ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS PAI N( Fi f t hv i t alsi gn) CHRONI C Pai nt hr eshol d -r ef l ect st he l ev elofst i mul us neededt ocr eat eapai nf ul sensat i on. Pai nt ol er ance-amountofpai n a per son can endur e wi t houthav i ng i ti nt er f er e wi t h nor mal f unct i oni ng Anal gesi cs-ar epr escr i bedf ort her el i efofpai n. o Opi oi d–mi l dt omoder at epai n o Nonopi oi d( nonnar cot i c)–moder at e t osev er e.NSAI Dnonopi oi d, ant i i nf l ammat or ypur poses. Noci cept or s–sensor ypai nr ecept or s o a r eact i v at edbynoxi ousst i mul i o ( mechani cal ,t her mal ,andchemi cal ) i nper i pher al t i ssues Longt er m CANCER Neur opat hi c pai n -i s an unusual sensor y di st ur banceof t eni nv ol v i ngneur al supersensi t i v i t y . o duet oi nj ur yordi seaseoft heper i pher alor cent r al ner v oussy st em ( CNS) . SOMATI C o c ompl ai nsofbur ni ng,t i ngl i ng,orel ect r i cal shocksi nt heaf f ect edar ea,of t ent r i gger ed byl i ghtt ouch. Ex. Di abet i c neur opat hy i n DM ( Sev er e, i nt r act abl e pai nf r om a her ni at ed di sk or spi nal cor di nj ur y . TYPEOFPAI N ACUTE DRUG TREATMENT Sudden; Mi l dpai n: r espondst o Schedul ed t r eat mentnonopi oi d sur ger y , t r auma, ( acet ami nophen, t i ssuei nj ur y , NSAI Dq6h) i nf l ammat i on, or sur ger y . Moder at epai n: Schedul ed Shor tt er m ( 03 combi nat i onof mont hs) nonopi oi dand opi oi d( oxy codone 5mg& acet ami nophen 325mgq4h) Page1of1 SUPERFI CI AL DEFI NI TI ON Sev er epai n: Schedul edpot ent opi oi d( mor phi ne 15mgq4h Pai nper si st sf or gr eat er t han 6 mont hs and i s di f f i cul tt ot r eat orcont r ol . VASCULAR VI SCERAL Pai nf r om pr essur eon ner v esand or gans, bl ockaget o bl oodsuppl y , or met ast asi st o bone. Sev er e Pai n ofskel et al muscl e, l i gament s, and j oi nt s. Pai nf r om sur f acear eas– ski nand mucous membr anes. Pai nf r om v ascul aror per i v ascul ar t i ssues cont r i but i ngt o headachesor mi gr ai nes. Pi nf r om smoot hmuscl e andor gans. Nonopi oi ds suggest ed. ar e Opi oi ds, i f used, shoul dmeett hese cr i t er i a: or al or t r ansder mal l ong dur at i on of act i on i ncl ude adj unct t her apy cause mi ni mal r espi r at or y depr essi on NSAI D’ sand opi oi ddr ugs admi ni st er edPO, t r ansder mal , I M, I V, orPCA Nonopi oi ds: NSAI D’ s, al soact asant i i nf l ammat or i es andmuscl e r el axant s. Mi l dpai n: Non opi oi d Moder at e: combi nat i onof opi oi dand nonopi oi d anal gesi c Nonopi oi ddr ugs. Opi oi ddr ugs. UNDERTREATMENTOFPAI N: Upt o75%ofpat i ent shav eunr el i ev edpai n. Re asonsf orunder t r eat ment : o soci ocul t ur alv ar i abl est hatmedi at ea pat i ent ’ s wi l l i ngness t o acknowl edge bei ngi npai n ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS o i nabi l i t yt odescr i bepai n o Pi npoi nt -t oxi c dose ( l otofmor phi ne i nt he o nur ses’ i nabi l i t yt omeasur epai n bl ood) o l ack of r egul ar pai n assessment r ounds Nur si ngPr ocess: o at t i t udesoft heheal t hcar et eam o unwi l l i ngnesst obel i ev et hepat i ent ’ s As sessment r epor tofpai n o De t er mi nedr ughi st or yandcheckf or o i nadequat eanal gesi cdose. dr ugal l er gi es. Ef f ect sofunr el i ev edpai n–mul t i t udeef f ect s ( i ncr ease RR & CR, HTN, i nc st r essed o As sesst het y peofpai n,l ocat i on,and r esponse,ur i nar yr et ent i on,f l ui d ov er l oad, dur at i onbef or egi v i ngopi oi ds. el ect r ol y t e i mbal ance,gl ucose i nt ol er ance Nur si ngdi agnoses hy per gl y cemi a, pneumoni a, at el ect asi s, o Pa i n,Acut er el at edt osur gi calt i ssue anor exi a, par al y t i c i l eus, const i pat i on, i n j u r y . weakness, conf usi on, i nf ect i on. o Br eat hi ng Pat t er n,I nef f ect i v er el at ed t oexcessmor phi nedosage. NONOPI OI DANALGESI CS( aspi r i n, acet ami nophen, Pl anni ng i bupr of en, napr oxen)ar el esspot entt hanopi oi d o Thepa t i ent ’ spai nwi l lber educedor anal gesi cs. al l ev i at ed. usedt ot r eatmi l dt omoder at epai n. o I nef f ect i v ebr eat hi ngpat t er nsr el at ed actonPNSatt hepai nr ecept orsi t es t oexcessmor phi nedosage. usual l yOTCexceptCOX2i nhi bi t or s. o Ri sk f or f al l s r el at ed t o sedat i v e ef f ect ssecondar yt omor phi ne OPI OI DANALGESI CS( OPI OI DAGONI STS) o Cons t i pat i onr el at edt omor phi ne moder at et osev er epai n. N u r s i n gi n t e r v e n t i o n s * addi ct i ondef