Docsity
Docsity
Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity

Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips
Guidelines and tips
Sell on Docsity
Sell on Docsity
Docsity AI
Docsity AI
Log inSign up

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search for your university

Find the specific documents for your university's exams

Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents
download point icon20 Points

For each uploaded document

Answer questions
download point icon5 Points

For each given answer (max 1 per day)

All the ways to get free points
Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

Antiepileptic Drugs and Antibiotics Review Guide, Study Guides, Projects, Research of Nursing

Atlantic Institute of Oriental Medicine (ATOM)Nursing

A comprehensive review guide for various antiepileptic drugs such as carbamazepine (tegretol), topiramate (topamax), levetiracetam (keppra), and valproate (depakote). It also covers the use of phentermine for obesity and lithium for manic-depressive illness. Additionally, the document discusses antibiotics like penicillin, cephalosporins, lincosamides, oxazolidinones, and antivirals, including their indications, contraindications, and side effects. It is a valuable resource for students studying pharmacology, medicine, or nursing.

Typology: Study Guides, Projects, Research

2023/2024

Available from 06/03/2024

DOCSGRADER001
DOCSGRADER001 🇺🇸

4.7

(9)

4K documents

1 / 11

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
Pharm Exam 2 Review Study Guide
Carbamazepine (Tegretol) – is an anticonvulsant = thought to affect Na+ channels to slow spread of
abnormal activity
•SE = decreases body’s production of blood cells, rare reports of aplastic anemia and agranulocytosis, can
cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis
•Should get a CBC Q3-4 months (watch for WBC count in particular)
•Carbamazepine is a strong inducer of hepatic enzymes/metabolism and can lead to lower levels
•Do NOT stop taking abruptly, has a shorter half-life w/repeated uses
Topiramate (Topamax) – is for tx of epilepsy, seizures, migraine prophylaxis
•Blocks sodium channels or potentiate GABA
•Peaks 2 hours after oral admin, mostly eliminated via urine
•Can cause ↓ Na bicarb levels which can lead to hyperchloremic metabolic acidosis
•Serum bicarbonate should be monitored at baseline and periodically
•Can cause ocular syndrome (acute myopia and glaucoma) – should inform provider immediately if pt
experiences eye pain or blurred vision
•Rare side effect is oligohidrosis (↓sweating) and hyperthermia
•Can increase the risk of suicidal behavior/ideation, cause weight reduction
•Should NOT be discontinued abruptly
•Is a pregnancy category D and can increase risk of cleft lip/palate in infants
Levetiracetam (Keppra) – antiepileptic, does NOT affect GABA, does inhibit burst firing and spread of
seizure activity
•Mostly cleared through renal system, is not extensively metabolized
•Absolute contraindication is sensitivity to the drug
•At increased risk for suicidal thoughts and depression, behavioral changes, somnolence, fatigue,
dizziness, muscle coordination difficulties
•Potential for withdrawal seizures if keppra is stopped abruptly
•Safer med for seizures in children and pregnancy
Valproate (Depakote) – is an anticonvulsant, for tx of bipolar disorder and mania also
•Blocks GABA uptake into presynaptic neurons
•SE = GI distress, heartburn, CNS depressant
•Is a pregnancy category X, known teratogen, may only be taken after the 1st trimester if necessary, bur
should recommend switching to different anticonvulsant like Keppra
Ethosuximide (Zarontin) – tx for seizures
pf3
pf4
pf5
pf8
pf9
pfa

Partial preview of the text

Download Antiepileptic Drugs and Antibiotics Review Guide and more Study Guides, Projects, Research Nursing in PDF only on Docsity!

