pharm test three

raises glucose levels
used for hypoglycemia or insulin over doses
"pancreatic" hormone
Can be given IV, IM, SQ

Antihypoglycemic Drugs

what are the side effects of antihypoglycemic drugs?

hypersensitivity reaction
transient blood pressure changes
hyperglycemia and hypokalemia

what are the nurses responsibilities regarding antihyperglycemic drugs?


what are our nursing measures for diabetic medications


an indication of glycemic control is a ALC less than or equal to ______


what is our normal range for blood glucose


insulin ______ serum glucose levels


__________ agents decrease the serum glucose levels

insulin and oral hypoglycemic meds

________ insulin functions as a substitute for the endogenous hormone


_______ restores the ability of the patient to metabolize carbs, fats, and proteins. As well as to store glucose in the liver and to convert glycogen to fat stores


_________ are the oldest group of oral diabetic drug


produce more insulin
2nd generation
stimulate the beta cells to produce more insulin
secondarily decreases the secretion of glycogen


what are the different types of sulfonylureas

glipizide (glucocotrol)
glyburide (Diabeta)
glimepride (amaryl)

______ can be used in conjunction with insulin and thiazolidinedione to treat type 2 diabetes


what are the side effects of sulfonylureas


what are our contraindications for sulfonylureas

in pt with an allergy
in pt that are predisposed to hypoglycemia
- decreased appetite
- ethanol use
- advanced age

Corticosteroids, estrogen, diuretics, and thyroid drugs can all ______ blood glucose levels


_______ can mask tachycardia from hypoglycemia

non selective beta blockers

_________ cause hypoglycemic effects

hyperglycemic drugs

what is our prototype for anterior pituitary drugs?

somatropin and somatrem

what do our anterior pituitary drugs (somatropin and somatrem) do?


what are our anterior pituitary drugs (somatropin and somatrem) used for?


what are the routes for anterior pituitary drugs (somatropin and somatrem)?

subcutaneously and IM

what are the side effects of somatropin and somatrem (anterior pituitary drugs)


what are the drug interactions we should be concerned with regarding somatropin and somatrem?

- not to be given with corticosteroids, anabolic steroids, androgens, estrogens, or thyroid hormones
- if patients are getting insulin they need to be monitored closely! (DECREASES ACTION OF INSULIN)

when are somatropin and somatrem contraindicated?


when should we use caution when giving somatropin and somatrem

in patients with severe renal/hepatic diseases
in patients who are pregnant or lactating

what are the nursing responsibilities for somatropin and somatrem


what are growth hormone antagonist (octreotide (sandostatin)) used for?


_______- the result of overproduction of growth hormones prior to puberty and sealing of the epiphyseal plates of the long bone


______- excessive growth hormone production in adults


what is the prototype drug for growth antagonist

octreotide (sandostatin)

what route do we give octerotide (sandostatin)

subcutaneously or IM

what are the side effects of octerotide (sandostatin)


what are the nursing responsibilities for octerotide (sandostatin)


when should we use octreotide (sandostatin) in caution?


what drug interactions are we worries about with octreotide (sandostatin)

- can cause hypoglycemia when given with PO antidiabetic drugs or insulin
- if taken with (beta-blockers and calcium channel blockers) cardiac drugs it can cause additive bradycardia

what are posterior pituitary drugs (vasopressin and desmopressin)


what are the method of action for vasopressin and desmopressin

-mimics the action of (ADH)
- increased water reabsorption in the distal tubules and collecting ducts of the nephrons
- they concentrate urine water excretion by 90%

when do we use vasopressin and desmopressin

to prevent or control polydispea (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous ADH

what are the side effects of posterior pituitary drugs (vasopressin and desmopressin)


what are the nursing implementations for vasopressin and desmopressin


what are the symptoms of H20 intoxication


What are the different thyroid hormones?


what is the MOA of thyroid hormones?

controls the metabolic rate of tissues and accelerated head production and O2 consumption

why do we use thyroid hormones


_______- can enhance the action of thyroid hormones

phenytoin (dilantin) and aspirin

what are the side effects of thyroid hormone meds


what are our nursing measures for thyroid hormone medicines


what do we need to educate patients on when taking thyroid medications


what are foods that can inhibit thyroid secretions and should therefor be avoided in patients taking thyroid medications


what are the signs and symptoms of hyperthyroidism (should be reported in patients that are taking thyroid hormones)


