NSG 2500 Class 3 Summer 2011

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NSG 2500 Class 3 Summer 2011

  1. 1. CLASS 3<br />
  2. 2. Narcotics<br />Narcotic=Greek word=STUPOR<br />Opium, Opium derivatives like heroin, morphine<br />
  3. 3.
  4. 4. Narcotic Use<br />TREATPAIN<br />
  5. 5. Narcotic Use<br />TREAT COUGH<br />
  6. 6. Narcotic Use<br />Alleviate Diarrhea<br />
  7. 7. Narcotic Use<br />Induce Anesthesia<br />
  8. 8. Modes of Administration<br />Orally<br />Transdermally<br />Injected<br />Suppositories<br />Abused by smoking, sniffing, injecting<br />
  9. 9. Narcotic Effects<br />euphoria<br />
  10. 10. Narcotic Effects<br />Decreased GI activity<br />
  11. 11. Narcotic Effects<br />pupil construction<br />
  12. 12. Narcotic Effects<br />Nausea and Vomiting<br />Flushing of Face and Neck<br />
  13. 13. Narcotic Effects<br />Dependence<br />Addiction<br />Tolerance<br />
  14. 14. Narcotic Effects<br />MOST SERIOUS:<br />Respiratory depression<br />
  15. 15.
  16. 16. Nursing Care of Patient on Narcotics<br />
  17. 17. Narcotic Withdrawal<br />
  18. 18. Suboxone<br />
  19. 19. Antimicrobial Drugs<br />
  20. 20. Chapter 8 <br />
  21. 21.
  22. 22. Antibiotic-Resistant Microorganisms<br />
  23. 23. Indications for Use<br />Empirical--most likely organism<br />Prophylactic therapy<br />
  24. 24.
  25. 25.
  26. 26.
  27. 27.
  28. 28.
  29. 29. Aminoglycosides<br />
  30. 30. Aminoglycosides<br />
  31. 31. Aminoglycosides<br />
  32. 32.
  33. 33. Aminoglycosides<br />renal failure [high peaks]<br />ototoxicity [high troughs]<br />
  34. 34. Drug Levels<br />Gentamycin levels<br />peak 5-10; trough <2<br />Amikacin<br />Peak 20-35; trough <5<br />Tobramycin<br />Peak 5-10; trough <2<br />
  35. 35. Carbapenems<br />Imipenem/cilastatin-Primaxin<br />Doripenem-Doribax<br />Ertapenem-Invanz<br />Is NOT<br />
  36. 36. Monobactam<br />Aztreonman<br />
  37. 37. Cephalosporins<br />Broad-spectrum gram + and –<br />First generation<br />Second generation<br />Third generation<br />Fourth generation<br />
  38. 38. Cephalosporins<br />
  39. 39. First Generation<br />Ancef<br />Kefzol<br />
  40. 40. Second GenerationCephalosporins<br />Mefoxin<br />
  41. 41. Third GenerationCephalosporins<br />Cefixime - Suprax]<br />Cefdinir - Omnicef<br />Cefpodoximine - Vantin<br />Ceftriaxone - Rocephin<br />
  42. 42. Fourth Generation Cephalosporin<br />Cefepime (Maxipime)<br />Cefditoren – Spectracef<br />
  43. 43. Nursing Care of Patient Taking Cephalosporins<br />Side/Adverse Effects:<br /> N/V/Diarrhea<br />Psuedomembranous colitis<br /> CNS Symptoms<br />Nephrotoxicity<br />Superinfections<br />
  44. 44. Pseudomembranous Colitis<br />
  45. 45. Disulfiram<br />
  46. 46. Examples of Quinolones<br />ciprofloxacin<br />enoxacin<br />lomefloxacin<br />norfloxacin<br />ofloxacin<br />levofloxacin<br />
  47. 47. Side EffectsQuinolones<br />CNS<br />HA, dizziness, fatigue, depression, & restlessness<br />GI<br />N/V/D, constipation, inc. LFTs, & thrush<br />DERM<br />rash, pruritis, photosensitivity, & flushing<br />Other<br />fever, chills, blurred vision, & tinnitus, tendon rupture<br />
  48. 48. Adverse Reactions<br />Hypersensitivity<br />anaphylaxis<br />Serum sickness<br />Skin rash<br />Urticaria<br />Nephrotoxicity<br />Neurotoxicity<br />Coagulation disorders<br />
  49. 49. How Penicillin works<br />
  50. 50. Beta-Lactam Antibacterials<br />Beta-lactamring<br />
  51. 51. Penicillins<br />Effective, Safe<br />Excreted Kidnes<br />Risk of hypersensitivity<br />Gram + bacteria<br />Contraindications—hypersensitivity or allergic reactions; potential for cross-sensitivity with cephalosporins and carbapenems<br />
  52. 52. Examples of Penicillins<br />Dicloxacillin (Dynapen)<br />Penicillin G<br />Penicillin V (Pen-Vee K)<br />Piperacillin (Pipracil)<br />