Pharm Exam 2 Review Study Guide

Carbamazepine (Tegretol) – is an anticonvulsant = thought to affect Na+ channels to slow spread of abnormal activity

  • SE = decreases body’s production of blood cells, rare reports of aplastic anemia and agranulocytosis, can cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis
  • Should get a CBC Q3-4 months (watch for WBC count in particular)
  • Carbamazepine is a strong inducer of hepatic enzymes/metabolism and can lead to lower levels
  • Do NOT stop taking abruptly, has a shorter half-life w/repeated uses Topiramate (Topamax) – is for tx of epilepsy, seizures, migraine prophylaxis
  • Blocks sodium channels or potentiate GABA
  • Peaks 2 hours after oral admin, mostly eliminated via urine
  • Can cause ↓ Na bicarb levels which can lead to hyperchloremic metabolic acidosis
  • Serum bicarbonate should be monitored at baseline and periodically
  • Can cause ocular syndrome (acute myopia and glaucoma) – should inform provider immediately if pt experiences eye pain or blurred vision
  • Rare side effect is oligohidrosis (↓sweating) and hyperthermia
  • Can increase the risk of suicidal behavior/ideation, cause weight reduction
  • Should NOT be discontinued abruptly
  • Is a pregnancy category D and can increase risk of cleft lip/palate in infants Levetiracetam (Keppra) – antiepileptic, does NOT affect GABA, does inhibit burst firing and spread of seizure activity
  • Mostly cleared through renal system, is not extensively metabolized
  • Absolute contraindication is sensitivity to the drug
  • At increased risk for suicidal thoughts and depression, behavioral changes, somnolence, fatigue, dizziness, muscle coordination difficulties
  • Potential for withdrawal seizures if keppra is stopped abruptly
  • Safer med for seizures in children and pregnancy Valproate (Depakote) – is an anticonvulsant, for tx of bipolar disorder and mania also
  • Blocks GABA uptake into presynaptic neurons
  • SE = GI distress, heartburn, CNS depressant
  • Is a pregnancy category X, known teratogen, may only be taken after the 1 st^ trimester if necessary, bur should recommend switching to different anticonvulsant like Keppra Ethosuximide (Zarontin) – tx for seizures
  • Should be monitored for blood dyscrasia (an abnormal condition or dx of the blood) Antiepileptics block transmission, raise the seizure threshold, so that the patient will not peak over the seizure threshold and have a seizure. Anticonvulsants in terms of monitoring (most common side effects, most serious side effects) – know that they are all monitored with blood work for their levels so that is a similarity amongst them
  • Carbamazepine – CBC – Causes agranulocytosis so be watching the white count in particular although there is other bone marrow suppression as well
  • What do you monitor? – TSH because the med can affect the thyroid
  • Never want anyone to d/c suddenly, must be weaned off
  • Talk to patients about safety – driving limitations, may have to report patient to DMV if they are having active seizures
  • Oral health can be affected by anti-seizure meds and extra trips to the dentist may be required Neurotransmitters
  • GABA – calming
  • Acetylcholine – muscle action, thought and learning ***If a specific drug is listed on the PowerPoint, know all about it.
  • All these drugs are listed on the PowerPoint
  • Seizure o Topiramate – topamax o Carbamazepine – Tegretol o Valproate – Depakote o Levetiracetam – Keppra
  • MAOI o Phenelzine – Nardil
  • Anxiolytics Phentermine (Adipex-P) – used for obesity, stimulating satiety centers
  • Should only be used short-term ( 6 months or less)
  • DO NOT mix w/ SSRIs or St. John’s Wart (Serotonin Syndrome), or w/ MAOIs (HTN crisis) Lithium — tx of choice for manic-depressive (bipolar) illness, ↓ severity/frequency of mania ▪ Replaces Na+ during depolarization in neurons = stops transmission of electrical impulses ▪ Inversely proportional to Na+ --- ↓Na+ = ↑Lithium ↑Na+ = ↓Lithium ▪ Lithium Toxicity can occur = drowsiness, nausea, course tremors, diarrhea, confusion, stupor ▪ NOT to be used in renal pts, children under 12, or pregnant women ▪ Pt education = avoid dehydration, eat a diet with consistent Na+ levels Antidepressants – SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram)
  • If someone has too much serotonin, it will act as an antagonist
  • Or if they do not have enough serotonin, it will act as an agonist in the post synaptic
  • Structure similar to clozapine which is an atypical antipsychotic
  • Pt with anxiety and depression may respond to buspirone and an SSRI combined
  • Is an appropriate first-line drug for mild to moderate generalized anxiety disorder
