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level: Level 1

Questions and Answers List

level questions: Level 1

QuestionAnswer
Penicillin (antibacterial)Penicillin G: Class
Inhibition of cell wall synthesis, BactericidalPenicillin G and Cephazolin: Mechanism of Action
Narrow spectrum, more effective for gram(+)Penicillin G: Spectrum
Used for syphilis, meningitis, endocarditis, pneumoniaPenicillin G: Indication
Hypersensitivity includes rash and anaphylaxis; Minor GI disturbances and diarrheaPenicillin G and Cefazolin: Side Effects
Most common drug allergy; renal impairmentPenicillin G: C/C
Check patient history for allergy; Unstable in stomach acid - parenteral route; Resistance continues to growPenicillin G: Nursing Implications
Cephalosporin (antibacterial)Cefazolin: Class
Used for infections of respiratory, urinary biliary, bones and joints, gonorrhea, septicemia; 1st line for surgery prophylaxisCefazolin: Indication
Do not give to patients w/ life-threatening penicillin allergy; caution with renal impairmentCefazolin: C/C
Surgery prophylaxis - should be given within 60 minutes of "cut" timeCefazolin: Nursing Implications
Vancomycin (antibacterial)Vancomycin: Class
Inhibition of cell wall synthesis - binds to the cell wall, BactericidalVancomycin: Mechanism of Action
Severe infections resistant to safer antibiotics (e.g. MRSA infections resistant to fluoroquinolones, C. Diff, meningitis)Vancomycin: Indication
Ototoxicity - can be irreversible; Renal toxicity; Red man syndrome (flushing, tachycardia, hypotension); Thrombophlebitis at IV injection siteVancomycin: Side Effects
Hypersensitivity to drug; impaired renal function; history of hearing loss; doesn't mix with other IV drugsVancomycin: C/C
Own IV line if possible; monitor infusion site for extravasationVancomycin: Nursing Implications
Tetracycline (antibacterial)Tetracycline: Class
Inhibition of protein synthesis, BacteriostaticTetracycline: Mechanism of Action
Drugs of choice for typhus, cholera, Rocky Mountain spotted fever, Lyme disease, H. pylori ulcers, and chlamydiaTetracycline: Indication
Superinfections, nausea, vomiting, epigastric burning, diarrhea, discoloration of teeth, photosensitivity, can worsen renal impairmentTetracycline: Side Effects
Pregnancy or nursing; Children < age 8; allergy to any drug in class; impaired hepatic or renal functionTetracycline: C/C
Widespread resistance; food can reduce absorption - no diary, no antacids, administer with 8 oz water on empty stomachTetracycline: Nursing Implications
Macrolide (antibacterial)Erythromycin: Class
Inhibition of protein synthesis - binds to 50S ribosomal subunit, BacteriostaticErythromycin: Mechanism of Action
Alternative to penicillin - minor ear, throat infections; eye prophylaxis for newbornsErythromycin: Indication
Nausea, vomiting, abdominal cramping; phlebitis and pain at IV site; small but serious risk of cardiac death from QT prolongationErythromycin: Side Effects
Decrease hepatic metabolism of other drugs - interactions possible; decrease liver functionErythromycin: C/C
Enteric coated given anytime; non-enteric coated oral must give w/ 8 oz water on empty stomach 1 hr before or 3 hrs after eatingErythromycin: Nursing Implications
Aminoglycoside (antibacterial)Gentamicin: Class
Inhibition of protein synthesis - binds to 30S ribosomal subunit, BactericidalGentamicin: Mechanism of Action
Broad spectrumGentamicin: Spectrum
Used for serious gram(-) infectionsGentamicin: Indication
Nephrotoxicity and ototoxicity are black box; Neuromuscular blockade is possible; Toxicity is associated with high troughGentamicin: Side Effects
Preexisting hearing loss, renal problems; Increased risk of nephrotoxicity with other drugs affecting kidneyGentamicin: C/C
Measure creatinine clearance and serum drug concentrations at specific intervals; Measure peak and trough to find therapeutic dose (Peak – highest concentration – 30-60 min after administration; Trough – lowest concentration – before administration of drug); Watch urine and hearingGentamicin: Nursing Implications
Fluoroquinolone (antibacterial)Ciprofloxacin: Class
Inhibition of DNA synthesis – inhibit enzyme essential to function, BactericidalCiprofloxacin: Mechanism of Action
Oral medication for serious infections used for wide variety of urinary, soft tissue, bone, and respiratory (drug of choice for Anthrax)Ciprofloxacin: Indication
