NUR 117 mod. 3

What are the dangers of IV med administration?

Infection, goes straight to the bloodstream, can't take them back/slow them down...

Over at least how much time should most IV push meds be administered?

At least 2 minutes, some meds are shorter/longer...

What should you assess before/during any IV med administration?

IV site, checking for redness, swelling, and infiltration...

Does your primary or secondary fluid hang higher on your IV pole?

Secondary

What should you always check when administering more than one IV medication through the same line?

Compatibility

Why do we flush IVs before and after medication administration?

Before to make the sure the line is flowing and running and after to push all of the med through the line and to avoid blood clots

What is selective toxicity?

To create an anti infective that only harms the infected organism and does not harm the host

What does -cidal mean?

Kills cells

What does static mean?

Stop/ interrupt

Can anti-infectives change from -static to -cidal?

Yes

What is natural resistance?

that particular cell, invading cell does not use the biological process or enzyme that the anti infective medication works on...

What is acquired resistance?

antiInfective organisms use to be effected by a medication but it has built up a resistance over time so the medication no longer works on it.

How can we prevent acquired resistance?

Get a Culture and Sensitivity... make sure we give the correct antibiotic, only prescribe when it's appropriate, teaching pt to take entire prescription/all antibiotics, and to take them at the right time.

What is the most common adverse effect of anti-infectives?

GI toxicity and Diarrhea

How can we help prevent this?

Taking antibiotics with food, take a probiotic with it, drink plenty of water

What are some drug-food interactions with ciprofloxacin?-

Tube feed, calcium fortified juices, dairy and fennel

What are some drug drug interactions with ciproflaxacin

Warfarin
NSAIDS
corticosteroids
Theophylline

What are some meds that would require inpatient cardiac monitoring if combined with ciprofloxacin

amiodarone, erythromycin, tricyclic antidepressants (end in -ine), sotalol

What bacteria's are treated with ciproflaxacin?

Escherichia coli
Proteus mirabilis
Klebsiella pneumoniae
Enterobacter cloacae
Proteus vulgaris/rettgeri
Haemophilus influenzae/parainfluenzae
Staphylococcus epidermis
Neisseria gonorrhoeae
Group D streptococci

What is the first antibiotic

Penicillin

How does amoxicillin work?

Interferes with bacterial cell wall synthesis by binding to one or more penicillin-binding proteins, causing the cell wall to break apart and kills bacteria.

What are some side effects of amoxicillin

Seizures
C diff
Anaphylaxis
Serum sickness

What do aminoglycosides do?

inhibit protein synthesis

What is the best antibiotic to use during pregnancy/lactation?

Amoxicillin

What teaching should be included if administering amoxicillin to a woman of child-bearing age?

Reduces effectiveness of hormonal birth controls

In what situations is vancomycin appropriate?

Drug of last resort... only use it if nothing else is going to work...

What is the maximum safe vancomycin dose for children?

<2 g/day

What assessment findings would prompt the nurse to immediately discontinue a vancomycin infusion and alert the provider?

Red-Man Syndrome- (itching, flushing, hives, headache, dizziness, angioedema (redness/swelling in face)...

What supplies should be readily available when administering vancomycin?

Crash cart, Epinephrine, and Antihistamine

What is the treatment for red man syndrome

Stop vancomycin infusion immediately
Oral antihistamines
IV fluids
Corticosteroids

What is a broad spectrum antibiotic and what are some indications for use?

A antobiotic that can be used against many different things, to use in the beginning of care before the C and S results come back...

WHAT ARE SOME OFF-LABEL USES FOR FAMOTIDINE?

Management of GI symptoms r/t NSAIDs
Pancreatic insufficiency
Urticaria- hives
Anaphylaxis

HOW DOES FAMOTIDINE WORK?

Selectively block H-2 receptors on parietal cells
Prevent release of gastrin
Block production of hydrochloric acid
Decreases pepsin production by chief cells

WHAT MAY HAPPEN WITH HIGH DOSES OF FAMOTIDINE?

Cardiac arythmias

CAN FAMOTIDINE BE USED FOR CHILDREN?

Yes it's the only H2 antagonist recommended for children

CAN OMEPRAZOLE BE CRUSHED?

No it's only available as extended release tablets

FOR WHICH POPULATION IS OMEPRAZOLE THE BEST CHOICE?