  • Works well for anxiety and has a synergistic effect with SSRI for someone who has a resistant type of depression that needs an extra boost
  • Will compete for metabolism site w/ antipsychotics (Haldol) MAOI Inhibitors
  • Phenelzine (Nardil)
  • Parmate
  • Marplan
  • Not used often and are not popular due to the amount of adverse effects
  • MAO – irreversibly inactivates the enzymes that metabolize NE, serotonin, and dopamine therefore increasing bioavailability of each so you get a longer serotonin, norepi effect such as more energy as well as a better mood)
  • Adverse effects: tardive dyskinesia
  • Do not mix with other substances (other MAOI’s)
  • Do NOT eat foods containing tyramine (aged cheese/meats, alcohol) as these can cause symptoms of HTN crisis (increased BP, tachycardia, HA, dizziness, sweating, tremors) which requires immediate tx
  • Do not mix well with other things so they need to be two weeks separated from anything else (assuming this is specifically referring to other antidepressants)
  • When starting new antidepressant, wean patient off this medication. Pt must be off of this medication at least two weeks before starting another antidepressant Benzodiazepines – binds to GABA receptors to inhibit the neurotransmitter release
  • Alprazolam, Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam
  • Effect/binds to GABA receptors – which is sedating, acts as anticonvulsant, muscle relaxant, helps with alcohol withdrawal
  • Tend to be very habituating – be aware of this and limit prescribing, CNS depressant
  • If you have to put a patient on a benzo, try to choose something that is longer acting so that patient does not need to redose constantly. Longer acting benzo example is klonopin
  • Short and intermediate acting benzos to tx insomnia, long-acting benzos to tx anxiety
  • An appropriate drug to initially tx panic disorder is diazepam (Valium)
  • CAUTION IN PRESCRIBING, alprazolam (Xanax) has greatest likelihood of rapid dependence Insomnia Meds
  • Familiarize yourself with what it means to utilize sleep hygiene and be sure your clients are using that.
  • Meds should only be for short term or occasional use because you want the patient to develop their own sleep patterns and not become dependent upon a pill to go to sleep at night.
  • Ambien – non-benzo type of sleep aid – works within the GABA receptors but non-benzo – considered to work at a benzo booster site.
  • Temazepam – benzodiazepine sleep aid – has same side effects as other benzos Anti-infective
  • Antibiotics is a broad term for a lot of things including antibacterial, antifungals, antiprotozoal, anthelmintic, and antiviral
  • Classified as gram positive or gram negative o Gram positive bacteria have no capsule – have a thick peptidoglycan wall which stains purple o Gram negative bacteria have a capsule that protects the cell peptidoglycan wall from staining so it will show as pink
  • Also classified by shape – i.e. flagellated, spirilla, cocci
  • Classified by oxygen use o Anaerobes – cannot grow in the presence of oxygen o Aerotolerant - most bacteria that cause humans to be sick. They can survive for 72 hours in the presence of oxygen, even though they may not usually, and they may not grow in oxygen o Most human flora is anaerobic deep within our bodies.
  • Anti-infective work in the following ways o Cell walls – an o Folic Acid metabolism – o Protein synthesis inhibitors at 30s and 50s ribosomal subunit o ****MUST KNOW EACH ANTIBIOTICS FAMILIES MECHANISM OF ACTION*****
  • Bacteriostatic vs bactericidal o Bacteriostatic – stop bacteria from reproducing but do not kill it = utilized in people who have an intact immune system that is able to go in and kill the bacteria as long as it is not reproducing o Bactericidal – wipes out the bacteria = the bad and the good which is where C. Diff and other things come from
  • What effects antibiotic efficacy? o People’s immune function – people with poor immune function may need bactericidal or higher levels of antibiotics ▪ Diabetic ▪ Steroids ▪ Chemotherapy ▪ Asplenia (absence of normal spleen function) ▪ Hx. Of previous infections ▪ Elderly ▪ Foreign bodies - catheters, artificial joints, valves, and shunts = may need to be removed if possible, in order for patient to be properly treated ▪ Autoimmune disease – autoimmune drugs lower ability to fight infection o Alteration in Distribution ▪ Not high enough albumin level ▪ Overweight ▪ Underweight – emaciated or cachectic (physical wasting) ▪ Renal function decreased ▪ Anything that can affect kinetics needs to be thought about in relation to antibiotic efficacy
