Term
|
Definition
| Requiring the presence of oxygen |
|
|
Term
|
Definition
|
|
Term
|
Definition
Bringing death to bacteria
Usually on effective against bacteria that are growing |
|
|
Term
|
Definition
| Restrains the development or production of bacteria |
|
|
Term
|
Definition
| Secondary infection caused by opportunistic pathogen, such as fungal infection after antibiotic tx |
|
|
Term
|
Definition
| Inactive or partially active drug that is metabolically changed in the body to an active drug |
|
|
Term
|
Definition
| accumulation of billirubin in CNS tissue (jaundice) |
|
|
Term
|
Definition
| Breakdown of hemoglobin in red blood cells after termination normal life span |
|
|
Term
|
Definition
| Decrease in hemoglobin caused by a decrease in red blood cell production or an increase in red blood cell destruction |
|
|
Term
|
Definition
| marked decrease in number of RBCs, WBCs, and platelets |
|
|
Term
|
Definition
| Decrease in number of neutrophils in blood (associated with leukemia) |
|
|
Term
|
Definition
| Decrease in number of WBCs |
|
|
Term
|
Definition
| bone marrow decrease in production of RBCs, WBCs, and platelets |
|
|
Term
|
Definition
| decrease in production of platelets |
|
|
Term
|
Definition
decrease in total amount of granulocytes in blood
(Neutrophils, Eosinophils, Basophils) |
|
|
Term
| Gram Positive wall has ____ layers |
|
Definition
2 layers:
cytoplasmic membrane
cell wall |
|
|
Term
| Gram negative wall has ____ layers |
|
Definition
3 layers:
cytoplasmic membrane
Thin cell wall
Outer membrane (difficult to penetrate) |
|
|
Term
| Location of Pencillin Binding Proteins |
|
Definition
|
|
Term
| 3 means of bacterial destruction |
|
Definition
1. Cell wall destruction (penicillins, cephalosporins)
cause bacterial lysis
2. enzymatic inhibition (sulfonamides inhibit PABA conversion)
3. Protein synthesis destruction |
|
|
Term
| Drug resistance develops in two ways: |
|
Definition
spontaneous resistance
conjugation |
|
|
Term
| Microbial mechanisms of drug resistance (4 ways) |
|
Definition
1. Elaborate drug metabolizing enzyme
2. Cell does not take in drug
3. Receptor site or biding changes
4. cell produces material that antagonize drugs from working |
|
|
Term
| MInimum inhibitory concentration |
|
Definition
| lowest concentration of antibiotic that produces complete inhibition of bacterial growth |
|
|
Term
|
Definition
|
|
Term
| Penicillin: bactericidal or bacteriostatic? |
|
Definition
|
|
Term
| Drugs that have Beta-lactam ring |
|
Definition
Penicillins
Cephalosporins
Aztreonam
Imipenem
Meropenem
Ertapenem |
|
|
Term
| True or false: Ampicillin can cross outer most wall of gram-negative bacteria |
|
Definition
| True. Ampicillin is a broad spectrum antibiotic |
|
|
Term
Skin infections are usually Gram ____
Internal infections are usually Gram ____ |
|
Definition
skin infections are usually gram POSITIVE
internal infections are usually gram NEGATIVE |
|
|
Term
Penicillin resistance occurs....
(2 ways) |
|
Definition
1. inability of PCN to reach their targets
2. inactivation of PCN by bacterial enzymes |
|
|
Term
Narrow Spectrum Penicillins
(penicillinase sensitive) |
|
Definition
|
|
Term
Narrow Spectrum Penicillins
(Penicillinase resistant) |
|
Definition
Methicillin
Naficillin
Oxacillin
Cloxacillin
Dicloxacillin |
|
|
Term
| Penicillins that act on Staph. aureus |
|
Definition
Narrow spectrum penicillins (penicillinase resistant):
Methicillin
Naficillin
Oxacillin
Cloxacillin
Dicloxacillin |
|
|
Term
Broad Spectrum Penicillins
(aminopenicillins) |
|
Definition
Ampicillin
Amoxicillin
Bacampicillin |
|
|
Term
Extended Spectrum Penicillins
(antipsuedomonal) |
|
Definition
Carbenicillin indanyl
Ticaricillin
Mezlocillin
Piperacillin |
|
|
Term
| What kind of penicillin is used against P. auerugenosa? |
|
Definition
Extended Spectrum Penicillins
(ex: ticarcillin, mezlocillin) |
|
|
Term
| What is the MOA of penicillins? |
|
Definition
| Weaken cell wall which causes cell wall to take up water and burst (lysis) through activation of autolysisns and transpeptidases |
|
|
Term
| True or False: Penicillin is effective against static bacteria. |
|
Definition
| False. Penicillins only work against cells undergoing growth and division. |
|
|
Term
| Penicillin G: what determines route of administration? |
|
Definition
Salt.
3 types: Potassium PCN G (fastest; IM or IV)
Procaine PCN G (IM)
Benzathin PCN G (IM) |
|
|
Term
| Which penicillin can be given PO? |
|
Definition
PCN VK (PenVK)
Other PCNs are not stable in acid and cannot be given PO |
|
|
Term
| All penicillins can be given by what route? |
|
Definition
|
|
Term
| True or False: Inflammation decreases PCN G distribution |
|
Definition
False.
