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What is a variable dose medication?
A variable dose medication is a type of medication where the dosage is adjusted individually for each patient based on specific factors such as age, weight, renal function, liver function, and other relevant clinical parameters. The dose may vary from person to person to achieve the desired therapeutic effect while minimising the risk of adverse effects.

What is the purpose of a variable dose medication?
The purpose of using a variable dose medication is to optimise therapeutic outcomes and safety for each patient. Since individuals can differ in their response to medications due to variations in metabolism, kidney function, or other factors, adjusting the dose based on individual characteristics helps ensure that the medication is effective and well-tolerated.

How do we calculate the dose for the gentamicin?
The dosage is typically based on the patient's weight and renal function expressed in (mg/kg). The dosing interval may vary depending on the indication and the severity of the infection.

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1. Purpose of variable dosed medication is to give doses dependent on how the patient is reacting to the medication, following tests etc
2. Based on weight?

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1. The purpose of variable dosed medication, such as gentamicin, is to tailor the dose to an individual patient's specific characteristics and needs. Not all patients are the same, and factors like age, weight, renal function, and the severity of the infection can influence how a medication is metabolized and excreted by the body. By adjusting the dosage based on these factors, healthcare providers aim to achieve optimal therapeutic outcomes while minimizing the risk of adverse effects.

2. Calculating the dose for gentamicin involves several steps and considerations:

1: Determine the patient's body weight, usually measured in kilograms (kg).

2: Assess the patient's renal function by estimating the creatinine clearance or glomerular filtration rate

3: Once the patient's weight and renal function are known, the healthcare provider will decide on the appropriate dosing regimen. 4: Gentamicin dosing is usually expressed in terms of milligrams per kilogram of body weight or as a total daily dose

It is essential that these calculations and dosing adjustments are carried out by qualified healthcare professionals, as incorrect dosing of gentamicin can lead to serious side effects and treatment failure. Always follow the dosing instructions provided by your healthcare provider and inform them of any medical conditions or medications you are taking to ensure safe and effective treatment

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Oxycodone
Class: Opioid
MOA: Acts on the mu-opioid receptors in the CNS and GIT, producing analgesic effects
Indictation for use: Acute or chronic mild, moderate to severe pain
Drug - drug interactions: Opioids and Benzodiazepines are both respiratory depressors, but no Benzos on her drug chart
Signs & symptoms: Hypotension (postural hypo), bradycardia, respiratory depression, drowsiness, constipation
How do these medications cause risk: Drug of dependence, side effects such as respiratory depression and over-sedation
How do we prevent, identify or manage risk/nursing considerations: Monitor RR and sedation, falls risk so ensure call bell is in reach and patient education, bowel chart and laxatives?, monitor for side effects,

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Amoxicillin
Class: penicillin-like antibiotics.
MOA:
kills bacteria by inhibiting bacterial cell wall synthesis by binding one or more of the penicillin binding proteins.
Indictation for use:
exacerbation of chronic bronchitis, pneumonia , acute ear infections (otitis media) , sinusitis , acute prostatitis , uti ect.
Drug - drug interactions: IV penicillins are physically and/or chemically incompatible with many substances (including aminoglycosides); give separately.
Gentamicin
Signs & symptoms: diarrhoea, nausea , pain and inflammation, vomiting.
How do these medications cause risk:'
allergy - rash, nausea or diarrhoea  and anaphylaxis reactions
How do we prevent, identify or manage risk/nursing considerations:

use frequent doses of penicillins for maximal antibacterial effect

monitor complete blood count and renal and hepatic function during prolonged high-dose treatment (>10 days use frequent doses of penicillins for maximal antibacterial effect

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Gentamicin
Class: Aminoglycosides
MOA: Inhibit protein synthesis by irreversibly binding to the 30S ribosomal subunit & causing cell membrane damage.
Indictation for use: gram -ve bacteria
Drug - drug interactions: magnesium sulfate
Signs & symptoms:
How do these medications cause risk: Nephrotoxicity Ototoxicity Neurotoxicity
Ataxia
Vertigo
How do we prevent, identify or manage risk/nursing considerations:
-Consider creatine clearance.
-Monitor hearing (dizziness)
-Report muscle weakness or paralysis
-Monitor for signs of ataxia and vertigo affecting gait, balance and functional activities. Balance problems, falls risk.
-Monitor signs of ototoxicity, including hearing loss, tinnitus and balance problems.
-monitor signs of hypersensitivity, include pulmonary symptoms (tightness in throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria).
-Advise and monitor patient: signs of nephrotoxicity, including blood or pus, decreased urine output, fatigue, and weight gain from fluid retention.

