Pharmacology nursing PDF

Preview

Summary

bullet points ...

Description

1.

Discuss the overuse of antibiotics. Superinfection: infections that take place because the antibacterial agent (antibiotics) are killing off normal flora as well as the bacteria. Example: A patient is on antibiotics and developes a yeast infection. Pseudomembranous colitis: norma flora is disrupted in the GI tract, patient develops colitis type symptoms.

Antibiotic therapy is considered toxic when the serum levels of the antibiotic are too high or when the patient has an allergic or other major adverse reaction to the drug. Reactions include… Rash, itching, hives, fever, chills, joint pain, difficulty breathing, or wheezing.

2.

Provide patient teaching for a patient taking the following drugs/drug classes: a. Nystatin (Mycostatin) ● Abstain from sexual intercourse until the treatment is completed and the infection is resolved. ● Continue to take medication even if actively menstruating ● Advise patient to contact prescriber if symptoms persist once treatment is completed. ● Encourage patient to practice good hand washing techniques at all times. ● Instruct the patient on the proper dosing instructions ● For oral: the suspension needs to be shaken thoroughly before measuring out each dose. ● Make sure medication is taken as directed. Ex: for oral suspensions often the dosing instructions are to place half in each cheek and then swallow and not to mix with food. ● Avoid commercial mouthwashes during therapy ● If vaginal: use the appropriate applicator with a gloved hand, insert high into the vagina and thoroughly wash hands. b. Acetaminophen (Tylenol) ● Do not combine with opioid prescribed medications such as hydrocodone (vicodin, norco) or oxycodone (percocet, tylox) because of danger of overdosage with the acetaminophen (recommended limit = 4000 mg). ● Adverse effects: skin disorders, nausea, vomiting; blood disorders, nephrotoxicity, hepatotoxicity (associated with overdosage) c. Acyclovir (Zovirax).. ● Alert the patient to the adverse effect of dizziness, and instruct him/her to use caution when driving or participating in activities requiring alertness ● Advise immunocompromised patients to avoid crows and persons with infections.

Condom use to prevent viral infections and STIs Encourage forcing (encouraging) fluids, up to 300mL/ 24 hours Education patient that this drug suppresses but does not cure the viral infection Emphasize the importance of follow-up appointments. Female patients with genital herpes are recommended to undergo Pap smear test d. Immunosuppressants ● Educate transplant patients on the need for lifelong immunosuppressant therapy with often complex therapeutic regimens. ● Emphasize the importance of avoiding situations that pose an increased risk for exposure to infections, such as crows, malls or movie theaters. ● Stress the importance of reporting any fever, sore throat, chills, joint pain, or fatigue to the prescriber. ● Female patients of childbearing age need to use some form of contraceptive during treatment and up to 12 weeks after therapy ends. ● Take the drug at the same time each day ● Follow up appointments are important. ● AVOID CROWDED PLACES ● WITH ALL DRUGS: TAKE IT AT THE SAME TIME OF DAY FOR THERAPUTIC LEVEL. ● Birth control, if you don’t take it at the right time then it might not work e. Vaginal antifungal drugs ● Abstain from sexual intercourse until the treatment is completed and the infection is resolved. ○ No tampons ● Wash hands before and after ● Continue to taken medication even if actively menstruating ● Advise patient to contact prescriber if symptoms persist once treatment is completed. ● Encourage patient to practice good hand washing techniques at all times. ● Instruct the patient on the proper dosing instructions ● Use the appropriate applicator with a gloved hand, insert high into the vagina and thoroughly wash hands. Identify adverse effects of the following drugs/drug classes: a. Azathioprine (Imuran) (used for the prophylaxis of organ rejection) ● Bone marrow suppression ● Development of lymphoma and other malignancies ● Hepatosplenic T-cell lymphoma, a rare white blood cell cancer that is fatal. ● Leukopenia ● Thrombocytopenia ● ● ● ● ●

3.

● Hepatotoxicity

b.