Inflammation increases PCN G distribution to CSF, eyes, and joints |
|
|
Term
| PCN G is eliminated by... |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Cross sensitive for penicillin |
|
Definition
| cephalosporins, carbapenems |
|
|
Term
| Cross sensitive for penicillin |
|
Definition
| cephalosporins, carbapenems |
|
|
Term
| 1st and 2nd generation are often effective against Gram ____ |
|
Definition
|
|
Term
| Amoxicillin + clavulanic acid = |
|
Definition
|
|
Term
|
Definition
| Flagyl first, then vancomycin |
|
|
Term
| ____ % of people have an allergic rxn to penicillin |
|
Definition
1-10%
rxn ranges from rash to anaphylaxis |
|
|
Term
| When giving extended spectrum penicillin w/ aminoglycosides, separate doses by at least... |
|
Definition
|
|
Term
| True or False: Augmentin increases diarrhea |
|
Definition
| True, especially in children |
|
|
Term
|
Definition
Used to treat P. aerugenosa
has disodium salt so be careful in pts with CHF |
|
|
Term
| What extended spectrum PCN interferes w/ platelet function? |
|
Definition
|
|
Term
|
Definition
1. disrupt cell wall synthesis
2. activate autolysins
bacteriacidal, similar to PCNs |
|
|
Term
| True or false: cephalosporins are optimally given PO |
|
Definition
False. Cephalosporins are poorly absorbed by the GI tract; given parenterally
Ceforoxime is the only cephalsoprin that can be given PO and injection |
|
|
Term
| Which generation of cephalosporins is most effective against meningitis? |
|
Definition
| 3rd generation (ex: cefoxtamine) |
|
|
Term
| Cephalosporin that can be given PO and injection |
|
Definition
|
|
Term
| 1st generation cephalosporins CAN be used for ____ and some ______ but not ______ |
|
Definition
staphylococci
streptococci
meningitis |
|
|
Term
| Refrigerate oral suspensions of... |
|
Definition
|
|
Term
| Probenecid prolongs/shortens effect of cephalosporins |
|
Definition
| Prolongs (delays renal excretion) |
|
|
Term
| True or False: You should check prothrombin time with cephalosporins |
|
Definition
True
Cephalosporins (esp. cefmetazole, cefoperazone, and cefotetan) promote bleeding |
|
|
Term
| Antibiotic effect on birth control |
|
Definition
|
|
Term
| Meropenem can be used for meningitis in children older than.... |
|
Definition
|
|
Term
|
Definition
| acute pelvic infections, UTIs, community-acquired pneumonia |
|
|
Term
| Infuse Vancomycin over ____ minutes |
|
Definition
|
|
Term
| Vancomycin is active against Gram ____ |
|
Definition
| Gram positive (S. aureus, S. epidermidis) |
|
|
Term
|
Definition
caused by C. diff
treat with flagyl first, then vancomycin |
|
|
Term
|
Definition
| Flagyl first, then Vancomycin |
|
|
Term
| True or False: Vancomycin contains beta-lactam ring |
|
Definition
False
Vancomycin does NOT contain beta-lactam ring |
|
|
Term
| Rapid infusion of vancomycin can cause: |
|
Definition
Red Man Syndrome
(infuse over 60 min or more) |
|
|
Term
| Give Vancomycin ___ for intestinal infections |
|
Definition
PO
(Given PO ONLY FOR infection of intestines) |
|
|
Term
| Adverse effect of Vancomycin |
|
Definition
Neprhotoxicity
Ototoxicity if exceeds 30 mcg/ml
Red Man Syndrome
Thombophlebitis (change infusion site and dilute) |
|
|
Term
|
Definition
| 2 grams/day @ 12-24 hr intervals |
|
|
Term
| Vancomycin dose: Children |
|
Definition
| 44 mg/kg/day 6-12 hr intervals |
|
|
Term
| True or false: Vancomycin can treat meningitis |
|
Definition
True
can be given IV but may need to give interthecally |
|
|
Term
| When do you check peaks/troughs with vancomycin? |
|
Definition
peaks: 1.5-2.5 hrs after infusion is complete
Trough: before giving next dose |
|
|
Term
| Vancomycin: acceptable peak level |
|
Definition
|
|
Term
| Bacteriostatic inhibitors of protein synthesis |
|
Definition
Tetracyclines (-cycline)
Macrolides (-mycin)
Lincosamides (-mycin) |
|
|
Term
|
Definition
Tertracyclines
Macrolides
Lincosomides |
|
|
Term
| True or false: take short acting tetracyclines with food |
|
Definition
False.
Take short acting tetracyclines on an empty stomach to increase absorption.
Take long acting w/ or w/o food |
|
|
Term
| Do not give short acting tetracyclines to pts. with... |
|
Definition
|
|
Term
| Tetracyclines are now mainly used for... |
|
Definition
|
|
Term
| Tetracyclines can be used against... |
|
Definition
| Rickettsia, spirochetes, Brucella, Chlamydia, Mycoplasma, H. pylori*, Bacillus anthracis*, virbrio cholerae, Lyme disease* |
|
|
Term
| Pregnancy and Tetracyclines |
|
Definition
| Avoid giving tetracycline during pregnancy |
|
|
Term
| Short acting tetracyclines |
|
Definition
Tetracycline, oxytetracycline
Low lipid solubility, give on empty stomach |
|
|
Term
| Long acting tetracyclines |
|
Definition
Doxycycline, minocycline
High lipid solubility
can be given w/ or w/o food |
|
|
Term
| Chelation can be caused by... |
|
Definition
Calcium (milk), iron, Mg 2+ (laxatives), aluminum, zinc
(basically anything w/ a positive charge) |
|
|
Term
| Chelating agents increase/decrease absorption of tetracyclines |
|
Definition
Decrease.
