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1) What dose will be given for the gentamycin?

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1) What dose will be given for the gentamycin?

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120mg/dose q12h

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2) What are the classifications, mechanism of action, potential adverse effects and nursing considerations for these drugs?

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2) What are the classifications, mechanism of action, potential adverse effects and nursing considerations for these drugs?

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Cefotetan:
Classification - ANTIINFECTIVE; ANTIBIOTIC; SECOND-GENERATION CEPHALOSPORIN

Action - Semisynthetic beta-lactam antibiotic, classified as a second-generation cephalosporin. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the bacterium. Generally less active against susceptible Staphylococci than first generation cephalosporins are but has broad spectrum of activity against gram-negative bacteria
Adverse Affects: Body as a Whole: Fever, chills, injection site pain, inflammation, disulfiram-like reaction. GI: Nausea, vomiting, diarrhea, abdominal pain, antibiotic-associated colitis. Hematologic: Thrombocytopenia, prolongation of bleeding time or prothrombin time. Skin: Rash, pruritus.

Nursing Considerations: Assessment & Drug Effects

Determine history of hypersensitivity to cephalosporins and penicillins, and other drug allergies, before therapy begins.

Lab tests: Perform culture and sensitivity studies before initiation of therapy and during therapy, as indicated. Therapy may begin pending test results. Perform periodic hematologic studies (including PT/INR and PTT) and evaluation of renal function, especially if cefotetan dose is high or if therapy is prolonged in order to recognize symptoms of nephrotoxicity and ototoxicity (see Appendix F).

Report onset of loose stools or diarrhea. If diarrhea is severe, suspect pseudomembranous colitis (see Appendix F) caused by Clostridium difficile. Check temperature. Report fever and severe diarrhea to physician; drug should be discontinued.

Patient & Family Education

Report promptly S&S of superinfection (see Appendix F).

Report loose stools or diarrhea.

Do not breast feed while taking this drug without consulting physician.

Metronidazole:
Classification - ANTIINFECTIVE; ANTITRICHOMONAL; AMEBICIDE; ANTIBIOTIC

Actions - Synthetic compound with direct trichomonacidal and amebicidal activity as well as antibacterial activity against anaerobic bacteria and some gram-negative bacteria.

Adverse Effects - Body as a Whole: Hypersensitivity (rash, urticaria, pruritus, flushing), fever, fleeting joint pains, overgrowth of Candida. CNS: Vertigo, headache, ataxia, confusion, irritability, depression, restlessness, weakness, fatigue, drowsiness, insomnia, paresthesias, sensory neuropathy (rare). GI: Nausea, vomiting, anorexia, epigastric distress, abdominal cramps, diarrhea, constipation, dry mouth, metallic or bitter taste, proctitis. Urogenital: Polyuria, dysuria, pyuria, incontinence, cystitis, decreased libido, dyspareunia, dryness of vagina and vulva, sense of pelvic pressure. Special Senses: Nasal congestion. CV: ECG changes (flattening of T wave).

Nursing Considerations - Assessment & Drug Effects

Discontinue therapy immediately if symptoms of CNS toxicity (see Appendix F) develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities).

Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary.

Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF.

Monitor patients on lithium for elevated lithium levels.

Report appearance of candidiasis or its becoming more prominent with therapy to physician promptly.

Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been eliminated.

Patient & Family Education

Adhere closely to the established regimen without schedule interruption or changing the dose.

Refrain from intercourse during therapy for trichomoniasis unless male partner wears a condom to prevent reinfection.

Have sexual partners receive concurrent treatment. Asymptomatic trichomoniasis in the male is a frequent source of reinfection of the female.

Do not drink alcohol during therapy; may induce a disulfiram-type reaction (see Appendix F). Avoid alcohol or alcohol-containing medications for at least 48 h after treatment is completed.

Urine may appear dark or reddish brown (especially with higher than recommended doses). This appears to have no clinical significance.

