Pharm exam 3 study guide PDF

Preview

Summary

exam 3 completed study guide...

Description

NURS 322 Pharmacology Across the Lifespan Exam 3 Blueprint Fall 2020 Topic

Approximate # questions

Renal 3 Pyelonephritis,cystitis,urinary incontinence ● Pyelonephritis ○ Upper urinary tract infection ○ Commonly seen in female patients ○ Most common organism involved, E. Coli ○ Symptoms ■ Chills, high fever, flank pain ■ Painful urination, frequency, urgency, pyuria ■ Bacterial count is > than 100,000 bacteria/mL ○ Severe cases might be hospitalized to receive IV antibiotics ● Acute Cystitis ○ Lower urinary tract infection ○ Frequently in females due to the short urethra ○ E. coli, Staphylococcus saprophyticus , Klebsiella, Proteus, Pseudomonas ○ Symptoms ■ Pain and burning on urination ■ Frequency ■ Urgency ○ In men usually due to prostatitis- similar symptoms ○ Need a urine culture prior to treating with antibiotics ● Urinary incontinence - know the meds used for it ○ Antimuscarinics/Anticholinergics ■ Control an overactive bladder ■ Decrease urge and urinary incontinence ○ Urinary Stimulants ■ Increase bladder tone of detrusor urinary muscle ■ Produces a contraction to stimulate urination ○ Urinary Antispasmodics ■ Direct action on smooth muscles to relieve spasms phenazopyridine MOA, SE, Teaching ● Phenazopyridine-Pyridium ○ Action ■ Relieve pain, burning sensation, frequency, urgency ■ Urinary analgesics ○ Side effects/adverse reactions ■ GI distress ■ Red-orange urine (dye) ■ Hemolytic anemia ■ Nephrotoxicity, hepatotoxicity ○ Teaching ■ Monitor glucose

Endocrine: Pituitary-Thyroid-Adrenal Disorders 8 Hypothyroid S/S and treatments ● Signs and symptoms ○ Decreased T4 and elevated TSH levels indicate hypothyroidism / acute or chronic inflammation of the thyroid gland ○ Hair loss, apathy, lethargy, dry coarse and scaly skin, muscle aches, constipation, intolerance to cold, receding hairline, face and eye edema, fatigue, slow speech, anorexia, brittle nails and hair ○ Late signs → bradycardia, weight gain, dec LOC, thickened skin, cardiac complications ● Treatments ○ Levothyroxine → synthetic T4 converted to T3 Hyperthyroid S/S, treatment including for pregnant patients, and contraindications ● Signs and symptoms ○ Increased T3 and T4 levels, decreased TSH levels ○ Intolerance to heat, finger clubbing, tremors, diarrhea, amenorrhea, muscle wasting, weight loss, enlarged thyroid, tachycardia, increased systolic BP, building eyes, facial flushing ● Treatment ○ Methimazole → inhibit thyroid hormone synthesis by blocking thyroid action ■ AVOID in first trimester of pregnancy ■ Report sore throat and fever immediately / reduces granulocytes (WBC) ■ Agranulocytosis most serious and dangerous toxicity ○ Propylthiouracil → MOA: inhibits thyroid production and prevents conversion of T4 to T3 in the periphery ■ Safer in pregnancy and in breast milk - does not cross placenta as easily as methimazole / preferred during 1st trimester pregnancy ■ Risk for liver injury / multiple doses a day / can cause agranulocytosis ○ Radioactive iodine → low doses to treat hyperthyroidism ■ Don't use in pregnancy/lactation or in pediatric patients ○ Non Radioactive iodine → thyrotoxic crisis / inhibits thyroid hormone secretion short term ○ Beta blocker → suppressed tachycardia and other symptoms of graves disease / also used in thyrotoxic crisis ■ No use with asthma patients Important administration guidelines with glucocorticoid medications ● Cortisol ● Regulate metabolism, Increase blood glucose. Regulate body’s stress response ● Side effects → increased appetite, tachycardia, hyperglycemia, edema, sodium and water retention ● caution→ tamper off gradually upon discontinuation / diabetes, acute peptic ulcers ● Contraindications → infection, laceration ● Drug interactions→ increased risk of GI bleeding and ulceration, increase potency taken concurrently, potassium wasting diuretics with these drugs increase potassium loss Diurnal patterns and what they mean ● The anterior pituitary hormones are released in a rhythmic manner into the bloodstream. ● Secretion varies with time of day (diurnal rhythm) or with physiological conditions such as exercise or sleep -increases over the day ● Affected by activity in the CNS, by hypothalamic hormones, by hormones of the peripheral endocrine glands, by certain diseases that can alter endocrine function, and by a variety of drugs, which can directly or indirectly upset the homeostasis in the body.

