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NR566 Midterm Study Guide
Community Acquired Pneumonia (CAP) - An infection of the lungs acquired outside of a healthcare setting Common pathogens microorganisms commonly responsible for causing CAP, - Pneumoniae, H. Influenzae, and P. Aeruginosa First line treatment for previously healthy adults with CAP - Macrolides, Doxycycline, and Amoxicillin What to give if first drug didn't work after first line of tx if given for CAP - Respiratory fluoroquinolones (LEVAQUIN) if not received antibiotics in the last 3 months Treatment for M. Pneumoniae in pediatric patient - Macrolides (ERYTHROMYCIN) Treatment of CAP in pregnancy - Amoxicillin, Cephalosporins, Erythromycin If someone has been treated with an antibiotic in the previous 90 days of contracting CAP, a quinolone would be a prudent choice to prescribe - FLOXACIN Treatment of chlamydial pneumonia in infant - Macrolide (AZITHROMYCIN) 500mg orally on day 1 followed by 250mg once daily on days 2-5; Erythromycin 12.5mg/kg PO QID x 14 days Broad vs narrow spectrum agents - Broad-spectrum antibiotics are used before culture results are available or in critically ill patients, while narrow-spectrum antibiotics are used when the pathogen is known
what is broad spectrum agents - - used before cultures are resulted
- critically ill patients after first cultures obtained
- based on NP knowledge of patient history
- local susceptibility / geographic location what is narrow spectrum agents - - used when the culture and sensitivity is resulted, and pathogen is known. what are Empiric antibiotics - An antibiotic that would work against any of the possible bacteria that could be causing the issue when are empiric antibiotics prescribed? - is prescribed to treat a serious infection until culture and sensitivity results are available give an example of empiric antibiotics - vanco, zosyn How to treat Clostridium difficile associated diarrhea - 1. Stop the antibiotic that may have caused it
- treat with vancomycin or metronidazole 3. then address hydration what medications are used for clostiridium difficile? - 1st - vancomycin 125mg PO QID x 10days 2nd - Metronidazole 500mg PO TID x 10days. Drug class known for ALL drugs in class to promote development of C. Diff. - 2nd and 3rd generation cephalosporins
what medications are aminoglycosides - amikacin, gentamicin, tobramycin Patient education needed for aminoglycosides - Report tinnitus, high frequency hearing loss, persistent headaches, nausea, dizziness, vertigo what medications are sulfonamides - sulfadiazine, sulfamethoxazole Patient education needed for sulfonamides - Finish full course, increase fluid intake (8-10 cups per day), take on an empty stomach, avoid sun exposure which sulfonamides can be prescribed to pregnant patients - do not use during the first trimester, it can cause kernicterus in infants. Renal adjustments for gentamicin - Decrease dosage for renal impairment How to treat tinea capitis - Antifungal drugs, such as Antifungal (griseofulvin) Specific drug to treat aspergillosis - Voriconazole Anthelmintic drugs that carry risk for hypotension with patients on antihypertensives - Ivermectin and Moxidectin Anthelmintic drugs that can cause bone marrow suppression and liver impairment - Mebendazole and Albendazole Anthelmintic drug that is generally safe to give without obtaining baseline data - Pyrantel Pamoate
anthelmintic drugs that are safe for pregnancy - praziquantel and moxidectin HIV Medications risks with didanosine - Lactic acidosis, Neuropathy, Pancreatitis, Hepatotoxicity, Optic disorders HIV Medications risks with saquinavir - Cardiac dysrhythmia, Heart failure PR Interval impacts use of which HIV drugs - Protease inhibitors: saquinavir, atazanavir, lopinavir, ritonavir How to measure success with antiretroviral therapy for HIV - Reduction in plasma HIV RNA & increased CD4 T-cells What does an increase in CD4 T-cell indicate - Restoration of some immune function When to use foscarnet in HIV+ patients - To treat HIV-infected patients with suspected or proven acyclovir-resistant HSV/VZY infections Metronidazole patient teaching - Can cause metallic taste in mouth, avoid alcohol due to risk of Disulfiram reaction Abacavir adverse effects - - Hypersensitivity (Steven-Johnson Syndrome)
- Fever
- Rash
- Myalgia
- Arthralgia
- N/V/Diarrhea
