2021 Pharm 2 > module 3 > Flashcards

module 3 Flashcards

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1
Q

expected therapeutic action

A

destroy bacteria by weaknening the cell walls

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2
Q

penicillin types

A
  • narrow-spectrum
  • broad-spectrum
  • antistaphylococcal
  • antipsudomonas
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3
Q

narrow-spectrum penicillins

A
  • PCN G
  • PCN V
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4
Q

broad-spectrum penicillins

A
  • amoxicillin/clavulanate (Augmentin)
  • ampicillin
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5
Q

antistaphylococcal penicillin

A

nafcillin (Nallpen)

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6
Q

antipseudomonas penicillins

A
  • ticarcillin/clavulanate (Timentin)
  • piperacillin/tazobactam (Zosyn)
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7
Q

penicillin G

A
  • trade name: Bicillin, Permapen
  • abbreviation: PCN G
  • class: antibiotic, penicillin
  • spectrum: narrow
  • route: IM, IV
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8
Q

penicillin V

A
  • abbreviation: PCN V, PCN VK
  • class: antibiotic, penicillin
  • spectrum: narrow
  • route: PO
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9
Q

amoxicillin/clavulanate

A
  • trade name: Augmentin
  • class: antibiotics, aminopenicillins, beta lactamase inhibitors
  • spectrum: broad
  • route: PO
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10
Q

ampicillin

A
  • class: antibiotic, aminopenicillin
  • spectrum: broad
  • route: PO, IM, IV
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11
Q

nafcillin

A
  • trade name: Nallpen
  • class: antibiotic, penicillinase-resistant penicillin
  • spectrum: antistaphylococcal
  • route: IM, IV
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12
Q

ticarcillin/clavulanate

A
  • trade name: Timentin
  • class: antibiotic, extended-spectrum penicillin
  • spectrum: antipseudomonas
  • route: IV
  • OFF-MARKET
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13
Q

piperacillin/tazobactam

A
  • trade name: Zosyn
  • class: antibiotic, extended-spectrum penicillin
  • spectrum: antipseudomonas
  • route: IV
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14
Q

penicillin uses

A
  • prophylaxis against bacterial endocarditis
  • UTI
  • gonorrhea
  • perionitis
  • pneumonia, other RTIs
  • septicemia
  • meningitis
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15
Q

penicillin SE

A
  • GI distress
  • oral/vaginal candidiasis
  • generalized rash
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16
Q

penicillin patient education

A
  • report S/Sx of allergic rxn
  • complete entire round of abx
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17
Q

If IVPB penicillin, and pt shows S/Sx of allergic rxn, what’s the priority action?

A

STOP THE INFUSION

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18
Q

Each generation of cephalosporins is _____, less likely to develop _____, and more likely to cross into CSF.

A
  • stronger
  • develop resistance
  • cross into CSF
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19
Q

cephalosporins spectrum

A

broad

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20
Q

cephalosporin uses

A
  • UTI
  • post-op infections
  • pelvic infections
  • meningitis
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21
Q

Cephalosporins have cross-sensitivity with _____, and should not be given to pts with Hx of _____ _____ to those.

A
  • PCN
  • severe rxn
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22
Q

cephalosporin prototype

A

cephalexin (Keflex; 1st-gen)

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23
Q

1st-gen cephalosporins

A
  • cephalexin (Keflex; prototype)
  • cefazolin (Ancef)
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24
Q

