CH 9: Antibiotics
Antibiotic Overview
-
Inhibit specific bacteria.
Made in living microorganisms, synthetic, & genetic engineering
Can be bacteriostatic (prevents growth of bacteria) or bactericidal (kills the bacteria directly)
Culture helps choose the right antibiotic that is going to be effective in the treatment.
Sensitivity testing helps to determine the organism will be most sensitive to
Broad spectrum is given if the organism cannot be identifying and prevent the pt to go to aspis
Bacteria classification:
-
-
-
Gram-positive: cell wall retains Gram’s statin
or resists decolorization with alcohol on
culture
o Infections of the respiratory tract
o Ex: pneumonia
Gram-negative: cell wall loses a stain or is
decolorized by alcohol
o Associated with infection in the
urinary or GI tract.
o Ex: E. coli cause of cystitis
Aerobic: depend on oxygen
Anaerobic: do not use oxygen
Aminoglycosides
OVERVIEW: Powerful antibiotic to treat serious
infection
PROTOYPE: acin
NURSING CONSIDERATIONS:
- Check renal function: BUN & Creatine
- Strict I & O: urine output 1200 ml/day
- Monitor peak: 30 minutes & trough (before
dose)
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: Bactericidal
Carbapenems
OVERVIEW: broad-spectrum antibiotics against (+, -)
and anaerobic bacteria
PROTOTYPE: penem
NURSING CONSIDERATIONS:
Lab tests: C&S prior to therapy
Monitor: liver and kidney function and seizures
Bacteria & Resistance to antibiotics
-
Bacteria adapts to their environment by
changing the cell wall leading to resistance
Use only when necessary
Result in superinfection or overgrowth of
resistant pathogens
Superinfections occurs because antibiotics
destroying bacteria and in the normal flora
o Ex: fungi or yeasts resulting in yeast
infections and candidiasis
MOA: inhibit protein synthesis. Irreversibly binding
to bacteria ribosomes leading to misreading of the
genetic code
INDICATIONS: serious infections susceptible to
penicillin when penicillin is contraindicated
Ex: E. coli, pseudomonas aeruginosa
CONTRAINDICATIONS: R & H disease, hearing less,
myasthenia gravis or Parkinson’s, active herpes, or
mycobacterial infections
DRUG-DRUG: diuretics, neuromuscular blocking
agents (muscle relaxer)
SIDE/ADVERSE EFFECT:
Ototoxicity: BLACK BOX WARNING, hearing loss, loss
of balance
Nephrotoxicity: BLACK BOX WARNINIG, proteinuria,
urine casts, dilute urine, elevated BUN, elevated
creatinine
Intense neuromuscular blockade, hypersensitivity
MOA: inhibits cell membranes synthesis in
susceptible bacteria causing death
INDICATIONS: intra-abdominal (peritonitis), urinary
tract, skin, gynecological infection, pneumonia
CONTRAINDICATIONS: allergy to PCN or
cephalosporins, seizure, lactation, meningitis, & pts
younger than 18 (ertapenem & meropenem)
History of hypersensitivity and if it occurs
discontinue drug
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: Bactericidal
Cephalosporins
OVERVIEW: broad-spectrum, effective +, - bacteria
GENERATIONS:
1. CEPHalexin, CEFazolin
2.CEFaclor, CEFaclor, CEFprozil
3.CEFotaxime (claforan), CEFtriazone (Rocephin)
4.CEFepime, CEFditoren, CEFtaroline
NURSING CONSIDERATIONS:
Take with food 2
Cross-allergy with penicillin
Avoid ETOH
Obtain C & S before 1st dose
May give false positive for proteinuria & glycosuria
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: Bactericidal &
Bacteriostatic (depends on the dose used & drug)
Fluoroquinolones
OVERVIEW: broad-spectrum to treat infection
caused by +, - bacteria
PROTOYPE: Ciprofloxacin (cipro)
NURSING CONSIDERATIONS:
C & S before therapy start
- Do not take with food (slows absorption), 1 hr
before meals or 2 hr after meals
- Do not take with iron preps or antacids
- Can take with probenecid (gout meds.)