Growth hormone-assessment and recommended use ● Stimulated growth in body tissues and bone ● GH releasing hormone - somatropin ○ Assessments → allergies, presence of closed epiphyses, underlying cranial lesions ○ Recommendations ■ Should be administered to child before the epiphyses are fused ■ Long term therapy can antagonize insulin secretion eventually causing diabetes ■ Athletes should not take HGH to build muscle because of its serious side effect as well as its effect on insulin ■ Corticosteroids can inhibit the effects of Somatropin so they should not be taken concurrently ■ Somatropin can also enhance the effects of antidiabetics and cause hypoglycemia ● GH inhibiting hormone (GH-IH) Somatostatin ○ Somatostatin helps regulate GH release, is produced in the hypothalamus and acts on the pituitary to inhibit GH release ● Pegvisomant,Lanreotide, Octreodtide, and Bromocriptine ○ Drugs for growth hormone excess- Gigantism and Acromegaly ■ Gigantism-Childhood ■ Acromegaly-adulthood usually due to a pituitary tumor ● Pegvisomant - blocks receptor sites, preventing abnormal growth by normalizing insulin-like growth factor 1 (IGF-1) ● Lanreotide - similar to somatostatin (GH inhibiting hormone) ● Octreotide – synthetic somatostatin (GH inhibiting hormone) ● Bromocriptine – dopamine agonist, inhibits the secretion of GH

Diabetes Mellitus 10 Hypo and DKA s/s and treatment ● Hypoglycemia (blood glucose under 70 mg/dL ○ Signs and symptoms ■ Fall fast → tachycardia, palpitations, sweating nervousness ■ Fall slow → confusion, drowsiness, fatigue ■ Risk irreversible brain damage / Severe hypoglycemia → coma, convulsions, death ○ Treatment ■ Conscious → fast acting oral sugars / glucose tablet, OJ, sugar cubes, non-diet soda ■ Unconscious → IV glucose immediately / parental glycogen ● Diabetic ketoacidosis ○ Insulin deficiency ○ Signs and symptoms → Blood sugar >250, polyuria, extreme thirst, fruity breath odor, Kussmaul breathing (deep rapid, labored breathing, distressed), dry mucous membranes, poor skin turgor ○ Treatment ■ correct hyperglycemia and acidosis ■ Insulin replacement ■ IVF’s → 0.9% NSS then hypotonic solution 0.45% NACL ■ Potassium replacement → monitor K+ & replace as needed / IV replacement

■ Bicarbonate → for acidosis correctment Know the names of rapid/long acting Insulins and when to administer ● Rapid acting : HOW QUICKLY THEY ACT-- NO NAMES ○ Lispro (humalog) → hits in 15-30 min / 15 min before or just after meals ○ Aspart (novolog) → hits in 10-20 min / 5-10 minutes before meals ○ Glulisine (apirda) → hits in 15-30 min / SQ within 15 min before or within 20 min after meals ○ Hits as early as 10 minutes, lasts for 3-6 hrs ● Long acting: ○ Glargine (lantus) → hits in 70 min and lasts for 24 hrs / once daily at the same time each day ○ Detemir (levemir) → hits in 60 -120 min and varies / twice daily or once daily Mixing of insulin- what do you need to know-how and why they are ordered ● Only compatible insulin ○ NPH and regular ○ NPH and lispro ○ NPH and aspart ○ NPH and glulisine ● Draw up the short acting insulin first - this prevents contaminating the stock vial of the short acting insulin with NPH insulin (Neutral Protamine Hagedorn) which delayed absorption Hgb AIC ● Target level novolin, humulin ● IV pump ○ Frequent measurement of BS (hourly) Difference between Type 1 & 2 DM ● Type 1 → destruction of pancreatic beta cells / total lack of insulin / less common ○ Risk for ketoacidosis ● Type 2 → decreased insulin release from defective beta cells in pancreas / peripheral insulin resistance / more common ○ Impaired insulin secretion, hyperglycemia leads to reduced beta cell function over time ○ Low risk for ketoacidosis Glucophage SE ● Drug for type 2 diabetes ● Side effects → decreased appetite, nausea, diarrhea, decreased B12 levels and folic acid deficiency External insulin pump teaching points ● Frequent measurement if BS hourly Antibiotic

