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49 Cards in this Set
- Front
- Back
Tuberculosis
-Mycobacterium tuberculosis Transmission: (2) |
-Person to person
-Inhaled infected aerosol (by inhaling infected sputum, or by coughing, sneezing) |
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**Principal cause underlying the emergence of resistance is
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inadequate drug therapy (treatment may be too short, dosage may be too low, patient adherence)
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Goal of TB treatment: (2)
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Eliminate symptoms
Prevent relapse |
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TB - Two phases
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-Induction phase
Eliminate active tubercle bacilli -Continuation phase Eliminate intracellular “persisters” |
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TB Medications
-Typically utilizes 2 or more |
antibiotics (test)
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TB typically has multiple resistances to drugs
A _____ is needed with C/S to determine most effective meds to administer |
sputum specimen
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Induction phase: lasts
what drugs are used? |
2 months
Daily therapy –RIPE Isoniazid test Rifampin test Pyrazinamide Ethambutol |
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Continuation phase: how many months
Daily or biweekly therapy includes what 2 meds? |
4 months
Isoniazid Rifampin |
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Isoniazid (INH) [Laniazid]
tell me about this medication? Bactericidal or Bactererstatis |
Primary agent to treat TB
Bactericidal – it’s a killer |
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Isoniazid (INH) [Laniazid]
Adverse effects – what system does it affect |
affects nervous system. Too much medication can lead to toxicity. Toxicity can lead to seizure.
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Isoniazid (INH) [Laniazid]
adverse reactions (4) |
-Peripheral neuropathy results from (pyridoxine, vitamin B6) Dose dependent
-Hepatotoxicity: due to production of toxic metabolites -Optic neuritis -Anemia |
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Isoniazid (INH) [Laniazid]
Nursing considerations what do we need to monitor (3) |
-CBC
-Monitor patients Liver function test -Monitor for S/S of liver inflammation ----Anorexia, fatigue, nausea, skin color changes, RUQ pain |
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Isoniazid (INH) [Laniazid]
Drug interactions: (2) |
Phenytoin (Dilantin)
ETOH, Rifampin & pyrazinamide : |
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Isoniazid and Phenytoin (Dilantin)
Interferes with: Signs of phenytoin excess include |
Interferes with metabolism causes increase levels of dilantin
ataxia and incoordinaiton Monitor dilantin levels |
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Isoniazid and ETOH, Rifampin & pyrazinamide :
increase risk of ______ secondary to ______ |
risk of hepatotoxicity secondary to metabolite accumulation (patients should be encouraged to reduce or eliminate alcohol intake)
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Rifampin [Rifadin]
Broad spectrum antibiotic Uses (5) |
-Tuberculosis
-Leprosy -Haemophilus influenzae – common bacteria that causes bronchitis and nose infections -Legionella -Neisseria meningitidis used prophylactically post exposure to men |
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Rifampin is the best drug for meningits, why?
What are the interactions? (can increase the___) |
it can cross the BBB!
Can increase the metabolism of numerous drugs that utilize cytochrome P450 enzymes |
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Rifampin and oral contraceptives
increases or decreases effectiveness of birth control pill |
decreases
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Rifampin and Warfarin
inhibits |
Inhibits proper metabolism higher levels in circulating blood can lead to increased potential for bleeding to occur
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Rifampin
Adverse reactions (2) |
Hepatotoxocity- Alcoholics and patients with liver disease are predisposed
Fluid Alterations: pt ed. Turns secretions red , sweat, saliva, tears red/brown, semen, vaginal secretion. Contacts will become stained by aqueous humor of eye |
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Ethambutol [Myambutol]
Bacteriostatic or Bacteriocidial Uses: Adverse effects (3) |
Bacteriostatic
Uses: tuberculosis Adverse effects Optic neuritis Allergy Hyperuricemia |
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Ethambutol [Myambutol]
Mycobacterium avium Complex Infection (Prophylaxis) --what 2 drugs can be confused with TB so you need a: |
Azithromycin
Clarithromycin you need a sputum specimen) |
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Latent TB -what is it
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A person who has the bacteria present, but are not experiencing symptoms and/or do not know that they have been exposed.
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Pts at risk for latent progressing to active:
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-HIV positive patients
-IV drug users -Immunosuppresive meds (prednisone) -Anyone who has received an organ transplant |
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Metronidazole Flagyl
Action: Bactericidal against _____ bacteria only examples |
anaerobic
CNS infections bone-joint infections abdominal organ infections vaginal infections (gardnerella) |
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Metronidazole Flagyl
Absorbed in the _____ Reacts with DNA of bacteria & converts it to |
small intestine
Flagyl’s active form |
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Metronidazole Flagyl
Used for women who |
has PID (pelvic inflammatory disease) whatever bacteria you had in vagina got into the cavity.