- Cipro must be given alone if IV
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: Bactericidal
Penicillin & Penicillinase Resistant
Antibiotics:
PCN: first antibiotic introduced for clinical use.
PROTOTYPE:
CAUTIONS: pregnancy, renal dysfunction
DRUG-DRUG: valproic acid (Depakote)
SIDE/ADVERSE:
GI Toxicity: monitor dehydration, electrolyte
imbalances
Superinfection
CNS: dizziness, H/A, & AMS, seizures
MOA: interferes with the cell wall building ability
when diving preventing the bacteria from
biosynthesizing
INDICATIONS: UTI, postop infection, pelvic
infections, meningitis
CONTRAINDICATIONS: allergies to penicillin
SIDE/ADVERSE: GI effects, CNS effect,
Nephrotoxicity, superinfections,
DRUG-DRUG: aminoglycosides, oral anticoagulants,
ETOH
MOA: using passive diffusion enters the bacterial cell
to interfere the action of DNA enzyme needed to for
reproduction
INDICATIONS:
- Urinary and respiratory tract, G, skin infection
- Prevention of anthrax infection (1q12h60d)
- Typhoid fever
CONTRAINDICATIONS: pregnancy, lactation &
uncomplicated infection
CAUTION: renal dysfunction
SIDE/ADVERSE:
Musculoskeletal: tendinitis, tendon rupture,
peripheral neuropathy, exacerbated muscle
weakness, BLACK BOX WARNING
GI: N/V/D/ D, dry mouth
Superinfection (C. Diff)
Phototoxicity, CNS, liver toxicity, BM suppression
DRUG-DRUG: antacids, warfarin, theophylline (lung
diseases, asthma & COPD)
MOA: prevent bacteria from building cells wall when
dividing causing cells to weaken becoming swell and
burst from osmotic pressure
PCNs: Penicillin
Penicillinase-Resistant Antibiotics: Nafcillin, Oxacillin
NURSING CONSIDERATIONS:
Risk of allergic reaction, MUST check for
hypersensitivity.
Take 1 hr before or 2 hrs after meals with 8 oz of
water (except amoxicillin and penicillin with meals)
Cross allergy with cephalosporins
Monitor liver functions: AST, ALT,
Renal function: BUN, urine output
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: Bactericidal
INDICATIONS: PNA, meningitis, infectious
endocarditis, pharyngitis, syphilis, prophylaxis against
bacterial endocarditis prior to dental procedures
CONTAINDICATIONS: allergies to PCN or
cephalosporins, renal disease
SIDE/ADVERSE: GI, ABD pain, glossitis, stomatitis,
gastritis, sore mouth, superinfections, renal
impairment, hypersensitivity
DRUG-DRUG: tetracyclines, parenteral
aminoglycosides, PO contraceptives
Sulfonamides
MOA: block para-aminobenzoic acid to prevent the
synthesis of folic acid in bacteria that synthesize their
own folates
INDICATIONS: trachoma (leading case of blindness),
nocardiosis (causes PNAs, brain abscesses,
inflammation), UTIs, STIs, ulcerative colitis, RA
CONTRAINDICATIONS: allergy to sulfonylureas or
thiazides diuretics, pregnancy/lactation
CAUTION: renal disease, history of kidney stones,
elderly
SIDE/ADVERSE: GI (ABD pain, anorexia, stomatitis),
hepatic injury, renal (crystalluria, hematuria,
proteinuria, nephrotic syndrome), CNS, BM
suppression, blood dyscrasias, photosensitivity
DRUG-DRUG: warfarin, phenytoin, sulfonylurea and
hypoglycemics, oral hormonal contraception
(decrease effects), cyclosporine, (high risk of
nephrotoxicity)