  • Bacteria cause resistance by o Breaking down beta lactam ring o Or breaking down whatever the drug is consisting of and inactivating it o Penicillin has things added to prevent the bacteria from breaking down the beta lactam ring o Reduce bacterial efflux pumps or change the influx of it so it cannot work as well o Alter the binding site so the medicine cannot exert its action
  • Every antibiotic drug class has resistant organisms that influence prescribing decisions
  • Common resistant organisms o MRSA ▪ Community acquired - Acquired from locker rooms, jails, prisons, gymnasiums, livestock handlers who handle animals who handle antibiotics
  • If you are wanting gram negative activity, do not choose cephalexin or cefazolin, you need to go to a different drug group altogether or something in a higher generation
  • Widely distributed
  • Renally excreted as is penicillin – if you have a patient that does not have a renal system that is working well, you may need to adjust your dosing and monitor the renal functions
  • Generally a pretty safe drug
  • Same adverse effects of penicillins; however, very uncomfortable at injection site o Rocephin – often mixed with lidocaine to ease discomfort
  • Mechanisms of resistance – also add a beta lactamase inhibitor type of medication to it o Has other mechanism of resistance such as ▪ Making bacterial cell wall impermeable to the antibiotic ▪ Effecting the upregulation and the pumping in of the antibiotic
  • If a client with strep pharyngitis is allergic to penicillin or cephalosporins then what do you use? o Macrolides – erythromycin or azithromycin – do not risk allergic reaction Vancomycin
  • Very toxic to the ear and the kidney
  • Has gram positive coverage – particularly effective in IV form for staph aureus or MRSA infection
  • Bactericidal – widely distributed and renally excreted – watch the kidneys
  • Does not absorb well in GI tract so mostly given IV unless somebody has C. diff in which case we can give it PO because it will work topically
  • Can cause phlebitis at IV site as well as nephro and ototoxicity
  • Red Man syndrome if infused too rapidly – histamine type release and patient feels flushed, fever, chills, tachycardia, pruritis, paresthesia’s – does not mean this is an allergic response, means we need to slow it down Bacteriostatic ABX limit bacterial growth by interfering w/bacterial protein production, DNA replication = Tetracyclines, Sulfonamides, Spectinomycin, Trimethoprim, Chloramphenicol, Macrolides, Lincosamides, Clindamycin, Ethambutol, Nitrofurantoin, Oxazolidinone. Tetracyclines
  • Doxycylcine 100 mg PO Q12H or BID for 14-28 days depending
  • If pt is on doxycycline for a chlamydia infection, recommend she use a back-up method of birth control (condom) since this med can ↓ effectiveness of oral contraception
  • Doxycycline can cause anorexia, N/V, diarrhea = should take w/food
  • Tetracyclines such as Minocycline are safe to use in adolescents for the tx of acne
  • If pt taking Minocycline complains of a HA, evaluate for pseudotremor cerebri
  • Do not give to children less than age 8 because it effects bone growth as well as causing stained teeth
  • Adverse effects = photosensitivity, lupus/hepatitis, fatty liver, tinnitus, SJS (serious), TEN
  • Can be inactivated by calcium ions, DO NOT give with an antacids or dairy (yogurt, milk) because that decreases the absorption
  • Bacteriostatic Macrolides, Azalides
  • Bacteriostatic as a general rule, inhibits bacterial protein biosynthesis (peptidyl transferase), binds to the P site of the 50S ribosome subunit
  • Vary in excretion – stool and urine
  • Cover some of the unusual or uncommon respiratory problems such as mycoplasma pneumonia, chlamydia pneumonia, Bordetella pertussis
  • There is a molecule with a macrolide ring on this drug
  • Have been around a really long time so we are starting to appreciate problems with resistance now
  • Azithromycin for sinus infection is not really used much more because of problems with resistance – gets to the ears and throat better as they are deeper in the body
  • Azithromycin is a good abx for strep throat especially if pt has developed a rash/rxn to PCN
  • Besides causing significant GI upset, can cause acute hepatitis, rash, prolonged QT and malignant arrhythmias
    • serious side effects that need to be monitoring
  • Given for upper and lower respiratory infections, uncomplicated skin infections
  • STIs Lincosamides
  • Clindamycin – relative of erythromycin – binds like they do to the bacterial 50s ribosomes
  • Bacteriostatic for certain bugs
  • Works deep within the body
  • Bactericidal for certain bugs
  • If a bacteria is resistant to macrolides, it will be resistant to clindamycin as well
  • If pt begins to have frequent diarrhea w/blood in it, assess pt for pseudomembranous colitis
