__________
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?
nausea
diarrhea
hypersensitivity reaction
transient blood pressure changes
tachycardia
hyperglycemia and hypokalemia
what are the nurses responsibilities regarding antihyperglycemic drugs?
#NAME?
what are our nursing measures for diabetic medications
#NAME?
an indication of glycemic control is a ALC less than or equal to ______
6.5
what is our normal range for blood glucose
70-130
insulin ______ serum glucose levels
decreases
__________ agents decrease the serum glucose levels
insulin and oral hypoglycemic meds
________ insulin functions as a substitute for the endogenous hormone
exogenous
_______ 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
insulin
_________ are the oldest group of oral diabetic drug
sulfonylureas
________
"-ride"
produce more insulin
2nd generation
stimulate the beta cells to produce more insulin
secondarily decreases the secretion of glycogen
sulfonylureas
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
sulfonylureas
what are the side effects of sulfonylureas
hypoglycemia
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
raise
_______ 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?
#NAME?
what are our anterior pituitary drugs (somatropin and somatrem) used for?
#NAME?
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)
#NAME?
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?
#NAME?
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
#NAME?
what are growth hormone antagonist (octreotide (sandostatin)) used for?
#NAME?
_______- the result of overproduction of growth hormones prior to puberty and sealing of the epiphyseal plates of the long bone
giantism
______- excessive growth hormone production in adults
acromegaly
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)
#NAME?
what are the nursing responsibilities for octerotide (sandostatin)
#NAME?
when should we use octreotide (sandostatin) in caution?
#NAME?
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)
antidiuretics
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)
#NAME?
what are the nursing implementations for vasopressin and desmopressin
#NAME?
what are the symptoms of H20 intoxication
#NAME?
What are the different thyroid hormones?
#NAME?
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
#NAME?
_______- can enhance the action of thyroid hormones
phenytoin (dilantin) and aspirin
what are the side effects of thyroid hormone meds
#NAME?
what are our nursing measures for thyroid hormone medicines
#NAME?
what do we need to educate patients on when taking thyroid medications
#NAME?
what are foods that can inhibit thyroid secretions and should therefor be avoided in patients taking thyroid medications
#NAME?
what are the signs and symptoms of hyperthyroidism (should be reported in patients that are taking thyroid hormones)
#NAME?
What do antithyroid medications do?
#NAME?
why are antithyroid medications used
hyperthyroidism
grave's disease
what are the antithyroid drugs
#NAME?
what are the side effects of antithyroid medications
#NAME?
what are the signs of iodism
vomiting
abdominal pain
metallic taste
rash
sore salivary glands
what are our nursing measures for patients taking antithyroid meds
#NAME?
what should we educate our patients on when taking antithyroid medications
#NAME?
what are the signs of a thyroid crisis
#NAME?
what is the prototype for meglitinides (oral hypoglycemic drugs)
repaglinide (prandin)
what is the method of action for repaglinide (prandin)
#NAME?
what is the most common side effect of repaglinide (prandin)
hypoglycemia
what are the contraindications for taking repaglinide (prandin)
#NAME?
what is the Thiasolidinediones/ glitazones prototype?
rogiglitazone (avandia)
what is the method of action for rogiglitazone (avandia)
#NAME?
when is the optimal release of rogiglitazone (avandia)
3-4 months of therapy
what are the side effects of rogiglitazone (avandia)
#NAME?
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?
betablockers
cimetidine
erythromycin
fluconazole
sulfonamide
antibiotics
DPP4 inhibitors
garlic
genseng
causes increased hypoglycemia
carbamazepine
phenobarbital
phenytoin
rifampin
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
metformin
that is the method of action for metformin
#NAME?
what are the side effects of metformin ( glucophage and glumetza)
#NAME?
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?
#NAME?
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)
#NAME?
what are the contraindications for acarbose (precose)
#NAME?
what are the incretin therapies injectable meds "memetics
#NAME?
what is the MOA for incetin therapies
#NAME?
incetin therapies do not cause ________
hypoglycemia
what are the side effects of incetin therapies
#NAME?
what are the types of corticosteroids?
hydrocortisone (cartef)
cortisone
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
glucocorticoids
________- 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
mineralocorticoids
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?
#NAME?
what are the side effects of glucocorticoids?
