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NaCl - MOA

supplement that causes isotonic diuresis

NaCl - Uses

treats hyponatremia - sodium serum levels below 130 mEq/L

NaCl - Side effects and symptoms

hypernatremia: altered mental status, decreased LOC
pulmonary edema:

KCl - MOA
Admin Alert!

Potassoim/Electrolyte Supplement
No IV push/bolus - only oral orSLOWLY through line - it's very irritating

KCl - uses

treats hypokalemia - less than 3.5mEq/L

KCl - side effects and thier symptoms

GI irritation
hyperkalemia: dysrythmias, heart block

Sodium Bicarbonate - MOA
Admin Alert!

neutralizes acids in the blood and other body fluids
oral give 2-3 hours before meals/meds

Sodium Bicarb - uses

metabolic acidosis - increases pH level in patients

Sodium Bicarb - side effects and symptoms

metabolic alkalosis: CNS stimulation, convulsions
constipation
cyanotic
slow irregular pulse
slow respirations to hold onto CO2
Stop infusion first, THEN notify phycisian

Spirinolactone - MOA

blocks action of aldosterone so body dumps sodium but holds onto potassium

Spirinolactone - Uses

hypertension
edema
reduces mortality in heart faliure

Spirinolactone - side effects/symptoms

Hyperkalemia: dysrythmias
hyponatremia: n+v, cramping, anorexia, confusion, lethargy, coma

Spirinolactone - roel of nurse

assess electrolytes

Spirinolactone - drug/drug interaction

With ACE Inhibitors increased risk of hyperkalemia so monitor the HEART

Spirinolactone - Patient Education

Aviod potassium rich foods - hyperkalemia!
and hawthorn - hypotension!

Safety precautions in patients with renal problems

Start with lower doasges.... need to clarify this

PUD - tx indicated

Start drugs when diagnosed, used to reduce incidence of complications ( bleeding, perforartion, obstruction)

IBDs, Chron's, Ulcerative Colitis - tx indictated

depends on clinical picture, maintain as normal lifestyle as possible, prevent nutritional deficiencies, minimize psyche and social impact of dz

GERD - tx indicated

for severe GERD

Constipation - Tx indicated

when patient feels bloated or has trouble moving bowels

Diarrhea - Tx indicated

for patients at risk of developing complications - elderly, preggers, kids

Nausea/Vomiting - Tx indicated

after waiting 24 hours to see if symptoms abate and when these are not symptoms of an underlying condition that requires immediate attention

Risk factors for PUD

Anything that increases stomach acid
stress
caffiene
smoking
alcohol

Proton Pump Inhibitor
often given with?

omeprazole (Prilosec)
antibiotics

Prilosec - MOA

Reduces stomach acidsecretions by binding irreversibly to enzymes H+, K+ - ATPase

Prilosec - Uses

Short term use 4-8 weeks for
peptic ulcers
GERD
* works better than other drugs

Prilosec - side effects/symptoms

headache
nasuea
diarrhea
rash
abdominal pain
Long Term: increased acid so you can get gastric cancer

Prilosec - Admin Alert

Take 30 minutes prior to eating usually before breakfast, Eating yougurt is beneficial to replace bacteria.
Enteric coated cannot be chewed or crushed must dissolve in stomach

H2 Receptor Agonist

Ranitidine (Zantac)

Ranitidine- MOA

block H2 receptors in stomach to decrease acid production

Ranitidine - uses

PUD

Ranitidine - side effects/symptoms

Constipation
impotence/libido loss
lower WBC, RBC and plateletts
Pernicous anemia because b12 is not absorbed well