i ned as psy chol ogi caland phy si cal o Admi ni st er mor phi ne bef or e pai n dependence upon a subst ance bey ond nor mal v ol unt ar ycont r ol ,usual l yaf t erpr ol ongeduseofa r eaches i t s peak t o maxi mi ze dr ug subst ance. ef f ect i v eness. actmost l yont heCNS o Moni t orv i t alsi gnsf r equent l yt odet ect decr easev / s,sl ow mov ement( RR<cpm l eadst o r espi r at or y changes. ( <10/ mi n can coma) i ndi cat er espi r at or ydi st r ess. ) o Che ckf orpupi l changesandr eact i on. Opi oi dst akenwi t hKav akav a,andSt .John’ swor t Mi osi si ndi cat emor phi neov er dose. mayi ncr easesedat i on. o Re cor d ur i ne out put – shoul d be at l east600mL/ day . MORPHI NE,apr ot ot y peopi oi d,i sobt ai nedf r om o C h e c k f o r b o w e l s o undsf ordecr eased t hesapofseedpodsoft heopi um poppypl ant . per i st al si s. Si deef f ect s/ adver ser eact i ons o Ha v e nal oxone av ai l abl e as an o Dr owsi ness, di zzi ness, euphor i a ant i dot e t o r ev er se r espi r at or y o Conf usi on, depr essi on, mi osi s ( ex cessi v e depr essi on i f mor phi ne ov er dose const r i ct i onofpupi l ), bl ur r edv i si on occur s. o GI di st r ess, f l at ul ence, const i pat i on o Ol deradul t s–checkf oral er t nessand o Or t host at i c hy pot ensi on( decr ease bp,sudden or i ent at i on because conf usi on i sa posi t i onchanges, weakness( r i skf orf al l , i nj ur y ) si deef f ect–si der ai l s. o Ur i nar yr et ent i on( checkf orur i neout put ) o Ps y chol ogi cal dependence( euphor i a) Ev al uat i on– ef f ect i v enessi nl esseni ngand o Re spi r at or ydepr essi on al l ev i at i ngpai n. Page2of2 ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS o Di l ut edt o5mLNSSf orI Vadmi ni st r at i onor 2mgorl essmustbegi v enov er25mi ns. o Moni t orRRcl osel y , adequat ehy dr at i on. MEPERI DI NE( Demer ol ) Schedul eI I Shor t erdur at i ont hanmor phi ne, f ast er4hr s or al , I V, I M pr ogr essl abor , decr easedpai n SI DEEFFECTSANDADVERSEREACTI ONS: o Dr owsi ness, di zzi ness, conf usi on o We akness, const i pat i on o Mi osi s, t ol er ance, dependence o Re spi r at or y r et ent i on depr essi on, ur i nar y o Or t host at i chy pot ensi on CONTRAI NDI CATI ONSOFOPI OI DANALGESI CS: Use o Pr i mar i l yef f ect i v ei nGIpr ocedur es o Pr ef er r ed t o mor phi ne dur i ng pr egnancy because i t does not di mi ni sh ut er i ne cont r act i onsandcausesl essconst i pat i onand ur i nar yr et ent i on o Notf orl ongt er m use. o Dos ei sl i mi t edt o600mgi n24hrf ornotmor e t han48t o72hr s. o Ca ut i onwi t hl ar gedosesi nol deradul t sand pat i ent swi t hadv ancedcancer o Ne ur ot oxi ci t y– i n pat i ent ’ s r ecei v i ng l ar ge doses o Ne r v ousness, agi t at i on, i r r i t abi l i t y ,t r emor s, sei zur es Si deef f ect s o L essconst i pat i onandur i nar yr et ent i ont han mor phi ne HYDROMORPHONE( Di l audi d) semi sy nt het i copi oi dsi mi l art omor phi ne. Use o Ana l gesi cef f ecti sappr oxi mat el ysi xt i mes mor epot entt hanmor phi ne o Fa st eronset ,shor t erdur at i onofact i ont han mor phi ne. o Sc hedul eI I o Or al , r ect al , subQ, I M, I V o Mode r at et osev er epai n. Page3of3 1.CIi n pat i ent s wi t h head i nj ur i es.– opi oi ds decr ease r espi r at i ons t hus causi ng accumul at i onofCO2. 2.A pat i ent wi t har espi r at or y di sor der onl y i nt ensi f i est her espi r at or ydi st r ess.I nast hma, opi at es decr ease r espi r at or y dr i v e whi l e si mul t aneousl yi ncr easi ngai r wayr esi st ance. 3.Apat i enti nshockort hosewi t hv er yl ow BP– hy pot ensi v est at emaywor sen. 4.Ol deradul tordebi l i t at edper son–dosemay be decr eased. COMBI NATI ONDRUGS o NSAI Dandopi oi danal gesi cmay be combi ned. o He l pst odecr easedr ugdependencyf r om l ongt er m useofopi oi dagent . o hy dr ocodoneandi bupr of en( opi oi dand NSAI D) o a cet ami nophenandcodei ne PATI ENTCONTROLLEDANALGESI A( PCA) o Thepat i entcont r ol sadmi ni st r at i onoft he opi oi danal gesi c,dependi ngont heamount ofpai n. o Tor ecei v et heopi oi d,t hepat i entpushesa but t on on t he PCA dev i ce,r el easi ng a ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS speci f i c dose of anal gesi c( e. g. ,1 mg mor phi ne)i nt ot heI Vl i ne. o Thenur set i t r at est heopi oi danal gesi cdose by r egul at i ng t he t i me i nt er v al s( ev er y sev er almi nut es)atwhi cht hedr ugcanbe r ecei v ed. chi l d’ sneedf orpai nr el i ef .