Depress
ants
ants
Benzos': Endings? Examples? Uses? Antidote? No longer than __ weeks
"Pam/Lam": Alprazolam (Xanax), Lorazepam (Ativan), Temazepam (Restoril), Triazolam (Halcion)
- Uses: Insomnia, anxiety, seizures
- Antidote: Flumazemil
- Use no longer than 6 weeks
Inhaled anesthetics: Ending? Examples? Most potent? May cause __ __ which is a serious reaction!
Ending in "ANE"
- Halothane, Methoxyflurane, Enflurane, Isoflurane, Desflurane, Sevoflurane, and Nitrous Oxide (laughing gas)
Halothane – highly potent
- A severe reaction to inhaled anesthetic causing an extremely high body temperature, rigid muscles, tachycardia, and other symptoms- Fatal if not treated immediately
Glycopeptides: Example? Use? Pregnancy? Oral use saved for? What is the TR? Hard on ____
Vacomycin
- Reserved for use with serious infections
- Used to treat MRSA and C-Diff
- NO PREGNANCY!
• Oral use is limited to treat c-diff for those patients who cannot tolerate or respond poorly to metronidazole - All other uses are IV infusions.
• Trough range is 10-20 mcgs/ml
- Very hard on the veins
Preferred site is PICC or central line - Watch IV site!
Aminoglycosides: Endings? Examples? Use? Toxic to what (Gent level?)?
"MYCIN"
Gentamicin, Amikacin, Neomycin, Streptomycin, Tobramycin
- Use: Used for serious infections due to toxicity risk
• “Toxic to ears and kidneys – Need to monitor therapeutic serum levels. Gentamicin trough should be <1-2 mcgs/ml
** Super toxic: Aminoglycosides and Glycopeptides: Peak and trough/Monitor! **
Ceph: No ___ and including __ days after the med; Routes: Take with or without food? IV.. does it hurt? Deep IM... hurts so you need to use ___ first?
• No alcohol during and including 3 days after finishing the medication
• Deep IM – It hurts! Some are mixed with lidocaine before injection
• IV – Irritating to the veins – watch IV site closely
• PO – Take with food or milk if GI Upset occurs
Benzo's: SE's? Avoid what? Can you stop whenever? Can you use Valium (Diazepam) to treat insomnia?
- SE: Drowsiness, dizziness, confusion, ataxia, hypotension, skin rashes, lethargy, respiratory depression
- Avoid grapefruit (increases drug effects) and green tea (decreases effects)
- Avoid alcohol and any other sedating drugs
- No driving or operating machinery that requires alertness
- Do not stop abruptly! (Withdrawal tremors and muscle twitching)
- Diazepam (Valium) is long acting and avoided here in the treatment of insomnia)
Local anesthetics: what are the 2 different uses for local anaesthetics?
1- Blocks pain at the site where the drug is administered by preventing conduction of the nerve impulses
2- Can be used in a localized area (dental work, sutures, etc) or as a nerve block using a spinal needle
Glycopeptides: SE's? Don't take drugs that are also what? ____ ___ ___: is NOT an allergic reaction... what to do? Signs of TOX?
• Any drug given concurrently that is also toxic to the ears or kidneys will increase the risk of Vancomycin toxicity and risk further damage to the ears and kidneys
• SE: Thrombophlebitis, ototoxicity, renal toxicity, Red Man Syndrome
• Red Man Syndrome (and SEVERE hypotension) is not an allergic reaction – it is caused by too rapid infusion
What do we do? Slow the infusion rate and continuously monitor patients BP
• Signs of toxicity: Vertigo, tinnitus, increasing BUN >20, increasing Creatinine >1.3, UOP < 30 mls/hr
** Super toxic: Aminoglycosides and Glycopeptides: Peak and trough/Monitor! **
Aminoglycosides: SE's? Give this or penicillin first? What is normal side effects and should not be reported? How to know kidneys failing?
• SE: GI distress, fatigue, anemia, allergic reaction, superinfection
- Muscle aches and muscle cramps are normal side effects for this class (don’t report)
- If penicillin is prescribed concurrently, give penicillin FIRST, then aminoglycoside (PCN helps to penetrate the bacterial cell wall so that aminoglycoside can get access
• “Too high, kidney will die, Too low, infection will grow” : Call provider for increasing BUN >20, Increasing creatinine >1.3 and urine output 30 ml/hr or less
Cillins: Examples? Route: Food or no? IV increase what? Deep IM.. why? SE's? Pregnancy?
Ampicillin, amoxicillin, Pen G, Pen V, amoxicillin/clavulanic acid (Augmentin), piperacillin/tazobactam (Zosyn)
- SE: GI distress, anaphylaxis, superinfection, decrease effectiveness of oral contraceptives
- Safe for pregnancy, Lower doses may be required for elderly and pts with renal disease
• PO: Best given on an empty stomach
• IM: Painful! Pen G is milky white and thick, needs to be given deep IM
• IV: Large doses can increase bleeding risks
Non-Benzo's: Examples (2)? Uses? SE's? ST use or LT use? Less than ___ days
Zolpidem (Ambien) and Eszopiclone (Lunesta)
• Uses: Short-term treatment (<10 days) of insomnia
• SE: Daytime sleepiness, dizziness, abnormal thinking and behavior
Spinal anesthetics: Are they awake? Into what space? What are the 4 different nerve blocks?
- The patient remains fully awake
- Local anesthetic is injected into the subarachnoid space below L1 in adults and L3 in children
Spinal: Subarachnoid space
Epidural: Epidural space
Caudal: Sacral hiatus
Saddle: Lower end of the spinal column to block the perineum
Macrolides: Ending? Examples? SE's? ___ toxic; They mess up what with the heart?