Ranitidine - admin alerts

can be can with or right after meals and at bedtime to prolong effect

Antacids

Aluminum hydroxide

Aluminum hydroxide - MOA

neutralizes stomach acid by raising pH of stomach contents

Aluminum hydroxide - uses

in combination with other drugs for relief of heartburn due to GERD or PUD

Aluminum hydroxide - side effects/symptoms

constipation

Aluminum hydroxide - admin alerts

take 2 hours before other meds so that absorption is not decreases

Pepto-Bismul - MOA

added to antibiotics, inhibits bacterial growth, prevents h. pylori from adhering to the stomach wall

Sulfucrate - MOA

sucrose plus aluminum hydroxide (antacid) produces a thick gel like substance that coats the ulcer protecting it against further erosion and promoting healing

Sulfucrate - admin alert

must be taken 4 times daily, must be taken BEFORE meals to be affective

misoprostole - MOA, uses

inhibits acid and stimulates mucus production
prevents peptic ulcers in patinets taking NSAIDs and corticosteriods

psillium mucilloid - MOA

Laxative that swells and increases the size of fecal mass

psillium mucilloid - uses

to promote passage of stool

psillium mucilloid - side effects/symptoms

may cause obstruction in the esophagus or intestines if patinet doesn't drink enough water

docusate - MOA

stool softener causes more water/fat to be absorbed into the stool . most often used to prevent constipation

docusate - side effects/symptoms

abdominal cramping - report to phycisian

mineral oil - MOA
side effects

lubricate stool and colon mucosa
can interfere with absorption of fat soluble vitamines

Milk of Magnesia and Fleet phospho-soda - MOA

saline/osmotics not absorbed in the intestine. They pull water into the fecal mass.
Dont use regularly, work quickly

bisacodyle - ducolax- MOA

stimulant that promotes peristalsis by irritaing the bowel mucosa - rapid acting, cause diarrhea and cramping, dont use often

Antiemetic

prochloperazine (compazine)

prochloperazine - MOA

blocks dopamine receptors in brainwhich inhibits signals to vomit center in medulla

prochloperazine - uses

for severe nausea and vomiting

prochloperazine - side effects/symptoms

dose related anticholinergic effects
-dry mouth, sedation constipation
- orthostatic hypotension, tachycardia
- extrapyramidal symptoms with prolonged use

prochloperazine - antidote

Congentin via IM immediately for extrapyramidal effects

Antidiarrheals

diphenoxylate with atropine (Lomotil) - this is a non-analgesic opiod

Lomotil - MOA

slows peristalsis

Lomotil -uses

moderate to severe diarrhea

lomotil - side effects/symptoms

dizziness
drowsiness

lomotil - tx od OD

nalaxone IV

Diet for diarrhea

BRAT bananas rice applesauce toast
or
ABCs apricots, bananas and carrots

Meds to administer for bowel prep surgery
Assess?

bisacodyle
fleet phospho-soda
tap water enema

Assess kidney function (creatine levels)

Why is culture & sensitivity testing done?

to identify sensitive or resistent bacteria
Broad spectrum antibiotics may be started before culture is completed

What symptoms might the patient present with that might warrant a provider ordering culture and sensitivity testing?

Sepsis, systemic infection, severe symptoms whose underlying cause is not identifiable.

How/why are superinfections are caused by anti-infective therapy ?

antibiotics kill microrganisms (host flora) normally present in bidy which allows pathogenic microorganisms to multiply and take over

symptoms of superinfections

diarrhea
bladder pain
abnormal vaginal discharge
painful urination

Pencillin G- MOA

Disrupts cell wall, fluid goes into cell and it bursts

Penicillin G - uses

Strep, Pneumonia, Staph infections that DON'T produce penicilinase.
Gohnerrhea
Syphallis

Penicillin G - side effects/symtpoms

nasuea
vomiting
abdominal pain
super infections ( yeast)
anaphylaxis

Penicillin G - interactions/admin alert

decreases effectiveness of oral contraceptives
pbserve for 30m. after perenteral admin. especially afetr first dose