( OUCHSCALE) Ol deradul t s –decr easedl i v erandr enalf unct i ons–dr ugs accumul at e, pr ol ongeddur at i onofact i on Maynotwantt or epor tpai n Maybel i ev et hatpai ni si nev i t abl eduet oagi ng Fearofaddi ct i on Nur sesmustper f or m pai nassessmenti nan unhur r i ed mannerand t each accur at e dr ug i nf or mat i on. o Al ockoutmechani sm ont heel ect r oni cal l y cont r ol l ed i nf usi on pump pr ev ent s t he pat i entf r om const ant l ypushi ngt hebut t on and causi ng a dr ug ov er dose.The PCA dev i cemai nt ai nsanear const antanal gesi c l ev el ,av oi di ngepi sodesofsev er epai nand ov er sedat i on. Medi cat i onsused o Mor phi nemostof t enusedf orPCA Cogni t i vel y i mpai r ed i ndi vi dual s – moans, gr i maci ng,cl enchedt eet h,noi syr espi r at i ons,and r est l essness. Oncol ogy pat i ent s – ar et i t r at ed f oroncol ogy pat i ent sunt i lpai nr el i efi sachi ev ed ort hesi de ef f ect sbecomei nt ol er abl e. Fore f f ect i v epai nmanagementi npat i ent swi t h cancer , ext r emel yhi ghdosesmayber equi r ed. The r ear eno setdosagel i mi t sf oroncol ogy pat i ent s. o Al so, f ent any l , hy dr omor phone. TRANSDERMALOPI OI DANALGESI CS o Tr ansder mal r out e, sy st emi cef f ect o Pot ent , equal bl oodl ev el s o Pr ov i de cont i nuous pai n cont r ol ar ound t he cl ock” o He l pf ul f orchr oni cpai n o Fe nt any l mor epot entt hanmor phi ne o Av ai l abl ei nv ar i ousst r engt hs OPI OI DUSEI NSPECI ALPOPULATI ONS Chi l dr en Mor edi f f i cul tt oassess Somewi l lnotv er bal i zeev enwhent heyar ei n sev er epai n Somea r ef ear f ul oft r eat ment sl i kei nj ect i ons. Us e ofageappr opr i at e ski l l st o ascer t ai na ADJUVANTTHERAPI ES Adj uv antt her apy o Usedal ongwi t hanonopi oi dandopi oi d Adj uv antanal gesi cs o Ant i conv ul sant s–actont heper i pher alner v es and CNS byi nhi bi t i ng spont aneous neur onal f i r i ng. Ne ur opat hi c pai n and pr ev ent i on of mi gr ai neheadaches. o Ant i depr essant s – pr ev ent t he r eupt ake of ser ot oni nandnor epi nephr i nei nt hecel l s.Ner v e ef f ect . o Cor t i cost er oi ds – ef f ect i v e by r educi ng noci cept i v est i mul i .( causi ngt i ssuei nj ur y ) o Ant i dy sr hy t hmi cs– bl ocksodi um channel st o r educepai n. o L ocalanest het i cs–i nt er r upt st het r ansmi ssi on ofpai nsi gnal st ot hebr ai n. OPI OI DAGONI STANTAGONI STS Opi oi dswi t hmi xedact i ons He t er ogenous gr oup of dr ugs wi t h moder at et ost r onganal gesi cact i v i t y . Notgi v enf orcancerpai n o Sa f ef orusedur i ngl abor o Sa f et ydur i ngear l ypr egnancyhasnotbeen Page4of4 ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS est abl i shed o Swe at i ng, f l ushi ng, agi t at i on, dy spnea Nal buphi nehy dr ochl or i de sl i ght l yl esspot entt hanmor phi ne. dur at i on( 34hr s) f orpostoper at i v eorbr eakt hr oughpai n Assessment o As sesst het y peofpai n, dur at i on, andl ocat i on bef or egi v i ngt hedr ug. o Obt ai nadr ughi st or yf r om t hepat i ent . o Not e basel i ne v i t al si gns f or f ut ur e compar i son. Nur si ngdi agnosi s Pa i n, Acut er el at edt ot r auma Pl anni ng Thei nt ensi t yoft hepat i ent ’ spai nwi l lbe l essened. Nur si ngi nt er vent i ons o Moni t orv i t al si gns. o Che ckbowelsoundsandt hedat eofl astbowel mov ementt oi dent i f yconst i pat i on. o De t er mi neur i neout put . o Wa r n pat i ent not t o use al coholor CNS depr essant swhi l et aki ngnal buphi ne. o Adv i sepat i entt or epor tsi deef f ect s. Eval uat i on – ev al uat eef f ect i v enessi nr el i ev i ngpai n.I fnot , anot heropi oi danal gesi cmayneedt obeor der ed. Vi t al si gns, r epor tabnor mal f i ndi ngs. OPI OI DANTAGONI STS Nal oxone( Nar can) , nal t r exoneHCl , nal mef ene Act i on o Bl ocksr ecept oranddi spl acesopi oi d Use o Ant i dot ef oropi at eov er doses o Re v er seef f ect sofopi at esi ncl udi ngr espi r at or y depr essi on, sedat i on, hy pot ensi on o Re spi r at or ydepr essi on Si deef f ect s/ adver seef f ect s Page5of5 o Hy po/ hy per t ensi on, t achy car di a o Na usea, v omi t i ng o El ev at edPTT, bl eedi ng o Re v er salofanal gesi a– t achy car di a,nausea, v omi t i ng, sweat i ng Nur si ngi nt er vent i ons o Moni t orv i t al si gnsandbl eedi ngcont i nuousl y . MI GRAI NEHEADACHES Char act er i st i cs o Uni l at er al t hr obbi ngpai n o Na usea, v omi t i ng, phot ophobi a Tr i gger s o Cheese, chocol at e, r