What do antithyroid medications do?


why are antithyroid medications used

grave's disease

what are the antithyroid drugs


what are the side effects of antithyroid medications


what are the signs of iodism

abdominal pain
metallic taste
sore salivary glands

what are our nursing measures for patients taking antithyroid meds


what should we educate our patients on when taking antithyroid medications


what are the signs of a thyroid crisis


what is the prototype for meglitinides (oral hypoglycemic drugs)

repaglinide (prandin)

what is the method of action for repaglinide (prandin)


what is the most common side effect of repaglinide (prandin)


what are the contraindications for taking repaglinide (prandin)


what is the Thiasolidinediones/ glitazones prototype?

rogiglitazone (avandia)

what is the method of action for rogiglitazone (avandia)


when is the optimal release of rogiglitazone (avandia)

3-4 months of therapy

what are the side effects of rogiglitazone (avandia)


when is rogiglitazone (avandia) contraindicated?

in patients with serious heart failure and pulmonary edema
caution in patients with liver or kidney disease

what are the drug interactions with glipizide?

DPP4 inhibitors
causes increased hypoglycemia
decrease effectiveness

what is the only drug in the biguanide class

metformin (glucophage, glumetza)

______ 1st line in therapy and is the most commonly used oral drug for the treatment of type 2 diabetes


that is the method of action for metformin


what are the side effects of metformin ( glucophage and glumetza)


when is metformin contraindicated?

- in patients with renal impairment, liver failure, concurrent serious infection
- should be stopped prior to and held for 48 hours after CT scans or procedures requiring IV contrast

what are the drug interactions for metformin?


what is our prototype drug for alpha glucosidase inhibitors?

acarbose (precose)

what is the method of action for alpha glucosidase inhibitors (acarbose (presose))

decreases glucose levels by interfering with carbohydrate absorption from the GI tract

what should we educate our patients about regarding acarbose (precose)

they should take it with food

what are the side effects of acarbose (precose)


what are the contraindications for acarbose (precose)


what are the incretin therapies injectable meds "memetics


what is the MOA for incetin therapies


incetin therapies do not cause ________


what are the side effects of incetin therapies


what are the types of corticosteroids?

hydrocortisone (cartef)

what are the classifications of corticosteroids

- glucocorticoids (anti-inflammatory)
- mineralocorticoids (salt retaining)

________- suppress inflammation and immunity and assist in the breakdown of fats, carbohydrates, and proteins
- maintenance of blood sugar
- stress effects


________- regulates the balance of salt and water in the body.
blood pressure control
maintenance of potassium levels and PH in blood stream
sodium and water reabsorption


what is the prototype for glucocorticoids

hydrocortisone (cortef)

what are all the types of glucocorticoids

-betamethasone (celestone)
- cortisone (cortone)
- fludrocortisone (florinef)
- triamcinolone (aristacort, kenacort)
- dexamethasone (decadron)
- methylprednisone (depo-medrol, solu-medrol)
-prednisolone (delta-cortef, prelone)
- prednisone (orasone, delt

what are corticosteroids used for?


what are the side effects of glucocorticoids?


what are the contraindications for glucocorticoids


when should we use glucocorticoids in caution


what are the drug interactions for glucocorticoids


what are the nursing implementations for taking glucocorticoids


what's the prototype for mineralocorticoids

fludrocortisone (florinef)

what is the method of action for mineralocorticoids


what are the adverse effects of mineralocorticoids (fludrocortisone)


what are calcium supplements taken for?

- prevention or treatment of hypocalcemia
- paget's disease
- osteomalacia
- chronic hyperparathyroidism

what are the adverse effects of calcium supplements


what are the contraindications for taking calcium supplements


calcium supplements should not be administered ________

subcutaneously or IM

what are the drug interactions for calcium supplements


__________- results in a high serum calcium level and bone demineralization and meds are used to lower serum calcium levels


_________- results in lower serum calcium level which increases neuromuscular excitability and the treatment includes calcium and vitamin D supplements


what are the bisphonate drugs


__________- increase bone density and used to treat osteoporosis and paget's disease.


what are the adverse effects of bisphonates


what are the cautions for bisphonates

- in patients with dysphagia
- esophagitis
- esophageal ulcer
- gastric ulcer
- fosamax should be taken 1st thing in the morning with 8 oz of water and patient should sit upright for at least 30 minutes