Geriatric patients d/t decreased risk of adverse effects

�WHAT ARE SOME ADVERSE EFFECTS OF LONG-TERM OMEPRAZOLE USE?

Gastric cancer
Decreased calcium levels/bone loss
Decreased magnesium levels/hypertension
C. diff
Pneumonia

How many medications can you administer at a time via gastric tube?

One at a time

With how much water do you flush a gastric tube before med administration?

30 mL

With how much water do you flush a gastric tube between different med administration?

10 mL

With how much water do you flush a gastric tube after med administration?

30 mL

What do you need to check before administering pills via gastric tube?

Check that the pill can be crushed

What is the appropriate client position for medication administration via gastric tube?

High fowler's

If a tube feed is running, what should the nurse consider before administering medications?

Consider whether the meds are all compatible with that tube feed

What should be done with the tube feed during med administration?

Place it on hold

How should the client be positioned following med administration?

Head of bed should be no lower than 30 degrees

Do you use the syringe to push meds/water into the gastric tube

No

When do you remove the plunger from the syringe?

It's the first thing you do

Which medication can be used for enuresis in children >6?

...

�What teaching should the nurse provide when children are prescribed antidepressant medications?

�Response of children to antidepressant medications is highly variable
�Long-term effects unknown
�Increase in suicidal ideation/behavior in children treated with antidepressant medications
�MAOIs inappropriate for children
�Close monitoring
�Prescribe lo

How long might it take for a client to start feeling better after initiating antidepressant therapy?

2-4 weeks

For what kind of clients should phenelzine be prescribed?

�Clients who cannot tolerate safer antidepressant medications
�Clients whose depression does not respond to safer alternatives

What is the most important assessment for clients taking phenelzine

...

What are some contraindications for diazepam

�Psychosis
�Shock
�Coma
�Acute narrow-angle glaucoma
�Acute alcohol intoxication
�Pregnancy/lactation
�Use cautiously and adjust dose for elderly/debilitated patients

What are some symptoms of withdrawal syndrome

�Nausea
�Headache
�Vertigo
�Malaise
�Irritability
�Nightmares

What are some indications for duloxetine?

Major depressive disorder
�Diabetic peripheral neuropathic pain
�Generalized anxiety disorder
�Fibromyalgia
�Chronic musculoskeletal pain

What are indications for gabapentin?

Adjunct therapy for partial seizures, restless leg syndrome, ALS, post herpatic neuralgia

What herbal supplements are contraindicated with antiseizure medications/clients with epilepsy?

Ginkgo

What is the appropriate course of action for a woman with epilepsy who becomes pregnant?

Do not stop taking the medication

�What is the most important teaching to provide for a woman of child bearing age who is taking phenytoin?

Do not breastfeed
Do not stop the medication

What is the therapeutic range for serum levels of phenytoin

Therapeutic serum level 10-20 mcg/ml

�What is the proper dosage/administration rate of phenobarbital for a pediatric client in status epilepticus

15-20 mg/kg IV over 10-15 minutes

�What are some adverse effects of phenobarbital

�Sedation
�Hypnosis
�Coma
�Higher doses create these effects

WHAT ARE SOME CLIENT/FAMILY TEACHING FOR ANTISEIZURE MEDICATIONS

�Avoid evening primrose/gingko biloba
�Take medications with food
�Regular CBC checks
�Do not abruptly discontinue medication
�Barrier contraception/pregnancy concerns
�Medical alert ID

What are some indications for diazepam as an antiseizure medication

Increases effects of GABA, which stabilizes nerve cell membranes
�Works mainly in limbic system and RAS
�Decreases nerve pathway conduction
�Relaxes muscles
�Relieves anxiety
�Limited effect on cortical function

What is phenytoin used for?

seizures- it's the first line medication for patients who cannot tolerate drowsiness/ sedation

What illnesses respond best with combination therapy?

Tuberculosis, HIV and malaria.

What is prophylaxis?

use of a drug to prevent imminent infection of a person at risk

Why can antibiotics cause super infections?

Destruction of normal flora, pathogens usually destroyed by normal flora invade tissues,

What are some examples of super infections

Yeast infections and C diff

What do carbapenems do?

inhibit cell wall synthesis