2nd-gen cephalosporins

A
  • cefaclor (Ceclor)
  • cefotetan (Cefotan)
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25
3rd-gen cephalosporins
* ceftriaxone (Rocephin) * cefotaxime (Claforan)
26
4th-gen cephalosporin
cefepime (Maximpime)
27
cephalosporin SE
* thrombophlebitis (IV infusion) * pain with IM injection
28
To minimize pain with cephalosporin IM injection, give the injection _____ and _____ in which _____ muscle?
* **deep** and **slow** * in **large** muscle * **ventrogluteal**
29
preventing thrombophlebitis with cephalosporin IV infusion
* rotate sites * give as diluted intermittent infusion * if bolus, give over 3-5 min in dilute solution
30
cephalosporin interactions
* ETOH-intolerance rxn with * cefotetan * cefazolin * cefoperazone
31
carbapenems
* drugs * imipenem/cliastatin (Primaxin) * meropenem (Merrem) * spectrum: broad
32
carbapenems SE
* allergic rxn * GI Sx * nausea * vomiting * diarrhea * suprainfection * diarrhea * oral or vaginal candidiasis
33
imipenem/cilastatin
* trade name: Primaxin * class: carbapenem, antibiotic * spectrum: broad * uses: severe infections of lower resp. tract, GU, peritoneum, *bone, joint, skin, endocardium, etc.* * route: IV
34
meropenem
* trade name: Merrem * class: antibiotic, carbapenem * spectrum: broad * uses: severe infections (lower resp. tract, GU, peritoneum, *septicemia, skin, meninges*) * route: IV
35
other abx for serious infections
* vancomycin (Vancocin, Firvanq) * aztreonam (Azactam, Cayston) * fosfomycin (Monurol)
36
Vancomycin, aztreonam, and fosfomycin are indicated for _____ infections caused by what **3 bacteria**?
* **serious** infections * bacteria * MRSA * E. coli * Staphylococcus epidermidis
37
Vancomycin is used to treat what diarrhea-inducing bacterial infection?
Clostridium difficile (C. diff)
38
pharm Tx for mild C. diff
PO metronidazole or vancomycin
39
pharm Tx for moderate-severe C. diff
* IV vancomycin * infusion of vanc directly into intestine
40
vancomycin SE/AE
* ototoxicity * assess hearing * teach pt to report * monitor vanc trough levels * renal toxicity: monitor * I&O * kidney fxn labs * vanc trough levels * infusion rxn: give over 60 min * IV site thrombophlebitis * rotate sites * monitor for inflammation * check IV patency before admin
41
drawing peak and trough levels of vanc
* wait until **after 3rd dose** * peak: 1-2 hrs after dose * trough: 30 min before dose
42
cephalexin
* **prototype** * trade name: Keflex * class: antibiotic, cephalosporin (1st-gen) * spectrum: broad * route: PO
43
cefazolin
* trade name: Ancef * class: antibiotic, cephalosporin (1st-gen) * spectrum: broad * route: IM, IV
44
cefaclor
* trade name: Ceclor * class: antibiotic, cephalosporin (2nd-gen) * spectrum: broad * route: PO
45
cefotetan
* trade name: Cefotan * class: antibiotic, cephalosporin (2nd-gen) * spectrum: broad * route: IM, iV
46
ceftriaxone
* trade name: Rocephin * class: antibiotic, cephalosporin (3rd-gen) * spectrum: broad * route: IM, IV
47
cefotaxime
* trade name: Claforan * class: antibiotic, cephalosporin (3rd-gen) * spectrum: broad * route: IM, iV
48
cefepime
* trade name: Maxipime * class: antibiotic, cephalosporin (4th-gen) * spectrum: broad * route: IM, iV
49
vancomycin
* trade name: Vancocin * class: glycopeptide antibiotic * spectrum: narrow; gram-positive bacteria * route: PO, IV, IT
50
aztreonam
* trade name: Azactam, Cayston * class: antibiotic, monobactam * spectrum: narrow; gram-negative aerobic bacteria * route: IM, IV, inhaln
51
fosfomycin
* trade name: Monurol * class: antibiotic * spectrum: narrow; E. faecalis and E. coli * route: PO
52
abx that inhibit protein synthesis
* tetracyclines * macrolides * aminoglycosides
53
tetracyclines
* minocycline (Dynacin, Minocin, etc.) * doxycycline (Doryx, Doxy, etc.) * demeclocycline
54
tetracycline uses
* top and PO: acne and periodontal dz * first-line Tx for * rocky mountain spotted fever * chlamydia * brucellosis * Mycoplasma pneumonia * Lyme dz * anthrax * H. pylori
55
tetracycline SE AE
* GI discomfort * cramping * N&V * diarrha * esophageal ulceration * yellow/brown tooth discoloration * hypoplasia of tooth enamel * hepatotoxicity * photosensitivity * suprainfection of bowel * dizziness and lightheadedness (minocycline)
56
interventions/education for tetracycline GI discomfort
* monitor * for N&V, diarrhea * I/O * take doxy and mino with meals if needed * avoid taking at bedtime to reduce esophageal ulceration
57
interventions/education for yellow/brown tooth discoloration and/or hypoplasia of tooth enamel
avoid in children \< 8 yo and pregnant women (cat. D)
58
interventions/education for tetracycline hepatotoxicity
* monitor for lethargy, jaundice * avoid high daily doses IV
59
education for suprainfection of bowel r/t tetracyclines
report diarrhea to provider
60
education about dizziness/lightheadedness r/t minocycline
be careful walking and report to provider
61
minocycline
* trade name: Dynacin, Minocin, etc. * class: antibiotic, tetracycline * spectrum: broad * route: PO, IV
62
doxycycline
* trade name: Doxy, Doryx, etc. * class: antibiotic, tetracycline * spectrum: broad * route: PO, IV
63
demeclocycline
* trade name: Declomycin * class: antibiotic, tetracycline * spectrum: broad * route: PO
64
tetracycline interactions
* **nonabsorbable chelate formation, ↓ absorption** * milk products * Ca supplements * Fe supplements * Mg laxatives/antacids * **↓ effectiveness of oral contraceptives** * **↑ risk of digoxin toxicity**: minocycline and doxycycline
65
interventions/education for tetracycline + Ca, Fe, or Mg
* take on empty stomach w/ full glass of water * take w/ food if GI distress occurs * minocycline: take with meals * give tetracyclines 1 hr before or 2 hrs after food and supplements w/ Ca and Mg
66
education/interventions for digoxin + minocycline or doxycycline
monitor digoxin level carefully
67
macrolides
* drugs * erythromycin * azithromycin * for pts w/ PCN allergy
68
macrolides uses
* Legionnaires' * pertussis * diphtheria * chlamydia * respiratory infections (Z-pack)
69
macrolides SE/AE
* GI discomfort * N&V * epigastric pain * prolonged QT interval * dysrhythmias * possible sudden cardiac death * ototoxicity w/ high-dose therapy
70
interventions/education for GI discomfort with macrolides
* take erythromycin w/ meals * observe for and report Sx
71
interventions/education for prolonged QT interval w/ macrolides
* use in pts with prolonged QT not recommended * avoid concurrent use w/ meds that affect hepatic drug metabolizing enzymes
72
interventions/education for ototoxicity w/ macrolides
* monitor for * hearing loss * vertigo * ringing in ear * notify provider
73
erythromycin interactions
* inhibits metabolism of * antihistamines * theophylline * carbamazepine * warfarin * digoxin * can lead to toxicity of these meds * avoid concurrent use or monitor carefully
74
nursing admin of macrolides
* PO: on empty stomach * monitor PT/INR in pts taking warfarin * monitor LFT if taking \> 1-2 wks
75
aminoglycosides
* drugs * **gentamicin** * amikacin * tobramycin * neomycin * streptomycin * paromomycin * **toxicity: oto and nephro**
76
aminoglycoside AEs
* ototoxicity * nephrotoxicity * ↑ neuromuscular blockade * hypersensitivity * neurologic d/o (streptomycin)
77
ototoxicity from aminoglycoside use
* damage * cochlear (hearing) * vestibular (balance) * S/Sx * tinnitus * HA * hearing loss * nausea * dizziness * vertigo
78
monitoring for ototoxicity with aminoglycoside use
* S/Sx * tinnitus * HA * hearing loss * nausea * dizziness * vertigo * baseline audiometric study
79
pt education for ototoxicity r/t aminoglycoside use
* stop drug and notify HCP for * tinnitus * hearing loss * HA
80
nephrotoxicity r/t aminoglycosides
* 2/2 high cumulative dose → acute tubular necrosis * S/Sx * proteinuria * casts in urine * dilute urine * ↑ BUN * ↑ creatinine
81
nursing actions for nephrotoxicity r/t aminoglycoside use
* monitor * I&O * BUN * creatinine * notify HCP of * hematuria * cloudy urine
82
pt education for nephrotoxicity r/t aminoglycoside use
report hematuria or cloudy urine
83
neuromuscular AE of aminoglycosides
