NR 293 Exam 1 Drugs. Chamberlain College of Nursing

NR 293 Exam 1 Drugs. Chamberlain College of Nursing.DRUG CLASS: ANTIBIOTICS – sulfonamides generic name / (Trade name) • sulfamethoxazole-trimethoprim (Bactrim, Septra) • co-trimoxazole (SMZ-TMP) MOA: Bacteriostatic – inhibits bacterial synthesis of folic acid required for synthesis of purines and nucleic acid for replication (does not affect human cells) Indications: • Effective against both gram (+/-) bacteria • UTIs caused by Enterobacter spp., E. Coli, Klebsiella spp., Proteus mirabilis, Proteus vulgarism and S. aureus (sulfamethoxazole-trimethoprim often combined for synergistic antibacterial effect) • Pneumocystis jiroveci pneumonia, & • Outpatient staph infections from high rate of community acquired MRSA infections • URIs Adverse Effects: • Blood – hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia • Integumentary – photosensitivity, exfoliative dermatitis, Steven-Johnson syndrome, epidermal necrolysis • GI – N/V/D, pancreatitis • Other – hepatotoxicity, convulsions, crystalluria, toxic nephrosis, h/a, peripheral neuritis, urticaria, cough Contraindications / Precautions: • G6PD deficiency (RBC breaks down faster than they are made – anemia) • Impaired renal & hepatic functions • Bronchial asthma • Hyperkalemia • Hypothyroidism • Pregnancy (C) Drug Interactions: • Warfarin – increases risk for bleeding Nursing Implications: • Obtain C&S before initiating therapy • Monitor renal function as abx are highly concentrated in kidneys, through which they are excreted (BUN, creatinine, I/O’s,) • Obtain urinalysis to assess for crystalluria • Monitor for allergic reactions / CNS effects (rash, bleeding, bruising, hallucinations, seizures, etc.) Patient Teaching: • Avoid sunlight / wear sunscreen • Report any signs of rash, bleeding, or unusual bruising • Report shortness of breath, diarrhea, blood in urine, fever, or severe/worsening rash immediately • Increase fluid intake (mL) to prevent crystalluria • Take with food to avoid GI distress • Use alt form of contraception • Take as directed and avoid use of alcohol DRUG CLASS: BETA-LACTAM ANTIBIOTICS – penicillin generic name / (Trade name) • ampicillin / sulbactam (Unasyn) [IV or IM injection] • amoxicillin / clavulanic acid (Augmentin) [ PO] MOA: Bacteriostatic – Binds to specific proteins called penicillinbinding proteins and inhibit peptidoglycan, which interfere with cell wall synthesis – resulting in lysis Indications: • Gram (+) bacterial infections caused: streptococcus spp., enterococcus spp., and staphylococcus spp. • Health care-associated infections – pneumonia, intrabdominal infections, and sepsis • Otis media, sinusitis, various respiratory, skin, and urinary tract infections, bacterial endocarditis, H. pylori infections Adverse Effects: • Seizures • Oral candidiasis, N/V/D, abdominal pain • Allergic reactions: urticaria, pruritis, hives, angioedema • Anemia, bone marrow depression, granulocytopenia • Hyperkalemia, hypernatremia, alkalosis Contraindications / Precautions: • Allergy/hypersensitivity to penicillin (should not receive cephalosporins) Drug Interactions: • Ethanol / alcohol (disulfiram-like reaction; severe nausea and vomiting, diaphoresis, headache) • Antacids, Fe+ (decreases oral absorption, resulting in decreased effectiveness) • Probenecid (decreases renal excretion, resulting in increased cephalosporin levels) • Oral contraceptives (increased risk for unintended pregnancy) Nursing Implications: • Obtain C&S before initiating therapy • Obtain accurate health history regarding allergies (types of reaction) • Assess for allergic reaction • Obtain/assess CBC Patient Teaching: • Take as directed • Use alternative form of contraceptives • Avoid use of alcohol • Report incidents of diarrhea, with blood, pus, to avoid dehydration • Report mouth pain (indicative of superinfection: thrush) • Encourage consumption of probiotics to avoid loss of normal intestinal flora (e.g., yogurt, buttermilk, and kefir) • Do not take PO penicillin with juices (acidic fluids may nullify antibacterial action) • Avoid taking w/ cola or caffeine-containing beverages, citrus or fruit juices, tomato juice (decreases effectiveness) Drug Profile: Natural penicillin G vs. penicillin V • Penicillin G (IM) • Penicillin V (PO) Aminopenicillins (amoxicillin / ampicillin) → amino group + penicillin = enhancing activity against gram (-) bacteria