Study guide test 2 pharm

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Peripheral neuropathy (tingling, numbness, burning pain, resulting from deficiency of pyridoxine, the vitamin known as vitamin b6. This can be prevented if vitamin B6 is administered. Hepatotoxicity... (liver toxicity) (anorexia, malaise, fatigue, nausea, yellowish discoloration of skin) PAGE 438-439 What two major organs are effected if patient if patient is toxic from gentamycin? The liver (nephrotoxicity) and the ears (ototoxicity) PAGE 422 Study Glucocorticoid inhalers and instructions to the patient: These drugs have an anti-inflammatory action and are indicated if asthma is unresponsive to bronchodilator therapy. It is thought that glucocorticoids have a synergistic effect when given with a beta 2 agonist. Anti-inflammatory glucocorticoid is used for CHRONIC asthma. Do not relieve symptoms of acute asthmatic attacks. Oral or inhaled forms. Inhaled forms reduce systemic effects. May take several weeks before full effects are seen. Treatment of bronchospastic disorders that are not controlled by conventional bronchodilators. NOT considered first-line agents for management of acute asthmatic attacks or status asthmatics. PAGE 595 The patient is on albuterol and glucocorticoid inhalers. How should the patient take these? Which one first: To use the inhaler: Hold the inhaler away from your mouth and breathe out slowly to the end of a normal breath. Keep the inhaler on its side and place the mouthpiece in your mouth. Close your lips around it, and tilt your head slightly back. Do not block the mouthpiece with your teeth or tongue Breathe in slowly through your mouth until you have taken a full deep breath. Take the inhaler from your mouth and hold your breath as long as you can up to 10 seconds. This gives the medicine time to settle in your airways and lungs. Hold the inhaler well away from your mouth and breathe out to the end of a normal breath. If your doctor has told you to use a second capsule, follow the same steps you used for the first capsule. When you have finished using the inhaler, pull the two halves of the inhaler apart and throw away the empty capsule shells. There is no need to remove the shell left in the small hole, except before cleaning. Put the two halves of the inhaler back together again and place it into its container to keep it clean. Inhaled glucocorticoids are more effective for controlling symptoms of asthma than beta 2 agonist such as albuterol. Use the beta 2 agonist first. Self-administer a bronchodilator first when taken at the same time as a steroid, and then wait 5 minutes for optimal bronchodilator effect before using the steroid. PAGE 593. How does the nasal spray oxymetazoline (Afrin) work? This is an adrenergic drug. Its site of action is the blood vessels surrounding nasal sinuses. This drug constricts small blood vessels that supply URI structure. As a RESULT these tissues shrink and nasal secretions in the swollen mucous membranes are better able to drain. Nasal stiffness is relieved. Shrinks enlarged nasal mucous membranes. Side effects of oxymetazoline (Afrin): Side effects of this drug are Nervousness, Insomnia, Palpitations, and tremors. (Systemic effects due to adrenergic stimulation of the heart, blood vessels, and CNS.) Characteristics of penicillin: Its action is it kills bacteria by disrupting the cell wall; it has a chemical makeup responsible for destroying its ring. Some bacteria are resistant so there are chemical modifications. Treatment of pneumonia, skin, bone and joint infection, blood infections, gangrene, meningitis. It is effective against gram positive and gram negative. Penicillin’s beta-lactam structure (beta-lactam ring) interferes with bacterial cell wall synthesis by inhibiting the bacterial enzyme that is necessary for cell division and cellular synthesis. The bacteria die of cell lysis. These are both bacteriostatic and bactericidal. Penicillin G is bactericidal. Pen G was the first to be administered orally and by injection. May cause hypersensitivity as a side effect. (404-405) When should peak and trough levels be drawn for a patient on gentamycin? This drug is drawn for the nursing intervention. Check that therapeutic drug monitoring has been ordered. Blood should be drawn 45 to 60 minutes after drug has been administered for peak levels and minutes before next drug dosing for trough levels. Gentamycin peak values should be 5 to 8 mcg/mL, and trough levels should be 0.5 to mcg/mL. PAGE 424 How should vancomycin be infused? Vancomycin can be infused either orally or intravenously. Most effective with MSRA; need peak and trough labs. How do you take rifampin? For example should it be taken with meals or an empty stomach? Tell patient to take antitubercular drug such as isoniazid 1 hour before meals or 2 hours after meals for better absorption. This drug can be taken orally, and it is well absorbed. It can be also be administered IM. PAGE 438 What contributes to bacterial resistance? If bacteria are resistant to an antibacterial, the pathogen continues to grow, despite administration of the antibacterial drug. Bacterial resistance may result naturally, but never by antibiotics. It may be passive, or acquired. Passive resistance occurs when without previous exposures to the antibacterial drug. An acquired resistance is caused by prior exposure to the anti-bacterial. For example, although staphylococcus aureus was once sensitive to penicillin g, repeated exposures have caused the organism to evolve and become resistant. Penicillinase, an enzyme produced by the microorganism, is responsible for penicillin resistance. Peninicillanase metabolizes Penicillin G. Another explanation is they may have grown a thicker cell wall. Infections acquired while patients are hospitalized are nosocomial infections. Another factor is that bacteria can transfer their genetic instruction to another bacteria species. PAGE 402 What teaching instructions do you have for a patient on cromolyn (Intal) and how does it work? Cromolyn does not have bronchodilator properties, instead it acts by inhibiting histamine release to prevent an asthma attack. This drug is administered by inhalation. Its side effects are cough and bad taste. It’s given via inhaler. It can be used with beta adrenergic and xanthine derivatives. PAGE 597 If a patient has ordered ceftriaxone and the patient had previously experience a rash while on amoxicillin, how should the nurse proceed? The nurse should watch for possible allergic drug reaction. PAGE 408 Before administering an antibiotic, what should happen first? To ascertain the effects antibacterial drugs have one specific microorganism, culture and sensitivity or antibiotic susceptibility lab testing is performed. A CULTURE AND SESNITIVITY test can detect the infective microorganism present in the sample. The organism causing the infection is determined by culture, and the antibiotics the organism is sensitive to are determined by sensitivity. PAGE 403. Tetracycline and concerns with children? Children younger than 8 years of age should not take tetracycline, because it irreversibly discolors teeth permanently. PAGE 419 Understand electrolytes NA and K and fluid balance. Know that a person must void >30 ml/hr? Potassium: 3.5 to 5.3 mEq/L Is responsible for neuromuscular activity and cellular metabolism. Potassium levels affect cardiac and skeletal muscle activity. Aldosterone plays a role in the excretion of potassium. Normal renal functioning is needed to maintain potassium balance. The majority is excreted in the kidneys. It functions is necessary for transmission and conduction of nerve impulses and for contraction of skeletal, cardiac, and smooth muscles. It is also normal for kidney functions and for the enzyme action used to change carbohydrates to energy. Potassium promotes glycogen storage in hepatic cells, regulates the osmolality in regular fluids and plays a role in acid base balance. Potassium Hypokalemia: Symptoms are alkalosis, Shallow respirations, irritability, [Show More]

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