* intensified neuromuscular blockade → respiratory depression or muscle weakness * closely monitor use in * myasthenia gravis * general anesthetics * skeletal muscle relaxants
84
neurologic d/o with aminoglycosides
* peripheral neuritis * optic nerve dysfunction * tingling/numbness in hands and feet * **promptly report manifestations to HCP**
85
nursing admin of aminoglycosides
* topical: wash w/ soap and water before application * measure levels to prevent toxicity * **for once daily dosing: only measure trough** * peak: 30 min after dose * **trough: 30 min before dose**
86
Meds for UTI are used to treat _____ infections and as _____ in high-risk pts.
* **active** infections * **prophylaxis** in high-risk pts
87
meds for UTI Tx
* sulfonamides * urinary tract antiseptics * floroquinolones * urinary tract analgesics
88
sulfonamides
* drugs * sulfamethoxazol/trimethoprim (SMZ-TMP; Bactrim, Septra) * sulfadiazine * trimethoprim (Primsol) * action: inhibit bacterial growth by preventing synthesis of folic acid
89
erythromycin
* trade name: Erythrocin * class: antibiotic, macrolide * spectrum: broad * route: IV, PO, top
90
azithromycin
* trade name: Zithromax * class: antibiotic, macrolide * spectrum: broad * route: PO, IV
91
gentamicin
* trade name: Garamycin * class: antibiotic, aminoglycoside * spectrum: broad * route: IM, IV, IT, topical
92
amikacin
* trade name: Arikayce * class: antibiotic, aminoglycoside * spectrum: broad * route: IM, IV, inhaln
93
tobramycin
* trade name: Bethkis, TOBI, Kitabis * class: antibiotic, aminoglycoside * spectrum: broad * route: IM, iV, inhaln
94
neomycin
* class: antibiotic, aminoglycoside * spectrum: broad * route: PO
95
streptomycin
* class: antibiotic, aminoglycoside * spectrum: broad * route: IM * **can cause neurologic d/o**
96
paromomycin
* class: antibiotic, aminoglycoside, amebicide * spectrum: broad * route: PO
97
sulfamethoxazol/trimethoprim
* abbreviation: SMZ-TMP * trade name: Bactrim, Septra * class: antibiotic, antiprotozoal, sulfonamide * spectrum: broad * route: PO, IV
98
trimethoprim
* trade name: Primsol * class: antibiotic, sulfonamide * spectrum: broad * route: PO
99
sulfadiazine\*\*\*
100
sulfonamide AE
* hypersensitivity including SJS * blood dyscrasias * crystalluria * kernicterus * photosensitivity
101
sulfonamide interactions
* ↑ effects of * warfarin * phenytoin * sulfonylurea oral hypoglycemics * tolbutamide * ↓ dosages may be required during SMZ-TMP therapy * Labs: PT/INR, phenytoin, and BG
102
hypersensitivity to sulfonamides
* do not give SMZ-TMP to pt with allergy to * sulfa drugs * thiazides * sulfonylureas * loop diuretics * stop drug at first sign of hypersensitivity * report to HCP
103
blood dyscrasias r/t sulfonamide use
* dyscrasias * hemolytic anemia * agranulocytosis * leukopenia * thrombocytopenia * aplastic anemia * baseline and periodic CBC * monitor for and report * **bleeding** * **sore throat** * **pallor**
104
crystalluria r/t sulfonamide use
* crystalline aggregates in kidneys, ureters, bladder → irritation and obstruction → acute kidney injury * prevention: 2-3 L/day PO fluid intake * monitor UOP: ≥ 1200 mL/day
105
kernicterus r/t sulfa drugs
* avoid giving SMZ-TMP to prevent * birth defects: 1st trimester * kernicterus * near-term pregnancy * breastfeeding * infants \< 2 mo
106
sulfonamide complications: SULFA
* **S**JS * **U**rine precipitation/Useful for UTIs * **L**eukopenia/anemia/thrombocytopenia * **F**otosensitivity * **A**dded effect of warfarin, phenytoin, and oral antidiabetics
107
urinary tract antiseptics
* drugs * nitrofurantoin * nitrofurantoin macrocrystals * spectrum: broad * action: damages bacterial DNA
108
urinary tract antiseptic pt teaching
* take nitrofurantoin w/ milk or meals * ↑ oral fluid intake * urine will be dark brown * notify HCP of * HA, drowsiness, dizziness * easy bruising, epistaxis * paresthesias, muscle weakness * SOB, CP, fever, cough, chills * anorexia, N&V, diarrhea
109
AE of urinary tract antiseptics
* GI discomfort * hypersentivity rxn * blood dyscrasias * peripheral neuropathy * HA, drowsiness, dizziness
110
GI discomfort w/ nitrofurantoin
* Sx * anorexia * N&V * diarrhea * give with milk or meals * ↓ dosage, use macrocrystalline tablet to reduce GI discomfort
111
hypersensitivity rxn w/ nitrofurantoin
* w/ severe pumonary Sx * dyspnea * cough * CP * fever * chills * alveolar infiltrations * stop med and call HCP * Sx should subside w/in several days after D/C * don't take nitrofurantoin again
112
blood dyscrasias w/ nitrofurantoin
* dyscrasias * agranulocytosis * leukopenia * thrombocytopenia * megaloblastic anemia * hepatotoxicity * baseline/periodic CBC * monitor for easy bruising and epistaxis * notify HCP of S/Sx
113
peripheral neuropathy w/ nitrofurantoin
* Sx * numbness, tingling of hands and feet * muscle weakness * notify HCP * **avoid chronic use** * **not recommended for pts w/ kidney failure**
114
HA, drowsiness, and dizziness w/ nitrofurantoin use
notify HCP
115
fluoroquinolones
* drugs (-floxacin) * **ciprofloxacin** * ofloxacin * moxifloxacin * levofloxacin * morfloxacin * spectrum: broad
116
fluoroquinolone uses
* alternative to parenteral abx for severe infection * infections of * GU * GI * respiratory * bone * skin * soft tissue * anthrax
117
AE of floroquinolones
* GI discomfort * Achilles' tendon rupture * suprainfection * phototoxicity
118
GI discomfort w/ fluoroquinolones
* usually mild * Sx: N&V, diarrhea * Tx for SE
119
Achilles' tendon rupture w/ fluoroquinolones
* look for Sx at site * pain * swelling * redness * notify provider * D/C cipro * don't exercise until inflammation subsides * do not give to pts \< 18 yo
120
suprainfection w/ fluoroquinolones
* types * candidiasis: vaginal, oral * ↑ risk of C. diff * S/Sx * cottage cheese-like lesions in mouth or genitals * diarrhea * notify HCP
121
phototoxicity w/ fluoroquinolones
* severe sunburn, even with sunscreen * exposure: direct and indirect sunlight, sun lamps * pt education * avoid sun exposure * wear protective clothing and sunscreen at all times * D/C immediately if occurs
122
nursing implications for fluoroquinolone admin
* add metronidazole if C. diff develops * don't take within 2 hrs of * milk and dairy * Al/Mg antacids * IV cipro: diluted, in large vein over 1 hr
123
urinary tract analgesics
* phenazopyridine (Pyridium) * works as local anesthetic
124
phenazopyridine
* trade name: Pyridium, Baridium * class: non-opioid analgesic, urinary tract analgesic * route: PO * available OTC in lower strength * azo dye
125
phenazopyridine use
* local anesthetic * relieves * dysuria * urinary frequency * urinary urgency
126
Phenazopyridine turns urine _____ and stains \_\_\_\_\_.
* urine **orange** * stains **clothes**
127
ciprofloxacin
* trade name: Cipro * class: antibiotic, fluoroquinolone * spectrum: broad * route: PO, IV
128
ofloxacin
* trade name: Floxin * class: antibiotic, fluoroquinolone * spectrum: broad * route: PO, otic
129
moxifloxacin
* trade name: Avelox * class: antibiotic, fluoroquinolone * spectrum: broad * route: PO, IV
130
levofloxacin
* trade name: Levaquin * class: antibiotic, fluoroquinolone * spectrum: broad * route: PO, IV
131
norfloxacin
* trade name: Noroxin * class: antibiotic, fluoroquinolone * spectrum: broad * route: PO * **off-market**
132
nitrofurantoin
* trade name: Macrobid, Macrodantin, Furadantin * class: antibiotic, urinary tract antiseptic * spectrum: broad * route: PO
133
antimycobacterial agents (anti-TB)
* highly specific for mycobacteria * drugs * isoniazid * pyrazinamide * ethambutol * rifapentine
134
latent TB Tx options
* isoniazid only for 6-9 months * isoniazid with rifapentine 1x/wk for 3 months
135
active TB Tx
* must use combo therapy to ↓ resistance * primary med: isoniazid * minimum Tx period: 6 months
136
isoniazid
* trade name: INH * class: antitubercular, antimycobacterial * spectrum: narrow * route: PO, IM
137
isoniazid precautions
* older adults * ETOH abuse
138
AE of isoniazid
* peripheral neuropathy * hepatotoxicity * hyperglycemia and ↓ BG control in DM
139
peripheral neuropathy w/ isoniazid