  • Adverse effects: nausea, vomiting, diarrhea – can cause c. diff diarrhea, metallic taste in mouth, dizziness, vertigo, hypotension, arrhythmias – if patient is having bad c. diff diarrhea from this med, that could be the reason the patient offloads their metabolism and has arrythmias Oxazolidinones
  • Linezolid – o Bacteriostatic although can be cidal against a few gram positives o Utilized for the big bads – pneumonias and more complicated infections, VREs – not first drug of choice o SHOULD NEVER BE USED within two weeks or concurrently with maoi d.t drug interactions o causes BONE MARROW SUPPRESSION – MONITOR CBC can cause lactic acidosis so be concerned with acid base balances, optic and peripheral neuropathies ▪ Especially if used greater than 28 days o Headache and nausea also ADRs o Originally developed as an MAOI, indirect acting sympathomimetic – giving an SSRI with this would cause serotonin syndrome and also interactions with tyramine rich foods (aged cheese, wines, etc.) Sulfonamides
  • Sulfamethoxazole – often utilized with trimethoprim (Bactrim)
  • Silver sulfadiazine – cream used in burns
  • Bacteriostatic, highly protein bound and well distributed
  • Effect folic acid so never use in somebody who has a folic acid deficit
  • If pt has sulfonamide allergy, then they are cross-sensitive to loop/thiazide diuretics and sulfonylureas
  • Excreted via the kidneys so make sure this is prescribed in somebody with good kidney function
  • Used to treat E. coli UTIs and occasionally strep pneumonia and pyrogens – used to be used for c. trachomatous
  • Adverse effects – folate deficiency because it disrupts folic acid synthesis. Can also cause SJS or TEN so systemic reaction can occur (esp. w/large doses). Glossitis, stomatitis, hepatitis – can cause transient jaundice, CNS effects – can suppress bone marrow, renal impairment
  • Contraindicated in people that are folate deficient or G6PD deficient (condition causing RBCs to break down in response to certain meds, infections, stressors)
  • Topically administered medications have different side effects Metronidazole (Flagyl)
  • Bacterial vaginosis, h. pylori, diverticulitis, etc. used for
  • Great for anaerobic coverage – things found deep within the body
  • Bactericidal
  • Works on nucleic acid synthesis
  • Can be IV or PO
  • Metabolized in the liver
  • **Biggest take away from this is to tell patients they can have nothing with alcohol (not even cough medicine) because they will vomit profusely (disulfiram like reaction) – tachycardia, nausea, vomiting Antimycobacterial and meds (TB)
  • Know what TB looks like – clinical manifestations – weight loss, night sweats, hemoptysis, fatigue
  • Rifampin used to tx TB, leprosy, and legionella
  • Isoniazid (INH) – used as 1 st^ line agent for prevention and tx of both waiting and active TB
  • Rifampin – causes red orange secretions and urine if someone is wearing contacts, they should be taken out because this med will ruin their contacts o Often see this given to people exposed to meningococcus as a preventative
  • Isoniazid – peripheral neuritis or neuropathy can occur so recommend Pyridoxine (vitamin B6) be taken while on INH
  • Pyrazinamide – increases uric acid (Gout flare-ups) but can also decrease liver functions and cause someone to become hepatotoxic (most dangerous side effect)
  • Ethambutol – can cause optic neuritis leading to visual problems such as green red color blindness, tell pt to report these symptoms immediately as it can be permanent Lyme disease medications – Doxycycline 100 mg Q12H for 21 days A pt with a small ventricle septal defect (VSD) that was repaired some years ago with no residual cardiac problems DOES NOT need ABX before dental procedures. A pt who is experiencing non-infectious diarrhea related to ABX administration will need to be assessed for C. diff colitis, so advise pt to increase probiotic intake w/yogurt to repopulate the gut flora. If a child comes to the clinic with a cough, low-grade fever, rhinorrhea, and the mucous is greenish-yellow then NO ABX should be prescribed because this is a virus. Antivirals
  • Make sure you know what the names are for influenza drugs and simplex and zoster drugs
  • Influenza – oseltamivir (Tamiflu) or zanamivir (Relenza) – start within 48 hours of influenza symptoms in order to successfully treat o Prophylactic treatment will occur in places such as nursing homes to prevent death
  • Acyclovir , famciclovir, valacyclovir – antivirals of choice for herpes simplex 1 and 2 as well as zoster o Start as soon as symptoms begin – numbness or tingling feeling o Drink lots of fluids when taking acyclovir (to help prevent nephrotoxicity)
  • Zoster o For herpes zoster (shingles) – asses renal function prior to taking valacyclovir

