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Pharm Exam 4 Review
Notes
Penicillin Interferes with Cell wall of Bacteria.
- Amoxicillin o Indications ▪ Infections of: Joints, Skin, Soft Tissue, Respiratory Tract, and Urinary Tract o Side Effects: ▪ GI Disturbances (N/V/D & Abdominal Pain) ▪ Dizziness, Headache, Rash o Adverse Reactions: ▪ Superinfection ▪ Bloody Dyscrasias( Thrombocytopenia ▪ Steven-Johnsons Syndrome ⟶ If rash occurs, stop med and call Dr. ▪ Liver Damage, Seizures ▪ C-Diff associated with Diarrhea o Contraindications: ▪ Allergy to PCN or Cephalosporins ▪ GI Disturbances o Interactions: ▪ Decrease Effectiveness of oral Contraceptives ▪ Increase Bleeding with Oral Anticoagulants ▪ Decrease effect with acidic juice/food (specifically amoxicillin) ⟶ **Don’t take with acidic foods & increase fluids! ** ▪ When IV PCN is mixed with an IV aminoglycoside both antibiotics are ineffective o Nursing Interventions: ▪ Perform C&S before therapy ▪ Administer with food ▪ Monitor for Bleeding(because of the adverse effect of thrombocytopenia ▪ Monitor for Superinfection ▪ Monitor I’s & O’s, and Allergic Reaction ▪ Monitor Liver enzymes o Patient teaching ▪ Encourage pt. to take all medications as prescribed ▪ Take with food Cephalosporin Interferes with Cell wall of Bacteria in preventing replication - Ceftriaxone
o Indications: ▪ Infections of: Bone, Joint, Skin, Soft Tissue, Respiratory Tract, & UTI’s o Side Effects:
▪ Older Adults & Children CAUTION ▪ Renal Dysfunction CAUTION o Interactions: ▪ Loop Diuretics ▪ Aminoglycosides o Nursing Interventions: ▪ Collect Specimen before starting antibiotics ▪ Monitor Kidney Function ▪ Monitor Peak and Trough Levels Monitor Baseline kidney Function – BUN and Creatinine Hearing Screens Macrolide Inhibits protein synthesis in the Bacterial Cell.
- Azithromycin, Erythromycin o Indications: ▪ Respiratory Infections (Pneumonia) ▪ Infections of the Skin, Bone, STI’s, & UTI’s ▪ Acne ▪ Ear Infections & Tonsillitis o Side Effects: ▪ GI Disturbances (N/V/D) ▪ Photosensitivity ▪ Dizziness o Adverse Reactions: ▪ Hepatotoxicity ▪ Steven-Johnson Syndrome ▪ Superinfection ▪ C-Diff (associated with diarrhea) o Contraindications: ▪ Severe Liver Disease o Interactions: ▪ Warfarin (Oral Anticoagulants) ▪ Cardiac Glycoside (Digoxin) ▪ Antacids (specifically azithromycin) o Nursing Interventions: ▪ Obtain C&S ▪ Monitor Liver function, I’s & O’s ▪ Monitor Superinfection ▪ Avoid Antacids for 2 hours before and after admin ▪ Avoid direct sunlight, and use sunscreen ▪ **Best if taken on empty stomach with full glass of water (avoid juice) ** Tetracycline
Inhibits protein synthesis in the bacterial cell.
- Doxycycline o Indications: ▪ Infections of: Skin, STI’s, MRSA, Respiratory tract, & UTI’s o Side Effects: ▪ GI Disturbances (N/V/D) ▪ Photosensitivity ⟶ #1 side effect ⟶ Use Sunscreen/Stay out of direct sunlight ▪ Rash ▪ Tooth/Nail discoloration o Adverse Reactions: ▪ Hepatotoxicity ▪ Steven-Johnson Syndrome ▪ Superinfection ▪ C-Diff associated with diarrhea o Contraindications: ▪ Renal & Hepatic Dysfunction CAUTION ▪ Pregnancy and Children less than 8 years old ⟶ **Avoid Pregnancy (can be harmful to the fetus) ** ⟶ Can cause permanent teeth discoloration is children o Interactions: ▪ Milk & Dairy Products ▪ Magnesium & Aluminum Antacids ▪ Iron ▪ Oral Contraceptives o Nursing Interventions: ▪ Obtain C&S before beginning ▪ Given on an empty stomach ▪ Monitor Renal and Liver Function Fluroquinolone (Quinolones) Interferes with DNA Synthesis. - Levofloxacin o Indications: ▪ Infections: Urinary tract, Respiratory tract, Sinusitis, Bronchitis, Skin ▪ Reserved for pt. who have no other alternative treatment due to the risk of serious adverse reactions. o Side Effects: ▪ GI Distress ▪ Dizziness, Blurred Vision ▪ Photosensitivity o Adverse Reactions:
Given IV, give slowly Sulfonamides Inhibits Bacterial Synthesis of Folic Acid.