#NAME?
what are the contraindications for glucocorticoids
#NAME?
when should we use glucocorticoids in caution
#NAME?
what are the drug interactions for glucocorticoids
#NAME?
what are the nursing implementations for taking glucocorticoids
#NAME?
what's the prototype for mineralocorticoids
fludrocortisone (florinef)
what is the method of action for mineralocorticoids
#NAME?
what are the adverse effects of mineralocorticoids (fludrocortisone)
#NAME?
what are calcium supplements taken for?
- prevention or treatment of hypocalcemia
-osteoporosis
- paget's disease
- osteomalacia
- chronic hyperparathyroidism
what are the adverse effects of calcium supplements
#NAME?
what are the contraindications for taking calcium supplements
#NAME?
calcium supplements should not be administered ________
subcutaneously or IM
what are the drug interactions for calcium supplements
#NAME?
__________- results in a high serum calcium level and bone demineralization and meds are used to lower serum calcium levels
hyperparathyroidism
_________- results in lower serum calcium level which increases neuromuscular excitability and the treatment includes calcium and vitamin D supplements
hypoparathyroidism
what are the bisphonate drugs
#NAME?
__________- increase bone density and used to treat osteoporosis and paget's disease.
bisphonates
what are the adverse effects of bisphonates
#NAME?
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
teriparatide
_____- helps prevent osteoporosis by stimulating estrogen receptors on bone and increases bone density
teriparatide
____________- 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
#NAME?
what are the side effects of SEMRIs
#NAME?
_______ is the active form for vitamin D supplements
calcitriol
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
#NAME?
what are the adverse effects of vitamin D supplements (calcitriol)
#NAME?
_________- stimulate growth in tissues (bone and muscle). Increases production of red blood cells.
anabolic steroids
what are androgens and anabolic steroids are used for______?
#NAME?
___________- 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
#NAME?
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
estrogens
_____- stimulate the uterine lining
progestins
what are the side effects of taking estrogens and progestins
#NAME?
what are the contraindications for taking estrogens and progestins
#NAME?
what are oral contraceptives
#NAME?
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)
-dienestrol
- 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
prostaglandins
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
abortifacient
what are the adverse effects of prostaglandins
#NAME?
oxytocin (uterine stimulant) pitocin and syntocinon __________
methylergonovine (methergine)
what is the use for oxytocin, pitocin, and syntocinon
#NAME?
what are the side effects of (oxytocin, pitocin, and syntocinon)
uterine rupture
_______- used in emergency intervention for serious post-partum hemorrhage
methergine
what are the side effects of methergine
hypertensive crisis
_________- uterine relaxants
tocolytics
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)
#NAME?
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)
cough
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"
(montelukast)
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
montekukast
_______
- 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)
PO
IV
PR
________
- 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)
#NAME?
what are the early sings of toxicity for Xanthines (theophylline)
#NAME?
what are the later signs of toxicity for xanthines (theophylline)
#NAME?
what is the therapeutic index for xanthines (theophylline)
10-15
20 is toxic
what are the intranasal steroids drugs?
#NAME?
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
#NAME?
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
antihistamines
intranasal steroids
decongestants
__________- 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
antihistamines
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
#NAME?
_________- are used to treat asthma, bronchitis, emphysema (COPD)
bronchodilators
_________ 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)
#NAME?
_______ A SABA drug that is often taken prior to exercise to prevent an attack and is given by MDI, nebulizer, and PO
albuterol
What are the LABA drugs
#NAME?
what med do we use for COPD
indacaterol ( arcapta, neohaler)
what is the intermediate acting bronchodilator
metaproterenol
_________
- 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
#NAME?
what are the different anticholinergic drugs
#NAME?
______- an anticholinergic that can be combined with albuterol
ipatropium (fltovent, combivent)
________- the only anticholinergic that can be used for acute attacks
MDI
_________
-tudorza pressair
-DPI
- anticholinergic used for the long term maintenance of COPD bronchospasms
aclidinium
________
- DPI
- longer time of onset
-anticholinergic
tiotropium (spiriva)
________
- DPI
Anticholinergic
umeclidinium (incrose ellipta)
_______- metered dose inhaler
MDI
________- dry powder inhalers
DPI
_________- type of device used to administer meds (5 different formulas)
ellipta
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
#NAME?