Aminoglycosides ● Nephrotoxicity (toxicity of the kindey’s) - 5%-25% of patients ● Ototoxicity (Toxicity of the ears) - 3-14% of patients - results in varying de-

grees of permanent hearing loss, depending on the dosage and duration. Can affect hearing and balance. ○ Symptoms include dizziness, tinnitus, a sense of fullness in the ears and hearing loss ○ ON EXAM ● Risk for these toxicities is greatest in patients with pre-existing renal impairment, patients already receiving other renally toxic drugs, and patients receiving highdose or prolonged aminoglycoside therapy. c. Penicillins ○ Uriticaria, pruritus, and angioedema. ○ A wide variety of idiosyncratic drug reactions can occur, such as maculopapular

eruptions, eosinophilia, stevens-Johnson syndrome, and exfoliative dermatitis. ○ Maculopapular rash. ○ Anaphylactic reactions are much less common. ○ Many are allergic to penicillin.

d.

Zidovudine (Retrovir) - Thymidine analogue - Bone marrow Suppression, nausea, headache. - Most efficient for HIV - *Safe for pregnant women & newborns e. Quinolones - Central Nervous System - Headache, dizziness, insomnia, depression, restlessness, convulsions, neuropathy - Gastrointestinal System - Nausea, constipation, increased AST and ALT levels, flatulence, heartburn, vomiting, diarrhea, oral candidiasis, dysphagia - Integumentary System - Rashes, Pruritus, urticaria, flushing - Other - Ruptured tendons and tendonitis, fever, chills, blurred vision, tinnitus. f. Muromonab-CD3 (Orthoclone OKT3) - Cardiovascular system - Chest pain - Central Nervous System - Pyrexia (fever), chills, tremors - Gastrointestinal system - Vomiting, nausea, diarrhea - Respiratory System - Dyspnea, wheezing, pulmonary edema - Other - Flu-like symptoms, fluid retention. - Can cause cytokine release syndrome

g.

4.

Clindamycin (Cleocin) - GI tract - (most common) include nausea, vomiting, abdominal pain, diarrhea, pseudomembranous colitis, and anorexia - Neuromuscular blocking properties that may enhance the actions of neuromuscular drugs. - Can be used for the treatment of acne Discuss MOA, indications, and contraindications for the following drugs/drug classes: a. Acyclovir (Zovirax) -

Mechanism of action - Blocks activity of a polymerase enzyme that normally stimulates the synthesis of new viral genomes. Indications - Herpes simplex types 1 and 2, herpes zoster, chickenpox. Contraindications - severe drug allergy It is not going to cure it , but increase time between infections

b. Antigout drugs pg. 699 MOA: the relief of gout is the inhibition of the enzyme xanthine oxidase, which prevents uric acid production. Indication: allopurinol is for patients whose gout is caused by the excess production of uric acid Contradiction: allopurinol is contraindicated in patients with a known hypersensitivity to it. Significant adverse effects of the drug include agranulocytosis, aplastic anemia and serious and potentially fatal skin conditions such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis. c. Nitrofurantoin (Macrodantin) - Mechanism of Action - Interferes with the activity of enzymes that regulate bacterial carbohydrate metabolism and also by disrupting bacterial cell wall formation - Indications - Primarily UTIs caused by gram-negative organisms and staphylococcus aureus - Contraindications - allergy and significant renal function impairment because the drug concentrates in the urine. d. Metronidazole (Flagyl) - Mechanism of Action - interferes with microbial DNA synthesis. - Indications - Primarily anaerobic and gram-negative infections of abdominal cavity, skin bone, and respiratory and GU tracts. - Contraindications - Allergy, DO NOT TAKE WITH ALCOHOL (24 hours before medication and 36 hours after last dose. e. Vancomycin - Mechanism of Action - destroys bacteria by binding to the bacterial cell wall, producing immediate inhibition of cell wall synthesis and death.

Indications - Severe staphylococcal infections; including MRSA infections; other serious gram-positive infections, including streptococcal infections. - Contraindications - in patients with a known hypersensitivity to it. Should be used with caution in those with preexisting renal dysfunction or hearing loss, as well as in older adult patients and neonates - Adverse effects: nephrotoxicity, ototoxicity, and rem man syndrome (flushing and/or itching of upper half of the body, occurs typically when drug is given too rapidly, alleviated by slowing the rate of the drug) f. Ribavirin (Virazole) - Mechanism of action - Blocks activity of polymerase enzyme that normally stimulates the synthesis of new viral genomes. Interferes with RNA & DNA - Indications - Respiratory syncytial virus infection. - Contraindications - Severe drug allergy, tetratogenic potential in pregnant women and their male sexual partner (teratogenic potential. g. Ganciclovir (Cytovene) - Mechanism of Action - block activity of a polymerase enzyme that normally stimulate the synthesis of new viral genomes. - Indications - CMV (cytomegalovirus) retinitis treatment or maintenance. - Contraindications - Severe drug allergy. - Adverse effect: Bone marrow suppression h. Fluconazole (Diflucan) - Mechanism of action - Act as either fungistatic or fungicidal drugs. When the production of ergosterol is inhibited, it results in a defect such as leaky cell membrane that allows needed electrolytes to escape. The fungal cells die because they cannot carry on cellular metabolism. Inhibits cytochrome P-450 - Indications indicated for the treatment of esophageal, oropharyngeal, peritoneal, urinary tract, vaginal, and systemic candida infections and cryptococcal meningitis. - Contraindications - Drug allergy, liver failure, kidney failure, and porphyria. -