__________- is the only drug that acts by stimulating bone formation


_____- helps prevent osteoporosis by stimulating estrogen receptors on bone and increases bone density


____________- are called calcimimetics because they mimic the effects of calcium in tissues. used for treatment of hypercalcium. nausea, vomiting, and diarrhea are common during therapy

cinacalcet (sensipar), etelacalcetide (parsabiv)

What are the different selective estrogen receptors (SERMs) drugs


what are the side effects of SEMRIs


_______ is the active form for vitamin D supplements


what is the method of action for vitamin D supplements (calcitriol)

increases serum calcium levels, decreases phosphate levels in the blood and decreases bone resorption and demineralization

calcitriol is contraindicated in patients with

an allergy in salmon

what are the nursing responsibilities for patients taking vitamin D and calcium supplements


what are the adverse effects of vitamin D supplements (calcitriol)


_________- stimulate growth in tissues (bone and muscle). Increases production of red blood cells.

anabolic steroids

what are androgens and anabolic steroids are used for______?


___________- stimulate the development of male sex characteristics and development of sex organs

testosterone and dihydrotestosterone ( androgens and anabolic steroids)

__________- block effects of androgens, 5-alpha reductase inhibitors, used in treatment of BPH

anogen inhibitors

what are the anogen inhibitor drugs

finasteride (proscar) and dutasteride

women should wear gloves when handling ________

anogen inhibitors (flinasteride (proscar) and dutasteride)

what are the side effects of finasteride (proscar) and dutasteride


why does finasteride (proscar) and dutasteride have a black box warning

it has the potential for developing thromboembolic disorders and heart attack

________- stimulate female reproductive tissue


_____- stimulate the uterine lining


what are the side effects of taking estrogens and progestins


what are the contraindications for taking estrogens and progestins


what are oral contraceptives


how do oral contraceptives work

by decreasing fertility by suppressing ovulation and thickening the cervix and making the lining of the endometrium less favorable for implementation.
useful in controlling irregular or excessive mensural cycles

what are the types of estrogen and progestins

- chlorotrianisene (trace)
- diethystibesterol (DES)
- estradol (estrace, climara, estraderm)
- estradiol valerate (depo-estradiol)
- estrogen congugated (premarin)
- estrogens estenfied (estratab)
- levenogestrel (norplant)
- medoxyprogestero

what are the drugs for abortifacients, prostaglandins, tocolytics, oxytocics


what are the prostaglandins

carboprost (hemabate), dinoproston (cervidil).

what are the actions of prostaglandins (carboprost and dinoprostan)

potent stimulator of the myometrium

________- used to soften and promote dilation of the cervix to facilitate vaginal delivery (maintain patient in supine position for 30 minutes)

dinoproston (cervidill)

what are the uses of prostaglandins


what are the adverse effects of prostaglandins


oxytocin (uterine stimulant) pitocin and syntocinon __________

methylergonovine (methergine)

what is the use for oxytocin, pitocin, and syntocinon


what are the side effects of (oxytocin, pitocin, and syntocinon)

uterine rupture

_______- used in emergency intervention for serious post-partum hemorrhage


what are the side effects of methergine

hypertensive crisis

_________- uterine relaxants


what are the drugs for Terbutaline sulfate (brethine)

magnesium sulfate, terbutaline

__________- activates beta-adrenergic receptors resulting in uterine smooth muscle relaxation
- used to delay preterm labor (slows contraction)

terbutaline sulfate (brethine), magnesium sulfate, terbutaline

what are the side effects of brethine (magnesium sulfate, terbutaline)


what is our prototype drug for mast cell stabilizers "preventer

cromolyn (intal)

_______- used to prevent the release of histamine and other inflammatory medications in the airway

cromolyn (intal) mast cell stabilizers

how is cromolyn (intal) given

nebulizer or MDI

what are the side effects of cromolyn (intal)

pharyngeal irritation
rebound bronchospasms (takes several weeks)

what are the cautions for cromolyn (intal)

- not for acute attacks
- give a dilator first and wait 5 minutes before giving
- do not stop abruptly