______
- beconase AQ spray
-quar-MDI
inhaled corticosteroid
beclomethasone
________
DPI
inhaled corticosteroid
buclesonide (pulmicort)
mometasone (asmanex)
fluticasone (aerobid) (and mdI)
_________
- MDI
- prodrug
- only in patients younger than 12
- inhaled corticosteroid
ciclesonide
what are the combinations for inhaled corticosteroids
fluticasone/salmeterol (advair)
ipratropium/ albuterol (combivent, duoneb)
what are the cautions for inhaled corticosteroids (beclomethasone)
#NAME?
what are the side effects of inhaled corticosteroids (beclomethasone)
#NAME?
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
#NAME?
what are the causes of increased respirations
#NAME?
what are the causes of decreased respirations
#NAME?
what are the disorders of the respiratory systems
#NAME?
___________- bronchoconstriction, inflammation, dyspnea, wheezing, chest tightness, cough, and possible sputum production.
ASTHMA
_________- develops after long term exposure to airway irritants. Bronchoconstriction and inflammation are more constant and less reversible
COPD
what are the routes of drugs for respiratory systems
#NAME?
__________ are used when bronchials are constricted
bronchodilators
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
DECONGESTANTS
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)
NASAL DECONGESTANT
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
ANTITUSSIVES
EXPECTORANTS
MUCOLYTICS
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
ANTITUSSIVES
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)
Opiods:
-Codeine�
-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
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.
-
MUCOLYTICS
what is the prototype for mucolytics
acetylcysteine (Mucomyst)
__________- the ability of an organism to cause a disease
pathogenicity
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 ________
opportunistic
______, _______, ________ 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
aerobic
________bacteria that do not require O2
anaerobic
________- a term that applies to any medication that is effective against pathogens
anti-infective
_________- drugs kill bacteria
bacteriocidal
______ halt bacteria growth and allow body's normal processes to eliminate the remaining microorganism
bacteriostatics
________- exert selective toxicity by targeting the unique differences between human and microbe cells
antibiotics
________- exert their elective toxicity by five major methods
antibacterials
_____________- 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
fluoroquinolones
what are the factors that affect a microbes acquired resistance to an anti- infectant
#NAME?
the widespread and sometimes uneducated use of antibiotics leads to _______
mutation and resistance
What are the CDCs guidelines for prevention of antibiotic resistance
#NAME?
how do we use antimicrobials wisely
#NAME?
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
#NAME?
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
antibiotics
__________ 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?
#NAME?
The antibiotic may be hindered from reaching the microbes by ________
#NAME?
What is an important nursing role regarding antibiotic therapy?
#NAME?
___________- 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
superinfections
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.
ampicillin
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
infections
what are the side effects of an anaphylaxis response
cardiovascular collapse
edema of mouth, tongue, pharynx, and larynx
confusion
seizures
hallucination
MAY HAPPEN WITHIN MINUTES CAN ALSO BE A DELAYED RESPONSE
How is Penicillin G administered?
IV, IM
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
cephalosporin
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.
ANAPHYLACTIC response
#NAME?
vancomycin
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
#NAME?
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
#NAME?
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
#NAME?
what are the common gram positive bacterias
#NAME?
what are the common gram negative pathogens
#NAME?
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
tetracycline
what are our nursing measures regarding tetracycline drugs
#NAME?
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
#NAME?
#NAME?
macrolide drugs
what are the adverse effects of macrolides?
#NAME?
_______
- clinical indications are limited due to serious adverse effects
- used for gram negative infections and or/ systemic infections
aminoglycoside
what is the prototype for aminoglycoside
gentamicin
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
#NAME?
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)
Proteinuria
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
- PROLONG THE QT INTERVAL AND MUST BE MONITORED!
Cipro
- 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
#NAME?
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
metronidazole
___________
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?
#NAME?
_______
_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
nystatin
__________
- 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
#NAME?
why are antipyretics given
to reduce fever
inflammation
redness, swelling, heat, pain, or loss of function
_______ are given for mild/moderate pain, inflammation and fever. (with sever inflammation corticosteroids are given)
NSAIDs
________
- 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
h.pylori
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
NSAIDS
what are the adverse effects of NSAIDS
#NAME?
what are contraindications for NSAIDs
allergic
PUD
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
ALT
AST
Billirubin
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