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The purpose of a variable dosed medication is required to achieve therapeutic range

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1. to avoid any serious adverse reactions relating to elevated toxicity levels. Dosage changes are dependant on renal function which is determined by the pts rate to clear creatinine from the body.

2. dosages are based on the pts weight:
CrCl >60 mL/minute, IM/IV 5–7 mg/kg once daily.

CrCl 30–60 mL/minute, IM/IV 4–5 mg/kg once daily.

CrCl <30 mL/minute, seek specialist advice

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Because it can have major effects of the kidneys and renal system
Dose may vary on patient factors

Blood tests or Renal function

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ONDANSETRON
interactions
apomorphine
- sever hypotension, loss of consciousness, bradycardia, seizure activity
rifampicin
- may increase metabolism, therefore decrease efficacy
tramadol
- may decrease tramadol analgesic affects, avoid combination

nursing management
apomorphine
- flag it with doctor as it is a combination to be avoided
rifampicin
- monitor clinical affect, and increase ondansetron dose if necessary
tramadol
- flag with doctor as it should be a combination to avoid OR change the antiemetic or opioid if these problems occur

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Oxycodone and marcolides (erythromycin):
Macrolides may increase oxycodone concentration and the risk of adverse effects due to oxycodone remaining in the bloodstream for longer periods of time.

Increase in adverse effects including; nausea, vomiting, constipation, dizziness, lightheadness and drowsiness.

Monitor for signs and symptoms and renal impairment.

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Cefazolin: There is no interaction with other drugs on her chart. However, if prescribed with aminoglycosides it may cause nephrotoxicity. Also IV cefazolin can affect the clotting process and may increase the effects of anticoagulants, however, she is not prescribed any anticoagulants.

Nursing Practice: If she is prescribed aminoglycosides, monitor renal and hepatic function and stop administration if decreased function while awaiting review. If ensure she is not on any aminoglycosides or anticoagulants and if she is advocate for her to be taken off these medications.

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The interaction between Erythromycin and Ondansetron it can increase the risk of irregualr heart rhythm.

Signs and Symptoms: irregualr heart rate, fatigue, weakness, dizziness, lightheadness, fainting, palpitations, shortness of breath

Nursing Management: monitor heart rate and heart rhythm. discuss with patient the importance of expressing any feeling of irregular heart rate, perform ECG,

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1. antimicrobial resistance is when the microbes mutates in the body and become resistant to antibiotics
2. the nurses role is to provide patient is to practice standard precautions, education on chain of infection, ensure patients are washing their hands before and after using communal spaces in the hospital, ensuring visitors understand infection precautions, ensure wound dressing are kept clean, dry, intact, according to the wound management protocols
3. washing hands, wearing mask in public places, keep visitors to a minimum until healed, trying to stay at home, how to cough safety/appropriately

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1.
- AMR occurs when disease causing bad bacteria, become resistant to the antibiotic used to kill them.
- Antibiotics are used to kill bacteria, however a few resistant bacteria can survive, which can multiply and spread to other people.
- The main cause is use of antibiotics.
- The more antibiotics we use, the faster the resistant bacteria develops.
- AMR can be slowed by the use of fewer antibiotics, such as only taking those perscribed by a doctor.

2.
- Ensure follow of medication rights
- Ensure appropriate tests (e.g. urine and blood)
- Switch from IV from orally

3.
- Use correct hand washing technique
- Use aseptic tecghnite
- Promote vaccination to protect patients from preventable infections.
- Dispose of unused antibitovis

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Antimicrobial resistance is where the microorganism evolves, through natural selection, to develop the ability to resist antimicrobial drugs and the immune defence mechanisms employed by the body.

only use antibiotics when absolutely necessary.
educate the pt to follow the full prescription of medication, even if they start to feel better.
health care staff using standard precautions in interactions with all patients.
using more then one type of antimicrobial drug at one time to make it more difficult for the bacteria to develop resistance to one drug.

Hand hygiene
General hygiene - clean environment
Cough etiquette
Take the full prescription of medication.

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1.  Is the mutation of bacteria / fungi in which they develop in a way to defeat/ survive the antibiotics originally designed to kill them

2.
- Only giving PRN doses when truely needed.
- Making sure patient isnt heavily reliant on drug.
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3. Education in hand hygine,

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GENTAMICIN - Aminoglycoside: Bind to 30s ribosomal subunit.

Common Interactions – Vancomycin (increased risk of ototoxicity and/or nephrotoxicity), Loop Diuretic (Irreversible hearing loss), NSAIDS (Reduce renal function, therefore increasing plasma concentration)

Nursing Practice Points – Monitor Creatinine Clearance and renal function, monitor for dizziness, monitor for tinnitus and confusion.

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1. Microbes change over time and develop protective mechanisms to withstand the effects of antimicrobials medication.

2.
- preventing infections in the first place
- preventing cross infection and spread
- make sure when mixing antibiotics to remain is clean as possible
- improve antibiotic prescribing
- disposing of antibiotic equipment
- performing hand hygiene
- making sure there are no miss doses.

3.
- Perform Hand Hygiene,
- Taking only prescribed antibiotic and antibiotic dosage.
- Keep her area as clean as possible, disposing of used waste

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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?