19

Bacteriostatic versus Bactericidal ● Bacteriostatic ○ Slows bacterial growth / does not cause cell death ○ Elimination of bacteria by host defenses ● Bactericidal ○ Directly lethal to bacteria ● Can go from bacteriostatic at low doses to bactericidal at higher doses Acquired Antibiotic resistance and prevention ● Resistance → Caused by previous exposure to antibacterial drug / bacteria continues to grow despite administration of the antibacterial drug ● Prevention → vaccinate, get catheter out, diagnose and treat infection effectively, antimicrobials, prevent transmission, finish all medication Narrow versus Broad spectrum ● Narrow spectrum → active only on a few microorganisms / generally preferred ● broad spectrum → active against a wide variety of microbes / leads to more resistance Vancomycin SE ● Anaphylaxis, superinfection ○ Redneck or red man syndrome ■ Occurs when IV too rapid ■ Severe hypotension ■ Red blotching of face, neck, chest, and extremities ○ GI distress and peripheral edema ○ Clostridium difficile-associated diarrhea ○ Stevens-Johnson syndrome ○ Ototoxicity and nephrotoxicity ○ Monitor peak & trough, renal function, monitor infusion times Penicillin G Mode of Action ● Causes bacteria cells to take in excessive amounts of water and rupture / lethal to bacteria undergoing active growth and division / The bacteria die of cell lysis (cell breakdown) Amoxicillin SE ● N/V/D, abdominal pain, rash, stomatitis, tongue and tooth discoloration, headache, dizziness, anxiety, confusion ● Adverse reaction → superinfection (vaginitis) ● Life threatening → Anaphylaxis, angioedema, hemolytic anemia, eosinophilia, leukopenia, thrombocytopenia, hepatic damage, seizures, and Stevens-Johnson Syndrome Peak and trough ● Peak is the highest concentration / 1 hr after completion of dose ● Through is the lowest concentration / 30 min prior to dose Superinfections ● resulting from a difficult-to-treat overgrowth of opportunistic organisms (e.g., fungi or resistant bacteria) ● usually occur with broad-spectrum antimicrobials, prolonged use, or combinations of agents that alter the normal microbial flora of the upper respiratory, intestinal, and genitourinary tracts. ○ Vaginitis or oral candida or c.diff ○ Like when u take antibiotics and get a yeast infection Sulfonamide – most common SE, and patient education ● Signs and symptoms ○ Skin rash and itching, crystalluria, photosensitivity, N/V/D ● Patient education