i.

NSAIDs (Nonsteroidal antiinflammatory drugs) - Mechanism of action - Work through inhibition of the leukotriene pathway, the prostaglandin pathway, or both. Relieve pain, headache, and inflammation by blocking the chemical activity of the enzyme called cyclooxygenase (COX). - Indications - ankylosing spondylitis, diabetic neuropathy, dysmenorrhea, gout, headahces, hepatotoxicity, history of aspirin or NSAID allergy, hypertension, osteoarthritis, risk for gastrointestinal toxicity, risk for nephrotoxicity, and warfarin therapy. - Contraindications - drug allergy and conditions that place the patient at risk for bleeding, including vitamin K deficiency and peptic ulcer disease. NOT recommended for nursing mothers.

GI PROBLEMS AND ULCERS! TAKE WITH FOOD OR WITH MILK, CREATES A PROTECTIVE LAYER. - Allopurinol, Aspirin, Celecoxib, Colchicine, Ibuprofen, Indomethacin, Ketorolac, Probenecid j. Tacrolimus (Prograf) - Mechanism of Action - Inhibits T-cell activation, possibly by binding to an intracellular protein known as FKBP-12 - Indications - Prevention of organ rejection in liver, kidney and heart transplantation. Unlabeled uses include prevention of rejection in bone marrow, pancreas, pancreatic islet cell, and small intestine transplantation; treatment of autoimmune diseases; and severe psoriasis. - Contraindications - drug allergy. May include renal or hepatic failure, hypertension, and concurrent radiation therapy. 5. Discuss salicylate toxicity. ● Usually from aspirin ● Chronic (salicylism) and acute ○ Chronic: results from either short-term administration of high doses or prolonged therapy with high or even lower dosages ● Most common manifestations of chronic: tinnitus and hearing loss ● Kids - Have hyperventilation & CNS effects ● Toxicity and what that looks like!! -

6. Discuss concerns with patients who are allergic to penicillin. What alternatives are there if they are allergic to penicillin and need an antibiotic? ● Understand the type of reaction that may occur in someone who is known to be allergic ● Due to trade names, drugs will not always end in “cillin” ● Increased risk for allergy to other beta-lactam antibiotics ● Penicillins are beta lactam drugs; cephalosporins can be given as an alternative to penicillins EXCEPT if → Patients with history with throat swelling and hives should not receive cephalosporins ● Symptoms of penicillin allergy - Skin rashes, hives, itching, watery eyes, runny nose, swelling of face and lips, fever; may have anaphylactic reaction 7. Discuss drug-drug and/or food-drug interactions of the following drugs/drug classes: a. Tetracyclines ● Oral absorption is reduced when taken with: antacids, antidiarrheal drugs, dairy products, calcium, enteral feedings or iron preparations. ] ● Can potent the effects of oral anticoagulants ● Antagonize the effects of bactericidal antibiotics and oral contraceptives b. Fluconazole (Diflucan) ● Amphotericin B

● Azole Antifungals

c.

Allopurinol (Zyloprim) ● Azathioprine ● Mercaptopurine

8.