Give 2 hours before or after consuming chelating agents |
|
|
Term
| Tetracycline distribution |
|
Definition
Crosses placenta
enters fetal circulation
CSF penetration POOR, does not treat meningitis |
|
|
Term
| Adverse effects of tetracyclines |
|
Definition
gastric burning, N/V diarrhea, cramps
Bones/teeth- brown/yellow discoloration in developing teeth
Hepatotoxicity (rare; postpartum and kidney failure most at risk)
Phototoxicity |
|
|
Term
| Avoid giving tetracyclines in children younger than.... |
|
Definition
|
|
Term
| Macrolides: Bactericidal or static? |
|
Definition
| Bacteriostatic, but can be -cidal at high concentrations or against susceptible organisms |
|
|
Term
|
Definition
| inhibit protein synthesis |
|
|
Term
|
Definition
| erythromycin, clarithromycin, azithromycin, dirithromycin, troleandomycin |
|
|
Term
| Tx of Mycobacterium avium complex |
|
Definition
|
|
Term
| Therapeutic uses of macrolides |
|
Definition
| URT and LRT infections, acute otitis media, ,GI infections, MAC (in pts. w/ advance HIV infection) |
|
|
Term
| Cytochrome P450 metabolizes... |
|
Definition
| Macrolides, theophylline, warfarin, carbamazepine, phenytoln, tolbutamide, chlorpropamide, sulfonamides, fluropquinolones |
|
|
Term
| Metallic taste occurs w/... |
|
Definition
|
|
Term
| True or False: give azithromycin with food |
|
Definition
False
Give azithromycin on empty stomach |
|
|
Term
Clarithromycin: w/ or w/o food?
spectrum? |
|
Definition
Extended release- take w/ food, others w/o
spectrum: Respiratory infection, H. hylori, MAC in HIV, uncomplicated skin infections |
|
|
Term
| Alternative to penicillin |
|
Definition
| Lincosoamides (Clindamycin) |
|
|
Term
| Cause pseudomembranous colitis (C. diff) |
|
Definition
Lincosamides, Macrolides, Tetracyclines
If pt. experiencing diarrhea, stop tx immediately |
|
|
Term
| Lincosamides: -static or -cidal? |
|
Definition
| static, but can be cidal if orgaism is especially sensitive |
|
|
Term
| Lincosamides: Therapeutic uses |
|
Definition
| Anaerobic infections outside CNS, gram + bacteria (good alternative to PCNs), gas gangrene (clostridium perfringes), abdominal and pelvic infections by B. fragilis |
|
|
Term
|
Definition
| flagyl first, then vancomycin or metronidazole |
|
|
Term
| Major potential side effects of Chloramphinicol (chloromycetin) |
|
Definition
| aplastic anemia, gray syndrome in infants |
|
|
Term
| Chloramphinicol: -cidal or -static? |
|
Definition
| usually bacteriostatic but can be "cidal" against highly susceptible organisms or if in high concentrations |
|
|
Term
| Good treatment for brain abcesses and meningitis |
|
Definition
Chloramphenicol (crosses BBB and enters CSF)
also crosses placenta and enters breast milk |
|
|
Term
|
Definition
PO: chloramphenicol base (active immediately)
IV: chloramphenicol succinate (prodrug) |
|
|
Term
| Metabolism of choramphenicol: |
|
Definition
| hepatically metabolized, renally excreted |
|
|
Term
| Therapeutic index of chloramphenicol |
|
Definition
NARROW THERAPEUTIC INDEX
monitor serum levels, especially neonates, infants, and children |
|
|
Term
| Peaks and troughs of chloramphenicol |
|
Definition
peak: 10-20 mcg/ml
trough: 5-10 mcg/ml |
|
|
Term
|
Definition
Adverse effect of chloramphenicol
1st- vomiting, abdominal distention, cyanosis, gray discoloration of skin
2nd- collapse and death
reversible if detected early |
|
|
Term
| Causes reversible bone marrow suppression |
|
Definition
Chloramphenicol;
usually reversible 1-3 wks after withdrawal
check CBC's prior to treatment and daily 2 days thereafter |
|
|
Term
| True or False: aplastic anemia is dose related |
|
Definition
False.
(1 in 35,000 pts)
generally develops weeks/months after treatment stops |
|
|
Term
| Drug interactions w/ Chloramphenicol |
|
Definition
(P450 drugs)
phenytoin, warfarin, tolbutamide, chlorpropamide |
|
|
Term
| True or false; take Chloramphenicol with food |
|
Definition
| False. Take on empty stomach (1 hr before eating or 2 hrs after eating) |
|
|
Term
| Reduce chloramphenicol dose in pts with... |
|
Definition
|
|
Term
| Examples of Aminoglycosides |
|
Definition
| getamicin, tobramycin, amikacin, kanamicin, neomycin, streptomycin |
|
|
Term
| Which aminoglycoside is least susceptible to inactivation by bacterial enzymes? |
|
Definition
Amikacin
(so use only for severe infection) |
|
|
Term
| Aminoglycosides- broad or narrow spectrum? |
|
Definition
|
|
Term
|
Definition
| aminglycosides, vancomycin, chloramphenicol |
|
|
Term
| Dose of aminoglycosides must be ________. |
|
Definition
Individualized.
dose is affected by age, % body fat, renal fxn, fever, edema, dehydration |
|
|
Term
| Can aminoglycosides kill anaerobes? |
|
Definition
No.