Report symptoms of candidal overgrowth: Furry tongue, color changes of tongue, glossitis, stomatitis; vaginitis, curd-like, milky vaginal discharge; proctitis. Treatment with a candidacidal agent may be indicated.

Do not breast feed while taking this drug.

Gentamycin:
Classification - ANTIINFECTIVE; AMINOGLYCOSIDE ANTIBIOTIC

Actions - Broad-spectrum aminoglycoside antibiotic derived from Micromonospora purpurea.

Adverse Effects - Special Senses: Ototoxicity (vestibular disturbances, impaired hearing), optic neuritis. CNS: neuromuscular blockade: skeletal muscle weakness, apnea, respiratory paralysis (high doses); arachnoiditis (intrathecal use). CV: hypotension or hypertension. GI: Nausea, vomiting, transient increase in AST, ALT, and serum LDH and bilirubin; hepatomegaly, splenomegaly. Hematologic: Increased or decreased reticulocyte counts; granulocytopenia, thrombocytopenia (fever, bleeding tendency), thrombocytopenic purpura, anemia. Body as a Whole: Hypersensitivity (rash, pruritus, urticaria, exfoliative dermatitis, eosinophilia, burning sensation of skin, drug fever, joint pains, laryngeal edema, anaphylaxis). Urogenital: Nephrotoxicity: proteinuria, tubular necrosis, cells or casts in urine, hematuria, rising BUN, nonprotein nitrogen, serum creatinine; decreased creatinine clearance. Other: Local irritation and pain following IM use; thrombophlebitis, abscess, superinfections, syndrome of hypocalcemia (tetany, weakness, hypokalemia, hypomagnesemia). Topical and Ophthalmic: Photosensitivity, sensitization, erythema, pruritus; burning, stinging, and lacrimation (ophthalmic formulation).

Nursing Considerations -
Assessment & Drug Effects

Lab tests: Perform C&S and renal function prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity.

Repeat C&S if improvement does not occur in 3–5 d; reevaluate therapy.

Note: Dosages are generally adjusted to maintain peak serum gentamicin concentrations of 4– 10 g/mL, and trough concentrations of 1–2 g/mL. Peak concentrations above 12 g/mL and trough concentrations above 2 g/mL are associated with toxicity.

Draw blood specimens for peak serum gentamicin concentration 30 min–1h after IM administration, and 30 min after completion of a 30–60 min IV infusion. Draw blood specimens for trough levels just before the next IM or IV dose. Use nonheparinized tubes to collect blood.

Check baseline weight and vital signs; determine vestibular and auditory function before therapy and at regular intervals. Check vestibular and auditory function again 3–4 wk after drug is discontinued (the time that deafness is most likely to occur).

Monitor I&O. Keep patient well hydrated to prevent chemical irritation of renal tubules. Report oliguria, unusual appearance of urine, change in I&O ratio or pattern, and presence of edema (prolongs elimination time).

Note: Ototoxic effect (see Appendix F) is greatest on the vestibular branch of eighth cranial (acoustic) nerve (symptoms: headache, dizziness or vertigo, nausea and vomiting with motion, ataxia, nystagmus). However, damage to the auditory branch (tinnitus, roaring noises, sensation of fullness in ears, hearing impairment) may also occur. Report promptly to prevent permanent damage.

Watch for S&S of bacterial overgrowth (opportunistic infections) with resistant or nonsusceptible organisms (diarrhea, anogenital itching, vaginal discharge, stomatitis, glossitis).

Patient & Family Education

Note: When using topical applications: Avoid excessive exposure to sunlight because of danger of photosensitivity; withhold medication and notify physician if condition fails to improve within 1 wk, worsens, or signs of irritation or sensitivity occur; and apply medication as directed and only for length of time prescribed (overuse can result in superinfections).

Do not breast feed while taking this drug without consulting physician.

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4. The C&S results return are as  follows

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4. The C&S results return are as  follows

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amikcin R
piperacillin R
Gentamycin S
Cefepime R
Cefotetan R
Ciprofloxcin S

What actions should the nurse take?