MOA: inhibits protein synthesis leading to the
inability of bacteria to multiply
INDICATIONS: acne; GU infections caused by
chlamydia trachomatis; periodontal disease; rocky
mountain spotted fever; brucellosis; Lyme disease,
pneumonia; anthrax, GI infections from H. pylori &
when PCN is contraindicated
CONTRAINDICATIONS: allergy to tartrazine,
pregnancy/lactation, ocular infections (ophthalmic
preparations), hepatic dysfunction
SIDE/ADVERSE: GI (ABD pain, glossitis, esophageal
ulceration, dysphagia), yellow/brown tooth
discoloration, hypoplasia of tooth enamel,
hepatotoxicity
DRUG-DRUG: penicillin G, oral contraceptives,
digoxin, iron, charcoal
OVERVIEW: Treat infections caused by +, - bacteria
PROTOYPE: sulfadiazine
NURSING CONSIDERATIONS:
Take with meals
Encourage fluids (3000 ml/day)
Good oral care (stomatitis risk)
CBC; BS; PT; BUN; Creatine
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: bacteriostatic
Tetracyclines
OVERVIEW: broad spectrum, against +, - bacteria
Based on the structure of soil mold, composed of 4
rings “tetra”
PROTOTYPE: demeclocycline, doxycycline,
tetracycline
NURSING CONSIDERATIONS:
Take on empty stomach with 8 oz of water, 1 hr
before meals or 2 hr after meals can take with food if
GI distress, do not take before lying down
Note the expiration date; might cause toxicity
Monitor renal function
Avoid sunlight or use sunscreen
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: Bacteriostatic
Antimycobacterial
OVERVIEW: classifies by the basis of their ability to
hold stain even in the presence of a destaining agent
such as acid
TUBERCULOSIS 1ST: ethambutol, INH, pyrazamide
TUBERCULOSIS 2ND: bedaquiline, capreomycin,
cycloserine
LEPROSY: dapsone
NURSING CONSIDERATIONS:
Monitor for hepatic side effects.
Monitor for CNS effects as numbness and tingling of
the extremities.
Collect sputum specimens as directed by healthcare
provider checking for acid fast bacteria.
Establish infection control measures based on extent
of disease condition and established protocol.
Establish therapeutic environment to ensure
adequate rest, nutrition, hydration, & relaxation
Monitor for dietary compliance (foods high in
tyramine)
Monitor client’s ability and motivation to comply
with therapeutic regimen.
To be taken 1 hour before meals or 2 hrs after
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL:
Ketolides
OVERVIEW:
PROTOTYPE: telithromycin (ketek)
NURSING CONSIDERATIONS:
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: Bactericidal
Lincosamides
OVERVIEW: similar to macrolides but more toxic
PROTOTYPE: clindamycin (cleocin), lincomycin
(lincocin)
NURSING CONSIDERATIONS:
GRAM POSITIVE OR GRAM NEGATIVE:
MOA: act on the DNA/RNA of the bacteria that
prevents synthesis of mycolic acid in the cell wall
leading to lack of growth & eventual bacterial death
INDICATIONS: mycobacterium tuberculosis,
mycobacterium leprae, mycobacterium aviumintracellular
CONTRAINDICATIONS: renal & hepatic failures,
pregnancy
SIDE/ADVERSE: peripheral neuropathy,
hepatotoxicity hyperglycemia, discolored body fluids
(orange urine, saliva, sweat, tear with rifampin (treat
tuberculosis), pseudomembranous colitis.