Cannot b/c glycosides require O2 for transport across cell membrane |
|
|
Term
| When do you take peaks and troughs with Aminoglycosides? |
|
Definition
peak: 30 minutes after injection/completion of IV
trough: before giving next dose |
|
|
Term
| Why are aminoglycosides limited use? |
|
Definition
Nephrotoxicity (bind tightly to renal tissue, achieving 50 times the dose of that of serum levels)
Ototoxicity (usually occurs during trough levels) |
|
|
Term
| Aminoglycosides are usually given by what route? |
|
Definition
| parenterally (IV or IM, very poor PO absorption) |
|
|
Term
| Postantibiotic effect (aminoglycosides) |
|
Definition
| antibiotic will continue to work even for hours after serum levels have dropped |
|
|
Term
| ________ bind 50 tightly to renal tissue, achieving 50 times the dose of that of serum levels (nephrotoxicity) |
|
Definition
|
|
Term
| Aminoglycosides can cause _____-toxicity and ______-toxicity |
|
Definition
| neprhotoxicity and ototoxicity |
|
|
Term
|
Definition
| aminoglycosides, vancomycin, chloramphenicol |
|
|
Term
| What other antibiotic reduces the effectiveness of aminoglycosides? |
|
Definition
| high concentrations of penicillins can inactivate aminoglycosides |
|
|
Term
| List some nephrotoxic drugs |
|
Definition
| Amphotericin B, cephalosporins, aminoglycosides, vancomycin, cyclosporins, polymixins, aspirin, NSAIDs |
|
|
Term
| MOA of selfamethoxazole and trimethoprim |
|
Definition
| inhibits sequential sequence enzymes in the tetrahydrofolic acid pathway (PABA) which prevents bacterial replication |
|
|
Term
| _______ is required for bacterial DNA, RNA, and protein synthesis |
|
Definition
|
|
Term
| Sulfamethoxazole and trimethoprim are used to treat... |
|
Definition
| UTIs, chronic carnii pneumonia in aids pts, S. aureus |
|
|
Term
| True or false: Sulfonamides are nephrotoxic |
|
Definition
False. Sulfa drugs have high water solubility, so renal damage is low.
Tell patient to take with a lot of water and check for sulfa allergy |
|
|
Term
| Sulfonamides are metabolized by... |
|
Definition
|
|
Term
|
Definition
structural analog of PABA
resistance occurs when bacteria increase synthesis of PABA, thus reducing binding of sulfonamides |
|
|
Term
| Antibiotic for UTIs caused by E. coli |
|
Definition
|
|
Term
| Routes of administration for sulfonamides |
|
Definition
|
|
Term
| True or false: Sulfonamides can cross the placenta |
|
Definition
| True. Can cause toxicity to fetus |
|
|
Term
| Adverse effects of sulfonamides |
|
Definition
| blood dsycrasias (especially in newborns), kernicterus, renal damage, rash, photsensitivity, hemolytic anemia, stevens-johnson syndrome |
|
|
Term
| True or false: sulfonamides are a pregnancy category A drug. |
|
Definition
| False. Do not give sulfonamides to children under 2 years old, or to pregnant or breast feeding women |
|
|
Term
| Only fluoroquinolone indicated for your children |
|
Definition
|
|
Term
| Fluroquinolones are ______ specturm and bacteri-_____ |
|
Definition
broad spectrum
bactericidal |
|
|
Term
| True or false: C. diff is often treated with fluoroquinolones |
|
Definition
| False- C. diff is resistant to fluoroquinolones |
|
|
Term
| True or false: fluoroquinolones effectively treat anaerobes |
|
Definition
| false. Fluoroquinolones are not useful for anaerobic infections |
|
|
Term
| systemic use can cause tendon injury |
|
Definition
fluoroquinolones
do not use in children under 18 |
|
|
Term
| adverse effects of fluroquinolones |
|
Definition
| possible tendon rupture, photosensitivity, candida infections, n/v, diarrhea, abdominal pain, dizziness, headache. Generally avoided in pregnant women |
|
|
Term
| Fluoroquinolones are used to treat... |
|
Definition
UTI and kidney infections caused by E.coli
post exposure to anthrax |
|
|
Term
| Only fluoroquinolone that can be used infants and children |
|
Definition
|
|
Term
| Drug interactions w/ fluoroquinolones |
|
Definition
| cation containing compounds (chelation; aluminum, magnesium, iron, zinc, sucrlfate, milk), theophylline, warfarin |
|
|
Term
| pigeons -> meningitis -> fatal |
|
Definition
| Cyrptococcsis (crytococcus neoformans) |
|
|
Term
|
Definition
| Histoplasmosis (histoplamsa capsulatum) |
|
|
Term
| Two groups of fungal infections |
|
Definition
| superficial mycoses, and systemic mycoses |
|
|
Term
| Opportunist systemic mycoses |
|
Definition
candidiasis, aspergillosis, cryptococssis, and mucormycosis
(occur after broad spectrum antibiotics) |
|
|
Term
| Non-opportunistic systemic mycoses |
|
Definition
| sporotrichosis, blastomycosis, histoplasmosis, coccidioidomycosis |
|
|
Term
|
Definition
increases cell permeability, binds to sterols
broad spectrum, can be fungacidal or fungistatic |
|
|
Term
| Drug of choice for systemic fungal infections |
|
Definition
| amphotericin B, but highly toxic |
|
|
Term
| True or false: amphotericin B is poorly absorbed by the GI tract |
|
Definition
| True, must be given IV infusion over 2-4 hours qd or qod for months |
|
|
Term
|
Definition
| 6-8 weeks, up to 3-4 months |
|
|
Term
| True or false: resistance to amphotericin B is high |
|
Definition
| False. Resistance to amphotericin B is rare |
|
|
Term
| How long is Amphotericin B detected in tissues after withdrawal |
|
Definition
|
|
Term
| How often do you check kidney function when giving Amphotericin B? |
|
Definition
|
|
Term
| Amphotericin B infusion reaction |
|
Definition
fever, chills, nausea, and headache starting 1-3 hours after starting infusion
give benadryl, tylenol, or aspirin |
|
|
Term
|
Definition
azole = antifungals
ex: fuconazole, itraconazole, ketoconazole, miconazole, clotrimazole, econazole, voriconazole |
|
|
Term
| Alternative to amphotericin B |
|
Definition
Itraconazole
Do not use w/ superficial fungal infections, save for more serious systemic infections
CAN be given PO |
|
|
Term
| Adverse effects of Itraconazole |
|
Definition
| liver injury (inhibits liver metabolizing enzymes), cardio suppression after initial dose but returns to normal after 12 hours |
|
|
Term
| Drug interactions of Itraconazoles |
|
Definition
INHIBITS CYP-450
cisapride, pimozide, defetilide, quinidine- potential ventricular dysrhythmias |
|
|
Term
| Flucytosine is used for... |
|
Definition
reserved to serious infections of candida and cryptococcous neoformans;
used in combo with amphotericin B |
|
|
Term
| Adverse effects of Flucytosine |
|
Definition
| bone marrow suppression (reversible thrombocytopenia, neutropenia), hepatotoxicity, ventricular dysrhythmias, ABSOLUTELY MONITOR RENAL FUNCTION |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| varicella-zoster virus (VZV) |
|
|
Term
|
Definition
|
|
Term
| True or false: shingles presents bilaterally |
|
Definition
False.