Being as the pt is prescribed piperacillin and is resistant to piperacillin they should call the doctor. The nurse should not give pt that meds in general being as it wouldn't be affective. There will likely be a new order. The nurse should monitor the s&s for improvement.

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5) The physician orders ciproflaxin 1g IV bid. What is the classification and mechanism of action of this drug 

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5) The physician orders ciproflaxin 1g IV bid. What is the classification and mechanism of action of this drug 

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Classification: Quinolone Antibiotic
The fluoroquinolones are a family of broad spectrum, systemic antibacterial agents that have been used widely as therapy of respiratory and urinary tract infections.  Fluoroquinolones are active against a wide range of aerobic gram-positive and gram-negative organisms

Mechanism of Action: Inhibits DNA-gyrase an enzyme necessary for bacterial DNA replication and in some aspects of transcription, repair, recombination, and transposition
Absorption: 60 - 80% from GI tract

Ophthalmic: Minimal absorption through cornea or conjunctive

Peak: Immediate release: 0.5 - 2 hrs; Cipro XR: 1 - 2.5 hrs; Proquin XR: 3.5 - 8.7 hrs

Onset: Topical 0.5 - 2 hrs

Duration: Topical 12 hrs

Half-life: 3.5 - 4 hrs

Distribution: Widely distributed including prostate, lung, and bone; crosses placenta; distributed into breast milk

Elimination: Primarily in urine with some biliary excretion

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1. What are the nursing responsibilities regarding these orders?

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1. What are the nursing responsibilities regarding these orders?

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Admit patient, swab sputum for C&S, confirm route for antibiotic, then start antibiotic treatment. Continue to monitor vitals for s&s of improvement or not.

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3) Why would 3 antibiotics be prescribed for the same patient?

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3) Why would 3 antibiotics be prescribed for the same patient?

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Metronidazole is prescribed pre-operatively to reduce anarobic bacteria of the GI tract
Cefotetan is given to inhibit the third and final stages of bacterial cell wall synthesis, and thus killing it
Gentamycin is used to prevent prophylaxis of bacterial endocarditis in patients undergoing operative procedures. It is also used to treat C.diff

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A neighbour asks a student nurse why her paediatrician does not prescribe antibiotics for her young son's "ear infection" like he used to for her older children, and her doctor will not phone in prescriptions when she has a "sinus infection" anymore.

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3) What are the major adverse effects and monitoring required when administering these medications?

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3) What are the major adverse effects and monitoring required when administering these medications?

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Adverse effects: Amphotericin B
* Body as a Whole: Hypersensitivity (pruritus, urticaria, skin rashes, fever, dyspnea, anaphylaxis); fever, chills.
CNS: Headache, sedation, muscle pain, arthralgia, weakness. CV: Hypotension, cardiac arrest. Special Senses: Ototoxicity with tinnitus, vertigo, loss of hearing. GI: nausea, vomiting, diarrhea, epigastric cramps, anorexia, weight loss.
Hematologic: Anemia, thrombocytopenia.
Metabolic: Hypokalemia, hypomagnesemia. Urogenital: Nephrotoxicity, urine with low specific gravity.
Skin: Dry, erythema, pruritus, burning sensation; allergic contact dermatitis, exacerbation of lesions. Other: Pain; arthralgias, thrombophlebitis (IV site), superinfections.
Vancomycin:
* Special Senses: Ototoxicity (auditory portion of eighth cranial nerve).
Urogenital: Nephrotoxicity leading to uremia.
Body as a Whole: Hypersensitivity reactions (chills, fever, skin rash, urticaria, shock-like state), anaphylactoid reaction with vascular collapse, superinfections, severe pain, thrombophlebitis at injection site, generalized tingling following rapid IV infusion. Hematologic: Transient leukopenia, eosinophilia.
GI: Nausea, warmth.
Other: Injection reaction that includes hypotension accompanied by flushing and erythematous rash on face and upper body ("red-neck syndrome") following rapid IV infusion.
Acyclovir:
Body as a Whole: Generally minimal and infrequent.
CNS: Headache, light-headedness, lethargy, fatigue, tremors, confusion, seizures, dizziness. GI: Nausea, vomiting, diarrhea. Urogenital: Glomerulonephritis, renal tubular damage, acute renal failure.
Skin: Rash, urticaria, pruritus, burning, stinging sensation, irritation, sensitization.
Other: Inflammation or phlebitis at IV injection site, sloughing (with extravasation), thrombocytopenic purpura/hemolytic uremic syndrome.