GI disturbance; photosensitivity; joint pain; confusion in older adults; toxic psychosis; seizures; cardiotoxicity; hepatotoxicity; tendon rupture (black box)Ciprofloxacin: Side Effects
Pregnancy; children <18; serious drug interactions; renal impairment; neurotoxic at high doses; seizures possible with rapid infusionCiprofloxacin: C/C
Watch for serious adverse effectsCiprofloxacin: Nursing Implications
Sulfonamides (antibacterial)Trimethoprim-Sulfamethoxazole: Class
Inhibition of metabolic pathways (folic acid metabolism), BacteriostaticTrimethoprim-Sulfamethoxazole: Mechanism of Action
UTITrimethoprim-Sulfamethoxazole: Indication
Rash; allergy; blood disorders; renal tubule damageTrimethoprim-Sulfamethoxazole: Side Effects
Folate deficiency; sulfa allergy; pregnancy or nursing; renal or liver impairmentTrimethoprim-Sulfamethoxazole: C/C
AntiviralAcyclovir: Class
Slow viral reproduction by stopping viral DNA productionAcyclovir: Mechanism of Action
Drug of choice for herpes simplex virus and varicella-zoster virus infectionsAcyclovir: Indication
Nausea, vomiting, anorexia; elevated hepatic enzymes; minor skin irritation, rash, itching; neurotoxicity at high doses; nephrotoxicity possible when given IVAcyclovir: Side Effects
Caution with renal impairment and other drugs affecting renalAcyclovir: C/C
Infuse slowly (at least 1 hour) with adequate hydration and frequent labs to monitor renal functionAcyclovir: Nursing Implications
AntiviralOseltamivir: Class
Stop spreading flu virus in resp tract by inhibiting neuraminidaseOseltamivir: Mechanism of Action
Reduce duration of or prevent influenza A or BOseltamivir: Indication
Teaching – works best within 12 hours of symptom; no longer helpful after 48 hours of symptomOseltamivir: Nursing Implications
Nucleoside reverse transcriptase inhibitor (NRTI)Zidovudine: Class
Replaces thymidine in RT enzyme to create defective DNA strandZidovudine: Mechanism of Action
HIV infection – symptomatic or asymptomatic, post exposure prophylaxis, and to reduce perinatal transmission from mother to baby in uteroZidovudine: Indication
Anemia, neutropenia, anorexia, nausea, diarrhea, fatigue, weakness, myalgia, headache; Serious – bone marrow toxicity, serious CNS effects, fatal acidosisZidovudine: Side Effects
Preexisting anemia, neutropenia, significant renal/hepatic impairment; avoid drugs that depress bone marrow; other similar agents may contribute to acidosis and hepatomegaly; caution with herbal supplementsZidovudine: C/C
Monitor labs and adverse reactions; Watch for opportunistic infections; Teach adherenceZidovudine: Nursing Implications
Polyene antifungalAmphotericin B: Class
Binds to sterols in fungal cell membrane, allowing cellular contents to leak outAmphotericin B: Mechanism of Action
Serious systemic fungal infectionsAmphotericin B: Indication
“Shake and bake” reaction – fever, chills, rigors, nausea, headache; Serious – cardiac arrest, ototoxicity, nephrotoxicityAmphotericin B: Side Effects
Highly toxic, causes renal injury – infuse 1 L saline on the same day; avoid administering with other drugs with renal toxicity or renal involvementAmphotericin B: C/C
Pre-treat with Benadryl + acetaminophen to reduce “shake and bake” symptoms; Administer IV slowly (2-6 hrs); Monitor cardiovascular and respiratory status during IV therapy; Reduce or discontinue if BUN over 40mg/dL or creatinine over 3 mg/dL; Check vitals every 30 min for 4 hours after test doseAmphotericin B: Nursing Implications
AntifungalFluconazole: Class
Inhibits synthesis of ergosterol in fungal cell membraneFluconazole: Mechanism of Action
Treatment of candidiasis, fungal meningitisFluconazole: Indication
Nausea, vomiting, diarrhea; Serious – Stevens-Johnson syndrome in immunosuppressed patientsFluconazole: Side Effects
Hepatic impairment, hypokalemia, preexisting renal impairment, many drug interactions (CYP450 involvement)Fluconazole: C/C
Monitor BUN, serum creatinine, and liver function laboratory testsFluconazole: Nursing Implications
Mycolic acid inhibitorIsoniazid: Class
Inhibits synthesis of mycolic acid – bactericidal for rapidly dividing organisms and bacteriostatic for dormant mycobacteriaIsoniazid: Mechanism of Action
TB prophylaxis and treatmentIsoniazid: Indication
Rash, fever; Serious – neurotoxicity, hepatotoxicity, blood dyscrasiasIsoniazid: Side Effects
History of hepatic disease; seizure disorder; Do not take with antacids and may interfere with drugs involved with CYP450; Do not take with alcoholIsoniazid: C/C