Caphalosporins

cefotaxime

cefotaxime - MOA

iterferes with cell wall building when GRAM negative bacteria divide

cefotaxime - uses

Treats infections of:
lower repiratory tract
CNS
GU
bones, blood, joint
Prophylactic: pre-op

cefotaxime - side effects/symptoms

n/v
diarrhea
ab. pain
anaphylaxis

cefotaxime - admin alerts

CI in pt.s allergic to penicillin
IM in a deep large muscle mass to prevent injury to surrounding tissues

Tetracycline - MOA

borad range antibiotic, inhibits protien synthesis

Tetracycline - uses

Clamydia
Ricketts
Mycoplasma

Tetracycline - side effects/symptoms

-toxic to body as it's similar to protiens found in the body
tooth discoloration
photosensitivity
rash
superinfections
GI - n/v, pain, diarrhea

Tetracycline - admin alert

caution in children under 8
dcreases effects of oral contraceptives
Admin on empty stomach 1 hour before or 2-3 hours after meal/meds
MILK reduces absorpotion

Macrolides

erythromyacin

erythromyacin- MOA

binds to bacterial cell membrane and changes protien function

erythromyacin - uses

whooping cough
diptheria
most gram positive bacteroa

erythromyacin - side effects/symptoms

GI
hepatoxicity

Aminoglycoside

gentamycin

gentamycin

inhibits protien synthesis - broad spectrum, bacteriocidal

gentamycin - uses

gram negative infections

E. coli, staph

gentamycin - side effects/symptoms

Ototoxicit
don't give to patinets with hearing problems cause you can't measure toxicity
\nephrotoxicity

gentamycin- admin alert

IM admin into deep muscle

isoniazide (INH) - MOA

inhibits synthesis of myoclic acids which are important to cell walls

isoniazide (INH) - uses

tuberculosis

isoniazide (INH) - side effects/symptoms

GI
fever
rash
numbness of hands/feet
- fatal hepatitis

Vancomyacin - Uses

severe infections of strep and S. aureas after other drugs have failed
MRSA

Vancomyacin - side effects/symptoms

ototoxicity
superinfections
nephrotoxicity
red-man syndrome

Vancomycin - admin alert

if upper bosy rash, decreased urine out put/ hearing - HOLD next dose THEN notify physician

Fluconazale - MOA

interferes with sythesis of ergosterol in the fungal cell membrane causing them to become permeable

fluconazale - uses

candida albicans

fluconozale - side effects/symptoms

GI w/ high doses
Stevns-Johnson syndrome in immunosupressed pts

metronidazole (Flagyl) - MOA

inhibits DNA synthesis so protozoa can't reproduce, cell dies

metronidazole (Flagyl) - interaction

don't drink alcohol while opn or 3 days after meds, take 1h before or 2h after meals

metronidazole (Flagyl) - side effects/interactions

CNS
GI
superinefctions

zidovudine

slows AIDs , doen't cure it

zidovudine - MOA

virus uses drug as nucleotide thus creating an innefective DNA starnd

zidovudine - uses

used iwth otherantiretrovirals for HIV clienety
used prophylactively for exposed healthcare workers

reduces rate of transmisioin from mom to fetus

zidovudine - side effects

savere bone marrow supression
anemia
GI
weakness/fatigue

acyclovir (Zovirax) - MOA

prevents viral DNA sythesis

acyclovir - uses

herpes -1and 2 : dcreases pain
at high dodes treats:
CMV
varicella zoster

acyclovire -side effects

GI
neuropathy
hair loss
rashes
headache
depression

acyclovir - admin alert

take with food

HAART

Highly Active Anti Viral Therapy

Advantages of HAART

reduces viral load to below the limit of detection, reducies the risk of drug resistance

laboratory tests associated with HIV/AIDlaboratory tests associated with HIV/AIDS

CD4-T cell count- determines immune functionand predicts for opportunistic infection

measurement of HIV RNA in plasma - detrmines viral load

THE END

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