* Sx * tingling * numbness * burning * pain * cause: pyridoxine (B6) deficiency
140
pt teaching for isoniazid
* peripheral neuropathy * take 50-200 mg vitamin B6 daily * observe for Sx and notify HCP * hepatotoxicity * observe for Sx and notify HCP * avoid ETOH * hyperglycemia in DM * monitor BG * may need additional DM meds
141
hepatotoxicity w/ isoniazid
* S/Sx * anorexia * malaise * fatigue * nausea * jaundice * monitor LFTs: may D/C if elevated
142
↓ BG control in DM w/ isoniazid
* monitor BG * DM pts may need extra DM meds
143
DOT
direct observation therapy
144
direct observation therapy for active TB
med is given by public health nurse to ensure compliance
145
pyrazinamide
* class: antimycobacterial, antitubercular * spectrum: narrow * route: PO
146
ethambutol
* trade name: Myambutol * class: antimycobacterial, antitubercular * spectrum: narrow * route: PO
147
rifapentine
* trade name: Priftin * class: antimycobacterial, antitubercular * spectrum: narrow * route: PO
148
rifampin
* trade name: Rifadin, Rimactane * class: antitubercular, rifamycin * **spectrum: broad** * route: PO, IV
149
rifampin AE
* discoloration of body fluids * hepatotoxicity * mild GI discomfort
150
rifampin: discoloration of body fluids
* teach pt * orange urine, saliva, sweat, and tears
151
hepatotoxicity w/ rifampin
* Sx * jaundice * anorexia * fatigue * malaise * monitor LFT * notify provider * **avoid ETOH**
152
mild GI discomfort w/ rifampin
* mild and usually doesn't require intervention * Sx * anorexia * abd discomfort * nausea
153
antiprotozoals
metronidazole
154
metronidazole uses
* intestinal amoebas * trichomoniasis * **abx-induced C. diff** * gardnerella vaginalis * bacterial vaginitis
155
contraindications of metronidazole
* active CNS d/o * blood dyscrasias * lactation
156
metronidazole precautions
* older adults * d/o of * sz * heart * kidneys
157
metronidazole interactions and interventions
* ETOH-intolerance rxn: avoid ETOH * metronidazole inhibits inactivation of warfarin * monitor PT/INR * adjust warfarin dosage as necessary
158
metronidazole AE
* GI discomfort * darkening of urine * CNS Sx
159
GI discomfort w/ metronidazole
* S/Sx * N&V * dry mouth * metallic taste * report to provider
160
Dark urine is a _____ SE of metronidazole.
harmless
161
CNS Sx with metronidazole
* Sx * numbness of extremities * ataxia * sz * notify provider * stop metronidazole
162
antifungals
* **IV only**: **amphotericin B** * **PO only: ketoconazole** * PO, top * flucytosine * nystatin * miconazole * clotrimazole * terminafine * fluconazole * griseofulvin
163
amphotericin B AE
* infusion rxn * thrompophlebitis * nephrotoxicity * bone marrow suppression * hypokalemia
164
infusion rxn w/ amphotericin B
* S/Sx * fever * chills * rigors * HA * timing: 1-3 hrs after infusion start * **test dose: 1 mg, slowly via IV** * pre-Tx: diphenhydramine, acetaminophen * rigors Tx: meperidine, dantrolene, or hydrocortisone
165
thrombophlebitis w/ amphotericin B
* monitor infusion site * rotate injection sites * give in large vein * pre-Tx: heparin
166
nephrotoxicity w/ amphotericin B
* baseline and weekly BUN and creatinine * monitor I&O * infuse 1 L saline on day of ampho infusion
167
bone marrow suppression w/ amphotericin B
baseline and weekly CBC
168
hypokalemia w/ amphotericin B
* monitor electrolyte panel, esp. K+ * give K+ supplements as indicated
169
ketoconazole AE
* hepatotoxicity * anorexia * N&V * jaundice * dark urine * clay-colored stools * baseline and monthly LFTs * notify HCP and D/C med
170
aminoglycosides + antifungals =
* **additive nephrotoxic risk** * avoid concurrent use
171
azole abx + antifungals =
* ↑ levels of some meds, including * digoxin * warfarin * sulfonylureas * if concurrent use necessary, monitor more closely for toxicity
172
nursing implications for antifungals
* amphotericin B * bad: only use for life-threatening infection * give IVPB over 2-4 hrs * watch closely for rxn * PO liquid nystatin for thrush * swish around and hold in mouth as long as possible, then swallow
173
antibiotic
* antimicrobial * treats infection caused by * bacteria * viruses * fungi
174
**3 ways** antimicrobials work to fight infection
* destroy bacterial cell wall * inhibit conversion of enzymes necessary for bacteria * impair protein synthesis to inhibit growth
175
conjugation
changes in micro-organism DNA that causes resistance
176
suprainfection
when normal flora killed of by abx and new, hard-to-treat infection develops
177
classes of antimicrobial meds
* by susceptible microbe * narrow-spectrum * broad-spectrum * by action * bactericidal * bacteriostatic * type of microbe * antibacterial * antifungal * antiviral
178
methods of identifying causative organism in infection
* testing body fluids * blood * urine * sputum * wound * collect specimen **before med is started** * avoid contamination
179
sensitivity testing
* done after microbe of infection is identified * gram stain: gram-negative bacteria harder to treat w/ impermeable wall
180
Immunocompromised pts may require _____ \_\_\_\_\_ to treat infections.
stronger abx
181
host factors affecting Tx of infection
* immune system * site of infection * age * pregnancy * allergies
182
age as a factor in Tx of infection
* infants: toxicity r/t immature kidney and liver fxn * older adults: toxicity r/t slowed metabolism and excretion
183
PG as a factor in Tx of infection
* not gentamicin: ototoxicity in baby * no tetracycline: tooth damage in baby
184
sites of infection that are harder to treat
* CSF: abx must cross BBB * heart * places w/ poor circulation * foreign objects: i.e., synthetic joints and heart valves
185
Combo abx therapy can cause what **3 types of effects**?
* additive * potentiative * antagonistic
186
pros of combo abx therapy
* Tx of * severe infection * infections caused by more than one microbe * prevents bacterial resistance from causing infection * ↓ chance of toxicity (↓ overall dosage) * more effective Tx
187
cons of combo abx therapy
* ↑ resistance to abx * ↑ cost of therapy * ↑ risk for adverse or toxic rxn * antagonistic effects of various abx * ↑ risk for suprainfection
188
prophylactic use of antimicrobial therapy in surgical pts
* GI * cardiac * vascular * orthopedic * some GYN surgeries
189
prophylactic use of antimicrobials
* surgical pts * exposure to flu * exposure to STDs * special cases: heart valve, recurring UTI
190
retrovirus
must attach to host cell to replicate
191
antiretrovirals
* Tx for HIV * not a cure * methods of action * prevent virus from entering cells * inhibit enzymes needed to replicate
192
goals of antiretroviral therapy
* ↓ viral load to undetectable level → * ↓ risk of transmission * longer life expectancy
193
ART
antiretroviral therapy
194
HAART
* highly active antiretroviral therapy * 3-4 meds concurrently * ↓ resistance, AE, and dosages
195
noncompliance with ART →
* resistance * possible Tx failure
196
NRTI
nucleoside reverse transcriptase inhibitor
197
NRTIs
* drugs * **zidovudine** * didansocine * stavudine * lamivudine * abacavir * first-line ART for HIV * many combos in one tablet or capsule
198
AE of NRTIs
* zidovudine: bone marrow suppression * lactic acidosis * nausea, vomiting, diarrhea * hepatomegaly/fatty liver
199
labs for NRTIs
* bone marrow suppression: CBC/platelets * GI distress: fluids and electrolytes * hepatomegaly/fatty liver: LFTs
200
S/Sx of lactic acidosis
* hyperventilation * nausea * abd pain
201
NRTIs: GI distress
* take med with food * monitor fluids/electrolytes
202
Teach pts taking NRTIs to take all meds daily to avoid _____ \_\_\_\_\_.
medication resistance
203
types of antiretrovirals
* NRTIs * protease inhibitors * acyclovir * ganiclovir
204
protease inhibitors
* drugs * rionavir * sazuinavir * indinavir * fsamprenavir * nelfinavir * lopinavir * action: inactivate virus by inhibiting enzymes needed for replication * **lots of interactions; get COMPLETE medication Hx**
205
AEs of protease inhibitors
* bone loss/osteoporosis * hyperglycemia * hypersensitivity rxn * N&V * ↑ serum lipids * thrombocytopenia, leukopenia
206
labs for protease inhibitors