- Trimethoprim-Sulfamethoxazole o Indications: ▪ Infections of: Urinary system, UTI’s, STI’s, Otitis media, Pneumonia o Side Effects: ▪ Photosensitivity ▪ GI Disturbances ▪ Vertigo & Depression o Adverse Reactions: ▪ Blood Dyscrasias (Neutropenia) ▪ Anemias ▪ Crystalluria ⟶ Increase Fluid intake! ▪ Steven-Johnson Syndrome o Contraindications: ▪ Severe Hepatic or renal disease ▪ Pregnancy ▪ Breast Feeding o Interactions: ▪ Oral Hypoglycemic agents ▪ Warfarin & Antacids o Nursing Interventions: ▪ Monitor Blood Sugars if taking oral antidiabetics (can cause Hypoglycemia) ▪ Give with Full Glass of water on an empty stomach and increase fluids ▪ Monitor CBC ▪ Report bleeding Nitroimidazole Disrupts DNA and protein synthesis of bacteria - Metronidazole o Indications ▪ Helicobacter pylori (associated with ulcers) ▪ Clostridium difficile infection (c-diff) ▪ Sexually transmitted disease ▪ Trichomonas vaginalis vaginosis o Side effects ▪ Harmless urine discoloration
o Adverse reactions o Contraindications o Interactions o Nursing interventions ▪ Monitor kidneys and Liver function ▪ CNS assessment ▪ Safety caution due to dizziness Antifungals Kills fungal cells by increasing permeability of the fungal cell causing the cell to fall apart.
- Fluconazole – Systemic antifungal agent o Lungs, CNS, abdomen o Will cause GI upset if on for a long period of time, but not severe enough to stop med o If on long term may have Hepatotoxicity
- Nystatin (oral) – Local antifungal agent o Indications: ▪ Oral Candidiasis (thrush), Vaginal Candidiasis (yeast infection), Tinea Pedis (athletes’ foot) ▪ Makes difficult to treat because it happens in warm, moist areas o Side Effects: (Systemic) ▪ Gi upset, H/A ▪ Hypokalemia ▪ Tinnitus ▪ Lethargy, & Dizziness o Adverse Reactions: ▪ Systemic – Renal and Liver Failure ▪ Local – Rash, Pruritus o Contraindications: ▪ Dizziness ▪ Taste disturbances - metallic taste ▪ Breastfeeding ▪ 1st trimester pregnancy ▪ Caution with liver dysfunction Alcohol Disulfiram-like reaction. (Flushing, vomiting, headache, dyspnea, tachycardia). ▪ Superinfection ▪ Peripheral neuropathy ▪ Seizures
- Acyclovir, Zanamivir o Indications: ▪ Influenza (treatment should start within 48 hours of first symptoms) ▪ Herpes Virus (helps with fever blisters) ▪ Varicella (zoster), HIV/AID’s, Hepatitis o Side Effects: ▪ Dizziness, Headache ▪ Hypotension ▪ Increased Bleeding time o Adverse Reactions: ▪ Nephrotoxicity ▪ Crystalluria ⟶ **Increase fluids! ** ▪ Blood dyscrasias o Contraindications: ▪ Milk Protein Hypersensitivity o Interactions: ▪ Food does not affect absorption ▪ Aminoglycosides ▪ Ibuprofen ▪ Increase risk of nephrotoxicity when given with aminoglycosides and ibuprofen Will not treat a bacterial infection If you take anti-inflammatories with this med, it will increase the risk for Nephrotoxicity Chapter 48 Urinary Anti-infective Inhibits bacterial enzymes and metabolism. - Nitrofurantoin o Indications: ▪ UTI’s o Side Effects: ▪ Urine may turn harmless brown color ▪ Can also stain teeth ▪ Drowsiness, Confusion o Adverse Reactions: ▪ Peripheral Neuropathy which may be irreversible ▪ Thrombocytopenia, hemolytic anemia ▪ Pulmonary symptoms ▪ Superinfection o Interactions: ▪ Antacids o Nursing Assessment: urinary symptoms and CBC (for long term use)
o Nursing interventions: collect urine specimen, monitor I & O’s, observe for side effects and adverse reactions o Patient teaching: ▪ Take with food ▪ If given in a liquid form they need to rinse their mouth out after ▪ Avoid antacids ▪ Monitor for superinfection Urinary Anesthetics An azo dye that relieves the burning and frequency associated with UTI.
