NR 293 Final Exam 2023/2024 Latest Update Graded A+

NR 293 Final Exam 2023/2024 bacteriostatic - answerdrugs that do not kill the bacteria, but slows their growth culture and sensitivity - answertake a blood culture so we can determine where the bacteria is growing; sensitivity report determines the best treatment antibiotic combos - answerAdditive potentiative antagonisitic empiric therapy - answertreatment of an infection before specific culture information has been obtained definitive therapy - answerantibiotic therapy tailored to treat organisms identified with cultures prophylactic therapy - answertreatment with antibiotics to prevent an infection, as in intraabdominal surgery or after trauma MOA of sulfonamides - answerBacteriostatic inhibit bacterial growth prevent bacterial synthesis of folic acid uses of sulfonamides - answerGramp positive and negative, broad spectrum respiratory tract infections infections of the small bowel UTIs: enterobacter, ecoli, klebsiella, proteus vulgaris, staphylococcus aureus contraindications of sulfonamides - answerdrug allergy pregnant women infants younger than 2 months potassium oral contraceptives (ineffective) Adverse effects of sulfonamides - answermild to moderate rash photosensitivity GI distress stomatitis crystalluria fatigue depression headache dizziness blood dyscrasias Steven Johnsons syndrome renal failure hyperkalemia prototype for sulfonamides, and administration - answersulfamethoxazole combined with trimethropim Administered IV, PO, Topical patient education/ nursing interventions for sulfonamides - answerPt. Education: take with a full glass of water increase fluid intake report sore throat, bruising, bleeding avoid direct sunlight Nursing interventions: push fluids Monitor CBC signs of bleeding (liver damage) check for superinfection beta lactam penicilins MOA - answersafest class bacteriocidal inhibition of bacterial cell wall synthesis uses of penicillins - answerstrep staph pneumonia meningitis skin, bone, and joint infections stomach infections blood and valve infections gas gangrene tetanus anthrax sickle cell anemia in infants broad spectrum penicillin - answerbacteriocidal ecoli salmonella influenza adverse effects of penicillin - answerallergy most common rash pruritus fever anaphylaxis lowered WBC, RBC, platelet count GI upset patient education for penicillins - answerside effects bleeding increase fluid intake take with food drugs for penicillin - answerbroad spectrum: amoxicillin combination: piperacillin plus tazobactam (zosyn) give 3 times a day infused over 4 hours or every 6 hours infused over 1 hour cephalosporins MOA - answerlargest class interfere with bacterial cell wall synthesis, bind to the same penicillin binding proteins uses of cephalosporins - answertreatment of gram positive and negative anaerobic bacteria mostly gram negative patients who cannot tolerate the less expensive penicillins respiratory infections urinary infections skin infections bone and joint infections genital infections contraindications of cephalosporins - answermay cause cross allergy potential with penicillin adverse effects of cephalosporins - answerweakness pruritus GI distress high doses can cause bleeding seizures nephrotoxicity patient education of cephalosporins - answerside effects administration monitor kidney function with 1st generation drugs for cephalosporins - answerfirst generation Cefazolin (ancef) not effective for beta lactase gram positive bacteria may cause kidney toxicity macrolides MOA - answerbroad spectrum inhibit protein synthesis binds reversibly to 50S ribosomal subunits of microbes uses of macrolides - answerwhooping cough legionnaires disease Hpylori streptococcus influenza mycoplasma pneumonia generic use: respiratory GI tract skin soft tissue adverse effects of macrolides - answertinnitus ototoxicity mild GI distress diarrhea abdominal pain superinfectionm hepatotoxicity patient education/ nursing interventions - answerPatient education: finish full regimen monitor hepatic function food-drug interactions (fruit juices) take on empty stomach Nursing interventions: monitor hepatic function bleeding, bruising, dark