-used to ease bronchoconstriction by reducing inflammation
- used when inhaled steroids and short acting beta agonist are not able to control asthma symptoms
- used to prevent asthma attacks induced by allergens, exercise, cold air, ASA and NSAI

leukotriene modifiers "ast"

what are the side effects of leukotriene modifiers

HA is common
interacts with many medications

what are the different types of leukotriene modifiers

montelukast (singulair)--> prototype
zafirlukast (accolate)
zileuton (zyflo)

what is the prototype drug for leukotriene modifiers

montelukokast (singulair)

- used if older than 12 months
- available as granules and chewables
leokotriene modifier


- known to increase liver enzymes, need a baseline liver function (look for signs of liver problems)
*if on coumadin, need to check patient level
leokotriene modifier

zileuton (zyflo)

- can cause weight loss and psych events
(leokotriene modifier)

roflumast (baliresp)

what is the prototype for xanthines

theophyline (slo-phyllin, theochron)

____________- used for long-term management of persistent asthma that does not respond to beta agonist or inhaled steroids

xanthines (theophylline, slo-phyllin, theochron)

what are the routes of administration for xanthines (theophylline)


- have narrow therapeutic index and interact with many meds
- have a stimulant effect like caffeine

xanthines (theophylline) slo-phyllin/theochron

what are the side effects of xanthines (theophylline)


what are the early sings of toxicity for Xanthines (theophylline)


what are the later signs of toxicity for xanthines (theophylline)


what is the therapeutic index for xanthines (theophylline)

20 is toxic

what are the intranasal steroids drugs?


What are the intranasal steroids used for

-1st line treatment for allergic rhinitis
- usually added with an antihistamine
- can dry nasal mucosa
- reduce tissue edema
- cause mild vasoconstriction
- often used after surgery to help decrease inflammation

- peak response 1-3 weeks
- used daily for best results
- use nasal decongestant 1st to open nasal passage


what is our caution for intranasal steroids

assess patient nares before using and after

what is our prototype drug for monoclonal antibodies

omalizumab (xolair)
reslizumab (cinqair)

_______- used to treat allergic rhinitis and moderate to severe asthma
- give SQ every 2-4 weeks
- ages 12 and older
- takes several weeks to see a response

omalizumab (xolair)

______ used to block inflammatory action caused by eosinophils
- IV every 4 weeks
- 18 and older

reslizumab (cinqair)

what are the drugs used to treat the common cold and allergic rhinitis

intranasal steroids

__________- most frequent use of these drugs is treatment of allergies.
- provide symptomatic relief of allergic rhinitis
- often combined with decongestants and antitussives in OTC
cold and sinus meds


how are antihistamines most effective

when taken prophylactically

what are the cautions for antihistamines

can cause CNS stimulation in children and elderly
stop 3-4 days before allergy testing
DONT use with alcohol or CNS depressants (can induce sedation)

what are the side effects of antihistamines

dry mouth
urination problems
thickened secretions

what is the prototype for antihistamines

fexofenadine (allegra) prototype

what are the 1st generation antihistamines (more sedating than 2nd)

diphenhydramine (benadryl)
brompheniramine (dimetapp)
chlorpheniramine (chlor-trimeton)
clemastine (travist)
promethazine (phenegran)

what are the 2nd generation antihistamines

fexofenadine (allegra)
cetirizine (zytec)
desloratadine (clarinex)
loratadine (clarytin)
azelastine (astelin)

what are the types of bronchodilators


_________- are used to treat asthma, bronchitis, emphysema (COPD)


_________ can raise heart rate and HA, nervousness, restlessness, palpation
caffeine will increase these effects

beta agonist/ sympathomimetics (-terols)

Don't take _______ with beta agonists because it will inhibit bronchodilation

beta blockers

long lasting beta agonist are not for ______ (LABA)

acute attacks

short acting beta agonist are _____ for _______

rescue agents for acute attacks (SABA)

what are the short acting beta agonist (SABA)


_______ A SABA drug that is often taken prior to exercise to prevent an attack and is given by MDI, nebulizer, and PO


What are the LABA drugs


what med do we use for COPD

indacaterol ( arcapta, neohaler)

what is the intermediate acting bronchodilator


- can be used with beta agonist resulting in better and longer bronchodilation due to ""additive effects

anticholinergic "iums" (inhaled) drugs

what are the side effects of anticholinergic drugs

dry mouth and GI distress

what are the cautions for anticholinergic drugs


what are the different anticholinergic drugs


______- an anticholinergic that can be combined with albuterol

ipatropium (fltovent, combivent)