DRUG-DRUG: INH inhibits metabolism of phenytoin;
rifampin decreases effectiveness of oral
contraceptives and warfarin
MOA: blocks protein synthesizes by binding to
ribosome subunits
INDICATIONS: mild to moderate communityacquired pneumonia
CONTRAINDCIATIONS: heart condition, bradycardia,
hypokalemia, MS (BLACK BOX WARNING- RISK OF
FATAL RESPIRATORY FAILURE)
CAUTIONS: renal or hepatic impairment, pregnancy
& lactation
ADVERSE EFFECT:
GI, superinfections, hypersensitivity, anaphylaxis
DRUG-DRUG:
Statins, pimozide, digoxin, metoprolol, rifampin
(treat tuberculosis), phenytoin, carbamazepine
(control seizures), phenobarbital, theophylline (lung
disease asthma & COPD)
MOA: bind to the subunit of the ribosome,
interfering with protein synthesis preventing cell
division depending on the drug
INDICATIONS: use to severe infection when a less
toxic antibiotic cannot be used
CAUTIONS: hepatic or renal impairment, pregnancy
& lactation
LIST WHAT IT DOES TO THE CELL: bactericidal &
bacteriostatic
Lipoglycopeptides
OVERVIEW: semisynthetic derivatives of vancomycin
PROTOTYPE: telavancin (vibativ)
NURSING CONSIDERATIONS:
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: bactericidal
Macrolides
OVERVIEW:
PROTOTYPE: thryomycin
NURSING CONSIDERATIONS:
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: bactericidal &
bacteriostatic
Oxazolidinones
OVERVIEW:
PROTOTYPE: erythromycin (Eryc)
NURSING CONSIDERATIONS:
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: Bactericidal
ADVERSE EFFECT:
GI: fatal colitis
Pain, skin infections, BM suppression
MOA: inhibit cell wall synthesis by interfering with
the polymerization and cross-linking of
peptidoglycans binding to cell membrane and disrupt
barrier function
INDICATIONS: complicated skin and skin structure
infections (IV use only)
CONTRAINDICATIONS: pregnancy/lactation (BLACK
BOX WARNING-FETAL RISK), women of childbearing
age
CAUTIONS: renal impairment
ADVERSE EFFECT:
GI, infusion site irritation
Nephrotoxicity: foamy urine
Red man syndrome: flushing, sweating, hypotension
(occur from rapid infusion)
DRUG-DRUG: nephrotoxic drug, drugs that prolong
QT interval
MOA: bind to the subunit of the ribosome interfering
with protein synthesis preventing cell division or cell
death deponing on the concentration of the drug
INDICATIONS: pelvic inflammatory disease, upper
respiratory infection, intestinal amebiasis,
prophylaxis for endocarditis before dental work in
pts with valvular heart disease if allergic to PCN
CONTRAINDICATIONS: eye infections (ocular
preparations)
CAUTIONS: hepatic & renal impairment, pregnancy
& lactation
ADVERSE EFFECT:
GI (ABD cramping, anorexia, diarrhea, vomiting,
colitis)
AMS, superinfections
Hypersensitivity: ranges from rash to anaphylaxis
DRUG-DRUG: Digoxin, oral anticoagulants,
theophylline, carbamazepine, corticosteroids,
cycloserine (treat tuberculosis TB)
MOA: interfere with protein synthesis on the
bacterial ribosome and act as monoamine oxidase
inhibitors (MAOIs)
INDICATIONS:
Vancomycin-resistant strains of enterococci (VRE)
Methicillin-resistant staphylococcus aureus (MRSA)
Penicillin-resistant pneumococci
Diabetic foot infections; Pneumonia
Skin and skin structure infections
Monobactam
OVERVIEW:
PROTOTYPE: aztreonam (azactam)
NURSING CONSIDERATIONS:
GRAM POSITIVE OR GRAM NEGATIVE:
LIST WHAT IT DOES TO THE CELL: Bactericidal
CONTRAINDICATIONS: MAOIs, hepatic impairment,
pheochromocytoma, HTN, hyperthyroidism, BM
suppression
ADVERSE EFFECT:
CNS: H/A, insomnia, dizziness
GI: N, V, D, dry mouth, colitis
Thrombocytopenia (tumor in adrenal gland)
HTN
DRUG-DRUG: meds that increase BP & bleeding,
NSAIDs, serotonergenic drugs (drugs that alter the
serotonin in the body)
DRUG-FOOD: Tyramine containing food.