The “thromycins”
Azithromycin and Erythromycin
• SE: GI distress, QT prolongation, fever, lowers WBC’s, ototoxicity, rash, anaphylaxis, superinfections, transient hearing loss with high dose therapy
• Liver toxic: Be careful with acetaminophen
• The thromycins throw QT waves & throw the liver out of whack
Fluoros: 2 examples? BBW? SE's? Does it affect kidney function? Many increase what lab?
Ciprofloxacin and levofloxacin
• “That fox likes to eat tendons” - BBW: Tendon rupture & peripheral neuropathy (tingling, pins/needles)
- SE: GI distress, dizziness, HA, confusion, photosensitivity, superinfection
• May cause an increase in liver enzymes (AST, ALT, LDH, Bilirubin)
- Does NOT affect kidney function
** Photosensitivity: No Fun in The Sun (FTS) Avoid direct sun, wear sunblock, increased risk for sunburn (Fluoroquinolones, Tetracyclines, Sulfonamides) **
Cillins: Cross sensitivity with what other two? Monitor ___ and ___; Why is it one of the most important antibiotics?
• Still one of the most useful and most important antibiotics: Can be basic (narrow) and extended spectrum (broad)
- Often combined with beta lactam inhibitors to stop the bacteria from inactivating the PCN and overcoming bacterial resistance
- Cross sensitivity: The three C’s: penicillins, cephalosporins, and carbapenems
• Monitor hepatic function and renal function
Non-Benzo's: What two things to report? BBW? Do not take with CNS ____; Allow __ hours of sleep at night
• Allow at least 8 hours of sleep per night
• Report unusual behaviors and suicide ideations
• Do not take with opioids (BBW) or other CNS depressants
What are the 4 different stages of Anesthesia?
1- Analgesia (Induction)
2- Excitement/delirium (Loss of consciousness)
3- Surgical (Surgery is performed in this stage)
4- Medullary paralysis (Toxic; cardiopulmonary collapse) *you don’t want this one to happen*
Macrolides: Route? With or without food? IV route what to watch for? Monitor what?
• Take PO dose with a full glass of water one hour before or two hours after meals
- Coated tablets may be taken with meals.
• IV route can irritate veins – watch IV site carefully
- Monitor hepatic function and renal function
** No food for MTF (Move-The-Food) Take on an empty stomach with a full glass of water (Macrolides, Tetracyclines, Fluoroquinolones) **
Fluoros: What to report? Don't take with ____; When to tale? Avoid direct ____; Caution with DM.. why?
- Do not take with antacids
- Take 2 hours before or after meals
- Drink plenty of water, can cause hypoglycemia – pts with DM need to monitor blood sugars more frequently
- Avoid direct sun exposure
- Report: Unusual joint or tendon pain, tingling sensation in arms/legs
** No food for MTF (Move-The-Food) Take on an empty stomach with a full glass of water (Macrolides, Tetracyclines, Fluoroquinolones) **
Tetras: 2 examples? Uses? SE's? Kids? Pregnancy? Take with or without food?
Doxycycline and Minocycline
- Broad spectrum, treats a wide variety of infections, including acne
- No pregnancy
- No children <8 yrs old (teratogenic and tooth discoloration)
- SE: GI distress, epigastric burning, superinfections, hepatotoxicity, renal toxicity, photosensitivity, rash, Stevens-Johnson syndrome
- Should be taken on an empty stomach with a full glass of water
** No food for MTF (Move-The-Food) Take on an empty stomach with a full glass of water (Macrolides, Tetracyclines, Fluoroquinolones) **
Inhaled anesthetics: Used when? SE's? Treatment for Malignant Hyperhtermia?
- Used during surgery
- SE's: Respiratory depression, hypotension, dysrhythmias, hepatic dysfunction
- Treatment: DANTROLENE
Note: ___ anesthetic can also be used in a pump to control pain and reduce the need for opioid use
Local
Carbapenems: Examples? Use? Monitor? Why to check allergies?? Route? SE's?
Meropenem, ertapenem, imipenem/cilastatin (Primaxin)
• Used for serious or life-threatening infections, especially nosocomial (this means hospital acquired infections)
• Beta lactam structure – cross sensitivity: the three C’s: Check allergies!
• SE: GI distress, allergic reactions, superinfection, rash, seizures (rare)
• Not given PO - IM: Deep muscle due to painful injections - IV: Reconstitute and dilute: Infuse on a pump over 45-60 minutes, irritating to veins – watch IV site carefully
• Monitor renal function and liver function
Ceph: Endings? SE's? Cross sensitivity with what other two? Chemically similar to ___
Five generations, all beginning with “cef” or “ceph”
• Chemically similar to penicillins with a beta lactam structure
• Cross sensitivity with the 3 C’s: peniCillins, Cephalosporins, and Carbapenems: Check allergies before giving!
• SE: GI distress, allergic reactions, superinfections, increased risk of bleeding with ceftriaxone and cefotetan
Tetras: Do not take with what products? Why to discard leftovers? IV.. hurt? What to do for 30 minutes after taking med?
• Sit up for 30 minutes after taking
- Do not take with dairy products, calcium, iron, or antacids
• Discard any leftover meds when expired (can become toxic)
- IV route can cause phlebitis – monitor IV site carefully
** Photosensitivity: No Fun in The Sun (FTS) Avoid direct sun, wear sunblock, increased risk for sunburn (Fluoroquinolones, Tetracyclines, Sulfonamides) **