 2 Mega Review Study Guide\u2022Topically administered medications have different side effectsMetronidazole (Flagyl)\u2022Bacterial vaginosis, h. pylori, diverticulitis, etc. used for\u2022Great for anaerobic coverage \u2013 things found deep within the body\u2022Bactericidal\u2022Works on nucleic acid synthesis\u2022Can be IV or PO\u2022Metabolized in the liver\u2022<\/em>*Biggest take away from this is to tell patients they can have nothing with alcohol (not even cough medicine) because they will vomit profusely (disulfiram like reaction) \u2013 tachycardia, nausea, vomitingAntimycobacterial and meds (TB)\u2022Know what TB looks like \u2013 clinical manifestations \u2013 weight loss, night sweats, hemoptysis, fatigue\u2022Rifampin used to tx TB, leprosy, and legionella\u2022Isoniazid (INH) \u2013 used as 1st line agent for prevention and tx of both waiting and active TB\u2022Rifampin \u2013 causes red orange secretions and urine if someone is wearing contacts, they should be taken out because this med will ruin their contactso Often see this given to people exposed to meningococcus as a preventative\u2022Isoniazid \u2013 peripheral neuritis or neuropathy can occur so recommend Pyridoxine (vitamin B6) be taken while on INH\u2022Pyrazinamide \u2013 increases uric acid (Gout flare-ups) but can also decrease liver functions and cause someone tobecome hepatotoxic (most dangerous side effect)\u2022Ethambutol \u2013 can cause optic neuritis leading to visual problems such as green red color blindness, tell pt to report these symptoms immediately as it can be permanentLyme disease medications \u2013 Doxycycline 100 mg Q12H for 21 daysA pt with a small ventricle septal defect (VSD) that was repaired some years ago with no residual cardiac problems DOES NOT need ABX before dental procedures.A pt who is experiencing non-infectious diarrhea related to ABX administration will need to be assessed for C. diff colitis,so advise pt to increase probiotic intake w\/yogurt to repopulate the gut flora.If a child comes to the clinic with a cough, low-grade fever, rhinorrhea, and the mucous is greenish-yellow then NO ABX should be prescribed because this is a virus.Antivirals\u2022Make sure you know what the names are for influenza drugs and simplex and zoster drugs\u2022Influenza \u2013 oseltamivir (Tamiflu) or zanamivir (Relenza) \u2013 start within 48 hours of influenza symptoms in order to successfully treato Prophylactic treatment will occur in places such as nursing homes to prevent death\u2022Acyclovir, famciclovir, valacyclovir \u2013 antivirals of choice for herpes simplex 1 and 2 as well as zosteroStart as soon as symptoms begin \u2013 numbness or tingling feelingoDrink lots of fluids when taking acyclovir (to help prevent nephrotoxicity)\u2022Zoster
NURS 615 Pharm Exam 2 Mega Review Study GuideoFor herpes zoster (shingles) \u2013 asses renal function prior to taking valacyclovir
NURS 615 Pharm Exam 2 Mega Review Study GuideoUnilateral rash along nerve root \u2013 will also be put on gabapentin or possible tricyclic to help with the painoPeople who are on antivirals for any length of time need monitoring for their liver functionAntifungals\u2022Organized according to polyenes, azoles, allyamines\u2022Can be systemic or topical depending on the infection\u2022Some require system \u2013 example is griseofulvin for ringworm (often seen on client\u2019s head)\u2022Ketonazole \u2013 can cause hepatoxicity (need to monitor AST\/ALT, alkaline phosphatase, and bilirubin)\u2022Amphotericin B is systemic and for serious type of fungal infection\u2022Candidiasis \u2013 topical tx (clotrimazole) = yeast, thrush, commonly used things are nystatin, mycostatin, itraconazole, fluconazole (big treatment for oral, oropharyngeal, or esophageal yeast, as well as vaginal yeast infection).\u2022Take note that these drugs can be hepatotoxic (need baseline LFTs) and nephrotoxic so good follow up is required for useAntihelminetics\u2022Lice and scabies = use permethrin cream and Ivermectin\u2022Mebendazole and agromectin used to tx intestinal parasitic worms\u2022Elimite cream \u2013 apply from head to toe, leave on for 8 hours before rinsing offHow do we know what we use?\u2022Lexicomp \u2013 expensive program but most hospitals have this\u2022Uptodate online \u2013 also expensive for individuals \u2013 most practices have one or the other\u2022Harriet lane is a good book \u2013 also online and is a good reference for pediatrics\u2022Consult infectious disease society of America\u2022American college of physicians\u2022Sanford guide \u2013 can place as download on phone<\/p>\n\n\n\n