Penicillin G: ClassPenicillin (antibacterial)
Penicillin G and Cephazolin: Mechanism of ActionInhibition of cell wall synthesis, Bactericidal
Penicillin G: SpectrumNarrow spectrum, more effective for gram(+)
Penicillin G: IndicationUsed for syphilis, meningitis, endocarditis, pneumonia
Penicillin G and Cefazolin: Side EffectsHypersensitivity includes rash and anaphylaxis; Minor GI disturbances and diarrhea
Penicillin G: C/CMost common drug allergy; renal impairment
Penicillin G: Nursing ImplicationsCheck patient history for allergy; Unstable in stomach acid - parenteral route; Resistance continues to grow
Cefazolin: ClassCephalosporin (antibacterial)
Cefazolin: IndicationUsed for infections of respiratory, urinary biliary, bones and joints, gonorrhea, septicemia; 1st line for surgery prophylaxis
Cefazolin: C/CDo not give to patients w/ life-threatening penicillin allergy; caution with renal impairment
Cefazolin: Nursing ImplicationsSurgery prophylaxis - should be given within 60 minutes of "cut" time
Vancomycin: ClassVancomycin (antibacterial)
Vancomycin: Mechanism of ActionInhibition of cell wall synthesis - binds to the cell wall, Bactericidal
Vancomycin: IndicationSevere infections resistant to safer antibiotics (e.g. MRSA infections resistant to fluoroquinolones, C. Diff, meningitis)
Vancomycin: Side EffectsOtotoxicity - can be irreversible; Renal toxicity; Red man syndrome (flushing, tachycardia, hypotension); Thrombophlebitis at IV injection site
Vancomycin: C/CHypersensitivity to drug; impaired renal function; history of hearing loss; doesn't mix with other IV drugs
Vancomycin: Nursing ImplicationsOwn IV line if possible; monitor infusion site for extravasation
Tetracycline: ClassTetracycline (antibacterial)
Tetracycline: Mechanism of ActionInhibition of protein synthesis, Bacteriostatic
Tetracycline: IndicationDrugs of choice for typhus, cholera, Rocky Mountain spotted fever, Lyme disease, H. pylori ulcers, and chlamydia
Tetracycline: Side EffectsSuperinfections, nausea, vomiting, epigastric burning, diarrhea, discoloration of teeth, photosensitivity, can worsen renal impairment
Tetracycline: C/CPregnancy or nursing; Children < age 8; allergy to any drug in class; impaired hepatic or renal function
Tetracycline: Nursing ImplicationsWidespread resistance; food can reduce absorption - no diary, no antacids, administer with 8 oz water on empty stomach
Erythromycin: ClassMacrolide (antibacterial)
Erythromycin: Mechanism of ActionInhibition of protein synthesis - binds to 50S ribosomal subunit, Bacteriostatic
Erythromycin: IndicationAlternative to penicillin - minor ear, throat infections; eye prophylaxis for newborns
Erythromycin: Side EffectsNausea, vomiting, abdominal cramping; phlebitis and pain at IV site; small but serious risk of cardiac death from QT prolongation
Erythromycin: C/CDecrease hepatic metabolism of other drugs - interactions possible; decrease liver function
Erythromycin: Nursing ImplicationsEnteric coated given anytime; non-enteric coated oral must give w/ 8 oz water on empty stomach 1 hr before or 3 hrs after eating
Gentamicin: ClassAminoglycoside (antibacterial)
Gentamicin: Mechanism of ActionInhibition of protein synthesis - binds to 30S ribosomal subunit, Bactericidal
Gentamicin: SpectrumBroad spectrum
Gentamicin: IndicationUsed for serious gram(-) infections
Gentamicin: Side EffectsNephrotoxicity and ototoxicity are black box; Neuromuscular blockade is possible; Toxicity is associated with high trough
Gentamicin: C/CPreexisting hearing loss, renal problems; Increased risk of nephrotoxicity with other drugs affecting kidney
Gentamicin: Nursing ImplicationsMeasure creatinine clearance and serum drug concentrations at specific intervals; Measure peak and trough to find therapeutic dose (Peak – highest concentration – 30-60 min after administration; Trough – lowest concentration – before administration of drug); Watch urine and hearing
Ciprofloxacin: ClassFluoroquinolone (antibacterial)
Ciprofloxacin: Mechanism of ActionInhibition of DNA synthesis – inhibit enzyme essential to function, Bactericidal
Ciprofloxacin: IndicationOral medication for serious infections used for wide variety of urinary, soft tissue, bone, and respiratory (drug of choice for Anthrax)