○

Avoided during pregnancy to avoid congenital malformation neural tube defects and kernicterus (brain damage from excessive jaundice) ○ Increase fluid intake, report reactions and educate about how to work with photosensitivity (wear sunscreen, sunglasses) ○ Primary use: UTI Fluoroquinolone use, SE and patient education ● Used → Urinary tract, bone, joint infections, bronchitis, pneumonia, gastroenteritis and gonorrhea ● Side effects ○ Gastrointestinal: N,V, D, abdominal pain, stomatitis ○ CNS: dizziness, H/A, confusion, blurred vision, retinal detachment ○ Candida of pharynx and vagina ○ Cardiac: palpitations, hypotension ○ Endocrine: hypoglycemia, hyperglycemia ○ Tendon rupture ■ Nursing: DC first sign of tendon pain or inflammation. ■ Patients should not exercise until tendinitis has been ruled out. ○ Phototoxicity (severe sunburn) ○ Permanent peripheral neuropathy (FDA warning) ○ Contraindicated in patients with Renal Disease ● Patient education ○ Obtain a specimen from the infected site for C&S. ○ Black box- increase risk for tendonitis and tendon rupture ○ Monitor vital signs and intake and output. ○ Check lab values for renal function. ○ Check for signs and symptoms of superinfection. ○ Encourage patients to report side effects. ○ Advise patients to wear sunglasses, sun block, and protective clothing when in the sun. Metronidazole patient education ● For C-diff and bacteroides fragilis ● Given IV sometimes oral therapy ● Disulfiram like reaction for alcohol-vomiting ● Avoid alcohol ● Metallic taste, dark red brown urine ● Report growth and adverse reactions Patient education regarding antibiotic use ● Surgery ● Maintain up to date immunization, complete full course of antibiotics, used infection control procedures, follow up, make sure treat infections and not viruses, Penicillin- high incidence of allergic reaction ● Bacterial Endocarditis—New guidelines ● Neutropenia ● Recurrent Urinary Tract Infections (UTI’s) ● Exposure to sexually transmitted diseases ● Exposure to bacterial meningitis ● Misuses ○ Viral illness ○ Fever of unknown origin ○ Improper dosage ○ Absence of bacteriologic data

○ Omission of surgical drainage ○ Not completing ENTIRE dose duration of treatment Tetracycline use and side effects/nursing interventions/teaching ● Used ○ Effective against gram-positive and gram-negative bacteria, such as Helicobacter pylori, MRSA, rickettsial diseases (Lyme's disease), H. Pylori, Mycoplasma pneumoniae pneumonia / Treats acne- topically and orally, anthrax, plague, gingivitis, cholera, STIs, skin, and urinary and respiratory infections ● Side effects ○ Ototoxicity, hepatotoxicity, nephrotoxicity ● Nursing interventions/teaching ○ Don't use in pregnancy/breast feeding/ children under 8 ○ Can cause renal impairment ○ Good alternative if patient had PCN allergy ○ Better absorbed on an empty stomach ○ Tell them to wear sunscreen ○ GI disturbances (bactrum) TMP-SMX common uses and MOA ● Used ○ Otitis media, gastroenteritis, MRSA, and respiratory and urinary tract infections ● Mode of action ○ Inhibits folic acid synthesis and protein synthesis of nucleic acids (bactericidal) ○ Bacteria cells are more sensitive so low doses used to treat bacteria ○ No effect on the host Nursing responsibilities related to antibiotic use ● Obtain all cultures prior to initiating antibiotic therapy ● Patient history (Allergies!) ● ***Cultures prior to initialization therapy*** ● Toxicity: check labs, culture and sensitivity, peak & trough ● Patient monitoring directly r/t severity of infection ● IV assessment & administration ● Drug – drug interactions ● Patient education ● Combination therapy may be needed Doxycycline patient education ● PE GOES UNDER TETRACYCLINE ● Mode of action → Inhibits the steps of protein synthesis, bacteriostatic and bactericidal ● Side effects → abdominal pain, swollen tongue (glossitis), dry mouth, vision changes ● Adverse reactions → superinfection, angioedema, HTN, renal dysfunction ● Life threatening→ Anaphylaxis, anemia, eosinophilia, thrombocytopenia, hepatotoxicity, Increased ICP Aminoglycoside SE/patient education ● Side effects ○ Ototoxicity, nephrotoxicity, neurotoxicity / Clostridium difficile–associated diarrhea/ Stevens-Johnson syndrome ● Patient education ○ Primarily administered IM or IV, however, neomycin can be given orally to decrease bacteria in the bowel

○ ○

○

Cannot be absorbed from the GI tract, nor can they cross into the CSF, they cross the BBB in children but not adults Used in combination with PCNs ■ PCN disrupts the cell wall allowing the aminoglycoside to better access the site of action ■ Do not run through same IV solution Use cautiously → ■ Impaired renal function ■ Taking another nephrotoxic medication ■ Taking another ototoxic medication

