Antibiotics
Beta Lactam Groups, MOA, & Major Consideration
What are penicillin, carbapenems, cephalosporins, and monobactams, inhibit cell wall synthesis, & cross-sensitivity?
Colonization vs. Infection
What is no host interference or interaction,, normal flora, protective qualities vs. host interaction with organism and immune system response?
Status Asthmaticus & Causes
severe asthma exacerbations that progress rapidly and don't respond to standard acute asthma therapy
main reasons: non-adherence to medications and infection
Long-Acting Beta-2 Agonists & Consideration
What are Terbutaline (Brethin) & Salmeterol (Severent) and never use LABA in a rescue situation and never double up on dose?
Antitussives Meds, Use, & Teaching
What is dextromethorphan (Delsym), centrally suppress dry, hacking nonproductive cough, administer undiluted and don't eat for 30 minutes afterward?
Adverse Effects of Vancomycin
Bonus Points: Use for C. diff
What are ototoxicity, nephrotoxicity, and red man syndrome cause by rapid infusion?
Bonus Points: Acts a bowel lumen
Teaching Points for C. Diff
Consequences of Chronic Bronchitis
What is excess mucus production (which blocks airways) & inflammation (damages alveoli)? This can also lead to increased respiratory infections
Leukotriene Inhibitor Drug & Adverse Effects
What is montelukast (Singulair) and depression and suicidal thoughts?
Neuraminidase Inhibitor, Admin Instructions, & Considerations
What is Oseltanivir (Tamiflu), begin treatment within 2 days or less after exposure, and take with food & DO NOT give to pregnant women?
Aminoglycoside prototype & MOA
Bonus Points: special nursing considerations
What is gentamicin (Garamycin) & binds to prevent protein synthesis?
Bonus Points: doses are based on serum drug concentrations! Need that trough before administration! do not mix aminoglycosides and penicillin in syringe, IV tubing, or IV bag (penicillin can inactivate aminoglycosides)
Normal WBC Level, Normal Kidney Lab Values, & Culture & Sensitivity Considerations
WBC: 4.5-11 10*9/L
Creatinine: 0.6-1.2 mg/dL
BUN: 7-21 mg/dL
culture - determines causative microorganism
sensitivity - determines susceptibility to antimicrobial agent
may take 48-72 hours to get back
Consequences of Emphysema
What are alveolar collapse, decreased surface area (leading to trapped air), and increased pulmonary artery pressure which can lead to corpulmonae (right-sided heart failure)?
SAMA & LAMA Drugs
Bonus Points: Which has better absorption and why
What are ipratropium and tiotropium?
Bonus Points: Tiotropium because it's a fine powder
Nitrofurantoin (Macrobid, Macrordantin) Use, Contraindications, & Teaching Points
What are treatment and prophylaxis of UTIs, renal insufficiency and pregnancy (can cause cleft palates), and may cause urine to turn brown & crystalluria?
Sulfide Drugs Prototype, MOA, & Adverse Effects
What is trimethoprim/sulfamethoxazole (Septra/Bactrim), inhibit enzyme systems required for folic acid production, renal impairment, blood dyscrasias (aplastic anemia- bone marrow not producing enough RBC, WBC, & platelets - pancytopenia, thrombocytopenia - low platelets, leukopenia - low WBC), SJS, photosensitivity?
Macrolide Prototype, Adverse Effects, & Contraindications
What are erythromycin, hearing loss, confusion hepatotoxicity, & St. John's wort, grapefruit juice, CYP3A4 inhibitors, antacids?
Combination Medications & Advantages
What are fluticasone/salmeterol (Advair), budesonide/formoterol (Symbicort), ipratropium/albuterol (Combivent Respimat)
Advantages:
Smaller dose of each agent can be given
Reduces adverse effects
Can reduce the corticosteroid use by 50%
Can reduce the non-compliance risk?
MOA of Corticosteroids, Meds (at leastone)
Bonus Points: Inhalation Teaching
What is suppresses the immune system, increases number of beta-2 receptors, and beclomethasone (QVAR), budesonide (Pulmicort), fluticasone (Flovent)?
Bonus Points: rinse mouth after use to prevent fungal infections
Principles of Corticosteroid Use
1. Smallest effective dose for shortest effective time
2. Long-term vs. short-term: LT - can cause loss of adrenocortical function & atrophy of adrenal cortex so prefer short term
3. alternate days that you take the therapy; used for maintenance therapy, decreases adverse effects
4. tapering must be done carefully to avoid possible cortisol deficiency
Fluroquinolone Prototype & Adverse Effects
Bonus Points: First Line for What
What is ciprofloxacin (Cipro) and photosensitivity, tendonitis, & Achilles rupture, lower seizure threshold in people with seizure disorders, cardiac effects, peripheral neuropathy, dermatological reactions (white and yellow lesions in the mouth and perianal itching)?
Bonus Points: Anthrax Exposure
Cephalosporins Prototype, Use, Adverse Effects, & Contraindications
Bonus Points: Major Consideration
What is Cefazolin, prevents surgical site infections, C. diff, bloody stools, sores in mouth/throat, hives, nephrotoxicity, drug-to-drug/drug-to-food interactions: alter how vitamin K is metabolized, bleeding can occur if taken with Aspirin, cannot be administered with calcium bc precipitates form in the kidneys, cannot be administered with other meds that can affect the kidneys (aminoglycosides, furosemide, vancomycin)
Bonus Points: Must be administered at least ONE HOUR before surgery
Types of Inhalation Drug Therapy and Brief Descriptions
Metered Dose Inhaler: breath in and inhale slowly (between two puffs, one minute); using a spacer will help to prevent waste and breaks the medication into smaller droplets which reaches the airways easier
Dry Powder Inhaler: take a deep fast inhale; requires a quick, fast breath so not the drug of choice during asthma flares; powdered so they can reach the tiniest airways; single dose (patient has to fill capsule each time); does not require hand-breath coordination
Nebulizer: convert medication into fine droplets, causes bronchodilation and reduces secretions
SABA Meds, Use, & Adverse Effects
Bonus Points: Teaching
What are albuterol (Proventil, Ventolin, ProAir), levalbuterol (Xopenex), rescue medications (MDI & Nebulization), Cardiac stimulation: Angina, tachycardia, palpitations, cardiac dysrhythmias, CNS stimulation: Anxiety, insomnia, seizures & muscle tremor?
The patient should wait 1 minutes b/w different inhaler (such as corticosteroid)
Types of Hypersensitivity Reactions and Mediators
Type I: IgE mediated, rapid onset (e.g. Anaphylaxis, Allergic Rhinitis)
Type II: IgG/IgM Tissue-specific reactions; antibodies mistakenly attack a person's "own cell bound antigens" (e.g. Hemolysis in drug allergies)
Type III: IgG/IgM Immune complex mediated; Immune complexes formed when antigens bind to antibodies; Joints and kidney are the common sites (e.g. Gluten "wheat" allergy)
Type IV: No antibody involved. Cell mediated (e.g. poison ivy "contact dermatitis" allergy).