  53. 53. Aminopenicillins<br />Ampicillin<br />Amoxicillin<br />
  54. 54. Extended-Spectrum PCN (Antipseudomonal)<br />Carbenicillin, ticarcillin, mezlocillin, and piperacillin—broad-spectrum<br />PCN/beta-lactamase inhibitor combinations<br />Unasyn<br />Augmentin<br />Timentin<br />Zosyn<br />
  55. 55. Cephalosporins and Penicillin<br />
  56. 56. Common Side Effects PCNs<br />N/V/D ; anxiety, and abdominal pain<br />less common<br />convulsions, inc. LFT’s, & increase in bleeding time<br />
  57. 57. Nursing Implications<br />Penicillins:<br />Empty stomach<br />Cephalosporins<br />
  58. 58. Sulfonamides<br />Broad spectrum, bacteriostatic<br />Gram + and -<br />Contraindicated<br />Hypersensitivity to sulfonamides, thiazides, sulfonylureas; renal failure; pregnancy, lactation; children <2 mos<br />
  59. 59. Examples of Sulfonamides<br />Sulfamethoxazole<br />Trimethoprim<br />AKA<br />BACTRIM and SEPTRA<br />
  60. 60. Side Adverse Effects<br />photosensitivity<br />
  61. 61. Prototype Sulfa Preps<br />Sulfamethoxazole<br />Azo Gantanol<br />Bactrim<br />azo gantanol <br />combo phenazopyridine and sulfa<br />as a Antibiotic for UTI<br />Bactrim<br />combo trimethoprim and sulfa<br />Antibiotic for UTI, PCP, ear infections, gonorrhea, etc.<br />Sulfasoxazole<br />Azogantrisin<br />Pediazole<br />azogantrisin<br />combo phenazopyridine and sulfa for UTI’s<br />Pediazole<br />sulfisoxazole and erythromycin for otitis media<br />
  62. 62. Urinary Antiseptics<br />Bactericidal<br />Not used in systemic infections<br />EXAMPLE:<br />Phenazopyridine<br />PYRIDIUM or AZO<br />
  63. 63. Tetracyclines<br />Contraindicated in pregnancy, children <8 yrs, and renal failure<br />
  64. 64. Examples of tetracyclines<br />demeclocycline<br />oxytetracycline<br />tetracycline<br />doxycycline<br />minocycline<br />
  65. 65. Taking Tetracyclines: NO:<br />
  66. 66. Macrolides and Ketolides<br />May be bacteriostatic or bacteriocidal<br />Erythromycin<br />Telithromycin (Ketek)<br />
  67. 67. Macrolides<br />first intro in early 1950’s [erythromycin]<br />inhibit growth of bacteria = bacteriostatic<br />four main macrolides:<br />erythromycin (many names)<br />Azithromycin (Zithromax)<br />Clarithromycin (Biaxin)<br />troleandomycin<br />
  68. 68. MACROLIDE: Indications for Use<br />Widely used for respiratory tract and skin/soft tissue infections<br />Used as penicillin substitute<br />Used in newborns (ophthalmic)<br />
  69. 69. Therapeutic EffectsMacrolides<br />Strep infections<br />Streptococcus pyogenes(group A beta-hemolytic)<br />mild to moderate URTI<br />Hemophilus influenza<br />spirochetal infections<br />syphilis & Lyme disease<br />gonorrhea, chlamydia, and mycoplasma<br />
  70. 70. Miscellaneous <br />Metronidazole—effective against anaerobic bacteria, some gram+, and protozoa<br />Quinupristin/dalfopristin— belongs to class streptogramins; bacteriostatic and bacteriocidal<br />Spectinomycin—treatment of gonococcal exposure<br />Vancomycin—active against gram+<br />Chloramphenicol—broad spectrum, bacteriostatic, active against gram+ and gram–<br />Clindamycin—bacteriostatic, effective against gram+, some anaerobes<br />Linezolid—member of new class oxalidinone; effective against aerobic gram+<br />
  71. 71. Principles of Therapy<br />Culture and sensitivity studies reviewed to treat with “right drug for right bug”<br />Erythromycin interferes with the elimination of several drugs<br />Monitor clients closely<br />
  72. 72. Zithromax<br />Loading dose of 500 mg<br />Daily dose of 250 mg for total of 5 days therapy<br />Given up t 10 days for CAP (community acquired pneumonia)<br />
  73. 73. BIAXIN<br />
  74. 74. Side EffectsMacrolides<br />GI<br />N/V/D, hepatotoxicity, flatulence, jaundice, & anorexia<br />primarily involve erythromycin<br />newer macrolides<br />[azithromycin & clarithromycin]<br />less SE’s, longer action, better efficacy, & better tissue penetration<br />