Antituberculars, Antifungal, Antiviral 9 TB treatment-INH, and prevention of SE ● Treatment → Antimycobacterial agents are used to treat Tuberculosis (Antituberculosis Drugs) ○ 6 medications: Isoniazid (INH), Rifampin (RIF)-- turns the body fluids orange, Pyrazinamide, Ethambutol, Rifabutin, ● Treatment- INH ○ latent infection (INH used alone) - only time we use ONE drug ■ 6/9 months of daily dosing ■ Preferred method for latent treatment ○ Active TB ■ IHN combined with other agents (rifampin) - combination therapy ■ 1st line Tx and combo of the 6 drugs - shortens time with given second drug ● Side effects → cough, fever, night sweats, GI distress and weight loss ○ Prophylaxis recommended for those with: ■ Administer vitamin B6 to avoid peripheral neuropathy Treatment regimen- multidrug ● Combination therapy recommended with two or more agents. ○ Single-drug therapy -ineffective ○ Multidrug therapy ■ Decreases bacterial resistance to drug ■ Treatment duration decreased Topical antifungal indications ● When Candida albicans affects the mouth, it is called oral candidiasis or thrush ● Vaginal Candida albicans is common in pregnant women, diabetic and immunocompromised patients or patients taking certain medications (antibiotics, oral contraceptives) ● Systemic fungal infections may involve the lungs, CNS, or abdomen and are usually transmitted to an individual through inhalation into the lungs ● May be mild (tinea pedis –athlete's foot) or severe (fungal disease of the lungs or meningitis) Oral antifungal MOA ● Polynes binds to steroids causing loss of intracellular potassium ● Azores inhibit P450 drug metabolizing enzyme and lower toxicity Amphotericin B precautions (fungal infections) ● HIGH toxicity ● GIVE FLUIDS - .9 NSS ● Reserved for potentially fatal infections ● ALL patients will experience infusion reaction and renal damage to varying degrees. ○ Dose > 4 grams = residual renal impairment!!

○ High incidence of phlebitis - monitor IV Adverse Effects: ○ Hypomagnesemia ○ Hypokalemia ○ Nephrotoxic ○ Hematological Effects-toxic to the bone marrow ■ Results in anemia / monitor H & H (CBC) Oral candidiasis treatment and patient education ● Nystatin ● Most commonly used is the oral suspension which is swished in the mouth and either spit out or swallowed Antiviral-influenza treatment and patient education ● Adamantanes and rimantadine → first generation drugs (PO) ○ Active against type A not B ○ Virus develops resistance quickly ● Neuraminidase inhibitors → second generation drugs (PO) ○ Oseltamivir and zanamivir ○ Active against type A and B ○ More effective, better tolerated / less risk of viral resistance ○ Taken within 48 hrs of flu symptoms Antiviral MOA ○ They inhibit viral replication by interfering with viral nucleic acid synthesis in the cell ○ ●

Malarial, Anthelmintic 2 Treatment of malaria ● prophylaxis, treatment of acute attack, and prevention of relapse ○ Prophylaxis = Chloroquine, preferred drug of choice ○ Treat acute attack = Chloroquine & Metholoquine or something ○ Prevent relapse = Primaquine ○ Active against erythrocytic form of malaria = quinine Chloroquine MOA ● Mode of actions → Inhibits parasitic growth by interfering with its protein synthesis Pathophysiology of malaria ● After the mosquito bites the human, the protozoan parasite passes through two phases: the tissue phase and the erythrocytic phase. ○ The tissue phase (invasion of body tissue) produces no clinical symptoms in the human ○ The erythrocytic phase (invasion of the red blood cells) causes symptoms of chills, fever, and sweating. ● Incubation period is 10-35 days, followed by flu like symptoms Ivermectin use ● Drug of choice for onchocerciasis (river blindness from parasite) and strongyloidiasis (roundworms) ● Single dose treatment with retreatment in 3-5 months HIV Viral load and patient teaching ● Viral load (HIV RNA) count

6

○

●

The HIV viral load is indicative of the level of virus circulating in the blood and is the best determinant of treatment efficacy ○ The key goal of therapy is to achieve and maintain a viral load below the limits of detection (...