________- the only anticholinergic that can be used for acute attacks


-tudorza pressair
- anticholinergic used for the long term maintenance of COPD bronchospasms


- longer time of onset

tiotropium (spiriva)


umeclidinium (incrose ellipta)

_______- metered dose inhaler


________- dry powder inhalers


_________- type of device used to administer meds (5 different formulas)


what is the method of action for anticholinergic drugs

blocks PNS
used as alternative bronchodilators

_________- help decrease inflammation/ block histamine and decrease mucus. takes 4-8 weeks to see maximum effects

inhaled corticosteroids "-ide and -one

what is the prototype for inhaled corticosteroids

beclomethasone (beconase AQ nasal spray Quar-MDI)

what are the uses for inhaled corticosteroids (beclomethasone)

- for prevention of asthmatic attacks (DOC)
- management of chronic asthma (DOC and PO)
:PO only short term 5-7 days
- decrease inflammation of the airway

what are the different inhaled corticosteroids


- beconase AQ spray
inhaled corticosteroid


inhaled corticosteroid

buclesonide (pulmicort)
mometasone (asmanex)
fluticasone (aerobid) (and mdI)

- prodrug
- only in patients younger than 12
- inhaled corticosteroid


what are the combinations for inhaled corticosteroids

fluticasone/salmeterol (advair)
ipratropium/ albuterol (combivent, duoneb)

what are the cautions for inhaled corticosteroids (beclomethasone)


what are the side effects of inhaled corticosteroids (beclomethasone)


stimulation of the ____________ cause constriction of bronchial smooth muscles- bronchial constriction

parasympathetic nerves

stimulation of the ______ causes relaxation of bronchial smooth muscles (bronchodilation)

sympathetic nerves

the _______ regulates the rate and depth of respirations

nervous system

______ - protects the lungs from foreign particles, air pollutants, bacteria, and other harmful substances

cough reflex

what are the signs of respiratory disorders


what are the causes of increased respirations


what are the causes of decreased respirations


what are the disorders of the respiratory systems


___________- bronchoconstriction, inflammation, dyspnea, wheezing, chest tightness, cough, and possible sputum production.


_________- develops after long term exposure to airway irritants. Bronchoconstriction and inflammation are more constant and less reversible


what are the routes of drugs for respiratory systems


__________ are used when bronchials are constricted


why must we be aware of what type of propellant is contained in inhalers?

some contain peanuts and soy (allergies)

________- "relieve" nasal congestion. Available PO, tabs, elixirs, nasal formulations. These are meds that help decrease over production of secretions


What is the prototype for decongestants

Pseudoephedrine (Sudafed)

_________Often combined with OTC meds to tx allergic rhinitis, sinus congestion, common cold

Pseudoephedrine (Sudafed

What are the side effects of Pseudoephedrine (Sudafed

Can stimulate CNS: insomnia, restless, dizziness, anxiety.

_________Causes vasoconstriction in nasal mucosa-shrink mucosal swelling, helps promote sinus drainage. Also causes bronchodilation.

Pseudoephedrine (Sudafed)

what are the cautions for Pseudoephedrine (Sudafed)

These are not used with MAOIs, pts with severe HTN, angina, or takes nitrates due to vasoconstriction

___________-these are OTC as sprays, drops......can cause rebound congestion if not used according to pkg directions of frequency or use and length of use (not > than 3-5 days)


what are the types of nasal decongestants

Oxymetazoline (Afrin 12 hour, Neo-Synephrine 12 hour)�
Phenylephrine (Afrin 4-6 hour)�
Pseudoephedrine (Actifed, Sudafed)�
Anticholinergic: ipratropium bromide (Atrovent)-

nasal spray 2 per nare 3-4 x/day for up to 4 days.
side effects .: urinary retention, worsening narrow-angle glaucoma

Anticholinergic: ipratropium bromide (Atrovent)

Used to treat symptoms of common cold.
Not usually recommended to use these OTC if < 6 years of age unless told by the HCP.
Not used usually more than 1 week if not seeing improvements, will need to see the HCP


medications for colds usually contain

Usually contain antihistamine, nasal decongestant, analgesic, and possibly expectorant and antitussive.