* BG: hyperglycemia * lipids: hyperlipidemia * CBC: thrombocytopenia, leukopenia
207
bone loss r/t protease inhibitors
* eat diet high in Ca and vitamin D * possible Tx for severe bone loss: raloxifene, alendronate
208
hyperglycemia r/t protease inhibitors
* adjust diet * give antidiabetic meds as prescribed * monitor for 3 Ps: polydipsia, polyuria, polyphagia
209
hypersensitivity rxn to protease inhibitors
rash
210
N&V r/t protease inhibitors
take with food
211
hyperlipidemia r/t protease inhibitors
adjust diet
212
blood dyscrasias r/t protease inhibitors
* monitor * CBC * S/Sx of infection * S of bleeding
213
acyclovir uses
* HSV * varicella-zoster
214
acyclovir contraindications
* dehydration * renal impairment * other nephrotoxic meds
215
AE of acyclovir
* phlebitis * rotate injection sites * monitor IV site * nephrotoxicity * give slowly over 1 hr * ensure adequate hydration; PO and IV fluids
216
ganciclovir uses
* CMV * prophylaxis in some pts * HIV * organ transplant * immunosuppression/compromise
217
ganciclovir contraindication
pts w/ neutrophils \< 500/mm3
218
ganciclovir AE
bone marrow suppression
219
zidovudine
* trade name: Retrovir * class: antiretroviral, NRTI * route: PO, iV
220
didansocine
* trade name: Videx * class: antiretroviral, NRTI * route: PO
221
stavudine
* trade name: Zerit * class: antiretroviral, NRTI * route: PO
222
lamivudine
* trade name: Epivir * class: antiretroviral, NRTI * route: PO
223
abacavir
* trade name: Ziagen * class: antiretroviral, NRTI * route: PO
224
rionavir
* trade name: Norvir * class: antiretroviral, protease inhibitor * route: PO
225
sazuinavir
* trade name: Invirase * class: antiretroviral, protease inhibitor * route: PO
226
indinavir
* trade name: Crixivan * class: antiretroviral, protease inhibitor * route: PO
227
fosamprenavir
* trade name: Lexiva * class: antiretroviral, protease inhibitor * route: PO
228
nelfinavir
* trade name: Viracept * class: antiretroviral, protease inhibitor * route: PO
229
lopinavir/ritonavir
* trade name: Kaletra * class: antiretroviral, protease inhibitor (lopinavir), metabolic inhibitor (ritonavir) * route: PO
230
acyclovir
* trade name: Sitavig, Zovirax * class: antiviral, purine analog * route: PO, buccal, IV, topical
231
genciclovir
* trade name: Cytovene * class: antiviral * route: IV
232
DSM 5 anxiety d/o
* generalized * panic d/o * OCD * social * PTSD
233
interventions for anxiety
* therapy * biofeedback * relaxation techniques * medications
234
common anxiety Sx
* nervousness * restlessness * feeling tense * sense of impending danger, panic, or doom * ↑ HR * hyperventilation * sweating * trembling * feeling weak or tired * trouble concentrating or thinking about anything other than the present worry * trouble sleeping * GI problems * difficulty controlling worry * urge to avoid things that trigger anxiety
235
classes of meds for anxiety
* benzodiazepines * atypical/non-barbiturate anxiolytics * SSRIs * SNRIs * TCAs
236
therapeutic uses of benzodiazepines
* sedative * hypnotic * anxiolytic
237
less common meds for anxiety
* MAOIs * mirtazapine (tetracyclic) * trazodone * hydroxyzine (antihistamine) * propranolol (stage fright) * prazosin (alpha blocker, for nightmares) * gabapentin (anticonvulsant)
238
benzodiazepines
* mostly -pam and -lam names * generally used short-term (risk for dependence) * drugs * **alprazolam (Xanax)** * diazepam (Valium) * lorazepam (Ativan) * chlordiazepoxide (Librium) * clonazepam (Klonopin) * **Schedule IV**
239
MOA: benzodiazepines
* work fast: rapid relief * enhances inhibitory effects of GABA in CNS
240
uses for benzodiazepines
* GAD and panic d/o * trauma d/o * sz d/o * insomni * muscle spasm * acute manifestations of ETOH withdrawal * induction of anesthesia * amnesic before surgery/procedure
241
complications of benzos
* CNS depression * anterograde amnesia * toxicity * paradoxical response * withdrawal Sx (long-term use)
242
CNS depression w/ benzos
* sedation * lightheadedness * ataxia * ↓ cognitive fxn
243
toxicity S/Sx w/ benzos
* oral * drowsiness * lethargy * confusion * IV * respiratory depression * hypotension * cardiac arrest
244
paradoxical response S/Sx w/ benzos
* insomnia * excitation * euphoria * anxiety * rage
245
withdrawal from benzos
* with long-term use * taper dose * Sx * anxiety * insomnia * diaphoresis * tremors * lightheadedness
246
retrograde amnesia
inability to recall past memories
247
anterograde amnesia
inability to create new memories
248
Tx for benzo OD
* PO * gastric lavage * activated charcoal or saline cathartics * IV * flumazenil to counteract sedation * maintain airway * IV fluids for BP * **be ready to resuscitate**
249
diazepam
* trade name: Valium, Diastat * class: **benzodiazepine**, anxiolytic, anticonvulsant, centrally acting muscle relaxant, sedative/hypnotic * **Schedule IV** * route: PO, IM, IV, rectal
250
diazepam contraindications and precautions
* pregnancy: D * contra * sleep apnea * respiratory depression * glaucoma * cuation * liver dz * Hx of mental illness or substance abuse
251
benzodiazepine interaction
* CNS depressants: may result in respiratory depression * ETOH * barbiturates * opioids * other
252
nursing admin for benzodiazepines
* take as prescribed * taper dose to prevent withdrawal * don't crush or chew sustained-release or enteric-coated * notify provider of concerns about developing dependence
253
atypical/non-barbiturate anxiolytic
buspirone
254
buspirone
* trade name: BuSpar * class: atypical/non-barbiturate anxiolytic * route: PO
255
buspirone action
* not fully understood * does not bind to serotonin and dopamine receptors * dependency much less likely * **no sedation or potentiation of effects of other CNS depressants**
256
buspirone uses
* panic d/o * social anxiety d/o * OCD * PTSD/trauma
257
complications of buspirone use
* dizziness * HA * lightheadedness * agitation * nausea: take with food * **teaching: most effects are self-limiting**
258
buspirone onset
* onset: 7-10 days * peak: 3-4 wks * **7 days to notice effects** * **up to 2-6 wks for full effect**
259
nursing admin of buspirone
* schedule dosage, not PRN * tolerance dependence, and withdrawal not an issue
260
SSRIs for anxiety
* American Association of Family Physicians * 1st-line Tx * therapy can be as effective as meds * antidepressants can work as anxiolytics
261
depressive d/o
* major * dysthymia * postpartum * w/ psychotic features * atypical * PMDD * bipolar * situational
262
therapies for depression
* cognitive behavioral * behavioral * psychotherapy
263
meds for depression
* antidepressants * antipsychotics
264
other interventions for depression
* ECT * hospitalization
265
common mood Sx of depression
* anxiety * apathy * general discontent * guilt * hopelessness * loss of interest * loss of interest or pleasure in activities * mood swings * sadness
266
common cognitive Sx of depression
* poor concentration * slowness in activity * thoughts of suicide
267
common behavioral Sx of depression
* agitation * excessive crying * irritability * restlessness * social isolation
268
common sleep Sx of depression
* early awakening * excess sleepiness * insomnia * restless sleep
269
common GI Sx of depression
* excessive hunger * loss of appetite * wt gain or loss
270
**2 other common Sx** of depression
* fatigue * repeatedly going over thoughts
271
**5 main classes** of antidepressants
* SSRIs * SNRIs * atypical * TCAs * MAOIs
272
SSRIs
* **1st-line Tx for depression** * drugs * **fluoxetine (Prozac)** * citalopram (Celexa) * escitalopram (Lexapro) * paroxetine (Paxil) * sertraline (Zoloft) * fluvoxamine (Luvox) * vortioxetine (Trintellix)
273
SSRI action
* selectively blocks reuptake of serotonin in synaptic space * intensifies effects of serotonin
274
SSRI uses
* major depression * OCD * bulimia nervosa * PMDD * panic d/o * PTSD
275
early complications of SSRI use
* 1st few days to wks * SE * nausea * tremor * diaphoresis * fatigue * drowsiness * report to provider * take med as prescribed * effects usually subside
276
later complications of SSRI use
* 5-6 wks * sexual dysfunction * impotence * delayed/absent * orgasm * ejaculation * ↓ libido * report to HCP * management * ↓ dose * med holiday * changing meds