How to treat otomycosis - 2% acetic acid solution 3-4x/day x 7 days, or if this does not work, 1% clotrimazole [Lotrimin] can be applied BID for 7 days how to treat otomycosis if the infection fails to respond to the initial treatment of acetic acid solution and clotrimazole - oral antifungal therapy may be needed. Options: itraconazole (Sporanox) and fluconazole (Diflucan). symptoms of acute otitis media - otalgia, fever, n/v/d, irritability, sleep disturbance How to treat acute otitis media for <6months old - antibiotics and pain relief for <6mos old How to treat acute otitis media for 6months-2yrs old - antibiotics when diagnosis is confirmed How to treat acute otitis media for >2yrs old - observation x2-3days or if severe symptoms/confirmed diagnosis then antibiotics. Treatment in pediatric patient with acute otitis media - - Amoxicillin 40-45 mg/kg bid x 5-10 days (non- severe)
- Amoxicillin 40-45mg/kg bid plus clavulanate 3.2mg/kg bid (severe), Macrolide
- if allergic to PCN (mild: Macrolide ; severe: Cephalosporin) Treatment for allergic rhinitis - monoclonal antibody drug treatment: Omalizumab: biologic therapy How to treat glaucoma in someone with COPD or asthma - Betaxolol (B1 selective beta blocker) or Latanoprost <-- does not affect the bronchi
Side effects of Latanoprost - Darkens color of iris (browning) Glucocorticoids therapeutic action in allergic reactions (nasal route) - Prevents inflammatory response to allergens and reduces symptoms Antihistamines mechanism of action (oral / nasal route) - Block histamine >1 receptors and decrease itching, sneezing, and rhinorrhea
- they do not reduce congestion Cromolyn mechanism of action - Prevents release of inflammatory mediators from mast cells and decreases all symptoms Sympathomimetics mechanism of action - Activates vascular α1 receptors and causes vasoconstriction, reducing nasal congestion; this does not decrease sneezing, itching, or rhinorrhea Guaifenesin therapeutic action - Expectorant: thins secretions to stimulate release of congestion Benzoyl peroxide side effects - Skin redness, stinging, dryness, peeling, photosensitivity; hypersensitivity reaction in asthma patients Benzoyl peroxide patient teaching - Continue to use the prescription on irritated or sunburned skin, avoid sunlight and UV light exposure Budesonide risks of use in children - Impaired growth of bones Organic sunscreen needs what ingredient to be effective - Avobenzone (to absorb UVA light rays)
What would happen if lorcaserin is given with a CYP2D6 substrate - It can increase substrate levels, so the dose of the substrate may need to be lowered to prevent toxicity Which weight loss drugs are DEA scheduled drugs - Lorcaserin, Diethyloprione, Phentermine/Topiramate On-going monitoring needs with long-term use of Phentermine - Cardiac function monitoring At what BMI level should bariatric surgery be considered - Greater than 35 Liraglutide baseline data needed - Hemoglobin A1C, lipid panel, renal panel Ongoing monitoring/assessment needs for Liraglutide - Signs/symptoms of cholecystitis, pancreatitis, depression, and suicidal ideation Loarcaserin baseline data needed - Cannot be pregnant, assessment of valvular disorders and pulmonary hypertension Ongoing monitoring/assessment needs for Loarcaserin - CBC with differential, signs/symptoms of blood dyscrasias, cognitive changes Patient education needed for Loarcaserin - Diabetics may have an increased number of hypoglycemia episodes due to suppressed appetite, encourage small meals to maintain blood glucose levels Naltrexone/bupropion baseline data needed - Blood glucose levels, liver function, renal function, mental status Patient education needed for Naltrexone/bupropion - Do not take with chronic opioid use, be aware of signs/symptoms of suicidal ideation, anxiety/depression
Ongoing monitoring/assessment needs for Naltrexone/bupropion - Blood glucose levels, renal and liver function, signs/symptoms of anxiety/depression, suicidal ideation, mania, pain due to opioid antagonist effects Phentermine baseline data needed - Cardiac assessment what is the ongoing monitoring/assessment needs for phentermine - cardiac function monitoring how to discontinue phentermine and/or topiramate - taper off therapy if 5% baseline weight has not been lost Topiramate therapeutic effect - Induces sense of satiety Orlistat patient education needed - - patient must supplement fat-soluble vitamins (D,A,K,E), add fiber to diet to combat side effect of oily/incontinent stools, take with food
- can decrease vitamin K - if on warfarin may need to lower dose of warfarin (monitor coagulation)
- can lead to hypothyroidism - if on synthroid should take 4 hours apart to prevent interaction Orlistat can decrease vit. K, so if on Warfarin may need to lower dose of warfarin - Monitor coagulation dose for tetracycline - adult: 1000-2000mg po q6hours pediatrics: 25-50mg mg/kg po q6 hours