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4) What assessments and lab results should be monitored while this patient is on this drug?

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4) What assessments and lab results should be monitored while this patient is on this drug?

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Cefotetan:
- History of hypersensitivity to cephalosporins and penicillins, and other drug allergies, before therapy begins.
- Lab tests: C & S, Hematologic studies PT/INR and PTT, Renal function.

Metronidazole:
- Discontinue therapy immediately if symptoms of CNS toxicity develop.
- Lab tests: Obtain total and differential WBC count before, during, and after therapy, especially if a second course is necessary.
- Monitor for lithium levels.
- Report appearance of candidiasis

Gentamycin:
- Lab test: C & S and renal function prior to first dose and periodically during therapy. Determine creatinine clearance and serum drug concentrations at frequent intervals.
- Monitor Peak & Trough levels
- Monitor for Ototoxicity

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5) Describe the assessments the nurse should perform to detect nephrotoxicity and ototoxicity.

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5) Describe the assessments the nurse should perform to detect nephrotoxicity and ototoxicity.

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Peak and trough levels.

Ototoxicity: audiological tests such as audiometry and DPOAEs that assess ultra-high frequencies and appropriate ototoxic grading criteria with high sensitivity and specificity.

Nephrotoxicity: diagnosed through a simple blood test, measurements of blood urea nitrogen (BUN), concentration of serum creatinine, glomerular filtration rate (reduced urine output) and creatinine clearance.

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1) How can the nurse explain these changes in antibiotic prescription practices? How are antibiotics misused?

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1) How can the nurse explain these changes in antibiotic prescription practices? How are antibiotics misused?

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Misuse of antibiotics has contributed to an antibiotic resistance. The resistance develops when harmful bacteria change in a way that reduces the effectiveness of the antibiotic.

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2) What type of chronic paediatric condition would warrant earlier treatment of sinus and ear infections?

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2) What type of chronic paediatric condition would warrant earlier treatment of sinus and ear infections?

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Sinusitis

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2. What type of antibiotic would the nurse expect to be ordered and why?

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2. What type of antibiotic would the nurse expect to be ordered and why?

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A broad-spectrum antibiotic until the doctor can diagnose and the results of the C&S is back.

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6) How does nephrotoxicity increase the risk of ototoxicity?

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6) How does nephrotoxicity increase the risk of ototoxicity?

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If the kidneys are not functioning properly the drug is not absorbed and the through levels will increase, causing ototoxicity.

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3) The neighbour states that she has antibiotics left over from the last infection. "I always have some in case I need it". She asks the nurse if it is okay to give this drug to her son since it was prescribed for him. How should the student nurse respond?

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3) The neighbour states that she has antibiotics left over from the last infection. "I always have some in case I need it". She asks the nurse if it is okay to give this drug to her son since it was prescribed for him. How should the student nurse respond?

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No, because she should have had her son finish the full dose

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6) What should the nurse monitor for when administering this drug

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6) What should the nurse monitor for when administering this drug

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-Monitor I & O ratio & patterns: Patients should be well hydrated; assess for S & S of crystalluria

-Monitor persons with myasthenia gravis for exacerbations of muscle weakness

-Monitor plasma theophylline concentrations with concurrent use, since drug may interfere with half-life
-Assess for S & S of GI irritation (e.g., nausea, diarrhea, vomiting, abdominal discomfort) in clients receiving high dosages & in older adults
-Monitor PT and INR in patients receiving coumarin therapy
-Assess for S & S of superinfections
-Monitor lab tests: Culture and sensitivity tests prior to initial dose.  Periodic LFT's, renal function tests, CBC with differential with prolonged therapy
-Report tendon inflammation or pain. Drug should be discontinued
-Administration with theophylline derivatives or caffeine can cause CNS stimulation

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4) Describe the clinical significance of bacterial resistance. 