Ciprofloxacin: Side EffectsGI disturbance; photosensitivity; joint pain; confusion in older adults; toxic psychosis; seizures; cardiotoxicity; hepatotoxicity; tendon rupture (black box)
Ciprofloxacin: C/CPregnancy; children <18; serious drug interactions; renal impairment; neurotoxic at high doses; seizures possible with rapid infusion
Ciprofloxacin: Nursing ImplicationsWatch for serious adverse effects
Trimethoprim-Sulfamethoxazole: ClassSulfonamides (antibacterial)
Trimethoprim-Sulfamethoxazole: Mechanism of ActionInhibition of metabolic pathways (folic acid metabolism), Bacteriostatic
Trimethoprim-Sulfamethoxazole: IndicationUTI
Trimethoprim-Sulfamethoxazole: Side EffectsRash; allergy; blood disorders; renal tubule damage
Trimethoprim-Sulfamethoxazole: C/CFolate deficiency; sulfa allergy; pregnancy or nursing; renal or liver impairment
Acyclovir: ClassAntiviral
Acyclovir: Mechanism of ActionSlow viral reproduction by stopping viral DNA production
Acyclovir: IndicationDrug of choice for herpes simplex virus and varicella-zoster virus infections
Acyclovir: Side EffectsNausea, vomiting, anorexia; elevated hepatic enzymes; minor skin irritation, rash, itching; neurotoxicity at high doses; nephrotoxicity possible when given IV
Acyclovir: C/CCaution with renal impairment and other drugs affecting renal
Acyclovir: Nursing ImplicationsInfuse slowly (at least 1 hour) with adequate hydration and frequent labs to monitor renal function
Oseltamivir: ClassAntiviral
Oseltamivir: Mechanism of ActionStop spreading flu virus in resp tract by inhibiting neuraminidase
Oseltamivir: IndicationReduce duration of or prevent influenza A or B
Oseltamivir: Nursing ImplicationsTeaching – works best within 12 hours of symptom; no longer helpful after 48 hours of symptom
Zidovudine: ClassNucleoside reverse transcriptase inhibitor (NRTI)
Zidovudine: Mechanism of ActionReplaces thymidine in RT enzyme to create defective DNA strand
Zidovudine: IndicationHIV infection – symptomatic or asymptomatic, post exposure prophylaxis, and to reduce perinatal transmission from mother to baby in utero
Zidovudine: Side EffectsAnemia, neutropenia, anorexia, nausea, diarrhea, fatigue, weakness, myalgia, headache; Serious – bone marrow toxicity, serious CNS effects, fatal acidosis
Zidovudine: C/CPreexisting anemia, neutropenia, significant renal/hepatic impairment; avoid drugs that depress bone marrow; other similar agents may contribute to acidosis and hepatomegaly; caution with herbal supplements
Zidovudine: Nursing ImplicationsMonitor labs and adverse reactions; Watch for opportunistic infections; Teach adherence
Amphotericin B: ClassPolyene antifungal
Amphotericin B: Mechanism of ActionBinds to sterols in fungal cell membrane, allowing cellular contents to leak out
Amphotericin B: IndicationSerious systemic fungal infections
Amphotericin B: Side Effects“Shake and bake” reaction – fever, chills, rigors, nausea, headache; Serious – cardiac arrest, ototoxicity, nephrotoxicity
Amphotericin B: C/CHighly toxic, causes renal injury – infuse 1 L saline on the same day; avoid administering with other drugs with renal toxicity or renal involvement
Amphotericin B: Nursing ImplicationsPre-treat with Benadryl + acetaminophen to reduce “shake and bake” symptoms; Administer IV slowly (2-6 hrs); Monitor cardiovascular and respiratory status during IV therapy; Reduce or discontinue if BUN over 40mg/dL or creatinine over 3 mg/dL; Check vitals every 30 min for 4 hours after test dose
Fluconazole: ClassAntifungal
Fluconazole: Mechanism of ActionInhibits synthesis of ergosterol in fungal cell membrane
Fluconazole: IndicationTreatment of candidiasis, fungal meningitis
Fluconazole: Side EffectsNausea, vomiting, diarrhea; Serious – Stevens-Johnson syndrome in immunosuppressed patients
Fluconazole: C/CHepatic impairment, hypokalemia, preexisting renal impairment, many drug interactions (CYP450 involvement)
Fluconazole: Nursing ImplicationsMonitor BUN, serum creatinine, and liver function laboratory tests
Isoniazid: ClassMycolic acid inhibitor
Isoniazid: Mechanism of ActionInhibits synthesis of mycolic acid – bactericidal for rapidly dividing organisms and bacteriostatic for dormant mycobacteria
Isoniazid: IndicationTB prophylaxis and treatment
Isoniazid: Side EffectsRash, fever; Serious – neurotoxicity, hepatotoxicity, blood dyscrasias
Isoniazid: C/CHistory of hepatic disease; seizure disorder; Do not take with antacids and may interfere with drugs involved with CYP450; Do not take with alcohol