Exam 2 Review Week 4

1) What are the anticipated side effects of Rifampin? Contraindications? What are the uses? What lab
testing is needed with this medication and other TB medications? Patient education?

Red orange tears and urine, Contraceptives don’t work well.

Purpose: Bacterialcidal as a result of inhibition of protein synthesis.

Uses: Broad spectrum antibiotic effective against gram + and Gram – bacteria. Used to treat TB in culmination with
other medications.

Administration: Oral or IV, administer 1 hour before or 2 hours after meals with full glass of water. Absorption is
decreased if given with food.

Adverse/Side Effects: Orange color of urine, saliva, sweat, and tears. Anorexia, nausea, and abdominal discomfort.
If jaundice, anorexia, and fatigue are present report as concern for hepatotoxicity. If abdominal pain persists or is
accompanied by fever, diarrhea, or bloody stool the patient may be at risk for Pseudomembranous colitis.

Contraindication: Pregnancy cat B, caution with patient with liver dysfunction.

Interactions: Warfarin, oral contraceptives, protease inhibitors, and non-nucleoside reverse transcriptase
inhibitors for HIV. Monitor PT INR, potential to increase HIV medication doses, non-hormonal contraceptives. No
alcohol use. Increased risk of hepatotoxicity with isoniazid and pyrazinamide. Monitor LFT.

Patient education: Non hormonal form of birth control, complete course of therapy

2) Understand the adverse effects, uses (types of infections), nursing administration assessment and
evaluation for Vancomycin.

Prototype Drug: Vancomycin

Actions: Cell wall inhibitor effective against methicillin-resistant Staphylococcus aureus, staphylococcus epidermis,
and streptococcal infections

Administration: If flushing occurs during administration, first action is to slow administration rate. Monitor for
signs of anaphylaxis and allergic reaction and discontinue. PO, IV (rotate sites, monitor for swelling, redness and
pain) or rectal use.

Adverse Effects: Redman syndrome (rashes, itching, flushing, tachycardia, and hypotension), ototoxicity,
thrombophlebitis, renal toxicity, allergic reactions.

Interactions: Vanco with other ototoxic drugs

Patient education: Notify for changes in hearing, symptoms of allergic reaction.

Contraindications: Use cautiously in patients with chronic kidney disease (CKD) related to nephrotoxicity and those
with hearing loss and allergy to vancomycin.

Labs: Renal function tests, I & O, & trough levels after blood level have reached steady state, close monitoring
before.

3) What are prophylactic abx and what patients are they commonly used for?
 4) Ciproflaxin uses, side effects, adverse effects, contraindications, nursing education for patient.

Cipro oral is used for post exposure to bacillus anthracis (anthrax), the plague, tularemia and brucellosis (all of
these are noted biological warfare,

Prototype Drug: Ciprofloxacin

Actions: Bactericidal due to inhibition of the enzyme necessary for DNA replication.

Administration: IV and Oral formulations. Used for multiple gram positive and gram-negative bacteria, UTI, URI, GI,
bones, joint, skin, soft tissue, anthrax prophylaxis, & STI. IV should be given in dilute solution slowly over 60 min in
large vein.

Side effects: rash, fever, nausea, diarrhea, dizziness and tinnitus, take with food for GI upset,

Adverse Effects: Anaphylaxis, tendon rupture in those over 60, super infections, PMC (pseudomembranous colitis),
seizures, peripheral neuropathy, phototoxicity (severe sunburn),and hepatotoxicity. There is potential affect to
cartilage development so they should be avoided in those under 18 years of age and those who are pregnant.
Cipro toxicity

Interactions: Fluoroquinolones use caution, cationic compounds (antacids, iron sales, sucralfate, dairy decrease
absorption (administer 6 hrs. before or 2 hours after), theophylline and warfarin levels may increase and may need
dose correction

Patient education: Take medication until complete, if used for STI refrain from intercourse until client and partner
complete treatment.

Contraindications: Children under 18 years of age unless specific use, caution with older adults and CV disease,
pregnancy assess risk vs benefit category C, no safety established in lactation, those with poor kidney function
should be used cautiously.