Shingles usually presents unilaterally.
Older adults need to start tx w/in 4 days to avoid lifelong problems |
|
|
Term
| Examples of anti-viral drugs |
|
Definition
| acyclovir, valacyclovir, famciclovir, gangciclovir, panciclovir |
|
|
Term
| Drug of choice for herpes simplex virus, varicella zoster virus, and cytomegalovirus |
|
Definition
|
|
Term
|
Definition
| inhibits viral replication by suppressing synthesis of viral DNA; does not eliminate virus or produce cure but reduces/relieves symptoms |
|
|
Term
| When do you give acyclovir IV? |
|
Definition
if genital infection is severe
infuse slowly over 1 hour and keep pt hydrated
never give IV bolus, IM, or SQ |
|
|
Term
| True or false: ganciclovir is safe for pregnant women |
|
Definition
| False. Ganciclovir is a teratogen |
|
|
Term
| How is cytomegalovirus transmitted? |
|
Definition
person to person through body fluids
Secondary infection in immunocompromised pts |
|
|
Term
| What does cytomegalovirus effet? |
|
Definition
| eyes, lungs, and GI tract |
|
|
Term
|
Definition
| prevention of CMV retinitis in immunocompromised pts and CMV infection in transplant pts |
|
|
Term
what are the 6 types of hepatitis?
which cause jaundice? |
|
Definition
A,B,C,D,E,G
(A,B, and C are the main ones)
ALL cause jaundice |
|
|
Term
| Which hepatitis viruses cause chronic hepatitis? |
|
Definition
| B,C, and D (cirrhosis, hepatocellular carcinoma, life-threatening liver failure |
|
|
Term
|
Definition
|
|
Term
| how does hepatits C transmission occur? |
|
Definition
through blood exchange
usually asymptomatic but can still pass to others
slow progression but eventual liver damage |
|
|
Term
| True or false: there is currently no vaccine for hepatits C |
|
Definition
|
|
Term
| How is heptatis C treated? |
|
Definition
with interferon alfa
ONLY used parenterally
used for a long time, results in flue like symptoms and depression |
|
|
Term
|
Definition
| blocks viral entry into cells, synthesis of viral mRNA, viral proteins, and viral assembly and release |
|
|
Term
| Adverse effects of interferon alfa |
|
Definition
flulike symtpoms - dminish with use, can treat w/ acetaminophin
severe depression - can treat w/ antidepressants |
|
|
Term
|
Definition
|
|
Term
| treatment of influenza A and B |
|
Definition
vaccination (primary)
drug treatment (secondary)- adamantanes and neuraminidase inhibitors |
|
|
Term
| Which influenza is more infectious- A or B? |
|
Definition
|
|
Term
| 2 types of influenza vaccine |
|
Definition
inactivated (given IM, may contain trace amounts of mercury)
live (attenuated intranasal spray only given to 5-49 year olds) |
|
|
Term
| Duration of influenza vaccine |
|
Definition
| begins 1-2 weeks after vaccination and can last 6 months or longer |
|
|
Term
| True or False: Guillain-barre syndrome (GBS) can occur with the active influenza vaccine |
|
Definition
False.
GBS can occur with the INACTIVE vaccine |
|
|
Term
|
Definition
| gastroesophageal reflux disease: gastric contents of the stomach empty into the esophagus causing heartburn b/c of relaxation of the esophageal sphincter, obesity, hiatal hernia, delayed gastric emptying |
|
|
Term
| True or False: GERD is caused by H. pylori |
|
Definition
False.
H. pylori plays little or no role in GERD. |
|
|
Term
|
Definition
proton pump inhibitors
histamine 2 receptor antagonist (decrease production of acid)
often used together |
|
|
Term
|
Definition
|
|
Term
|
Definition
| difficulties swallowing, GI bleeding, anemia, persistent vomiting |
|
|
Term
|
Definition
erosion of the lower curvature of the stomach and upper part of the duodenum by exposure to acid and pepsin which can lead to perforation
General cause is Helicobacter pylori |
|
|
Term
|
Definition
generally the cause of PUD
plays little to no role in GERD |
|
|
Term
|
Definition
| H. pylori, NSAIDs, acid, pepsin, smoking |
|
|
Term
|
Definition
| mucus, bicarbonate, blood flow, prostaglandins |
|
|
Term
| How does Bicarbonate provide defense in PUD? |
|
Definition
| neutralizes hydrogen ions |
|
|
Term
| How do prostaglandins provide defense in PUD? |
|
Definition
stimulate secretion of mucus and bicarbonate and promotes vasodilation to maintain mucosal blood flow
also suppresses secretion of gastric acid |
|
|
Term
| True or False: H. pylori is destroyed by the low pH of the stomach |
|
Definition
False.