edwi ne, aspar t ame, f at i gue, st r ess,monosodi um gl ut amat e,mi ssedmeal s, odor s,l i ght ,hor monechanges,dr ugs,weat her , t oomuchort ool i t t l esl eep. Pat hophy si ol ogyt heor y o Duet oneur ov ascul arev ent si ncer ebr al cor t ex CLUSTERHEADACHES Char act er i st i cs o Se v er euni l at er al nont hr obbi ngpai n o Us ual l yl ocat edar oundey e o Oc curi naser i esofcl ust erat t acks Oneormor eat t acksev er ydayf orsev er al weeks o Nota ssoci at edwi t hanaur a o Donotc ausenauseaandv omi t i ng o Mor ecommoni nmal es Mi gr ai neandCl ust erHeadaches Pr event i on 1.Bet aadr ener gi cbl ocker s Pr opr anol ol At enol ol 2.Ant i conv ul sant s Va l pr oi caci d Ga bapent i n 3.Tr i cy cl i cant i depr essant s Ami t r i pt y l i ne I mi pr ami ne Management 1.Anal gesi cs ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS Aspi r i nwi t hcaf f ei ne, acet ami nophen Pr act i ceQuest i on#2 1.NSAI Ds: i bupr of en, napr oxen Thenur seassessesapat i entr ecei v i ngmor phi ne 2.Opi oi danal gesi cs v i aaPCApump.Thepat i enthasar espi r at or yr at e 1.Meper i di ne,but or phanolnasal of 6 br eat hs/ mi n. The nur se ant i ci pat es spr ay admi ni st r at i onofwhi choft hef ol l owi ngdr ugs? 3.Er gotal kal oi ds 1.Di hy dr oer got ami nemesy l at e 4.Sel ect i v eser ot oni n1r ecept oragoni st s A. Nal oxone 1.Sumat r i pt an, zol mi t r i pt an B. Sumat r i pt an SUMATRI PTAN 5HT1r ecept oragoni st :ant i mi gr ai ne C. Nal buphi ne Pr egnancycat egor yC D. Hy dr omor phone Act i on Ca usesv asoconst r i ct i onofcr ani al ar t er i es Pr act i ceQuest i on#3 Use Thenur sei dent i f i eswhi choft hef ol l owi ngasa o Tr eat smi gr ai neandcl ust erheadaches common si deef f ect / adv er seef f ectofmor phi ne Si deef f ect s t her apy ? o Di zzi ness, dr owsi ness, f l ushi ng, f at i gue o Dy sgeusi a, nausea, v omi t i ng o Par est hesi a, sei zur es o Dy sr hy t hmi as,t hr omboembol i sm,hear tat t ack, st r oke, sui ci dal i deat i on DRUGS USED TO TREAT SEVERE MI GRI ANE HEADACHES 1. sumat r i pt an( I mi t r ex) 2. nar at r i pt an( Amer ge) 3. r i zat r i pt anbenzoat e( Maxal t ) 4. zol mi t r i pt an( Zomi g) 5. al mot r i pt an( Axer t ) A. Di ar r hea B. Hy per t ensi on C. Ur i nar yr et ent i on D. Tachy pnea Pr act i ceQuest i on#4 Apat i entr ecei v edmor phi nesul f at ef orsev er epai n. Thenur seassessest hepat i ent20mi nut esl at er . Whati st hebesti ndi cat i ont hatt hemedi cat i onhas beenef f ect i v e? 6. f r ov at r i pt an( Fr ov a) 7.el et r i pt an( Rel pax) Pr act i ceQuest i on#1 The nextday ,t he pat i ent ’ s pai n medi cat i on i s changedf r om mor phi nesul f at et ohy dr omor phone. Whi ch st at ementr egar di ng hy dr omor phonedoes t henur sei dent i f yasbei ngt r ue? A. Hy dr omor phone must be admi ni st er ed i nt r av enousl y . B. Hy per t ensi oni sacommonsi deef f ect . C. Phy si caldependencedoesnotoccurwi t h hy dr omor phonet her apy . D. Hy dr omor phone i s mor e pot ent t han mor phi ne. Page6of6 A. Pat i entv er bal i zespai nr el i ef . B. Pat i enthasani ncr easei nhear tr at e. C. Pat i enti sr est i ng. D. Pat i enthasani ncr easei nbl oodpr essur e. ANTI BI OTI CS/ ANTI BACTERI ALS ar eagent smadef r om l i v i ngmi cr oor gani sms, sy nt het i c manuf act ur i ng, and genet i c engi neer i ng t hatar e used t oi nhi bi tspeci f i c bact er i a. Theycanbebact er i ost at i c, bact er i ci dal , orbot h. ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS Bact er i a Cont r ai ndi cat i onsandCaut i ons mi cr oor gani smst hati nv adet hehuman body t hr ough many r out es l i ke r espi r at or y , gast r oi nt est i nal , andski n. Human i mmune r esponse i s act i v at ed once bact er i ai nv adet hebody .Ast hebodyt r i est or i d i t sel fofbact er i a, cl assi csi gnsofi nf l ammat i on( e. g. swel l i ng,heat ,r edness,and pai n) ,f ev er ,and l et har gybegi nt oshowup. Thegoalofant i bi ot i ct her apyi st odecr easet he popul at i onofi nv adi ngbact er i a. CLASSESOFANTI BI OTI CS 1.Ami nogl y cosi des 2.Peni ci l l i ns 3.Peni ci l l i nr esi st antdr ugs 4.Sul f onami des 5.Tet r acy cl i nes 6.Ant i my cobact er i al s ( ant i t uber cul ar s and l epr ost at i c) 7.Ket ol i des 8.Li ncosami des 9.Li pogl y copept i des Thef ol l owi ngar econt r ai ndi cat i onsandcaut i ons f ort heuseofami nogl y cosi des: Knownal l er gyt oami nogl y cosi des. Renalorhepat i cdi sease.Canbeexacer bat ed by ami nogl