- Phenazopyridine o Indications: ▪ Pain relief from urinary tract infections Will cause body fluids to be a Red-Orange color – Harmless For all ABT Use different form of contraceptives Can increase bleeding effects if taken with Warfarin Obtain C&S before administering an ABT Monitor for Superinfection
- Take probiotics, eat yogurt! DON’T take antacids with them Take full course Rinse mouth after oral nitrofurantoin Antacids
- Aluminum hydroxide, magnesium hydroxide o Indications ▪ Neutralize stomach acid, GERD, GI ulcer o Side effects ▪ Aluminum cpds – constipation ▪ Magnesium cpds – diarrhea ▪ Muscle weakness Commonly aluminum and magnesium are combined to help prevent constipation and diarrhea o Adverse reactions ▪ Aluminum- hypophosphatemia and hypercalcemia ▪ Magnesium - hypermagnesemia o Contraindications ▪ Aluminum- hypophosphatemia ▪ Magnesium- hypermagnesemia ▪ Renal disease- CAUTION
Laxative Increases peristalsis by irritating sensory nerve endings in the intestinal mucosa. Promotes water accumulation in intestine and stool. Lubricate feces for easier passage.
- Bisacodyl o Indications: ▪ Frequent Constipation o Side Effects: ▪ N/V/D ▪ Mild abdominal cramping ▪ Insufficient fluid intake causes intestinal obstruction o Adverse Reactions: ▪ Electrolyte imbalances ⟶ Potassium, Calcium, Magnesium ▪ Fluid imbalances ▪ Dependence o Contraindications: ▪ Bowel Obstruction ▪ GI Bleeding ▪ Inflammatory bowel disease ▪ Appendicitis ▪ Undiagnosed abdominal pain ▪ Pregnancy ▪ Electrolyte Imbalances CAUTION o Interactions: ▪ Antacids, H2 Blockers, PPI’s ▪ Milk o Assessment ▪ Health/medication history ▪ Frequency, amounts and consistency of BM ▪ Baseline VS ▪ Abdominal assessment Antiemetic Acts on the chemoreceptor trigger zone (CTZ) and vomiting center in H receptor sites. o Indications: ▪ N/V
- Post-operative
- Motion Sickness
- Chemotherapy and radiation induced ▪ Sedation induction - Promethazine o Side Effects: ▪ Drowsiness, Dizziness, Confusion
▪ Anticholinergic effects ⟶ (Dry Mouth, Constipation, Urinary retention, Blurred vision) ▪ Hypo or Hypertension o Adverse Reactions: ▪ Blood Dyscrasia ▪ Extrapyramidal Syndrome ▪ Respiratory Depression o Contraindications: ▪ Liver Dysfunction ▪ Blood Dyscrasias ▪ IV administration o Interactions: ▪ CNS depressants ▪ Alcohol If given too much of it, can cause respiratory depression
- Metoclopramide (Miscellaneous Antiemetic) o Side Effects: ▪ Drowsiness, Headache, Fatigue o Adverse Reactions: ▪ Extrapyramidal syndrome ▪ Suicidal Ideation ▪ High doses can cause Sedation and Diarrhea o Contraindications: ▪ GI obstruction ▪ Hemorrhage ▪ Perforation Post-operative N/V is typically what it is used for Serotonin Receptor Antagonist Blocks serotonin receptors in chemoreceptor trigger zone (CTZ). Blocks the vagal nerve terminal in upper GI tract. - Ondansetron o Indications: ▪ N/V o Side Effects: ▪ Headache, Fatigue, Dizziness ▪ Diarrhea, Constipation o Adverse Reactions: ▪ Cardiac Dysrhythmia More used for Chemo induced N/V o Assessment ▪ Thorough pt. history o Patient teaching
▪ To prevent NSAID induced ulcers ▪ Helicobacter Pyloric Infection (H. Pylori) o Side Effects: ▪ Headache, Dizziness, Diarrhea ▪ Abdominal Pain, Constipation o Adverse Reactions: ▪ Elevated AST and ALT (liver enzymes) ▪ GI Bleeding ▪ Anemia ▪ Thrombocytopenia o Contraindications: ▪ Hepatic Disease CAUTION ▪ Pregnancy CAUTION ▪ Older Adults CAUTION o Interactions: ▪ Digoxin ▪ Oral Anticoagulants ▪ Diazepam ▪ Food decreases peak level Can lower Vit B12, need to take supplement o Nursing Assessment: ▪ Obtain drug history, ▪ monitor food intake, ▪ caution with hepatic Disease ▪ Obtain baseline liver functions and CBC ▪ May be used with other medications to treat H pylori o Teaching ▪ Take on empty stomach ▪ Provides quick relief if taking for Reflex or heartburn ▪ May take weeks if taken for ulcer Pepsin Inhibitor Protects the gastric mucosa or lining of the stomach DOES NOT decrease Gastric Secretions