Compare and contrast fluconazole (Diflucan) and amphotericin B. BOTH ANTIFUNGALS Fluconazole (Diflucan) ● Often prefered over Amphotericin B because it has less adverse effects ● Excellent bioavailability ● Oral and injectable forms Amphotericin B ● Drug of choice for the treatment of severe systemic mycoses ● Many adverse effects: fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia and vomiting, and headache. 9. Discuss the therapeutic effectiveness of antibiotic therapy. ● Begins with a clinical assessment to determine whether the common signs and symptom of infection are there ● Decrease in the specific signs and symptoms of infection compared with the baseline findings. ● Assessed during AND after antibiotic therapy to... 1. Evaluate the effectiveness of the drug therapy 2. Monitor for adverse effects 3. Make sure the infection is not recurring 10. Discuss the nursing process and nursing interventions for a patient taking the following drugs/drug classes: pg. 644 a. Muromonab-CD3 (Orthoclone OKT3) ● Complete a thorough documentation of baseline vital signs and other presenting complaints because of the possible occurrence of cytokine release syndrome. ● Requires assessment for cardiovascular disorders as well as a history of GI and

respiratory disorders ● Usually infused over one minute. When dose is prepared, withdraw the medication from the ampule through and low protein-binding 0.22-micron filter, detach the filter, and apply a new sterile needle after withdrawing the medication. b. Vancomycin pg. 633 ● Ask questions about other medications the patient is taking, especially drugs that are nephrotoxic or ototoxic ● Assess for history of preexisting renal disease or hearing loss due to the possibility of nephrotoxicity or ototoxicity ● Note the baseline hearing status

Labs will be ordered before the next dose to check levels of vancomycin Note color of patient's skin because of the risk for red man syndrome Orally: poorly absorbed, only used to treat microbes in the GI tract. Parenteral: used to treat infections outside of the intima of the GI tract. Reconstitute IV dosages as recommended and infuse over at least 60 min ○ Too rapid=severe hypotension and red man syndrome ○ extravasation=cause local skin irritation and damage, so frequently monitor infusion, particular IV site. Peek: 18-50 mcg/ml Trough: 10-20 mcg/ml c. Amphotericin B ● Identify any contraindications, cautions and drug interactions. ● Baseline renal function ● Avoid any concurrent administration of nephrotoxic drugs ● Assessment and documentation of amy issues with cardiovascular and GI system ● Do not administer solutions that are cloudy or have precipitates ● Monitor vital signs every 15 minutes to assess for adverse reactions. ● Document weight frequently d. Azathioprine (Imuran) ● Assess signs and symptoms of infection ● Assess white blood cells and platelet counts ● Assess especially for signs and symptoms of bone marrow suppression (infection, anemia, and bleeding) e. Basiliximab (Simulect) ● Complete a thorough documentation of baseline vital signs and other presenting complaints because of the possible occurrence of cytokine release syndrome. ● Administered parenterally ● Follow manufacturer guidelines regarding the type and amount of dilutional solution. ● Closely monitor the IV drip and use an IV infusion pump to help ensure that the proper dose is administered. ● ● ● ● ●

11. Discuss the rationale for administering two antibiotics at the same time. ● The second antibiotic may delay the bacteria resistant to the first antibiotic ● Hoping to cover as many bacteria as possible before culture is back ● May be synergistic with one another (one antibiotic may enhance the effectiveness of the other) 12. Discuss the proper methods of collecting a culture and administering antibiotics.  It is ESSENTIAL to obtain cultures from appropriate sites BEFORE beginning antibiotic therapy

●

Empiric therapy: treatment of an infection before specific culture information has been reported or obtained

● Definitive therapy: antibiotic therapy tailored to treat organism identified with cultures

13. Discuss the overall effects of antivirals within the body. ● Antiviral drugs can kill or suppress viruses by either destroying virions or inhibiting their ability to replicate. ● The body's immune system has a better chance of controlling or eliminating a viral infection when the ability of the virus controlling or eliminating a viral infection when the ability of the virus to replicate is suppressed. ● Antiviral drugs are all synthetic compounds that work indirectly by inhibiting viral replication as opposed to directly by destroying mature virions themselves. ● Viruses replicate only inside host cells, and antiviral drugs must therefore enter these cells to disrupt viral replication. ● For viruses to replicate, virions must first attach themselves to host cell membranes in a process known as fusion. Once inside the cell, the viral genome makes nucleic acids and proteins, which are used to build new viral particles, or virions. ● Most antiviral drugs enter the same cells that the viruses enter. Once inside, antiviral drugs interfere with viral nucleic acid synthesis. Other antiviral drugs work by preventing the fusion process itself. 14. Math: Alyssa’s pictures below :) a. Mg/kg b. Mg/ml c. Mg/kg/day KHD(B)DCMNM m L g

SCI Notes: *Encourage patient to take full dose of antibiotics. Teach patient to not stop once they “feel better” -Illness may return quickly and in a more virulent form

KNOW WHAT CD4 CELLS ARE – WHAT THE COUNT SHOULD BE (?)...