y cosi des and may i nt er f er e wi t h met abol i sm andexcr et i onoft hesedr ugs. Pr eexi st i nghear i ngl oss.Canbei nt ensi f i edby t oxi cdr ugef f ect sont heaudi t or yner v e. Act i v ei nf ect i onwi t hher pesormy cobact er i al i nf ect i ons.Canbewor senedbyt heef f ect sof an ami nogl y cosi de on nor mal def ense mechani sms. My ast heni a gr av i s orpar ki nsoni sm.Can be exacer bat ed by t he ef f ect s of a par t i cul ar ami nogl y cosi desont hener v oussy st em. Lact at i on.Ami nogl y cosi desar eexcr et edi nt he br eastmi l kandcanpot ent i al l ycauseser i ous ef f ect si nt hei nf ant . Ami kaci nshoul dnotbeusedf orl ongert han710day sbecausei ti spar t i cul ar l yt oxi ct ot he bonemar r ow, ki dney s, andGI . St r ept omy ci ni s onl yf or speci alsi t uat i ons becausei ti sv er yt oxi ct ot he8t hcr ani alner v e andki dney . 10.Macr ol i des 11.Monobact ams 1.Ami nogl y cosi des gr oup ofant i bi ot i cs i ndi cat ed f ori nf ect i ons causedbygr amnegat i v eaer obi cbaci l l i . Ther apeut i cAct i on Exer t bact er i ci dal ef f ect t hr ough i nhi bi t i on of pr ot ei nsy nt hesi si nsuscept i bl est r ai nsofgr amnegat i v ebact er i a.Speci f i cal l y , t heybi ndt oauni tof t hebact er i ar i bosomesandcausemi sr eadi ngof t hegenet i ccodel eadi ngt ocel l deat h. Page7of7 2.Car bapenems Car bapenemsar ear el at i v el ynew cl assofbr oadspect r um ant i bi ot i cs ef f ect i v e agai nst gr amposi t i v eandgr amnegat i v ebact er i a. Ther apeut i cAct i on Exer t bact er i ci dal ef f ect by i nhi bi t i ng cel l membr ane sy nt hesi s i n suscept i bl e bact er i a, l eadi ngt ocel l deat h. I ndi cat i ons I nf ect i ons caused by suscept i bl e st r ai ns: S. pneumoni ae,H. i nf l uenzae,E. col i ,K. pneumoni ae, B. f r agi l i s, P. mi r abi l i s, P. aer ugi nosa, andP. bi v i a. ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS Cont r ai ndi cat i onsandCaut i ons cl ass ofant i bi ot i cs wi t h a br oad spect r um of act i v i t y . Knownal l er gyt ocar bapenemsorbet al act ams. Ther apeut i cAct i on Sei zur edi sor der s.Exacer bat edbydr ugs. The desi r ed and benef i ci al act i on of Meni ngi t i s.Saf et yi snotest abl i shed. f l uor oqui nol onesi s: Lact at i on.Notknownwhet herdr ugcancr oss I nt er f er e wi t h t he act i on of DNA enzy mes i nt obr eastmi l kornot . necessar yf orgr owt h and r epr oduct i on oft he b a c t e r i a . Er t apenem i s notr ecommended f oruse i n pat i ent sy oungert han18y ear sofage. Hasl i t t l ecr ossr esi st ancebutmi suseoft hi sdr ug f o r as h o r t t i mew i l l l e a dt oe x i s t e n c eo f r e s i s t a nt Mer openem i sassoci at edwi t hdev el opmentof s t r a i n s . pseudomembr anouscol i t i sandshoul dbeused i ncaut i oni npat i ent swi t hi nf l ammat or ybowel I ndi cat i ons di sease. Tr eat i ngi nf ect i ons( r espi r at or y ,ur i nar yt r act ,and ski n) caused by suscept i bl e st r ai ns: E. col i , P . mi r a b i l i s , K . p n e u mo n i a e , P . v u l g a r i s , M. mo r g a n i i , 3.Cephal ospor i ns P. aer ugi nosa, H. i nf l uenzae, S. aur eus, S. epi der mi di s, Cephal ospor i nswer ef i r sti nt r oducedi nt he1960s. N. gonor r hoeae, andgr oupDst r ept ococci . Ther apeut i cAct i on Exer tbact er i ci daland bact er i ost at i c ef f ect s by i nt er f er i ng wi t ht he cel l wal lbui l di ng abi l i t y of bact er i adur i ngcel l di v i si on. Ci pr of l oxaci nwasappr ov edi n2001f orpr ev ent i on ofant hr axi nf ect i oni nar east hatmi ghtbeexposed t oger m war f ar e.I ti sal soef f ect i v eagai nstt y phoi d f ev er . Cont r ai ndi cat i onsandCaut i ons Cont r ai ndi cat i onsandCaut i ons Knownal l er gyt ocephal ospor i nsandbet al act ams. Cr ossr eact i onsar ecommon. Knownal l er gyt of l uor oqui nol ones. Hepat i corr enal i mpai r ment . Pr egnancyandl act at i on.Pot ent i alef f ect sont he f et usandi nf antar enotknown;useonl yi fbenef i t s cl ear l yout wei ght hepot ent i alr i skoft oxi ci t yt ot he f et usori nf ant . Pr egnancyandl act at i on.Pot ent i alef f ect son t hef et usandi nf antar enotknown;useonl yi f benef i t scl ear l yout wei ght hepot ent i alr i skof t oxi ci t yt ot hef et usori nf ant . Sei zur es.Can be exacer bat ed byt he dr ugs’ ef f ect soncel l membr anechannel s I nt er act i ons Ami nogl y cosi des: i ncr easedr i skf ornephr ot oxi ci t y Or al ant i coagul ant s: i ncr easedbl eedi ng Al cohol :av oi dedf or72hour saf t erdi scont i nuat i on oft hedr ugt opr ev entdi sul f i r aml i ker eact i on( e. g. f l ushi ng, t hr obbi ngheadache, nauseaandv omi t i ng, chestpai n,pal pi t at i ons,dy spnea,sy ncope,v er t i go, conv ul si ons, et c. ) 4.Fl uor oqui nol ones Fl uor oqui nol ones ar ear el at i v el y new sy nt het i c Page8of8 5.Peni ci l l i ns Ant i bi ot i cs and Peni ci l l i naseResi st ant Peni ci l l i nwast hef i r stant i bi ot i ci nt r oducedf or cl i ni cal use. Var i ous modi f i cat i ons wer e subsequent l ymadet oaddr essr esi st antst r ai ns andt odecr easedr ugadv er seef f ect s. Ther apeut i cAct i on Exer tbact er i ci dalef f ectby i nt er f er i ng wi t ht he abi l i t yofsuscept i bl e bact er i at o bui l dt hei rcel l wal l swhent heyar edi v i di ng.Thesedr ugspr ev ent ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS t hebact er i af r om bi osy nt hesi zi ngt hef r amewor k Cont r ai ndi cat i onsandCaut i ons oft hecel lwal l , andt hebact er i awi t hweakenedcel l Knownal l er gyt o sul f onami des,sul f ony l ur eas,or wal l sswel landt henbur stf r om osmot i cpr essur e t hi azi dedi ur et i cs.Cr osssensi t i v i t ycanoccur . wi t hi nt hecel l . Renal di sease.I ncr easedt oxi cef f ect soft hedr ug. I ndi cat i ons Pr egnancy .Cancausebi r t hdef ect s. Tr eat ment of st r ept ococcal i nf ect i ons ( e. g. phar y ngi t i s, t onsi l l i t i s, scar l etf ev er , endocar di t i s) . Lact at i on.I ncr easedr i skf orker ni ct er us,di ar r hea, andr ashi ni nf ant s. Tr eat mentofmeni ngococcalmeni ngi t i si fgi v enat hi ghdoses I nt er act i ons Cont r ai ndi cat i onsandCaut i ons Tol but ami de, t ol azami de, gl y bur i de, gl i pi zi de, chl or pr opami de: i ncr easedr i skofhy pogl y cemi a Knownal l er gyt openi ci l l i nsandcephal ospor i ns. Cy cl ospor i ne: i ncr easedr i skofnephr ot oxi ci t y Renal di sease.Dr ugexcr et i oni sr educed. Pr egnancyandl act at i on.Noadequat est udi eson t he ef f ecton f et us butt hese dr ugs can cause di ar r heaandsuper i nf ect onsmayoccuri nt hei nf ant . 7.Tet r acy cl i nes Tet r acy cl i nesar esemi sy nt het i cant i bi ot i csbased ont hest r uct ur eofacommonsoi l mol d. I nt er act i ons Ther apeut i cAct i on Tet r acy cl i nes: decr ease i n ef f ect i v eness of peni ci l l i ns I nhi bi tpr ot ei nsy nt hesi sl eadi ngt oi nabi l i t yoft he bact er i at omul t i pl y .Theaf f ect edpr ot ei ni ssi mi l ar t opr ot ei nf oundi nhumancel l ssot hesedr ugscan bet oxi ct ohumansathi ghconcent r at i ons. Par ent er al ami nogl y cosi des: i nact i v at i on ami nogl y cosi des of 6.Sul f onami des Sul f onami des ar e dr ugs t hati nhi bi tf ol i c aci d sy nt hesi s. Ther apeut i cAct i on I nhi bi tf ol i caci dsy nt hesi sr equi r edaspr ecur sor sof RNAandDNA. I ndi cat i ons Tr eat mentofi nf ect i ons caused by suscept i bl e st r ai ns:C. t r achomat i s,Nocar di a,andsomest r ai ns ofH. i nf l uenzae, E. col i , andP. mi r abi l i s. No l onger used much but t hey r emai n an i nexpensi v eandef f ect i v et r eat mentf orUTI sand t r achoma,especi al l yi ndev el opi ngcount r i eswher e costi sani ssue. Can al so be used i n t r eat ment of sexual l y t r ansmi t t eddi seases. Sul f asal azi ne i s used i nt r eat mentoful cer at i v e col i t i sandr heumat oi dar t hr i t i s. Page9of9 I ndi cat i ons Tr eat mentofi nf ect i ons caused by suscept i bl e st r ai ns:Ri cket ssi ae,M. pneumoni ae,B. r ecur r ent i s, H. i nf l uenzae, H. ducr ey i , Bact er oi desspp. , V. comma, Shi gel l aspp. , D. pneumoni ae, andS. aur eus. Adj uncti nt r eat mentofpr ot ozoal i nf ect i ons. Cont r ai ndi cat i onsandCaut i ons Knownal l er gi est ot et r acy cl i nesort ot ar t r azi ne Pr egnancy and l act at i on.Ef f ect on dev el opi ng bonesandt eet h Fungal ,my cobact er i al ,orv i r alocul ari nf ect i ons. Opht hal mi c pr epar at i ons can ki l lbot h undesi r ed bact er i aandnor mal f l or a Usei n caut i on i n chi l dr en bel ow ageof8.Can pot ent i al l ydamagedev el opi ngbonesandt eet h. Hepat i c or r enal dy sf unct i on. Dr ugs ar e concent r at edi nt hebi l eandar eexcr et edi nur i ne. I nt er act i ons ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS Peni ci l l i nG: decr easedef f ect i v enessofpeni ci l l i nG Or alcont r acept i v es:decr eased ef f ect i v eness of or alcont r acept i v es and addi t i onalf or m ofbi r t h cont r ol i sneeded