277
other complications of SSRIs
* bruxism * wt gain * hyponatremia * GI bleed * **withdrawal syndrome** * **serotonin syndrome**
278
bruxism w/ SSRIs
* grinding/clenching teeth, usually in sleep * report to provider * switch to another med class * Tx w/ low-dose buspirone * use mouth guard
279
hyponatremia w/ SSRIs
* more likely in older adults taking diuretics * baseline/periodic serum Na+
280
GI bleed w/ SSRIs
* report S/Sx * avoid NSAIDs
281
withdrawal syndrome w/ SSRIs
* S/Sx * nausea * sensory disturbances * anxiety * tremor * malaise * unease * minimize by tapering * **DO NOT D/C ABRUPTLY**
282
S/Sx of serotonin syndrome
* agitation * confusion * disorientation * difficulty concentrating * anxiety * hallucinations * hyperreflexia * incoordination * tremor and rigidity * fever * diaphoresis * shivering/↑ temp
283
onset of serotonin syndrome
2-72 hrs after start of Tx
284
Serotonin syndrome resolves within ___ hrs of _____ of meds affecting serotonin, and can be \_\_\_\_\_.
* resolves within **24** hrs of **D/C** * can be **lethal**
285
serotonin syndrome pt education
* S/Sx * watch for a report immediately
286
D/C MAOIs ___ days before starting an SSRI.
**14** days
287
factors ↑ risk of serotonin syndrome
* concurrent use of * St. John's wort * other meds affecting serotonin * MAOIs * TCAs * tryptophan
288
serotonin syndrome
toxic state caused by ↑ in brain serotonin activity
289
SSRI interactions
* MAOIs, TCAs, St. John's wort: serotonin syndrome * fluoxetine * can displace warfarin from bound protein → ↑ warfarin level * can ↑ levels of TCAs, lithium * suppresses platelet aggregation
290
fluoxetin + warfarin =
* ↑ warfarin level * cause: fluoxetine displaces warfarin from bound protein * interventions * monitor PT/INR * assess for bleeding * may need dosage adjustment
291
fluoxetine + TCA or lithium =
* ↑ TCA or lithium levels * avoid concurrent use
292
suppressed platelet aggregation in fluoxetine use
* ↑ risk of bleeding * avoid concurrent use of * NSAIDs * anticoagulants * pt education * monitor for bruising, hematuria, other s of bleeding * notify provider
293
SSRI precautions
* Hx of GI bleed or ulcers * meds affecting coagulation * Hx of sz * debilitation (risk of sz) * chronic illness * multiple-drug therapy * DM * angle-closure glaucoma * hepatic impairment * dz * peds * geri * pregnancy: C
294
SSRI contraindications
* hypersensitivity * concurrent use of * MAOIs or MAO-like drugs * pimozide * thioridazine: D/C fluoxetine ≥ 5 wks before therapy
295
atypical antidepressant
bupropion (Wellbutrin)
296
bupropion uses
* depression * SAD * alternate to SSRI if sexual dysfunction is major problem * ADHD * smoking cessation * wt loss
297
bupropion action
* not fully understood * likely inhibits dopamine uptake
298
bupropion AE
* HA * dry mouth * GI distress * constipation * ↑ HR * restlessness * insomnia * suppressed appetite * wt loss * sz
299
pt education and interventions for bupropion AE
* notify provider if effects intolerable * HA: mild analgesic * dry mouth: sip fluids * constipation: ↑ fiber and fluids * monitor pt wt and food intake * avoid use in pts w/ sz risk * monitor for sz, treat
300
buproprion + MAOIs =
* ↑ risk of toxicity * D/C MAOI 2 wks before starting bupropion
301
TCAs
* **prototype: amitriptyline** * action: blocks reuptake of norepinephrine and serotonin
302
TCA uses
* **depression** * **depressive episodes of bipolar d/o** * neuropathic pain * fibromyalgia * anxiety d/o * insomnia
303
AEs of TCAs
* orthostatic hypotension * anticholinergic effects * sedation * toxicity → cholinergic blockade, cardiac toxicity * ↓ sz threshold: monitor pts w/ sz d/o * excessive sweating
304
S/Sx of TCA toxicity
* early * dysrhythmias * confusion * agitation * late * sz * coma * death
305
nursing actions for TCA toxicity
* monitor ECG * monitor VS frequently * monitor for S/Sx of toxicity * notify provider of signs
306
anticholinergic effects and interventions
* dry mouth: sugarless gum, sip water * blurred vision * photophobia: sunglasses outdoors * urinary hesitancy or retention: void just before taking * constipation: ↑ fiber, 2-3 L fluid/day * exercise regularly * **notify provider if effects persist**
307
TCA interactions
* avoid concurrent use * MAOIs, St. John's wort: serotonin syndrome * antihistamines, other anticholinergics * ↑ effects of epinephrine, dopamine * ↓ effects of ephedrine, amphetamine * CNS depressants: additive effect
308
MAOI prototype
phenelzine (Nardil)​
309
uses for MAOIs
* depression * bulimia nervosa
310
MAOI action
* block MAO action in brain * → ↑ available norepinephrine, dopamine, and serotonin
311
MAOI complications
* CNS stim * orthostatic hypotension
312
S/Sx of CNS stim in MAOI use
* anxiety * agitation * mania * **notify provider**
313
MAOI interactions
* vasopressors: HTN * dietary tyramine: HTN crisis * TCAs, SSRIs: serotonin syndrome
314
vasopressor + MAOI =
* HTN * avoid foods containing PEA, caffeine
315
PEA
phenylethylamine
316
phenylethylamine
* organic compound that acts as neurotransmitter * found in foods like * chocolate * nuts * beans * byproduct of phenylalanine
317
dietary tyramine + MAOI =
* hypertensive crisis * call 911 or go to ER
318
TCA or SSRI + MAOI =
* serotonin syndrome * seek medical attention immediately
319
hypertensive crisis
* systolic ≥ 180 * diastolic ≥ 120
320
tyramine-rich foods
* aged cheese * pepperoni * salami * smoked fish * avocados * figs * bananas * protein supplements * soups * soy sauce * some beers * red wine
321
S/Sx of hypertensive crisis
* ↑ BP * **Nausea** * **↑ HR** * ***Severe HA*** * *Epistaxis* * *Blurred vision* * *SOB* * *Severe anxiety* * ​***bold: most common** * italic: call 911*
322
nursing admin for all antidepressants
* teaching * regimen * withdrawal * duration * assess for suicide risk: highest in \< 25 yo
323
antidepressant regimen
* onset: 1-3 wks for therapeutic effect * full effect: 2-3 months * duration * usually 6 months after Sx resolve * can continue ≥ 1 yr
324
Antidepressants can _____ risk for suicide, esp. during _____ Tx. Pt starts to feel better, has _____ to act on negative feelings.
* **increase** risk * during **initial** Tx * has **motivation** to act
325
pt teaching for SSRIs
* take in morning to minimi sleep disturbance * take with food to minimize GI issues
326
nursing admin: TCAs
* monitor for toxicity (cardiac dysrhythmias) * take at bedtime (sedation, orthostatic hypotension
327
nursing admin for MAOIs
* tyramine-rich food list for pt * avoid any other meds unless approved by HCP
328
SSRI nursing admin
* pt education: take in morning w/ food * older adults: baseline/periodic Na+
329
evaluation of antidepressant effectiveness
* verbalizing improvement in mood * ability to perform ADLs * improved sleeping/eating habits * increased peer interaction
330
bipolar d/o
* bipolar I * bipolar II * rapid cycling * mixed bipolar * cyclothymia
331
therapies for bipolar d/o
* support group * cognitive behavioral * psychoeducation * family therapy * psychotherapy
332
meds for bipolar
* **first-line: mood stabilizers** * anticonvulsants * antipsychotics * SSRIs
333
mood stabilizers prototype
lithium carbonate (Lithan, Eskalith, Lithotabs)
334
mood stabilizer action
* neurochemical changes including serotonin receptor blockade * can show * ↓ in neuronal atrophy * ↑ in neuronal growth
335
mood stabilizer uses
* Tx of bipolar d/o * controls acute mania episodes * helps prevent mania or depression * ↓ incidence of suicide * other * ETOH use disorder * bulimia nervosa * psychotic d/o
336
other classes of meds used for bipolar d/o
* anticonvulsants * atypical antipsychotics * anxiolytics * antidepressants
337
complications of mood stabilizers
* GI distress * fine hand tremors * wt gain * polyuria and mild thirst * renal toxicity * goiter/hypothyroidism * bradycardia, hypotension, electrolyte imbalance
338
Fine hand tremors with mood stabilizer use is an early sign of \_\_\_\_\_.
toxicity
339
labs with mood stabilizers
* baseline/periodic renal fxn * baseline annual thyroid fxn