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4) Describe the clinical significance of bacterial resistance. 

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Bacterial resistance is more difficult to treat than a non-resistant bacteria. Bacteria develop the ability to produce substances which blocks the action of antibiotics or change their target or ability to penetrate cells. Antibiotic resistance leads to more toxic & expensive drugs, prolonged hospitalization & increased mortality rates.

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7) Which toxicity is most likely to be permanent?

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7) Which toxicity is most likely to be permanent?

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Ototoxicity is drug or chemical damage to the inner ear. Causing damage to both the hearing mechanism and the vestibulocochlear nerve that sends hearing and balance information to the brain. Because of this, ototoxic drugs may cause hearing impairment and loss of balance.

The extent of ototoxicity varies with the drug, the dose, and other conditions. In some cases, there is full recovery, in other cases, the extent of damage is permanent.

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5) The neighbour asks what she can do to prevent resistance to antibiotics. What suggestions should the student nurse make?

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5) The neighbour asks what she can do to prevent resistance to antibiotics. What suggestions should the student nurse make?

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- Finish the full dose.

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6) What role can nurses and other health care providers play in reducing infections and antibiotic resistance?

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6) What role can nurses and other health care providers play in reducing infections and antibiotic resistance?

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-Control symptoms before administering antibiotic.

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7) What in the patient's history may contribute to potential drug-drug interactions 

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7) What in the patient's history may contribute to potential drug-drug interactions 

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The patient is currently on an anticoagulant when taking an anticoagulant such as warfarin the interaction of the drugs may increase PT
Other interactions:
Drug:

-May increase theophylline levels 15 -30%; ANTACIDS, sulcralfate, iron decrease absorption of ciprofloxacin; may increase PT for patients on warfarin

Food:

-Calcium decreases the levels of ciprofloxacin

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3. Discuss the classification and mechanism of action of the medications ordered.

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3. Discuss the classification and mechanism of action of the medications ordered.

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piperacillin/tazobactam is an extended-spectrum penicillin. It is primarily used for infections with Pseudomonas aeruginosa and is ineffective against most strains of Staph. aureus. P. aeruginosa is often found in the immunocompromised and is very difficult to eradicate, which is why tazobactam is added.

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8) How can the nurse prevent drug interactions?

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8) How can the nurse prevent drug interactions?

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- Look at the medication that the patient is taking and ensure that there is no drug-drug interactions between the medications in the drug guide and monitor patient for adverse effects
- Use seperate bags when administering medications and flush line between administration (shortest dose first)

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9. The pt will be going home on oral ciprofloxacin. Will be explaining the medication to the pt. What information is important share about this medication? (e.g. potential adverse effects, what foods should be avoid when taking oral ciprofloxcin)

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9. The pt will be going home on oral ciprofloxacin. Will be explaining the medication to the pt. What information is important share about this medication? (e.g. potential adverse effects, what foods should be avoid when taking oral ciprofloxcin)

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potential adverse affects: nausea,
vomiting, diarrhea,
cramps, gas,
pseudomembranous
colitis, transient increases
in liver transaminases,
alkaline phosphatase, lactic
dehydrogenase &amp;
eosinophilia count, tendon rupture,
cartilage erosion, headache,
vertigo, malaise, perpheral
neuropathy, seizures
Food interactions: calcium decreases the levels of ciprofloxacin.
Drug interactions: may increase
theophylline levels 15 -30%; ANTACIDS, sulcralfate, iron
decrease absorption of ciprofloxacin; may increase PT for
patients on warfarin.