Di goxi n: i ncr easeddi goxi nt oxi ci t y Cal ci um sal t s, magnesi um sl at s, zi nc sal t s, al umi num sal t s, bi smut h sal t s, i r on, ur i nar y al kal i ni zer s,andchar coal :decr easedabsor pt i onof t et r acy cl i nes 8.Ant i my cobact er i al s Ant i my cobact er i al s ar e ant i bi ot i cs used i nt he t r eat ment of i nf ect i ons caused by pat hogens r esponsi bl ef ort uber cul osi sandl epr osy . My cobact er i um t uber cul osi scausest uber cul osi s, t hel eadi ngcauseofdeat hf r om i nf ect i ousdi sease i nt hewor l d. My cobact er i um l epr aecausesl epr osyorHansen’ s di sease,char act er i zedbydi sf i gur i ngski nl esi ons anddest r uct i v eef f ect sont her espi r at or yt r act . Ther apeut i cAct i on Actont heDNAand/ orRNAoft hebact er i a, l eadi ng t ol ackofgr owt handev ent ual l yt obact er i al deat h. I ndi cat i ons Tr eat mentoft uber cul osi sandl epr osy . Cont r ai ndi cat i onsandCaut i ons Knownal l er gi est oant i my cobact er i al s. Pr egnancy . Adv er se ef f ect s on f et us. Saf est ant i t uber cul osi sr egi men i n pr egnancy i soni azi d, et hambut ol , andr i f ampi n. Sev er e CNS dy sf unct i on. Exacer bat ed by t he ef f ect soft hedr ug Hepat i c orr enaldy sf unct i on.I nt er f er e wi t ht he met abol i sm andexcr et i onofdr ugs. 9.Ot herAnt i bi ot i cs Ket ol i desi sacl assofant i bi ot i csi nt r oducedi n 2004.I ti si ndi cat edf ort r eat mentofmi l dt o moder at e communi t y acqui r ed pneumoni a Page10of10 causedbysuscept i bl ebact er i a. Li ncosami desar esi mi l art omacr ol i desbutt hey ar emor et oxi c.Theyar eusedt ot r eatsev er e i nf ect i onswhen peni ci l l i n orot herl esst oxi c ant i bi ot i cscannotbeused. Li pogl y copept i desar eant i bi ot i csi nt r oducedi n 2010.Theyar eusedt ot r eatcompl i cat edski n and ski nst r uct ur e i nf ect i ons caused by suscept i bl est r ai nsofgr amposi t i v eor gani sms. Macr ol i des ar e ant i bi ot i cs t hati nt er f er e wi t h pr ot ei nsy nt hesi si nsuscept i bl ebact er i a.They ar e used t ot r eatr espi r at or yi nf ect i ons and ur et hr i t i s i n adul t s and ot i t i s medi a and phar y ngi t i s/ t onsi l l i t i si nchi l dr en.Ey t hr omy ci ni s t hedr ugofchoi cef orLegi onnai r e’ sdi seaseand i nf ect i onscausedbyC. di pht her i ae,Ur eapl asma spp. ,my copl asmapneumoni a,andchl amy di al i nf ect i ons. Monobact am ant i bi ot i cs ar e i ndi cat ed f or t r eat ment of gr amnegat i v e ent er obact er i al i nf ect i ons. Ther apeut i cAct i on Ket ol i desandl i ncosami desbl ockpr ot ei nsy nt hesi s l eadi ngt ocel ldeat h.Ket ol ami desar est r uct ur al l y t hesamewi t hmacr ol i des. Li pogl y copept i des i nhi bi t bact er i al cel l wal l sy nt hesi s byi nt er f er i ng wi t h pol y mer i zat i on and cr ossl i nki ngofpept i dogl y cans.Theybi ndt ot he bact er i almembr anceand di sr uptt hemembr ane bar r i erf unct i oncausi ngbact er i al cel l deat h. Macr ol i desbi ndt ot hebact er i alcel lmembr aneand change pr ot ei nf unct i on.Thi s pr ev ent s bact er i a f r om di v i di ngandcauset hei rcel l deat h. Monobact am di sr upt sbact er i alcel lwal lsy nt hesi s andpr omot el eakageofcel l ul arcont ent sandcel l deat h. NURSI NGCONSI DERATI ONSFORANTI BI OTI CS Nur si ngAssessment 1.Assess f or t he ment i oned caut i ons and cont r ai ndi cat i ons ( e. g. dr ug al l er gi es, CNS depr essi on,CV di sor der s,et c. )t opr ev entany ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS unt owar dcompl i cat i ons. 5.Educat e cl i enton dr ug t her apy t o pr omot e under st andi ngandcompl i ance. 2.Per f or m at hor oughphy si calassessment( ot her medi cat i onst aken,CNS,ski n,r espi r at i ons,and 6.Pr ov i det hef ol l owi ngpat i entt eachi ng:saf et y l abor at or yt est sl i ker enalf unct i onst est sand pr ecaut i ons( e. g.changi ngposi t i ons,av oi di ng compl et e bl ood countorCBC)t o est abl i sh hazar doust asks, ec. ) , dr i nki ngl ot soff l ui dsand basel i nedat abef or edr ug t her apybegi ns,t o t omai nt ai nnut r i t i onev ent houghnauseaand det er mi ne ef f ect i v eness of t her apy ,and t o v omi t i ngmayoccur ,r epor tdi f f i cul t ybr eat hi ng, ev al uat ef oroccur r enceofanyadv er seef f ect s sev er eheadache,f ev er ,di ar r hea,andsi gnsof associ at edwi t hdr ugt her apy . i nf ect i on. 3.Per f or m cul t ur eandsensi t i v i t yt est satt hesi t e ofi nf ect i ont oensur