  75. 75. Drugs to Treat Leprosy<br />DAPSONE AND THALIDOMIDE<br />
  76. 76. Other Antibiotics<br />Clindamycin(Cleocin)<br />Daptomycin (Cubicin)<br />Linezolid(Zyvox)<br />Metronidazole (Flagyl)<br />Quinupristin/dalfopristin (Synercid)<br />Vancomycin (Vancocin)<br />
  77. 77. Tuberculosis (TB)<br />Infectious disease that usually affects the lungs<br />May infect lymph nodes, pleurae, bones, joints, kidneys, and GI tract<br />Caused by Mycobacterium tuberculosis<br />Multiplies slowly and remains dormant for years<br />Natural history of TB<br />Transmission<br />Primary infection<br />Latent tuberculosis infection (LTBI)<br />Active tuberculosis<br />
  78. 78. TB<br />Principle organ affected is lungs<br />Caused by Mycobacterium tuberculosis<br />Transmission<br />Primary infection<br />Latent (LTBI)-Active TB<br />
  79. 79. How TB is spread<br />
  80. 80. Chapter 34Drugs for Tuberculosis and Mycobacterium avium Complex (MAC) Disease<br />
  81. 81. What does a positive PPD mean?<br />Positive reaction is Induration NOT redness<br />Low risk >15 mm<br />>10 mm high risk<br />>5mm persons at highest risk, HIV<br />
  82. 82. Primary Antitubercular Drugs<br />Rifapentine (Priftin)—used with at least one other drug; less frequent administration (1-2X/wk)<br />Ethambutol (Myambutol)—part of 4-drug regimen<br />Pyrazinamide—used with INH and rifampin for 2 mos<br />Streptomycin—used in 4-drug regimen<br />Isoniazid (INH)—most commonly used; bacteriocidal, inexpensive, and nontoxic<br />Rifampin—works synergistically with INH<br />Rifabutin (Mycobutin)—used in patients with HIV with MAC; longer half-life than rifampin<br />
  83. 83. Secondary Antitubercular Drugs<br />Para-aminosalicylic acid (PAS)<br />Capreomycin (Capastat)<br />Cycloserine (Seromycin)<br />Ethionamide (Trecator SC)<br />Indicated for clients when other agents are contraindicated or drug resistant<br />
  84. 84. Other Drugs Used in Multidrug-Resistant Tuberculosis<br />Aminoglycosides (amikacin and kanamycin) <br />May be component of 4- to 6-drug regimen<br />Fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin, and sparfloxacin) may be used<br />
  85. 85. Resistant TB<br />For INH-resistant TB—rifampin, pyrazinamide, and ethambutol for 6 mos<br />
  86. 86. Resistant TB<br />For rifampin-resistant TB—INH and ethambutol for 18 mos or INH, pyrazinamide, and streptomycin for 9 mos<br />
  87. 87. Resistant TB<br />MDR-TB—5- to 6-drug regimen individualized according to susceptibility reports<br />
  88. 88. Resistant TB<br />For intermittent schedules, healthcare providers administer or directly observe therapy (DOT)<br />
  89. 89. Resistant TB<br />During pregnancy—3-drug regimen of INH, rifampin, and ethambutol used with close monitoring of LFT<br />
  90. 90. Mycobacterium Avium Complex Disease (MAC)<br />Mycobatcteriumavium and Mycobacterium intracellulare are grouped together as MAC<br />Found in water and soil; transmitted by inhalation of droplets<br />Opportunistic infection of immunocompromised<br />Main drugs used—macrolides, azithromycin and clarithromycin, and rifabutin<br />Prophylactic therapy life-long<br />3-drug regimen—macrolide, rifabutin, and ethambutol<br />
  91. 91. TB drugs<br />first line agents<br />ethambutol<br />isoniazid<br />pyrazinamide<br />rifampin<br />streptomycin<br />second line agents<br />paraaminosalicylate sodium (PAS)<br />capreomycin<br />cycloserine<br />ethionamide<br />kanamycin<br />
  92. 92. Drugs used to Treat TB<br />INH-Isoniazid<br />Most common<br />least expensive<br />300 mg/day or 900 mg 2x/week<br />Adverse effects:<br />Hepatotoxicity<br />Peripheral neuropathy<br />(Give B6-pyridoxine 25 to 50 mg daily)<br />