o Unilateral rash along nerve root – will also be put on gabapentin or possible tricyclic to help with the pain o People who are on antivirals for any length of time need monitoring for their liver function Antifungals

  • Organized according to polyenes, azoles, allyamines
  • Can be systemic or topical depending on the infection
  • Some require system – example is griseofulvin for ringworm (often seen on client’s head)
  • Ketonazole – can cause hepatoxicity (need to monitor AST/ALT, alkaline phosphatase, and bilirubin)
  • Amphotericin B is systemic and for serious type of fungal infection
  • Candidiasis – topical tx ( clotrimazole ) = yeast, thrush, commonly used things are nystatin, mycostatin, itraconazole, fluconazole (big treatment for oral, oropharyngeal, or esophageal yeast, as well as vaginal yeast infection).
  • Take note that these drugs can be hepatotoxic (need baseline LFTs) and nephrotoxic so good follow up is required for use Antihelminetics
  • Lice and scabies = use permethrin cream and Ivermectin
  • Mebendazole and agromectin used to tx intestinal parasitic worms
  • Elimite cream – apply from head to toe, leave on for 8 hours before rinsing off How do we know what we use?
  • Lexicomp – expensive program but most hospitals have this
  • Uptodate online – also expensive for individuals – most practices have one or the other
  • Harriet lane is a good book – also online and is a good reference for pediatrics
  • Consult infectious disease society of America
  • American college of physicians
  • Sanford guide – can place as download on phone