eappr opr i at euseoft he dr ug. 4.Conductor i ent at i onandr ef l exassessment ,as wel lasaudi t or yt est i ngt oev al uat eanyCNS ef f ect soft hedr ug( ami nogl y cosi des) . Ev al uat i on 1.Moni t orpat i entr esponset ot her apy( decr ease i nsi gnsandsy mpt omsofi nf ect i on) . Nur si ngDi agnoses 2.Moni t orf oradv er seef f ect s( e. g.or i ent at i onand af f ect , hear i ng changes, bone mar r ow suppr essi on,r enalt oxi ci t y ,hepat i cdy sf unct i on, et c) . Acut epai nr el at edt oGIorCNSdr ugef f ect s 3.Ev al uat epat i entunder st andi ngondr ugt her apy by aski ng pat i ent t o name t he dr ug,i t s i ndi cat i on, andadv er seef f ect st owat chf or . Def i ci entf l ui dv ol umeandi mbal ancednut r i t i on: l esst hanbodyr equi r ement sr el at edt odi ar r hea Di st ur bedsensor yper cept i on( audi t or y )r el at ed t oCNSdr ugef f ect s Ri sk f or i nf ect i on r el at ed t o bone mar r ow suppr essi on ( ami nogl y cosi des)and r epeat ed i nj ect i ons( cephal ospor i ns) . I mpl ement at i onwi t hRat i onal e 1.Checkcul t ur eandsensi t i v i t yr epor t st oensur e t hatt hi si st hedr ugofchoi cef ort hi spat i ent . 2.Ensur et hatpat i entr ecei v es f ul lcour se of ami nogl y cosi desaspr escr i bed,di v i dedar ound t he cl ock t o i ncr ease ef f ect i v eness and decr easet her i skf ordev el opmentofr esi st ant st r ai nsofbact er i a. 3.Moni t ori nf ect i onsi t eandpr esent i ngsi gnsand sy mpomst hr oughoutcour seofdr ug t her apy because f ai l ur e of t hese mani f est at i ons t o r esol v emayi ndi cat et heneedt or ecul t ur et he si t e. 4.Pr ov i desaf et ymeasur est opr ot ectt hepat i ent i fCNS ef f ect s( e. g.conf usi on,di sor i ent at i on, numbness)occur . Page11of11 4.Moni t orpat i entcompl i ancet odr ugt her apy . ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS ANTI BI OTI CS:GENERI CANDBRANDNAMES Cl assi f i cat i on Gener i cName Br andName Ami nogl y cosi des ami kaci n Ami ki n gent ami ci n Gar amy ci n kanamy ci n Kant r ex neomy ci n My ci f r adi n st r ept omy ci n gener i c t obr amy ci n TOBI , Tobr ex Car bapenems Dor i penem Er t apenem I nv anz I mi penemci l ast at i n Pr i maxi n mer openem Mer r em I V Dor i bax Cephal ospor i ns Fi r st Gener at i on cef azol i n Zol i cef cephal exi n Kef l ex Se cond- Gener at i on cef acl or cef oxi t i n gener i c cef pr ozi l gener i c cef ur oxi me Zi nacef Thi r dGener at i on Page12of12 cef adr oxi l cef di ni r gener i c Cecl or gener i c ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS cef ot axi me Cl af or an cef podoxi me Vant i n cef t azi di me Cept az, Tazi cef cef t i but en Cedax cef t i zoxi me Cef i zox cef t r i axone Rocephi n Four t h- Gener at i on cef di t or en cef epi me Maxi pi me cef t ar ol i ne Tef l ar o Fl uor oqui nol ones ci pr of l oxaci n gemi f l oxaci n Fact i v e l ev of l oxaci n Lev aqui n moxi f l oxaci n Av el ox nor f l oxaci n Nor oxi n of l oxaci n Fl oxi n, Ocuf l ox Spect r acef Ci pr o Peni ci l l i ns and Peni ci l l i nase- Resi st ant Ant i bi ot i cs Pe ni ci l l i ns peni ci l l i nGbenzat hi ne peni ci l l i nGpot assi um Pf i zer pen peni ci l l i nGpr ocai ne Wy ci l l i n peni ci l l i nV Veet i ds Ex t ended- Spect r um Peni ci l l i ns ampi ci l l i n Pe ni ci l l i nase- Resi st ant Ant i bi ot i cs amoxi ci l l i n Bi ci l l i n, Per mapen Amoxi l , Tr i mox Pr i nci pen naf ci l l i n oxaci l l i n Page13of13 Sul f onami des sul f adi azi ne sul f asal azi ne Azul f i di ne gener i c ANALGESI CS, ANTI I NFLAMMATORI ES, ANTI BACTERI ALS cot r i moxazol e Sept r a, Bact r i m Tet r acy cl i nes demecl ocy cl i ne doxy cy cl i ne Dor y x, Per i ost at mi nocy cl i ne Mi noci n t et r acy cl i ne Sumy ci n Decl omy ci n Ant i my cobact er i al s Ant i t uber cul osi s Fi r st l i ne et hambut ol py r azi nami de Ny dr azi d r i f ampi n gener i c r i f apent i ne Ri f adi n, Ri mact ane st r ept omy ci n gener i c Se condl i ne capr eomy ci n My ambut ol Capast at cy cl oser i ne Ser omy ci n et hi onami de Tr ecat or SC r i f abut i n My cobut i n Lepr ost at i c dapsone gener i c Ket ol i de t el i t hr omy ci n Ket ek Li ncosami des cl i ndamy ci n Cl eoci n l i ncomy ci n Li ncoci n Ot herAnt i bi ot i cs Li pogl y copept i des Page14of14 t el av anci n Vi bat i v Macr ol i des azi t hr omy ci n Zi t hr omax cl ar i t hr omy ci n Bi axi n er y t hr omy ci n Er y Tab, Er y c Monobact am azt r eonam Azact am