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8) What assessment should be monitored by the nurse to determine clinical response to the antibiotic

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8) What assessment should be monitored by the nurse to determine clinical response to the antibiotic

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Improvement in the temperature of the patient, minimizing the fever, for irritability to be decreased, cough and secretions to be decreased as well
The drug is used to treat the following: UTI's, lower respiratory tract infections, skin & skin structure infections, bone & joint infections, GI infection or infectious diarrhea, chronic bacterial prostatitis, nosocomial pneumonia, acute sinusitis. Post exposure prophylaxis for anthrax

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4) What intervention can the nurse employ to reduce the risk of kidney damage by amphotericin B?

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4) What intervention can the nurse employ to reduce the risk of kidney damage by amphotericin B?

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* Monitor I&O and weight. Report immediately oliguria, any change in I&O ratio and pattern, or appearance of urine [e.g., sediment, pink or cloudy urine (hematuria)], abnormal renal function tests, unusual weight gain or loss. Generally, renal damage is reversible if drug is discontinued when first signs of renal dysfunction appear.
* Consult physician for guidelines on adequate hydration and adjustment of daily dose as a possible means of avoiding or minimizing nephrotoxicity

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9) What changes in the dosages of medications would be necessary if the patient were 80 years old instead of 15?

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9) What changes in the dosages of medications would be necessary if the patient were 80 years old instead of 15?

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Older adults have decreased renal function. Dose needs to be adjusted according to their renal function (dose should be lowered)

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11) The nurse notices that the patient's INR is 3.5. What should the nurse do?

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11) The nurse notices that the patient's INR is 3.5. What should the nurse do?

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INR is high meaning there is a high risk for bleeding. Nurse should monitor for any signs of bleeding. Cefotetan can affect blood clotting abilities and cause bleeding. The nurse should acknowledge the effects of  Cefotetan, and notify the physician of the patients current INR before administering. The nurse could also withhold the medication if the concerns regarding bleeding are high.

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12) Three days post-operatively, the patient has progressed to a soft diet and develops severe watery diarrhea. What are possible causes of diarrhea?

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12) Three days post-operatively, the patient has progressed to a soft diet and develops severe watery diarrhea. What are possible causes of diarrhea?

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C. diff
Side effect of Cefotetan

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13) What are possible electrolyte imbalances that could occur and what are their symptoms?

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13) What are possible electrolyte imbalances that could occur and what are their symptoms?

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Hyponatremia: confusion, headache, nausea and vomiting, fatigue, irritability, seizures, and coma.

Hypocalcemia: numbness and/or tingling of the hands, feet, or lips. Also causes muscle cramps, muscle spasms, seizures, facial twitching, muscle weakness, lightheadedness, and slow heartbeat.

Hypokalemia: fatigue, weakness, heart palpitations, numbness, and breathing difficulty.

Hypomagnesemia: some patients have no symptoms, but the ones that do present with symptoms may experience: facial twitches, weakness and exhaustion, nausea and vomiting, personality changes, tremors, pronounced reflexes, and constipation.

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10. What new problem might the patient develop while taking the antibiotic?

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10. What new problem might the patient develop while taking the antibiotic?

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cirpofloxacin increases the risk of killing off the bacteria that usually keeps C. diff from developing. By killing those bacteria, the patient has a higher risk of developing C. diff.

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5) Why is it important for the prescriber to first order a 1mg test done of  amphotericin B?

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5) Why is it important for the prescriber to first order a 1mg test done of  amphotericin B?

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To check if pt develops any allergies/ adverse effects b/c there is a risk of acute infusion reactions.

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6) The amphotericin B viral is supplied as a powder. This 50mg of powder must be reconstituted using 10mL of sterile water that does not contain a bacteriostatic agent to a concentration of 5mg/mL. This solution is further diluted in sterile water to provide a concentration of 0.1mg/mL for infusion. Why must the drug be mixed this way?