  93. 93. Rifampin and Rifabutin<br />Metabolized in liver<br />SE: RED BODY FLUIDS<br />GI irritation, hepatitis, <br />Numerous drug interactions<br />
  94. 94. Ethambutol<br />Major adverse effect is optic neuritis<br />Moniter visual acuity and red/green discrimination<br />OK to give with food<br />
  95. 95. Miscellaneous Drugs <br />Chloramphenicol-Chloromycetin<br />Used in serious infections<br />Toxicity-life threatening blood dyscrasias<br />Therapeutic levels 10-20mcg/mL<br />“Gray baby syndrome” (cardiovascular collapse in newborns)<br />Frequent CBC monitoring <br />
  96. 96. Clindamycin (Cleocin)<br />Rx Severe Infection<br />Topical use - acne<br />Diarrhea serious SE<br />Persistent, bloody stools<br />(>5 stools a day)—stop drug, assess for presence of C. Diff.<br />
  97. 97. Vancomycin<br />Gram +<br />Used in serious infections<br />Primarily IV<br />PO for Rx of C.difficile<br />Rx of MRSA<br />Emergence of VRE<br />IV – give slowly over 1-2 hrs to avoid RED MAN Syndrome<br />
  98. 98. Viruses<br />Viruses spread by secretions, ingestion, breaks in skin and mucous membranes, blood transfusions, sexual contact, pregnancy, breast-feeding, and organ transplantation<br />Viral replication is parasitic in nature<br />Viruses induce antibodies and immunity<br />
  99. 99. Antiviral Drugs<br />Few drugs inhibit viruses without being excessively toxic to host tissues<br />Most antivirals inhibit viral replication but do not eliminate viruses from tissues<br />Available drugs are expensive, relatively toxic, and effective in a limited number of infections<br />
  100. 100. Drugs for Herpesvirus Infections<br />Acyclovir, famciclovir, and valacyclovir<br />Penetrate virus-infected cells, become activated by an enzyme, and inhibit viral DNA reproduction<br />Treatment of herpes simplex and herpes zoster infections<br />Cidofovir, foscarnet, ganciclovir, and valganciclovir <br />Inhibit viral reproduction <br />Treat cytomegalovirus (CMV) retinitis most commonly seen in AIDS<br />Foscarnet treats acyclovir-resistant herpes simplex<br />
  101. 101. Drugs for Influenza A<br />Amantadine and rimantadine inhibit replication of the influenza A virus <br />Oseltamivir (Tamiflu) and zanamivir (Relenza) approved for influenza A or B<br />Seasonal prophylaxis used in high-risk patients<br />Treat early and may shorten illness length<br />
  102. 102. Drug for Respiratory Syncytial Virus (RSV)<br />Ribavirin used to treat bronchiolitis or pneumonia caused by RSV<br />Used in hospitalized infants and young children<br />Given by inhalation with Viratek small particle aerosol generator<br />
  103. 103. How HIV Drugs work<br />
  104. 104. Drugs for HIV and AIDS (Antiretrovirals)<br />See Handout in Class<br />
  105. 105. Antifungal Drugs<br />Mechanism of action is to disrupt the structure and function of various fungal cell components<br />Polyenes and azoles act on ergosterol to disrupt fungal cell membranes<br />Echinocandins or glucan synthesis inhibitors are a new class of antifungals that disrupt cell walls rather than cell membranes<br />
  106. 106. Azoles <br />Ketoconazole (Nizoral)<br />given orally and is less toxic; little absorption occurs topically<br />Disadvantage is there are many drug–drug interactions<br />Fluconazole (Diflucan)<br />Synthetic broad-spectrum agent that may be used long-term<br />Increases effect of several drugs<br />Itraconazole (Sporanox)<br />Synthetic broad-spectrum agent similar to fluconazole<br />May be used in long-term suppression of histoplasmosis<br />Voriconazole (Vfend)<br />Broad-spectrum activity<br />
  107. 107. Polyenes<br />Amphotericin B <br />Highly toxic to humans and recommended only for serious, potentially fatal infections<br />Nystatin<br />Used topically only; too toxic for systemic use<br />

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