- Aged cheese, chicken liver, summer sausage,
red wine, soy sauce
MOA: disrupts bacterial cell wall synthesis which
promotes leakage of cellular contents
INDICATIONS: urinary tract, skin, intra-abdominal,
and gynecological infections, septicemia
CONTRAINDICATINS: Hx of allergy to PCN or
cephalosporins, renal & hepatic impairment,
pregnancy & lactation
ADVERSE EFFECT:
GI, elevated hepatic enzymes, injection site irritation,
& anaphylaxis
DRUG-DRUG: nafcillin, cephradine, metronidazole
CH 51: DIURETIC AGENTS
Kidney Function Review
-
Regulate fluid balance
Regulate electrolyte composition
Acid-base balance of body fluids
Secrete renin (regulates BP) & erythropoietin
(Stimulates RBC production)
Produce calcitriol (active of Vit D to help
maintain bone homeostasis)
Renal failure
-
-
-
-
-
Renal Failure Treatment
-
-
Treatment: manage the cause of the
dysfunction
Diuretics: increase urine output
Cardiovascular: treat underlying HTN or heart
failure
Dietary management: prevent worsening of
renal impairment
o Need protein restriction
o Reduction of Na+, K +, phosphorus,
Mg intake
Moderate to severe renal failure decreased
drug dosages
-
Decrease in the kidney ability to maintain
electrolyte & fluid balance & to excrete waste
products
Primary treatment goal is to maintain blood
flow through the kidneys and adequate urine
output
Need to diagnose the degree of kidney failure
Urinalysis: look for proteinuria and
albuminuria
Acute: immediate treatment to reverse
retention of nitrogenous waste that result in
death caused by renal hypoperfusion
Chronic: period of months or year that may
go undiagnosed for many years gradual
development & nonspecific symptoms
End-stage renal disease (ESRD): dialysis,
kidney transplant
Diuretic Overview
Increased the amount of urine produced by
the kidneys
Increase sodium & water excretion
Indications
o Edema associated with congestive
heart failure
o Acute pulmonary edema
o Liver disease (including cirrhosis)
o Renal disease
o Hypertension
o Decrease intraocular pressure
(glaucoma)
o Condition that cause hyperkalemia
Classes of diuretics
-
Thiazide & Thiazide- lie diuretics
Loop Diuretics
Carbonic anhydrase inhibitors
Potassium-Sparing Diuretics
Osmotic Diuretics
Thiazide & Thiazide- Like Diuretics
Loop Diuretics
MOA:
-Action is to block the chloride pump
-prevents reabsorption of water
-slight increase in the volume of urine produced
-urine that is excreted will be rich in sodium
-promote reabsorption of calcium
-works with renal function is not impaired
INDICDATIONS:
-treatment of edema associated with CHF, liver, or
renal disease
-drug of choice for essential HTN
PROTOTYPES:
Thiazide Diuretics: hydrochlorothiazide,
chlorothiazide, hydroflumethiazide
Thiazide-Like Diuretics: chlorthalidone, indapamide,
metolazone
CONTRAINDICATIONS:
Allergy to thiazides or sulfonamides, fluid &
electrolyte imbalances, renal impairment
CAUTION:
Lupus, glucose intolerance/DM, liver disease,
hyperparathyroidism, bipolar disorder,
pregnancy/lactation
DRUG-DRUG:
Digoxin, lithium, antihypertensives, NSAIDs
ADVERSE EFFECTS:
Hypotension, dehydration, increased LDL cholesterol
Hypokalemia: weakness, muscle cramps,
arrhythmias
Hypo/natremia, chloremia
Hyper/glycemia, uricemia
NURSING CONSIDERATIONS:
Monitor electrolytes K+, Na+, CI-, Mg
Monitor BUN, serum creatinine, uric acid, glucose.
Cholesterol levels
Assess for dysrhythmias
Take in the AM- may take with food
Monitor weight, BP
MOA:
-block the chloride pump in the ascending loop of
Henle
-production of a copious amount of sodium-rich
urine
-Decreased reabsorption of sodium, chloride, &
water
-Works to cause extensive diuresis in the presence of
severe renal impairment.