H. pylori (Gram -) resides b/n the epithelial cells and mucus barrier in the stomach and is NOT destroyed by acid or pepsin. |
|
|
Term
| What does H. pylori produce? |
|
Definition
| urease that forms CO2 and ammonia, causing belching |
|
|
Term
| Zollinger-Ellison syndrome |
|
Definition
| tumor that secretes gastrin which stimulates gastric acid |
|
|
Term
| relation between pepsin and pH |
|
Definition
| higher the pH, the less pepsin |
|
|
Term
| how does smoking effect PUD? |
|
Definition
| smoking reduces secretion of bicarb and accelerates gastric emptying which delivers more acid to the duodenum |
|
|
Term
|
Definition
2 antibiotics 2x/day +
protein pump inhibitor 1x/day
for 10-14 days |
|
|
Term
| What antiulcer drug is pregnancy category X? |
|
Definition
Misoprostol
(used as an abortificant; prostaglandin analog) |
|
|
Term
| How does sucralfate work? |
|
Definition
| sucralfate is an mucosal protectant used in PUD. acts as a "cement barrier" to coat stomach and protect it from acid |
|
|
Term
| Effects of prostaglandin in PUD |
|
Definition
increases mucus, bicarb, and bloodflow
decreases gastric acid |
|
|
Term
|
Definition
proton pump inhibitors
(esomeprazole, lansoprazole, omeprazole, pantoprazole, raberprazole) |
|
|
Term
|
Definition
histamine 2 receptor antagonist
(cimetidine, famotidine, nizatidine, ranitidine) |
|
|
Term
|
Definition
| aluminum hydroxide, calcium carbonate, magensium hydroxide |
|
|
Term
| what pH must be reached to inactivate pepsin? |
|
Definition
|
|
Term
|
Definition
| Amoxicillin, bismuth salicylate, clarithromycin, tetracycline, metronidazole |
|
|
Term
| Misoprostol pregnancy category |
|
Definition
|
|
Term
|
Definition
| Aluminum hydroxide (constipation), calcium carbonate (constipation), magnesium hydroxide (diarrhea), and sodium antacids (generally only used for acidosis; systemic effects) |
|
|
Term
|
Definition
| eradicate H. pylori (antibiotics), Reduce gastric activity (H2 rec. antagonists, PPI's, muscarinic antagonists), enhance mucosal defenses (sucralfate, misoprostol) |
|
|
Term
|
Definition
diet- eat smaller meals to decrease fluctuations in pH
cease smoking - smoking increases ulcers and retards recovery
avoid NSAIDS, aspirin, and alcohol |
|
|
Term
| True or false: effective treatment of H. pylori can be achieved with one drug |
|
Definition
| False. Always use drugs in combo to tx H. pylori |
|
|
Term
|
Definition
|
|
Term
| Actions of synthetic prostaglandin (misoprostol) |
|
Definition
increase mucus and bicarb secretion, increase blood flow
decrease gastric secretion |
|
|
Term
|
Definition
| suppress gastric acid secretion by inhibition of H+/K+ ATPase (the enzyme that makes gastric acid) |
|
|
Term
| if a pt complains of gastric acid all the time they should take... |
|
Definition
PPI
(takes 24-48 hours to start working) |
|
|
Term
| if a pt complains of gastric acid triggered by foods they should take.... |
|
Definition
| H2 receptor agonist 30 minutes before eating |
|
|
Term
| If a pt complains of gastric acid right NOW they should take... |
|
Definition
|
|
Term
|
Definition
|
|
Term
| True or false: cimetidine should be taken with food |
|
Definition
True.
Cimetidine is best if taken with food to slow absorption and prolong effects. |
|
|
Term
| Adverse effects of cimetidine |
|
Definition
| diarrhea, constipation, gynecomastia, impotence, decreased libido, decreased sperm count, hepatic/renal problems, confusion, hallucination, lethargy |
|
|
Term
| Nursing Mgmt of cimetidine |
|
Definition
| assess for pain, assess renal/hepatic funciton, maintenance therapy at hour of sleep, avoid late evening meals, separate with antacids by 1 hour, IV slowly, avoid ETOH, caffeine, high-fat food, large meals, smoking cessation, 4-6 weeks of therapy |
|
|
Term
|
Definition
| block final step of acid production, nonreversible inhibition of H+/K+ ATPase |
|
|
Term
| when should the pt take omeprazole |
|
Definition
| 30 minutes before morning meal |
|
|
Term
| adverse effects of omeprazole |
|
Definition
diarrhea, abdominal pain, n/v, constipation, headache, dizziness
rare: anemia, thrombocytopenia, eosinopenia, leukocytosis |
|
|
Term
|
Definition
| drugs dependent on gastric pH (iron salts, ampicillin), dizepam, phenytoin, warfarin |
|
|
Term
| Misoprostol (cytotec) MOA |
|
Definition
analog to prostaglandin E1
Aspirin and NSAIDs inhibit prostaglandins; misoprostol serves as a replacement; increases bicarbonate and mucus production, decreases acid secretion |
|
|
Term
| Misoprostol is a category ____ drug |
|
Definition
|
|
Term
| Misoprostol pharmacotherapeuitcs |
|
Definition
| prevention of NSAID and aspirin induced ulcers |
|
|
Term
| Nursing MGMT of misoprotsol |
|
Definition
| obtain serum pregnancy test before initiation, initiate drug therapy on 2nd-3rd day of next period, provide verbal and written instructions to females of abortificant properties, assess for adequate contraception, discontinue drug immediately if pregnancy suspected, do not share drug w/ others, report diarrhea > 1 week |
|
|
Term
| Adverse effects of misoprostol |
|
Definition
| diarrhea, constipation, abdominal pain, n/v, dyspepsia, flatulence, headache |
|
|
Term
|
Definition
| sedation, tremors, convulsions, dyspnea, abdominal pain, diarrhea, fever, palpitations, bradycardia, hypotension |
|
|
Term
| Cytoprotective drug: sucralfate (carafate) |
|
Definition
| short term therapy of ulcers, prophylaxis; gives stomach some time to heal; "cement" layer |
|
|
Term
| True or false: sucralfate is maximally absorbed by the GI tract |
|
Definition
False.