tea looking urine, jaundice drugs for macrolides - answerwe do not need peak or troughs for Azithromycin (Zithromax, Zpack) only take for 5 days due to its long half life administer antacids 2 hours before or after on an empty stomach with full glass of water tetracyclines MOA - answerbroad spectrum inhibit protein synthesis uses of tetracyclines - answeracne Rocky Mountain spotted fever typhus cholera lymes disease peptic ulcers Hpylori contraindications of tetracyclines - answerdrug allergy children under 8 pregnancy category D, fetal growth/develeopment milk antacids iron decrease effect of oral contraceptives increases effect of digoxin adverse effects of tetracycline - answerdiscoloration of teeth retard fetal skeletal development if taken during pregnancy photsensitivity alteration of intestinal and vaginal flora reversible bulging fontanelles in neonates thrombocytopenia heolytic anemia hepatotoxicity (IV or high doses) nephrotoxicity (outdated meds) GI distress patient education of tetracyclines - answeruse sunblock store out of light/heat good oral hygeine food-drug interactions labs administration times drugs for tetracyclines - answertetracycline (achromycin) administer 1-2 hours after meals aminoglycosides MOA - answerprevent protein synthesis in bacteria uses of aminoglycosides - answerserious gram negative bacteria: ecoli serratia proteus psuedomonas mycobacteria some protozoans common category to treat klebsiella combined with penicillin, cephalosporins, or vancomycin for enterococcal infections may be given to sterilize bowel prior to surgery contraindications for aminoglycosides - answerrenal patients adverse effects of aminoglycosides - answernephrotoxicity ototoxicity: hearing impairment dizzy loss of balance persistant headache ringing in ears possible deaf superinfection photosensitivity anaphylaxis GI distress rash patient education/nursing interventions for aminoglycosides - answerPt. education monitor hearing use sunblock lab work nursing interventions monitor drug levels monitor serum levels drugs for aminoglycosides - answergentamicin (garamycin) if GI can not absorb, give IV give deep into leg muscle IM withhold if peak levels are above normal range quinolone (fluroquinonlones) MOA - answerbroad spectrum (bacteriocidal) destroy bacteria by altering their DNA, interfere with bacterial enzymes DNA gyrase and topoisomerase uses of quinolones - answerwide variety of gram negative and selected gram positive (strep, salmonella) complicated UTIS respiratory infections skin infections GI infections bone and joint infections STIS food poisoning anthrax (ciprofloxacin treats) contraindications of quinolones - answerdrug allergy children under 18 caffeine and caffeine like drugs such as theophylline (increase serum levels) calcium, magnesium, iron, or zinc (reduce absorption of quinolones by as much as 90%) adverse effects of quinolones - answerrash uritcaria tinnitus heamturai photosensitivty GI upset superinfection tendon inflammation or rupture (achilles, increase risk: less than 60 years old and taking corticosteroids) patient education on quinolones - answerincrease fluid intake to more than 2 liters food drug interaction s drugs for quinolones - answerciprofloxacin (cipro) levofloxacin (levaquin) bacteria resistant to quinolones - answerpseudomonas aeruginose Staph auereus pneumonococcus enterococcus enterobacteriacae, including ecoli Nitrofurantoin (macrodantin) MOA - answerbacteriostatic or bactericidal depends on dose uses of nitrofurantoin - answergram positive and negative bacteria: ecoli staph aureus klebsiella enterbacter UTI is the primary use contraindications of nitrofurantoin - answerimpaired renal function adverse effects of nitrofurantoin - answeranorexia nausea vomit diarrhea abdominal pain rust/brown color urine rash pulmonary reactions: dyspneal chest pain fever cough hepatotoxicity metronidazole (flagyl) uses - answeramebiasis anaeorbic bacteria respiratory infections bone infections skin infections CNS infections C.diff adverse reactions of metronidazole - answeranorexia nausea diarrhea headache dry mouth metallic taste bone marrow suppression