INDICATIONS:
-used in emergent need for rapid mobilization of
fluid
-acute CHF, acute pulmonary edema, hypertension,
hypercalcemia,
PROTOTYPE: called loop bc work in the loop of Henle
-Furosemide (lasix): most commonly used, less
powerful than new drugs, larger margin of home
safety
-Bumetanide (bumex) & Torsemide (Demadex): new
drugs, more powerful than Lasix
-Ethacrynic acid (edecrin): first loop diuretic
introduced, used less frequently in the clinical setting
CONTRAINDICATIONS:
Electrolyte depletion, anuria (severe renal failure).
Hepatic coma, pregnancy
CAUTION:
Lupus, glucose intolerance/DM, gout, children older
than 18 years
DRUG-DRUG:
Digoxin, lithium, antihypertensives, NSAIDS,
anticoagulants
ADVERSE EFFECTS:
Dehydration, alkalosis, ototoxicity,
Decreased HDL cholesterol, increased LDL
cholesterol
Hypokalemia: weakness, muscle cramps,
arrhythmias
Hypocalcemia: muscle twitching, cramps, tingling of
hands & feet
Take K+ supplements as directed & rich foods:
bananas, potatoes, dried fruits, nuts, spinach, &
citrus fruits
Report tenderness or pain in joints
Hypomagnesemia: weakness, tremors, muscle
twitching
Hyper: glycemia, uricemia
Hypo: natremia, chloremia, tension,
NURSING CONSIDERATIONS:
-monitor electrolytes: k+, Na+, CI-, Ca+, Mg
-Monitor BUN , serum creatinine, uric acid, glucose,
cholesterol levels
-assess for dysrhythmias & hearing loss
-Take in the AM- may take with food,
-Change position slowly
-Monitor weight, BP
-Take with K+ supplements as directed and rich foods
-Reports symptoms of hypokalemia
-Report tinnitus or hearing loss
Potassium-Sparing Diuretics
CARBONIC ANHYDRASE INHIBITORS
MOA:
-blocks the action of aldosterone in the distal tubule
& collecting tubule
-causes excretion of sodium & water while retaining
potassium
-therapeutic effect can take 12-48 hrs
INDICDATIONS:
-adjuncts with thiazide or loop diuretics for
potassium sparing effects to treat HTN and edema
-Heart Failure
-patients who are at risk for hypokalemia
PROTOTYPES:
Amiloride (Midamor)
Spironolactone (Aldactone)
Triamterene (dyrenium)
CONTRAINDICATIONS:
Hyperkalemia, severe renal failure anuria
DRUG-DRUG: antihypertensive, potassium
supplements, salicylates
ADVERSE EFFECTS:
Hyperkalemia: lethargy, confusion, ataxia, muscle
cramps, arrhythmias, dyspnea
Endocrine effects: deepened voice, impotence,
menstrual cycle irregularities,
Drowsiness
Metabolic acidosis: drowsiness, restlessness
NURSING CONSIDERATIONS:
-monitor electrolytes K+, Na+
-monitor BUN, serum creatinine, glucose
-Assess for dysrhythmias
-take in the am- may take with food
-monitor weight, BP
MOA:
-Blocks the effects of carbonic anhydrase preventing
formation of carbonic acid in the proximal tubule
-More sodium and bicarbonate are lost in the urine
INDICDATIONS:
-adjuncts to other diuretics when a more intense
diuresis is needed
-open angle glaucoma decreasing secretion of the
aqueous humor of the eye
PROTOTYPES:
Acetazolamide (diamox)
Methazolamide (generic)
CONTRAINDICATIONS:
Allergy to sulfonamides or thiazides
DRUG-DRUG:
-salicylates
-lithium
ADVERSE EFFECTS:
-acid-base & electrolyte imbalances
-metabolic acidosis
-hypokalemia: weakness, muscle, cramps,
arrhythmias, fatigue
-paresthesia of extremities, confusion, drowsiness
-report symptoms of hyperkalemia
-Avoid k+ based salt substitutes
-Avoid excess amounts of high K+ foods
OSMOTIC DIURETICS
MOA:
-pull water into the proximal tubule & loop of Henle without Na+ loss
-prevent Na+ & H2O reabsorption
In the blood the gradient allows fluid to be drawn from the intracellular into intravascular spaces
INDICDATIONS:
-increase intracranial pressure
-prevents renal failure due to shock, drug overdose, trauma, or severe hypotension
PROTOTYPES: Mannitol (Osmitrol) sugar, given continuous IV infusion, often used in acute situations
CONTRAINDICATIONS: renal failure & anuria, pulmonary edema, intracranial bleeding, dehydration, CHF
CAUTION:
DRUG-DRUG:
ADVERSE EFFECTS: related to drop in fluid levels (hypotension, N/V, light-headedness, confusion, H/A)
heart failure, pulmonary edema, rebound increased intracranial pressure, fluid & electrolyte imbalances,
metabolic acidosis
NURSING CONSIDERATIONS:
-
Nursing Considerations
Assess daily weight (report increase of 3 lbs or more/day),
Adequate intake (1500 mL/day) & output (report urine <30 mL/hr)
Skin turgor/moisture
Vital signs
Breath sounds
Presence of edema
Safety
CH 43: DRUS AFFECTING BLOOD PRESSURE
Hypertension
Risks of Coronary Artery Disease rt HTN
Conditions RT Untreated HTN
Treating HTN
Antihypertensive Agents
Diuretics:
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin III receptor blockers (ARBs)
Beta-adrenergic antagonists
Calcium channel blockers
Direct-acting vasodilators
ACE Inhibitors
MOA:
INDICATIONS:
CONTAINDICATIONS:
ADVERSE EFFECTS:
DRUG-DRUG:
PROTOYPE:
INDICATIOS:
ADVERSE EFFECT:
THERAPEUTIC CLASS:
PHARMACOLOGIC CLASS:
PREGNANCY CATERGORY:
Angiotensin II Receptor Blockers (ARBS)
MOA:
CONTRAINDICATIONS:
CAUTION:
ADVERSE EFFECTS:
DRUG-DRUG:
Calcium Channel Blockers
MOA:
INDICATIONS:
CONTAINDICATIONS:
ADVERSE EFFECTS:
DRUG-DRUG:
PREGNANCY CATERGORY:
PROTOYPE:
INDICATIOS:
ADVERSE EFFECT:
THERAPEUTIC CLASS:
PHARMACOLOGIC CLASS:
PROTOYPE:
INDICATIOS:
ADVERSE EFFECT:
THERAPEUTIC CLASS:
PHARMACOLOGIC CLASS:
PROTOYPE:
INDICATIOS:
ADVERSE EFFECT:
THERAPEUTIC CLASS:
PHARMACOLOGIC CLASS:
Direct Vasodilators
MOA:
INDICATIONS:
CONTAINDICATIONS:
ADVERSE EFFECTS:
DRUG-DRUG:
PREGNANCY CATERGORY:
Diuretics
Hypotension
Nursing Considerations:
Anti-hypotensive Agents
OVERVIEW:
MOA:
INDICATIOS:
CONTRAINDCIATIONS:
CAUTION:
ADVERSE EFFECT:
DRUG-DRUG:
Ch 46: ANTANGINAL AGENTS
Coronary Artry Disease Definitions
Types of Angina
Nitrates
Actions of Antianginal Drugs
PROTOYPE:
OVERVIEW:
INDICATIONS:
ADVERSE EFFECT:
CONTRAINDICATIONS:
CAUTION:
DRUG-DRUG:
Beta Blockers
OVERVIEW:
PREVENTION:
ADVERSE EFFECTS:
CONTRAINDICATIONS:
CAUTIN:
DRUG-DRUG:
Calcium Channel Blockers
OVERVIEW:
CONTRAINDCIATIONS:
CAUTION:
ADVERSE EFFECTS:
DRUG-DRUG:
THERAPEUTIC CLASS:
PHARMACOLOGIC CLASS:
PREG CAT:
PROTOYPE:
THERAPEUTIC CLASS:
PHARMACOLOGIC CLASS:
PREG CAT:
PROTOYPE:
TERAPEUTIC CLASS:
PHARMACOLOGIC:
PREG CAT:
Nursing Considerations