_________________Used for dry, hacking cough that interferes with rest and sleep. Not usually taken during the day or post op because want to cough and deep breathe.
Can have narcotic component with these.
Short term treatment only.
Act on the cough contr

825 Table 45.5 antitussives & expectorants

what are the cautions for ANTITUSSIVES

Used with caution with asthmatics because bronchoconstriction can occur; also not usually with pt's with chronic lung problems because can suppress respiratory fxn.

what's the prototype for ANTITUSSIVES

Dextromethorphan (Robitussin, Sucrets, Delsym)

what are the types of ANTITUSSIVES

-Benxonatate (Tessalon)
-Hydrocodone combined with homatropine (Hycodan)

These stimulate the production of respiratory secretions (increase mucus flow) so they can be eliminated with coughing.
Helps increase productive cough to clear the airways.
Help with removal of those secretions
Found in many OTC cold remedi


expectorants work best with ______

a dry nonproductive cough

what's the prototype for EXPECTORANTS

guaifenesin (Mucinex,Robitussin)

what should we teach patients about guaifenesin (Mucinex,Robitussin)

they should drink a lot of water to loosen secretions

________Given by PO or inhalation to liquefy and loosen thick secretions in respiratory tract. The mucus becomes thinner and can be removed easier with coughing. Used with CF, chronic bronchitis, etc. Can help breakdown the chemical structure of mucus.


what is the prototype for mucolytics

acetylcysteine (Mucomyst)

__________- the ability of an organism to cause a disease


when the body's immune system is depressed, pathogens take the opportunity to invade in situations which they would normally be prevented. these organisms are considered ________


______, _______, ________ are all terms that identify the rate and rigor at which pathogens can enter a host

virulence, invasiveness, endo and exotoxins

_____ is used to identify which bacteria types are sensitive to which antibiotic

gram staining

what are the different shapes of bacteria

rod, sphere, and spiral

______ bacteria that thrive in oxygen rich environments


________bacteria that do not require O2


________- a term that applies to any medication that is effective against pathogens


_________- drugs kill bacteria


______ halt bacteria growth and allow body's normal processes to eliminate the remaining microorganism


________- exert selective toxicity by targeting the unique differences between human and microbe cells


________- exert their elective toxicity by five major methods


_____________- inhibit the cell wall synthesis and cause the cell to absorb water and eventually lyse.

the penicillins (cephalosporin, vancomycin)

________- inhibit the cells synthesis of protein

tetracyclines and aminoglycosides

_______ act by interfering with the pathogen's plasma membrane

antifungal meds (amphotericin B)

______- inhibition of nucleic acid synthesis is the mechanism of action


what are the factors that affect a microbes acquired resistance to an anti- infectant


the widespread and sometimes uneducated use of antibiotics leads to _______

mutation and resistance

What are the CDCs guidelines for prevention of antibiotic resistance


how do we use antimicrobials wisely


the nurses primary role regarding bacteria

prevent infection

what are the most common sites of infection

urinary tract.
surgical wounds
respiratory tract
and blood

what are the four general sources of hospital associated infections

patient flora
invasive devices
medical personal
and medical environment

what are the resistant strains of bacteria


why is the correct selection of an antibiotic of the utmost importance

the wrong antibiotic allows the microbes to grow and change (culture and sensitivity testing identifies the correct antibiotic)

what are the two major classes of antibiotics

broad spectrum- effective against a wide variety of organisms
narrow spectrum- effective against smaller groups of bacteria (produces less side effects)

_______ should not be prescribed in viral disorders


__________ may result in decreased effectiveness of both drugs

combination therapy with antibiotics

when would you want to use multiple antibiotics

when an infection is caused by more than one bacteria

what are the host factors in an individual patient that have a significant influence on the success of anti-infective therapy?


The antibiotic may be hindered from reaching the microbes by ________


What is an important nursing role regarding antibiotic therapy?


