Latest ATI [NUR] Final Exam

1. amphotericin B (antifungal) pharm effect and therapeutic use: PE: acts on fungal cell membranes to cause cell death (can be fungistatic or funicidal) TU: systemic fungal infections and nonoppurtunistic mycoses 2. amphotericin B (antifungal) adverse effects and nursing interventions for each: -infusion reaction 1-3 hr after intiating: infuse slowly, pretreat with benadryl and tylenol -thrombphlebitis: observe infusion sites for signs of erythema, swelling, and pain; rotate injection sites; administer in large vein nephrotoxicity: obtain baseline kidney function (BUN) and do weekly kidney tests hypokalemia: montor electrolyte levels bone marrow suppression: obtain baseline CBC 3. amphotericin B (antifungal) contraindications: clients who have renal dys￾function 4. amphotericin B (antifungal) interactions: aminoglycosides: have additive mephrotoxic risk azole antibiotics: increase levels of multiple drugs (digoxin, warfarin, and sulfony￾lurea) 5. nursing administration of amphotericin B (antifungal): its highly toxic and should be reserved for life threatening fungal infections infuse slowly via IV take full course of antifungal even if symptoms subside 6. amoxicillin and penicillin action and use: action: broad spectrum penicillin; destroy bacteria by weakening cell wall use: gram positive cocci, meningitis, pneumonia, syphilis 7. amoxicillin and penicillin adverse effects and nursing interventions for them: allergic reaction/anaphylaxis: interview clients for prior allergies, observe pt for 30 minutes after administration of penicillin renal impairment: monitor kidney function hyperkalemia/dysrhythmias: monitor cardiac status and electrolyte levels 8. amoxicillin and penicillin contraindications: contraindicated for pts with se￾vere allergic rxn history use cautiously in children who are at risk for kidney dysfunction 9. amoxicillin and penicillin interactions: inactivates aminoglycosides - do not mix in the same IV solution probenecid delays excretion of penicillin 10. amoxicillin and penicillin nursing administration tips: tell pts these may be taken with meals tell pts to report signs of allergic rxn complete entire course of Tx regardless if symptoms stop 1 / 12 pharm fnal exam ATI Study online at 11. cephalosporins (as a whole): action: beta-lactam antibiotics, similar to peni￾cillins that destroy bacterial cel walls causing destruction of micro-organisms use: UTI, postop infections, pelvic infections, and meningitis 12. as cephalosporins go into higher generation: they are more likely to reach cerebrospinal fluid less likely to be destroyed by beta-lactamases more effective against gram negaive organisms and anaerobes 13. cephalosporins (as a whole) adverse effects and nursing inerventions: -al￾lergic rxn/anaphylaxis: if indications of allergy appear, stop drug immediately and notify provider -bleeding: avoid use in clients w bleeding disorders; observe clients for signs of bleeding; adin parenteral vitamin K -thrombophlebitis: rotate injection sites; admin as diluted solution or administer slowly over 3-5 min 14. cephalosporins (as a whole) contraindications: should not be given to ppl with severe penicillin allergc rxns use cautiously in ppl with renal impairment or bledding tendencies 15. cephalosporins (as a whole) interactions: disulfiram reaction occurs when cefotetan is mixed with alcohol - tell pts not to mix with alcohol! probenecid delays renal excretion 16. cephalexin: first generation cephalosporing cant cross BBB 17. cefotetan: second generation cephalosporin cant cross BBB 18. ceftriaxone: third generation cephalosporin can cross BBB 19. amphotericin B + flucytosine: these two are mixed bc antifungal effects of flucytosine are potentiated with concurrent use of amphotericin B this allows for reduction in dosage of amph B 20. acyclovir use and action: action: prevent the reproduction of viral DNA and thus interrupt cell replication use: herpes simplex, varicella-zoster virus 21. acyclovir adverse effects and nursing interventions: -phlebitis: rotate injec￾tion site, monitor IV site for swlling and redness -nephrotoxicity: administer acyclovit infusion slowly over 1 hr; ensure adequate hydration during infusion -mild discomfort with oral therapy (N/D, HA): observe for symptoms and notify provider 2 / 12 pharm fnal exam ATI Study online at 22. acyclovir contraindications: use cautiously in pts who have renal impairment or dehydration, and in clients taking nephrotoxic meds 23. acyclovir interactions: probenecid may decrease elimination of acyclovir: mon￾itor medication for toxicity concurrent use of zidovudine may cause drowsiness 24. acyclovir nursing interventions: -administer iv infusion slowly over 1 hr or longer -inform clients to expect symptom relief but not cure -tell pt to wash infected area 3-4 times a day with soap and water -advise pt to avoid sexual contact while lesions are present 25. ciprofloxacin action and use: action: bacteriacidal as a result of inhibition of the enzyme necessary for DNA replication use: broad spectrum antimicrobials used for a wide variety of microorganisms suuch as aerobic gram negative bacteria, gram positive bacteria; UTI, RTI and GI tract infections 26. ciprofloxacin adverse effect and corresponding nursing interventions: -GI discomfort: administer meds accordingly -achilles tendon rupture: instruct client to observe for pain, swelling, or redness at tendon site, and notify provider if they occur; discontinue if this happens - dont exercise til pain subsides -suprainfection: instruct the client to observe for clinical manifestations of yeast infection and notify provider if they occur -phototoxicity (severe sunburn): instruct pt to avoid sun exposure and wear protec￾tive clothing; discontinue immediately if phototoxicity occurs 27. ciprofloxacin contraindications/precautions: dont administer to children un￾der 18 y.o. unless for E. Coli of UTI or inhaled anthrax increases risk of developng C. diff can effect the CNS - use with cautino in elderly and those with cardiovascular diseases 28. ciprofloxacin interactions: -cationic compouds decrease absorption of ciprofloxacin: administer cationic compounds 6 hr before or 2 hr after ciprofloxacin -plasma levels of theophylline can increase -plasma levels of warfarin can increase 29. ciprofloxacin nursing considerations: -discontinue other IV or use another IV site when administering IV -decrease dose in pts with renal dysfunction -IV solution should be administered in dilute solution over 60 min in large vein 3 / 12 pharm fnal exam ATI Study online at 30. ethambutol use and action: bacteriastatic only to ~M. tuberculosis~ action: highly specific to mycobacteria use: active and latent TB 31. isoniazid use and action: action: inhibits growth of mycobacteria by preventing synthesis of mycolic acid in the cell wall use: latent TB (6-9 months), active TB (minimum 6 months) 32. isoniazid contraindications: contraindicated for clients wtih liver disease use cautiously in older clients and those who have diabetes mellitus or alcohol use disorder 33. isoniazid interactions: inhibits metabolism of phenytoin, leading to buildup of medication and toxicity (ataxia and incoordination may indicate toxicity) - monitor the client's levels of phenytoin. dosage of phenytoin may beed to be adjusted based on phenytoin levels) 34. pyrazinamide use and actions: actions: inhibits mycobacteria of TB use: latent and active TB 35. pyrazinamide interactions: use with alcohol can increase risk of hepatotoxicity - instruct clients to avoid alcohol, monitor liver function 36. ethambutol, isoniazid, and pyrazinamide (anti-TB) adverse effects and corresponding nursing interventions: -peripheral neuropathy (tingling, numbness, burning): instruct clients to observe for manifestations and to notify the provider if they occur -hepatotoxicity (anorexia, malaise, fatigue, nausea): instruct clients to observe for manifestations and notify the provider if they occur; monitor liver function, instruct clients to avoid alc use; may need to discontinue if liver function test results are elevated -hyperglycemia and decresed glucose control in pts with DM: monitor blood glucose 37. ethambutol, isoniazid, and pyrazinamide (anti-TB) nursing administration tips: -usually adminstered orally,; when given IM, make sure its free of crystals and inject deeply into large muscle -for active TB, direct observation therapy is done to ensure adherence -advise clients to take isoniazid 1 hr before meals or 2 hours after; if gastric discomfort occurs, can take with meals 38. rifampin (anti-TB) use and action: action: bacteriacidal as a result of inhibition of protein synthesis use: broad spectrum antibiotic for gram-negative and gram-positive bacteria, M. tuberculosis