contraindications of metronidazole - answeroral anticoagulants hypoprothombinemia alcohol (deathly sick if they drink) lithium (increases levels) how to administer metronidazole - answertopical: treats rosacea combination: treat h pylori infection vancomycin MOA - answerbacteriocicdal inhibits cell wall synthesis uses of vancomycin - answergram positive bacteria bone infection skin infection lower respiratory infection MRSA (Most effective drug for MRSA) adverse effects of vancomycin - answerflushing hypotension ototoxicity nephrotoxicity Steven Johnsons syndrome red man syndrome (occurs, when rapid IV admin, large amounts of histamine are released and dace, neck, trunk of body turn red) blood dycrasias pseudomembranous colitis nursing interventions for vancomycin - answerpeak and trough levels are drawn after 3 doses Labs (BUN, Cr) monitor hearing administer over 1-2 hours nursing role for antibiotics - answercultures prior to antibiotic therapy monitor 1/2nd dose for allergy monitor labs (kidney, liver, peak and trough) increase fluids check for superinfection (fever, perineal itching, cough, lethargy, unusual discharge) educate patient to finish prescription even if they feel better amphotericin B MOA - answerbroad spectrum anti fungal medication binds to ergosterol in fungal cell membranes uses of amphotericin B - answersevere systemic infections adverse effects of amphotericin B - answerfever rash chills hypotension tachycardia malaise muscle and joint pain anorexia nausea and vomit headache hypokalemia hypomagesemia nephortoxicity liver failure anaphylaxis MI thombocytopenia leukopenia agranulocytosis anemia administration of amphotericin B - answerpremedicate: 1st dose: 1 mg over 20-30 min administer slowly via IV, can cause cardiovascular collapse withhold if BUN is over 40mg withhold if serum creatinine rises about 3mg nursing interventions for amphotericin B - answermonitor labs Cr, BUN, ALK AST and ALT may increase K, Ca, Mg may decrease premeditate with antipyretics, antihistamines, antiemetics and corticosteroids monitor vital signs promote hydration liquid form of drug causes fewer side effects but is more expensive antiviral acyclovir (Zovirax) MOA - answerprevents viral DNA synthesis acyclovir uses - answerherpes virus decreases duration and episodes contraindications of acyclovir - answerrenal impairment adverse effects of acyclovir - answerPO: nausea/ vomit anorexia headache elevated hepatic enzymes IV: nephrotoxicity neurotoxicity patient education of acyclovir - answerstart as soon as signs and symptoms begin virus may be activated by stress, trauma, fever, sunlight, sex menstruation, immunosuppressive drugs refrain from sex when you have visible lesion drowsiness in older adults may increase fall risk CNS depressants dose dependents - answerlow: calms without inducing sleep high: calms with sleep main groups of CNS depressants: benzodiazepines MOA - answerdepress CNS activity affects hypothalamic, thalamic, and limbic systems of the brain: calming effect controls agitation and anxiety (panic attack) reduce sensory stimuli. inducing sleep induce skeletal and muscle relaxation does not suppress REM sleep as much as baribiturates does not increase metabolism of other drugs what receptor is used for benzodiazepines? - answerGABA: gamma aminobutyric acid uses or benzodiazepines - answersedation sleep induction skeletal muscle relaxation anxiety relief/ depression acute seizure disorders alcohol withdrawl agitation relief balanced anesthesia (before they give you actual anesthesia they will give this to you to calm you down) side effects of benzodiazepines - answerheadache, drowsiness, dizzy cognitive impairement vertigo lethargy fall hazard for older adults hangover effect toxicity and OD for benzodiazepines - answersomnolence confusion coma diminished reflexes contraindication of benzodiazepines - answerother CNS depressants (alcohol, opioids): hypotension and respiratory depression azalea antifungals verapamil diltiazem protease inhibitors macrolide antobiotics grapefruit juice olanzapine rifampin overdose treatment of benzodiazepines - answerFlumazenil (romazicon) administered IV