___________- can occur when an anti-infective antibiotic kills host flora. some microbes have a purpose in the human body; they break down toxins and produce antibacterial substances


superinfection is a new infection caused by _______

antibiotic treatment

the use of ________ is more likely to lead to superinfections than narrow spectrum antibiotics

broad spectrum

when are antibiotics given prophylactically (prevention)

before surgeries or going out of the country

- most effective against gram-positive bacteria
- have a narrow spectrum of antimicrobial activity
- widely distributes to most body tissues
- rapidly excreted by the kidney
- most have short half lives

penicillin G

______- is the prototype for a cell wall inhibitor

penicillin G

what are the common adverse effects of penicillin G

urticaria (itching) and delayed skin reactions

_______ the prototype penicillin G. A broad spectrum penicillin.


what are the side effects of ampicillin?

rash and diarrhea
anaphylaxis (rare)

when is penicillin G (ampicillin) used?

against gram positive bacteria
- skin/soft tissue
- respiratory
- gastrointestinal
- genitourinary

what are the side effects of an anaphylaxis response

cardiovascular collapse
edema of mouth, tongue, pharynx, and larynx

How is Penicillin G administered?


how do we treat an overdose of penicillin G

just have to treat the symptoms

what is the prototype for cephalosporin

cefazolin (ancef, kefzol)

- not effective against MRSA (staph infection)
- given before surgery prophylaxis

cefaxolin (ancef, kefzol)

what are the adverse effects of cephalosporin (ancef, kefzol)

allergic reaction!
itching and delayed skin reaction
rash and diarrhea

what is the prototype for carbapenems

Imipenem -cilastatin (Primaxin)

- short half life and must be given every six hours because of the short half life

carbapenems (imipenem- cilastatin (primaxin))

what are the adverse effects of primaxin

nausea, vomiting, diarrhea, pain, and phlebitis at the injection site.



what are the adverse effects of vancomycin

red man syndrome (STOP INFUSION)
tinnitus and hearing loss after the drug is discontinued
nephrotoxicity (renal function, less urine produced)
extravasation may lead to tissue necrosis (watch IV site)

what are the signs of red man syndrome


how does a nurse know if the antibiotic is working

signs and symptoms of infection/fever diminished

what are the nurses assessment responsibilities regarding antibiotics


what are signs of nephrotoxicity

dark urine
decreased urine output
weight gain

what is a sign of a superinfection

foul smelling diarrhea with pus

what are our nursing planning measures regarding antibiotic


what are the common gram positive bacterias


what are the common gram negative pathogens


what is the alternate drug for penicillin and cephalosporin (give if a patient has an allergy to one of these)

tetracycline drugs and macrolide drugs

_____- one of the broadest antimicrobial spectrums of any class of antibiotics. used to treat chlamydia, acne, alternate to PCN, traveler's diarrhea


what are our nursing measures regarding tetracycline drugs


what are the side effects of tetracycline

pseudomembranous colitis (PMC) - rare, severe caused by certain classes of antibiotics
- photosensitivity (tingling, burning sensation, exaggerated sunburn)
- superinfections
- worsen kidney impairment

what are the contraindications for tetracycline drugs



macrolide drugs

what are the adverse effects of macrolides?


- clinical indications are limited due to serious adverse effects
- used for gram negative infections and or/ systemic infections


what is the prototype for aminoglycoside


what are the adverse effects of aminoglycoside

neurotoxicity shows up in hearing
loss of hearing or balance may be permanent
early signs are tinnitus, vertigo, and persistent headaches (STOP INFUSION)

what are the contraindications for aminoglycosides


what are our nursing measures for aminoglycoside drugs

- keep patients well hydrated to avoid serum concentrations
- DIURETICS (flurosemide/lasix) may increase risk for nephrotoxicity
- monitor levels closely (therapeutic and renal function)

what are signs of nephrotoxicity

Urinary casts (visible remnants of destroyed renal cells)
Increased blood urea nitrogen (BUN) and serum creatinine levels

- used to treat gram positive and gram negative infection (most effective for negative)
- given for respiratory, GI, GU, and soft tissue infections
- oral and IV route

- fluroquinolones

what are the side effects of Cipro

nausea, vomiting, diarrhea CAN PROLONG QT INTERVAL (give with food)

what are the nursing measures regarding cipro


what are the contraindications for cipro

in pregnant and hypersensitive patients
caution in kidney impaired patients (excreted through kidneys)

- clinical indications: used for complicated skin infections
- adverse effects: abnormal liver function test, elevated adverse CPK, dyspnea, and pneumonia

Daptomycin (cubicin)

- clinical indications: fights bacteria and multicellular parasites
- trichomoniasis, giardiasis, and amebiasis
- treats pylori


treats topical skin infections, mucous membranes or gram negative eye infections
rarely used IV route

polymyxin B

- used to prevent influenza and type b and meningococcal disease
- used for tb

rifampin (rifadin, rimactane)

what is the 1st line treatment for tuberculosis

isoniazid (INH)

- may be used for a year to treat TB
- can be given PO or IM

isoniazide (INH)

what are the adverse effects of Isoniazid (INH)

rash and fever
neurotoxicity- paresthesia of feet and hands

what is the antidote for isoniazid overdose (seizures)

pyridoxine (give until patient regains consciousness)

When is Isoniazid contraindicated?