340
early lithium toxicity serum level
\< 1.5 mEq/L
341
early lithium toxicity manifestations
* diarrhea * N&V * thirst * polyuria * muscle weakness * fine hand tremor * slurred speech
342
early lithium toxicity interventions/education
* withhold med * notify provider * new dosage based on serum level
343
advanced lithium toxicity serum level
1.5-2.0 mEq/L
344
advanced lithium toxicity manifestations
* ongoing GI distress * N&V * diarrhea * mental confusion * poor coordination * coarse tremors
345
advanced lithium toxicity interventions
* withhold med * notify provider * new dosage * severe: may ↑ excretion
346
severe lithium toxicity serum level
\> 2.0 mEq/L
347
S/Sx of severe lithium toxicity
* serum level 2.0-2.5 mEq/L * extreme polyuria of dilute urine * tinnitus * blurred vision * ataxia * sz * severe hypotension → * coma * possibly death from respiratory complications
348
severe lithium toxicity Tx (2.0-2.5 mEq/L)
* emetic for alert pt * gastric lavage * one of these meds to ↑ rate of excretion * urea * mannitol * aminophylline
349
severe lithium toxicity manifestations (\> 2.5 mEq/L)
rapid progression of Sx → coma and death
350
severe lithium toxicity Tx (\> 2.5 mEq/L)
hemodialysis
351
lithium contraindications
* pregnancy * D * teratogenic, especially in 1st trimester * breastfeeding
352
lithium precautions
* renal dysfunction * heart dz * sodium depletion * dehydration
353
lithium interactions
* diuretics: ↓ serum Na+ → ↓ lithium excretion → toxicity * NSAIDs * anticholinergics
354
pt teaching for lithium
* take in adequate sodium * get 2-3 L water/day * **need regular labs to check level** * ​risk of toxicity * look for * diarrhea * vomiting * excessive sweating * regimen: 2-3 doses daily * onset: 1-2 wks
355
nursing admin for lithium
* periodic plasma levels * periodic * more frequent for older adults * draw in morning * toxicity * need care in acute setting * supportive measures * hemodialysis possible
356
monitoring lithium levels
* initially: q 2-3 days * periodic: q 1-3 months * draw in morning, usually 12 hr after last dose * therapeutic range: 0.4-1.0 mEq/L
357
psychotic d/o
* disorders * schizophrenia (most common) * schizoaffective d/o * schizophreniform d/o * brief psychotic d/o * delusional d/o * substance-induced psychotic d/o * clinical course: acute exacerbations w/ intervals of semi-remission
358
positive Sx of schizophrenia
* presence of problematic behaviors * examples * hallucinations, esp. auditory * delusions, esp. persecutory * disorganized thought * nonsensical speech * bizarre behaviors
359
negative Sx of schizophrenia
* absence of healthy behaviors * examples * flat affect * ↓ social interaction * anhedonia * avolition * alogia * catatonia
360
anhedonia
lack of pleasure in acts that are usually pleasurable
361
avolition
lack of motivation, initiative, or focus on tasks
362
alogia
* complete speechlessness * poverty of speech * negative Sx of schizophrenia
363
catatonia
* moving less * characterized by motor immobility, behavioral abnormalities, and stupor
364
delusions
* illusory beliefs * fixed, false belief that is not grounded in reality and persists despite clear evidence that it is mistaken
365
hallucinations
* false perception having no relation to reality and not accounted for by any exterior stimulus * dreamlike or nightmarish perception occurring while awake * **can affect any of the 5 senses** * auditory * visual * tactile * gustatory * olfactory
366
goals of pharmacological Tx in psychotic d/o
* **suppressing** acute episodes * **decrease** in psychotic findings * **preventing** acute recurrence * maintaining **highest possible level of fxn**
367
first-generation (conventional) antipsychotics
* works mostly to control **positive Sx** * reserved for those * using them successfully and **tolerating SE** * with **violent or aggressive behaviors** * **​prototype: chlorpromazine (Thorazine)**
368
2nd- and 3rd-gen (atypical) antipsychotics
* **meds of choice** for psychotic d/o * fewer SE * more effective * relief of **positive AND negative Sx** * ↓ affective manifestations * improve cognitive deficits * ↓ relapse
369
other 1st-gen (conventional) antipsychotics
* high-potency * haloperidol (Haldol) * fluphenazine (Prolixin) * thiothixene (Navane) * medium-potency: perphenazine (Trilafon)
370
MOA: 1st-gen (conventional) antipsychotics
* blocks brain receptors for * **dopamine (D2)** * acetylcholine * histamine * norepinephrine (NE) * inhibition of psychotic manifestations (D2)
371
uses for 1st-gen (conventional) antipsychotics
* acute and chronic psychotic d/o * schizophrenia spectrum d/o * bipolar d/o, esp. manic phase * Tourette's d/o * prevention of N&V
372
chlorpromazine
* trade name: Thorazine * class: antiemetic, antipsychotic, phenothiazine * route: PO, IM, IV
373
haloperidol
* trade name: Haldol * class: antipsychotic, butyrophenone * potency: high * route: PO, IM, IV
374
fluphenazine
* trade name: Prolixin * class: antipsychotic, phenothiazine * potency: high * route: PO, IM
375
thiothixene
* trade name: Navane * class: antipsychotic, thioxanthene * potency: high * route: PO
376
perphenazine
* trade name: Trilafon * class: antipsychotic, phenothiazine * potency: medium * route: PO
377
EPS
extrapyramidal side effects
378
EPS of medications
* muscular rigidity * tremor * bradykinesia * difficulty walking (neuroleptic meds) * drug-induced parkinsonism
379
EPS of 1st-gen (conventional) antipsychotics
* acute dystonia * parkinsonism * akathisia * tardive dyskinesia (TD)
380
TD
tardive dyskinesia
381
acute dystonia r/t conventional antipsychotics
* **crisis situation**: rapid Tx needed * Sx: severe spasms of * tongue * neck * face * back * onset: 5 hrs to 5 days after first dose
382
Tx for acute dystonia r/t conventional antipsychotics
* anticholinergic agent * benztropine * diphenhydramine * PO for less acute * IM or IV for serious effects
383
parkinsonism r/t conventional antipsychotics
* S/Sx * bradykinesia * rigidity * **shuffling gait** * drooling * tremors * onset: within 1 month of start of therapy
384
Tx for parkinsonism r/t conventional antipsychotics
* possible meds * benztropine * diphenhydramine * amantadine * D/C these to see if resolved * if Sx return, give atypical antipsychotic
385
akathisia r/t conventional antipsychotics
* S/Sx * inability to stand or sit still * continually pacing and agitated * onset: within 2 months of start of Tx
386
management of akathisia r/t conventional antipsychotics
* beta blocker * benzodiazepine * anticholinergic
387
TD r/t conventional antipsychotics
* S/Sx: involuntary movements * tongue and face (lip-smacking) * arms, legs, or trunk * onset: months or yrs after start of Tx * can improve w/ med change or **become permanent**
388
management of TD r/t conventional psychotics
* lowest dosage possible to control Sx * evaluate after 12 months of therapy, then q 3 months * if TD appears, ↓ dosage or switch to atypical agent
389
other complications of conventional antipsychotics
* neuroleptic malignant syndrome * anticholinergic effects * neuroendocrine effects * sz * photosensitivity * dermatitis * orthostatic hypotension * severe dysrhythmias * sedation * sexual dysfunction * agranulocytosis
390
neuroleptic malignant syndrome S/Sx
* sudden high-grade fever * BP fluctuations * dysrhythmias * muscle rigidity * change in LOC → coma
391
non-pharm Tx for neuroleptic malignant syndrome
* stop antipsychotic med * monitor VS * apply cooling blankets * ↑ fluid intake * wait 2 wks before resuming therapy * consider switch to atypical
392
pharm management for neuroleptic malignant syndrome
* antipyretics: ASA, acetaminophen * diazepam (Valium) for anxiety * dantrolene (Dantrium) to relax muscles
393
anticholinergic effects
* dry mouth * blurred vision * photophobia * urinary hesitance/retention * constipation * tachycardia
394
neuroendocrine effects of conventional antipsychotics
* gynecomastia * galactorrhea * menstrual irregularities
395
Pts need regular health care visits and _____ about conventional antipsychotics and potential \_\_\_\_\_.
* **teaching** about * potential **complications**
