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Drugs used in Med-Surg Clinical

ANTIBIOTIC CLASSIFICATION

Cephalosporins

Cephalosporins

ANTIBIOTIC - broad-spectrum

Action: break down gram -ive bacteria and anaerobes by interfering with cell wall synthesis
- reach the cerebrospinal fluid
Use: Infections
Contraindications: allergies to penicillins
Side Effects:
- hypersensitivity reactions: rash, pruritus, fever
- anorexia, N/V, flatulence, diarrhea
- 3rd gen meds: possible superinfection
Nursing Implications:
- evaluation IM & IV sites for reactions, e.g. abscesses & phlebitis
- monitor rate of infusion; ck labelling
- monitor renal & hepatic studies throughout therapy
- advise client to hydrate; notify HCP if experiencing diarrhea
- with medications that cause bleeding tendencies, monitor for bleeding

Define: Superinfection

- new infection occurring in a patient while being treated for another infection
- often caused by micro-organisms that have become resistant to the antibiotics used earlier

ANTIBIOTIC CLASSIFICATION

Tetracyclines

Tetracyclines

ANTIBIOTIC - broad spectrum

Action: Bacteriostatic, suppresses bacterial growth & replication; DOES NOT KILL cells outright. 2nd line drug for infections resistant to 1st line drugs.
Use:
- Rickettsial diseases
- uncommon infections, tropical intestinal infections, peptic ulcer disease
- acne, sinusitis, cystitis, Lyme disease, periodontal disease
Precautions:
- renal & hepatic dysfunction
- DO NOT GIVE TO <11yr or PREGNANT women
- may cause staining of dentin of developing teeth (dark enough to be visible through the enamel)
Side Effects: N/V, abdominal cramping, vomiting, diarrhea, superinfection, photosensitivity
Nursing Implications
- take on empty stomach
- antacids, milk products, iron supplements SHOULD NOT BE consumed UNTIL AT LEAST 2hrs AFTER dose taken
- DO NOT ADMIN TO <11yr or PREGNANT women to avoid tooth discoloration
- monitor carefully for diarrhea: may indicate SUPRAINFECTION of bowel. (C. difficile)
- ck dose & rate IV
- wear sunscreen & protective clothing

Define: Rickettsial diseases

acute infectious rickettsial bacterial disease transmitted by ticks, mites, or body lice; include typhus, spotted fever, Q fever, trench fever, & tsutsugamushi disease

Define: peptic ulcer disease

Definition - hole in the gut lining of the:
* stomach (gastric ulcer)
* duodenum (duodenal ulcer)
* esophagus (esophageal ulcer)
Causes:
- Helicobacter pyloricus (H. pylori) is leading cause
- NSAIDs interfer with prostaglandins located in the stomach which help gut linings resist corrosive acid damage.
- tobacco smoking causes ulcers & hinders treatment of ulcers

NSAIDs CLASSIFICATION

Aspirin
ibuprofin (Motrin)
naproxen (Naprosyn
etodolac (Lodine

ANTIBIOTIC CLASSIFICATION

Metronidazole (Flagyl)

Metronidazole (Flagyl)

ANTIBIOTIC

Action: direct trichomonacidal & amebicidal against anaerobic bacteria, gram -ive anaerobic bacilli & clostridia:
- Trichomonas vaginalis
- Enamoeba histolytica
- Clostridium difficle
- Giardia lamblia
Uses:
- Asymptomatic & symptomatic trichomoniasis in F & M clients
- acute intestinal amebiasis & antibiotic-associated colitis
Contraindications:
- active CNS disease, blood dyscrasias
- FIRST trimester of pregnancy, BREASTFEEDING mothers
Precautions:
- 2nd & 3rd trimesters of pregnancy
- alcoholism, hepatic disease
Side Effects:
- N/V, headache, dry mouth, anorexia, epigastric distress
- metallic taste, darkening of the urine, seizures
Nursing Implications:
- take on EMPTY stomach if possible; may take w food if nauseated
- NO ALCOHOL-based products (ingested or applied e.g. aftershave, perfume) to avoid disulfiram-type reaction
- Mothers should wait 3 days after last dose to resume breast-feeding
- teach client that harmless darkening of the urine may occur

Define: CNS disease

Neurodegenerative disease - the nervous system progressively & irreversibly deteriorates

Multiple Sclerosis
Parkinson's disease

Define: blood dyscrasias

pathologic condition in which any of the constituents of the blood are abnormal in structure, function, or quality

- leukemia - white blood cells
- hemophilia - clotting factors
- Von Wilebrand's Disease - clotting factors
- sickle cell anemia - red blood cells

Define: disulfiram reaction

disulfiram is a drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol.

reaction occurs when disulfiram (TETD) and alcohol are combined

- flushing, N/V, anorexia, palpitations, tachycardia, psychosis

ANTIBIOTIC CLASSIFICATION

Isoniazid (INH)

Isoniazid (INH)

ANTIBIOTIC - antituberculosis agent

Action: Interferes with biosynthesis of bacterial protein, nucleic acid, & lipids
- Bacteriostatic to "resting organisms"
- Bacteriocidal to actively dividing organisms
Uses:
- treatment of all forms of active tuberculosis
- preventive in high-risk persons (+ive TB skin test or exposure)
Contraindications & Precautions
- history of INH associated hypersensitivity reaction
- renal & liver problems
- convulsive disorders or alcoholism
Side Effects:
- peripheral neuritis, clumsiness, unsteadiness, muscle ache
- epigastric distress, jaundice, drug-induced hepatitis
Nursing Implications:
- teach client to take on an EMPTY stomach
1 HR BEFORE or 2 HRS AFTER meals
- DEPLETES Vit B6; will need supplementation during treatment
- peripheral neuritis, the most common adverse effect, is preceded by paresthesias (e.g., numbness, tingling, burning, pain) of the feet & hands
- teach clients to reduce or eliminate consumption of alcohol to reduce risk of hepatotoxicity
- antituberculosis treatment always involves 2 or more medications; INH is often combined with rifampin

ANTIBIOTICS used in TB

STRIPE

ST - streptomycin
R - rifampin
I - isoniazid
P - pyrizinamide
E - ethambutol

ANTIBIOTIC CLASSIFICATION

Aminoglycocides

Aminoglycocides

ANTIBIOTIC - narrow spectrum

Action: bactericidal against wide variety of gram - ive bacteria & certain gram +ive organisms. Disrupts bacterial protein synthesis
Uses:
- parenteral use restricted to treatment of serious infection of the gastrointestinal, respiratory, & urinary tracts; CNS; bone; skin; & soft tissue, including burnes
- topically - primary & secondary skin infection
Contraindication:
-Hx of hypersensitivity or toxic reaction with aminoglycoside antibiotics
Precautions:
- renally impaired clients
- Hx of CN VIII impairment
(Vestibulocochlear nerve/Auditory nerve,)
- myasthenia gravis clients

Define: parenteral

"aside from gastrointestinal tract"

administration of substances via other than via the oral route:
- subcutaneous
- intramuscular
- intrasternal (epidural)

Define: myasthenia gravis

autoimmune neuromuscular disorder characterized by fatigue & exhaustion of muscles

Cranial Nerves

I-Olfactory nerve,
II-Optic nerve,
III-Oculomotor nerve,
IV-Trochlear nerve,
V-Trigeminal nerve,
VI-Abducens nerve,
VII-Facial nerve,
VIII-Vestibulocochlear nerve/Auditory nerve,
IX-Glossopharyngeal nerve,
X-Vagus nerve,
XI-Accessory nerve/Spinal accessory nerve and
XII-Hypoglossal nerve...

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