IV Vancomycin is reserved for the treatment of...
MRSA
AEs of vancomycin
ototoxic
nephrotoxic
"Red man syndrome"- rash, hypotension
-use correlates with VRE
Additive effect
2 drugs with similar actions
-sedative drug + alcohol = increased sedation
Iron Replacement medication considerations
Take with food
-Food may decrease absorption, but GI intolerance may require
it
-Take with vitamin C or citrus juices to enhance absorption
-Calcium decreases absorption (avoid milk, antacids)
Increase fluids, fiber, stool softener to prevent constipation
Drug-drug interactions
-decreases absorption of tetracyclines, fluoroquinolones,
levothyroxine
-avoid PPIs, H2RA (acidic stomach pH increases absorption)
Synergism or potentiation
,2 drugs with different mechanisms of action that produce greater
effects when taken together
-ex. acetaminophen + codeine = Tylenol #3 (greater analgesia)
Children Iron Replacement
liquid iron- Fer-In-Sol gtts
-15 mg elemental iron/1 ml
Lincosamide example
clindamycin PO, IM, IV
Interference
interference by one drug with the metabolism or elimination of a
second drugs results in increased effects of the second drug
-ex. cimetidine inhibits drug metabolizing enzymes in the liver;
thus, decreased metabolism of many drugs such as
benzodiapines, beta-blockers, theophylline
Liquid iron considerations
Double/triple check dose calculations!!: different
forms/concentrations exist; dose varies based on age and weight
-Mix with juice because of bitter taste
-Drink through straw (stains teeth) and then rinse mouth
Clindamycin
useful in gram + and -, MRSA
Displacement
,displacement of one drug from the plasma protein binding sites
by a 2nd drug = increasing the effects of the displaced drug
-warfarin + aspirin = increased anticoagulant effect of warfarin
IV Iron Replacement
Iron dextran
-risk of anaphylaxis: ordered as small test dose prior to
therapeutic dose
-emergency drugs and equipment must be available when
administered
AEs of clindamycin
Pseudomembraneous colitis: use is limited due to this; life-
threatening
Antidote
given to antagonize the toxic effects of another drugs
-ex. naloxone - given for opioid overdoses; opioid antagonist
Nursing considerations for IV Iron dextran
-epinephrine and benadryl usually taped to the IV pole
-bedside monitoring for the first 15 minutes
-hourly vital signs and completion vital signs
-usually given in about 50 ml over one hour
Anti-TB: Isoniazid (INH) MOA
inhibits formation of bacterial cell walls
-kills actively growing organisms and inhibits growth of
dormant organisms
AEs of isoniazid
, Peripheral neuropathy: take vitamin B6 (pyridoxine)
Hepatotoxicity: monitor LFTs
Decreased intestinal absorption
when oral drugs combine to produce unabsorbable compounds
-ex. antacids taken with tetracycline
Children are given ___________ to clean the stomach during an
iron overdose.
activated charcoal
Nursing implications for isoniazid
-take on an empty stomach: 1 hour before or 2 hours after a meal
-food delays absorption
Pediatric patient is defined as a person...
younger than 16 years old and weighing less than 50 kgs (110
lbs)
Causes of diarrhea
viral infections
bacterial infections
spicy foods
inflammatory bowel disease (Crohn's, UC)
IBS
antibiotics
stress/anxiety
hyperthryoidism
intestinal neoplasm
bypass surgery