396
substance use disorder substances
* ETOH * caffeine * cannabis * hallucinogens * inhalants * opioids * sedatives/hypnotics/anxiolytics * stimulants * tobacco * anabolic steroids * betel nut * others
397
abstinence
suddenly withdrawing from a substance to which a physical dependence has developed
398
tolerance
requirement for increased amounts of a substance to achieve the desired effect
399
withdrawal
physiological manifestations occurring upon decline of the blood concentration of a substance to which a person is physically dependent
400
Degree of withdrawal severity depends on the \_\_\_\_\_.
substance
401
withdrawal manifestations
* GI distress * neurological and behavioral changes * CV changes * sz * coma * death
402
ETOH withdrawal timing
* onset: within 4-12 hrs of last intake * peak: after 24-48 hrs * duration: 5-7 days, unless delirium occurs
403
ETOH withdrawal manifestations
* N&V * tremors * restlessness * insomnia * depression * irritability * ↑ VS * toni-clonic sz * illusions
404
delirium timing
* onset: 2-3 days after cessation of ETOH * duration: 2-3 days
405
ETOH withdrawal delirium is a medical \_\_\_\_\_.
emergency
406
ETOH withdrawal delirium findings
* severe disorientation * hallucinations * severe HTN * cardiac dysrhythmias that may → death
407
most important question about alcohol withdrawal
When was your last alcoholic drink?
408
drugs to manage ETOH withdrawal
* chlordiazepoxide (Librium) * diazepam (Valium) * lorazepam (Ativan)
409
therapeutic actions of pharm management in ETOH withdrawal
* maintenance of VS WNL * ↓ risk of sz * ↓ intensity of Sx
410
ETOH abstinence maintenance drug prototype
* disulfiram (Antabuse) * daily PO med * aversion (behavioral) therapy
411
disulfiram + ETOH =
acetaldehyde syndrome
412
S/Sx of acetaldehyde syndrome
* N&V * weakness * sweating * palpitations * hypotension * can → * respiratory depression * CV suppression * sz * death
413
Pts taking disulfiram should be taught about the potential danges of drinking any \_\_\_\_\_. This includes what common products?
* alcohol * products * mouthwash * cough syrup * aftershave lotion
414
pt education for disulfiram/abstinence maintenance
* **dangers of any alcohol intake** * wear medical alert bracelet * participate in 12-step program * effects persist for 2 wks after D/C of disulfiram * will need frequent LFTs
415
labs for disulfiram
frequent LFTs
416
other drugs for ETOH abstinence maintenance
* naltrexone * acamprosate
417
naltrexone for ETOH abstinence
* opioid antagonist * suppresses cravings and pleasurable effects of ETOH * take an accurate Hx * ask if pt also dependent on opioids * natrexone + opioids = ↑ risk of opiate OD
418
acamprosate for ETOH abstinence
* ↓ unpleasant effects (anxiety, restlessness) * pt education * possible SE: diarrhea * maintain adequate fluid intake * get adequate rest
419
opioid withdrawal timing
within 1 hr to several days after cessation
420
Manifestations of opioid withdrawal are non\_\_\_\_\_-\_\_\_\_\_\_, but _____ may occur.
* **nonlife-threatning** * **SI** may occur
421
opioid withdrawal clinical findings
* agitation * insomnia * flu-like Sx * rhinorrhea * yawning * sweating * diarrhea
422
Tx for opioid cessation
* withdrawal: clonidine * substitution/maintenance (must be tapered) * methadone * buprenorphine * encourage 12-step
423
clonidine for opioid withdrawal
* centrally acting alpha agonist * **won't reduce cravings** * Tx for Sx of withdrawal
424
methadone for opioid substitution/maintenance
* PO * opioid agonist * prevents withdrawal * can be used long-term
425
buprenorphine for opioid substitution/maintenance
* partial opioid agonist * ↓ cravings * may help with adherence
426
nicotine withdrawal Sx
* dry mouth * insomnia
427
drugs for nicotine withdrawal
* bupropion (Wellbutrin) * nicotine replacement therapy * varenicline (Chantix)
428
bupropion for nicotine cessation
* ↓ nicotine craving * ↓ withdrawal manifestations
429
Use of nicotine replacement therapy approximately _____ the rate of smoking cessation.
doubles
430
nicotine replacement therapy products
* gum: not recommended for \> 6 months * patch * nasal spray: rapid rise in blood level like smoking
431
pt education for nicotine replacement therapy
* avoid nicotine products while PG or breastfeeding * avoid use of other nicotine products while using replacement
432
varenicline for nicotine cessation
* nicotinic receptor agonist * promotes release of dopamine * ↓ cravings and severity of withdrawal * blocks desired effects of nicotine * ↓ incidence of relapse
433
contraindications for varenicline
* chronic depression * serious mental illness * SI
434
pt education for varenicline
* take after meal * monitor * BP * BG if DM * follow instructions for titration to minimize AE * notify provider of * N&V * insomnia * new-onset depression * suicidal thoughts
435
evaluation for substance cessation
* absence of injury, legal issues, etc. * ↓ cravings for substance * abstinence * regular attendance of self-help group * improved coping skills to replace use
436
meds for children and adolescents with mental health issues
* antidepressants * antipsychotics * nonbarbiturate anxiolytics * CNS stimulants
437
Parents should understand that pharm management of mental health issues in children and adolescents is most effective when accompanied by techniques to _____ \_\_\_\_\_.
modify behavior
438
CNS stimulants for children and adolescents
* methylphenidate (Rialin, Methylin) * dexmethylphenidate (Focalin) * destroamphetamine (Dexedrine) * amphetamine mixture (Adderall) * lisdexamfetamine dimesylate
439
CNS stimulant action
* ↑ CNS levels of * norepinephrine * serotonin * dopamine
440
CNS stimulant use in children and adolescents
* ADHD * oppositional defiant d/o * conduct d/o * intermittent explosive d/o * autism spectrum d/o
441
methylphenidate trade names
* ​short-acting: Ritalin, Methylin * intermediate-acting: Ritalin SR, Methylin ER * long-acting: Ritalin LA, Concerta, Daytrana (TD)
442
dexmethylphenidate trade names
* short-acting: Focalin * long-acting: Focalin XR
443
dextroamphetamine trade names
* short-acting: Dexedrine * long-acting: Dexedrine Spansule
444
amphetamine mixture trade names
* short-acting: Adderall * long-acting: Adderall XR
445
lisdexamfetamine dimesylate trade name
long-acting: Vyvanse
446
AE of CNS stimulants
* insomnia, restlessness * **wt loss** * CV effects * hallucinations, paranoia * withdrawal rxn * hypersensitivity skin rxn (TD formula)
447
contraindications for CNS stimulants
* Hx of * substance use d/o * CV d/o * severe anxiety * psychosis
448
pt education for insomnia, restlessness r/t CNS stimulants
* notify provider of Sx * give last dose before 1600
449
interventions/education for wt loss r/t CNS stimulants
* baseline/periodic wt and ht * give med immediately before or after meals * promote good nutrition in children * eat at regular meal times * avoid unhealthy snacks
450
interventions/education for CV effects r/t CNS stimulants
* S/Sx * dysrhythmias * CP * high BP * ↑ risk of sudden death w/ heart abnormalities * monitor VS, ECG * observe for effects and notify provider
451
pt education: psychotic manifestations r/t CNS stimulants
* includes hallucinations, paranoia * D/C med * report immediately
452
withdrawal rxn r/t CNS stimulants
* do not stop abruptly * may cause depression and severe fatigue
453
pt education for hypersentivity skin rxn to TD CNS stimulant
remove patch and notify provider
454
CNS stimulant interactions
* ↑ CNS stimulation w/ * caffeine * OTC cold/decongestant meds * sympathomimetics * avoid concurrent use
455
pt education for CNS stimulants
* give on regular schedule * patch: place on one hip every morning for ≤ 9 hrs; alternate hips daily * family and cognitive therapy will improve outcomes * handwritten Rx required (controlled substance) * safety and storage * high potential for substance use d/o
456
evaluation of CNS stimulant use
* improvement in * manifestations * behavior * grades * task completion * peer interaction * impulse control
2021 Pharm 2
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