_treats most fungi in people
- used prophylactic for severely immunosuppressed patients
- given IV mostly
adverse effects: frequent and serious
- contraindications/ caution : cardiac issues
-overdose: cardiac arrest ( treat symptoms)

amphoterocin B

- treats candida albicans and other fungus
- adverse effects - nausea, vomiting, diarrhea
- Dont give to patients with chronic kidney disease
- overdose--- give hemodialysis

fluconazole (diflucan)

- comes in several forms
- does not treat onychomycosis (fungus in nail plate)
- adverse effects: minor skin irritation or burning on skin


- used to treat amebiasis (parasites found in water) also rosacea
- adverse effects are nor serious enough to stop
- may cause bone suppression
( watch CBC, toxicity, liver impairment)

metronidazole (vermox)

-antiviral for herpes virus
- given po or IV
- herpes is blister like lesion on the skin, genitals, and mucous membranes
- one in six people are infected
- the drug decreases the duration and severity of acute herpes symptoms also used to preven

Acyclovir (zovirax)

what is the goal for anti inflammatory drugs


why are antipyretics given

to reduce fever


redness, swelling, heat, pain, or loss of function

_______ are given for mild/moderate pain, inflammation and fever. (with sever inflammation corticosteroids are given)


- salicylate, NSAID classification
- antipyretic
- found in a lot of drugs
- used for MI prevention and stroke prevention
1% of population is allergic (use acetaminophen instead)

Aspirin (antipyretic, antiplatelet)

what are the routes for aspirin

mouth, rectal,

what are the side effects for aspirin

- hypersensitivity reaction (bronchospasm, laryngeal edema, and anaphylaxis)
-GI bleeding!
may cause bleeding in other sites
- may cause contractions in third trimester
(stop 1 week before surgical and dental procedure)

who is at a high risk for GI bleeds when taking aspirin

peptic ulcers
older than 60
taking other anticoagulants or corticosteroids
smokers and drinkers
(MISOPROSTOL (cytotec) provides protection against

what are our concerns regarding children when giving aspirin? under 19

do not give if flu symptoms are present
risk for reye's syndrome-> fatal swelling of the brain and liver damage

what are side effects of long term use of aspirin

nephrotoxicity and hepatotoxic effects
tinnitus and hearing are common

when is aspirin contraindicated

- hypersensitive
- chronic rhinitis
- bronchospasm
- head trauma/ICP
- GI bleeding
- vitamin K deficiency
- heart failure
- pregnancy and lactation
- children under 19
- adults over 60

what are the symptoms of aspirin overdose (salicylism -levels over 200)

tinnitus acidosis, hyperventilation, dehydration, agitation, CNS depression, nausea and vomiting.

how do you treat an aspirin overdose

gastric lavage and alkalization or urine (hemodialysis for severe cases)

-used to treat pain from symptomatic RA, osteoarthritis, headache, dental pain, dysmehorrhea
- ibuprofen
- available in chewables, drops, and solutions
- DONT give with cardiac problems
BLACK BOX WARNING - increase cardiac event risk


what are the adverse effects of NSAIDS


what are contraindications for NSAIDs

bleeding abnormalities
hear problems

how do you treat an overdose of NSAID

activated charcoal and NG suction

-used for pain relief and reduce fever
- no anti-inflammatory properties
-primary alternant for NSAIDs
- used with opioid analgesics
- no issues with cardiac toxicity, no GI bleeding or ulcers
- given by mouth, rectal, or IV

acetaminophen (tylenol)

what drug is the #1 reason for acute hepatic failure in the us

acetaminophen (tylenol)

what levels should a nurse monitor for a patient taking tylenol

hypoglycemia, hepatic coma, acute renal failure

what are signs of acute acetaminophen poisoning (overdose of tylenol)

N/V/D, anorexia, dizziness, lethargy, diaphoresis, chills, and epigastric/abdominal pain

how do you treat a tylenol overdose

give oral or IV acetylcsteine (Acetadote)
done within 8 hours of ingestion