Labs: PT/INR for those on warfarin, theophylline levels

5) Amphotericin B uses, laboratory values to monitor, adverse effects and side effects.

6) Penicillin G side effects, adverse effects, post admin monitoring, administration protocol.

Actions: Narrow spectrum bacterialcidal that affects the cell wall, treats gram positive cocci, gram – cocci
meningitis, gram – spirochetes, prophylaxis for endocarditis

Administration: Assess for any penicillin allergy prior to administration! IM or IV (do not administer in the same
IV solution as aminoglycosides), give IM injections carefully to avoid nerve or artery damage and administer in the
dorsogluteal or ventrogluteal sites, monitor for allergic reaction for 30 minutes post administration (be aware they
can occur up to 72-hour post administration). If allergic reaction noted during administration, stop infusion
immediately!

Adverse Effects: Allergic reaction, anaphylaxis, renal impairment (monitor RFP & I & O, hyperkalemia &
dysrhythmias (penicillin G), hypernatremia (IV ticarcillin-clavulanate)
Interactions: Probenecid & aminoglycosides

Patient education: Wear allergy identification bracelet, if allergic to one considered allergic to all

Contraindications: Prior allergic reaction to penicillin, cephalosporins, or imipenem, care for patients at risk for
kidney dysfunction

Labs: Renal function

7) Cephalaxin uses, adverse effects, contraindication, and interactions.

8) Define anaphylaxis and understand what it is related to the reaction of the body. Know what the assess,
how to treat, and follow up care

Anaphylaxis: Mass systemic release of histamine and other chemical mediators of inflammation that may lead to
life threatening shock.

 Always assess for penicillin allergy and know all penicillin-based components to avoid reactions
 Administer epinephrine sub-Q immediately, as ordered for anaphylaxis. Request this meds as a standing
order for these administrations.
 Assure you and your clients are aware of the signs and symptoms (s/s) of allergic reaction
 Stress the importance of making physicians and staff aware of an history of allergic reaction Discontinue
medications immediately if an allergic response is suspected.

9) Penicillin/Amoxicillin/Ampicillin administration, side effects, adverse effects, allergies which medication

do we need to know as a potential allergy risk, self-monitoring, contraindication, nursing interventions &
s/s

Prototype Drug: Amoxicillin

Other medications: Penicillin, Augmentin (amoxicillin/clavulanate)

Actions: Eradication of infection

Administration: Used for otitis media and other various infections throughout the body. PO & IV administration.
Assess for any penicillin allergy prior to administration! If allergic reaction noted during administration, stop
immediately!

Side Effects: GI upset, notify provider for severe diarrhea

Adverse Effects: Allergic reaction, anaphylaxis, suprainfection

Interactions: Reduces effectiveness of hormonal contraceptives

Patient education: Wear allergy identification bracelet, if allergic to one considered allergic to all, take with food to
minimize GI upset, take full course even if symptoms are improved

Contraindications: Prior allergic reaction to penicillin, caution with cephalosporin allergy, and care for patients
under 3 months of age due to risk for immature kidney function and risk of toxicity

Labs: Renal function

 10) Gentamicin: understand the peak and trough laboratory, adverse effects, side effects, preventing adverse
effects, nursing administration information. Understand different routes and patient administration
education.

Prototype Drug: Gentamycin Bactericidal through disruption of protein synthesis

Actions: Bactericidal through disruption of protein synthesis
Administration: Treats gram – bacilli (e-coli, klebsiella, proteus mirabilis, and pseudomonas) Monitor serum levels.
When administering topically for wound administration assess the site and always clean with soap and water
before placing new application of medication. IV, IM, and topical, administer 2 hours after antibacterial and
antifungal medications
Adverse Effects: Ototoxicity (monitor for tinnitus, hearing loss, headache, nausea, dizziness, and vertigo),
nephrotoxicity, hypersensitivity reaction
Interactions: Penicillin and other ototoxic medications. Caution for those taking ethcrynic acid, amphotericin B,
cephalosporins, vancomycin, and neuromuscular blocking agents.
Patient education: Notify for any kidney impairment as lower doses are needed.
Contraindications: Pregnancy risk category C, caution with kidney impairment, hearing loss, myasthenia gravis
Labs: A peak should be drawn immediately prior to administration and 30 minutes after the dose is administered
to assure to minimize any toxic or systemic effects. Serum levels should be monitored. Assess hearing before and if
needed during treatment. Monitor I & O, BUN, and creatinine. Notify for cloudy urine or hematuria.