Sucralfate is minimally absorbed then excreted by kidneys. Instruct pts to take with lots of water and do not take if they have kidney problems |
|
|
Term
| Contraindications of sucralfate |
|
Definition
|
|
Term
| adverse effects of sucralfate |
|
Definition
| constipation, indigestion, flatulence, dry mouth, gastric discomfort, if raise pH >4, decreased effect |
|
|
Term
| pH greater than ____ decreases pepsin activity |
|
Definition
|
|
Term
| Which antacid is systemically absorbed? |
|
Definition
| Sodium antacids are systemically absorbed, used to treat acidosis. All others are not systemically absorbed so they do NOT affect systemic pH |
|
|
Term
| Rapid acting antacids w/ long duration of action |
|
Definition
| magnesium hydroxide, calcium carbonate |
|
|
Term
| magnesium hydroxide adverse effects |
|
Definition
diarrhea b/c of water retention in intestinal lumen
DO NOT GIVE to pts with RENAL IMPAIRMENT due to Mg+ toxicity |
|
|
Term
| adverse effects of aluminum hydroxide |
|
Definition
constipation, decreased phosphate absorption
HIGH NA+ CONTENT; be careful w/ pts that have HTN |
|
|
Term
| Adverse effects of calcium carbonate |
|
Definition
| possible rebound which can increase acid secretion, release of CO2 in stomach, so can cause belching and flatulence, constipation |
|
|
Term
|
Definition
| not good for tx of ulcers but good for tx of acidosis, elevates urinary pH and excretes acidic drugs, rapid acting but short lasting |
|
|
Term
| Adverse effects of sodium bicarbonate |
|
Definition
| belching, flatulence, DO NOT give to pts with HTN |
|
|
Term
|
Definition
| hard or infrequent stools, excessive straining, prolonged effort or incomplete or unsuccessful defecation |
|
|
Term
|
Definition
| forms stool over 1 or more days |
|
|
Term
|
Definition
| immediate evacuation of bowel |
|
|
Term
|
Definition
| absorb water and electrolytes |
|
|
Term
| ___ % of water gets absorbed back into the body from the colon |
|
Definition
|
|
Term
| drugs that cause constipation |
|
Definition
| analgesics, antacids (aluminum, calcium), anticholinergics, antidepressants, antidiarrheal agents, antihistamines, antihypertensives, antiparkinsonian drugs, barium sulfate, diuretics, iron supplements, muscle relaxants |
|
|
Term
|
Definition
softens stool by pulling more water into the small intestine and colon and increases fecal mass, which promotes peristalsis. FIBER drugs- can be used for diarrhea or constipation
ex: methlycellulose, psyllium, polycarophil |
|
|
Term
|
Definition
lowers stool surface tension, water penetrates the small intestine and colon softening stools
ex: doscusate sodium or calcium
can use all the time |
|
|
Term
|
Definition
stimulates peristalsis and softens stool secreting water and electrolytes into the intestines
ex: bisacodyl (colon), senna (colon), castor oil (small intestine) |
|
|
Term
|
Definition
work by osmosis in the small intestine and colon, softening feces and promoting fecal swelling and peristalsis
ex: magnesium (sulfate, citrate, hydroxide), sodium phosphate, polyethylene glycol (PEG) |
|
|
Term
|
Definition
| lubricates and decreases water absorption in the colon; can cause lipid pneumonia therefore not recommended |
|
|
Term
|
Definition
| lubricates and causes reflex rectal contraction (colon) |
|
|
Term
|
Definition
similar to osmotic laxatives. good for pts with cirrhosis.
(cirrhosis produces excessive amounts of ammonia; lactulose helps remove ammonia) |
|
|
Term
|
Definition
opens chloride channels in the intestinal epithelium which increases intestinal motility and secretion of fluid into lumen (small intestine and colon)
used for idiopathic constipation in adults and IBS in women over 18 y.o
INCREASES PERISTALSIS
NONE IS ABSORBED, so very little side effects |
|
|
Term
| what should you tell a pt taking surfactant laxatives? |
|
Definition
| take with a full glass of water |
|
|
Term
| which laxative has a high abuse factor? |
|
Definition
stimulant laxatives (bisacodyl, castor oil)
these are not for long term use. |
|
|
Term
| legitimate uses of stimulant laxatives |
|
Definition
| opioid induced constipation, tx of slow intestinal tract |
|
|
Term
| which laxative acts like normal dietary fiber? |
|
Definition
|
|
Term
|
Definition
acts like normal dietary fiber; nondigesable fiber and noabsorbable solution that softens and swells fecal mass causing peristalsis
produces soft, formed stools 1-3 days after tx
take w/ full glass of water |
|
|
Term
|
Definition
| be careful w/ lactulose and diabetes bc lactulose contains a lot of sugar |
|
|
Term
| what adverse effects apply to all laxatives? |
|
Definition
|
|
Term
| adverse effects of mineral oil |
|
Definition
lipid pneumonia
deposition of mineral oil in liver |
|
|
Term
| use of glycerin suppositories |
|
Definition
used to re-establish normal bowel function following termination of laxative abuse
evacuation occurs in 30 minutes
osmotic agent that softens and lubricates feces and stimulates rectal contraction |
|
|
Term
|
Definition
isosmotic w/ body fluids so water and electrolytes are neither absorbed nor secreted into the lumen so NO electrolyte imbalances occur
good for pts who are dehydrated (esp. if cardiovascular disease or renal impairment |
|
|
Term
| drugs that cause diarrhea |
|
Definition
| magnesium antacids, antihypertensives, antimicrboials, antineoplastics, bile acids, cardiac glycosides, cholingeric agonist, cholinesterase inhibitors, osmotic and stimulant laxatives, quinidine |
|
|
Term
| most effective anti-diarrheal agents |
|
Definition
|
|
Term
| contraindications for diphenoxylate HCL |
|
Definition
| acute bowel infections or inflammation, glaucoma, prostatic hypertrophy |
|
|
Term
| drug interactions with diphenoxylate HCL |
|
Definition
ETOH, barbituates, tranquilizers, MAOI
(central nervous system depressants) |
|
|
Term
|
Definition
opioid antagonist; otc
analog of meperidine. Activates opioid receptors, leads to constipation/stops diarrhea
decreases bowel motility and suppresses fluid secretion into intestinal lumen.