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6) The amphotericin B viral is supplied as a powder. This 50mg of powder must be reconstituted using 10mL of sterile water that does not contain a bacteriostatic agent to a concentration of 5mg/mL. This solution is further diluted in sterile water to provide a concentration of 0.1mg/mL for infusion. Why must the drug be mixed this way?

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rapid infusion with a high dose can cause hypotension and cardiovascular collapse

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7) What nursing measures she the nurse take when infusing amphotericin to prevent infusion related adverse effects?

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7) What nursing measures she the nurse take when infusing amphotericin to prevent infusion related adverse effects?

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Amphotericin B for infusion should be administered by slow intravenous.

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Describe red man syndrome and the nursing measures that can be taken to prevent this reaction?

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Describe red man syndrome and the nursing measures that can be taken to prevent this reaction?

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Red man syndrome is an adverse effect of Vancomycin
To prevent it, we need to give diphenhydramine to the individual before their first vancomycin infusion. Also, it is important for the infusion to be administered over 60 minutes to minimize the adverse effects.

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1)  What doses will you give for acyclovir and amphotericin B?

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1)  What doses will you give for acyclovir and amphotericin B?

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280 mg q12h of Acylclovir, 170 mg daily of Amphotericin B

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8) Refer to the IV monograph for Vancomycin and indicate how you would prepare and administer this medication (Supplied - Vancomycin powder 1g vials) 

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8) Refer to the IV monograph for Vancomycin and indicate how you would prepare and administer this medication (Supplied - Vancomycin powder 1g vials) 

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Reconstitute 1g vial with 20mL sterile water (repeat it in second vial) and withdraw 30 mL b/c you need 1.5g for a final concentration of 50mg/mL. Further dilute with N/S or D5W to max a concentration of 5mg/mL and to be infused over . 90 mins.

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7) what nursing measures should the nurse take when infusing amphotericin B to prevent infusion-related adverse effects?

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7) what nursing measures should the nurse take when infusing amphotericin B to prevent infusion-related adverse effects?

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Alternate IV sites with each dose to prevent thrombophlebitis, protect IV solution from light, monitor for hypotension and arrhythmias, infuse slowly to prevent cardiovascular collapse

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2) What is the classification and mechanism of action of these medications?

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2) What is the classification and mechanism of action of these medications?

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Acyclovir:
Classification: ANTIINFECTIVE; ANTIVIRAL
MOA: Acyclovir is a synthetic acyclic purine nucleoside analog, derived from guanine. It reduces viral shedding and formation of new lesions and speeds healing time. Acyclovir triphosphate preferentially interferes with DNA synthesis of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) and varicella-zoster virus, thereby inhibiting viral replication.

Acyclovir demonstrates antiviral activity against herpes virus simiae (B virus), Epstein-Barr (infectious mononucleosis), varicella-zoster and cytomegalovirus, but does not eradicate the latent herpes virus.

Amphotericin B:
Classification: ANTIINFECTIVE; ANTIFUNGAL ANTIBIOTIC
MOA: Fungistatic antibiotic produced by Streptomyces nodosus. Fungicidal at higher concentrations, depending on sensitivity of fungus.

Exerts antifungal action on both resting and growing cells at least in part by selectively binding to sterols in fungus cell membrane.

Vancomycin:
Classification: ANTIINFECTIVE; ANTIBIOTIC
MOA: Prepared from Streptomyces orientalis, with bactericidal and bacteriostatic actions. Acts by interfering with cell membrane synthesis in multiplying organisms.

Active against many gram-positive organisms, including group A beta-hemolytic Streptococci, Staphylococci, Pneumococci, Enterococci, Clostridia, and Corynebacteria. Gram-negative organisms, mycobacteria, and fungi are highly resistant.

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9) Describe red man syndrome and the nursing measures that can be taken to prevent this reaction?

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9) Describe red man syndrome and the nursing measures that can be taken to prevent this reaction?

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It is a hypotensive reaction, and most common adverse reaction to vancomycin administration. It causes a red rash on face, neck, and torso. Nursing measures include infusing over at least one hour. If reaction occurs, give next dose over 2 hours.