11) Nystatin uses, administration, adverse effects, side effects, and storage.

12) Metronidazole uses, administration, adverse effects, side effects and patient education.

Prototype drug: metronidazole (Flagyl)

Mechanism of action: to act as antiprotozoal drug that also has antibiotic activity against anaerobic bacteria

Primary use: treats most forms of amebiasis; preferred drug for giardiasis and trichomoniasis.

Adverse effects: anorexia, nausea, diarrhea, dizziness, headache, dry mouth, unpleasant metallic taste

Must avoid all alcohol, even mouthwashes & perfumes

Contraindicated with hematologic disorders, severe skin disorders, active organic disease of CNS, during first
month of pregnancy, alcoholism

Used cautiously with preexisting cardiovascular disease, lactating patients

13) Cefoxitin adverse effects, side effects, contraindications, uses, administration.

14) Erythromycin patient education, uses, administration, adverse and side effects.

Prototype Drug: Erythromycin

Actions: Bacteriostatic inhibits protein synthesis, bactericidal at high doses
Administration: take on empty stomach unless GI discomfort presents, IV only if no PO means, used for
prophylaxis, legionnaires, pertussis, diptheria, chlamydia
Side effects: GI discomfort
Adverse Effects: Ototoxicity (monitor for ringing in ears, changes in hearing, vertigo),& prolonged QT
Interactions: antihistamines, theophylline, carbamazepine, warfarin, digoxin, verapamil, diltiazem, HIV protease
inhibitors, antifungals, and nefazodone.
Patient education: Decreased hormonal contraceptive use back up method, take all medication, for STI avoid
sexual activity until both client and partner complete treatment
Contraindications: Pregnancy risk B, liver disease and long QT are contraindications.
Labs: PT/INR for those on Warfarin, LFT for treatment greater than 2 weeks

15) Mebendazole use, adverse effects, education, and lab results.

Prototype drug: mebendazole (Vermox)

Mechanism of action: as broad-spectrum antihelminthic drug

Primary use: to treat wide range of helminth infections

Adverse effects: as worms die, abdominal pain, distension, and diarrhea may be experienced

16) Fluconazole use, adverse effects, contraindications, and side effects.

Prototype drug: fluconazole (Diflucan)

Mechanism of action: to act by interfering with synthesis of ergosterol

Primary use: to treat fungal infections in CNS, bone, eyes, urinary tract, respiratory tract

Not effective against non-albicans Candida species

Adverse effects: nausea, vomiting, diarrhea reported at high doses, SJS in immunocompromised, Drug induced
hepatitis (ketoconazole)

Week 5
17) Methotrexate uses, adverse effects, side effects, laboratory tests and patient education.

18) Zidovudine uses, adverse effects, side effects, laboratory monitoring, and contraindications.

19) Understand the administration order with inhaled medications, how to take inhaled medications, patient
education with inhaled medications.
20) In what ways does albuterol work within the body, when is it a priority for the patient, and what is proper
administration?

21) Prednisone side effects, adverse effects, weaning protocols, why weaning protocols are in place, and uses.

22) Know why a metered dose inhaler is used and the steps to advise a patient to use it.

23) Theophylline uses, adverse effects, side effects, administration formats and patient education.

24) Montelukast uses, therapeutic effects, patient administration, patient education, side effects and adverse
effects.

25) What is the purpose of an expectorant? When are they used and why? Side effects, adverse effects, and
patient education.

26) Understand which medications are commonly used for asthma attacks, prevention and the rationale for
each.

27) Fluticasone/Salmeterol dry powder inhaler uses, education, and adverse effects.

28) Doxorubicin administration, assessment, interactions, and black box warning

29) Skin cancer prevention education

30) Mental health- What is projection? What is agoraphobia? , Using open ended questions and statements ,
Providing support and holistic care