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Erythromycin
Class:macrolides

MOA:Inhibit hepatic CYP450 involved with the metabolism of other drugs • Target the ribosomes which remember other protein factory of the cell, inhibiting protein synthesis through binding to the larger subunit 50s

Indictation for use: respiratory tract infection
skin infection
diphtheria
intestinal amebiasis

Drug - drug interactions: antihistamin medication such as domperidone

Signs & symptoms:Candidiasis (infection) • CVD: May alter the electrical conduction of the heart, resulting in an increase in time for the ventricle depolarisation and repolarisation (increase in QT interval on a ECG • GIT disturbances

How do these medications cause risk:

How do we prevent, identify or manage risk/nursing considerations:
Monitor CVD function • Monitor GIT function -Bowel chart -Stool chart

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1. When bacteria and fungi change over time and become resistant to the antibiotics made specifically to destroy them
2. Hand hygiene and clean clinical environment, advocating for the over prescription of antibiotics, education on the importance of finishing antibiotic treatment, ensuring pharmacy orders are made and there in time for patients treatment
3. Washing her hands before and after eating, covering her mouth and nose when coughing and sneezing, wiping surfaces at home

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1. Can you explain what is antimicrobial resistance in your own words?
- it occurs when bacteria in your body changes or mutates and becomes less sensitive to an antibiotic, it may occur due to over use of antibiotics
2. What is the RN's role within the multidisciplinary team in preventing it?
- hand hygiene
- PPE
3. What strategies could the nurse provide Nita to help her prevent the spread of infection on the ward and at home?
- educate- only take antibiotics when prescribed, and take correct dosage. practice good hygiene , don't take when you have a virus as it increases antimicrobial resistance and doesn't fight virus.

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Infection and prevention control
-Assess risk of transmission type of infection, fungal, antibacterial or viral
-Use standard transmission-based precautious, even before implemented when suspected, to prevent hospital based transmission.
-Correctly collect microbiological specimens when indicated and ensure timely transfer to maintain specimen quality.

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Cefazolin
Class: Beta- Lactam Cephalosporin antibiotic
MOA: Interfere with bacterial cell wall peptidoglycan synthesis , eventually leading to cell lysis and death; bactericidal.
Indictation for use: staphylococcal and streptococcal infections in people with mild-to-moderate penicillin allergy, surgical prophylaxis, UTI
Drug - drug interactions: warfarin, metformin
Signs & symptoms: nausea, diarrhoea, allergic reaction, pain and inflammation at the injection site
How do these medications cause risk: these medications can cause renal impairment. Administration with other drugs that have the same effect can increase the risk of nephrotoxicity
How do we prevent, identify or manage risk/nursing considerations: avoid rapid IV infusion, monitor for risk of bleeding (INR levels), monitor renal function, take note of any previous allergies

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1. occurs when microorganisms such as bacteria become resistant to antimicrobial medicines such as antibiotics

2. providing education to the patient on safe administration - prevent the risk of misuse or overuse of the drug. Education on infection prevention, especially in hospital setting due to the increased risk of exposure to bacteria

3. strategies may include keeping up with hand hygiene and teaching Nita to adopt the habit of washing her hands when coming into the hospital as well as when at home to prevent the spread of infection. Another strategy would include the use of hand sanitiser when in the hospital as well as at home.

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Gentamicin has been written up as a variable dose.
1. What is the purpose of variable dosed medication?
2. How do we calculate the dose for the gentamicin?

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What would they be for this medication chart?

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Significant risks / drug-drug interactions???

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Significant risks / drug-drug interactions???

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How / why does it occur?
What are they and what signs and symptoms would we see?
What do we as nurses do;
- prevent and/ or manage these?

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Note: Always consider:
Is there anything in the patient's condition/ past history that may increase the risks?

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Compare and contrast the mode of action of the drug classes

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Compare and contrast the mode of action of the drug classes

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Did you find a simpler way to describe them?
Could you say in your own words what they are?
Did you need to go and look them up again? Do you need to rethink your explanation into your own words?

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1. Can you explain what is antimicrobial resistance in your own words?
2. What is the RN's role within the multidisciplinary team in preventing it?
3. What strategies could the nurse provide Nita to help her prevent the spread of infection on the ward and at home?