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Metronidazole Flagyl
drug of choice for: |
c diff
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Metronidazole Flagyl
if given IV needs to be given how |
slowly over 1 hour
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Metronidazole Flagyl
Adv Rx & Nursing Considerations GI- What tests do we monitor? Antabuse? |
GI: N/V diarrhea and upset stomach
GU: monitor Kidney function Monitor K+ levels if client is having diarrhea Antabuse-like reactions with alcohol violent projectile vomiting because flagyl reacts with it. |
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Metronidazole Flagyl
-Pregnancy Category __ Not to be given during the |
B
1st trimester |
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Metronidazole Flagyl
Drug interactions |
Warfarin:
Inhibits the inactivation of warfarin potentially can cause an increases INR = potential for hemorrhage |
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Antifungal
Systemic mycoses (fungal) Superficial mycoses (fungal) mycoses means |
Antifungal
fungal |
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Antifungal
Amphotericin B -Drug of choice for: |
Broad spectrum
Fungicidal or fungistatic- Dose dependent Highly toxic Drug of choice for systemic fungal infections |
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Amphotericin B
Administration -how is it given? -needs to have? -how long does it take each infusion for it to be complete? -how long is treatment take? -what is it important to watch IV site for? |
IV
-Needs to have a inline filter -Each infusion can take 6-8 hours to complete -Tx can be as long as 6-8 weeks -Important to watch IV site for extravasation |
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Amphotericin B
Infusion reactions Shake & bake: what will you see -what is it caused by: -typically seen how many hours after infusion has been started? what can you pre-treat them with? |
-Fever, chills, muscle tightening, nausea, H/A
-Caused by the release of cytokines from monocytes and macrophages -Typically seen occurring 1-3 hrs after infusion started -Pre-treat with Bendaryl & Tylenol |
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Antifungal
-Amphotericin B This drug is potentially contraindicated if the pt has _____can occur 2° to kidney damage |
kidney insuffienceny (Nephrotoxicity)
hypokalemia |
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Antifungal
-Amphotericin B *Can be reversible* Damage can be decreased by |
hydrating the patient with 1000cc of NS or more during the IV infusion of the drug.
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Amphotericin B
-Nursing considerations What does the nurse have to monitor closely? how often? |
-Monitor VS q15 min then q1hr during infusion
(Watch P & B/P carefully) Daily weights (Monitor for fluid accumulation) |
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Amphotericin B
-Nursing considerations Labs: |
K+
BUN/Creat (kidney function tests) Mg+ Na+ Liver function tests CBC |
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Ketoconazole Nizoral
Broad spectrum fungal agent Fungistatic at __ Fungicidal at __ |
Broad spectrum fungal agent
Fungistatic at low conc. Fungicidal at high conc. |
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Ketoconazole Nizoral
In order for these medications orally, stomach needs to be |
acidic environment for dissolution
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Drugs for Superficial Mycoses
Dermatophytic infections (e.g., ringworm) Tinea pedis- on foot Tinea corporis -on abdomen Tinea cruris -groin crotch Tinea capitis -on head |
Drugs:
Clotrimazole—topical Griseofulvin—oral |
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Whenever you hear tinea ---think
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fungal
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Ketoconazole Nizoral
Administration: (3) when given PO, what does the nurse have to know? |
PO, topically, shampoo
When given PO, the patient needs to work up a good sweat. Sweat carries antibiotic and the antibiotic has to dry on the skin because then it will kill the fungal infection Let it dry on the skin for this drug to be effective. |
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Ketoconazole Nizoral
Drug interactions (2) |
H2 blockers and antacids can decrease effects of the antifungal agent
Aminoglycosides: gentamicin; can increase the possibility of nephrotoxicity |
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Miconazole Monistat
what is it: what is it used for: |
Antifungal
Used for vaginal infections |
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Fluconazole - is an oral med
Diflucan- begins working when: |
Diflucan 1 drug, begins working within 24 hours
Fungistatic Vaginal Candidiasis Oropharyngeal, esophageal, systemic |
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Nystatin - Mycostatin
Treats (3) |
Oral candidiasis
Intestinal candidiasis Topical & vaginal candidiasis |