- Sucralfate o Indications: ▪ To prevent gastric mucosal injury from drug-induced ulcers (aspirin, NSAIDs) o Side Effects: ▪ Dizziness, Drowsiness, Nausea ▪ Flatulence, Constipation
o Adverse Reactions: ▪ Hyperglycemia ⟶ Monitor BS ▪ Hypophosphatemia o Contraindications: ▪ Renal Impairment ▪ Diabetes Mellitus o Interactions: ▪ Antacids ▪ Digoxin ▪ Furosemide Do not eat or drink for 20-30 minutes after taking med o Nursing interventions ▪ Hx of diabetes ▪ Baseline of electrolyte ▪ Monitor phosphate, electrolyte and blood glucose levels o Patient teaching ▪ Take as prescribed ▪ Take on empty stomach ▪ Take antacids 30 mins before or after taking pespin inhibitors ▪ Other medications should be taken 1-2 hours before or after Chapter 34 Erythropoietic-Stimulating Agent Stimulates production of RBC
- Epoetin Alpha o Indications: ▪ Severe Anemia in dialysis pt. (Increase Hemoglobin) o Side Effects: ▪ Headache, Flu-like symptoms ▪ Rash, Edema ▪ Injection site reaction (Normal) ▪ Bronchospasm/cough o Adverse Reactions: ▪ Anaphylaxis ▪ Antibody Formation ▪ Hypertension ▪ CVA/MI o Contraindications: ▪ Uncontrolled Hypertension ▪ Albumin Hypersensitivity ▪ Hgb greater than 12g/dL ⟶ **DO NOT give if Hgb is greater than 12! ** Granulocyte Colony-Stimulating Factor
▪ Food ⟶ Must be taken on empty stomach and remain upright for 30 minutes Especially in pt. with GI disorders If pt. has falls they need to notify their provider immediately Estrogen Replacement Binds to estrogen receptors in the body.
- Conjugated Estrogen o Indications: ▪ For moderate to severe vasomotor symptoms of menopause and vaginal dryness/atrophy o Side Effects: ▪ N/V ▪ Fluid retention ▪ Leg Cramps o Adverse Reactions: ▪ Thromboembolic disorders/thromboembolism ▪ Stroke/PE ▪ Reproductive cancers o Contraindications: ▪ Previous history of breast cancer or reproductive cancer ⟶ Will not give to those pt.! ▪ Venous thrombosis ▪ Liver Disease o Interactions: ▪ Increased effects with steroid ▪ Decreased effects of anticoagulants, and oral hypoglycemics Chapter 53 Adrenergic Blocker Causes smooth muscles in the bladder neck and prostate to relax, resulting in an improvement in urine flow rate and a reduction in symptoms of BPH. - Tamsulosin o Indications: ▪ Improves urination in men with BPH o Side Effects: ▪ Postural Hypotension ▪ Dizziness ▪ Headache o Adverse Reactions: ▪ Palpitations ▪ Changes in HR o Contraindications: ▪ Renal Disease
▪ Angina o Interactions: ▪ Other anti-hypertensives ▪ Nitrates ▪ Alcohol Take with food Androgen Binds to androgen receptors in the body.
- Testosterone o Indications: ▪ Androgen deficiency, Hypogonadism ▪ Replacement therapy for testicular failure ▪ Delayed puberty in adolescent o Side Effects: ▪ GI upset ▪ Changes in libido ▪ Aggressive behavior o Adverse Reactions: ▪ Acne ▪ Gynecomastia ▪ Children ⟶ Inappropriate enlargement of genitalia o Contraindications: ▪ Kidney/Liver Disease ⟶ Monitor Liver enzymes, if elevated must stop med ▪ Reproductive Cancers ▪ History of MI o Interactions: ▪ Increases effects of anti-coagulants ▪ Decreases effect with barbiturates and phenytoin Phosphodiesterase (PDE) Inhibitor Enhances blood flow to the penis for ejaculation and erection. - Sildenafil o Indications: ▪ Used in the treatment of erectile dysfunction ▪ Also prescribed to treat pulmonary hypertension o Side Effects: ▪ Abnormal vision ▪ Headache, Nasal Congestion ▪ Flushing, Dizziness o Adverse Reactions: ▪ Priapism ▪ Hypertension