Poorly absorbed and does not cross BBB |
|
|
Term
| antiemetics can be given by which routes? |
|
Definition
|
|
Term
| adverse effects of atropine |
|
Definition
| blurred vision, dry mouoth, urinary retention, tachycardia |
|
|
Term
| effect of atropine on diarrhea |
|
Definition
| relieves cramping but does not alter fecal consistency or volume |
|
|
Term
|
Definition
anticipatory- occurs before drugs are given (memory triggers)
acute- begins minutes to hours from initiating meds
delayed- a day more more after receiving meds |
|
|
Term
| True or false: antiemetics are better at preventing than suppressing vomiting |
|
Definition
False.
Antiemetics are better at suppressing than preventing. Better to administer before meds are given
PO and IV are equally effective |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
used for chemo treatment, radiation, and postoperative;
MOA: blocks 5ht3 receptors on vagal afferents and in the chemotrigger receptor zone |
|
|
Term
|
Definition
|
|
Term
|
Definition
| can cause irreversible shakes |
|
|
Term
| what antihistamine is given via transdermal patches? |
|
Definition
| scopolamine for motion sickeness |
|
|
Term
| ondansteron contraindications |
|
Definition
impaired hepatic/renal functioning
caution in pregnancy and lactation |
|
|
Term
| adverse effects of ondansetron |
|
Definition
| constipation (biggest problem), headache, rash, transient elevations in AST and ALT (liver enzymes |
|
|
Term
| what do you monitor w/ ondansetron treatment? |
|
Definition
| bowel function, liver enzymes |
|
|
Term
| Glucocorticoids for emesis |
|
Definition
methylprednisolone and dexamethasone IV
effective alone or in combo, generally not given alone |
|
|
Term
| only approved cannabinoid |
|
Definition
dronabinol (marinol)
thc; used for N/V and for increase in appetite
schedule III drug
does not produce the same high as with smoking |
|
|
Term
|
Definition
| right ventricular failure |
|
|
Term
|
Definition
| abnormally deep breathing |
|
|
Term
|
Definition
|
|
Term
|
Definition
| difficulty breathing in supine position |
|
|
Term
|
Definition
|
|
Term
|
Definition
| deficiency in O2 concentration in the blood |
|
|
Term
|
Definition
| greater than normal amounts of CO2 in the blood |
|
|
Term
|
Definition
| increase concentration of hydrogen ions and retention of CO2 (pH less than 7.35) |
|
|
Term
|
Definition
excess of bicarbonate ions (pH greater than 7.45)
Loss of CO2 and hyperventilation |
|
|
Term
|
Definition
| a measure of the packed cell volume of red cells expressed as a percentage of total blood volume |
|
|
Term
|
Definition
| carries O2 to the cell from the lungs and CO2 away from the cell to the lungs |
|
|
Term
|
Definition
| nose, nasal cavity, paranasal sinuses, pharynx |
|
|
Term
|
Definition
conducts air to the lower respiratory tract
conveys food to the esophagus |
|
|
Term
|
Definition
| larynx, trachea, bronchi, bronchioles, avioli of the lungs |
|
|
Term
| which division of the respiratory system is more difficult to treat? |
|
Definition
|
|
Term
| Right lung has ___ lobes and is ____ than left lobe because of ____ position, left lung has ___ lobes because of the _____ |
|
Definition
| right lung has 3 lobes and is higher than left lobe because of liver position; left lung has two lobes because of the heart |
|
|
Term
|
Definition
| smoking cessation, treatment and prevention of acute exacerbations, reduce rate of progression of disease (stop smoking), receive influenza and pneumococcal vaccinations as standard-of-care |
|
|
Term
|
Definition
chronic or recurrent excess mucous production w/ cough.
cough occurs more days during a 3 month period for at least two consecutive years
always has condition but symptoms may get better
acute exacerbations usually due to infection |
|
|
Term
|
Definition
abnormal permanent enlargement of air spaces distal to the terminal bronchiole with destruction of their wall. Loss of lung elasticity.
Normal inhalation, difficult exhalation
less CO2; pink puffer; shallow breathing |
|
|
Term
| Emphysema presents shallow/deep breathing |
|
Definition
|
|
Term
| True or false: emphysema has difficult inhalation but normal exhalation |
|
Definition
False.
Normal inhalation, difficult exhalation |
|
|
